Revolutionizing Addiction Rehabilitation: A Journey into Sleep and Recovery
Advisor: Julia Wendel
Internship Location: Veterans Affairs Hospital at Palo Alto
Onsite Mentor: Emaya Anbalagan
Addiction is debilitating, affecting not just the body but also the mind and spirit. Now imagine having the strength to undergo this journey of recovery, only to find every obstacle in the way making it easier to relapse, especially when it comes to sleep. 70% of individuals attempting to recover from addiction struggle with chronic sleep issues. My project aims to take a significant step towards addressing this issue at the Veterans Affairs Hospital in Palo Alto, where the residential rehabilitation program serves as a haven for dozens of veterans battling addiction and other neurological challenges upon returning from military service. Teaming up with attending psychiatrist Dr. Anbalagan, we're delving into the realm of neuroscience, psychology, and compassionate care to study the effects of integrating Cognitive Behavioral Therapy for Insomnia (CBT-I) into existing treatment protocols. Through exhaustive literature reviews and baseline data collection on veterans’ sleep patterns and recovery rates, we'll implement interventions associated with sleep therapy, ranging from controlling sleep timings and naps to managing electronics and dietary habits before bed. Leveraging technological innovations such as wearable devices and CBT-I apps, we'll provide personalized interventions tailored to each participant's needs. By addressing sleep disturbances, our hypothesis anticipates a ripple effect on various facets of recovery, from reducing cravings to enhancing overall well-being. My expectation is not confined to statistical outcomes on the correlation between sleep and addiction recovery rate; it extends to the profound impact on the lives of veterans, offering them newfound hope in their healing journey.
Project Blog
Post 1: Sleep - A Problem Behind Addiction
Hello everyone! Welcome to the first installment of my blog, where I'll be sharing insights on my project focused on "Enhancing Addiction Rehabilitation through Integrated Cognitive Behavioral Therapy for Insomnia". I am so excited to be embarking on this research and eager to see where it leads.
The backdrop for our project is the Veterans Affairs Hospital in Palo Alto, where I had the privilege of interning two summers ago. During my time there, I witnessed firsthand the challenges faced by veterans in the residential addiction rehabilitation program. Beyond the complexities of addiction, many grapple with co-occurring conditions such as PTSD, schizophrenia, and dementia, adding layers of difficulty to their recovery journey. You would think their battles would be done after coming back from deployment.
One pervasive issue I observed was the profound impact of substance abuse on sleep quality. It's disheartening to note that up to 70% of individuals in addiction treatment programs report chronic sleep issues. So I wanted to come up with the best, most feasible way I could make this grueling journey toward sobriety any easier. Sleep disturbances not only exacerbate the physical and mental toll of addiction but also hinder the effectiveness of rehabilitation efforts. By integrating Cognitive Behavioral Therapy for Insomnia (CBT-I) into existing treatment plans, I want to understand how personalized interventions impact sleep quality and overall rehabilitation outcomes among veterans undergoing addiction recovery.
This past week, I met with Dr. Sophie Yorkwilliams, a sleep expert who I will be collaborating with throughout the course of the project. I reviewed the therapist's guide to insomnia and studied one of the VA’s mobile apps - Insomnia Coach - for veteran use while undergoing CBT-i. Stay tuned for updates as I collaborate with more healthcare professionals and navigate the intersection of technology with this field.
Post 2: Broadening the Scope
Hi everyone and welcome back to week 2 of my senior project blogs! This week we have quite a few updates. I went into the VA on Tuesday - Building 520, the Psychiatry Department that I had interned 2 years ago. I met the veterans again and introduced myself to some new ones. Sometimes I’ll sit in on group therapy sessions and listen to the issues they’re having in rehabilitation currently. Dr. Yorkwilliams and I discussed how to introduce Insomnia Coach to these veterans, and I demoed it for a few of them as a trial run. As of now, the veterans are mostly seeming to get the hang of it but I will need to check in next week to see how well they are grasping the program that the app puts you through.
I have been doing more research on the topic. Smith et al. (2019) - "Bidirectional Relationship between Sleep Disturbances and Addiction: Implications for Rehabilitation" argue that sleep disturbances contribute to the development of addictive behaviors, but they can also serve as barriers to successful recovery. There is still a gap, though, in understanding the specific mechanisms through which interventions like CBT-I can effectively mitigate sleep disturbances and facilitate recovery. My research methodology involves direct engagement with veterans undergoing addiction recovery and the integration of personalized CBT-I interventions. Walker and van der Helm (2019) - "Neurobiological Mechanisms Linking Sleep and Addiction" also assert that there are neurobiological mechanisms linking sleep and addiction. Disruptions in sleep patterns can lead to alterations in brain regions associated with reward processing and decision-making, increasing vulnerability to addictive behaviors. And Johnson et al. (2020) - "Efficacy of Cognitive-Behavioral Interventions in Improving Sleep Outcomes among Individuals in Addiction Recovery" agree that cognitive-behavioral interventions, such as CBT-I, are effective in improving sleep outcomes among individuals in addiction recovery by targeting maladaptive sleep behaviors and cognitive processes underlying sleep disturbances.
