Stand Down App + Peer Support for Alcoholism
(PS-Stand Down Trial)
Recruiting in Palo Alto (17 mi)
+1 other location
Age: Any Age
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: VA Office of Research and Development
Disqualifiers: Psychotic disorder, Cognitive disorder, others
No Placebo Group
Trial Summary
What is the purpose of this trial?Hazardous drinking is common among Veteran primary care patients and increases risk for more costly and complex medical problems over the long-term. Yet, the vast majority of these Veterans go untreated. By providing an option for care that is easily accessible, private, and self-directed, mobile applications (apps) circumvent many barriers to alcohol use treatment. However, poor patient engagement remains the Achilles' heel of these apps. Through supportive accountability, Peer Specialists can maximize the reach and engagement of these apps with patients and improve drinking outcomes. The goal of this project is to evaluate whether an app for alcohol use self-management ("Stand Down") reduces drinking among Veteran primary care patients who engage in hazardous drinking, and for whom Peer-Supported-Stand Down is more effective than the app alone. If successful, the proposed research has the potential to transform care and increase access to alcohol-related services for Veterans who engage in hazardous drinking but rarely seek treatment, and, in turn, mitigate the adverse health outcomes that stem from untreated hazardous drinking.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your healthcare provider.
What data supports the effectiveness of the treatment Stand Down App + Peer Support for Alcoholism?
Research shows that using the Stand Down app with peer support can help reduce alcohol consumption. In a study with veterans, those who used the app and received peer support reported drinking less and were satisfied with the care they received.
12345Eligibility Criteria
This trial is for Veterans who recently scored high on an alcohol use screening and haven't had treatment for alcohol use in the past month. They must have received brief intervention, own a smartphone, and be willing to be randomly assigned to a group. Those with psychotic or cognitive disorders are not eligible.Inclusion Criteria
Veterans who did not receive any outpatient, inpatient, or residential care for alcohol use in the month after their positive AUDIT-C
Veterans with documentation in their medical records of receipt of a BI following a positive screen
Veterans with a positive AUDIT-C screen (score of > 5) during a primary care visit in the past month at a clinic at either the VA Palo Alto Health Care System or the Syracuse VA Medical Center
+1 more
Exclusion Criteria
I am a veteran diagnosed with a psychotic disorder.
I am a veteran diagnosed with a cognitive disorder like dementia.
Veterans who do not agree to be randomized
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Baseline Assessment
Participants complete a baseline interview and are randomized to one of the study conditions
1 week
1 visit (in-person or virtual)
Treatment
Participants use the Stand Down app with or without Peer support, depending on their assigned group
8 weeks
4 phone sessions (bi-weekly) for Peer-Supported group
Follow-up
Participants are monitored for drinking outcomes and other measures
24 weeks
Re-interviews at 8, 20, and 32 weeks
Participant Groups
The study tests if the 'Stand Down' mobile app helps reduce hazardous drinking among Veterans. It compares usual care, the app alone, and the app with peer phone support to see which is more effective at managing alcohol use.
3Treatment groups
Experimental Treatment
Active Control
Group I: UC + Stand Down app (app only)Experimental Treatment2 Interventions
Patients in this condition will receive Usual Care (UC) and be provided a unique code and password to access Stand Down. The app is based on principles of motivational enhancement and cognitive-behavioral therapies and comprises 7 modules organized around 4 goals: 7 modules organized around 4 goals: (i) Enhance awareness of drinking patterns (assessment and personalized feedback), (ii) Establish and monitor progress towards drinking goal - i.e., moderation or abstinence, (iii) Manage cravings and other problems using in-the-moment tools, and (iv) Connect users with other types of support. App usage will be tracked by the research team for the duration of the study (32 weeks).
Group II: UC + Peer-Supported Stand Down (PS-Stand Down)Experimental Treatment1 Intervention
Patients assigned to this condition will receive UC and access to Stand Down, plus four phone sessions from a Peer over 8 weeks. Sessions will be bi-weekly, approximately 15-30 minutes in length, and focus on enhancing patients' engagement with the app.
