E-health as a remedy for addictions

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The Actions Addictions Fund has submitted to MILDECA its report " Addictions: the eHealth revolution ", Which promotes e-Health for the prevention, identification, diagnosis and treatment of addictions. Presentation.

Addictive behaviors constitute a major challenge for our society requiring a strong mobilization of all actors through a discourse of truth, backed by solid scientific data. The fight against drugs and addictive behaviors must be harmonized with new technologies: accumulated experience, recent developments in IT (AI, Big Data, etc.) or the advent of mobile health profoundly modify the landscape.

Many French people make daily use of psychoactive products – 13 million tobacco, 5 million alcohol, 700,000 cannabis. Others use it more occasionally. At 17, many adolescents have experienced these three products and some settle into regular use. Almost half of them recognize a significant one-time drinking episode (" binge drinking ”) in the previous month.

 

The “Treatment Gap” of addictions in France

Faced with the needs and demand for prevention, care, support and risk reduction, the current offer, however diverse and composed of competent and committed professionals, is no longer enough. This is called " Treatment Gap Which defines the gap between the number of people suffering from addiction and the number of patients treated.

In France, less than 20% of people with substance use disorders receive treatment, whether it be smokers, problematic users of alcohol or illicit drugs. Addictive pathologies are, among psychiatric pathologies, those with the rates of " Treatment Gap »Highest in most countries.

However, seeking treatment too late contributes to the worsening of disorders and the installation of difficulties of all kinds: somatic complications, psychological and psychiatric disorders, social and professional disinsertion, financial deterioration.

E-Health: a huge potential to improve the treatment of addictions

In this context, Nicolas Prisse, President of the Interministerial Mission to Combat Drugs and Addictive Behaviors (MILDECA) entrusted, at the end of 2018, to Professor Michel Reynaud, president of the Actions Addictions Fund, and to Doctor Jean-Pierre Thierry, advisor e-Health of the fund, the mission to offer an overview and a first analysis of the expected benefits of e-Health for people suffering from addiction.

These results were presented on May 14 as part of a half-day discussion at MILDECA, bringing together parliamentarians, addictologists and health professionals, patient associations and institutional health actors.

For the authors of the report, digital tools offer new opportunities for patient support and can easily allow a qualitative leap in the prevention and management of addictions.

E-Health thus makes it possible to respond to new challenges, particularly in terms of health democracy, by more effectively mobilizing new players (such as patient associations, patient-experts, psychologists, preventers, etc.) and can also be a valuable response to land-use planning issues in terms of access to healthcare.

Clinical research, prevention, initial identification, care and support for people suffering from addictions must rely on the appropriate use of information and communication technologies. Digital technologies make it possible to more effectively mobilize new players (such as patient associations, expert patients, psychologists, preventers, etc.).

"Digital technologies must also facilitate the care pathways, which are currently not very coherent and have many break points. Digital technologies allow consumers to assess and treat themselves with effective medical devices. The rapid digital transformation of our society can easily be applied to the prevention and management of addictions and allow a rapid qualitative leap in the prevention and management of pathologies insufficiently treated at present.

Digital integration corresponds to a modern and effective approach to addictology: after the period of fight against social scourges in the 1990s, then that of a medical and scientific approach to addictions in the 2000s, it corresponds to the current period which positions patients as actors and integrates health democracy.

The experience available internationally and in France provides a sufficient level of evidence to justify the deployment of solutions such as community and social networks, teleconsultation and telemedicine, telephone assistance, mobile applications, some "companion" smart health connected objects. Conversational agents (chatbot), serious games and virtual reality are the subject of more recent research and their effectiveness in real life needs to be better established.

Big Data and Artificial Intelligence (AI) are already playing a major role in redefining clinical and public health research practices in addiction. The study of behavioral disorders in addictions and in mental health will be revolutionized by AI applied to data generated by smartphones in passive form (data characterizing the use of the smartphone and behaviors coupled or not with geolocation) or active ( multimedia exchanges, questionnaires). "

This report highlights in particular that “the smartphone must now be considered as the preferred vector for the adoption of e-Health services and solutions in the field of addictions. As with other chronic diseases, but more particularly in the field of addictions and mental health, the smartphone has changed the situation and justifies a real "reversal" of the traditional approach. For the user, the smartphone is indeed a platform for integrating the various services and solutions currently and in the future offered by e-Health.

Starting from the user / patient perspective, taking into account the availability of the smartphone, it is possible to establish priorities based on the analysis of uses, and taking into account the maturity of the solutions and the levels of evidence characterizing their effectiveness. The internet and mobility should improve the supply of care and reach more people and reduce the treatment gap.

It is also now a question of communicating better in order to inform, especially the youngest, so as not to leave the field open to the promotion and sale of addictive substances thanks to the mobile applications currently used by the greatest number. Community networks thus stand out as one of the means to be favored, in the first instance, to improve prevention and encourage people most at risk to seek appropriate care.. "

10 recommendations for an e-health plan in addictions

This report "Addictions: the e-Health Revolution" puts forward 10 recommendations to develop e-health in the fight against addictions:

  1. Create an Addictions and e-Health Task Force

  2. Accelerate the development of national and regional platforms including information, assessment tools and interactive community spaces (website and applications dealing with non-personal data) including for companies and mutuals. Train and recruit preventive physicians, psychologists and expert patients to run online services (level 2 website, mobile applications, peer communities and forum dealing with personal data or at risk of re-identification).

  3. Encourage the development of content aimed at adolescents and young adults by associating young people trained in risk and harm reduction (level 1 and 2 website, mobile applications, peer community and forum). Capitalize on existing initiatives and achievements (eg Young health thread, Avenir Santé, Plus belle la nuit…).

  4. Define a framework for the development, selection and integration of dedicated mobile applications in order to create a library of validated and reference applications available to promoters of digital platforms and solutions.

  5. In collaboration with the CNAMTS and the various stakeholders, study the conditions for the development of addictology care thanks to new pricing for long-distance exchanges with psychologists and expert patients.

  6. Encourage the development of teleconsultations in addictions and recognize an ALD for severe addictions. Develop platforms (level 3) for medical care, management of personal data and use of applications and smart health connected objects and define the conditions of use of the DMP and the future Digital Health Space for the improvement of prevention , identification and treatment of addictions (tobacco and alcohol).

  7. Identify two or three pilot health regions for the experimentation of a territorial integration of e-Health for the improvement of the quality of the coordination of care and the course of patients benefiting from the support of GRADeS – Regional Grouping of Support for the Development of e-Health (Level 4 platform: telehealth, care pathway, coordination file, management of appointments, management of smart health connected objects)

  8. Encourage the development and recognition of the role of expert patients in providing information to caregivers, therapeutic education and the animation of integrated platforms and solutions specializing in addictions.

  9. Create an observatory of digital communication strategies likely to favor addictive behaviors and targeting in particular the youngest. This observatory will also be responsible for coordinating digital strategies likely to counter these incentives.

  10. Encourage research in the field of addictions based on the analysis of population and behavioral data (in connection with the Health Data Hub). Foster the development of research within the framework of the Interdisciplinary Institutes of Artificial Intelligence (3IA) taking into account the potential of mobile health, chatbots, serious games and virtual reality.

To view the full report, click here>

Source: Interministerial Mission to Combat Drugs and Addictive Behaviors (MILDECA)

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