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In recent years, there has been increasing interest in implementing digital technologies to diagnose, monitor, and intervene in substance use disorders. Smartphones are now a vehicle for facilitating telepsychiatry visits, measuring health metrics, and communicating with health care professionals. In light of the COVID-19 pandemic and the movement toward web-based and hybrid clinic visits and meetings, it has become especially salient to assess phone ownership among individuals with substance use disorders and their comfort in navigating phone functionality and using phones for mental health purposes.
The aims of this study were to summarize the current literature around smartphone ownership, smartphone utilization, and the acceptability of using smartphones for mental health purposes and assess these variables across two disparate substance use treatment sites.
We performed a focused literature review via a search of two academic databases (PubMed and Google Scholar) for publications since 2007 on the topics of smartphone ownership, smartphone utilization, and the acceptability of using mobile apps for mental health purposes among the substance use population. Additionally, we conducted a cross-sectional survey study that included 51 participants across two sites in New England—an inpatient detoxification unit that predominantly treats patients with alcohol use disorder and an outpatient methadone maintenance treatment clinic.
Prior studies indicated that mobile phone ownership among the substance use population between 2013 and 2019 ranged from 83% to 94%, while smartphone ownership ranged from 57% to 94%. The results from our study across the two sites indicated 96% (49/51) mobile phone ownership and 92% (47/51) smartphone ownership among the substance use population. Although most (43/49, 88%) patients across both sites reported currently using apps on their phone, a minority (19/48, 40%) reported previously using any apps for mental health purposes. More than half of the participants reported feeling at least neutrally comfortable with a mental health app gathering information regarding appointment reminders (32/48, 67%), medication reminders (33/48, 69%), and symptom surveys (26/45, 58%). Most patients were concerned about privacy (34/51, 67%) and felt uncomfortable with an app gathering location (29/47, 62%) and social (27/47, 57%) information for health care purposes.
The majority of respondents reported owning a mobile phone (49/51, 96%) and smartphone (47/51, 92%), consistent with prior studies. Many respondents felt comfortable with mental health apps gathering most forms of personal information and with communicating with their clinician about their mental health. The differential results from the two sites, namely greater concerns about the cost of mental health apps among the methadone maintenance treatment cohort and less experience with downloading apps among the older inpatient detoxification cohort, may indicate that clinicians should tailor technological interventions based on local demographics and practice sites and that there is likely not a one-size-fits-all digital psychiatry solution.
Handheld phones evolved at a lightning pace over the past 2 decades. Once devices that were solely used to text or call, smartphones now connect millions through social media, track health metrics, and have GPS-sensing capabilities. Smartphones also have a burgeoning role in telepsychiatry, which has been widely adopted during the COVID-19 pandemic. Tens of thousands of mental health apps are available through app stores. Digital phenotyping, which involves using passively and continuously collected sensory and user data to track movement, phone utilization, and communication, has potential apps for relapse prediction in schizophrenia [
Smartphone apps have expanded and can be used for the diagnosis, monitoring, and treatment of substance use disorders [
With smartphones playing an increasingly integral role in the delivery of substance use care, addressing equity and understanding the adoption and utilization of smartphones and the acceptability of related technologies have become ever more pressing. We performed a nonsystematic review of literature around smartphone ownership and utilization among individuals with substance use disorders, and we present original data from our 2-site, cross-sectional survey study assessing smartphone ownership, smartphone utilization, and the acceptability of using mental health apps. We hypothesize that a vast majority of individuals own smartphones and would be open to using smartphone apps to address substance use. The aim of this study is to inform clinicians who plan to develop or implement digital interventions for patients with substance use disorders on how to anticipate and optimize adoption and engagement.
The purpose of the literature review was to identify articles that assessed smartphone or phone ownership and/or utilization to answer the following questions: what proportion of patients with substance use disorders own mobile phones or smartphones, how did they utilize their phones, and how open were they to mobile health (mHealth) intervention through smartphones?
A nonsystematic search was conducted in January 2022 within PubMed and Google Scholar, using the key terms
We developed a survey that closely mirrored the one developed by Torous et al [
Do you currently own any type of phone?
