More than 15 million American adults -- 8.4 percent of men and 4.2 percent of women -- suffer from some form of alcohol-use disorder, according to the National Institute on Alcohol Abuse and Alcoholism. (NIAAA). The federal health agency estimates that the annual economic cost of alcohol misuse hovers around $249 billion once one weighs the tolls on our health-care system, public safety and productivity, to say nothing of the inestimable emotional cost.
Yet less than 10 percent of adults with alcohol-use disorders receive specialized treatment such as detoxification, counseling and medication. When individuals do reach out for help, wait periods can stretch into weeks, leading to high no-show rates. Those who do receive treatment too often relapse or miss appointments.
People battling addiction need all the support they can get. One promising source of that help is a smartphone app. ACHESS is a tool to alleviate the dueling problems of high costs and self-defeating delays in treatment and recovery for alcohol and other addictions. The technology was developed by the Center for Health Enhancement System Studies at the University of Wisconsin-Madison with support from the Robert Wood Johnson Foundation and the federal government. The center's director, David Gustafson, and its deputy director, Fiona McTavish, came to the Harvard Kennedy School to present ACHESS for this year's Innovations in American Government Award, a competition for which the app was named a finalist.
When the app launched in 2014, it came pre-loaded in data-enabled smartphones for a cost of $60 a month, including phone service, for study-trial members. Now, the application is available to any entity or individual managing addiction issues, and pricing is determined by the nature and scope of use of the system.
ACHESS has several features to support those seeking or undergoing addiction treatment, including a mapping function to help them avoid running into trouble. Patients and counselors work together to map high-risk areas such as favorite bars, liquor stores or dealer locations. When an app user gets near one of these destinations, ACHESS automatically generates a little nudge, asking, "Do you really want to be here right now?" It also sends a notice to the user's counselor or caregiver.
For those facing acute cravings, the app has a panic button to alert peer-support networks and counselors. A feature called "Motivations" enables users to preload their phones with pictures and videos of family members, as well as recordings of self-pledges to stay sober. The app provides medication and appointment reminders, volunteer-monitored forums, and functions to build a recovery plan and to maintain a journal of the recovery journey.
ACHESS also comprises a number of data-collecting features to help app users, counselors and researchers better understand treatment efficacy. It measures recovery strength through a weekly survey and conducts a daily assessment ("Do you think you can make it through the day?"). The system allows caregivers to administer surveys to individuals or groups, and has a reporting function to organize the data. Likewise, caregivers can target any teaching content to individuals or groups using the system.
In the background, data scientists and addiction-treatment workers are able to analyze data produced by ACHESS to keep track of its performance and even help prevent relapses. "Right now, we have over four million data points that we're able to use to better understand the relationship between things like relapse and the number of swear words that a person uses in a text," said Gustafson. "We find that the correlation between swear words and relapse is statistically significant, so we now use them as part of an early warning sign."
The application is currently distributed to about 5,300 individuals. SSTAR, an addiction-treatment nonprofit, uses it to work with methadone patients in Fall River, Mass. The Optum health-services company is pilot-testing the app in the Harvard Pilgrim Health Plan. A program employing the app in West Virginia increased abstinence by 33 percent. "I feel like I've got a 24/7 clinic in my pocket," said one ACHESS user. "It feels great."
This article was originally published on Governing.