Ecological momentary assessments for self-monitoring and counseling to optimize methamphetamine treatment and sexual risk reduction outcomes among gay and bisexual men

This pilot study evaluated the use of smartphone ecological momentary assessments (EMA) for self-monitoring to optimize treatment outcomes among gay and bisexual men enrolled in an outpatient methamphetamine abuse treatment service program. Participants (N = 34) received EMA prompts five times daily to self-monitor their methamphetamine use, cravings, sexual risk behaviors, and associated triggers and affect throughout the 8-week treatment program. Participants were randomized into either a self-directed condition with access to a web-based EMA response visualization dashboard (“EMA + Dashboard”; n = 16); or, a counselor-supported condition incorporating weekly, 30-min, one-on-one counseling sessions to review and discuss the participant's self-monitoring data on the dashboard (“EMA + Dashboard + Counselor”; n = 18). Pilot participants were compared with historical controls (n = 102) as the reference group in multiple regression analyses to assess the impact of the two study conditions on the treatment service program outcomes. Study participants with weekly counseling (EMA + Dashboard + Counselor) exhibited significantly greater reductions in the number of condomless anal intercourse episodes than historical controls (IRR = 0.02, 95% CI [0.00, 0.30]), whereas the reduction was of similar magnitude as controls in the EMA + Dashboard self-directed condition (IRR = 0.23, 95% CI [0.02, 3.56]). Treatment effects were not significant for comparisons between the two study conditions and historical controls for self-reported methamphetamine use (EMA + Dashboard: IRR = 1.06, 95% CI [0.32, 3.49]; EMA + Dashboard+Counselor: IRR = 0.46, 95% CI [0.14, 1.49]), number of male partners (EMA + Dashboard: IRR = 1.02, 95% CI [0.39, 2.61]; EMA + Dashboard+Counselor: IRR = 0.54, 95% CI [0.20, 1.45]), and the likelihood of providing a urine sample that tested positive for methamphetamine metabolites (EMA + Dashboard: OR = 1.00, 95% CI [0.79, 1.25]; EMA + Dashboard + Counselor: OR = 0.93, 95% CI [0.74, 1.16]). The pilot study provides preliminary evidence that the treatment outcome for condomless anal intercourse can be improved through a combination of smartphone- and counselor-assisted self-monitoring.