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Using Text Messages to Improve Substance Use Disorders Treatment Outcomes


Nancy Roget, MS, MFT, LADC

Co-Director, Mountain Plains ATTC


Annually, the Substance Abuse Mental Health Services Administration (SAMHSA) conducts a survey called the National Survey on Drug Use and Health (NSDUH). This survey interviews almost 68,000 individuals across the nation regarding their use of alcohol, prescribed medications, and illicit drugs. In 2019, the NSDUH survey found that almost 20 million individuals over the age of 18 had a substance use disorder (SUD), with less than 10% of these 20 million receiving treatment services. To address this vast treatment gap between individuals who report having a SUD and those that enter treatment, both researchers and policy-makers advocated for strategies that increase access to treatment services, promote low-cost resources, and offer engagement activities. An innovative response suggests that behavioral health technologies may offer one solution.

According to Ashford and colleagues (2018), in the last decade the use of technology by

SUD treatment and recovery support providers has helped increase the reach of their services, lower the threshold for patient engagement (e.g., made it easier for patients to enter treatment or recovery support services) and offer services that serve as an adjunct or complement to treatment and recovery services (p.19). At the same time, the use of technology (e.g., mobile phone, smart phone, tablet, computer, and internet) has increased in the general public. Recent data from Pew (2019) found that 81% of adults owned a smartphone, which was up 4% from 2018, and 73% had high speed internet at home. Smartphone use has increased among SUD treatment populations as well, with smartphone ownership ranging from 57% to 80% (Ashford et al., 2018; Dahne & Lejuez, 2015; Milward et al., 2015; Winstanley et al., 2018). These reported smartphone ownership rates for individuals involved with SUD treatment services have increased dramatically from an initial study done in 2013. Mobile phone ownership for this population increased substantially as well, ranging between 83% and 95%. Access to the internet is still low for the SUD treatment population but most individuals reported accessing internet services through their phones rather than home broadband. The bottom line as highlighted in the above-mentioned studies is that most patients have access to a mobile phone that can be used to receive or send text messages and/or to access the internet. Finally, a recent study (Ashford et al., 2018) showed that individuals in SUD treatment expressed a strong interest in using digital resources to manage and monitor their recovery, which included their preference to use an app on their phone or receive text messages. 

In light of these recent findings on technology use and patient feasibility/interest data, the Mountain

Plains ATTC worked with Dr. Scott Walters, a noted professor, National Institute on Drug Abuse (NIDA) researcher, and psychologist to develop a series of products and training/technical assistance activities. These products and activities were created for treatment and recovery support providers on how to create and implement one-way short message service (SMS) text messaging. The goal of implementing this innovation was to increase patient/peer engagement aligning with services like groups/individual sessions. A text messaging curriculum was created by Dr. Walters and piloted by the Mountain Plains ATTC in a two-part webinar series in Spring 2019, after which revisions were made to the manual and webinars, and a text messaging poster created that reminds providers and peers about texting language and tips. In August 2019, the webinar series was facilitated again, recorded, and posted in the products section on the Mountain Plains ATTC website along with the poster and manual. In November 2019, a small four-week intensive technical assistance (ITA) pilot was implemented with six SUD treatment providers located in Region 8 to assist with the implementation of text messaging within one of their treatment/recovery support components. Currently, these six providers are participating in the last part of the ITA project that includes individualized consultation sessions with Dr. Walters to assist with implementation issues. Results from this ITA project will be posted under a ‘lessons learned’ document. Initial feedback from participants reflects the principles of technology transfer that the innovation was easy to use, met a need at the agency, and enhanced their current service delivery. A recent Norwegian study by (Bjerke et al., 2009) on the use of text messaging found that patients felt a greater sense of connectedness to the providers through the use of text messaging. The Mountain Plains ATTC staff hopes the providers involved in this project receive similar patient feedback.

References
Ashford, D. R., Lynch, K., & Curtis, B. (2018). Technology and social media use among patients enrolled in outpatient addiction treatment programs: Cross-sectional survey study. Journal of Medical Internet Research, 20(3), e84. http://dx.doi.org/10.2196/jmir.9172.

Bergman, B. G., Greene, M. C., Hoeppner, B., & Kelly, J. (2018). Expanding the reach of alcohol and other drug services: Prevalence and correlates of US adult engagement with online technology to address substance problems. Addictive Behaviors, 87, 74–81. https://doi.org/10.1016/j.addbeh.2018.06.018.

Bjerke, T. & Kummervold, P., Christiansen, E. & Hjortdahl, P. (2009). “It made me feel connected”—An exploratory study on the use of mobile SMS in follow-up care for substance abusers. Journal of Addictions Nursing, 19, 195-200. 10.1080/10884600802504735.

Bliuc, A. M., Best, D., Iqbal, M., & Upton, K. (2017). Building addiction recovery capital through online participation in a recovery community. Social Science & Medicine, 193, 110–117. https://doi.org/10.1016/j.socscimed.2017.09.050.

Dahne, J. & Lejuez, C. (2015). Smartphone and mobile application utilization prior to and following treatment among individuals enrolled in residential substance use treatment. Journal of Substance Abuse Treatment, 58(Supplement C), 95–99. https://doi.org/10.1016/j.jsat.2015.06.017.

Masson, C. L., Chen, I. Q., Levine, J. A., Shopshire, M. S., & Sorensen, J. L. (2018). Health-related internet use among opioid treatment patients. Addictive Behaviors Reports, 9, 100157. doi:10.1016/j.abrep.2018.100157

Milward, J., Day, E., Strang, J., & Lynskey, M. (2015). Mobile phone ownership, usage and readiness to use by patients in drug treatment. Drug and Alcohol Dependence, 146(Supplement C), 111–115. https://doi.org/10.1016/j.drugalcdep.2014.11.001.

Pew Research Center (2019). Mobile Technology and Home Broadband 2019. Accessed January 2020 from https://www.pewresearch.org/internet/2019/06/13/mobile-technology-and-home-broadband-2019/.

Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/.

Winstanley, E. L., Stroup-Menge, B., & Snyder, K. (2018). The promise of technology-based services for addiction treatment clients residing in nonurban areas. Journal of Studies on Alcohol and Drugs, 79(3), 503–504.

Published:
03/18/2020
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The opinions expressed herein are the views of the authors and do not reflect the official position of the Department of Health and Human Services (DHHS), SAMHSA, CSAT or the ATTC Network. No official support or endorsement of DHHS, SAMHSA, or CSAT for the opinions of authors presented in this e-publication is intended or should be inferred.

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