{
    "abstract": "Misuse 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.\nThis study aims to adapt Woebot for the treatment of substance use disorders (W-SUDs) and examine its feasibility, acceptability, and preliminary efficacy.\nAmerican 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.\nThe 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%).\nW-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.\nClinicalTrials.gov NCT04096001; http://clinicaltrials.gov/ct2/show/NCT04096001.",
    "authors": [
        {
            "affiliation": "Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA, United States.",
            "firstname": "Judith J",
            "initials": "JJ",
            "lastname": "Prochaska"
        },
        {
            "affiliation": "Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA, United States.",
            "firstname": "Erin A",
            "initials": "EA",
            "lastname": "Vogel"
        },
        {
            "affiliation": "Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA, United States.",
            "firstname": "Amy",
            "initials": "A",
            "lastname": "Chieng"
        },
        {
            "affiliation": "Department of Psychiatry & Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States.",
            "firstname": "Matthew",
            "initials": "M",
            "lastname": "Kendra"
        },
        {
            "affiliation": "Department of Epidemiology & Population Health, School of Medicine, Stanford University, Stanford, CA, United States.",
            "firstname": "Michael",
            "initials": "M",
            "lastname": "Baiocchi"
        },
        {
            "affiliation": "Woebot Health, San Francisco, CA, United States.",
            "firstname": "Sarah",
            "initials": "S",
            "lastname": "Pajarito"
        },
        {
            "affiliation": "Woebot Health, San Francisco, CA, United States.",
            "firstname": "Athena",
            "initials": "A",
            "lastname": "Robinson"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9Judith J Prochaska, Erin A Vogel, Amy Chieng, Matthew Kendra, Michael Baiocchi, Sarah Pajarito, Athena Robinson. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.03.2021.",
    "doi": "10.2196/24850\n10.1001/archpsyc.61.8.807\n10.1111/dar.12578\n10.3389/fpsyg.2017.00954\n10.3389/fpsyg.2017.00954\n10.1007/s40501-019-00190-y\n10.2196/mhealth.4924\n10.1177/0706743719828977\n10.2196/14567\n10.1136/eb-2018-102891\n10.1016/j.chb.2014.04.043\n10.1016/j.chb.2014.04.043\n10.1089/109493102753770480\n10.2196/jmir.8252\n10.2196/mental.7785\n10.1016/j.invent.2017.10.002\n10.1007/s10916-017-0771-y\n10.1016/j.pec.2017.04.015\n10.1016/j.intcom.2010.02.001\n10.1016/j.intcom.2009.12.001\n10.3389/frobt.2017.00051\n10.1038/srep42656\n10.1038/srep42656\n10.3233/THC-170899\n10.2196/14166\n10.3389/fpsyt.2019.00746\n10.3389/fpsyt.2019.00746\n10.1371/journal.pone.0052735\n10.1371/journal.pone.0052735\n10.1080/16506073.2019.1669701\n10.1371/journal.pmed.1001454\n10.1371/journal.pmed.1001454\n10.1186/1471-2458-5-76\n10.1186/1471-2458-5-76\n10.1037/adb0000318\n10.1016/j.cpr.2013.07.007\n10.1001/archinte.158.16.1789\n10.1016/0306-4603(82)90005-3\n10.1016/0306-4603(82)90005-3\n10.1016/s0005-7967(99)00152-7\n10.1016/j.jad.2008.06.026\n10.1016/j.jad.2008.06.026\n10.1001/archinte.166.10.1092\n10.1016/j.jsp.2012.08.006\n10.1016/j.jsp.2012.08.006\n10.1016/0149-7189(79)90094-6\n10.1016/0149-7189(79)90094-6\n10.1080/10503300500352500\n10.2196/14842\n10.1007/s13142-016-0453-1\n10.2196/13244\n10.1001/jamanetworkopen.2020.10791\n10.1001/jamanetworkopen.2020.10791\n10.1037//0022-006x.64.3.447\n10.1037/h0085885\n10.1037/0022-0167.38.2.139\n10.1080/16506070802408086\n10.1016/j.pec.2004.09.008\n10.1016/j.pec.2004.09.008\n10.1038/s41746-020-0224-8\n10.1038/s41746-020-0224-8\n10.1093/jamia/ocy072",
    "journal": "Journal of medical Internet research",
    "keywords": [
        "acceptability",
        "addiction",
        "artificial intelligence",
        "chatbot",
        "conversational agent",
        "craving",
        "feasibility",
        "mobile phone",
        "psychoeducation",
        "psychotherapeutic",
        "substance misuse",
        "treatment"
    ],
    "methods": null,
    "publication_date": "2021-03-24",
    "pubmed_id": "33755028\n15289279\n29388330\n28649211\n26537656\n30897957\n31573916\n29871870\n12025884\n29674307\n28588005\n30135751\n28699083\n28495391\n20628581\n28205601\n28800346\n31628789\n31681047\n7778330\n23326352\n31638472\n23723742\n16026611\n29199843\n24029221\n9738608\n7183189\n11104185\n18752852\n16717171\n23375174\n10245370\n32134720\n27966189\n31899454\n32678450\n8698936\n19221919\n16198215\n32128451\n30010941",
    "results": "The 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%).",
    "title": "A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study.",
    "xml": "<Element 'PubmedArticle' at 0x788503b0dad0>"
}