Mobile App Shows Promising Results for Addiction Recovery Among People Experiencing Homelessness

A smartphone app designed for people experiencing both substance use disorders and housing instability has demonstrated measurable success in reducing drug use and improving mental health outcomes, according to new research from Washington University School of Medicine that challenges persistent assumptions about the digital divide among vulnerable populations.

The study, published February 1 in Drug and Alcohol Dependence, tracked 378 individuals with unstable housing who used the uMAT-R mobile application over a one-month period. Participants who engaged with the app's features—particularly those who communicated with trained coaches through the platform's chat function—were approximately 50% less likely to report opioid or illicit drug use compared to baseline measurements and non-users.

Beyond reductions in substance use, participants showed improvements in health literacy, diminished drug cravings, and decreased feelings of social isolation and perceived burdensomeness—psychological factors closely linked to both depression and relapse risk. The findings arrive as the nation continues grappling with a substance use crisis that, despite recent declines in overdose deaths, remains severely undertreated among the most vulnerable populations.

The Intersection of Two Crises

The research addresses a critical gap at the convergence of America's twin epidemics of homelessness and addiction. People experiencing housing instability face overdose rates dramatically higher than the general population while simultaneously encountering formidable barriers to accessing traditional treatment programs. Unstable living situations make it difficult to maintain consistent contact with providers, attend scheduled appointments, or complete multi-week residential programs that require stable housing as a prerequisite for admission.

Dr. Vidya Eswaran, an assistant professor in WashU Medicine's Department of Emergency Medicine and the study's lead author, witnesses this dynamic daily in her work at Barnes-Jewish Hospital's emergency department. She notes that patients without secure housing contend with compounding challenges: inconsistent healthcare access, heightened mental health burdens, trauma exposure, and the practical difficulties of managing medication regimens or following treatment plans while living in shelters or on the street.

"There is a lot of overlap with people who are experiencing housing insecurity and have substance use disorders, so it is important to make sure that the interventions that we provide are addressing the needs of this specific subpopulation," Eswaran explained in a statement about the research. "Some people might think that these groups would not have a mobile phone or the digital literacy to use an app like this, but the results show people were not only using it, but also getting benefit from it."

That last observation directly contradicts a common misconception that has historically limited digital health investments targeting homeless populations. While housing instability certainly creates technology access challenges, research increasingly shows that smartphone ownership among people experiencing homelessness has risen substantially in recent years, with many viewing mobile devices as essential lifelines for communication, navigation, and accessing social services.

Origins in Online Communities

The uMAT-R app—the name is pronounced "you matter," a deliberate choice reflecting its mission—grew out of observations about how people with substance use disorders found support in online communities during their most isolated moments.

Dr. Patricia Cavazos-Rehg, a professor in WashU Medicine's Department of Psychiatry and the study's senior author, spent years studying how individuals turned to social media platforms to ask clinical questions, share experiences, reduce stigma, and locate resources when traditional support systems felt inaccessible or judgmental.

"I observed how folks use social media venues to support each other, even during times when they were feeling most alone or stigmatized," Cavazos-Rehg said. "They would ask questions on social media about clinical care and seek out resources for mental health help. This inspired me to develop a tool for people who are going through mental health problems or are in recovery support."

Launched in 2018 with funding from the Missouri Department of Mental Health, uMAT-R was designed as a comprehensive digital platform addressing multiple dimensions of recovery. The app works on both iOS and Android smartphones and offers several interconnected features: educational content about withdrawal management and maintaining sobriety, information about treatment options and social support resources specific to the user's geographic area, tools for tracking sobriety milestones, and a chat function connecting users with trained "e-coaches" available weekdays.

The e-coaches—not automated chatbots but actual professionals trained in substance use counseling—provide encouragement, answer questions about treatment options, help users navigate crises, and offer accountability without judgment. This human element distinguishes uMAT-R from purely automated digital interventions and reflects the peer-to-peer support dynamics that originally inspired the platform.

Cavazos-Rehg emphasized that sustained state funding made the project viable. "They recognized that a lot of life happens outside of traditional in-person mental health and substance use treatment settings, and that mobile apps can be affordable, accessible tools that can improve the health and wellbeing of people, especially during critical times when other types of help may not be readily available," she noted.

Study Design and Participant Characteristics

The research team analyzed data from uMAT-R users enrolled between 2020 and 2024. Of 972 initial enrollees, more than 70% self-identified as experiencing housing insecurity—a category encompassing people living in shelters, on the street, in treatment facilities or hospitals, or in temporary arrangements at someone else's home without long-term stability.

This high proportion of unstably housed participants wasn't accidental. Most enrollees found the app through clinical encounters at treatment centers, emergency departments, or other healthcare settings serving vulnerable populations, or learned about it through word-of-mouth from other users. The app isn't yet publicly available through standard app stores; instead, it operates as part of ongoing research with a controlled enrollment process that allows for rigorous data collection.

