AlcoChange: a smartphone tool to reduce alcohol use and admissions in alcoholic liver disease
Royal Free London NHS Foundation Trust
- Run by Royal Free London NHS Foundation Trust.
- Aimed to reduce alcohol use and hospital admissions for patients with alcoholic liver disease (ALD).
- ALD patients were given a smartphone app and breathalyser to accurately self-monitor alcohol intake and allow contact by alcohol workers, to influence sustained behaviour change.
- Project ran from spring 2015 to the end of 2017.
Alcohol contributes to over 5% of deaths worldwide, and UK death rates from alcohol-related liver disease (ARLD) are rising. Ongoing alcohol use in ARLD leads to markedly increased mortality, however, there are no effective pharmacological therapies for maintaining abstinence. Behaviour change interventions (BCIs) are effective psychological tools for reducing alcohol use but are difficult to scale.
This project developed a smartphone app and breathalyser (AlcoChange), to:
- facilitate self-monitoring and deliver BCIs in response to patient triggers
- undertake an open-label pilot study of 60 patients with ARLD, to determine compliance with the app/breathalyser and changes in self-reported alcohol consumption.
AlcoChange was developed following feedback from alcohol service users. It allows monitoring of craving, alcohol consumption and breath alcohol, and provides motivational messaging in response to patient triggers.
The pilot study recruited inpatients/outpatients at the Trust with ARLD and recent alcohol use. Inclusion criteria were intended to maintain abstinence and possession of a compatible phone. Exclusion criteria were Child-Pugh score >7, or inability to provide consent. The primary endpoint was self-reported alcohol use.
Twenty participants completed both the baseline and three-month visits. Six subjects were lost to follow-up, and one died. Self-reported alcohol intake showed a trend to reduction at three months. Following sub-group analysis for compliance with the app (>20 logins/three months), compliant participants reduced alcohol consumption, whereas non-compliant participants increased.
The study demonstrates that an app and breathalyser can be used for self-monitoring and BCIs in patients with ARLD, and apps are a scalable intervention to help maintain abstinence in ARLD. The study remains open, with further data to present. Future opportunities include the use of AlcoChange in a National Institute for Health Research clinical trial application, and engagement with local commissioners to embed into alcohol services.