Digital Therapeutic Results in Strong Retention Rates Among People with Methamphetamine Use Disorder

A new study suggests a digital therapeutic designed to treat people with methamphetamine use disorder (MUD) can obtain higher completion levels than more traditional, in-person therapy.

The app, which includes a monetary reward component, appeared to lead to long-term results in at least a subset of patients, according to the study. The report was published in Frontiers in Psychiatry.

Kristin Muhlner

An estimated 1.6 million people in the United States are in need of treatment for methamphetamine use, but only about one-third (32%) are actually receiving treatment, said corresponding author Kristin Muhlner, and colleagues. Furthermore, the authors said, the 1.6 million figure is likely an under-estimate of the actual number of people in need of treatment. Muhlner is the chief executive of Affect Therapeutics, Inc., which developed the MUD therapeutic evaluated in the study.

Affect’s app uses a variety of tools, including individual and group-based cognitive behavioral therapy, therapeutic tasks, remote drug testing, oversight by healthcare professionals, and contingency management (CM) procedures. The latter includes things such as rewards for clean drug tests and task completion.

Those strategies are the same types of strategies used in other MUD treatment programs, the authors said.

“Still, no single modality or combination has been consistently effective in retaining individuals with MUD in treatment, partly because traditional models of treatment delivery require frequent in-person attendance at clinical settings, which is a barrier to engagement and can inhibit retention, compromising outcomes,” Muhlner and colleagues said.

In the new study, the investigators wanted to know whether their therapeutic would be successful at retaining and engaging patients over the course of the 8-week intervention, as well as whether it was effective at reducing or stopping methamphetamine usage among app users.

The investigators recruited 49 adults with moderate-to-severe MUD to start the program. Of those who started, 27 completed the program. That statistic alone is meaningful, the authors said. They noted that a long-term study looking at the dropout rates for MUD programs over a 50-year time frame found 53.5% of people dropped out. Another report, based on 2019 data, found just 31.2% of people in outpatient programs for stimulant drug-use completed their course of therapy.

“Our results confirm the feasibility of the Affect program’s remote management of CM procedures, which were conducted via app,” the authors said, “including the delivery of rewards for completion of tasks and activities.”

In the program, patients received “small” financial rewards when they kept appointments and when they had negative drug screens. Patients were also given bonuses for consecutive streaks of negative drug tests. The investigators found that participants were more likely to test negative for methamphetamine at week 8 compared to week 1 (odds ratio for negative test = 1.57).