The scope of addiction interventions has widened owing to the expanding use of digital technology in mental health. Because people now can reach therapists and counsellors worldwide using internet-based technologies, merging the efficacy of evidence-based treatments with the advantages of wide-reaching interventions is possible, ensuring interactive responses. In addition, technological innovations can provide tailored support to people regarding substance use or addiction disorders management. The importance of this technological intervention also reflects in substance use disorder patients. When patients have to attend inpatient or outpatient treatment, they usually tend to lose focus or motivation, resulting in a disruption in the initiation of treatment, and they drop out of rehab for addiction treatment.
If data or statistics are observed closely, you will find that there were 66.11 million internet users in the United Kingdom (U.K.) at the start of 2023. Owing to this drastic growth, it is right to predict that we must start using technology and the internet in substance use management services. Using technology can even help those who do not have enough money to afford rehab services.
This article will summarise the use of digital technology, such as mobile applications, in addiction treatment and prevention. Furthermore, we will also discuss the role of technological advances in overcoming the barriers to improving access to substance use care.
Patient Facing Technology
Smartphone applications and emails are widely used as a part of digital technology to connect with people worldwide in the present era. However, earlier, digital technology devices such as alarm watches and beepers were used in mental health research to remind about paper-based assessments. This approach was named the Experience Sampling Method (ESM) or Ecological Momentary Assessment (EMA). ESM or EMA collected data and helped gain insights about changes in the outcome measures with the daily life activities, which was hard to access with other research methodologies.
Also, in the early stages, descriptive studies were used to compare different psychiatric or addiction disorders, which is not the case today. Now, the focus has shifted towards exploring specific disorders’ nature. Though initial studies were dependent on the intensity and duration of mobile device use, they demonstrated the uniqueness and service of this research methodology in mental health research. Also, the paper-based methods limited the utility of E.M.A. For example, most of the time, it took a lot of work for the participants to mention the accurate timings of the assessments. However, when new technology emerged with the availability of smartphones and palmtop computers, it became feasible to collect data. For example, the data entry time points in the daily reports had the date and time stamps, increasing E.M.A.’s reliability. The technological advancement also provided the ease of using therapeutic interventions when needed.
In addition, multiple modalities have been tried in mental health, involving the patients directly. However, for the addiction-related research, patients were directed towards psychosocial interventions. Motivation, craving management, patient insight facilitation, developing coping strategies, and relapse prevention were the significant motives of these interventions.
Internet-based interventions are mainly divided into four categories:
- Web-based Interventions
- Artificial intelligence and virtual reality therapeutic software
- Online counselling and therapy
- Other online activities
Web-Based Self-Help Interventions
Web-based interventions are self-guided programmes that provide either basic information and intervention or information only. Executed or managed by a structured website, these programmes allow clients to explore the information provided. Also, web-based interventions are subdivided into four types, depending on how the required information is communicated.
- Information and education-based intervention: If a client needs information about any specific problem, such as diagnostic criteria of specific addiction disorders, symptoms, causes, and treatment strategies, these programmes can help. Information and education-based interventions aim to provide information about addiction disorders concisely and understandably. You can also find links to websites based on rehab for addiction treatment that contain the answers to your addiction-related questions. While these programmes do not provide therapy or treatment, they may suggest what therapy can help you based on your addiction severity.
- Self-guided Web-based Therapeutic Interventions: These programmes are one step ahead of what web-based interventions provide to clients. In addition to the specific information about addiction disorders, these programmes also offer therapeutic feedback, which starts with an elaborated assessment of the particular behaviour or symptoms. Once done, tailored feedback is provided to the clients, including the suggested ways to modify the problematic behaviours. Also, clients get this feedback either in the form of a large text or graphics over the screen or an automated email or text message.
- Human-supported Therapeutic Web-based Intervention: Like the self-guided approaches, these programmes aim to help clients change their behaviour through therapeutic feedback. However, human contact is an added advantage that provides support, communication, and feedback by health professionals or peer supporters. The human touch in these programmes can be provided through instant messages, webcams, or one-to-one by email, followed by the variability of amount/quantity, frequency, and immediacy of the response. For example, when a client connects with health professionals online, the response may vary from a few minutes to several hours. The frequency of the consultation also depends on the availability of the healthcare professionals. For example, they may take sessions one to several times daily to once off over the entire intervention. Clients may also receive delayed responses through emails rather than immediate ones through chat or webcam.
- Therapeutic Education System: A web-based psychosocial skills training intervention, the therapeutic education system is a community reinforcement approach for individuals with substance use disorders. It encourages behaviour change in individuals using different interactive multimedia modules, such as cognitive behavioural skills (e.g. refusal skills for risk behaviour and managing harmful thoughts) and psychosocial functions (e.g. family and social relations and managing negative moods). In addition, this intervention system is self-directed, including assessing a patient’s understanding and functionality to build individualised treatment plans and adjusting the pace and level of repetition of material to promote skill mastery.
