Like many other chronic diseases, addiction is a constant battle that can’t be cured—but it can be managed, according to the National Institute on Drug Abuse. Because addiction recovery is an ongoing process, it’s important treatment options are as creative as possible to keep patients engaged.
One solution is the Hey,Charlie app, which alerts people recovering from addiction of environmental triggers.
In an interview with Clinical Innovation + Technology, Hey,Charlie co-founder Emily Lindemer, PhD, discussed the app and how the healthcare industry benefits from patient-monitoring tools.
“No, not everyone in recovery will benefit from a tool like Hey,Charlie, but some will, and that's important. It's the same way that some individuals feel that [Alcoholics Anonymous] saved their life; others hate it, and medication-assisted therapy helps some and not others,” Lindemer said. “If we can be open-minded about this idea that there isn't one solution, we can move towards a goal of figuring out the right combination of tools and treatments for specific individuals, and hopefully keep more people in recovery for longer.”
Clinical Innovation + Technology: Where did the idea for the Hey,Charlie app originate?
Emily Lindemer, PhD: Hey,Charlie was born out of a healthcare hackathon run by MIT Hacking Medicine in May 2016. The organization's hackathon model asked participants to get up and pitch a problem—not a solution—to something in healthcare. At the time, someone close to me had been struggling with addiction and was bouncing in and out of recovery. One of the key things I saw that led to relapses wasn't something that clinics or medication could touch—it was social and environmental triggers. You could almost predict a relapse based on who this person was calling, texting and getting rides with. I thought, "Is there a way to tap into that?" and over the course of the hackathon weekend, we formed an idea. We won Best Mental Health Hack and figured it had some promise, so we’ve been working ever since on refining, building and piloting the idea.
How does Hey,Charlie work? Why is it helpful for someone overcoming addiction?
Hey,Charlie has a relatively straightforward premise. The end-user goes through an onboarding process where they answer a few questions about themselves, a few questions about frequently visited locations and a few questions about their frequently contacted mobile contacts. From this input, we try to infer how different locations and relationships relate to the end-user's sobriety and if any of them might be triggers. The end-user never really has to use Hey,Charlie after that initial process—although they can to access different recovery-based content—but for the most part the app acts passively as a background process. Anytime communication is initiated with someone who might be risky for recovery (for example, an incoming or outgoing text message), Hey,Charlie will give a pop-up notification first that says something like, "Hey there, take a second, are you sure you want to talk to this person right now?" What it does is it gives the end-user a moment of pause before engaging in a behavior that might be triggering—kind of like a friend who is always there on your shoulder. Likewise, positive feedback is given through similar notifications when communication is initiated and sustained with contacts and locations that we think are positive for the end-user's recovery.
How can healthcare benefit from these kinds of patient-monitoring tools?
Since recovery from substance use disorder is something that individuals have to work on constantly, in the 24/7 of their lives, it's a difficult disease for healthcare providers to tackle. They can't be there right when triggers might arise, and they can't expect their patients to discuss all of these triggers with them when they get so little face time together. What Hey,Charlie can do is aggregate moment-to-moment data about potential triggers and deliver it back to healthcare providers to give them starting points for conversations. These conversations can then in turn lead to better, more personalized strategies for dealing with triggers and staying in recovery.
What challenges—such as HIPAA and data security concerns—do app developers face in medicine?
HIPAA and data security both pose challenges for app developers in medicine, especially when working with vulnerable populations such as those in recovery. Even if you build a secure, HIPAA-compliant cloud structure to collect and store data in, you also have to worry about the individual's physical phone itself. If the phone is lost or stolen, you have to ensure that your app does not put the individual at risk for incriminating them or stigmatizing them for their condition. These are all things that we pay close attention to and prioritize with development.
How have patients received the technology so far? Have there been any concerns about security or sharing too much data?
The feedback from the patients who we have piloted thus far has been very positive. We hear feedback that it helps patients keep their sobriety at the front of their minds, helps them to pause and think before engaging with people who they know can be triggering and that it makes them feel supported when they are traveling through areas that bring up stressful feelings related to drug use. Surprisingly, most patients who have used Hey,Charlie have had relatively low levels of concern about security and data sharing. I think that this is for two reasons: First is that in this day and age, people are used to allowing apps permissions for accessing their geolocation and their contact base, so it doesn't feel very out of the ordinary. Second is something that I think people get wrong about substance use disorder a lot: These individuals want support and tools that can help them stay healthy. If it means giving up a little bit of information about what they're up to, it's often worth it to them. Most of the patients we've piloted with are even open to having direct conversations with their clinicians about their mobile contacts, which surprised us even more. It's very promising and I think shows how much these individuals want to be understood and how much the societal stigma of addiction makes us misjudge them.
Danielle covers Clinical Innovation & Technology as a senior news writer for TriMed Media. Previously, she worked as a news reporter in northeast Missouri and earned a journalism degree from the University of Illinois at Urbana-Champaign. She's also a huge fan of the Chicago Cubs, Bears and Bulls.