The statistics related to deaths caused by drug and alcohol misuse are shocking and are unfortunately a global problem. In 2016 the Office for National Statistics recorded 7,327 premature deaths from alcohol and 2,593 deaths due to drug abuse in the UK alone. Similar patterns can be seen across the world with some parts of the US fighting an Opioid Epidemic, with the National Institute of Health publicising that more than 115 people in the US dying every day from Opioid overdose, including the misuse of prescription pain relieving medication.
Historically addiction treatment was very much a collaboration between counselling/support groups/sponsors; focusing on behavioural treatments and regulated, supervised medication substitute plans. The advances in technology are not necessarily changing the status quo, however new innovations are making support immediately accessible and providing interaction at crucial relapse potential times.
The National Institute of Drug Abuse found that in the States the highest percentage of drug users fell in the age group of teenagers to people in their twenties. I guess it is only natural that support would be on offer to, and more readily accepted by, this particular group via social media and internet groups. Where the interaction can be anonymous (if they wish), immediate and more organic as part of their day to day activities. A report published last Summer in the Guardian newspaper suggests British teenagers are “extreme internet users” with 1 in 3 spending more than six hours online a day. The statistics from the US are very similar with 91% of American teenagers logging on every day and 71% of them regularly using more than one social media platform.
One of the applications that I read about with interest is Triggr Health. This mobile app provides an alternative to open peer support groups (such as Alcoholics Anonymous, Narcotics Anonymous) and provides online chat facilities with recovery coaches that can be accessed at any time. They address the user’s goals for the day and any problems they are having whilst also monitoring the number of days that they have been in recovery. It also offers access to other online support, including GPS directions to your closest peer support group from your current location and the recovery team will be alerted if the user has not been in contact at all on any given day. More importantly, and impressively, it also collects data about the user – from their text and sleep patterns, phone logs, screen engagement and the use of alert words, for example “craving” or “stress”. This data is used to track normal behaviour of the user and is used to detect any anomalies and any potential indications of relapse. Again, the recovery team are alerted and contact the user. At the time of the article being published (April 2017) the app was predicting a relapse in the next three days on a 92% accuracy. Given that 75% or people who attended AA/NA relapse in the first year, this immediate intervention could prove pivotal in halting this potential downward spiral in its tracks.
Addicaid is another application that has been discussed in research papers and was founded in San Francisco – this app allows users access to a wide resource library, support team and a peer network group where feelings and challenges can be discussed and advice on interventions given from other users. It also has an in-person meeting finder and focuses on Cognitive Behavioural Therapy strategies to stop the unwanted behaviour patterns that lead to relapse.
The Reset Device is the first FDA approved prescription mobile medical app for people with addictions to cocaine, marijuana and stimulants specifically. Again, CBT is employed to empower the user to change their behavioural patterns and support them with strategies to prevent relapse. When compared to people undergoing more traditional therapy, 40% of people using the Reset Device were able to abstain from substance abuse – compared to 18% in the traditional therapy group.
WeRecover works as an online matching facility. The user simply fills in the application form and based on their addiction, situation, location and their budget for treatment – recommended a list of nearby addiction recovery facilities that have open beds and match their criteria. Affording them quick and tailored access to support.
Emocha is a Directly Observed Therapy (DOT) app that focuses on adherence to medication interventions as part of drug abuse rehabilitation and is being used in clinical trials, opioid abuse programmes and hospitals. Using a video interface medication taking is captured by video to ensure adherence to prescribed dosages and to deter abuse. Its use in recent trials has increased medication programme adherence from 50% to 95% and has been pivotal in establishing trust between patients and care providers.
Virtual reality devices have been employed more and more in relation to distraction therapy but its application here is more in the vein building coping strategies and aversion therapy.
Using virtual reality, the user is immersed into a range of different scenarios to see how they react. These range from a relaxing environment, a high risk one and an aversive one. The high-risk scenario would be highly customised to the user but would be the scenario in which they would usually be when abusing their particular substance, including their reported triggers. For example, a bar/nightclub for alcohol dependent users and a scenario where drug paraphernalia is clearly visible for those recovering from substance abuse. The aversive scenario would involve the smell of alcohol and/or people being sick from alcohol abuse and is part of understanding and curing the psychological aspect of the addiction. One study took brain scans of the participants, using positron emission tomography (PET) and computerised tomography (CT) before and after the therapy and on comparison to the control group found that those patients suffering from alcohol addiction had a faster brain metabolism – meaning that they were more sensitive to stimulants. Post therapy this was found to have reduced, opening the doors for further, larger research studies in this area.
On the back on the Opioid crisis research has turned to look at alternatives to the potentially habit-forming pain-relieving drug. A biotechnology company based in Nebraska is developing a drug delivery technology called Neurocarrus - which disrupts pain signals. This drug therapy which is named N-001, stops pain from tissue damage or inflammation by safely disrupting peripheral sensory neurons.
Studies are also looking at the possibility of eradicating addiction, or the ability to become addicted to substances permanently. Although these are obviously employing far more invasive measures.
Neurofeedback and its application to addiction is being used to combat the psychological part of addiction. Using electrodes to measure brain waves and their reaction to stimuli is giving positive indications. Again, the patient is placed in different scenarios where their decision-making processes are monitored in response to various images. Positive reinforcement is used to promote appropriate reactions to the good stimuli and over time it is hoped that this positive reinforcement becomes more attractive than the negative stimulus (i.e. drugs or alcohol). Obviously, this technique would be lengthy but clues learned about how and why the brain responds to certain stimuli would be beneficial for future areas or research.
Gene therapy is another area of research that is showing interesting results. Studies have focused on enzymes used in the breakdown of alcohol in the human body and found that that inhibition of the enzyme in the second stage of the process causes something that has been delightfully names “the upchuck factor”. ALDH2 (aldehyde dehydrogenase 2), which breaks acetaldehyde to acetic acid, was found to cause intense sickness, dizziness, headache, anxiety and a flushed face. Interestingly, it has been found that this enzyme inhibition natural occurs within approximately 540 million people worldwide and is commonly found in people of Japanese, Chinese and Korean descent.
Studies focusing on increasing the brain level of receptors for dopamine have also show positive results in the use of cocaine. By increasing the “pleasure chemical” – the feelings of reward and wellbeing are increased and the need to turn to substance abuse is reduced. It is also interesting that although substance abuse does lead to an increase in dopamine, over time they deplete the receptors and make it harder and harder for the person to produce dopamine from normal everyday pleasurable activities, resulting in a reduction overall and an inability to produce it without the abused substance.
Currently the gene therapy studies have been completed with animals and should they translate to the same success within human addiction, they would only be offered as a last resort – after all other options have been exhausted. However, given the alarming statistics noted at the start of this blog, and the fact that year on year they have increased, it may be, quite literally, a lifeline for many.
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Julie has written numerous interesting and well researched blogs on a wide range of topics related to Medical Devices and Human Factors. Please click here to read more of Julie's blogs and here to find out more about Julie.