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

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.

This is a preview of subscription content, log in to check access.

Fig. 1

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):1090–1101

    Article  PubMed  Google Scholar 

  2. Charmaz K (2012) The power and potential of grounded theory. Medical Sociology Online 6(3):2–15

    Google Scholar 

  3. Charmaz K (2014) Constructing grounded theory. Sage

  4. Chen, Kuo (2007) HIV-1 in Taiwan. Lancet 369:623–625. doi:10.1016/S0140-6736(07)60291-8

    Article  PubMed  Google 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):703–705

    Article  PubMed  PubMed Central  Google 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):29–35

    Article  Google 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 13:190

    Article  PubMed  PubMed Central  Google 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):245–250

    Article  Google 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):1320–1333

    Article  PubMed  Google 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):185–189

    Article  Google Scholar 

  11. Des Jarlais DC, Semaan S (2008) HIV prevention for injecting drug users: the first 25 years and counting. Psychosom Med 70(5):606–611

    Article  PubMed  Google Scholar 

  12. Dole VP, Nyswander M (1965) A medical treatment for diacetylmorphine (heroin) addiction. A clinical trial with methadone hydrochloride. J Am Med Assoc 193:646–650

    CAS  Article  Google 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):552–556

    PubMed  Google 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):179–187

    Article  PubMed  Google Scholar 

  15. eMarketer (2014) 2 Billion consumers Worldwide to get Smart(Phones) by 2016. http://www.emarketer.com/Article/2-Billion-Consumers-Worldwide-Smartphones-by-2016/1011694#sthash.DZVjChdO.dpuf http://www.emarketer.com/Article/2-Billion-Consumers-Worldwide-Smartphones-by-2016/1011694

  16. Fjeldsoe BS, Marshall AL, Miller YD (2009) Behavior change interventions delivered by mobile telephone short-message service. Am J Prev Med 36(2):165–173

  17. Gao P, Pan S (2014) Permanent mechanism for community-based drug addiction treatment. Journal of Shanxi Normal University (Social Science Edition) 41(3):59–64

    CAS  Google Scholar 

  18. 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):77–89

    Article  PubMed  Google Scholar 

  19. Gustafson DH, McTavish, FM, Chih MY et al. (2014) A Smartphone Application to Support Recovery From Alcoholism. JAMA Psych 71(5):566–572

  20. Heron KE, Smyth JM (2010) Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behavior treatments. Brit J H Psych. 15(1):1–39

  21. Hser YI, Evans E, Grella C, Ling W, Anglin D (2015) Long-term course of opioid addiction. Harv Rev Psychiatry 23(2):76–89

    Article  PubMed  Google Scholar 

  22. 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):1437–1445

    Article  PubMed  Google Scholar 

  23. 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):1305–1315

    Article  PubMed  PubMed Central  Google Scholar 

  24. Johnson K, Isham A, Shah DV, Gustafson DH (2011) Potential roles for new communication technologies in treatment of addiction. Curr Psychiatry Rep 13(5):390–397

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kelly JF (2003) Self-help for substance abuse disorders: History, effectiveness, knowledge gaps and research opportunities. Clin Psychol Rev 23:639–663

    Article  PubMed  Google Scholar 

  26. Kleber HD (2008) Methadone maintenance 4 decades later: thousands of lives saved but still controversial. J Am Med Assoc 300(19):2303–2305

    CAS  Article  Google Scholar 

  27. Klevens RM, Hu DJ, Jiles R, Holmberg SD (2012) Evolving epidemiology of hepatitis C virus in the United States. Clin Infect Dis 55:S3–S9

    Article  PubMed  Google Scholar 

  28. 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 80:183–191

    CAS  Article  PubMed  Google Scholar 

  29. 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 6:6

    Article  PubMed  PubMed Central  Google Scholar 

  30. 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 34:121–130

    Article  PubMed  Google Scholar 

  31. Li ES (2013) The new drug detoxification system in China: a misused tool for drug rehabilitation. E Asia L Rev 9:168–212

