Using mobile phones to support people with alcohol dependence

Back in May 2011, NHS Bolton and its Community Alcohol Team identified a problem.

They knew that within the first year of someone successfully completing detoxification treatment for alcohol dependency, 80–90% of people would start to drink again. Analysis of local data told the team that many people relapse in the period immediately following a successful detox. Yet only 60–70% of clients attended meetings during this phase of treatment, known as ‘aftercare’, and where alcohol services commit most of their time, skills and budgets in supporting clients.

Phil Ramsell and colleagues at NHS Bolton thought that the solution to this problem might be better communication with alcohol services and clients between appointments – using mobile phones. ‘To our knowledge, mobile phones haven’t been used as an engagement tool to monitor and prevent relapse in the alcohol field before, so this is an innovative approach,’ says Phil, Health Improvement Specialist at NHS Bolton.

Mood monitoring

The Community Alcohol Team joined forces with digital technology company d2 Digital by Design and successfully applied for a £75,000 grant from the Health Foundation’s Shine programme. It aims to fund innovative approaches in the NHS so they can be tested and developed to deliver better quality healthcare. This chimed with the aim of the Bolton Shine Alcohol Relapse Prevention Project – to increase the number of people who engaged with and finished the alcohol dependency aftercare programmes.

Staff gave mobile phones to clients who agreed to take part in the project and an automated system, managed by the agency, sent them two types of text messages. The first were reminders of service appointments. The second were daily questions to monitor clients’ ‘mood’ to which they responded by texting ‘1’ (green), ‘2’ (amber), or ‘3’ (red), depending on how well they were coping.

Personalising responses

A green answer promoted encouragement to keep up the good work via SMS and a red response meant clients were told that they’d be contacted by the service as soon as possible. Amber suggested low mood and the client was sent personalised feedback based on strategies to help them deal with their cravings. ‘Though this system was automotive, it allowed for a great deal of flexibility because we could customise messages people received,’ says Phil.

The service psychologist developed questions for clients which a key worker went through with them, and these became the personal amber responses. They could be anything from ‘Perhaps you could take the dog for a walk’ to ‘Think about your granddaughter and all the progress you have made’. ‘This reminds the client of the work that they have done to get this far and their motivations for succeeding,’ says Phil.

A more efficient system

The project received further funding from the local Primary Care Trust, running for 20 months until December 2012. Overall feedback from clients was positive. ‘(The phone) made me feel like there was always someone there to help if I needed it,’ said one client, while staff felt the project helped them better connect with clients.

Quantitative analysis showed that more than two thirds (69%) of Shine clients were discharged from the aftercare service having completed their treatment, compared with just 41% of non-Shine clients.

The team used this data to extrapolate that Shine clients would be less likely to return to the alcohol service over time. They found that this work could potentially achieve significant savings in treatment and costs to other parts of the health service and wider social care and criminal justice system. ‘The service is more efficient and that is good for clients and for the service providers,’ says Phil. ‘More detailed work is required to find out exactly how much the service could save and how it could improve re-referral rates.’

Positive potential

The project is now on hold in Bolton as the alcohol detoxification service is now being run by a new service provider. But the text message scheme is running as a pilot in Rochdale to support people who have drug misuse problems.

Phil sees great potential for the project to achieve future cost savings in health and other services. ‘I think we need to try a randomised controlled trial of the system but I have great faith in it and can see it being rolled out across the NHS,’ he says.