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- 1. SoberDiary A Phone-based Support System to Assist Recovery from Alcohol Dependence Bing (Chuang-Wen) You, Kuo-Cheng Wang, Ming-Chyi Huang, Yen-Chang Chen, Cheng-Lin Lin, Hao-Chuan Wang, Polly Huang, Hao-Hua Chu
- 2. Outline • Motivation • Approach • Design and implementation • User study – Quantitative results – Qualitative results • Conclusion Outline
- 3. Outline • Motivation • Approach • Design and implementation • User study – Quantitative results – Qualitative results • Conclusion Outline
- 4. 4 Alcohol Dependence A chronic disorder debilitating psychiatric disorder, and is associated with maladaptive and destructive behavior
- 5. 5Source: http://www.AustinRecovery.org Alcohol Withdrawal Treatment Alcohol-dependent patients need to enter rehab centers to receive withdrawal treatment and stop drinking alcohol
- 6. Follow-up maintenance program Revisit rehab center Drinking diary
- 7. Difficulties in staying sober in daily life • Drinking triggers in natural environment • No continuous & accurate tracking • Lack long-term maintenance program
- 8. Difficulties in staying sober in daily life Drinking triggers in natural environment
- 9. Difficulties in staying sober in daily life No continuous & accurate tracking
- 10. Difficulties in staying sober in daily life Lack long-term maintenance program
- 11. 11 Alcohol Relapse Up to 50% of people treated for alcohol dependence experience periods of relapse in the 2 years following treatment Source: http://sobercoach1.com
- 12. How to help alcohol-dependent patients stay sober in daily life? Sobriety Relapse
- 13. SoberDiary A phone-based support system
- 14. Outline • Motivation • Approach • Design and implementation • User study – Quantitative results – Qualitative results • Conclusion Outline
- 15. CarSafe video SoberDiary video Narrated by: Hsin-Liu Cindy Kao
- 16. Continuous patient monitoring Researchers / psychiatrists Obtain statistical data Alcohol-dependent patients Momentary feedback Data summarization & suggestions Upload behavior data Peer achievements BrAC results Self-administered alcohol breath tests System architecture Sensing Feedback Data collection
- 17. Outline • Motivation • Approach • Design and implementation • User study – Quantitative results – Qualitative results • Related work • Conclusion Outline
- 20. • Self-monitor daily alcohol use – Breath Alcohol Concentration (BrAC) level • Screening frequency – Morning, afternoon, and night slots – Complete at least two slots per day • Prevent cheating – Show faces using the breathalyzer in front of the phone camera Alcohol screening Functional design
- 22. Progress feedback Functional design • Enable patients to review alcohol use • Contingency management • Encourage patients to stay sober
- 24. • Goal sentences – The 12-step program of Alcoholics Anonymous (AA) • Identify positive elements – Browsing through the guide Self-fulfilling guide Functional design Goal sentence
- 25. Drawings depicting 12 goal sentences
- 26. Outline • Motivation • Approach • Design and implementation • User study – Quantitative results – Qualitative results • Conclusion Outline
- 27. • A real-life 12-week user study • 27 alcohol-dependent patients who used SoberDiary • Quantitative study – Self-monitoring adherence & accuracy – Sober outcomes • Qualitative study – How patients use SoberDiary User study
- 28. Intervention Control # of participants 27 20 Gender 23 males, 4 females 16 males, 4 females Age 31 ~ 58 28 ~ 53 Treatment Standard treatment + SoberDiary Standard treatment Craving index (9)* 2.9 (2.7) 1.4 (2.0) # of heavy drinking days (day) 53.1 (35.1) 70.3 (26.4) Total alcohol consumption (drink) 1239.1 (1524.0) 1406.1 (1061.0) Participants
- 29. • Each participant in the intervention group – Provided a Bluetooth breathalyzer – Installed the SoberDiary application Device
- 30. Procedure for the intervention group Pre-study Intervene 0 1 2 3 4 5 6 7 8 9 10 11 12 Week • Pre-study medical assessment – Baseline collected with Time-Line Follow-back (TLFB) method – Training session for using SoberDiary • 12-week real-life study – Clinical assessment session – Technical support session • Post-study interviews
- 31. • Pre-study medical assessment – Baseline collected with Time-Line Follow-back (TLFB) method – Training session for using SoberDiary • 12-week real-life study – Clinical assessment session – Technical support session • Post-study interviews Procedure for the control group
- 32. Outline • Motivation • Approach • Design and implementation • User study – Quantitative results – Qualitative results • Conclusion Outline
- 33. Outline • Self-monitoring adherence – Complete 2.6 slots per day on average • Screening accuracy – Average difference between TLFB-recalled and system-detected drinking days • 2.44 days per month Self-monitoring adherence and screening accuracy
- 34. • Successfully complements current maintenance treatment Comparison of sober outcomes between groups Intervention Control Craving index 59.0%↓ 53.8%↑ Drop-out rate 22% (6 of 27) 45% (9 of 20) Total alcohol consumption 94.4%↓ 93.3%↓ # of heavy drinking Days 86.5%↓ 88.6%↓ Reduced cravings Lower dropout rate Significant reductions
- 35. Outline • Motivation • Approach • Design and implementation • User study – Quantitative results – Qualitative results • Conclusion Outline