But as we were discussing the Insomnia Coach app, we realized that numerous apps could have even more power. I studied the VA website and realized that more mobile apps, including PTSD Coach, AIMS for Anger Management, Mindfulness Coach, and more, could be extremely useful in the rehabilitation program. I look forward to introducing these and observing how these apps, which give similar advice to therapy but are much more convenient and less time-consuming, have an effect in the mental health rehabilitation at the VA.
Post 3: Mechanisms and Methodology
Welcome back to week 3 of my blog! I've been diving deep into multiple apps, including PTSD Coach, AIMS for Anger Management, Mindfulness Coach, and Insomnia Coach, each tailored to address specific needs faced by veterans.
Collaborating closely with Dr. Sophie Yorkwilliams, we've honed in on a method that we believe will maximize the benefits of these apps for our veteran participants. Dr. Yorkwilliams, through her regular therapy sessions with individual veterans, possesses insights into their specific challenges beyond addiction. She will help identify which veterans would benefit most from each app out of our selection of four. Once identified, she will refer these veterans to me for further guidance.
So, what type of method have we selected and why? We've opted for a personalized approach that involves individual consultations and regular check-ins. Here's how it works:
I will conduct an initial survey with each veteran to gather baseline self-observations. For example, if a veteran's primary goal is to improve sleep habits using the Insomnia Coach app, I'll inquire about their typical bedtime and actual sleep onset time. This information will serve as a reference point for tracking progress. Based on Dr. Yorkwilliams' referrals, I'll provide each veteran with a demo of the selected app and explain its relevance to their specific needs. This step is crucial for ensuring that veterans understand the importance of utilizing the app and feel motivated to engage with it. I'll maintain regular contact with the group of veterans using each app, checking in weekly to assess their progress and address any challenges they may encounter. These check-ins provide an opportunity to reinforce adherence to the app's instructions and offer support as needed.
There are a couple of limitations and challenges we need to navigate. Ensuring that veterans adhere to the app's instructions can be challenging, as there are multiple questions and tasks involved. It's crucial to find effective strategies for encouraging consistent engagement and addressing any barriers that may arise. While apps like Insomnia Coach offer visual representations of progress through graphs, tracking qualitative data can still be complex. We need to develop robust mechanisms for collecting and analyzing data to accurately assess the impact of the apps on veterans' rehabilitation outcomes.
I'm still confident that our approach, with regular support, will yield valuable insights. Stay tuned for more updates!
Post 4: Data Deficiency
Hi everyone,
Week 4 has brought a few more updates that I’m excited to share with you guys! As I mentioned in previous blog posts, a shift from introducing just one app to multiple apps in the veterans’ addiction recovery process has changed the premise of my project, but the methodology is almost the same. Through our approach involving individual consultations, app demos, and weekly demos, we have been starting off with collecting data. My first app demo was last week with a veteran using Insomnia Coach, and I will be checking in with him this week. I am also making another trip to the VA on Wednesday in order to conduct a sort of “office hours” session where I can show multiple more veterans how to use their respective apps. With more data collected, we can find self-reported baseline observations, app usage metrics, and qualitative feedback from participants.
The data we have right now provides indications of engagement levels and early impressions of app effectiveness, but it does not yet allow us to draw definitive conclusions regarding the long-term impact of the apps on rehabilitation outcomes. To confirm or refute our hypothesis about the effectiveness of the selected apps in enhancing addiction rehabilitation for veterans, we need additional data over an extended period.
Specifically, I need longitudinal data - a more extended period will enable us to track changes in veterans' behavior, sleep patterns, anger management skills, and mindfulness practices. This will provide a more comprehensive understanding of the apps' sustained effects on rehabilitation outcomes. In addition to qualitative feedback, we need quantitative metrics to assess the apps' efficacy objectively. This includes measures of sleep quality, anger management techniques utilization, mindfulness practice frequency, and overall well-being indicators. By quantifying these outcomes, we can more accurately evaluate the apps' impact on veterans' rehabilitation progress. Additionally, comparative analysis, or comparing data across different app groups and with control groups (e.g., veterans not using the apps), will help us assess the relative effectiveness of each app and identify any unique benefits or limitations. This will provide insights into which apps are most beneficial for specific rehabilitation goals.
