Organizational Coaching to Increase Uptake, Engagement, and Sustainment of a Digital Substance Use Disorder Recovery App: A Cluster Randomized Trial (Preprint)

BACKGROUND Evidence-based digital interventions have demonstrated benefits for individuals with substance use disorders (SUDs), yet uptake within routine clinical practice remains limited. Implementation strategies that help treatment organizations integrate digital tools into clinical workflows may help address this implementation gap. OBJECTIVE This cluster-randomized trial evaluated the effectiveness of the Network for the Improvement of Addiction Treatment–Technology Implementation (NIATx-TI) organizational coaching model for increasing uptake, engagement, and sustainment of the ACHESS recovery support application (ACHESS) in specialty SUD treatment settings. The trial evaluated uptake (account creation), engagement (days of app use), and sustainment (continued account creation after coaching ended). METHODS The study population was 40 clinical sites from 10 specialty SUD treatment organizations in Iowa. Sites were randomly assigned to either standard digital health implementation support (control) or NIATx-TI organizational coaching (intervention). The primary implementation outcomes were (1) uptake, measured as the number of new ACHESS accounts relative to the number of eligible outpatient admissions, (2) engagement, measured as days of ACHESS use, and (3) sustainment, measured as account creation during a 10-month post-intervention sustainment period. RESULTS During the 18-month intervention period, intervention sites achieved substantially greater uptake of ACHESS than control sites, with an account creation rate of 17.0% relative to eligible outpatient admissions, compared with 3.9% at control sites, an absolute difference of 13.1 percentage points (p < .01). Model-predicted ACHESS engagement, measured by mean app-use days, was higher in the intervention arm than in the control arm across the intervention period (p < .01), with the magnitude of the between-arm difference varying over time. During the 10-month sustainment period following withdrawal of active coaching, intervention sites continued to outperform control sites, with account creation rates of 17.1% and 2.6%, respectively (p < .01). CONCLUSIONS The NIATx-TI implementation strategy significantly improved uptake, engagement, and sustainment of an evidence-based digital recovery support application in specialty SUD treatment settings. These findings suggest that organizational coaching and implementation support can help bridge the gap between evidence-based digital interventions and routine clinical practice. Even with this gain, absolute uptake remained modest, suggesting that integration with electronic health records and reimbursement structures that incentivize use may be needed alongside coaching to achieve broader penetration of patient-centered digital tools in SUD treatment. CLINICALTRIAL ClinicalTrials.gov NCT03954184.