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A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study.
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In: Journal of medical Internet research, vol 23, iss 3 (2021)
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Abstract:
BackgroundMisuse of substances is common, can be serious and costly to society, and often goes untreated due to barriers to accessing care. Woebot is a mental health digital solution informed by cognitive behavioral therapy and built upon an artificial intelligence-driven platform to deliver tailored content to users. In a previous 2-week randomized controlled trial, Woebot alleviated depressive symptoms.ObjectiveThis study aims to adapt Woebot for the treatment of substance use disorders (W-SUDs) and examine its feasibility, acceptability, and preliminary efficacy.MethodsAmerican adults (aged 18-65 years) who screened positive for substance misuse without major health contraindications were recruited from online sources and flyers and enrolled between March 27 and May 6, 2020. In a single-group pre/postdesign, all participants received W-SUDs for 8 weeks. W-SUDs provided mood, craving, and pain tracking and modules (psychoeducational lessons and psychotherapeutic tools) using elements of dialectical behavior therapy and motivational interviewing. Paired samples t tests and McNemar nonparametric tests were used to examine within-subject changes from pre- to posttreatment on measures of substance use, confidence, cravings, mood, and pain.ResultsThe sample (N=101) had a mean age of 36.8 years (SD 10.0), and 75.2% (76/101) of the participants were female, 78.2% (79/101) were non-Hispanic White, and 72.3% (73/101) were employed. Participants' W-SUDs use averaged 15.7 (SD 14.2) days, 12.1 (SD 8.3) modules, and 600.7 (SD 556.5) sent messages. About 94% (562/598) of all completed psychoeducational lessons were rated positively. From treatment start to end, in-app craving ratings were reduced by half (87/101, 86.1% reporting cravings in the app; odds ratio 0.48, 95% CI 0.32-0.73). Posttreatment assessment completion was 50.5% (51/101), with better retention among those who initially screened higher on substance misuse. From pre- to posttreatment, confidence to resist urges to use substances significantly increased (mean score change +16.9, SD 21.4; P<.001), whereas past month substance use occasions (mean change -9.3, SD 14.1; P<.001) and scores on the Alcohol Use Disorders Identification Test-Concise (mean change -1.3, SD 2.6; P<.001), 10-item Drug Abuse Screening Test (mean change -1.2, SD 2.0; P<.001), Patient Health Questionnaire-8 item (mean change 2.1, SD 5.2; P=.005), Generalized Anxiety Disorder-7 (mean change -2.3, SD 4.7; P=.001), and cravings scale (68.6% vs 47.1% moderate to extreme; P=.01) significantly decreased. Most participants would recommend W-SUDs to a friend (39/51, 76%) and reported receiving the service they desired (41/51, 80%). Fewer felt W-SUDs met most or all of their needs (22/51, 43%).ConclusionsW-SUDs was feasible to deliver, engaging, and acceptable and was associated with significant improvements in substance use, confidence, cravings, depression, and anxiety. Study attrition was high. Future research will evaluate W-SUDs in a randomized controlled trial with a more diverse sample and with the use of greater study retention strategies.Trial registrationClinicalTrials.gov NCT04096001; http://clinicaltrials.gov/ct2/show/NCT04096001.
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Keyword:
acceptability; addiction; Adult; Alcoholism; Artificial Intelligence; Behavioral and Social Science; Brain Disorders; chatbot; Clinical Research; Clinical Trials and Supportive Activities; Cognitive Behavioral Therapy; conversational agent; craving; Depression; Drug Abuse (NIDA Only); feasibility; Female; Humans; Information and Computing Sciences; Medical and Health Sciences; Medical Informatics; Mental Health; mobile phone; Neurosciences; psychoeducation; Psychology and Cognitive Sciences; psychotherapeutic; Substance Abuse; substance misuse; Substance-Related Disorders; treatment
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URL: https://escholarship.org/uc/item/38v7w5g9
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A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study
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In: J Med Internet Res (2021)
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A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study (Preprint)
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Applying linguistic methods to understanding smoking-related conversations on Twitter
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Validity Study of the K6 Scale as a Measure of Moderate Mental Distress based on Mental Health Treatment Need and Utilization
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