Advertisement

Journal of Neuroimmune Pharmacology

, Volume 11, Issue 3, pp 511–522 | Cite as

A Smartphone Application Supporting Recovery from Heroin Addiction: Perspectives of Patients and Providers in China, Taiwan, and the USA

  • Marya Schulte
  • Di Liang
  • Fei Wu
  • Yu-Ching Lan
  • Wening Tsay
  • Jiang Du
  • Min Zhao
  • Xu Li
  • Yih -Ing Hser
ORIGINAL ARTICLE

Abstract

Smartphone-based interventions are increasingly used to support self-monitoring, self-management, and treatment and medication compliance in order to improve overall functioning and well-being. In attempting to develop a smartphone application (S-Health) that assists heroin-dependent patients in recovery, a series of focus groups (72 patients, 22 providers) were conducted in China, Taiwan, and the USA to obtain their perspectives on its acceptance and potential adoption. Data were analyzed according to the Diffusion of Innovation (DOI) theory of characteristics important to the adoption of innovation. Important to Relative Advantage, USA participants cited S-Health’s potential ability to overcome logistical barriers, while those in China and Taiwan valued its potential to supplement currently limited services. In terms of Compatibility, participants across sites reported recovery needs and goals that such an application could be helpful in supporting; however, its utility during strong craving was questioned in China and Taiwan. Important factors relevant to Complexity included concerns about smartphone access and familiarity, individualization of content, and particularly in China and Taiwan, participants wanted assurance of privacy and security. The study results suggest a general acceptance, but also indicate cultural variations in access to therapeutic and other social support systems, legal repercussions of substance use, societal perceptions of addiction, and the role of family and other social support in recovery. Taking these factors into consideration is likely to increase diffusion as well as effectiveness of these smartphone-based interventions.

Keywords

Smartphone application Recovery from heroin addiction Diffusion of innovation theory S-Health 

Notes

Compliance with Ethical Standards

Funding

This study was funded by the National Institute on Drug Abuse (P30DA016383, R21DA033285, & R13 DA035084; PI:Hser).

