Many of today’s cell phones come with advanced GPS technology that can tell you where you are, where you need to go, how you can get there and what to do if you want to stop for coffee, gas or a bite to eat along the way.
But what if that same GPS technology could also help individuals maintain their recovery from substance use disorders?
That’s the concept behind Yale School of Public Health (YSPH) doctoral student Adam Viera’s research. Viera, a fourth-year Ph.D. candidate in the Department of Social and Behavioral Sciences, recently received a $106,000 grant to develop and test a new mobile app, tentatively called “e-Covery,” that uses GPS technology to support individuals struggling with both alcohol and opioid use.
The F31 diversity grant from the National Institutes of Health (NIH) and the National Institute on Alcohol Abuse and Alcoholism is also known as a Ruth L. Kirschstein National Research Service Award. It is noteworthy in that it specifically provides support to qualified predoctoral fellows in order to promote diversity in health-related research. Viera identifies as Hispanic/Latinx. His family is Puerto Rican.
As Viera explains, his app-based intervention would use GPS technology to alert individuals when they are near places associated with their alcohol or opioid use.
“The purpose of the app is to support people in the early stages of recovery,” Viera said. “We know from prior research that people who are just starting to change their substance use behavior are the ones most likely to return to old habits.”
Research has shown that between 40% and 60% of individuals completing substance abuse treatment will return to using within a year. Those struggling with both alcohol and opioids face even poorer outcomes.
“The other thing we know is that substance use often isn’t something that happens in isolation,” said Viera. “You use with other people and you use in different locations. So going back to those locations or interacting with those people can serve as a trigger.”
Most substance use treatment programs urge participants to just stay away from people and places that are triggers for them. But that can be really challenging, Viera said, especially when the person who is a trigger is a family member or close friend and the package store or bar you are trying to avoid is right next door to your home or place of work.
By linking GPS location with behavior, Viera hopes to create an intervention that targets people when and where they need it most – right at the point of the potential triggering event they are experiencing.
“Many of the apps that are out there are built so that the individual has to seek out support in a time of need,” said Viera. “But my thought was, what if the app could just “sense” that you were in a location that was triggering and then send a message supporting you to make you more conscious and thoughtful about where you are and what you are doing? This is important because we know that for many people, the return to use is almost a subconscious process. So we want to bring it into their conscious mind.”
Viera calls what the app does “nudging.”
Viera said part of the focus of the research will be to determine when such messages, or nudges, should be sent and what they should say to be most effective. He admits that the last thing he wants the app to do is simply alert people to nearby places and friends related to their prior substance use, as such information could easily trigger a relapse. Rather, Viera said, the app might be time sensitive so that if a person is noticeably lingering in a certain location, it would trigger a message. Importantly, the person using the app will pre-load key locations into the app and allow for GPS monitoring.
“We’ll be interviewing people who test the app to see, based on their experiences, which kind of messages worked well, and which ones were counter-productive,” Viera said. “We know that many people rely on their own advocacy and confidence to resist triggers and perhaps our messages can re-enforce that mindset.”
Viera said the study also seeks to learn more about how and why people’s connection to certain individuals and places influences their substance use.
Viera is initially focusing on individuals with co-occurring alcohol and opioid use because those individuals tend to have some of the most difficult struggles with substance use. But he says the app, if successful, could easily be adopted by people struggling with just alcohol use, any number of drug addictions or any other behavior that poses a risk to their health.
A former pre-doctoral fellow with Yale’s Center on Interdisciplinary Research on AIDS (CIRA), Viera has been exploring ways harm reduction interventions can be used to address the health consequences of substance use for more than 15 years. His prior professional career focused on preventing HIV transmission by addressing drug use.
Viera’s current research is being guided by four faculty mentors, who he said have been invaluable in helping him prepare proper research methodologies and gather data. Viera’s primary mentor and sponsor is Trace Kershaw, Ph.D., chair of the YSPH Department of Social and Behavioral Sciences and the Susan Dwight Bliss Professor of Public Health (Social and Behavioral Sciences). Other sponsors for the project are Dr. E. Jennifer Edelman, M.D., M.H.S. ‘12, associate professor of medicine at the Yale School of Medicine and of Social and Behavioral Sciences; Zeyan Liew, Ph.D., M.P.H., assistant professor of epidemiology (Environmental Health); and Carolyn Lauckner, Ph.D., an assistant professor in the Department of Behavioral Sciences at the University of Kentucky College of Medicine.
Viera’s research project is an extension of on-going research being conducted by Kershaw and Jessica Muilenburg, an associate professor at the University of Georgia. That research team is investigating the use of smartphones to better understand the link between social and geographical contexts and return to alcohol use among individuals completing substance use treatment programs.