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Reshaping the Landscape of Addiction Treatment

A Behavior Analytic Account of the Effectiveness of Sober Sidekick’s Platform on Relapse Prevention


Reshaping the Landscape of Addiction Treatment
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By Amber L. Valentino, Psy.D., BCBA-D


This white paper addresses the complex terrain of addiction as a public health crisis and explores an innovative technology platform (Sober Sidekick) aimed toward recovery and resilience.



The Addiction Epidemic


In the quiet corners of society, a silent epidemic rages on—an epidemic that knows no bounds of age, gender, socioeconomic status, or geography. Addiction has emerged as a formidable public health crisis that permeates communities around the world. The insidious grasp of substance abuse has the potential to disrupt lives, families, and entire societies. Understanding the multifaceted nature and the far-reaching consequences of addiction is paramount.


Nearly 21 million Americans suffer from addiction, with alcohol being the most widely abused substance (National Institute on Drug Abuse, 2022). People are not only suffering—they are also dying. Each year, nearly 140,000 people die of alcohol-related deaths (National Institute on Alcohol Abuse and Alcoholism, 2023) and over 96,000 die of drug overdoses (National Center for Drug Abuse Statistics, 2023). Although addiction is highly treatable, treatment can be difficult to access. There is a significant shortage of trained professionals and limited access to treatment facilities. There are not nearly enough mental and behavioral health providers to support those suffering—the most recent data from the Bureau of Labor Statistics (n.d.) shows only 351,000 counselors nationwide trained in substance abuse, behavioral disorder, and mental health and only 14,000 treatment facilities. According to a recent behavioral health business report, “Provider shortages continue to be a top issue and a barrier to patients receiving care. In fact, 38% of industry insiders polled in a survey said insufficient provider availability was the most significant challenge patients face when receiving treatment” (Lovett, 2023).


The shortage of providers creates a significant gap in the ability of people struggling to access care, and certain groups of people may be even more vulnerable to experiencing barriers that prevent them from getting help. For example, people battling addiction in rural and remote areas lack access to nearby treatment facilities and access to community support. Even those who live close to treatment options may struggle to access these resources due to lack of transportation, lack of accessible childcare, or inflexible work schedules that prevent them from participating in meetings, groups, or therapy. Even when these barriers can be overcome, a person’s mental health concerns, fear, or anxiety may prevent them from seeking social support or obtaining treatment for their addiction. As one anonymous person wrote: “I live in a smaller area, and I don’t want to see people I know because I work in the community.” Unfortunately, there is a strong stigma associated with addiction and recovery, a stigma many people cannot avoid. This stigma often prevents those suffering from seeking care that might reveal their addiction.


Those who suffer from addiction need accessible support that they can contact any time and from any place. They need modern solutions for avoiding stress that can commonly be experienced by attempting to access traditional treatment options, and for contacting immediate reinforcing contingences for sobriety.


An Effective Solution


In a time defined by technological advancement and connectivity, the potential to revolutionize substance abuse and dependence treatment is both unprecedented and promising. With the world more interconnected than ever before, technology stands as a beacon of hope, illuminating a path towards accessible, personalized, and effective interventions. Sober Sidekick is an innovative mobile application designed to support individuals on their journey to recovery. Sober Sidekick utilizes gamified peer-to-peer support to foster meaningful connections around sensitive topics that individuals may be hesitant to discuss elsewhere. The app utilizes an “empathy algorithm,” which ensures a 100% response rate from peers, meaning that each time a member posts on the platform, they receive support from the Sober Sidekick community, typically within seconds. The platform also offers support meetings 24 hours per day, 7 days per week, and members can join a meeting any time. Sober Sidekick seeks to leverage the strength of the community to expand positive outcomes and to preserve lives. Given the shortage of treatment providers and lack of accessibility to existing treatment options for many people, Sober Sidekick aims to scale preventative health and provide comprehensive support to individuals seeking recovery (Validation Institute, 2023). One anonymous user of the platform wrote: “It is the support that gets you through—this app is one of the best supports you can have. I post something, and from all over, you get the support that you need.”


