Can Smartphone Monitoring Help People With Dual Diagnosis?

People who receive a dual diagnosis have simultaneous problems with a non-substance-related mental illness and some form of substance abuse or substance addiction. Doctors often have difficulty properly treating affected individuals, and the presence of dual diagnosis can seriously degrade any given person’s short- and long-term well-being. In a study published in September 2014 in the Journal of Dual Diagnosis, a team of American researchers sought to determine if remote monitoring of patients through modern smartphone technology can increase the ease and effectiveness of dual diagnosis treatment.

Substance Problems and Dual Diagnosis

Millions of people throughout the U.S. have diagnosable problems with alcohol, drug or medication intake. According to figures compiled by the National Alliance on Mental Illness, most of those individuals affected by drug/medication problems also have separate issues with some form of mental illness. In addition, large numbers of people dealing with alcohol problems (more than 33 percent) have separate mental illness issues to contend with. Dual diagnosis also impacts large percentages of people dealing with diagnosable mental health problems. When figures include all such people, the prevailing rate of alcohol, drug and/or medication problems is roughly 30 percent. The rate rises to a substantially higher 50-plus percent when the relevant figures include only people dealing with the most serious forms of mental illness such as major depression and schizophrenia. Substances particularly noted for their effects in cases of dual diagnosis include alcohol, methamphetamine and marijuana/cannabis.

Dual Diagnosis Impact and Treatment

As a rule, a person dealing with simultaneous symptoms of substance abuse/addiction and another form of mental illness has more significant problems than a person who just has symptoms of abuse/addiction or who just has symptoms of mild, moderate or severe mental illness. Doctors commonly refer to two or more conditions that combine to produce an unusually sharp decline in mental or physical health as comorbid conditions. Well-established comorbid impacts of dual diagnosis include fairly frequent unavailability of proper treatment, a tendency among affected individuals to underutilize treatment when available, much more complicated disease management needs, increased exposure to the most negative outcomes of substance problems and mental illness, and a greater chance of dying long before age peers not dealing with dual diagnosis.

Uncontrolled substance intake can greatly diminish the effectiveness of many of the most common medication options for severe mental illness. For this reason, doctors treating dual diagnosis often start by addressing their patients’ substance-related issues and then broaden the scope of treatment to include mental illness once substance intake has fallen off or stopped altogether.

Potential of Smartphone Monitoring

In the study published in the Journal of Dual Diagnosis, researchers from Dartmouth College, Northwestern University and Thresholds used a 12-week project to evaluate the potential usefulness of smartphone technology in increasing the level of effective monitoring provided to people recovering from dual diagnosis. This project included a total of 17 people dealing with various combinations of substance abuse/addiction and a form of mental illness capable of producing the debilitating mental state called psychosis.

Every day, a trained social worker sent these study participants customized text messages designed to probe such issues as general medical status and level of compliance with guidelines for medication intake. In addition, the social worker responded to questions from the participants and provided advice on topics that included methods of dealing successfully with the day-to-day effects of dual diagnosis. At the end of the 12-week experiment, each participant rated the ease of using the smartphone monitoring system and his or her level of satisfaction with the system, and also provided his or her perception of the strength of the bonds formed with the social worker and the larger group of professionals involved in treatment.

The researchers found that the study participants responded to the overwhelming majority (87 percent) of the interactive text messages sent to them over the course of the project. In addition, 90-plus percent of the participants felt that the smartphone monitoring helped them cope with their condition and contributed to their ability to carry out a fulfilling routine. Interestingly, the researchers also concluded that, compared to the bonds formed with caregivers they periodically talked with in person, the study participants developed much stronger bonds with the social worker they interacted with virtually on a daily basis. Overall, the study’s authors believe that their work demonstrates the viability of using smartphone technology to improve the treatment provided to people affected by dual diagnosis.

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