Wearables offer addiction treatment providers tantalizing opportunities to improve care outcomes.
Increasingly sophisticated devices are now available at affordable price points. Effortless data collection opens the door to more objectivity in a highly subjective field.
But there’s a serious problem. Researchers and practitioners still need to figure out what to do with the mountains of data that wearables could produce.
“From our standpoint, the best use [of wearables] right now is to collect that data to figure out how we can best utilize that data,” Dr. Greg Hobelmann, co-CEO of Havre de Grace, Maryland-based Ashley Addiction Treatment, told Behavioral Health Business.
Ashley Addiction Treatment announced an ongoing research program with the wearables company WHOOP in November.
Outside of research settings, wearables are not widely used in treatment in large part because there are no clear, scientific connections between the most common data wearables track — heart rate and movement — and addiction itself and addiction treatment interventions.
“I think that the value in a wearable is if you are changing your behavior as a result of the information you’re getting,” Hobelmann said. “The information has to be provided in a way that people can understand it, and then understanding how their behavior can improve that.”
Ashley Addiction Treatment operates its main campus in Havre de Grace, Maryland houses 117 beds on a 147-acre campus. It also operates two outpatient locations in Bel Air and Elkton, Maryland.
In its fiscal year 2021, it generated $58.4 million in revenue and served over 2,000 patients, according to its latest annual report.
Dr. Jean-Luc Neptune, CEO of Suntra Modern Recovery, a concierge addiction treatment provider, told BHB addiction treatment providers “don’t really use anything on a day-to-day basis.”
“There are some people using wearables that do gather information about heart rates, which is very interesting in terms of heart rate variability,” Neptune said. “But you’d need a whole layer of interpretation, and then, and then actualization to actually use that technology.”
Where they can help now
The behavioral health industry’s interest in increasing its objectivity through data gathering and analysis is growing. Much of that is connected to the measurement-based care movement and to value-based care payer arrangements.
At the bleeding edge, some companies seek to translate passively collected data from cell phones and other forms of remote patient monitoring to address both of these ideas.
But the tech used in measurement-based and value-based care systems is a step or two removed from patient care or measuring the state of the patient’s body as represented by physiological data.
“Right now, there is a recognition that we have to improve how we’re handling substance use disorders in general,” Dr. Andrew Huhn, a professor at Johns Hopkins University School of Medicine, told BHB. he also leads research efforts at Ashley Addiction Treatment. “I do think there’s a sense of urgency.”
Part of the urgency is to find meaningful applications even with the limited understanding of what wearables data means for addiction treatment.
The likely best place to start is with the most obvious consumer application for wearables: fitness and wellness tracking.
Exercise and fitness are effective additions to other clinical interventions. One randomized trial found that exercise reduced cravings and boosted mood for several hours afterward. However, literature reviews find limited conclusions about exercise’s impact while also pointing to potential promising outcomes for offsetting other mental health issues related to addiction, like anxiety and depression.
Anecdotally, Huhn and Hobelmann said Ashley Addiction Treatments see exercise as a core component to helping patients attain health.
“We’re not treating a substance use disorder in a vacuum,” Hobelmann said.
He added that wearables might help people improve fitness and more clearly see the impact of improved fitness.
Wearables may fall short in gathering self-reporting data, especially if a person is nearing relapse.
“Trying to get an input from the patient is actually very unlikely to succeed because what we see is that, when people are relapsing, all of a sudden they’re sort of collapsing inward and ignoring as much as they can,” Neptune said.
The better use would be to alert a care provider or coach that someone may benefit from additional outreach.
“In that way, we may be able to catch somebody one day into the relapse or 12 hours into the relapse as opposed to seven days into the relapse … before things have gotten much, much worse,” Neptune said.
What wearables could do and shouldn’t do
In the future, using wearables presents opportunities but also potential pitfalls.
The intermingling of data and tracking and law enforcement as a response to addiction raises critical questions of privacy, and it also raises questions about compulsion and civil rights.
“When you’re talking about a very vulnerable population, that idea that this needs to be a technology that they opt-in to, that we don’t lock it on anyone’s wrist,” Dr. Stephanie Carreiro, associate professor of emergency medicine at University of Massachusetts Chan Medical School, told BHB. “[The technology] needs to be used to help people and not in any punitive fashion. It’s so important in earning the trust of this community and making sure that technology is used in a way that helps people.”
Wearables and software need to be calibrated to the lowest technological denominator. Programs that only work on the latest flagship smartwatch aren’t feasible, Carreiro said. In her 10 years studying wearables, Carreiro has seen the “amount of technology for the money” improving dramatically and she anticipates that will continue.
Once common wearable-generated data is tied to addiction treatment, patients and providers can spell out the places, things, or even people that lead them to relapse.
“The idea is that the process of being aware can be helpful to people,” Carreiro said.
She also said that providers could use wearables to detect overdoses. This would be a potent and new form of harm reduction, ensuring people in addiction stay alive or minimize damage while in addiction.
Some wearables would be able to detect respiratory depression and blood-oxygen saturation that indicates overdose and then perhaps alert emergency services or a proximate caretaker that the person may need treatment.
Taking that idea further, it’s possible to have patients use a device akin to a continuous glucose monitor and pump. The device would monitor and potentially transmit data indicating an overdose and administer medication such as naloxone for opioid overdose.
However, the risks for inadvertent medical harm from such a device are high. Administering the medication at the wrong time or giving too much may not kill a patient, but it may push them into precipitated withdrawal.
“So I don’t think we’re there yet when everyone can walk into their substance use treatment provider and show them their app and make treatment all better,” Carreiro said. “But I think we have to keep asking the right questions so that we find things that save people time and energy and let them concentrate on what’s important.”
In the long term, Ashley Addiction Treatment’s goal is to create predictive models from wearable data and traditional self-reported data. The organization has a partnership with Trac9 to gather and review data. Eventually, Ashley Addiction Treatment hopes to add genetics data.
“But it’s going to take a really long time to gather this data to figure out what’s there and how do we best analyze it,” Hobelmann said.