A blog by Jo Neale[1], Alice Bowen[2] and Paul Lennon[3]

Researchers at King’s College London have recently completed a programme of work that has resulted in the development of an addiction recovery app, called SURE Recovery. SURE Recovery is now available to download for free from Google Play and the App Store. The work to produce SURE Recovery was undertaken in collaboration with people using alcohol or other drugs, in treatment and in recovery. It was also supported by an addiction service user research group linked to a London-based peer mentoring service called the Aurora Project.

A wide range of other people were also involved in developing SURE Recovery. These included addiction clinicians, Create Recovery (a small Arts Charity that supports people with experience of addiction issues to develop their creativity) and Mindwave Ventures (an app developer that focuses on user-centred digital design). The work was generously funded from various sources, including Action on Addiction, the Alexander Mosley Charitable Trust, the Mackie Foundation, and the NIHR Maudsley Biomedical Research Centre, King’s College London.

In developing SURE Recovery, the project team followed a co-design process to make sure that the app would meet the needs and expectations of people experiencing addiction. They conducted interviews and focus groups with people who were using substances, in treatment and in recovery in order to better understand the process of recovery and how an app might support this. Successive versions of the app were also reviewed and tested by people with lived experience of addiction to make sure that functionality was optimised, the meaning of all text was clear, all graphics and images were appropriate, and there were no bugs or system crashes.

SURE Recovery is intended for people who are using drugs or alcohol, in recovery, or thinking about recovery. It has five main aims and six key features. The five aims are:

  1. To enable people to track and monitor their own recovery journeys
  2. To enable people to recognise when they might need help
  3. To enable people to identify sources of support
  4. To enable people to find inspiration from others in recovery, and
  5. To generate new data that will help researchers better understand substance use and recovery

The six key features are:

  1. A recovery tracker: this allows people to monitor their own recovery using a co-designed validated outcome measure called the Substance Use Recovery Evaluator (or SURE). Once SURE is completed within the app, personalised feedback and a score are generated. Weekly, monthly and yearly scores can then be viewed in a graph so allowing app users to view and track how their scores change over time.
  2. A sleep tracker: this feature works in a similar way to the recovery tracker. App users can complete a co-designed validated scale of sleep problems called the Substance Use Sleep Scale (or SUSS). This will then produce personalised feedback and a score that also allows app users to monitor and review their sleep problems over time.
  3. A diary function: this provides a private space where people can record their thoughts and feelings.
  4. Artwork: the app provides a platform for people to share their artwork with the recovery community. App users can submit their artwork for potential display in the banner on the home screen of the app.
  5. A naloxone resource: this feature provides instruction on the use of naloxone in the event of a heroin or other opioid overdose. There are also informational resources, including a training video and a knowledge tracker which uses the Opioid Overdose Attitudes Scale (OOAS), a validated measure of overdose management competency.
  6. Reading material: app users have free access to the book, ‘The Everyday Lives of Recovering Heroin Users’. This book is based on the lived experiences of people in recovery.

In addition, the SURE Recovery app provides those using it with an opportunity to participate in further research. To this end, app users are invited to share their anonymised data with researchers at King’s College London in order to improve understanding of substance use and treatment. Separately, they are also asked whether they would like to share their email addresses with researchers at King’s College London so that the research team can contact them to participate in further related studies. The sharing of anonymised data and participation in further research are both completely optional.

Not everyone has a smart phone or tablet computer, but there is evidence that people who use substances increasingly have good access to mobile technology. Mobile health apps, such as SURE Recovery, tend to be easy to download and cheap to use. They can therefore be an additional valuable resource for people who may not be in contact with services, and for people who may be thinking about, or working on, their recovery. We know that people do not generally use mobile health apps in a sustained way for months and years. Instead, apps tend to be used as and when people feel they meet their current needs. This is how we expect that SURE Recovery will be used.

The SURE Recovery app was only launched in October 2019, so it is too early to say exactly how people are engaging with it. It seems likely that the different features will appeal to different populations at different points in time and with different effects. For example, the recovery tracker, with its personalised feedback, may ‘nudge’ people to reduce their substance use, change their behaviours, or encourage those who are not in treatment to enter treatment. The artwork feature may have a therapeutic effect, enhance self-esteem or appeal to those who find it difficult to express themselves in words. Meanwhile, the naloxone feature may increase engagement with take home naloxone and improve overdose management competency, so potentially saving lives.

In 2020, the research team will be conducting further research to investigate how people are using SURE Recovery, what they most like most about it, and whether it can be improved. We therefore encourage anyone with lived experience of addiction and an interest in recovery to download the app and give it a try. If you like it, we ask that you tell other people so they know about it too. If you think it can be improved, please let the research team know. People with experience of addiction have a right to good mobile health apps, just like any other population. The aim going forward is to ensure that the SURE Recovery app is a resource that can help as many people as possible.

If you have an android device, the SURE Recovery app can be downloaded from Google Play here. If you have an iOS device, the SURE Recovery app can be downloaded from the App Store here.