If no, for what reason do you not have a phone?
Is your phone a smartphone (eg, iPhone, Android, etc)?
What is the name of your smartphone (eg, Samsung Galaxy)?
How comfortable are you sending text messages on your phone?
What type of payment plan do you use for text messages?
Do you download apps onto your phone?
Have you ever downloaded an app for your mental health?
Do you currently use any apps for your phone?
How comfortable or uncomfortable would you feel about a mental health app gathering and/or sending the following data from your smartphone to your clinician in the context of your care?
Appointment reminders
Medication reminders
Symptom surveys (eg, survey questions about your mood or thoughts throughout the day)
Your location (phone GPS sensor)
Your social information (call and text logs without any phone numbers or context of messages; eg, how many people you called and for how long)
Coaching for healthy living (eg, exercise, sleep, and diet)
Mindfulness or therapy exercises
Communicating with my clinician about my mental health
Select up to 3 top concerns you may have about mental health apps or apps for substance use disorders:
Privacy
Accuracy of recommendations from app
Hard to use
Sharing information with clinician
Cost
Time
Hard to set up
Select up to 3 top benefits you may see in mental health apps or apps for substance use disorders:
Privacy
Accuracy of recommendations from app
Easy to use
Sharing information with clinician
Cost
Time
Easy to set up
This study was approved and monitored by the Mass General Brigham Institutional Review Board (approval number 2020P001656) and Rutland Regional Hospital Institutional Review Board (approval number 2020P001656/RRMC24). This study was identified as human subjects research and was classified as exempt by the Mass General Brigham Institutional Review Board, given the minimal risk to subjects and the use of a survey tool with no identifiable information obtained. This study adheres to the ethical guidelines set forth by the Mass General Brigham Human Research Protection Program [
For the inpatient detoxification cohort, the study team approached 35 participants, of whom 25 consented to answering the survey and 22 completed it (response rate: 22/35, 63%). Further, 2 participants were discharged from detoxification prior to completion, and 1 participant dropped out.
The BWFH inpatient detoxification sample skewed toward male (12/22, 55%) and White (20/22, 91%) patients, and the West Ridge Clinic sample skewed toward female (18/29, 62%) and White (23/29, 79%) patients (
Summary of participant demographic characteristics (N=51).
Variable | All participants (N=51) | BWFHa inpatient detoxification clinic (n=22) | West Ridge Clinic (n=29) | |||
Age (years), mean (SD) | 41.47 (13.0) | 48.71 (11.8) | 36.04 (11.2) | .001 | ||
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.24 | |||||
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Male | 23 (45) | 12 (55) | 11 (38) |
|
|
|
Female | 28 (55) | 10 (45) | 18 (62) |
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.32 | |||||
|
Black or African American | 1 (2) | 0 (0) | 1 (4) |
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|
|
White | 43 (84) | 20 (91) | 23 (79) |
|
|
|
Hispanic or Latinx | 3 (6) | 2 (9) | 1 (4) |
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|
Other | 3 (6) | 0 (0) | 3 (10) |
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|
Alaska Native | 1 (2) | 0 (0) | 1 (4) |
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.20 | |||||
|
Completed high school or General Educational Development | 13 (25) | 5 (23) | 8 (28) |
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|
|
Some high school | 7 (14) | 1 (4) | 6 (21) |
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|
|
Completed college or associate degree | 6 (12) | 3 (14) | 3 (10) |
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Some college or associate degree | 17 (33) | 7 (32) | 10 (34) |
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|
Graduate school | 8 (16) | 6 (27) | 2 (7) |
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.18 | |||||
|
Full-time employment | 12 (23) | 4 (18) | 8 (28) |
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Part-time employment | 5 (10) | 1 (5) | 4 (14) |
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Unemployed | 18 (35) | 7 (32) | 11 (38) |
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|
SSDb or SSIc | 9 (18) | 4 (18) | 5 (17) |
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|
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Other | 3 (6) | 2 (9) | 1 (3) |
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Retired | 4 (8) | 4 (18) | 0 (0) |
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.10 | |||||
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Own or rent apartment | 18 (36) | 10 (45) | 8 (29) |
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Family or friends | 10 (20) | 6 (27) | 4 (14) |
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|
Single room occupancy | 8 (16) | 4 (18) | 4 (14) |
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Halfway house | 3 (6) | 1 (5) | 2 (7) |
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Homeless | 11 (22) | 1 (5) | 10 (36) |
|
aBWFH: Brigham and Women’s Faulkner Hospital.
bSSD: Social Security Disability.
cSSI: Supplemental Security Income.
dOne participant did not answer the question regarding place of residence.
