Michael G. Boyle

A Smartphone Application to Support Recovery From Alcoholism A Randomized Clinical Trial

IMPORTANCE Patients leaving residential treatment for alcohol use disorders are not typically offered evidence-based continuing care, although research suggests that continuing care is associated with better outcomes. A smartphone-based application could provide effective continuing care. OBJECTIVE To determine whether patients leaving residential treatment for alcohol use disorders with a smartphone application to support recovery have fewer risky drinking days than control patients. DESIGN, SETTING, AND PARTICIPANTS An unmasked randomized clinical trial involving 3 residential programs operated by 1 nonprofit treatment organization in the Midwestern United States and 2 residential programs operated by 1 nonprofit organization in the Northeastern United States. In total, 349 patients who met the criteria for DSM-IV alcohol dependence when they entered residential treatment were randomized to treatment as usual (n = 179) or treatment as usual plus a smartphone (n = 170) with the Addiction-Comprehensive Health Enhancement Support System (A-CHESS), an application designed to improve continuing care for alcohol use disorders. INTERVENTIONS Treatment as usual varied across programs; none offered patients coordinated continuing care after discharge. A-CHESS provides monitoring, information, communication, and support services to patients, including ways for patients and counselors to stay in contact. The intervention and follow-up period lasted 8 and 4 months, respectively. MAIN OUTCOMES AND MEASURES Risky drinking days--the number of days during which a patients drinking in a 2-hour period exceeded 4 standard drinks for men and 3 standard drinks for women, with standard drink defined as one that contains roughly 14 g of pure alcohol (12 oz of regular beer, 5 oz of wine, or 1.5 oz of distilled spirits). Patients were asked to report their risky drinking days in the previous 30 days on surveys taken 4, 8, and 12 months after discharge from residential treatment. RESULTS For the 8 months of the intervention and 4 months of follow-up, patients in the A-CHESS group reported significantly fewer risky drinking days than did patients in the control group, with a mean of 1.39 vs 2.75 days (mean difference, 1.37; 95% CI, 0.46-2.27; P = .003). CONCLUSIONS AND RELEVANCE The findings suggest that a multifeatured smartphone application may have significant benefit to patients in continuing care for alcohol use disorders. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01003119.

Explicating an Evidence-Based, Theoretically Informed, Mobile Technology-Based System to Improve Outcomes for People in Recovery for Alcohol Dependence

Post-treatment relapse to uncontrolled alcohol use is common. Currently available communication technology can use existing models for relapse prevention to cost-effectively improve long-term relapse prevention. This paper describes: (1) research-based elements of alcohol consumption-related relapse prevention and how they can be encompassed in self-determination theory (SDT) and Marlatts cognitive behavioral relapse prevention model, (2) how technology could help address the needs of people seeking recovery, (3) a technology-based prototype, organized around sexual transmitted disease and Marlatts model, and (4) how we are testing a system based on the ideas in this article and related ethical and operational considerations.

Intensive Case Management as a Jail Diversion Program for People With a Serious Mental Illness A Review of the Literature

This article reviews the research on intensive case management (ICM) programs as a jail diversion intervention for people with a serious mental illness (SMI). The review includes two types of ICM programs: (a) general ICM programs that included an assessment of arrests and incarceration rates for people with an SMI and (b) ICM programs specifically implemented as a component of a jail diversion intervention for people with an SMI. Results indicate that general ICM programs (19) rarely led to reductions in jail or arrest rates over time, and these rates were similar to those found in standard mental health services. General ICM programs that included an integrated addiction treatment component (8) had mixed results but a trend toward reductions in rates of arrests and incarceration over time for individuals with an SMI and a co-occurring substance use disorder. Results were mixed for jail diversion interventions with an ICM program, but most ICM programs (8) led to significant reductions in arrests and incarcerations over time. Specific elements of effective ICM jail diversion programs are discussed.

The educational goals of people with psychiatric disabilities.

OBJECTIVE Many people with psychiatric disability have educational goals. In this paper, we survey a sample to describe the frequency of academic interests, specific goals related to this interest, and barriers that undermine education. METHODS One hundred and four people from a large Midwestern mental health center completed the Educational Goals Survey (EGS) which was developed with feedback from two consumer focus groups. RESULTS Almost two thirds of respondents never got beyond high school education. Of this group, 54.5% wanted to go back to school. Reasons for returning to school included improving ones job status and enhancing personal growth. CONCLUSIONS Two sets of barriers emerged from the data; those which are consistent with any adult student and those which must be addressed because of disability. We make sense of these data by comparing results with the U.S. Census where appropriate.

