A randomized controlled trial of a therapeutic relational agent for reducing substance misuse during the COVID-19 pandemic. (1st October 2021)

• Record Type: Journal Article
• Authors: Prochaska, Judith J.; Vogel, Erin A.; Chieng, Amy; Baiocchi, Michael; Maglalang, Dale Dagar; Pajarito, Sarah; Weingardt, Kenneth R.; Darcy, Alison; Robinson, Athena
• Is Part Of: Drug and alcohol dependence. Volume 227(2021)
• Publication Date: 2021-10-01
• Subjects: COVID-19 pandemic -- Artificial intelligence -- Substance-related disorders -- Randomized controlled trial -- Relational conversational agent; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2021.108986
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Woebot for Substance Use Disorders (W-SUDs) is a fully automated therapeutic agent. During the pandemic, W-SUDs was tested in a randomized trial with a waitlist control. W-SUDs use metrics and participant acceptability and feasibility ratings were high. W-SUDs significantly reduced substance use occasions more than the waitlist control. Reduced substance use occasions was associated with better mental health outcomes. Abstract: Background: The COVID-19 pandemic disrupted access to treatment for substance use disorders (SUDs), while alcohol and cannabis retail sales increased. During the pandemic, we tested a tailored digital health solution, Woebot-SUDs (W-SUDs), for reducing substance misuse. Methods: In a randomized controlled trial, we compared W-SUDs for 8 weeks to a waitlist control. U.S. adults (N = 180) who screened positive for substance misuse (CAGE-AID>1) were enrolled June–August 2020. The primary outcome was the change in past-month substance use occasions from baseline to end-of-treatment (EOT). Study retention was 84%. General linear models tested group differences in baseline-to-EOT change scores, adjusting for baseline differences and attrition. Results: At baseline, the sample (age M = 40, SD = 12, 65% female, 68% non-Hispanic white) averaged 30.2 (SD = 18.6) substance occasions in the past month. Most (77%) reported alcohol problems, 28% cannabis, and 45% multiple substances; 46% reported moderate-to-severe depressive symptoms. Treatment participants averaged 920 in-app text messages (SD = 892, Median = 701); 96% of completed lessons were rated positively; and 88% would recommend W-SUDs. Relative to waitlist, W-SUDs participants significantly reduced past-month substance use occasions (M = −9.1, SE = 2.0 vs. M = −3.3, SE = 1.8; p = .039). Secondary substance use and mood outcomes did not change significantly by group; however, reductions in substance use occasions correlated significantly with increased confidence and fewer substance use problems, cravings, depression and anxiety symptoms, and pandemic-related mental health effects (p-value<.05). Conclusions: W-SUDs was associated with significant reductions in substance use occasions. Reduction in substance use occasions was associated with better outcomes, including improved mental health. W-SUDs satisfaction was high.