The Use of Wearable Alcohol Biosensor Monitoring in Patients with Alcohol Associated Liver Disease

Background: Abstinence is the definitive treatment for alcohol-associated liver disease (ALD). Early alcohol identification can prevent morbidly and mortality. Innovative wearable alcohol biosensors (ABM)1 that identify alcohol use through perspiration are an emerging technology with potential application for early identification in this vulnerable population.

Methods: We conducted an IRB approved 3-month pilot of ABM in patients with a recent hospitalization for decompensated ALD. Participants wore the ABM device 24/7. Our primary aim was to determine ABM usability, acceptability, and feasibility for ALD patients. Quantitative data using the Technology Acceptance Model 2 (TAM2)2 was collected at intake and study conclusion. The TAM2s 13 items cover 4 scales; perceived usefulness, perceived ease of use, attitude and intention to use on a 7-point Likert scale (1= very likely to 7=very unlikely). Lower scores indicate better acceptance. During monthly sessions participants were also asked open-ended questions about wearing the device.

Results: Twenty-seven participants completed the time 1 interview and 21 completed the time 2 interview (1 withdrew, 4 died, 1 was too ill). The cohort was 60% female, 89% white, mean age 45+10 and most had a severe alcohol use disorder (mean number of DSMV criteria=8). Forty-eight percent were in addiction treatment/attending AA.

At intake, acceptance across all TAM2 subscales was high (mean scores ranging 1.2-2.2). Only one participant rated the perceived usefulness worse (score=4.75) than the scale midpoint (4) and intent to use ABM as quite unlikely (score=6). By the end of the 3-month ABM wearing period perceptions and attitudes had not changed and remained highly positive (mean scores ranging 1.3-2.3). Thus, there were no statistical differences between pre- to post-TAM2 subscale scores (df=19, Ps 0.3-0.8). Interestingly the single participant who rated the ABM technology poorest at intake improved their views with subscale scores 2-3 at study end. From the monthly sessions several themes emerged including concerns about skin irritation/indentation, strap feeling itchy/hot and discomfort sleeping with it, and ABM catching on clothing. Some did not like the ABM appearance and felt others noticed it. Several noted ABM was a positive reminder of their intent to stay sober with comments like “it was a security blanket" and gave accountability.

Conclusions: Patient perspectives are essential for translation of ABM technology into clinical practice. In our pilot study ABM appears to have good patient acceptance both before and following 3 months of use. However 19% of the cohort experienced serious illness or died during the study indicating a need for earlier deployment in the course of ALD.

1.Marques PR, McKnight AS. Field and laboratory alcohol detection with 2 types of transdermal devices. Alc:Clin & Exp Rsrch. 2009;33:703–711.

2.Venkatesh V and Davis FD. A Theoretical Extension of the Technology Acceptance Model. Management Science 46(2)2000:186–204.