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| REVIEW ARTICLE |
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| Year : 2023 | Volume
: 5
| Issue : 1 | Page : 55-58 |
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Smartphone Apps for Addictive Disorders
Yasser Khazaal
Department of Addiction Medicine, CHUV and University of Lausanne, Lausanne, Switzerland; Department of Psychiatry and Addiction, University of Montreal, Montreal, Quebec, Canada
| Date of Submission | 09-Mar-2023 |
| Date of Acceptance | 09-Mar-2023 |
| Date of Web Publication | 26-Apr-2023 |
Correspondence Address:
Dr. Yasser Khazaal
Department of Addiction Medicine, CHUV and University of Lausanne, Lausanne, Switzerland; Department of Psychiatry and Addiction, University of Montreal, Montreal, Quebec, Canada
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/wsp.wsp_7_23
The use of smartphone apps for addiction treatment has become increasingly popular in recent years. These apps aim to support individuals in their recovery by providing a range of features such as digital brief intervention, assessment and normative feedback, cognitive behavioral therapy and social support networks. Some of the available apps rely on behavior changes theories. Several studies have demonstrated the potential efficacy of smartphone apps for the treatment of addictive disorders. There are also some challenges associated with the use of smartphone apps for addictive disorders such as concerns about the privacy and security of personal data as well as challenges related to drop-out rates in natural settings. Further development are also need for blended integration of such tools with the other services.
Keywords: Addictive disorders, apps, smartphone
How to cite this article:
Khazaal Y. Smartphone Apps for Addictive Disorders. World Soc Psychiatry 2023;5:55-8 |
| Introduction | |  |
The market for smartphones has grown significantly in recent years.[1],[2],[3] This market has been accompanied by the development of digital services delivered by smartphone applications (apps).[1],[2] They offer great flexibility through their ability to integrate all kinds of interactive media and computer technologies.
Addictive disorders are frequent and yet insufficiently treated. For instance, <10% of the people concerned are in contact with appropriate care services. This phenomenon is due to multiple barriers, structural (e.g., organization of services), environmental (e.g., social stigma), or personal (e.g., shame, skepticism, severity of the disorder, and ambivalence).
The aim of this article is to present the potential of apps for addictive disorders, to describe some of the behavior change theory models that could be integrated into such digital services and finally briefly describe the current state of evidence on this patient.
| The Potential of Apps | | |
The mobility, permanent accessibility, and ubiquity of apps have the potential to meet two major challenges.
The first is accessibility
Because of their permanent accessibility, perceived anonymity, and for free access, they can reach a part of the target audience, as evidenced by their popularity in the general population.[1],[3],[4] In fact, app downloads are very heterogeneously distributed among the available products, with a very heterogeneous distribution of the market between the apps, some of them getting highest parts of the downloads.[4] This success cannot be explained by the scientific validity of the available tools.[5] A large proportion of the apps available on the market are not studied and/or are not based on scientific knowledge.[5],[6],[7],[8],[9]
The second is community support
Indeed, apps could offer their users, in their natural environment, appropriate support at the right time, in the right context, reinforcing learning, and possibly fostering behavioral change.[10],[11]
There are many addiction-related apps available.[5],[11],[12],[13],[14],[15],[16],[17] Most of them come in fully automated versions or with some form of human support.[18] Apps with human guidance are designed to offer additional assistance to users (integrated messaging, video or telephone calls, or other means of communication). These in a number of studies appear to improve retention and impact of digital interventions.[8]
| Theories of Change | | |
Apps for addiction treatment can be based on theories of change depending on their specific objectives.[17],[19],[20] Some of these theories are particularly mentioned because of their adaptability in digital format.
The self-determination theory[21],[22],[23] postulates that intrinsic motivation is essential for behavior change. It identifies three basic psychological needs for the satisfaction of intrinsic motivation: autonomy, competence, and relatedness.
This theory can help in the development or evaluation of an app. For example, the design of the app can be adapted to meet each of these basic needs.
For autonomy: the app should offer customization options for users, allowing them to determine their own goals, and choose which features they want to use and when and how they want to use them.