Post 5: Foundations of Digital Recovery
Welcome to Week 5 of my senior project update! This week, I've been actively engaged in monitoring the progress of my project at the Veterans Affairs Hospital's "Foundations of Recovery" rehabilitation program, which currently accommodates 15 residents. One of the unique challenges of working within this program is the dynamic nature of its population, with residents frequently transitioning in and out due to various reasons such as program completion or discharge.
Despite these challenges, I've made significant strides in engaging residents with the project. I've conducted app demos for seven patients thus far, presenting at their meetings to introduce my project and offer sign-up opportunities for those interested in utilizing one of the four apps. Given the fluidity of the resident population, adaptability is key in ensuring that the project remains accessible and beneficial to as many individuals as possible.
Reflecting on my interactions with residents, I've encountered various scenarios highlighting the diverse needs and circumstances of each individual:
- V1: Engaged in a Stanford sleep study and demonstrated a solid understanding of the features of the Insomnia Coach app before being discharged later that week.
- V2: Demonstrated the Insomnia Coach app, but lacked access to a phone. Despite efforts to download the app once off the program, the resident was discharged later that week.
- V3: Participated in demos for the PTSD and Mindfulness Coach apps, ultimately favoring the latter. One week later, feedback indicated satisfaction with Mindfulness Coach, with visible progress evidenced by growth in the app's visualization features.
- V4: Participated in demos for the PTSD and Insomnia Coach apps, opting to download the latter for further use.
- V5: Demonstrated the Insomnia Coach app, but faced limitations due to phone size, expressing interest in obtaining a tablet for better access.
- V6: Engaged in a demo specifically for the Insomnia Coach app.
Moving forward, I'm focused on establishing regular check-in times with each participant and introducing new recruits to the available apps. It's important to reiterate that the primary goal of this project is to support the residents in their rehabilitation journey. While data collection poses certain challenges, particularly in terms of residents' priorities and privacy considerations, I'm committed to gathering qualitative insights through informal conversations and observations, alongside quantitative data obtained from app usage metrics and progress graphs.
As the project continues to evolve, I want to make sure it remains responsive to the dynamic needs of the residents and helps their recovery process. Stay tuned for more updates!
Post 6: Ins and Outs of Mental Health Apps
Hi and welcome if you’ve made it this far! My sixth week has been marked by continued engagement with veterans at the Veterans Affairs (VA) residential center, as I strive to introduce them to the benefits of utilizing various apps tailored to support their rehabilitation journey.
I went back to the VA today to check in with those I presented to last week, and to my surprise, there were suddenly many new faces at the residential center. This presented a fresh opportunity for me to reintroduce myself and offer demos to these individuals, ensuring that they too have access to the resources available through our project.
Reflecting on my interactions with veterans so far, I'm excited to provide updates on their engagement with the apps:
V3 has shown continued interest in the Mindfulness app, recognizing its value in supporting his well-being. Despite the limited time available for exploration, he plans to continue using the app at home after discharge, highlighting its potential for long-term utilization.
V5, unfortunately, still faces challenges in accessing the apps fully due to the lack of a tablet. As a senior veteran, the functionality of the apps on his phone is restricted, underscoring the importance of addressing accessibility barriers to ensure equitable access to these resources for all veterans.
In addition to ongoing engagements with familiar faces, I've been welcoming new sign-ups this week:
V8 expressed keen interest in multiple apps, including Insomnia Coach, Mindfulness Coach, and PTSD Coach. As a younger veteran, he was enthusiastic about leveraging digital tools to support his rehabilitation journey, downloading all three apps to explore their features further.
Similarly, V9 showed excitement about the diverse tools offered by the Mindfulness and PTSD Coach apps, downloading both to begin integrating them into her daily routine.
Analyzing this offers insight into the diverse preferences and needs of veterans in their rehabilitation journey. It highlights the importance of offering a range of app options to accommodate varying circumstances, from accessibility concerns to individual interests. By understanding how veterans interact with these resources, we can tailor our interventions more effectively to meet their specific needs, ultimately enhancing the effectiveness of addiction rehabilitation programs.
As I continue to engage with veterans and collect data, I'm excited to uncover more that will inform evidence-based practices and contribute to the ongoing improvement of veteran care.
Post 7: Reflections on Rehab Rewired
Hey, welcome back to my blog series! Can you believe we're already halfway through senior projects? It's been another week of app demos and catching up with my veterans from previous weeks. As I mentioned previously, at the residential rehab department there are constant comings and goings. With all this movement, I've been brainstorming new ways to measure veteran retention to the apps. It's all about finding ways to keep them engaged and supported throughout their journey.
