Glass Joseph E, McKay James R, Gustafson David H, Kornfield Rachel, Rathouz Paul J, McTavish Fiona M, Atwood Amy K, Isham Andrew, Quanbeck Andrew, Shah Dhavan
Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, Seattle, WA, USA.
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
J Subst Abuse Treat. 2017 Jun;77:57-66. doi: 10.1016/j.jsat.2017.03.011. Epub 2017 Mar 30.
We estimated the efficacy of the Addiction-Comprehensive Health Enhancement Support System (A-CHESS) in increasing the use of services for addiction and examined the extent to which this use of services mediated the effects of A-CHESS on risky drinking days and abstinence from drinking.
We conducted secondary data analyses of the A-CHESS randomized controlled trial. Recruitment occurred in five residential treatment programs operated by two addiction treatment organizations. Participants were 349 adults with alcohol use disorders recruited two weeks before discharge from residential treatment. We provided intervention arm participants with a smartphone, the A-CHESS application, and an 8-month service plan. Control arm participants received treatment as usual. Telephone interviews at 4, 8, and 12-month follow-ups assessed past-month risky drinking days, past-month abstinence, and post-discharge service utilization (past-month outpatient addiction treatment and past-week mutual help including Alcoholics Anonymous and Narcotics Anonymous). Using mixed effects latent variable models, we estimated the indirect effects of A-CHESS on drinking outcomes, as mediated by post-discharge service utilization.
Approximately 50.5% of participants reported outpatient addiction treatment and 75.5% reported mutual help at any follow-up interview in the year following randomization. Assignment to the A-CHESS intervention was associated with an increased odds of outpatient addiction treatment across follow-ups, but not mutual help. This use of outpatient addiction treatment mediated the effect of A-CHESS on risky drinking days, but not abstinence. The effect of A-CHESS through outpatient addiction treatment appeared to reduce the expected number of risky drinking days across follow-ups by 11%.
The mobile health (mHealth) intervention promoted the use of outpatient addiction treatment, which appeared to contribute to its efficacy in reducing risky drinking. Future research should investigate how mHealth interventions could link patients to needed treatment services and promote the sustained use of these services.
我们评估了成瘾综合健康强化支持系统（A-CHESS）在增加成瘾服务使用方面的效果，并研究了这种服务使用在多大程度上介导了A-CHESS对危险饮酒天数和戒酒的影响。
我们对A-CHESS随机对照试验进行了二次数据分析。招募工作在由两个成瘾治疗组织运营的五个住院治疗项目中进行。参与者为349名患有酒精使用障碍的成年人，他们在住院治疗出院前两周被招募。我们为干预组参与者提供了一部智能手机、A-CHESS应用程序和一份为期8个月的服务计划。对照组参与者接受常规治疗。在4个月、8个月和12个月的随访中进行电话访谈，评估过去一个月的危险饮酒天数、过去一个月的戒酒情况以及出院后服务利用情况（过去一个月的门诊成瘾治疗和过去一周的互助情况，包括戒酒互助会和匿名戒毒会）。使用混合效应潜变量模型，我们估计了出院后服务利用所介导的A-CHESS对饮酒结果的间接影响。
在随机分组后的一年中，约50.5%的参与者报告接受了门诊成瘾治疗，75.5%的参与者在任何一次随访访谈中报告接受了互助。被分配到A-CHESS干预组与随访期间门诊成瘾治疗的几率增加有关，但与互助无关。这种门诊成瘾治疗的使用介导了A-CHESS对危险饮酒天数的影响，但对戒酒没有影响。A-CHESS通过门诊成瘾治疗的效果似乎使随访期间危险饮酒天数的预期数量减少了11%。
移动健康（mHealth）干预促进了门诊成瘾治疗的使用，这似乎有助于其在减少危险饮酒方面的效果。未来的研究应调查mHealth干预如何将患者与所需的治疗服务联系起来，并促进这些服务的持续使用。
