A randomized controlled trial of a therapeutic relational agent for reducing substance misuse during the COVID-19 pandemic

Prochaska, Judith J.; Vogel, Erin A.; Chieng, Amy; Baiocchi, Michael; Maglalang, Dale Dagar; Pajarito, Sarah; Weingardt, Kenneth R.; Darcy, Alison; Robinson, Athena

doi:10.1016/j.drugalcdep.2021.108986

Cited by 114Digital Mental Health InterventionsSubstance Abuse Treatment and OutcomesMobile Health and mHealth Applications

The DOI matches its Crossref record; 33 of the 34 references it cites were found in a registry or an index.

A randomized controlled trial of a therapeutic relational agent for reducing substance misuse during the COVID-19 pandemic

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Prochaska, Judith J., Vogel, Erin A., Chieng, Amy, Baiocchi, Michael, Maglalang, Dale Dagar, Pajarito, Sarah, Weingardt, Kenneth R., Darcy, Alison, Robinson, Athena·2021·Drug and Alcohol Dependence

DOI 10.1016/j.drugalcdep.2021.108986PMC PMC8423936

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Abstract

BACKGROUND: The COVID-19 pandemic disrupted access to treatment for substance use disorders (SUDs), while alcohol and cannabis retail sales increased. During the pandemic, we tested a tailored digital health solution, Woebot-SUDs (W-SUDs), for reducing substance misuse. METHODS: In a randomized controlled trial, we compared W-SUDs for 8 weeks to a waitlist control. U.S. adults (N = 180) who screened positive for substance misuse (CAGE-AID>1) were enrolled June-August 2020. The primary outcome was the change in past-month substance use occasions from baseline to end-of-treatment (EOT). Study retention was 84%. General linear models tested group differences in baseline-to-EOT change scores, adjusting for baseline differences and attrition. RESULTS: At baseline, the sample (age M = 40, SD = 12, 65% female, 68% non-Hispanic white) averaged 30.2 (SD = 18.6) substance occasions in the past month. Most (77%) reported alcohol problems, 28% cannabis, and 45% multiple substances; 46% reported moderate-to-severe depressive symptoms. Treatment participants averaged 920 in-app text messages (SD = 892, Median = 701); 96% of completed lessons were rated positively; and 88% would recommend W-SUDs. Relative to waitlist, W-SUDs participants significantly reduced past-month substance use occasions (M = -9.1, SE = 2.0 vs. M = -3.3, SE = 1.8; p = .039). Secondary substance use and mood outcomes did not change significantly by group; however, reductions in substance use occasions correlated significantly with increased confidence and fewer substance use problems, cravings, depression and anxiety symptoms, and pandemic-related mental health effects (p-value<.05). CONCLUSIONS: W-SUDs was associated with significant reductions in substance use occasions. Reduction in substance use occasions was associated with better outcomes, including improved mental health. W-SUDs satisfaction was high.

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A study of the chatbot app Woebot, used to help reduce substance misuse, found that greater frequency of use (numbers of in-app text) was not significantly associated with a reduction in substance use occasions (r = 0.23).
“A study of the chatbot app Woebot, used to help reduce substance misuse, found that greater frequency of use (numbers of in-app text) was not significantly associated with a reduction in substance use occasions (r = 0.23) (50).”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [50]
The Results section ('W-SUDs use and acceptability') reports that the correlation between in-app text count and reduction in substance use occasions was not statistically significant (p = .06). However, it gives r = −.23, not the claimed r = 0.23. (LLM, conf=0.92)
Experimental — accuracy not yet measured
A study of the app Woebot, used to reduce substance misuse during COVID-19, found that the bond subscale rating was higher than task and goal subscales ratings.
“A study of the app Woebot (a therapeutic chatbot that delivers CBT), which was used to reduce substance misuse during the COVID-19, found that the bond subscale rating was higher than task and goal subscales ratings (50).”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [50]
Two studies showed that users could potentially build a bond with chatbot apps.
“However, two studies showed that users could potentially build a bond with chatbot apps.”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [50]
Clarke et al. measured number of program interactions (i.e., logins), number of modules completed, and frequency of self-monitoring, while Prochaska et al. measured days used, in-app text messages, and completed modules.
“Clarke et al. (14) measured number of program interactions (i.e., logins), number of modules completed, and frequency of self-monitoring, while Prochaska et al. (50) measured days used, in-app text messages, and completed modules.”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [50]
Previous research demonstrated Woebot's efficacy to reduce substance abuse among adults.
“Previous research demonstrated Woebot’s feasiblity and acceptability as well as efficacy to reduce (1) depression and anxiety among young adults [20], (2) depression among postpartum women [32,33], and (3) substance abuse among adults [34,35].”
From Chatbot-Delivered Cognitive Behavioral Therapy in Adolescents With Depression and Anxiety During the COVID-19 Pandemic: Feasibility and Acceptability Study (2022) · cites this paper as [35]