- 36. Post-study interview Semi-structured interview Data analysis
- 37. 1. Constructive cheating 2. Present SoberDiary results as a way to communicate with family members 3. Coupons and performance ranking encouraged routine application usage, but was ineffective to alter determination 4. Experience reflection and goal setting enhanced determination Salient themes
- 39. Theme 1 How patients cheat 24 22 2 4 618 12 20 16 14 10 8 Night Afternoon Morning Pass Pass
- 40. • Cheating – A unique characteristic of this user group – Care about their performance in SoberDiary – Learn how to control drinking behavior • Flexibility for constructive cheating – Control the drop-out rate Theme 1 Allowing cheating may be constructive
- 41. Theme 2 Present SoberDiary results as a way to communicate with family members
- 42. 42 Theme 2 Improve family communication
- 43. Outline • Motivation • Approach • Design and implementation • User study – Quantitative results – Qualitative results • Conclusion Outline
- 44. • Novel phone-based support system • 12-week study with 27 clinical patients – Improved sober outcomes • Main themes on cheating – Prevent cheating – Leverage constructive cheating – Cross the mistrust barrier with family members Conclusion
- 45. Outline Download from Google Play
- 46. 46
Editor's Notes
- - Hi, my name is Bing, currently an assistant researcher in Intel-NTU center. - I am very glad to be here to present SoberDiary, a phone-based support system to assist recovery from alcohol dependence. - This work is a joint project with university researchers and psychiatrists from Taipei city psychiatric center.
- - This is the outline of my talk.
- - I will first present the motivation of this project.
- - Alcohol dependence is a psychiatric disorder worldwide and leads to multiple harms.
- - For serious alcohol dependent patients, they need to enter rehab center to receive treatment and stop drinking alcohol.
- - Once patients could stop drinking without suffering from serious withdrawal symptoms, they will leave rehab center and start a maintenance program to stay sober in daily life. [click] ★ - In this maintenance program, patients intermittently revisit rehab center to receive follow-up therapy and tracking. [click] ★ - Psychiatrists will ask patients to maintain a drinking diary for them to review. - However, they often forget to record drinking behavior. - Without enough drinking data, psychiatrists can provide only limited suggestions to improve their sober outcomes.
- - So, what makes it difficult for patients to stay sober in daily life. - There are three main reasons.
- - First, they need to handle drinking triggers not present in rehab center but common in patients’ natural environments
- - Second, no continuous & accurate tracking to be used in daily life
- - Third, lack long-term maintenance program to assist patients in learning relapse prevention skills and sustain their motivation
- - Due to these difficulties, after finishing withdrawal treatment, many patients experience periods of relapse.
- - So, how to help them stay sober in daily life?
- - We introduce SoberDiary, [click] ★ - a phone-based support system to assist recovery from alcohol dependence.
- - How does SoberDiary assist patients on the road of recovery? - Let’s watch a video.
- [play the video] ★
- - The system contains three parts. - For behavior sensing, we built a Bluetooth breathalyzer wirelessly connected to the SoberDiary app, [click] ★ patients can perform breath alcohol tests to self-monitor their own alcohol use. [click] ★ - For behavior feedback, the SoberDiary app provides various supporting functions so that patients can appropriate them to better manage their emotion and triggers. [click] ★ - To collect data, we built a server to record all test results.
- - In the following slides, I will present the design and implementation of SoberDiary.
- - The soberdiary app provides three major supporting functions.
- - Patients use alcohol screening function to self-monitor their alcohol use
- - We customized a Bluetooth breathalyzer to let patients self-monitor their breath alcohol concentration level. - To increase the frequency of alcohol screening while not placing an excessive burden on them, we divided a day into morning, afternoon and night slots. - Patients need to perform tests in at least two slots per day - To prevent cheating, that is, other people taking the test for the patients. - We require them to show their faces using the breathalyzer in front of the phone camera, as shown in the right screenshot. - Since cheating is a unique characteristic of this user group, you will hear more cheating-related design and findings.
- - After completing tests, the test results, as well as other incentives, will be visualized as personal progress
- [click] ★ - On the screen top, soberdiary visualizes personal progress so that users can review daily, weekly, and monthly summaries. [click] ★ - In the middle, soberdiary shows tangible rewards earned by the user, such as coupons, to reinforce positive sober behavior. - At the bottom, soberdiary ranks individual performance among all users.
- - Soberdiary provides a self-fulfilling guide. - Its goal is to help patients in recognizing positive concept during each recovery step.
