Digitally Assisted Peer Recovery Coach to Facilitate Linkage to Outpatient Treatment Following Inpatient Alcohol Withdrawal Treatment: Proof-of-Concept Pilot Study

• Published in: JMIR formative research 2023-07, Vol.7, p.e43304-e43304
• Main Authors: Suzuki, Joji, Loguidice, Frank, Prostko, Sara, Szpak, Veronica, Sharma, Samata, Vercollone, Lisa, Garner, Carol, Ahern, David
• Format: Article
• Language: English
• Subjects: Addictions; Alcohol use; Alcohol withdrawal; Alcoholism; Caregivers; Continuity of care; Emergency medical care; Health care; Informed consent; Mortality; Original Paper; Outpatient care facilities; Patients; Recovery (Medical); Smartphones; Substance abuse treatment
• ISSN: 2561-326X; 2561-326X
• DOI: 10.2196/43304

Alcohol use disorder (AUD), associated with significant morbidity and mortality, continues to be a major public health problem. The COVID-19 pandemic exacerbated the impact of AUD, with a 25% increase in alcohol-related mortality from 2019 to 2020. Thus, innovative treatments for AUD are urgently needed. While inpatient alcohol withdrawal management (detoxification) is often an entry point for recovery, most do not successfully link to ongoing treatment. Transitions between inpatient and outpatient treatment pose many challenges to successful treatment continuation. Peer recovery coaches-individuals with the lived experience of recovery who obtain training to be coaches-are increasingly used to assist individuals with AUD and may provide a degree of continuity during this transition. We aimed to evaluate the feasibility of using an existing care coordination app (Lifeguard) to assist peer recovery coaches in supporting patients after discharge and facilitating linkage to care. This study was conducted on an American Society of Addiction Medicine-Level IV inpatient withdrawal management unit within an academic medical center in Boston, MA. After providing informed consent, participants were contacted by the coach through the app, and after discharge, received daily prompts to complete a modified version of the brief addiction monitor (BAM). The BAM inquired about alcohol use, risky, and protective factors. The coach sent daily motivational texts and appointment reminders and checked in if BAM responses were concerning. Postdischarge follow-up continued for 30 days. The following feasibility outcomes were evaluated: (1) proportion of participants engaging with the coach before discharge, (2) proportion of participants and the number of days engaging with the coach after discharge, (3) proportion of participants and the number of days responding to BAM prompts, and (4) proportion of participants successfully linking with addiction treatment by 30-day follow-up. All 10 participants were men, averaged 50.5 years old, and were mostly White (n=6), non-Hispanic (n=9), and single (n=8). Overall, 8 participants successfully engaged with the coach prior to discharge. Following discharge, 6 participants continued to engage with the coach, doing so on an average of 5.3 days (SD 7.3, range 0-20 days); 5 participants responded to the BAM prompts during the follow-up, doing so on an average of 4.6 days (SD 6.9, range 0-21 days). Half (n=5) successfully linked with ongoing