Digital Innovations to Support the Health and Wellbeing of Individuals with Problematic Substance Use and Substance Use Disorder

Abstract

This dissertation explores the questions “What technology-based interventions are of most benefit in supporting the health and/or rehabilitation of individuals with substance use disorders? Where and how can they be most effectively embedded in the health system?” Chapter 1 begins with an introduction, presenting the need for change associated with the approach and management of substance use disorders (SUDs), and describes the role that digital technology can play in bridging gaps and enhancing care. Chapter 2 presents a brief historical synopsis of the social and clinical recognition of SUDs to provide a contextual introduction of the field of addiction, and to elucidate the need for change associated with the approach and management to these disorders, for which digital innovations hold promise. This chapter then describes the neurobiological foundations of addiction, followed by an overview of evidence supporting the theoretical and neurobiological mechanisms of treatment and intervention. This information provides a high-level evidentiary basis on which the chapters that follow are built. Chapter 3 is a review of digital technological addiction and mental health interventions, with an emphasis on interventions targeting SUDs. Evaluations on effectiveness are included where possible. This chapter concludes with a discussion addressing both the opportunities as well as possible negative implications of new innovations. Chapter 4 is divided into three sections: (1) a historical review of the social and clinical recognition of Fetal Alcohol Spectrum Disorder (FASD), which frames the landscape and context for the study that follows; (2) an original study examining the use of a specialized breathalyzer device, added as an additional service to the regular care for women who are pregnant and have a history of problematic alcohol use and/or are diagnosed with alcohol use disorder, with diagnosis of Fetal Alcohol Syndrome (FAS–the most severe form of FASD) as the primary outcome measure; and (3) a review that complements the discussion section of the study that precedes it, and explores issues posed for researchers, clinicians, and public policy leaders alike caused by the lack of standardization of diagnostic criteria for FASD. Chapter 5 provides an evaluation of the Text4Support program–a text messaging intervention using the principles of cognitive behavioural therapy–as a complementary service for individuals seeking addiction and mental health supports. Chapter 6, reflecting on the work that precedes it, explores the final query of this thesis (“where can technology-based interventions be most effectively embedded in the health system?”), and includes a discussion of public policy implications and considerations for further research.