Prior studies indicated that mobile phone ownership among the substance use population from 2013 to 2019 ranged from 83% to 94%, while smartphone ownership ranged from 57% to 94% [
In our study, a large proportion of respondents reported owning a mobile phone (49/51, 96%) and smartphone (47/51, 92%). All patients (22/22, 100%) at the inpatient detoxification clinic reported owning a mobile phone, while 27 of 29 patients (93%) reported owning a mobile phone at the outpatient methadone clinic. Of the 49 respondents who owned mobile phones across both sites, 47 (96%) categorized them as smartphones; 2 participants opted out of this question.
Mobile phone and smartphone ownership among individuals with substance use disorders across studies.
Authors, year | Patient population | Sample size, N | Mobile phone |
Smartphone |
McClure et al, 2013 [ |
Adult patients who were undergoing substance abuse treatment and were enrolled at 8 drug-free psychosocial or opioid-replacement therapy clinics in Baltimore | 266 | 91 | N/Aa |
Dahne and Lejuez, 2015 [ |
Adult patients admitted to a residential substance use treatment center in Washington, District of Columbia | 251 | 86.9 | 68.5 |
Tofighi et al, 2015 [ |
Adult patients with opiate dependence in an urban, safety-net office–based buprenorphine program in New York City | 71 | 93 |
63 |
Milward et al, 2015 [ |
Patients enrolled in 4 UK community drug treatment services (74% were undergoing treatment for heroin addiction) | 398 | 83 |
57 |
Masson et al, 2018 [ |
Adult patients enrolled in methadone maintenance treatment in San Francisco | 178 | 87 | N/A |
Ashford et al, 2018 [ |
Adult patients in 4 intensive outpatient substance use disorder treatment facilities in Philadelphia | 259 | 93.8 |
64.1 |
Curtis et al, 2019 [ |
Adolescents (aged 13-17 years) and emerging adults (aged 18-35 years) engaged in outpatient substance use treatment in the Southwest and Northeast regions of the United States | 164 | 92.2 | 80.9 |
Tofighi et al, 2019 [ |
Adult patients enrolled in an inpatient detoxification program at a safety-net tertiary referral center in New York City | 206 | 86 |
66 |
aN/A: not applicable.
Based on our review of the literature, 79% to 96% of individuals with substance use disorders have phones with text messaging capabilities [
Patients were also asked about their mobile phone use patterns in our study (
Mobile phone use patterns (N=51).