Conflict of Interest

All authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Chak E, Talal AH, Sherman KE, Schiff ER, Saab S (2011) Hepatitis C virus infection in USA: An estimate of true prevalence. Liver Int 31(8):1090–1101CrossRefPubMedGoogle Scholar
  2. Charmaz K (2012) The power and potential of grounded theory. Medical Sociology Online 6(3):2–15Google Scholar
  3. Charmaz K (2014) Constructing grounded theory. SageGoogle Scholar
  4. Chen, Kuo (2007) HIV-1 in Taiwan. Lancet 369:623–625. doi: 10.1016/S0140-6736(07)60291-8 CrossRefPubMedGoogle Scholar
  5. Chen AYM, Lan YC, Lai SF, Yang JY, Tsai SF, Kuo SHS (2006) HIV-1 CRF07_BC infections, injecting drug users, Taiwan. Emerg Infect Dis 12(4):703–705CrossRefPubMedPubMedCentralGoogle Scholar
  6. Chih MY, Patton T, McTavish FM, Isham AJ, Judkins-Fisher CL, Atwood AK, DH G (2014) Predictive modeling of addiction lapses in a mobile health application. J Subst Abus Treat 46(1):29–35CrossRefGoogle Scholar
  7. Chou YC, Shih SF, Tsai WD, Li CS, Xu K, Lee TS (2013) Improvement of quality of life in methadone treatment patients in northern Taiwan: a follow-up study. BMC Psychiatry 13:190CrossRefPubMedPubMedCentralGoogle Scholar
  8. D’Aunno T, Pollack HA, Frimpong JA, Wuchiett D (2014) Evidence-based treatment for opiod disorders: a 23-year national study of methadone dose levels. J Subst Abus Treat 47(4):245–250CrossRefGoogle Scholar
  9. Degenhardt L, Charlson F, Mathers B, Hall WD, Flaxman AD, Johns N, Vos T (2014) The global epidemiology and burden of opioid dependence: Results from the global burden of disease 2010 study. Addiction 109(8):1320–1333CrossRefPubMedGoogle Scholar
  10. Deren S, Goldstein MF, Des Jarlais DC, Richman BL, Kang S, Flom PL (2005) Drug use, HIV-related risk behaviors and dropout status of new admissions and re-admissions to methadone treatment. J Subst Abuse Treat 2001 Mar 20(2):185–189CrossRefGoogle Scholar
  11. Des Jarlais DC, Semaan S (2008) HIV prevention for injecting drug users: the first 25 years and counting. Psychosom Med 70(5):606–611CrossRefPubMedGoogle Scholar
  12. Dole VP, Nyswander M (1965) A medical treatment for diacetylmorphine (heroin) addiction. A clinical trial with methadone hydrochloride. J Am Med Assoc 193:646–650CrossRefGoogle Scholar
  13. Duan S, Han J, Tang RH, Yang YC, Xiang LF, Ye RH, Yang SS, Yang YB, Long YC, Li GQ, Yin MS, Pang L, Rou KM, Wu ZY, He N (2013) Study on the incidence and risk factors of HCV infection among heroin addicts who were on methadone maintenance treatment in Dehong prefecture, Yunnan province. Zhonghua Liu Xing Bing Xue Za Zhi 34(6):552–556PubMedGoogle Scholar
  14. Dutra L, Stathopoulou G, Basden SL, et al. (2008) A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiatry 165(2):179–187CrossRefPubMedGoogle Scholar
  15. Fjeldsoe BS, Marshall AL, Miller YD (2009) Behavior change interventions delivered by mobile telephone short-message service. Am J Prev Med 36(2):165–173Google Scholar
  16. Gao P, Pan S (2014) Permanent mechanism for community-based drug addiction treatment. Journal of Shanxi Normal University (Social Science Edition) 41(3):59–64Google Scholar
  17. Gibbons MC, Fleisher L, Slamon RE, Bass S, Kandadai V, Beck JR (2011) Exploring the potential of Web 2.0 to address health disparities. J Health Commun 16(Suppl 1):77–89CrossRefPubMedGoogle Scholar
  18. Gustafson DH, McTavish, FM, Chih MY et al. (2014) A Smartphone Application to Support Recovery From Alcoholism. JAMA Psych 71(5):566–572Google Scholar
  19. Heron KE, Smyth JM (2010) Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behavior treatments. Brit J H Psych. 15(1):1–39Google Scholar
  20. Hser YI, Evans E, Grella C, Ling W, Anglin D (2015) Long-term course of opioid addiction. Harv Rev Psychiatry 23(2):76–89CrossRefPubMedGoogle Scholar
  21. Huang YF, Kuo HS, Lew-Ting CY, Tian F, Yang CH, Tsai TI, Gange SJ, Nelson KE (2011) Mortality among a corhort of drug users after their release from prison: an evaluation of the effectiveness of a harm reduction program in Taiwan. Addiction 106(8):1437–1445CrossRefPubMedGoogle Scholar
  22. Ingersoll KS, Dillingham RA, Hettema JE, Conaway M, Freeman J, Reynolds G, Hosseinbor S (2015) Pilot RCT of bidirectional text messaging for ART adherence among nonurban substance users with HIV. Health Psychol 34(Suppl):1305–1315CrossRefPubMedPubMedCentralGoogle Scholar