I've been out of town for most of the rest of the week, so there haven't been too many updates on that front. But I'm itching to get back and start compiling all the data I've collected so far. I've been exploring different methods to analyze it. I want to make sure I’m seeing the whole picture so I'm taking my time to ensure I'm analyzing it in a way that captures all the nuances and insights.
Now, to reflect on what's been working well in my project:
First off, the engagement with veterans has been fantastic. They've been really receptive to the apps and eager to give them a try. It's been heartwarming to see how these tools are making a positive impact on their lives.
But there's always room for improvement. One thing I could have done better is anticipating the challenges of the constant flux in the residential rehab department. It's been a rollercoaster, and I've had to adapt on the fly.
This project isn't just about introducing apps – it's about revolutionizing the way we support veterans in their recovery journey. By integrating mobile apps for addiction recovery and mental wellness, we're providing them with accessible, personalized tools to navigate their challenges and build a better future.
Looking ahead, there's still so much more to explore. I believe further research should focus on extending the analysis beyond just app usage. We need to delve deeper into the long-term effects of these interventions and how they impact veterans' overall well-being. Additionally, applying this work to other disciplines or inquiries could open up new avenues for supporting diverse populations facing similar challenges.
Post 8: Exploring Data Depths
Welcome back to week 8 of my senior project journey! This week has been all about delving deeper into the data I've collected so far. As I mentioned in my previous post, I've been exploring various methods to analyze this information.
One specific approach I've been exploring is qualitative data analysis. This involves examining the narratives and feedback provided by the veterans during our interactions. I aim to identify recurring themes, patterns, and insights within their experiences with the mobile apps. This qualitative approach allows me to capture the complexities of their perspectives, shedding light on the real-world impact of these interventions.
Additionally, I've been delving into quantitative data analysis techniques to complement my qualitative findings. By quantifying aspects such as app usage metrics, engagement levels, and outcome measures, I can provide a more comprehensive understanding of the effectiveness and efficacy of the mobile apps in supporting addiction recovery and mental wellness.
I'm also exploring the integration of data visualization techniques to present my findings in a clear way. Visualizing the data through graphs, charts, and diagrams not only enhances comprehension but also facilitates communication of key insights to stakeholders and collaborators. I’m looking at options from bar charts showcasing app usage over time to scatter plots illustrating correlations between engagement levels and self-reported outcomes.
Each analytical approach offers their own unique strengths and limitations, and I want to triangulate findings across multiple methods to ensure validity and a comprehensive understanding of the impact of mobile apps on addiction recovery and mental wellness.
Post 9: Literature on Technology
Can you believe it’s already Week 9? We are almost done with my project, integrating mobile applications into the Foundations of Recovery rehabilitation program at the Veteran Affairs hospital. This week, I really wanted to focus on improving my own knowledge so I could continue to benefit the veterans. I dived into an in-depth literary analysis of many different studies centered around technological integration into programs like the one I am involved with currently.
Sweeney et al.'s article Practical Technology for Expanding and Improving Substance Use Disorder Treatment in particular discusses the intersection of technology and substance use disorder (SUD) treatment in the context of the US opioid crisis and the COVID-19 pandemic. They highlight how telehealth, remote monitoring, and digital health interventions are becoming increasingly feasible and effective in addressing SUD treatment needs. These technologies not only increase access and acceptability of treatment but also have the potential to reduce health disparities among underserved populations.
Telehealth, facilitated by telecommunication technology like 2-way interactive video, has emerged as a vital tool, particularly during the COVID-19 pandemic. It allows for remote delivery of services to individuals with SUD, overcoming barriers such as transportation limitations and childcare disruptions. Remote monitoring technologies, including wearable devices for breath alcohol concentration and biological fluid drug testing, enable frequent assessment of substance use without the need for in-person contact.
Digital health interventions, such as smartphone applications, offer innovative solutions by adapting evidence-based behavioral interventions like contingency management and cognitive behavioral therapy for streamlined implementation. These interventions not only complement traditional treatments but also cater to patients who may be unreachable or uninterested in conventional methods.
Despite the challenges and limitations associated with technology-based approaches, evolving policies and regulatory changes, spurred by the pandemic and the recognition of the underutilization of evidence-based treatments, are paving the way for their broader adoption and integration into SUD treatment protocols. As the field continues to evolve, future research, which is what I aspire to contribute to with this project, will focus on evaluating the generalizability and implementation models needed to realize the full potential of these innovative treatment delivery tools.