A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study

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Abstract

Background

Misuse of substances is common, can be serious and costly to society, and often goes untreated due to barriers to accessing care. Woebot is a mental health digital solution informed by cognitive behavioral therapy and built upon an artificial intelligence–driven platform to deliver tailored content to users. In a previous 2-week randomized controlled trial, Woebot alleviated depressive symptoms.

Objective

This study aims to adapt Woebot for the treatment of substance use disorders (W-SUDs) and examine its feasibility, acceptability, and preliminary efficacy.

Methods

American adults (aged 18-65 years) who screened positive for substance misuse without major health contraindications were recruited from online sources and flyers and enrolled between March 27 and May 6, 2020. In a single-group pre/postdesign, all participants received W-SUDs for 8 weeks. W-SUDs provided mood, craving, and pain tracking and modules (psychoeducational lessons and psychotherapeutic tools) using elements of dialectical behavior therapy and motivational interviewing. Paired samples t tests and McNemar nonparametric tests were used to examine within-subject changes from pre- to posttreatment on measures of substance use, confidence, cravings, mood, and pain.

Results

The sample (N=101) had a mean age of 36.8 years (SD 10.0), and 75.2% (76/101) of the participants were female, 78.2% (79/101) were non-Hispanic White, and 72.3% (73/101) were employed. Participants’ W-SUDs use averaged 15.7 (SD 14.2) days, 12.1 (SD 8.3) modules, and 600.7 (SD 556.5) sent messages. About 94% (562/598) of all completed psychoeducational lessons were rated positively. From treatment start to end, in-app craving ratings were reduced by half (87/101, 86.1% reporting cravings in the app; odds ratio 0.48, 95% CI 0.32-0.73). Posttreatment assessment completion was 50.5% (51/101), with better retention among those who initially screened higher on substance misuse. From pre- to posttreatment, confidence to resist urges to use substances significantly increased (mean score change +16.9, SD 21.4; P<.001), whereas past month substance use occasions (mean change −9.3, SD 14.1; P<.001) and scores on the Alcohol Use Disorders Identification Test-Concise (mean change −1.3, SD 2.6; P<.001), 10-item Drug Abuse Screening Test (mean change −1.2, SD 2.0; P<.001), Patient Health Questionnaire-8 item (mean change 2.1, SD 5.2; P=.005), Generalized Anxiety Disorder-7 (mean change −2.3, SD 4.7; P=.001), and cravings scale (68.6% vs 47.1% moderate to extreme; P=.01) significantly decreased. Most participants would recommend W-SUDs to a friend (39/51, 76%) and reported receiving the service they desired (41/51, 80%). Fewer felt W-SUDs met most or all of their needs (22/51, 43%).

Conclusions

W-SUDs was feasible to deliver, engaging, and acceptable and was associated with significant improvements in substance use, confidence, cravings, depression, and anxiety. Study attrition was high. Future research will evaluate W-SUDs in a randomized controlled trial with a more diverse sample and with the use of greater study retention strategies.

Trial Registration

ClinicalTrials.gov NCT04096001; http://clinicaltrials.gov/ct2/show/NCT04096001.

Related collections

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Author and article information

Contributors

Judith J Prochaska:

ORCID: https://orcid.org/0000-0001-7925-326X

Stanford Prevention Research CenterSchool of MedicineStanford UniversityMedical School Office Building, X3161265 Welch RoadStanford, CA, 94305United States1 650 724 3608jpro@stanford.edu

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J Med Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: March 2021

Publication date (Electronic): 23 March 2021

Volume: 23

Issue: 3

Electronic Location Identifier: e24850

Affiliations

[1 ] Stanford Prevention Research Center School of Medicine Stanford University Stanford, CA United States

[2 ] Department of Psychiatry & Behavioral Sciences School of Medicine Stanford University Stanford, CA United States

[3 ] Department of Epidemiology & Population Health School of Medicine Stanford University Stanford, CA United States

[4 ] Woebot Health San Francisco, CA United States

Author notes

Corresponding Author: Judith J Prochaska jpro@ 123456stanford.edu

Author information

Judith J Prochaska https://orcid.org/0000-0001-7925-326X

Erin A Vogel https://orcid.org/0000-0002-7193-8720

Amy Chieng https://orcid.org/0000-0003-2739-7338

Matthew Kendra https://orcid.org/0000-0002-4065-1217

Michael Baiocchi https://orcid.org/0000-0002-7571-5268

Sarah Pajarito https://orcid.org/0000-0003-3201-0353

Athena Robinson https://orcid.org/0000-0002-1393-1563

Article

Publisher ID: v23i3e24850

DOI: 10.2196/24850

PMC ID: 8074987

PubMed ID: 33755028

SO-VID: 157d98c2-ff8a-4878-8455-807cf40e50dd

Copyright © ©Judith J Prochaska, Erin A Vogel, Amy Chieng, Matthew Kendra, Michael Baiocchi, Sarah Pajarito, Athena Robinson. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.03.2021.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 7 October 2020

Date revision requested : 14 December 2020

Date revision received : 19 January 2021

Date accepted : 31 January 2021

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