For competence: the app should offer tools and resources to help users develop the skills relevant to the chosen change and to develop the confidence they need in using these skills.
For social connection: users of the app should feel supported, possibly through an online community and/or messages from the app itself, or by sharing their progress with significant people they have chosen.
The “COM-B theory: capability, opportunity, motivation behaviour” change theory[15] posits that for behavior to be changed, three key elements must be taken into account: capabilities, opportunities, and motivation. These elements interact with each other to influence a specific behavior.
The COM-B model can guide the development of an app:
For capacities: the aim is to identify, train, and reinforce the skills needed for a given change.
Opportunities refer to factors that influence behavior. This part is about factors that can be influenced to a greater or lesser extent by an app, for example, giving an opportunity for support and indicating places to go out without alcohol.
For motivation: the app could offer features to help users strengthen their motivation, identify the arguments for a given change, visualize the benefits of a change, get personalized incentives, or rewards for target behaviors.
The theory of planned behavior
The theory of planned behavior[17],[24],[25] posits that human behavior is determined by intentions, which are in turn influenced by attitudes, social norms, and perceived control. Applications can help modify these factors to help define and plan behavior[25] but also enhance perceptions of control or modify beliefs about social norms, for example, by providing normative feedback.[26]
| Evaluation of Apps for the Treatment of Addictive Behaviors | | |
Apps for addiction and mental health treatment[8] can be evaluated in terms of effectiveness, safety, adherence, and usability.
Evaluations of effectiveness can be carried out, for example, through randomized controlled clinical trials that compare a given app with a control group or a standard intervention.
Such studies,[27],[28] and the first available meta-analyses on apps (mainly on alcohol and tobacco),[8],[13],[29],[30] although still preliminary, and still limited in the field of gambling and gaming disorders[31] and prohibited substances[32] have shown that some apps can be effective in helping users to modify their behaviors.
These results need to be balanced against small to moderate effect sizes, heterogeneity of the populations included, the measures, and the control groups. Few studies have included active control or even placebo interventions.[12]
These results do not mean that apps are effective, but that specific apps can be of some help in specific contexts and with specific populations.
Apps and digital interventions in general have the potential to attract many people, including women who are less represented in traditional services.[33] However, digital treatments, and in particular apps, have difficulty maintaining engagement in the natural environment. This phenomenon limits the effectiveness of such interventions.[34] This finding highlights the importance of engaging end users in the app development process from the beginning of the design process and as the app is improved.[35],[36] Digital interventions should involve the user to reach their full empowerment potential.
Security[37],[38] of such interventions and in particular the risks to the privacy and confidentiality of users and their personal health information are a major concern. Hence, it is important to be aware of these issues and to check carefully how each app handles them.
The integration of apps into clinical practice is still relatively limited. However, such an approach has shown promise in a study comparing an alcohol app integrated with standard treatment versus standard treatment alone.[27]
The integration of such tools into the clinic is the patient of ongoing projects, notably in Australia.[39],[40] Although there is a growing interest in using technology to improve treatment outcomes, there are still cultural (propensity of carers and patients to use these tools.), technical (interoperability of computerized records and data security), conceptual (app models complementary to the clinical offer), and financial (bearing the costs of app development and maintenance.) barriers to the widespread use of smartphone applications in clinical practice. We must also remain vigilant to digital inequities[41],[42] and think about our health systems and the future of apps considering the inequities in access and usability of such services in the general population. For example, in Switzerland, about 8% of the population does not use a smartphone and half of the adult population has an insufficient level of digital literacy (e.g. people find information but do not know what to do with it).
| Perspectives | | |
In the coming years, we can expect progress in the development and use of smartphone apps for the treatment of addictive disorders.
Artificial intelligence and machine learning[3],[43] could improve the personalization of treatment by allowing apps to adapt to individual patient needs. For example, machine learning algorithms can analyze data collected by smartphone apps to identify behavioral patterns that trigger addictive behaviors, which would allow treatment to be tailored accordingly to targeted interventions at the right time. The future of apps for addiction treatment will depend on technological advances, acceptance by health-care professionals and the population, research on the patient, and the integration of apps into a coherent health-care ecosystem.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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