Variable | All participants (N=51), n (%) | BWFHa inpatient detoxification clinic (n=22), n (%) | West Ridge Clinic (n=29), n (%) | |||||||
|
49 (96) | 22 (100) | 27 (93) | .21 | ||||||
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Smartphone (n=47)b | 47 (100) | 20 (100) | 27 (100) |
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|||||
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||||||||||
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Extremely, very, or somewhat comfortable | 45 (92) | 19 (86) | 26 (96) | .21 | |||||
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.30 | |||||||||
|
Flat fee for unlimited text messages | 42 (89) | 19 (95) | 23 (85) |
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|||||
|
Flat fee for limited text messages | 2 (4) | 1 (5) | 1 (4) |
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|||||
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Pay-per-text plan | 3 (7) | 0 (0) | 3 (11) |
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|||||
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43 (88) | 17 (77) | 26 (96) | .04 | ||||||
|
Has downloaded app for mental health | 19 (40) | 10 (48) | 9 (33) | .32 | |||||
|
Currently uses any apps on phone | 43 (88) | 18 (82) | 25 (93) | .25 | |||||
|
||||||||||
|
Appointment reminders | 32 (67) | 11 (52) | 21 (78) | .06 | |||||
|
Medication reminders | 33 (69) | 12 (57) | 21 (78) | .13 | |||||
|
Symptom surveys | 26 (58) | 11 (52) | 15 (63) | .49 | |||||
|
Location | 18 (38) | 7 (33) | 11 (42) | .53 | |||||
|
Social information | 20 (43) | 8 (38) | 12 (46) | .58 | |||||
|
Coaching for healthy living | 27 (56) | 11 (52) | 16 (59) | .63 | |||||
|
Mindfulness or therapy exercises | 31 (65) | 12 (57) | 19 (70) | .34 | |||||
|
Communicating with clinician about mental health | 30 (63) | 11 (52) | 19 (70) | .20 | |||||
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||||||||||
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Privacy | 34 (67) | 14 (64) | 20 (69) | .69 | |||||
|
Accuracy of recommendations | 12 (24) | 4 (18) | 8 (28) | .43 | |||||
|
Hard to use | 9 (18) | 5 (23) | 4 (14) | .41 | |||||
|
Sharing information with clinician | 14 (28) | 7 (32) | 7 (24) | .54 | |||||
|
Cost | 15 (29) | 2 (9) | 13 (45) | .006 | |||||
|
Time | 16 (31) | 5 (23) | 11 (38) | .25 | |||||
|
Hard to set up | 11 (22) | 7 (32) | 4 (14) | .12 | |||||
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||||||||||
|
Privacy | 11 (22) | 4 (18) | 7 (24) | .61 | |||||
|
Accuracy of recommendations | 14 (28) | 3 (14) | 11 (38) | .05 | |||||
|
Easy to use | 22 (43) | 10 (46) | 12 (41) | .77 | |||||
|
Sharing information with clinician | 19 (37) | 8 (36) | 11 (38) | .91 | |||||
|
Cost | 8 (16) | 2 (9) | 6 (21) | .26 | |||||
|
Time | 20 (39) | 8 (36) | 12 (41) | .72 | |||||
|
Easy to set up | 18 (35) | 4 (18) | 14 (48) | .03 |
aBWFH: Brigham and Women’s Faulkner Hospital.
bTwo participants who reported owning a mobile phone did not provide information about whether it was a smartphone.
cTwo participants did not answer questions regarding their comfort with sending text messages.
dFour participants did not answer questions regarding their current text message payment plan.
eTwo participants did not answer questions regarding downloading apps onto their phones.
fThree participants did not answer questions regarding their comfort with mental health apps gathering personal information.
Based on our review of the literature, 70.4% of adult participants in one study stated that they would use a relapse prevention app [
Over half of all participants at both sites were at least neutrally comfortable with a mental health app gathering information regarding appointment reminders (32/48, 67%), medication reminders (33/48, 69%), and symptom surveys (26/45, 58%). Most participants also found it acceptable to use mental health apps to engage in coaching for healthy living (27/48, 56%), mindfulness or therapy exercises (31/48, 65%), and communication with their clinician about their mental health (30/48, 62%). Notably, most of our sample expressed concerns about privacy (34/51, 67%) and reported being uncomfortable with an app gathering information about location (29/47, 62%) and social information (27/47, 57%) for health care purposes. The top three noted concerns about using mental health apps were privacy, cost, and time; patients at the outpatient methadone clinic were significantly more likely to perceive cost as a top-three concern (13/29, 45% vs 2/22, 9%;
Patients' comfort with a mental health app gathering information on smartphone by clinic location. BWFH: Brigham and Women’s Faulkner Hospital.
Patients' perceived concerns about mental health apps by clinic location. BWFH: Brigham and Women’s Faulkner Hospital.
Patients' perceived benefits about mental health apps by clinic location. BWFH: Brigham and Women’s Faulkner Hospital.
