App Aids Substance Use Recovery in Vulnerable Populations

The rate of substance use disorder in the United States remains undertreated despite a decline in drug overdose deaths last year, with fewer than one in five individuals receiving treatment. A particularly vulnerable population – those experiencing housing insecurity – faces significantly higher risks of overdose and barriers to accessing care. However, a new mobile application developed by researchers at Washington University School of Medicine in St. Louis is showing promise in addressing this critical gap in care.

Published February 1st in Drug and Alcohol Dependence, a study details the effectiveness of the uMAT-R (pronounced “you matter”) app in helping individuals with substance use disorder and unstable housing take steps toward recovery. Participants who used the app reported significant reductions in both opioid and non-opioid substance use after one month, compared to those who did not engage with the application. Improvements were also observed in health literacy and key mental health measures associated with successful treatment.

The challenge of treating substance use disorder among those without stable housing is multifaceted. Vidya Eswaran, MD, an assistant professor in the WashU Medicine Department of Emergency Medicine and lead author of the study, highlights the distinct needs of this population. “Patients struggling with housing insecurity have inconsistent access to care and greater mental health burdens,” she explained, noting these factors can make sustaining treatment more difficult than for those with secure housing. “We see important to make sure that the interventions that we provide are addressing the needs of this specific subpopulation.”

Addressing Misconceptions About Digital Access

A common assumption is that individuals experiencing homelessness lack access to smartphones or the digital literacy required to utilize such applications. However, the study’s findings challenge this notion. “Some people might think that these groups would not have a mobile phone or the digital literacy to use an app like this, but the results show people were not only using it, but also getting benefit from it,” Eswaran stated.

uMAT-R, launched in 2018, was conceived by a team led by Patricia Cavazos-Rehg, Ph.D., a professor in the WashU Medicine Department of Psychiatry. The app aims to provide free, accessible support for individuals with any substance use disorder – including opioids, stimulants and hallucinogens – with the overarching goal of reducing overdose deaths. It is compatible with both iOS and Android smartphones.

The app offers a range of resources, including information on local treatment options and social support services. Users can track their sobriety, access educational content on managing withdrawal and maintaining recovery, and improve their mental health. A key feature is a chat function allowing participants to communicate with trained “e-coaches” Monday through Friday for advice and encouragement.

Inspired by Online Support Communities

The development of uMAT-R was inspired by the observation of online addiction-support communities. Cavazos-Rehg noted, “I observed how folks use social media venues to support each other, even during times when they were feeling most alone or stigmatized. They would ask questions on social media about clinical care and seek out resources for mental health help.” This observation led to the creation of a tool designed to provide similar support in a readily accessible format.

“They recognized that a lot of life happens outside of traditional in-person mental health and substance use treatment settings, and that mobile apps can be affordable, accessible tools that can improve the health and well-being of people, especially during critical times when other types of help may not be readily available,” she added.

Study Details and Findings

The study analyzed data from 378 individuals enrolled in uMAT-R between 2020 and 2024 who completed a one-month follow-up survey. Over 70% of the initial 972 enrollees self-identified as experiencing housing insecurity, encompassing situations such as living in shelters, on the street, in treatment facilities, or temporarily with others.

Participants completed initial surveys assessing substance use patterns, cravings, and health literacy – defined as the ability to find and utilize health information. The surveys also measured mental health indicators correlated with depression, such as feelings of being a burden and social alienation. Follow-up surveys after one month of app usage were used to identify changes in these measures and correlate them with app usage patterns.

The research revealed that participants who used uMAT-R were approximately 50% less likely to report non-opioid illicit drug use after one month compared to those who did not use the app. Those who engaged with the e-coach function were about 50% less likely to report opioid use. Higher levels of app engagement were associated with greater reductions in overall illicit drug use.

Beyond reducing substance use, uMAT-R use was linked to decreased cravings and lower feelings of being a burden. Utilizing the chat function was associated with improved health literacy and reduced feelings of social isolation.

Eswaran emphasized the potential of mobile health technologies in reaching underserved populations. “These results speak to the promise of what mobile health and digital health technologies can bring to the treatment of hard-to-reach populations,” she said, adding that she is planning a similar study focused on recently incarcerated individuals with substance use disorders. “Going forward, there’s potential to think creatively about how we adapt and refine tools like this even more to support vulnerable populations.”