Digital Service Development in Substance Use Disorder Treatment

Substance Abuse Treatment, Prevention, and Policy | 2024, Vol. 19, No. 36, p. 1-11

Navigating challenges and opportunities: perspectives on digital service development in substance use disorder treatment

Janika Kosonen;  Tampere University, Tampere, Finland

Gillian W. Shorter; Queen’s University Belfast, Belfast, Northern Ireland, UK

Katja Kuusisto; Tampere University, Tampere, Finland

Background: Some people with substance use disorders (SUD) can experience multiple co-occurring social problems. Digital solutions have been developed to support effective and cost-effective social welfare and healthcare in addictions treatment. Given the varying severity of problems from alcohol and other drug use, digital service tools can save money and provide tailored care.

Objective: In this study, we aimed to understand the perspectives of those who develop digital service tools for people with SUD and treatment encounters. As a case, we interviewed those who have been involved in the development of a digital client segmentation tool, The Navigator. Methods: Ten (N = 10) semi-structured interviews were conducted with professionals involved in digital client segmentation tool development and were analyzed with inductive content analysis. Participants were asked about the development of the Navigator from the perspectives of their own role as developers, the clients, the effectiveness of the services, and decision-making processes.

Findings: Some people with SUD may face several obstacles when using digital services. Digital divide, feared or experienced stigma and biased attitudes, complex life situations, and difficulties in committing to treatment were identified as challenges. Nevertheless, digital solutions can offer clients alternative ways of using the services that can better meet their individual needs. The anonymity and facelessness of digital solutions can reduce the fear of immediate judgment. Implementing digital solutions in substance use work poses challenges due to chronic staff shortages. Digitalization often results in the creation of multiple simultaneously managed channels, potentially reducing time consumption but increasing the perceived workload. There is a call for multi-professionalism, acknowledging inequalities between various disciplines within the field. 

Substance use; substance use disorder; addiction; digitalisation; health care; social work,; stigma

“Digitalisation is becoming increasingly common in social welfare and healthcare services, shaping the methods of receiving and accessing care, treatment, and services … Digital solutions for addiction care and treatment can have both positive and negative effects on clients and those who care for them. Positive effects can include e.g., reduced stigmatisation, increased addiction identification, better cost-efficacy and cost-control and lower threshold access to services. However, digital interventions seem to best serve those whose life situations, experienced challenges and use of intoxicants are under control and not yet escalated since they tend to require a certain level of self-direction and independency. Also, reduced costs are not self-evident, and sometimes the adherence maintenance costs can even equal face-to-face treatment” (p. 1-2).

“In this study, we are interested in exploring how professionals involved in the development of digital solutions for social welfare and health care purposes perceive the compatibility of digital service tools for the care of people with SUD. As a case, we interviewed professionals involved in the development of a Finnish digital client segmentation tool called the Navigator. The Navigator was originally developed for healthcare purposes in Finland while there have been efforts to expanding it to social work purposes. Within the Navigator, client segmentation occurs during client-professional interaction, in the service needs assessment phase, and the outcome is based on both the client’s and the professional’s perceptions of the client’s service needs. The Navigator has four different client groups or segments, aiding delivery of appropriate services to the client. The Navigator has proven feasible for diabetes patients during nurses’ appointments in primary care” (p. 2). 

“Participants were partners of the research project recruited to the study via email request and gave informed consent. All were involved in the development of the Navigator and had diverse educational backgrounds including economics, nursing, social work, administration, pharmacy, and medicine... There were ten interviews with eleven participants. Interviews were audio-recorded and transcribed verbatim… J.K. conducted the preliminary analysis. This involved data familiarisation through reading the texts thoroughly before coding transcripts by content in the second reading round. These were then condensed into a thematic map with two pre-determined overarching main themes on ATLAS.ti version 23.1.1.0. These were 1) reflections on individuals with SUD as the end users of digital solutions, and 2) substance use workers as the end users of digital solutions” (p. 2-3).

“ The findings highlighted both benefits (anonymous and faceless service use, alternative ways of using services that can better meet the individual needs, decreased time consumption) and challenges (digital divide, complex life situations, accessibility, commitment, stigma and biased attitudes, increased workload, service standardization) associated with digital solutions for vulnerable and stigmatised groups” (p. 8).

“Challenges like the digital divide, experienced or anticipated stigma and shame, complex life circumstances, and difficulties in committing to treatment were identified as barriers to digital service utilisation. In turn, digital solutions were perceived as avenues that could offer alternative and more tailored services to address client’s individual needs. Client-oriented approach was called for, advocating for increased client involvement in service development and production. This sits uncomfortably alongside the stigma which disempowers clients” (p. 8). 

“ Participants advocated for a multi-professional approach, highlighting existing inequalities in funding and representation between social services and healthcare. Contrary to its intended purpose of reducing workload and enhancing efficacy, the findings suggested digitalisation might, in fact amplify workload by introducing additional co-existing working channels… To achieve the benefits for their clients, the professionals must be given time to learn and internalise new digital solutions prior to use” (p. 8).

“Ultimately, the digital revolution is an opportunity to change services to reduce stigma and biased attitudes and improve healthcare outcomes; people should no longer encounter stigma in the care system and this study aligns with previous works to illustrate that biased attitudes still persist. People with SUD were seen as hard to reach and difficult to commit to the treatment. This observation is in line with previous research while treatment seeking rates have typically been low and treatment dropout rates high among people with substance use problems. However, pointing out these issues to the client instead of the stigmatising and discriminatory structures of the care system can prevent us from seeing the root causes and taking responsibility and ultimately improving care through effective partnership. For some, digital solutions were seen to lower the threshold to access the services due to reduced fear of stigmatisation which is in line with previous observations. Availability and anonymity have been observed to be important factors for choosing to use online-based services. However, anonymity or lower threshold to services will not help in the long run if the system-level structures (e.g., language and attitudes) maintain stigma. It is essential for the public care system to actively address stigma and prevent reproducing it, fostering a safe environment to access services and seek help. User-involvement and a firm evidence base are vital when designing and implementing digital solutions for stigmatised groups. There is a risk that digital development leads to digital inequality and deepens the digital divide. Implementing new digital interventions for stigmatised groups without sufficient evidence base can, at worst, jeopardize clients’ position in the service system. The challenges identified in the interviews of those involved in the development of the Navigator indicate that there may have been too little evidence before implementing the tool for this clientele” (p. 8-9).

“This study has a couple limitations to be mentioned. One limitation is that the data was collected from experts who were all involved with the same digital solution, the Navigator, rather than multiple or different digital solutions. However, the interviews revealed valuable information on how digital solutions may be adopted in other fields beyond SUD and other stigmatised groups. Also, the study participants represented various educational backgrounds, enriching the data. T he results of this study have several implications in both public care system practices and the practices of companies developing digital services for public care purposes. Findings can support developing, planning, implementing, or deploying digital solutions for a range of different target populations and especially for stigmatised groups in health care and welfare. For future research this study calls for including end users in the discussion of digitalisation, efforts to reduce stigma, and overcoming the digital divide" (p. 9).