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Innovation Update

Stand Down: Think Before You Drink—A Mobile App for Veterans Engaging in Hazardous Drinking Departments

One in four Veteran primary care patients screens positive for hazardous drinking, yet the vast majority do not engage in treatment.¹ Stigma related to treatment-seeking and the costs of traveling to VA are key barriers to accessing alcohol-related care. Mobile apps can bypass these barriers; however, the evidence base supporting the efficacy of apps for reducing hazardous drinking in Veterans is limited. Step Away is an evidence-based mobile app for self-management of hazardous drinking.² The app provides assessment of and personalized feedback on users’ drinking patterns, allows users to track progress towards drinking goals, and includes in-the-moment tools to manage cravings. However, Step Away was not designed for Veterans per se, and low patient uptake is the Achilles’ heel of mobile apps for hazardous drinking.³

In a VA Health Services Research & Development-funded pilot study, we used community-based participatory research methods to repurpose Step Away to fit the needs and preferences of the Veteran primary care population. Using feedback from patients and a steering committee of key stakeholders, we created a Veteran version of the app, Stand Down: Think Before You Drink.⁴ In a single-arm, pre-post design over four weeks, we tested the feasibility and acceptability of using peer specialists to facilitate engagement with the Stand Down app with 31 Veterans who screened positive for hazardous drinking in primary care but were not engaged in treatment. In the phone-based protocol, peers provided supportive accountability and instruction and encouragement for app use. A priori benchmarks for app usage and satisfaction with care were surpassed and patients significantly reduced their drinking pre-to-post. These data provide a strong foundation for a full-scale randomized controlled trial of this intervention, in which we will test if peer-supported Stand Down is superior to the app alone in enhancing app usage and improving outcomes, as well as clarify for whom phone support is most beneficial.

References

1. Glass JE, et “Prevalence and Correlates of Specialty Substance Use Disorder Treatment for Department of Veterans Affairs Healthcare System Patients with High Alcohol Consumption,” Drug Alcohol Dependence 2010; 112:150-5.
2. Gonzalez VM, Dulin “Comparison of a Smartphone App for Alcohol Use Disorders with an Internet-Based Intervention Plus Bibliotherapy: A Pilot Study,” Journal of Consulting and Clinical Psychology 2015; 83:335-45.
3. Bertholet N, et “Smartphone Application for Unhealthy Alcohol Use: Pilot Randomized Controlled Trial in the General Population,” Drug Alcohol Dependence 2019; 195:101-5.
4. Blonigen DM, et “From “Step Away” to “Stand Down”: Tailoring a Smartphone Application for Self-Management of Hazardous Drinking for Veterans,” JMIR mHealth and uHealth 2020; 8(2):e16062.