Can a Chatbot-delivered Alcohol Intervention Engage Users and Enhance Outcomes Over a Smartphone App? Development and Feasibility Testing of a StepAway 'Bot'

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PROJECT SUMMARY / ABSTRACT A wide gap exists between the number of individuals needing alcohol treatment and those actually receiving it. Many factors account for this gap, including stigma, treatment availability and affordability, and individuals wanting to solve their problems independently. Technologically-delivered interventions may dramatically increase the number of individuals who receive needed alcohol intervention services due to their ability to circumvent treatment barriers. Smartphones are the ideal devices to provide empirically-supported intervention assistance whenever and wherever it is needed. Our research team previously developed and tested a stand-alone, self-administered smartphone-based intervention system for alcohol use disorders that was based on empirically supported face-to-face treatments. This Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A) system provided a progression through psychoeducational modules and in-the-moment interventions to reduce the likelihood of drinking. In a preliminary 6-week trial study, we contrasted the LBMI-A with a web-based intervention, the Drinker's Checkup (DCU) that was supplemented with bibliotherapy. While alcohol consumption was reduced by >50% in both interventions, only the LBMI-A produced a significant increase in percentage of days abstinent. Greater LBMI-A usage was associated with greater reductions in drinking. A revised and improved iPhone-based version, Step Away, has been developed and has been used by individuals downloading it from the iTunes App Store. Our Step Away usage data indicate that user engagement with modules that are not “pushed” to the user is relatively low, which is a problem that many health apps experience. A new method of delivering Step Away through an artificially intelligent chatbot will be developed in this study that holds potential for providing enhanced user engagement and effectiveness as it can reach out through a text interface to introduce new intervention steps and respond to the user with Step Away's in-the-moment help with having a craving, experiencing distress or needing social support. It could serve as a personal assistant that guides a user through a process of changing their drinking. This project will focus on developing a Step Away chatbot during the first phase of the study. We will also enhance the existing Step Away app's user interface for optimal usability. The second phase will entail performing a pilot study to determine if the Step Away chatbot has enhanced user engagement, intervention fidelity and outcome efficacy in comparison to the Step Away app among a group of problem drinkers. A control condition will consist of a minimal intervention; an assessment-only app. Participants will be interviewed to determine their perceptions of both interventions with a view towards understanding barriers to user engagement. Finally, this project will set the stage for a further, large-scale evaluation of Step Away, the content of which will be determined by the outcome of the pilot study.