Recovery is Possible!

A case study exploring the research phase of developing an app to support individuals recovering from drug and alcohol addiction

I worked with a small startup to improve a daily inventory for individuals in various stages of recovery from drug addiction. The purpose of the inventory is for individuals to reflect on their recovery and set goals for the next day. By using the inventory daily, users can track their recovery and share their progress with a sponsor, treatment provider or friend to maintain their recovery.

The company was developed to help those in recovery recognize if a relapse was happening and provide support to help them through it. The inventory tool provides daily reminders to engage with the form and the team can engage with users as needed to provide additional support.

The end goal is to expand this tool and test with users who are currently involved in a treatment center located in Austin, Texas.

The Challenge

The inventory was written using 12-step (such as Alcoholics Anonymous or “AA”) language. Some users find the language and spiritual aspect to be off-putting, so my first task was to make the form more accessible to all in recovery.

By doing this task, I discovered there are a lot apps to support recovery and I wanted to better understand the landscape and options for users. This launched a quest to understand the strengths and weaknesses of existing apps and how we might set ourselves apart.

Why this project and what are we hoping to achieve?

Resources for drug and alcohol addiction are needed now more than ever.

Research shows that there is currently limited access to care, especially for those with opiate addiction. By creating an app focused on recovery from addiction, the goal is to reduce relapse and provide support from anywhere.

At this time, the product in development is not public but the story is still worth telling. I learned enough to form ideas on how we might improve existing tool and how we can grow to meet the need for tools for those struggling with addictions.

Part 1: Adapting the inventory for a broad audience

Some of the criticism of the 12-step methodology was the idea of spirituality was a turn off for users. Because our inventory was entirely based on 12-step literature, we wanted to make the form accessible to all. The first challenge I was tasked with was improving the daily inventory form. I proposed 4 steps for improving the form:

1. I changed the language of the form to read more positively. For example “I was honest today” instead “I was dishonest today”

2. I wrote a friendly statement stating users will receive their daily pledge to their sobriety the next day after filling out the inventory. The order of the questions would stay the same in this phase.

3. After 4 weeks, change the order of the questions to make them logical and continue to make the statements more secular and grounded in current evidence-based recovery tools

4. Ensure that users are informed of how their answers are protected and are aware of upcoming changes and are able to anticipate them before they are implemented. Add a privacy statement at the end of the form so users understand why they are entering their phone number and how it will remain safe.

Part 2: Research and future implications

I chose to conduct desk research to understand the landscape of addiction recovery tools.

I reviewed three scholarly articles to understand the current best practices for addiction treatment and critiques of current apps for addiction recovery and conducted a competitive analysis.

I intended to use these methods to better understand what should be a priority as we expanded the tools available to users. I wanted to see what tools users were currently using and what features they found to be helpful. For example, users liked having tools such as daily reminders, safe community engagement and positive language and encouragement. Audiences responded well to interfaces that were not cluttered and were easy to navigate. Tools users found less helpful were sobriety counters that reset when a relapse would happen without support to get back on track and tools that were primarily 12-step focused.

From a clinical standpoint, the biggest criticism was a 12-step based app was not considered evidence-based. Recommendations included a broad variety of modalities. In order to use this product in a clinical setting, it would need to include evidence-based elements. What I found in research was with any clinical treatment, utilizing a variety of tools was helpful for recovery. One tool cannot work for all individuals and would need to be customizable for users.

What did I gain from the research?

Lots and lots of questions! I wrote down each question and thought as they came to mind such as:

• Who is this app for? Who is this app not for?

• Would users actually find this helpful?

• How can we make this app as inclusive as possible?

• What features of similar apps are missing that we might provide?

Current limitations that we need to keep in mind:

• Existing gaps in access to addiction and mental health care overall

• Lack of evidence-based modalities in current recovery-based apps

• Lack of quality information, resources and access to treatment (specifically medication-assisted treatment for opiate addiction)

The image above is the visual representation of the whiteboard used to write down all questions for further exploration

Competitive analysis

Whiteboarding gave me the idea to study 8 different apps that are recovery-focused. I wanted to see what users found helpful, what made using the app appealing or unappealing and what features might be necessary for our tool in the future.

Key takeaways from competitive analysis:

• Don’t fit too many features into an app-some (like a journal or sobriety counter) may not be useful

• A clean interface is important to users

• The tool should be easy to navigate and provide experiences that a user will want to engage with

• Cost can be a deterrent to using an app-hidden fees, difficult to cancel membership, etc.

This is a sample from the analysis that I conducted. Strengths and weaknesses were identified through user reviews and reviews from the academic research articles. This analysis taught me some of the tools we may want to build (i.e. an ongoing reminder to complete the daily inventory), and confirmed our idea that 12-step language isolated a section of the recovery community who might otherwise benefit from our tool.

Still more questions than answers

As I was trying to find patterns based on insights from the initial round of research, I didn’t have enough information to draw meaningful conclusions.

I attempted to take insights from the competitive analysis and articles. I put the insights on sticky notes to try to create categories and groups for affinity mapping, but my idea shifted to prioritizing features and user needs. In the end, this was not a task I would have started to save myself time. While it has value in other projects, it was not something I would repeat if I was to do this project over again.

It’s time to talk to people!

After my bungled attempt with the sticky notes, I started to consider how interviews with users could go. I discovered some considerations as I plan for the next phase of research.

• There are 14 current users in various phases of recovery from addiction who have used our tool.

  • What do current users think about the inventory? What tools do they currently use for support recovery? What might be helpful to them in their recovery in the future?

  • Face-to-face interviews or survey?

  • How feasible is it to connect with individuals who use this product and can we guarantee privacy?

Test, validate and iterate

The next phase of the project includes more research, interviews and a review of the project goals

• Research suggests the app should include evidence-based methods (such as cognitive-behavioral therapy, dialectical behavior therapy, motivational interviewing, etc.) but can include other methods such as mindfulness.

• Usability testing of the current tool: gather responses from current users and find patterns based on their feedback

  • interviews with current users: what recovery tools do they currently use? What tools or support would have been most helpful when they were in early recovery?

• Prioritize features and build them

  • Based on user feedback, research and business needs such as: do we have the budget? Do we have the team and skills to implement our ideas? How will we ship the initial product? Who would be our target demographic to start?

Limitations/constraints:

We want to launch this product for those currently involved in a residential treatment program (commonly referred to as “rehab”) as this would complement the work being done and would give us access to quality information. However, we have to be aware of confidentiality laws and the consequences for potential violations.

This creates some barriers with accessing feedback, however using an anonymous survey would be one method to gain insights without breaching confidentiality. Interviewing users is much more difficult given the confidentiality constraints and limitations of working with a treatment facility. Instead, we could approach the recovery community at large and involve volunteers who would be willing to be anonymously interviewed for usability testing. Again, privacy is a major concern and approaching individuals for interviews before or after a meeting would border on ethical concerns and may not be advisable.

In summary

This is the beginning of a process to provide a service to those in recovery and provide another tool to prevent relapse and provide an evidence-based platform that can be used in any setting. The goal is to increase the number of users from 14 and track engagement over the next 6 months.