# Implementing real-time assessments of substance use cravings, triggers, and mood: a feasibility study with justice-involved populations

## TL;DR

A mobile health tool with real-time assessments was found to be feasible and well-accepted by justice-involved individuals in addiction treatment.

## Contribution

The study demonstrates the feasibility of integrating real-time assessments into a mobile health system for justice-involved populations.

## Key findings

- Participants showed excellent compliance with the EMA and DPS surveys (91.9%).
- Participants reported high satisfaction and found the surveys easy to understand.
- Qualitative feedback indicated the EMA surveys helped identify patterns in mood, cravings, and triggers.

## Abstract

The Daily Progress System (DPS) is a daily mobile health monitoring tool that allows clients with opioid use disorder to track substance use, recovery-related symptoms, and recovery support activities (e.g., 12-step groups) over a 24-hour period. This pilot study explored the feasibility of equipping the DPS with an ecological momentary assessment (EMA) feature.

Thirty participants with justice involvement were recruited from an outpatient addiction treatment clinic in Maryland. Participants completed an integrated 14-day DPS + EMA protocol that assessed cravings, triggers, and mood three times per day (3–7 items; morning, afternoon, evening), and recovery-related symptoms and activities once per day (DPS, 10 items; evening). Financial incentives were provided for each survey completed. Descriptive statistics described sample characteristics and usage metrics (e.g., compliance). Friedman and Wilcoxon signed-rank tests were used to compare differences in non-normal compliance rates based on time of day and survey type.

Overall compliance with the EMA and DPS surveys was excellent (91.9%). No significant differences in compliance were observed based on time of day or survey type. In terms of acceptability, participants reported high overall satisfaction (MEMA = 8.9/10; MDPS = 9.5/10) and reported that the surveys were easy to understand (MEMA = 4.9/5; MDPS = 4.8/5). Qualitative feedback suggested that the EMA surveys helped participants identify patterns and glean additional insights into their mood, cravings, and triggers. Participants provided suggestions for future development, such as incorporating additional opportunities to report cravings and triggers outside of the primary delivery windows.

These findings suggest that equipping the DPS with real-time assessments of cravings, triggers, and mood is feasible and acceptable among individuals with justice involvement who are engaged in outpatient treatment. Further research is needed with larger samples and over longer periods of time to evaluate the long-term benefits of this approach and its potential to enhance treatment adherence, patient engagement, and downstream recovery outcomes. However, these findings support the continued development and refinement of the DPS equipped with real-time assessments.