  23. Johnson K, Isham A, Shah DV, Gustafson DH (2011) Potential roles for new communication technologies in treatment of addiction. Curr Psychiatry Rep 13(5):390–397CrossRefPubMedPubMedCentralGoogle Scholar
  24. Kelly JF (2003) Self-help for substance abuse disorders: History, effectiveness, knowledge gaps and research opportunities. Clin Psychol Rev 23:639–663CrossRefPubMedGoogle Scholar
  25. Kleber HD (2008) Methadone maintenance 4 decades later: thousands of lives saved but still controversial. J Am Med Assoc 300(19):2303–2305CrossRefGoogle Scholar
  26. Klevens RM, Hu DJ, Jiles R, Holmberg SD (2012) Evolving epidemiology of hepatitis C virus in the United States. Clin Infect Dis 55:S3–S9CrossRefPubMedGoogle Scholar
  27. Lan YC, Elbeik T, Dileanis J, Ng V, Chen YJ, Leu HS, Cheng SH, Wong JC, Wong WW, Chen YM (2008) Molecular epidemiology of HIV-1 subtypes and drug resistant strains in Taiwan. J Med Virol 80:183–191CrossRefPubMedGoogle Scholar
  28. Lee TS, Shen HC, Wu WH, Huang CW, Yen MY, Wang BE, Chuang P, Shih CY, Chou YC, Liu YL (2011) Clinical characteristics and risk behavior as a function of HIV status among heroin users enrolled in methadone treatment in northern Taiwan. Subst Abuse Treat Prev Policy 6:6CrossRefPubMedPubMedCentralGoogle Scholar
  29. Lewden C, Salmon D, Morlat P, Bevilacqua S, Jougla E, Bonnet F, Heripret L, Costagliola D, May T, Chene G (2005) Causes of death among human immunodeficiency virus (HIV)-infected adults in the era of potent antiretroviral therapy: emerging role of hepatitis and cancers, persistent role of AIDS. Int J Epidemiol 34:121–130CrossRefPubMedGoogle Scholar
  30. Li ES (2013) The new drug detoxification system in China: a misused tool for drug rehabilitation. E Asia L Rev 9:168–212Google Scholar
  31. Lyu SY, Su LW, Chen YM (2012) Effects of education on harm-reduction programmes. Lancet 379(9814):e28–e30CrossRefPubMedGoogle Scholar
  32. Magiorkinis G, Sypsa V, Magiorkinis E, Paraskevis D, Katsoulidou A, Belshaw R, Fraser C, Pybus OG, Hatzakis A (2013) Integrating phylodynamics and epidemiology to estimate transmission diversity in viral epidemics. PLoS Comput Biol 9(1):e1002876CrossRefPubMedPubMedCentralGoogle Scholar
  33. Marsch LA (2012) Leveraging technology to enhance addiction treatment and recovery. J Addict Dis 31(3):313–318CrossRefPubMedPubMedCentralGoogle Scholar
  34. Mattick RP, Breen C, Kimber J, Davoli M (2009) Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev 3:CD002209PubMedGoogle Scholar
  35. McCann MJ, Rawson RA, Obert JL, Hasson A (1994) Treatment of opiate addiction using methadone: a counselor manual. Center for Substance Abuse Treatment, RockvilleGoogle Scholar
  36. McHugh RK, Hearon BA, Otto MW (2010) Cognitive-behavioral therapy for substance use disorders. Psychiat Clin North Am 33(3):511–525CrossRefGoogle Scholar
  37. Miller WR, Rollnick S (1991) Motivational interviewing: preparing people to change addictive behavior. J Community Appl Soc Psychol 2:299–300Google Scholar
  38. Moore BA, Fazzino T, Garnet B, Cutter CJ, Barry DT (2011) Computer-based interventions for drug use disorders: a systematic review. J Subst Abus Treat 40(3):215–223CrossRefGoogle Scholar
  39. Narcotics Control Bureau of the Ministry of Public Security P. R. China (2014) Annual report on drug control in China. http://www.bjjdzx.org/157/2014-07-15/60020.htmhttp://www.bjjdzx.org/157/2014-07-15/60020.htm. Accessed 10 Sept 2015
  40. National Institute on Drug Abuse (2014) Drug facts: Heroin. http://www.drugabuse.gov/publications/drugfacts/heroin. Accessed 13 Sept 2015
  41. Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D, Degenhardt L (2011) Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet 378(9791):571–583CrossRefPubMedPubMedCentralGoogle Scholar
  42. Ng MH, Chou JY, Chang TJ, Lee PC, Shao WC, Lin TY, Chen VC, Gossop M (2013) High prevalence but low awareness of hepatitis C virus infection among heroin users who received methadone maintenance therapy in Taiwan. Addict Behav 38(4):2089–2093CrossRefPubMedGoogle Scholar
  43. Noar SM, Willoughby JF (2012) eHealth interventions for HIV prevention. AIDS Care 24(8):945–952CrossRefPubMedPubMedCentralGoogle Scholar
  44. Nolan S, Dias Lima V, Fairbairn N, Kerr T, Montaner J, Grebely J, Wood E (2014) The impact of methadone maintenance therapy on hepatitis C incidence among illicit drug users. Addiction 109(12):2053–2059CrossRefPubMedPubMedCentralGoogle Scholar