The overall rate of mobile phone ownership was 96% (49/51), and the overall rate of smartphone ownership was 92% (47/51). The participants recruited at the community inpatient detoxification site were overall older (mean 48.71 vs mean 36.04 years;
A majority of participants across both clinic sites indicated feeling comfortable with mental health apps gathering most forms of personal information, specifically appointment reminders (32/48, 67%), medication reminders (33/48, 69%), symptom surveys (26/45, 58%), coaching for healthy living (27/48, 56%), mindfulness or therapy exercises (31/48, 65%), and communications with their clinician about their mental health (30/48, 62%). Most individuals were uncomfortable with a mental health app tracking location (29/47, 62%) or social information (ie, their call and text logs; 27/47, 57%). The differential views on cost as a barrier to using a mental health app across the two sites (methadone clinic: 13/29, 45%; inpatient detoxification clinic: 2/22, 9%;
Overall, our cross-sectional study suggests that individuals with substance use disorders are generally amenable to using a smartphone app for mental health monitoring or treatment purposes. Interestingly, while smartphone ownership was slightly lower among participants in the MMT site compared to that among the detoxification site participants, which is unsurprising given that the participants at the MMT site were of lower socioeconomic status, our data suggest that the individuals recruited at the MMT site had higher digital literacy, as reflected by their comfort with downloading apps and their perception that ease of use is a benefit of using a mental health app for substance use interventions. In conclusion, clinicians should consider patient demographics, digital literacy, and practice sites when implementing mHealth interventions for substance use disorders in an equitable fashion.
To our knowledge, this study represents the first literature review of smartphone ownership, smartphone utilization, and the acceptability of using mHealth among individuals with substance use disorders and the first cross-sectional survey study to address this topic since the beginning of the COVID-19 pandemic. Smartphone and mobile phone ownership rates in our cross-sectional survey study were higher than those reported in all prior studies, likely reflecting the growing adoption of smartphones. Overall rates of downloading apps across both survey sites (43/49, 88%) were also higher than the 61% to 64% of participants who reported downloading mobile apps in a study by Dahne and Lejuez [
This study has several limitations. First, we performed a brief, nonsystematic review, and it is likely that relevant papers may not have been included. We attempted to strengthen the robustness of this focused literature review by utilizing two independent reviewers, two separate search engines, and broad key words to capture and screen more abstracts. Future works should incorporate a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-based systematic review to capture a broader range of studies. Second, the relatively small sample of our cross-sectional survey study precluded our ability to explore the impacts that race, socioeconomic status, age, and other factors have on smartphone ownership, utilization, and acceptability. Third, the predominantly White sample, especially the predominantly White inpatient detoxification cohort, limits the generalizability of this study. However, we recruited from two disparate clinical sites in two very different geographic locations to expand the diversity of recruited participants. Fourth, the degree of selection bias among our outpatient methadone clinic cohort is difficult to assess without ascertaining a survey response rate and consequently may impact the reliability of our results. However, we were able to obtain a survey response rate among individuals at our inpatient detoxification site. Those who turned down the survey at the inpatient detoxification site were asleep, were medically unwell, or were preoccupied at the time of survey distribution.
Future work in this area should include larger patient populations across various sites, which might include non–methadone outpatient substance use clinics. Further, in vivo, randomized controlled studies of promising mental health apps for substance use disorders are needed to establish clinical efficacy. Studies clarifying the effects of socioeconomic status, race, and other factors on digital literacy, smartphone utilization, smartphone ownership, and the acceptability of using apps for substance use interventions among individuals with substance use disorders are needed. Privacy and security concerns around mental health apps will need to be addressed, especially given that individuals with mental health and substance use disorders are particularly vulnerable.
Addiction-Comprehensive Health Enhancement Support System
Brigham and Women’s Faulkner Hospital
mobile health
methadone maintenance treatment
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
We acknowledge Faith Stone from Vermont Blueprint for Health. This study was supported in part by the American Psychiatric Association/Substance Abuse and Mental Health Services Administration Minority Fellowship Program Grant, the Brigham Research Institute Microgrant, and a National Institutes of Health/ National Institute on Drug Abuse grant (K23DA042326).
All data are represented in the tables and figures displayed in this publication. The data sets that were generated and/or analyzed during this study are available from the corresponding author on reasonable request.
This paper has not been published in and is not in review by another journal, and it has not been presented at any conference.
The final manuscript has been seen and approved by all authors.
MH is on the scientific advisory board of Healthy Gamer, LLC. JT is a cofounder of Precision Mental Wellness.