Internet Technology Mediated Therapy (Online Counselling)
This intervention method allows patients or support groups to connect with therapists worldwide through an online platform. Though much strong resistance was created against this method of communication for therapy, the increase in its utility and success diminished all that. For example, this intervention has the advantage of surpassing the distance barriers. Clients can contact their counsellor or therapist anytime, anywhere, as required. It also allows clients to attend work or school regularly without hindrance. In addition, clients can write an email to their counsellors, which equates to face-to-face interaction. However, there are certain disadvantages to it, such as:
- The client needs to fit into this type of counselling, and the therapist has to ensure it. For example, patients with poor digital literacy are not the right fit for this type of addiction disorder
- Writing is a prime means to connect with counsellors in this type of counselling. Hence, non-verbal cues such as gestures, body language, and voice are often missed, which may create misunderstanding.
- Because this counselling method is not a face-to-face interaction, clients may find it difficult to express themselves.
- The distance barrier doesn’t provide the flexibility to connect in emergencies.
Multiple ethical and legal issues exist in online therapy.
Owing to these disadvantages, multiple ethical guidelines were set by professional associations time-to-time, such as the International Society for Mental Health Online.
Internet Operated Therapeutic Software
These interventions include sophisticated therapeutic software with advanced capacities, such as artificial intelligence (AI). They can be broadly divided into three types, including:
- Robotic Simulation of Therapists: This simulation-based intervention encourages dialogue-based therapy with patients for successful recovery rates. The programming in these interventions is done to detect specific pattern matches, simple vocabulary, and conversation rules. While the text-in and text-out were the leading communication platform in this intervention, recent development has been done in the software, and now artificial intelligence (A.I.) is used. For example, the Artificial Linguistic Computer Entity (A.L.I.C.E.) is built to recognise voice patterns and reply in the same manner rather than the text. Certain studies have also shown that AI-based applications can detect users’ emotional needs and create a perception of care and empathy, improving compliance.
- Rule-based Expert System: A rule-based expert system is mainly created for the assessment and treatment section, followed by progress monitoring. It is carried out by preparing a background algorithm based on specific rules for streamlining the process. For example, ‘Drinker’s Check-Up’ is built to detect the level of risk caused by alcohol consumption and a person’s readiness to change. Similarly, software like these with the basic capacity to calculate the scoring systems, such as AUDIT, are easily accessible with the help of smartphones. This software also promotes behavioural changes.
- Games and Virtual 3D Systems: Virtual 3D systems are an excellent innovation in the technology field that uses virtual ‘avatars’ for treating addiction disorders, and their popularity is increasing every day. One of the popular examples of virtual systems is Second Life. In this system, the programmes are designed in a way that a participant can create their virtual avatar to connect with the virtual world full of discussion forums, blogs, shopping, news resources, information exchange, and more. Another example is an application called MindCotine. In this setup, a virtual avatar is used in cue exposure therapy, and the participants are taught to curb the cravings for smoking or drinking, thus preventing relapse.
Therapeutic Use of Social Media
Another successful addiction disorder intervention is the therapeutic use of social media, such as personal blogs or participation in support groups via audio, chat, or webcam communication channels.
- Virtual Visit/Telepsychiatry: One of the significant challenges faced by people with substance use disorder is the logistic difficulty of accessing treatment services. Hence, virtual visits or telepsychiatry allow patients to connect with doctors at a remote site through video conferencing. Though this treatment domain has been around for a decade, it has gained popularity recently. This method uses teleconferencing to evaluate patients, establish a doctor-patient relationship, and facilitate documentation.
Also, telepsychiatry can be a real-time live interaction or a store-forward approach, which helps the physician and patient equally. A few advantages of telepsychiatry are as follows:
- It overcomes geographical barriers to accessing rehab for addiction treatment.
- It can reach the remotest areas where healthcare is a luxury.
- It saves time and money spent travelling or accessing specialist doctors in person.
The only disadvantage of telepsychiatry is that it may be an extra burden on the physician, considering the dynamics of healthcare resources.
Digital intervention has finally arrived for treating addiction disorders, and undoubtedly, it is here to stay. Starting from simple smartphones and digital sensors to machine learning, the means of establishing an intervention will only increase with time. For example, reSET is an FDA-approved application used to prevent long-term relapse. Also, among all, smartphones are frontrunners in digital intervention because of their data sensors, large screens, and numerous communication modalities.
Digital technology ultimately aims to enhance the engagement between the patient and physician for successful recovery. This attempt to strengthen the connection between the two parties also reduces the need for physical rehab for addiction treatment. However, multiple hindrances need to be addressed, such as digital trust and transparency, interoperability, cost and accessibility, and handling big data to produce best practices.