Ecological Momentary Interventions Delivered by Smartphone Apps: Applications in Substance Use Treatment in Indian Scenario.

Sir,

Ecological momentary interventions (EMIs) are defined as treatments which are provided to patients between sessions during their everyday lives (i.e., in real time) and in natural settings (i.e., natural settings).[1] Clinicians have tried to extend some aspects of psychotherapy into patients' everyday lives to encourage activities and skill building in a variety of conditions including mental illnesses. EMI can be delivered in a variety of ways which includes unstructured recommendations to structured interventions. Such kind of interventions has been delivered using mobile and palmtop computers in previous decades. Mobile technology is ideal for delivering EMI because of its widespread usage and acceptability among the general population.[1] To date, EMIs have been delivered to patients with illnesses such as diabetes, obesity, and mental illnesses among many others.[1]

Substance use disorders treatments have shown promising results when EMI have been included in patients' daily lives using mobiles/palmtops. Evidence suggests a decrease in the smoking and alcohol use among participants who used EMI as compared to control subjects. One such study tested the efficacy of EMI in a sample of 1705 young nicotine dependent (smokers) individuals.[2] Results suggested a significantly higher short-term quit rates among participants receiving EMI as compared to control group. Similarly, another study done on college students with alcohol use reported lesser consumption of alcoholic drinks after starting EMI than their peers.[3]

On the other hand, use of mobiles in the form of the smartphone is increasing, especially in countries like India.[4] More importantly, there is also a dramatic increase in the use of smartphone apps. Among many other potential uses of smartphone apps (e.g., screening of illness, monitoring of symptoms, medication compliance, etc.), psychotherapy has also been proposed as one of the potential usages.[5] Some studies have shown benefits of EMI provided by smartphone apps in substance use treatment. One recent randomized clinical trial done on alcohol use disorder patients reported significantly lowered alcohol drinking rates in patients with smartphone app based EMI as compared to controls.[6] Another study that assessed early stage usability and effectiveness of such smartphone app based intervention, reported similar results.[7]

Providing EMIs using smartphone apps have its own benefits, especially in countries like India. Because of stigma related to mental illnesses which limits assess to treatment, smartphone app-based interventions might be useful to break the barrier. Furthermore, EMI delivered by this method may be more suitable because of more widespread usage of smartphones, especially in India. These apps might also help the clients with means to assess their symptoms status and provide feedback which might be useful to their self-efficacy. It may help to bridge the mental health gap existing in the field of substance use treatment in India. However, this mode of intervention has its own pitfalls. There is a lack of scientific evidence as of now for the effectiveness of such apps.[5] Most of these apps are developed without help from the specialists working in substance use area. One of the most important issues, especially in India is that most of such apps are available in English while the majority of Indian population is non-English speaking and so data on its usefulness might not be generalizable.[5] Confidentiality of data is another major concern.

In conclusion, EMI when delivered by smartphone apps can be a useful option for substance use treatment, especially in countries like India. However, more scientific data are required before its widespread usage for such purposes.

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Conflicts of interest

There are no conflicts of interest.