Feasibility and Preliminary Efficacy of a Community-Based Addiction Rehabilitation Electronic System in Substance Use Disorder: Pilot Randomized Controlled Trial

Abstract

Background: Drug use disorder has high potential for relapse and imposes an enormous burden on public health in China. Since the promulgation of the Anti-drug law in 2008, community-based rehabilitation has become the primary approach to treat drug addiction. However, multiple problems occurred in the implementation process, leading to a low detoxification rate in the community. Mobile health (mHealth) serves as a promising tool to improve the effectiveness and efficiency of community-based rehabilitation. Community-based addiction rehabilitation electronic system (CAREs) is an interactive system for drug users and their assigned social workers.

Objective: The study aimed to examine the feasibility and preliminary efficacy of CAREs in community-based rehabilitation from the perspective of drug users and social workers in Shanghai, China.

Methods: In this pilot randomized controlled trial, 40 participants were recruited from the community in Shanghai from January to May 2019. Participants randomized to the intervention group (n=20) received CAREs + community-based rehabilitation, while participants in the control group (n=20) received community-based rehabilitation only for 6 months. CAREs provided education, assessment, and SOS (support) functions for drug users. The assigned social workers provided service and monitored drug use behavior as usual except that the social workers in the intervention group could access the webpage end to obtain drug users' information and fit their routine workflow into CAREs. The primary outcome was the feasibility of CAREs, reflected in the overall proportion and frequency of CAREs features used in both app and webpage end. The secondary outcomes were the effectiveness of CAREs, including the percentage of drug-positive samples, longest period of abstinence, contact times with social workers, and the change of Addiction Severity Index (ASI) from baseline to the 6-month follow-up.

Results: The number of participants logged in to the app ranged from 7 to 20 per week, and CAREs had relatively high levels of continued patient use. Drug users preferred assessment and education features in the app end while their social workers showed high levels of use in urine results record and viewing assessment results on the webpage end. After the 6-month intervention, 3.3% (17/520) of samples in the intervention group and 7.5% (39/520) in the control group were drug-positive (F=4.358, P=.04). No significant differences were noted between the control and intervention groups in terms of longest duration of abstinence, number of contact times and ASI composite scores.

Conclusions: The study preliminarily demonstrated that with relatively good feasibility and acceptability, CAREs may improve the effectiveness and efficiency of the community-based rehabilitation, which provided instruction for further improvement of the system.

Trial registration: ClinicalTrials.gov NCT03451344; https://clinicaltrials.gov/ct2/show/NCT03451344.

International registered report identifier (irrid): RR2-10.3389/fpsyt.2018.00556.

Keywords: China; community health service; drug use; mobile health; rehabilitation.

Figure 1

CONSORT flowchart of the study.

Figure 2

Location-tracking feature for social workers to monitor participants in intervention group: (A) close shot of Shanghai: drug users moving around within the supervision area; (B) number of locations accessed and not accessed (failed) from CAREs app per week; (C) remote view of Shanghai: some drug users had left the supervision area without reporting to the matched social workers, and the system automatically initiated alarm; and (D) number of alarms per week.

Figure 3

Number of unique participants who log in to the CAREs app at least once each week.

Figure 4

(A) Total number of people using education (in the form of text or video) function from CAREs app per week; (B) number of unique users who used assessment function from CAREs app per week (maximum number of people was 20); (C) mean scores of assessment results decreased over time.

Figure 5

Mean number of times of SOS features per week: (A) relaxation training (including music relaxation and abdominal breathing); (B) call forwarding service to doctors and voluntary drug rehabilitation center; (C) call forwarding service to family members; (D) message board used in both drug user and social worker ends.