At enrollment, participants completed comprehensive baseline surveys assessing their substance use patterns, frequency and intensity of drug cravings, and level of health literacy—defined as the ability to find, understand, and apply health information when making decisions about care. The surveys also measured two psychological factors strongly correlated with depression and relapse: perceived burdensomeness (feeling like they were a burden to others) and thwarted belongingness (lacking meaningful social connections).

One month after enrollment, the 378 participants who completed follow-up surveys provided updated information on these same measures, allowing researchers to identify changes and correlate them with patterns of app usage tracked through the platform's backend analytics.

Measurable Reductions in Substance Use

The core finding—that uMAT-R users were approximately 50% less likely to report non-opioid illicit drug use after a month, and that those engaging with the e-coach chat function showed similar reductions in opioid use—represents a substantial effect size for a relatively low-intensity intervention.

The research revealed a dose-response relationship: participants who used the app more frequently and engaged with more of its features showed greater reductions in substance use overall. This pattern suggests the app's effectiveness stems not just from initial motivation or selection bias among participants who chose to engage, but from the actual content and support delivered through the platform.

Beyond the headline substance use reductions, the psychological and social outcomes carry significant implications for long-term recovery sustainability. Participants using uMAT-R reported diminished drug cravings—often cited by people in recovery as one of the most difficult aspects of maintaining sobriety, particularly during early stages. The app's educational content and coaching support appeared to provide coping strategies that helped users manage these cravings without relapsing.

The improvements in health literacy matter because navigating the fragmented addiction treatment system requires substantial knowledge: understanding different treatment modalities, knowing how to access insurance coverage or sliding-scale programs, recognizing warning signs of complications, and identifying quality providers. For people experiencing homelessness, who often cycle through multiple systems (healthcare, social services, criminal justice) with little continuity, this knowledge becomes particularly crucial.

Perhaps most striking were the social and mental health improvements. Participants who engaged with the e-coach function showed reduced feelings of social alienation and perceived burdensomeness—changes that carry significance beyond their immediate psychological relief. Research has consistently identified these factors as precursors to suicidal ideation, and people with untreated substance use disorders already face dramatically elevated suicide risk. The app's ability to foster connection and reduce isolation, even through digital channels, suggests potential protective effects.

Challenging the Digital Divide Narrative

The study's success directly challenges assumptions that have sometimes limited digital health investments in homeless services. Skeptics have argued that people experiencing homelessness lack consistent smartphone access, reliable internet connectivity, or the digital literacy necessary to navigate health apps effectively.

The reality appears more nuanced. While housing instability certainly creates technology access challenges—phones get lost or stolen, charging becomes difficult without reliable shelter, data plans may be unaffordable—smartphone penetration among people experiencing homelessness has grown substantially. Multiple surveys conducted in major cities over recent years have found smartphone ownership rates exceeding 60% even among chronically homeless populations, with many viewing phones as essential survival tools.

The WashU study's high engagement rates suggest that when digital tools are designed thoughtfully with user needs in mind, they can reach and benefit populations facing severe material hardship. The key lies in understanding how housing instability shapes technology use: people may access apps intermittently based on phone availability and battery life, prefer asynchronous features that don't require real-time connectivity, and value tools that address immediate practical needs alongside longer-term recovery goals.

Broader Context and Treatment Gaps

The research arrives amid persistent gaps in addiction treatment access nationwide. Fewer than one in five people with substance use disorders report receiving any form of treatment, according to national surveys—a rate that has remained stubbornly low despite decades of public health efforts and increased awareness following the opioid crisis.

For people experiencing homelessness, treatment access rates are even lower. Residential programs often require stable housing as a precondition. Outpatient programs expect regular attendance at scheduled appointments—difficult to maintain without reliable transportation or when daily survival needs take precedence. Insurance coverage gaps, documentation requirements, and geographic access barriers compound these challenges.

Meanwhile, drug overdose deaths, though declining from pandemic-era peaks, continue at historically elevated levels. The Centers for Disease Control and Prevention reported approximately 54,000 opioid-related overdose deaths in 2024, down from 79,000 in 2023 but still far above pre-pandemic levels. People experiencing homelessness die from overdoses at rates multiple times higher than the general population.

Digital interventions like uMAT-R don't replace comprehensive treatment programs, medication-assisted treatment, or housing-first approaches that address the root causes of instability. But they offer a complementary tool that meets people where they are—literally and figuratively—providing support, education, and connection during periods when traditional treatment remains out of reach.

Implementation Challenges and Scalability

Despite promising results, significant questions remain about how to scale digital interventions like uMAT-R to serve the broader population of people experiencing both addiction and housing instability.

The current model relies on controlled enrollment through healthcare settings and research partnerships, with professional e-coaches providing personalized support during business hours. Expanding to serve tens or hundreds of thousands of users would require substantial infrastructure: more trained coaches, robust technical systems to handle increased traffic, quality assurance mechanisms to maintain effectiveness, and sustainable funding beyond research grants.

