Numbers don't lie, but some substance abusers do.
That's why treatment facilities and researchers are increasingly turning to digital health tools – sometimes augmented with nurse case managers – to help recovering alcoholics and drug users kick their habits and stay clean long after discharge from treatment programs.
For example, as attendees of the American Telemedicine Association annual conference heard May 6, Baylor College of Medicine in Houston, Texas is employing the Zephyr BioHarness wireless vitals monitor – the same technology others are testing to measure performance of elite athletes and to track vitals during childbirth – to assess cardiovascular and respiratory changes in cocaine users.
Cocaine abuse may not be as widespread as it was in the 1970s or '80s, but it is still an issue, according to Dr. Jin Ho Yoon, a psychologist at Baylor. During a presentation to the ATA meeting, he said cocaine today represents just 1.5 percent of all illicit drug use but 41.7 percent of ED visits related to overdoses from street drugs. "There are profound social consequences," Yoon said, naming a propensity for incarceration, violence, homelessness, crime, infectious disease and death.
Yoon has been leading an NIH-funded trial of the BioHarness to see how effectively the device could measure changes in heart and lung function when people are exposed to cocaine.
Trial participants, all volunteers who had been hooked on cocaine, were infused with low-dosage intravenous cocaine in standard hospital beds, while a control group received saline solution. The BioHarness detected a sharp uptick in heart rates for the first 10 minutes after exposure, and the hearts of users continued to beat noticeably faster than those in the control group throughout the entire 30-minute measuring period, Yoon reported.
Breathing rates also were higher for people exposed to the IV cocaine, based on the BioHarness readings, particularly for the first 10 minutes.
The researchers also measured heart rate every 5 minutes with standard hospital equipment, and found that the BioHarness readings were similar, but more useful. "BioHarness detected significant differences in heart rate and breathing rate," Yoon said.
The Zephyr product could yield data on more metrics and at a lower cost than hospital monitors – and it works outside clinical environments, opening up the possibility of continuously monitoring people during the post-discharge recovery process to make sure they don't fall off the wagon. However, the battery life is only one day, fine for inpatient applications but perhaps not good enough for home monitoring since it gives recovering drug abusers an easy way to avoid detection.
In the future Yoon wants to try BioHarness to see if it helps people quit cigarette smoking and helps people exercise more to fight obesity.
Another Baylor psychologist, Dr. Jan Lindsay, noted earlier research showing a correlation between recovering drug addicts calling an interactive voice response system for treatment and staying abstinent after inpatient discharge. Those who were given rewards for calling were nearly five times more likely to call an IVR-based support line daily and those who called more often were more likely to remain sober.
"That got me to thinking about mobile apps," Lindsay said. Lindsay, who works with addicts at the DeBakey VA Medical Center in Houston, is developing and testing an app to help extend treatment into patients' everyday lives and tailor interventions to individual needs.
The app will help identify what triggers relapses, and send data to each patient's therapist so the clinician can work with the patient in search of ways to change behaviors that lead to triggers.
"We're designing an interactive mobile app and then using those real-time data collection tools in the context of therapy," Lindsay said. "We have to understand that lapses are common. It's kind of the rule."