    Google Scholar 

  32. Lyu SY, Su LW, Chen YM (2012) Effects of education on harm-reduction programmes. Lancet 379(9814):e28–e30

    Article  PubMed  Google Scholar 

  33. 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):e1002876

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. Marsch LA (2012) Leveraging technology to enhance addiction treatment and recovery. J Addict Dis 31(3):313–318

    Article  PubMed  PubMed Central  Google Scholar 

  35. 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:CD002209

    PubMed  Google Scholar 

  36. McCann MJ, Rawson RA, Obert JL, Hasson A (1994) Treatment of opiate addiction using methadone: a counselor manual. Center for Substance Abuse Treatment, Rockville

    Google Scholar 

  37. McHugh RK, Hearon BA, Otto MW (2010) Cognitive-behavioral therapy for substance use disorders. Psychiat Clin North Am 33(3):511–525

    Article  Google Scholar 

  38. Miller WR, Rollnick S (1991) Motivational interviewing: preparing people to change addictive behavior. J Community Appl Soc Psychol 2:299–300

    Google Scholar 

  39. 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):215–223

    Article  Google Scholar 

  40. 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

  41. National Institute on Drug Abuse (2014) Drug facts: Heroin. http://www.drugabuse.gov/publications/drugfacts/heroin. Accessed 13 Sept 2015

  42. 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):571–583

    Article  PubMed  PubMed Central  Google Scholar 

  43. 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):2089–2093

    Article  PubMed  Google Scholar 

  44. Noar SM, Willoughby JF (2012) eHealth interventions for HIV prevention. AIDS Care 24(8):945–952

    Article  PubMed  PubMed Central  Google Scholar 

  45. 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):2053–2059

    Article  PubMed  PubMed Central  Google Scholar 

  46. Olsen Y, Sharfstein JM (2014) Confronting the Stigma of Opioid Use Disorder—and Its Treatment. J Am Med Assoc 311(14):1393–1394

    Article  Google Scholar 

  47. 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):33–40

    Article  PubMed  Google Scholar 

  48. 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):1993–2002

  49. Rogers EM (2002) Diffusion of preventive innovations. Addict Behav 27(6):989–993

    Article  PubMed  Google Scholar 

  50. Rosen HR (2011) Clinical practice. Chronic hepatitis C infection. N Engl J Med 364(25):2429–2438

    CAS  Article  PubMed  Google Scholar 

  51. 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

  52. Substance Abuse and Mental Health Services Administration (2015) Behavioral Health Treatment Services Locator. https://findtreatment.samhsa.gov/. Accessed 10 Dec 2015s

  53. Sullivan SG, Wu Z (2007) Rapid scale up of harm reduction in China. Int J Drug Policy 18(2):118–128

    Article  PubMed  Google Scholar 

  54. Taiwan Ministry of Health and Welfare (2015) 2014 Anti-drug report http://www.moj.gov.tw/public/Attachment/410291426435.pdf. Accessed 13 Dec 2015

  55. United Nations Office on Drug and Crime (2013) World Drug Refport. Vienna: UNODC, 2013

  56. 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):403–418

    Article  Google Scholar 

  57. 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 166:1632–1641

    Article  PubMed  Google Scholar 

  58. 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

  59. 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, Chicago

    Google Scholar 

  60. 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.

  61. World Health Organization (2015) Injecting drug use: HIV/AIDS. http://www.who.int/hiv/topics/idu/about/en/. 14 September 2015

  62. 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):206–212

    Article  Google Scholar 

  63. 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–ii37

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Yih -Ing Hser.

Ethics declarations

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.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schulte, M., Liang, D., Wu, F. et al. A Smartphone Application Supporting Recovery from Heroin Addiction: Perspectives of Patients and Providers in China, Taiwan, and the USA. J Neuroimmune Pharmacol 11, 511–522 (2016). https://doi.org/10.1007/s11481-016-9653-1

Download citation

Keywords

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