There's also the question of how such tools integrate with existing treatment systems. Ideally, apps like uMAT-R would serve as bridges connecting people to comprehensive care rather than standalone interventions. The app's resource navigation features attempt this integration, but seamless connections between digital platforms and brick-and-mortar programs remain technically and administratively challenging, particularly across fragmented local systems.

Privacy and data security present another consideration. People experiencing homelessness often have well-founded mistrust of systems that collect their information, whether due to previous negative experiences with authorities, concerns about immigration status, or simple desire for autonomy. Building trust requires transparent data practices, strong security measures, and clear explanations of how information will and won't be used.

Emergency Medicine's Evolving Role

The study reflects emergency medicine's expanding role in addiction treatment, a shift driven partly by necessity. Emergency departments have become de facto access points for people experiencing substance use crises, particularly among populations without regular primary care.

Eswaran's work embedding app enrollment into emergency department workflows represents a broader trend toward "warm handoffs"—using emergency encounters not just to treat acute crises but to connect patients with ongoing support. Rather than discharging someone back to the street after treating an overdose, ED staff can now enroll them in uMAT-R, providing immediate access to resources and coaching that bridge the gap until more comprehensive treatment becomes available.

This approach acknowledges that healthcare happens in moments and places beyond scheduled clinic appointments—a reality particularly true for people experiencing homelessness, whose interactions with the medical system often occur episodically through emergency services rather than continuous primary care relationships.

Future Directions and Related Research

Eswaran indicated she's planning similar research examining uMAT-R's effectiveness for recently incarcerated people with substance use disorders—another population facing elevated overdose risk and significant treatment access barriers during the vulnerable reentry period.

The parallels are substantial: both groups experience housing instability, disrupted social networks, complex trauma, systemic barriers to care, and heightened stigma. Digital tools designed to address these overlapping challenges could serve multiple vulnerable populations with appropriate customization.

Cavazos-Rehg's team continues refining the app based on user feedback and usage patterns. Potential enhancements under consideration include more sophisticated sobriety tracking features, expanded resource databases covering more geographic areas, integration with medication-assisted treatment programs to support adherence, and culturally responsive content addressing the specific needs of different demographic groups.

There's also interest in studying whether the benefits observed at one month persist over longer periods. Sustained recovery requires months or years of effort, and whether digital interventions can maintain engagement and effectiveness over extended timeframes remains an open question requiring longitudinal research.

Policy Implications

The research carries implications for how states and localities allocate resources for addiction treatment among vulnerable populations. Digital health interventions offer relatively low cost per user compared to intensive in-person programs, potentially allowing limited resources to reach more people.

Missouri's investment in uMAT-R development and deployment represents a model other states might consider: using public funds to create digital tools addressing specific gaps in their treatment systems, then rigorously evaluating effectiveness through academic partnerships that ensure scientific credibility.

Federal agencies including the Substance Abuse and Mental Health Services Administration and the National Institutes of Health have also supported the research, recognizing digital health as a priority area for expanding treatment access. As these tools demonstrate effectiveness, they could become standard components of comprehensive addiction response strategies rather than experimental additions.

Beyond the Headlines

Beneath the statistics and percentages lie individual stories of people finding support during intensely difficult periods. The app's name—"you matter"—reflects an explicit attempt to counter the stigma and social isolation that often accompany both addiction and homelessness.

For someone living in a shelter, struggling with opioid cravings at 2 AM, having access to educational content about what they're experiencing, strategies for managing the urge to use, and the ability to message a coach the next morning represents a form of support that didn't exist even a few years ago. The technology doesn't solve underlying problems of poverty, trauma, or systemic inequity, but it provides a tool that acknowledges people's dignity and agency in their own recovery.

Washington University School of Medicine, which maintains one of the largest National Institutes of Health funding portfolios among U.S. medical schools, has positioned itself at the intersection of cutting-edge research and practical community health interventions. The uMAT-R project exemplifies this approach: rigorous scientific evaluation of a pragmatic tool designed to address a pressing public health problem affecting some of society's most marginalized members.

As the overdose crisis continues evolving—with new substances, changing use patterns, and shifting demographics—the need for innovative, accessible interventions becomes more urgent. Digital health tools won't replace the fundamental work of treatment, housing, and social support, but they can fill gaps, build bridges, and reach people in moments when other help remains unavailable.

The Washington University study suggests that technology, thoughtfully designed and rigorously evaluated, can serve as one component of a comprehensive response to addiction among vulnerable populations—not a replacement for human connection and comprehensive care, but a valuable complement that meets people where they are and supports them through the difficult journey of recovery.

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If you or someone you know is struggling with substance use, the SAMHSA National Helpline (1-800-662-4357) provides free, confidential support and treatment referrals 24/7.