Two University of Wisconsin professors have been granted an award from the National Institutes of Health to conduct work with the goal of combating opioid relapse.
The NIH granted Dhavan Shah and John Curtin $3.42 million to work on a mobile phone app. The app seeks to prevent relapse amongst those recovering from addiction.
John Curtin, Professor and Director of Clinical Training in Department of Psychology and a co-principle investigator, focuses his research on the psychological and neural mechanisms involved in risk, prevention and intervention for patients with drug use disorders.
“Relapse happens frequently early in recovery for alcohol and substance use disorders but it can also happen months and even years after someone quits,” Curtin said. “Therefore, one of the biggest challenges that people with alcohol and substance use disorders have is to continually monitor their recovery and look out for risks for relapse, essentially for the rest of their lives.”
Curtin’s previous research with Shah worked to monitor these risks for relapse, although in that case the project was focused on recovery from alcohol addiction.
Curtin said relapses can have triggers or methods with which to predict them and that he focuses on tracking them in his work.
“Lapses and relapse often seem to come out of the blue from the perspective of the participant, though in hindsight, there were usually reasons to be [concerned],” Curtin said. “Over the past five years, my lab has been working to use emerging mobile sensing capabilities from smartphones and wearable sensors to build models that can predict, in real time, the likelihood that someone will lapse back to drug use.”
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Shah, who is a Louis A. & Mary E. Maier-Bascom Professor in UW-Madison’s School of Journalism and Mass Communication, said his work and Curtin’s work combined created a strong platform for this project.
Shah’s research focuses on communication influence on social judgments and health support and behavior.
Shah added that this project was a real collaborative effort. He said that by utilizing computer science, engineering, psychology, and his own work in communications, it showed the real change and collaboration a large university can facilitate.
Curtin also discussed a first project that he and Shah collaborated on — one close to being finished. It also focuses on addiction and relapse.
“We are about to complete a first project that has followed people with alcohol use disorder for the first three months of their sobriety,” Curtin said. “We can predict with better than 90 percent accuracy whether they will use alcohol on any given day. More importantly, we can do this with almost completely passively, with no burden placed on them.”
Curtin said they used patients’ cell phones to track their locations by looking at their cellular communications like voice and text messages. Curtin added that they also placed sensors in their beds to monitor the quality of their sleep.
All these were passive, requiring minimal active effort from patients, Curtin said. Providing a rich context around these signals was also important.
“We establish locations they have used alcohol in the past, addresses and contact numbers of people that support or detract from their abstinence,” Curtin said. “We know the addresses of their health care providers. We can combine GPS and communications data with this context to produce powerful signals about the integrity of their recovery and the likelihood that they will use alcohol or drugs in the near term.”
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Curtin said this relapse risk signal can guide them to seek further support from friends, treatment providers or a health app.
Curtin added that not only is the app helpful for determining when someone will relapse, but why. The app can then direct them to a temporary solution.
“These same models can not only identify when someone is at risk for relapse but also why they might relapse,” Curtin said. “This information can be used to guide the person to the tools and services that are both tailored specifically to them and to that moment in time. Someone who is at high risk for relapse because of a momentary strong urge could use games or other distracting activities … to wait out the urge until it passes. Someone who is at risk for lapse because of mounting stressors [or] hassles would instead be directed to use guided relaxation or meditation modules.”
Curtin said the current project would directly extend their work from alcohol use disorder to opioid use disorder.
He added that they would be altering their sample as well.
“[The new project] will also focus on recruiting a nationally representative sample,” Curtin said. “This will be important because the signals that predict relapse back to opioid use are likely different for someone who lives in an urban versus suburban versus rural part of the country. This is particularly important for use in a state like Wisconsin, where we want to be able to use the model to help people in urban areas like Milwaukee and Madison but also in more rural areas that have been also severely affected by the opioid crisis.”
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Curtin said that in the new grant, they would follow people further into their recovery — up to one and a half years after the initial abstinence.
Curtin said that the triggers for relapse are likely different for someone in the first stage of recovery, as opposed to after they have achieved stability. He said by tracking later into their recovery process, the tool can learn how these triggers change.
Shah said he believed the project exemplified the Wisconsin Idea.
“The project is a great example of the way UW contributes to the Wisconsin Idea,” Shah said. “Addiction treatment is a huge issue, so it’s an important story to tell. You can make a difference in the lives of people outside of this campus and all over the world.”