How Sober Sidekick Works


Sober Sidekick is a peer-led app and social media platform. Community members are recovering addicts. The app is available for free and can be downloaded within seconds. Sober Sidekick aims to protect anonymity, so the only thing needed to create a profile is a username and a sobriety start date. There is a sobriety counter at the top of the feed that shows the number of days, weeks, months, and years of a member’s sobriety, as well as the amount of money a member has saved while maintaining their sobriety. Community members can post and receive positive support through empathy badges, or comments from other community members. There is a messaging feature, and members can connect to a virtual support meeting 24 hours per day/7 days per week.


Early Outcomes


Sober Sidekick aims to reduce relapse, and the platform automatically captures data to analyze this variable. Specifically, all community members must enter a sobriety date when they sign up to use the app. When a member’s sobriety date changes (i.e., they relapse), they reenter a new date, and this data is captured. Thus, relapses are defined as the act of setting a new sobriety date later in the members’ user journey. The organization hypothesizes that, the more engaged a community member is with the app (i.e., they post, offer support to others, and receive positive reinforcement for sobriety), the less likely they are to relapse.


This hypothesis was evaluated in a recent report published by Validation Institute (2023). Data from 50,000 Sober Sidekick users was analyzed to determine the association between engagement and relapse. Sober Sidekick users were segmented by the number of peer-to-peer written engagements they had. For each segment—such as those having two engagements—the percentage who reported a new sober date (relapsed) was averaged for 12 months. The comments from new users for November 2022 through January 2023 were tracked to determine how many and how quickly they engaged. The starting point was the total number of new users; then, the analysis tracked the average amount of time before users had at least one comment, two comments, and up to five comments. The validation report made several key findings, including: (a) as the number of engagements with Sober Sidekick increases, the number of relapses decreases; (b) frequent app users (defined as those with five or more engagements) are more likely to be enrolled and engaged in the program at 12 months; (c) those who engage with the app on the first day are more likely to remain sober than those who do not; and (d) abstinence rates among community members are similar to rates found in residential treatment facilities.


Figure 1 demonstrates Finding 1 from Validation Institute’s (2023) report, that as the number of engagements increases, the number of relapses decreases.


Figure 1

Finding 1 From Validation Institute

Note. Data derived from Validation Institute’s 2023 Sober Sidekick validation report.


Figure 2 below depicts these data differently—that the more engagements a person has with the Sober Sidekick platform the less likely they are to relapse.


Figure 2

Finding 2 From Validation Institute

Note. Data derived from Validation Institute’s 2023 Sober Sidekick validation report.


These initial outcomes present a very promising outlook, with evidence that Sober Sidekick has an important role to play in preventing relapse. Sober Sidekick is currently investigating the use of artificial intelligence to predict relapse. If relapse can be predicted to a high degree, interventions can be developed to reduce the likelihood of relapse, including reaching out to members through the messaging system on a regular basis, encouraging engagement, and applying reinforcement contingencies for sobriety.


Possible Mechanisms of Change Underlying Behavior Amongst Sober Sidekick Community Members


The ideal treatment for substance abuse and dependence is accessible and cost-effective and produces excellent long-term outcomes (i.e., lasting sobriety). Given the initial evidence of success of the Sober Sidekick platform on relapse prevention, it is worth hypothesizing the behavioral mechanisms that may be responsible for the positive outcomes observed. These hypotheses can lead toward additional investigation by behavioral scientists to further isolate the variables influencing these outcomes, and toward greater societal and financial investment in Sober Sidekick’s platform with the overall goal of scaling preventative healthcare.


The exact mechanisms responsible for behavior changes are likely due to a complex mix of variables that influence choice, including but not limited to concurrent schedules of reinforcement, reinforcement value, and stimulus control. A behavioral economic analysis is warranted. Despite these complexities, we can draw from existing literature to form some basic hypotheses about the effectiveness of the Sober Sidekick Platform.