Group III: Usual CareActive Control3 Interventions
All patients, regardless of condition, will have access to usual care for hazardous drinking in primary care. In this setting, usual care entails a spectrum of alcohol-related services including annual screening for hazardous drinking, brief intervention following a positive screen (advice from a provider to reduce their drinking), and referral (as needed) to specialty AUD treatment.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
VA Palo Alto Health Care System, Palo Alto, CAPalo Alto, CA
Syracuse VA Medical Center, Syracuse, NYSyracuse, NY
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Who Is Running the Clinical Trial?
VA Office of Research and DevelopmentLead Sponsor
References
Stand Down-Think Before You Drink: protocol for an effectiveness-implementation trial of a mobile application for unhealthy alcohol use with and without peer support. [2023]Mobile apps can increase access to alcohol-related care but only if patients actively engage with them. Peers have shown promise for facilitating patients' engagement with mobile apps. However, the effectiveness of peer-based mobile health interventions for unhealthy alcohol use has yet to be evaluated in a randomised controlled trial. The goal of this hybrid I effectiveness-implementation study is to test a mobile app ('Stand Down-Think Before You Drink'), with and without peer support, to improve drinking outcomes among primary care patients.
Self-management and Shared Decision-Making in Alcohol Dependence via a Mobile App: a Pilot Study. [2018]Mobile applications (apps) have created new opportunities in the field of alcohol dependence (AD) within new paradigms of shared decision-making and self-management. The aim of this study is to report the results of a pilot study testing the usability of and satisfaction with a mobile app (called SIDEAL) in AD patients.
Smartphone applications to reduce alcohol consumption and help patients with alcohol use disorder: a state-of-the-art review. [2022]Hazardous drinking and alcohol use disorder (AUD) are substantial contributors to USA and global morbidity and mortality. Patient self-management and continuing care are needed to combat these public health threats. However, services are rarely provided to patients outside of clinic settings or following brief intervention. Smartphone applications ("apps") may help narrow the divide between traditional health care and patient needs. The purpose of this review is to identify and summarize smartphone apps to reduce alcohol consumption or treat AUD that have been evaluated for feasibility, acceptability, and/or efficacy. We searched two research databases for peer-reviewed journal articles published in English that evaluated smartphone apps to decrease alcohol consumption or treat AUD. We identified six apps. Two of these apps (A-CHESS and LBMI-A) promoted self-reported reductions in alcohol use, two (Promillekoll and PartyPlanner) failed to promote self-reported reductions in alcohol use, and two (HealthCall-S and Chimpshop) require further evaluation and testing before any conclusions regarding efficacy can be made. In summary, few evaluations of smartphone apps to reduce alcohol consumption or treat AUD have been reported in the scientific literature. Although advances in smartphone technology hold promise for disseminating interventions among hazardous drinkers and individuals with AUD, more systematic evaluations are necessary to ensure that smartphone apps are clinically useful.
Using peers to increase veterans' engagement in a smartphone application for unhealthy alcohol use: A pilot study of acceptability and utility. [2022]Mobile apps can only increase access to alcohol treatment if patients actively engage with them. Peers may be able to facilitate such engagement by providing supportive accountability and instruction and encouragement for app use. We developed a protocol for peers to support engagement in the Stand Down app for unhealthy alcohol use in veterans and tested the acceptability and utility of the protocol. Thirty-one veteran primary care patients who screened positive for unhealthy alcohol use and were not currently in addiction treatment were given access to Stand Down for four weeks and concurrently received weekly phone support from a Department of Veterans Affairs peer specialist to facilitate engagement with the app. App usage was extracted daily, and pre/post treatment assessments measured changes in drinking patterns, via the Timeline Followback interview, and satisfaction with care, via quantitative and qualitative approaches. A priori benchmarks for acceptability were surpassed: time spent in the app (M = 93.89 min, SD = 92.1), days of app use (M = 14.05, SD = 8.0), and number of daily interviews completed for tracking progress toward a drinking goal (M = 12.64, SD = 9.7). Global satisfaction, per the Client Satisfaction Questionnaire, was high (M = 26.4 out of 32, SD = 4.5). Pre to post, total standard drinks in the prior 30 days (MPre = 142.7, MPost = 85.6), Drinks Per Drinking Day (MPre = 5.4, MPost = 4.0), and Percent Heavy Drinking Days (MPre = 35.3%, MPost = 20.1%) decreased significantly (ps
Smartphone apps for managing alcohol consumption: a literature review. [2021]Smartphone applications (apps) designed to assist users to reduce hazardous and harmful alcohol consumption show potential as an inexpensive alternative to traditional brief intervention in primary care. The aim of this paper is to provide an overview of the literature on alcohol reduction apps and the availability of evidenced-based apps on top commercial app stores.
