Wilde JA, Zawislak K, Sawyer-Morris G, Hulsey J, Molfenter T, Taxman FS. The adoption and sustainability of digital therapeutics in justice systems: A pilot feasibility study. Int J Drug Policy. 2023;116:104024. doi:10.1016/j.drugpo.2023.104024
This article reports the adoption and sustainability of the Connections App (CHESS Health, 2018) in self-referred and justice-referred participants. The Connections App is an evidence-based smartphone app that uses community engagement and cognitive behavioral therapy programming to support patients in recovery from substance use disorder (SUD). Participants were either given access to the Connections App through justice-related programs or by voluntary enrollment in the study. Participation was completely voluntary in both groups and included free access to the Connections app including in-app tools such as Computer-Based Treatment for Cognitive Behavioral Therapy (CBT4CBT) and access to external access to recovery support services. Of the 1973 participants offered use of the Connections app only 796 individuals (40.3%) downloaded the app (declined: justice-referred n = 994, self-referred n = 183). Of those that downloaded the app, less than half (n = 350) engaged with the app. Most of the self-referred participants (77.9%) engaged with the app, whereas less than half (36.2%) of the justice-referred participants used the app once downloaded. When comparing the groups across engagement type, the number of participants who used the app alone was the same between referral types. In contrast to this a greater proportion of the justice-referred subjects used the additional external recovery support services compared to self-referred participants (p < 0.001). Referral type did not impact the number of activities completed or days of maintained app usage. While brief addiction monitor (BAM) scores were reported, a third of participants (engaged users, n = 350) only completed the assessment one of the possible 43 times (n = 111). Approximately 35% completed the BAM more than once (n = 121), with only 3.4% completing it more than 20 times (n = 12). Both groups showed the benefits of continued use of the Connections app, as demonstrated by BAM score improvement over time using the app. Future research is needed to address the implementation issues revealed during site debriefing that hindered downloads in justice-referred populations.