Contingency Management


Contingency management (CM) focuses on providing reinforcement or incentives for sobriety. For example, if a person recovering from opioid use provides a urine sample that tests negative for opioids, they receive a reward or voucher that can be used for various items or activities, such as groceries, movie tickets, or other items they find personally meaningful. These items act as positive reinforcement for sobriety. Positive urine tests for opioids would result in predetermined consequences, such as a temporary loss or reduction of access to these types of rewards. Feedback is provided consistently, highlighting the importance of maintaining abstinence. The science of behavior analysis has demonstrated that CM is more effective than traditional psychosocial approaches to treating substance abuse disorders (Madden, 2008). CM has been shown to be effective in promoting short-term abstinence and reducing use among individuals with substance use disorders.


CM, an established and effective solution for preventing relapse, may benefit from modernized practices that involve technology, gamification, and instant access to rewards that do not need to be delivered by trained professionals. This modernization is particularly important, given that the implementation of traditional CM programs can be resource-intensive and costly, which can limit their availability and sustainability.


Sober Sidekick may work to replicate CM in a different form. Although contingencies are not directly manipulated by a trained professional, the Sober Sidekick community provides social praise, encouragement, and direction for sober behaviors, all of which may function as positive reinforcement for sobriety for community members. The platform likely works in the same way traditional social media platforms operate, though Sober Sidekick has a clear target behavior to reinforce—sobriety. Community members provide immediate praise in the form of comments and badges to members maintaining sobriety, and those who utilize those forms of positive reinforcement also receive reinforcement for their engagement with the platform in the form of empathy badges. The hypothesis that Sober Sidekick is a form of CM may help to explain Validation Institute’s (2023) finding that the more engaged and active someone is on the app, the more likely they are to maintain their sobriety. Put simply, when community members engage with the app, they contact the contingencies for maintaining sobriety; when they don’t engage with the app, they do not access these same contingencies.


Self-Management


The most effective self-management programs specify a goal and define the behavior to be changed, have a mechanism for self-monitoring behavior, and have an avenue for evaluation of effects. Additionally, publicly announcing commitment to change and having self-management partners can increase the likelihood of success (Cooper, Heron, & Heward, 2019, pp. 707). Sober Sidekick meets the requirements for an effective self-management system and much of the success of active platform users in maintaining sobriety could be due to self-management. Sober Sidekick provides the structure needed for community members to successfully self-manage, including defining their target behavior (i.e., sobriety), a tracking system, and public visibility.


Modeling


Some research (e.g., Caudill & Lipscomb, 1980) suggests that alcohol consumption can be modified by the social influences of modeling; thus, modeling can be an effective intervention for sobriety. The effectiveness of modeling may help explain why traditional peer support programs (e.g., Alcoholics Anonymous) have proven effective. However, as aforementioned, access to these groups and community resources can be severely restricted to those who have the physical ability and mental health that allow them to attend meetings. Simply put, these programs are often difficult for many people to access.


Working on the premise of modeling as a powerful tool, we can hypothesize that Sober Sidekick provides access to numerous models demonstrating the positive effects of sobriety as well as the negative effects of relapse. For example, it is common for community members to post pictures of themselves spending time with their children on the weekends without a hangover, walking in nature, and participating in hobbies such as cooking—all things they can do because of their sobriety. It is also common for community members to post the negative effects of relapse; for example, getting a DUI, experiencing a black eye, or losing custody of their children because of excessive alcohol use. Sober Sidekick makes modeling more accessible and significantly reduces the response effort associated with accessing models that community members would not have access to without the technology offered by Sober Sidekick.


Replacement Behavior


A final viable behavioral explanation for the positive outcomes achieved by Sober Sidekick may be that the app functions as a replacement behavior for drinking. This explanation is highlighted by community members, who often post that upon feeling the urge to drink, they turn on the app and engage with it. This app engagement immediately allows them to contact the contingencies for sobriety and can serve as a replacement behavior for drinking. The contingencies may be more valuable for app engagement than for drinking.

CM, self-management, modeling, and replacement behaviors are four viable behavioral explanations for the positive effects of Sober Sidekick on preventing relapse. Of course, there are a variety of other behavioral mechanisms likely responsible for change, including but not limited to rules and rule-governed behavior, completing behaviors, prompts, stimulus control, and behavioral economic variables influencing choice.


