Opportunities and Challenges for Technology Use in Substance Use Disorder Recovery

Abstract

This dissertation investigates the role technology plays in substance use disorder (SUD) recovery, with the goal of characterizing technology’s potential role in effective recovery care.

The findings in this dissertation are derived from four studies: one design space analysis of commercially available SUD recovery mobile applications, including user reviews (n=55 apps), and three interview studies with SUD recoverees and support professionals such as therapists, social workers and peer recovery coaches. Interview study one had 18 participants (8 recoverees and 10 support professionals), with topics focused on the process of re-entering digital spaces after beginning recovery. Interview study two had 11 participants (all support professionals), and focused on the role of social media in recovery and the impacts of distance care on providing recovery support. Interview study three had 10 participants (5 support professionals, 5 recoverees) and was part of a user experience study testing a prototype app that would help support professionals and recoverees communicate and share resources.

Drawing on the findings of these studies throughout the dissertation, I discuss four dimensions of SUD recovery that can be facilitated by technology: social networks, professional support, resource access, and self-guided activities. For each, I investigate the opportunities and challenges of different affordances, and identify strategies for maximizing benefits and mitigating dangers.

For social networks, recoverees must reshape their digital social environment to get access to supportive communities without exposing themselves too much to destabilizers. For professional support, professionals must capitalize on the flexible, convenient communication afforded by technology without making a recoveree feel isolated and care feel impersonal. For resource access, recoverees must be able to access up-to-date, accurate information while avoiding misinformation and prohibitively high search costs. Lastly, for self-guided activities, recoverees need to be able to get the therapeutic “active ingredients” without being exposed to design that creates discouragement and distrust.

I use my analysis in these recovery dimensions to argue that there are two important functions of technology in SUD recovery that are often overlooked: a connection amplifier and gentle on-ramp. As an on-ramp, technology offers a low-stakes way for people to explore recovery if they are feeling ambivalent about engaging. As a connection amplifier, technology serves to deepen connections between recoverees and their support network by giving them more ways to connect and communicate. This has implications for intervention design. For example, rather than attempting to replace a human therapist with a chatbot, designers might instead focus on building decision support systems that help therapists track client needs and suggest therapy exercises. Everyone involved in the work of SUD recovery is likely operating under an enormous cognitive load, and so it is important to have technology absorb as much of this cognitive load as possible, especially the monotonous work that lends itself to automation. This way, recoverees and professionals can focus on the parts of the recovery journey that are irreducibly human.