Effect of a smartphone intervention as a secondary prevention for use among university students with unhealthy alcohol use: randomised controlled trial
BMJ 2023; 382 doi: https://doi.org/10.1136/bmj-2022-073713 (Published 16 August 2023) Cite this as: BMJ 2023;382:e073713Linked Editorial
Digital tools and apps to reduce alcohol use
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Dear Editor
Substance use disorders (SUD) are a global health crisis. According to the United Nations Office on Drugs and Crime, in 2018, around 275 million people used substances and over 36 million had a substance use disorder. Unfortunately, this number is expected to keep rising.(1)
Secondary prevention is directed at patients with mild alcohol problems or hazardous drinking patterns that do not meet diagnostic criteria for alcohol abuse and dependence. As of today, evidence on Internet-based interventions for unhealthy alcohol use is available, but it is mostly lacking on smartphone interventions, even though this research area has been the focus of more research efforts in recent years (2,3)
The absence of biological measures of alcohol use is a major limitation and not achievable due to many practical reasons, poor sensitivity for low-level unhealthy alcohol use and lack of resources. Another potential limitation is the potential for a bias for reflection on one’s own alcohol use in repeated assessments (4).
There is no doubt that the revolution in mobile technologies has provided considerable advances for addiction research by overcoming several methodological barriers that characterize traditional research tools. These advances include solutions for temporal barriers, contextual constraints, and discipline-specific isolation. However, the application of mobile technologies as a means of clinical intervention is far less controlled and should remain a focus of both scientific and ethical debate in the years to come. (5)
Several systems for treating alcohol-use disorders (AUDs) like text-messaging monitoring and reminder systems, text-messaging intervention systems, comprehensive recovery management systems, and game-based systems exist that operate on mobile phones. Text-messaging monitoring and reminder systems deliver reminders and prompt reporting of alcohol consumption, enabling continuous monitoring of alcohol use whereas Text-messaging intervention systems additionally deliver text messages designed to promote abstinence and recovery. The recent evidence suggests that although texting-based applications may have beneficial effects, they are probably insufficient as interventions for AUDs. Comprehensive recovery management systems have the strongest theoretical base and have yielded the strongest and longest-lasting effects, but challenges remain, including cost, understanding which features account for effects, and keeping up with technological advances. (6)
It has also been reported that A-CHESS app (Addiction–Comprehensive Health Enhancement Support System) provided effective remote continuing care for alcohol use disorder for individuals who had completed residential treatment for alcohol dependence.(7)
Studies show that the theoretical background of their smartphone applications was based on self-determination theory, cognitive-behavioural therapy, motivational enhancement therapy, contingency management, and 12-step facilitation therapy. All these therapies have been found to be good in lowering the “spirit level” without affecting the “spirits”.
1. Bhagavati S, Natekar D, Dhandargi U. Prevalence, Pattern and Determinants of Substance Abuse Among Adolescents in Bagalkot, Karnataka, India. National Journal of Community Medicine. 2023;14(07):412-7.
2. Riper H, Hoogendoorn A, Cuijpers P, Karyotaki E, Boumparis N, Mira A, Andersson G, Berman AH, Bertholet N, Bischof G, Blankers M. Effectiveness and treatment moderators of internet interventions for adult problem drinking: an individual patient data meta-analysis of 19 randomised controlled trials. PLoS medicine. 2018;15(12):e1002714.
3. Song T, Qian S, Yu P. Mobile health interventions for self-control of unhealthy alcohol use: systematic review. JMIR mHealth and uHealth. 2019;7(1):e10899.
4. McCambridge J, Kypri K. Can simply answering research questions change behaviour? Systematic review and meta analyses of brief alcohol intervention trials. PloS one. 2011;6(10):e23748.
5. Swendsen J. Contributions of mobile technologies to addiction research. Dialogues in clinical neuroscience. 2016 ; 18(2): 213–221.
6. Quanbeck A, Chih M, Isham A, Gustafson D. Mobile delivery of treatment for alcohol use disorders: a review of the literature. Alcohol Res. 2014; 36 (1): 111–22.
7. McKay JR, Gustafson DH, Ivey M, Pe‐Romashko K, Curtis B, Thomas T, Oslin DW, Polsky D, Quanbeck A, Lynch KG. Efficacy and comparative effectiveness of telephone and smartphone remote continuing care interventions for alcohol use disorder: a randomized controlled trial. Addiction. 2022;117(5):1326-37.
Competing interests: No competing interests
Re: Effect of a smartphone intervention as a secondary prevention for use among university students with unhealthy alcohol use: randomised controlled trial
Dear Editor
First of all, we would like to express our gratitude to your prestigious magazine for sharing the original articles.
Alcohol consumption is a daily practice in our young population with increasing frequency. Recognized as a legal drug and gatekeeper of other possible drugs. Tolerance is its fastest effect to consider the increase in consumption or need to use another drug.
The use of smartphones in this population to reduce or eradicate alcohol consumption is something of merit. Let us remember the change of activity is an indispensable instrument in the work of psychiatry. Socializing with technology and seeking support in this way is something fruitful that has increased in use since COVID 19.
The rescue of this population group from alcohol consumption is something of merit. Therefore, the medical community must work from all media platforms to guarantee the recovery of our population for the sake of its improvement.
We would like to end this short communication making a point that the indiscriminate use of technology can also lead our population to another addiction as we all know, gambling addiction. Thanks to its authors for presenting the article.
Competing interests: No competing interests