Conclusion and Call to Action


Further investment in Sober Sidekick is necessary to help identify the exact mechanisms responsible for change and to invest in modern solutions to tackle addiction as a public health crisis. This investment may come through funding from public and private health initiatives, independent research, managed healthcare investment, and community support.


Sober Sidekick’s creative integration of technology offers a transformative opportunity to reshape the landscape of addiction treatment. By harnessing the power of virtual connectivity, data analytics, and user-centric design, we stand on the cusp of a new era where recovery and support are at the fingertips of those who need it most.


About the Author


Amber Valentino, Psy.D., BCBA-D

Chief Clinical Officer – Trumpet Behavioral Health

Dr. Valentino is the Chief Clinical Officer for Trumpet Behavioral Health where she develops workplace culture initiatives, supports clinical services, leads all research and training activities, and builds clinical standards. Her research and clinical work span a variety of topics including verbal behavior, ways to connect the research to practice gap, professional ethics, and effective supervision. She has published several peer-reviewed research articles, invited book chapters, and she recently published a book in partnership with New Harbinger Publications titled: Applied Behavior Analysis Research Made Easy: A Handbook for Practitioners Conducting Research Post-Certification.


Dr. Valentino has served as an Associate Editor for Behavior Analysis in Practice and for The Analysis of Verbal Behavior. She is on the editorial board for the Journal of Applied Behavior Analysis (JABA) and serves as a frequent reviewer for several behavior analytic journals. She works to support dissemination of behavior analysis to the general parent population through her personal website, behavior-mom.com.


Author’s Disclosure. I have used Sober Sidekick in my personal journey to sobriety. I affirm that I have no other conflicts of interest related to the subject matter discussed in this white paper. I confirm that I have not received any financial incentives, sponsorships, or other forms of compensation for the creation, development, or publication of this white paper.


References


Caudill, B. D., & Lipscomb, T. R. (1980). Modeling influences on alcoholics’ rate of alcohol consumption. Journal of Applied Behavior Analysis, 13(2), 355–365. http://dx.doi.org/10.1901/jaba.1980.13-355


Cooper, J. O., Heron, T. E., & Heward, W. L. (2019). Applied Behavior Analysis (3rd Edition). Hoboken, NJ: Pearson Education.


Lovett, L. (2023, August 11). ‘There’s a lot of growth in that industry’: Addiction treatment viewed as behavioral health’s top expansion area. Behavioral Health Business. https://bhbusiness.com/2023/08/11/theres-a-lot-of-growth-in-that-industry-addiction-treatment-viewed-as-behavioral-healths-top-expansion-area/


Madden, G. J. (2008). Ammunition for fighting a demand-side war on drugs: A review of contingency management in substance abuse treatment. Journal of Applied Behavior Analysis, 41, 645–651. http://dx.doi.org/10.1901/jaba.2008.41-645


National Center for Drug Abuse Statistics (2023). Drug overdose death rates. https://drugabusestatistics.org/drug-overdose-deaths


National Institute on Alcohol Abuse and Alcoholism. (2023). Alcohol-related emergencies and deaths in the United States. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-related-emergencies-and-deaths-united-states


National Institute on Drug Abuse. (2022, March 28). NIDA IC fact sheet 2023. U.S. Department of Health and Human Services, National Institutes of Health. https://nida.nih.gov/about-nida/legislative-activities/budget-information/fiscal-year-2023-budget-information-congressional-justification-national-institute-drug-abuse/ic-fact-sheet-2023


U.S. Bureau of Labor Statistics. (n.d.). Occupational outlook handbook: Substance abuse, behavioral disorder, and mental health counselors. U.S. Department of Labor. Retrieved August 26, 2023, from https://www.bls.gov/ooh/community-and-social-service/substance-abuse-behavioral-disorder-and-mental-health-counselors.htm#tab-6


Validation Institute (2023). Validation program report: Sober Sidekick. https://validationinstitute.com/validated-provider/sober-sidekick/

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