Kolmac Outpatient Recovery Centers

Recognizing early relapse warning signs is a major focus in outpatient addiction treatment. Can smartphones help with this? That is a question that a medical technology company called Mindstrong is trying to address with a newly developed smartphone app. The Mindstrong strategy is based on the discovery that people tap and swipe their smartphones thousands of times a day in a way that is unique to them, creating a “digital fingerprint.” This distinctive pattern changes when a person’s mental state shifts. Certain characteristic shifts have already been used to detect changes in people with mood disorders. Early indications are that a similar shift occurs in people who are struggling with substance use disorders and are drifting toward relapse.  Kolmac has been asked to see if this finding can be used to benefit these people by detecting this development and intervening.

Patients often experience a relapse as a sudden event that occurs with little warning. Relapse, however, is best understood as an extended process with multiple warning signs appearing before actual return to use occurs. This means that the process can be interrupted before use occurs if the person recognizes the warning signs and intervenes effectively. Up until now, we have depended entirely on psychosocial strategies, urging our patients to stay connected to recovery supportive individuals and to be open with them when they experience early warning signs.

Our past efforts to use technology to reduce relapses have been unsuccessful. In part, this has been because the approaches that we have used required patients to reach out for help at the very time that, as part of the relapse process, they were inclined to withdraw. What is different about this new approach is that it circumvents this problem. Here’s how it works: The patient agrees to install a smartphone app that continuously tracks phone use patterns and detects shifts as they occur. These shifts are communicated wirelessly to a monitoring clinician who responds to these changes by reaching out to the patient via text messaging.

Several issues will need to be resolved before this intervention can be implemented. For example, we are in the early stages of working out the coordination between the monitoring clinician and the Kolmac staff. In addition, I expect privacy concerns to arise despite the fact that only patterns of a person’s interaction with the phone and not the content itself are monitored. Our patients have shown enough initial interest for us to move forward. I will be writing periodic updates about how this is proceeding and whether its potential for improving addiction treatment is realized.

 

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