The readiness of addiction treatment agencies for health care reform

The Patient Protection and Affordable Care Act (PPACA) aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for using technology, evidence-based treatments, and integrated, patient-centered care to modernize the delivery of health care services. These changes are designed to ensure effectiveness, efficiency, and cost-savings within the health care system.To gauge the addiction treatment field’s readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI) survey for addiction treatment agencies. Addiction treatment administrators and providers from around the United States completed the survey located on the http://www.niatx.net website. Respondents self-assessed their agencies based on 13 conditions pertinent to health reform readiness, and received a confidential score and instant feedback.On a scale of “Needs to Begin,” “Early Stages,” “On the Way,” and “Advanced,” the mean scores for respondents (n = 276) ranked in the Early Stages of health reform preparation for 11 of 13 conditions. Of greater concern was that organizations with budgets of < 

Analyses of employment incentives and barriers for individuals with psychiatric disabilities.

5 million (n = 193) were less likely than those with budgets > 

Implementing Recovery Management in a Treatment Organization

5 million to have information technology (patient records, patient health technology, and administrative information technology), evidence-based treatments, quality management systems, a continuum of care, or a board of directors informed about PPACA.The findings of the HRRI indicate that the addiction field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater expectations for information technology use, a credentialed workforce, accountability for patient care, and an integrated continuum of care.

AN E­HEALTH SOLUTION FOR PEOPLE WITH ALCOHOL PROBLEMS

OBJECTIVE Individuals with psychiatric disabilities experience 90% unemployment rates; however, individuals experience 61% employment rates when engaged in high-fidelity individual placement and support programs. To build on current research of variables influencing employment outcomes, we hypothesized that an Incentive factor and a Barrier factor are related to employment status. This mixed method study developed the Employment Commitment Measure (ECM) and explored the correlation between employment commitment and employment status. METHOD In our 1st phase of this mixed method study, we developed the ECM consisting of an Incentive factor with 5 items and a Barrier factor with 6 items through community-based participatory research. In our 2nd phase of this mixed method study, 198 randomly picked individuals with psychiatric disabilities completed a demographic survey and the ECM. We completed independent sample t tests with Bonferroni correction, cross-tabulated chi-square analyses, confirmatory factor analysis, Cronbachs alpha tests, a logistic regression, and a slope plotting. RESULTS The ECM consists of 11 items, with 5 items loading on an Incentive factor and 6 items loading on a Barrier factor. Results indicated that the Incentive factor scores were associated with employment status and significant differences on Incentive factor scores between employed and unemployed participants. Results indicated nonsignificant differences between employed and unemployed participants by age, education, gender, ethnicity, housing, mental health tenure, and agency tenure. CONCLUSIONS Our findings indicated incentives for employment may provide a better guide for correlations of and commitment to employment when compared to barriers. We discuss the implications for employment for individuals with psychiatric disabilities.

Recovery From Addiction and From Mental Illness: Shared and Contrasting Lessons.

This chapter will provide an overview of how a large behavioral health provider has implemented the principles of recovery management for treating individuals with a substance use disorder over the past 10 years. The story begins with the launching of the Behavioral Health Recovery Management (BHRM) project in 1999 and the subsequent funding of the grant project from the Illinois Division of Alcohol and Substance Abuse. We will briefly review the differences between recovery management and the broader disease management model. The BHRM project was the catalyst and incubator for implementing many of the principles outlined in this book. We will review the trials launched, successes achieved, barriers encountered, mistakes made, and lessons learned while incorporating the principles of recovery management within the existing, publicly funded addiction and mental health treatment system in Illinois. We will highlight the challenges involved in translating recovery principles into the existing medical or professional model of treatment. In particular, we will discuss the philosophical challenges involved in altering the views and values of staff, limitations with the Federal and State funding streams, and structural barriers associated with publicly funded organizations. The chapter will close with a discussion of how to translate the lessons learned to other organizations, future applications of the BHRM principles in an emerging concept of integrative care, and expanding the model to include emerging technologies.