  45. Olsen Y, Sharfstein JM (2014) Confronting the Stigma of Opioid Use Disorder—and Its Treatment. J Am Med Assoc 311(14):1393–1394CrossRefGoogle Scholar
  46. Quaglio G, Lugoboni F, Pajusco B, Sarti M, Talamini G, Lechi A, Mezzelani P, Des Jarlais DC (2003) Factors associated with hepatitis C virus infection in injection and noninjection drug users in Italy. Clin Infect Dis 37(1):33–40CrossRefPubMedGoogle Scholar
  47. Reback CJ, Grant DL, Fletcher JB, Branson BM, Shoptaw S, Rhode Bowers J, Charania M, Mansergh G (2012) Text messaging reduces HIV risk behaviors among methamphetamine-using men who have sex with men. Aids and Beh. 16(7):1993–2002Google Scholar
  48. Rogers EM (2002) Diffusion of preventive innovations. Addict Behav 27(6):989–993CrossRefPubMedGoogle Scholar
  49. Rosen HR (2011) Clinical practice. Chronic hepatitis C infection. N Engl J Med 364(25):2429–2438CrossRefPubMedGoogle Scholar
  50. Substance Abuse and Mental Health Services Administration (2013) National Survey of Substance Abuse Treatment Services Report: Trends in the Use of Methadone and Buprenorphine at Substance Abuse Treatment Facilities: 2003 to 2011 http://www.samhsa.gov/data/sites/default/files/N-SSATS%20Rprt%20Trnds%20Use%20Methadone%20&%20Buprenorphine%20at%20SA%20Trmt%20Facs%20%2003-11/N-SSATS%20Rprt%20Trnds%20Use%20Methadone%20&%20Buprenorphine%20at%20SA%20Trmt%20Facs%20%2003-11/sr107-NSSATS-Buprenorph.htm. Accessed 10 Dec 2015
  51. Substance Abuse and Mental Health Services Administration (2015) Behavioral Health Treatment Services Locator. https://findtreatment.samhsa.gov/. Accessed 10 Dec 2015s
  52. Sullivan SG, Wu Z (2007) Rapid scale up of harm reduction in China. Int J Drug Policy 18(2):118–128CrossRefPubMedGoogle Scholar
  53. Taiwan Ministry of Health and Welfare (2015) 2014 Anti-drug report http://www.moj.gov.tw/public/Attachment/410291426435.pdf. Accessed 13 Dec 2015
  54. United Nations Office on Drug and Crime (2013) World Drug Refport. Vienna: UNODC, 2013Google Scholar
  55. Vigilant LG (2004) The stigma paradox in methadone maintenance: Naïve and positive consequences of a “treatment punishment” approach to opiate addiction. Humanit Soc 28(4):403–418CrossRefGoogle Scholar
  56. Weber R, Sabin CA, Friis-Moller N, Reiss P, El-Sadr WM, Kirk O, Dabis F, Law MG, Pradier C, De Wit S, et al. (2006) Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study. Arch Intern Med 166:1632–1641CrossRefPubMedGoogle Scholar
  57. White W (2009) Long-term strategies to reduce the stigma attached to addiction, treatment, and recovery within the City of Philadelphia (with particular reference to medication-assisted treatment/recovery). Philadelphia, PA: Department of Behavioral Health and Intellectual Disability Services. http://dbhids.org/technical-papers-on-recoverytransformation/. 15 September 2015
  58. White WL (2011) Narcotics Anonymous and the pharmacotherapeutic treatment of opioid addiction. Great Lakes Addiction Technology Transfer Center and Philadelphia Department of Behavioral Health and Intellectual Disability Services, ChicagoGoogle Scholar
  59. World Health Organization (2014) Reducing harm, preventing HIV, saving lives: China’s vast methadone maintenance treatment program marks successes even as it addresses key challenges ahead. http://www.wpro.who.int/china/mediacentre/releases/2014/2014112702/en/. 13 September 2015.
  60. World Health Organization (2015) Injecting drug use: HIV/AIDS. http://www.who.int/hiv/topics/idu/about/en/. 14 September 2015
  61. Wu F, Peng CY, Jiang H, Zhang R, Zhao M, Li J, Hser YI (2012) Methadone maintenance treatment in China: perceived challenges from the perspectives of service providers and patients. J Public Health 35(2):206–212CrossRefGoogle Scholar
  62. Yin W, Hao Y, Sun X, Gong X, Li F, Li J, Wu Z (2010) Scaling up the national methadone maintenance treatment program in China: achievements and challenges. Int J Epidemiol 39(Suppl 2):ii29–ii37PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Marya Schulte
    • 1
  • Di Liang
    • 1
  • Fei Wu
    • 2
  • Yu-Ching Lan
    • 3
  • Wening Tsay
    • 4
  • Jiang Du
    • 5
  • Min Zhao
    • 5
  • Xu Li
    • 5
  • Yih -Ing Hser
    • 1
    • 3
  1. 1.University of CaliforniaLos AngelesUSA
  2. 2.Los Angeles CountyUSA
  3. 3.China Medical UniversityTaichungTaiwan
  4. 4.Food and Drug AdministrationTaipeiTaiwan
  5. 5.Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghaiChina

Personalised recommendations