Development of a mobile harm reduction treatment for alcohol use disorder (mHaRT-A)

ABSTRACT Since the COVID-19 pandemic, deaths due to alcohol use spiked to 25% percent beyond its expected toll. It is this ever-growing global burden of alcohol-related harm that has propelled our team to conduct over 15 years of research to codevelop with people with AUD and then scientifically test a highly flexible, patient-driven, low- barrier, in-person treatment known as harm-reduction treatment for alcohol use disorder (HaRT-A). HaRT-A meets people where they are at to help them create goals around reducing alcohol-related harm and engage safer-drinking strategies, even if they are not ready, willing or able to stop drinking. Findings from our recent, NIH-funded randomized clinical trials have shown the efficacy of this low-barrier, in-person HaRT-A in reducing heavy alcohol use and alcohol-related harm and in improving health-related quality of life, even in a population that is socially marginalized and severely impacted by AUD. However, the vast majority of people with AUD -- approximately 93% in 2021 -- do not seek in-person treatment. Barriers to alcohol treatment attendance include the high time and monetary cost of in-person treatment, its lack of patient-centeredness and flexibility, and the stigma of others knowing one is in treatment. In addition, the pandemic made greater swaths of the general public comfortable with digital technologies for health and treatment service provision. Thus, a mobile application of HaRT-A could reduce barriers to help-seeking by creating easier access to evidence-based alcohol interventions. In this STTR phase 1 application, we propose to develop and initially test a mobile application to deliver the HaRT-A components (mHaRT-A) and thus address alcohol-related harm and AUD in a more accessible and scalable as well as less costly and stigmatizing way. We plan to accomplish this goal by building the mHaRT-A prototype with a human-centered design framework and then iteratively testing its usability, feasibility and acceptability among people with AUD. Our Aim 1 milestone is a human-centered prototype of the mHaRT-A progressive web application that will advance for usability testing in Aim 2. Our Aim 2 milestone is to complete lab-based usability testing of the mHaRT-A and achieve a System Usability Scale score of 70 or greater, which would indicate an adequate system. Our Aim 3 milestone is to test the feasibility and acceptability of the high-fidelity mHaRT-a prototype and the planned STTR Phase 2 randomized clinical trial procedures as demonstrated via adequate recruitment, retention and implementation of the planned procedures. Successful completion of the STTR Phase 1 project will create the foundation for a well-powered STTR Phase 2 randomized clinical trial testing mHaRT-A’s efficacy in reducing alcohol-related harm and improving health-related quality of life. If successful, this overarching project will build an evidence base for the successful commercialization and dissemination of mHaRT-A to people with AUD and to healthcare providers and systems.