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A relational agent for treating substance use in adults: A randomized controlled trial with a psychoeducational comparator
Prochaska, J. J., Wang, M., Chieng, A., Moore, J. B., Vogel, E. A., Baiocchi, M., Pajarito, S., Pirner, M., Bullard, L., Darcy, A. M., et al. (2026) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2026.209993 · Cited by 1
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A relational agent for treating substance use in adults: Protocol for a randomized controlled trial with a psychoeducational comparator
Prochaska, J. J., Vogel, E. A., Chieng, A., Baiocchi, M., Pajarito, S., Pirner, M., Darcy, A. M., & Robinson, A. H. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107125 · Cited by 10
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COVID 19—impact on substance use treatment utilization and provision in South Africa
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Perceptions of individuals in treatment for substance use disorder during COVID-19: insight on mental health, sobriety, access to treatment, and telehealth
Bayers, T., Strohmaier, T., Shreffler, J. R., & Huecker, M. R. (2021) · Journal of Addictive Diseases · doi:10.1080/10550887.2021.1948292 · Cited by 5

Authors: Prochaska, J. J., Vogel, E. A., Chieng, A., Baiocchi, M., Maglalang, D. D., Pajarito, S., Weingardt, K. R., Darcy, A., & Robinson, A.
Affiliations: Stanford Medicine (US)
Stanford University (US)
Woebot Health (United States) (US)
Corresponding author: Prochaska, Judith J.
ORCID: Prochaska, Judith J.
Vogel, Erin A.
Chieng, Amy
Baiocchi, Michael
Maglalang, Dale Dagar
Pajarito, Sarah
Weingardt, Kenneth R.
Darcy, Alison
Robinson, Athena
Venue: Drug and Alcohol Dependence
Publisher: Elsevier BV
Published: 2021-10
Volume: 227
Pages: 108986
ISSN: 0376-8716 (ISSN-L)
DOI: 10.1016/j.drugalcdep.2021.108986
PMC: PMC8423936
OpenAlex: W3196926390
Cited by: 113
References: 34
Citations by year: 2026: 42 · 2025: 17 · 2024: 24 · 2023: 22 · 2022: 8
FWCI: 12.12
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
Locations: Drug and Alcohol Dependence (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
eScholarship (California Digital Library) (submittedVersion)
Funders: National Institutes of Health (44-D048712, 32HL007034)
National Institute on Drug Abuse (44-D048712, 32HL007034)
National Heart, Lung, and Blood Institute (44-D048712, 32HL007034)
Topics: Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords: substance use disorders, COVID-19 pandemic, digital health interventions, chatbot therapy, alcohol consumption, cannabis use, substance use reduction, depression, anxiety, craving, user satisfaction
MeSH terms: COVID-19, SARS-CoV-2, Adult, Female, Humans, Male, Mental Health, Substance-Related Disorders, Pandemics

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A randomized controlled trial of a therapeutic relational agent for reducing substance misuse during the COVID-19 pandemic

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