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Computer programs and applications for cell phones and other mobile devices are increasingly popular as tools for prevention and treatment of substance use disorders.
These technology-based interventions can be used either as an adjunct to traditional treatment, or in some cases as a stand-alone therapy, according to Lisa A. Marsch, PhD, Director of the Center for Technology and Behavioral Health at the Dartmouth Psychiatric Research Center.
She is heading up several projects focused on developing and evaluating interactive, computer-based systems that deliver evidence-based interventions. “There are many psychosocial behaviors that are effective in treating substance use disorders, but there are challenges to finding the resources to deliver them, because of many reasons including staff training and turnover, and time constraints,” she says. “Using technology can improve substance abuse prevention and treatment in a way that is cost-effective and increases reach to new target audiences, including the many people with substance use disorders who are not in treatment. We are not trying to replace highly trained clinicians, but they are not always available.”
Her research has demonstrated that technology-based interventions can be as effective as science-based interventions delivered by highly trained clinicians. “We want to expand clinicians’ toolbox, so they can have more tools that can be accessed in a wide array of settings by diverse populations, either as a stand-alone or as a supplement to other models of care.”
Technology-based interventions can be made available in locations that may have limited resources for substance abuse treatment, including prisons and schools, Dr. Marsch notes.
One web-based program Dr. Marsch is testing is called Therapeutic Education System (TES), a self-directed interactive intervention for people with substance use disorders. TES is being studied in a multi-site clinical trial, funded by the National Institute on Drug Abuse, as an adjunct to community-based, outpatient substance abuse treatment. It is also being tested in prisons and in methadone treatment centers, among other settings.
The program provides immediate feedback and requires participants to demonstrate mastery of the information and skills being learned. TES includes interactive video-based computer simulations of real-world experiences, to allow program users to imagine “what if” scenarios and possible behavioral choices.
For example, a video on learning skills to refuse drugs shows a young woman who tells a group of friends she doesn’t want the drugs they offer her. The program points out the young woman said the right things but did not have convincing body language. It instructs the user to watch the video again, this time paying particular attention to her body language. “Say no. Make continuous eye contact,” the program advises.
Technology-based interventions can also be delivered via mobile devices to individuals in drug treatment. In a pilot study, Dr. Marsch found that offering a behavioral intervention via a mobile phone app to clients in a methadone treatment center along with standard methadone treatment, led to significantly decreased opioid use. Using the app also helped patients stay in treatment longer. “They used the program on their mobile devices when they felt most at risk, any time of day or night,” she said.
She has also developed several substance abuse multimedia prevention programs for children and teens. Delivering substance abuse prevention and treatment interventions through technology can be a cost-effective way to reach this age group, Dr. Marsch concluded in a study published in 2007. One computer game for elementary school students in grades 3-5, called “Head On: Making Good Choices,” is designed to build up protective factors against drug use and other risky behavior.
Topics include how to establish and maintain healthy relationships, general decision-making skills, and consequences of substance use. Dr. Marsch studied the effectiveness of the program by comparing it to a life skills training course, delivered by educators, and to a control group that received no intervention. She found children who participated in the Head On group, for 15 sessions during the school year, had significantly greater knowledge about drug use compared with the other groups. Another version of the program, “Head On: Substance Abuse Prevention,” is designed for grades 6-8.
“If you develop these programs well, you can get reliably good outcomes,” Dr. Marsch says. “We’ve seen this in populations ranging from elementary school children to injection-heroin users.”