- - Design of the guide incorporates the 12-step program proposed by Alcoholics Anonymous. [click] ★ - Each step is visualized as drawing plus a goal sentence. - When patients browse this guide, it motivates them to stay sober.
- - Here are the 12 drawings for the 12 steps in the guide.
- - To demonstrate the feasibility of using SoberDiary in daily life, we conducted a real-life user study.
- - This study involved 27 patients who used SoberDiary after treatment. - The study quantitatively evaluate patients' self-monitoring adherence and accuracy and their sober outcomes. - Further, we also conducted qualitative interviews to understand how patients use soberdiary to self-monitor and manage their drinking behavior.
- - We recruited 27 real patients who completed treatment. - To explore how well soberdiary complements current treatment, another data was collected from other 20 participants of the control group, who only received standard treatment in an ongoing project.
- - We gave a Bluetooth breathalyzer to each patient in the intervention group. - And, helped them install the soberdiary app on their phones.
- - The procedure for the intervention group is consisted of three parts. [click] ★ - In the pre-study medical assessment, we collected the baseline craving index and alcohol consumption prior to the study through the time-line follow-back method. -Participants also attended a training session to learn how to use the app and breathalyzer. [click] ★ - In the 12-week study, we collected ground truth drinking data and addessed questions related to app use. Patients were required to visit rehab center and attend scheduled medical reviews [click] ★ - held at Week 1, 2, 4, 8, and 12. - Each medical review consists of a clinical assessment and a technical support session. [click] ★ - Finally, a post-study interview at Week 12.
- - For patients in the control group, they underwent identical baseline and follow-up medical reviews, [click] ★ - without the SoberDiary intervention.
- - Through analyzing results collected from medical reviews and the Soberdiary app, quantitative results are presented in the following slides.
- - According to application logs, most participants were able to complete at least two slots per day. - And, the average difference between recalled and detected drinking days is less than 3 days per month - This shows that most patients were able to complete the soberdiary test requirement in their daily lives.
- - In this table, we compared sober outcomes between two groups. [click] ★ - In contrast to the increasing cravings of the control group, the final cravings of the intervention group greatly decreased after the SoberDiary intervention. [click] ★ - And, soberdiary exhibited a lower dropout rate. [click] ★ - Further, participants in the intervention group also showed significant reduction in alcohol consumption and the number of heavy drinking days. - Results demonstrated SoberDiary successfully complements current maintenance treatment in reducing patients’ cravings and dropout rate.
- - Qualitative interviews were conducted to collect patient feedback
- [click] ★ - We randomly selected 8 patients from all participants for semi-structured interviews. [click] ★ - We transcribed, coded, and analyzed the interview recordings to identify main themes.
- - Due to time limit, I will describe the first two themes.
- - The first theme is constructive cheating.
- - Some participants expressed that requiring 2 or 3 tests per day can still create a cheating window. [click] ★ - For example, a user can take and pass the night test as early as possible, [click] ★ - then start drinking, [click] ★ - and take the next morning test as late as possible. [click] ★ - He can hope that alcohol metabolize out of his body in time to pass the late morning test. - However, this means that he can not go uncontrolled drinking all night - because too much alcohol will fail the test.
- - To cheat successfully, he needs to learn how to control drinking. - This is one of our findings related to cheating, a unique characteristic of this user group. - Instead of thinking cheating negatively, it is possible to leverage cheating to be constructive and positive for the alcoholic users. - Cheating suggests that they cared about their performance in SoberDiary. - Cheating gives them room to learn how to gradually control drinking behavior and keep them engaged in Soberdiary. - By providing flexibility, constructive cheating may help to prevent patient drop-out, particularly at the initial stage.
- - For the second theme - Patients commented that the family members had more confidence and trusted the breathalyzer results much more than the participants’ words. - Because many of them have cheated their family members many times before. - As a result, their words have little or no credibility.
- - By presenting alcohol screening results on the SoberDiary app, [click] ★ - participants said that it had helped them re-establish trust with family members and improve family communication. - Even if screening results are not perfect, participants can still show month-long data collected by a third party device and app. - This screening data is more convincing than their words and helped them cross this mistrust mental barrier with their family members.
- - To wrap up my talk.
- - We present a novel phone-based support system to enable alcoholics to self-monitor and -manage alcohol use after treatment - We conducted 12-week study with 27 clinical patients and found that soberdiary improved their sober outcome. - Our main findings are related to cheating, which is a unique characteristic of this alcoholics user group. - First, to prevent cheating. Soberdiary use phone camera to watch them take the screening test. - Second, to leverage constructive cheating. Soberdiary gives them room to cheat, so that they can gradually control drinking behavior while saving their face. - Third, to help them cross the mistrust barrier with family members. Soberdiary provides them screening data to help in starting a positive conversation.
- - If you were interested in SoberDiary, You can download the soberDiary app from Google play and try it out. - Or you can find me after the session.
- - Thanks for listening my talk.