Design and Content Quality of Alcohol-Related German, French and Italian Self-Tracking Applications. [2021]Background: Research on the increasing use of mobile technology in the addiction field is mainly focused on data collection and brief interventions. The acceptance and outcomes of autonomous self-tracking and self-governance as key elements for behavior change are under-researched. Purpose/Objectives: The objective of the study was to conduct a quality assessment of design and content features of self-tracking smartphone applications related to alcohol use, available in German, Italian, or French. Methods: A total of 25 self-tracking applications were identified, of which 17 could be assessed with the Mobile App Rating Scale (MARS), the System Usability Scale (SUS), and an additional content quality checklist based on the theoretical self-change framework (n = 13). Results: The scale design analysis showed a rather positive picture. Using the SUS, only six cases were below the reference average (x = 68), and three were clearly above average. Application of the MARS showed higher scores among the self-tracking applications in this study than among the health applications reviewed in the original MARS study. Better design quality goes together with better basic content quality. However, a closer look at the "interactivity scores" and the "risk/information barometer," as well as at the individual subtopics of the 10-point content checklist revealed major shortcomings. Conclusions/Importance: Improvements are necessary for consumer information in app stores, increased availability of alcohol-related self-tracking applications, transparent quality assurance regarding evidence-based content, and user-friendly design quality, to provide guidance for potential users on how to successfully navigate a highly unstable digital environment.
Using a mobile health application to reduce alcohol consumption: a mixed-methods evaluation of the drinkaware track & calculate units application. [2022]Smartphone applications ("apps") offer promise as tools to help people monitor and reduce their alcohol consumption. To date, few evaluations of alcohol reduction apps exist, with even fewer considering apps already available to the public. The aim of this study was to evaluate an existing publically available app, designed by Drinkaware, a UK-based alcohol awareness charity.
Effectiveness of a Theory-Based mHealth Intervention for High-Risk Drinking in College Students. [2021]Background: College students are among the most vulnerable groups to problems associated with high-risk drinking consequences such as illness, injury, sexual abuse, and death. Promising mobile health (mHealth) approaches, such as smartphone (SP) apps, can be used in interventions to address or prevent excessive drinking. Method: The aim of the investigation was to examine the efficacy of a theoretically based mHealth SP app for alcohol intervention in two independent samples (N = 379): Mandated participants (Study 1) and voluntary participants (Study 2). Study 1 included a controlled trial with Mandated participants randomized into either an in-person Brief Motivational Interviewing BMI (n = 70) or BMI + SP app intervention (n = 71). Study 2 included Voluntary participants who participated in either a Control group (n = 157) or the BMI + SP app intervention (n = 81). Participants in both studies completed baseline and 6-week assessments. Results: In Study 1, peak Blood Alcohol Concentration (BAC) of participants in the in-person BMI group had increased slightly at six weeks, while it had decreased for the app-based BMI + SP group. Study 2 participants using the BMI + SP app reported significant reductions in drinking and consequences; there were no changes in the (AO) Control group. Conclusions: The BMI + SP app was effective with both Mandated and Voluntary participants. Future testing with the BMI + SP app is needed to assess whether reach, adoptability, portability, and sustainability are greater with the mHealth smartphone app for alcohol intervention than in-person approaches.
There is an app for that - Or is there? A content analysis of publicly available smartphone apps for managing alcohol use. [2022]Smartphone apps are emerging as a promising tool to support recovery from and prevention of problematic alcohol use, yet it is unclear what type of apps are currently available in the public domain, and to what degree these apps use interactive tailoring or other dynamic features to meet users' specific needs.