HSC research partners awarded $3 million grant to expand smartphone study for reducing alcohol use among the unhoused

[Link]Dr. Scott Walters, regents professor of population and community health at The University of North Texas Health Science Center at Fort Worth's College of Public Health, with research partners from the University of Oklahoma, has received over $3 million in funding from the National Institute on Alcohol Abuse and Alcoholism to expand their previous work that used a smartphone app to reduce drinking among adults experiencing homelessness.

The new grant, which extends through April 2029, builds on prior research by co-principal investigators Dr. Walters and Dr. Michael Businelle, a core faculty member in the TSET Health Promotion Research Center at the OU Health Stephenson Cancer Center. Joining in this new stage of research is Dr. Jason Oliver from the OU College of Medicine.

The pilot study

Walters and Businelle were first awarded a $650,000 NIH grant in 2018 to test a smartphone-based alcohol treatment program through a pilot study of Dallas-area participants. The study compared people's drinking patterns before and after receiving automated treatment messages on their smartphone.

The pilot study reached 78 people through almost 5,000 phone surveys conducted throughout the day, enabling the app to predict 82% of drinking episodes based on the person's self-report of what was happening in the moment.

"Machine learning allowed us to use things like people's moods and urges, and alcohol availability, to predict whether or not they were likely to start drinking. The app then gave tailored suggestions that could curb people's intentions to drink," Walters said. "When the app predicted a person was about to drink, a message was enabled, encouraging them to practice refusal skills, engage in mindful breathing, practice other awareness techniques or move to a different location."

"The content of each message was unique to the particular risk factors the person was experiencing at that moment."

In addition to suggestions from the app, individuals were also given access to videos, tips and online resources.

The pilot study found that when people received the phone messages, their drinking decreased over four weeks, compared to people who did not receive the messages.

The alarming prevalence of drinking among the unhoused

According to the National Coalition for the Homeless, up to 55% of unhoused people suffer from alcohol use disorder.

American Addiction Centers estimates that around 1/3 of people experiencing homelessness have problems with alcohol and/or drugs, and AlcoholHelp.com notes that "a major problem facing many American cities is homeless alcoholism - few populations experience rates of alcohol use disorders as the homeless … the scope is massive."

Alcoholism is caused by and is also a cause of being unhoused. AlcoholHelp.com reports that some people experiencing homelessness "turn to alcohol to combat the stress of daily living and dangers, while others have suggested substance abuse is the cause of their homelessness."

The researchers' new, expanded study

Walters and Businelle's pilot study was completed in 2021, and its results were used to seek funding for this new, larger, trial that is expected to recruit more than 600 people in locations across Texas and Oklahoma over the next four years. The study will follow people over six-months, enabling the researchers to test the effect of the messages over a longer time. People who need a phone will receive assistance in securing one.

"The goal is to detect and then head off drinking before it occurs," Walters said.

Additional features of the new study will include tips on the benefits of sobriety, coping mechanisms for improving sleep and other useful advice. The app can also be used to connect users to their shelter or other local resources to improve their lives and keep them safe and sober.

Recruitment for this study is expected to begin in January 2025.

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