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APP REVIEWS

Alcohol Consumption

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Dr. Rajesh Girdhari
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For centuries, alcohol has been among the most used and abused substances in the world. In Canada, national survey data estimate that approximately 90% of the population will use alcohol at some point in their lifetimes.1 These same data also estimate that 10-20% of alcohol users drink in excess of Canada’s low risk drinking guidelines (“problem drinkers”).2 Problem drinkers, in particular, are at greatest risk of developing short-term — injuries, overdose — and long-term — liver cirrhosis, certain cancers — negative health effects from their alcohol consumption. Many of these patients may also go on to develop alcohol addiction, more recently referred to as Alcohol Use Disorder in the DSM-5.

A wide variety of treatments for problematic alcohol use have been developed over the years, including psychotherapy, social support groups, spirituality and medication. Over the last 10 years, app developers have entered into the alcohol treatment space as well, primarily focusing on spirituality and psychotherapy aids (e.g., 12-step methodology and drink trackers). More recent apps have also attempted to create social support networks for individuals with problematic alcohol use. No apps seem to incorporate medication use and adherence. Because of the sheer number and wide variety of apps in this space, comparing apps for alcohol use can sometimes be like comparing apples and oranges — but I have tried compare them anyway!

Apps Reviewed

Saying When: How to quit drinking or cut down
4 stars4 stars4 stars4 stars4 stars
AlcoDroid
3 stars3 stars3 stars3 stars3 stars
I Am Sober
3 stars3 stars3 stars3 stars3 stars
Nomo – Sobriety Clocks
3 stars3 stars3 stars3 stars3 stars
SoberTool
2.5 stars2.5 stars2.5 stars2.5 stars2.5 stars

SoberTool

2.5 stars2.5 stars2.5 stars2.5 stars2.5 stars

Heavily based in 12-step ideology, SoberTool takes a different approach to helping users maintain their sobriety. Like I am Sober, SoberTool is not a drink tracker, but rather a sobriety tracker. When users first open the app, users input the amount of money they spend on alcohol on a daily basis. Users can go to one of the main screens in the app to see how many days they have been sober and how much money they have saved to date as a result. What distinguishes this app from others is its extensive collection of motivational quotes that the user can reveal by navigating through a series of questions based on their current feelings (e.g., “Are you thinking of relapsing?”). The app also contains a link to a tool that helps users find a 12-step program in their area.

There is a message in this app that states, “…this app will respect your privacy and not invade your contact list.” Aside from that, there is nothing mentioned about data privacy or data sharing.

Detailed Review View All

Features

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A versatile app in the sense that it can be applied to any addiction. The success of the app really depends on how much users like the targeted motivational quotes and 12-step methodology. No clinical integration or data export features.

Effectiveness

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This app is likely to resonate well with believers in 12-step approaches to addiction treatment. For those who don’t believe in this approach, the app has little to offer. The creator claims to be a substance use counsellor. The app includes no specific endorsements.

Usability

+-

Can be difficult to find a question in the app that accurately reflects the user’s current frame of mind. There is a search tool that can be helpful. Red and white is a bad choice for colour scheme.

Privacy & Security

+-

There is a message in the app that states “this app will respect your privacy and not invade your contact list.” Aside from that, there is nothing mentioned about data privacy or data sharing. No password protection.

Reliability

+-

This appears to be the first app created by this company. They are dedicated to seeing it succeed as evidenced by their timely email support responses. The app is quick and responsive.

Accessibility

+-

SoberTool is available for free on both iOS and Android platforms. There is a “pro” version without advertisements. The support messages are quite lengthy and may turn off some users with references to “Higher Powers”. English only.

AlcoDroid

3 stars3 stars3 stars3 stars3 stars

This popular free app on the Android platform — 500,000 to 1 million downloads — is similar to other apps in allowing users to track drinks and the amount of money they are spending on alcohol. However, it also calculates a user’s blood alcohol content (BAC) based on user-input drink data and data about the user like weight. AlcoDroid provides a link to general symptoms that appear at various BACs, including overdose, coma, and death at high BACs. AlcoDroid also predicts when user BACs will fall below a certain threshold, i.e., when users will become “sober”. It may be this latter feature that users find more appealing than simply the drink tracking functionality.

This app has no clear privacy or security policy.

Detailed Review View All

Features

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Only useful for alcohol and not other drugs. Has the interesting feature of BAC calculation and future prediction, which users may find engaging. This may deter some users from impaired driving. No clinical integration, but users can export data to the phone’s SD card.

Effectiveness

+-

Users can select to measure standard “Canadian” drinks, though it is not clear what standard the app is using. Development does not appear to be linked to any credible expert group. The BAC calculator simply provides an estimate and has not been clinically validated – this may be confusing for some users who may believe the BAC calculator is accurate.

Usability

+-

This app is quite visually unappealing with its green/gray/black colour scheme and DOS-era graphics. It also contains banner adds that further worsen the user experience. Adding drinks is simple and can be done with a minimum number of clicks. The app contains a minimum of words/text.

Privacy & Security

+-

This app has no clear security or privacy policy. It does not disclose if it is doing any data sharing or where data is stored. No clear information about whether any personal health information is being collected and the app is not password protected. The app asks for permission to read and write to the contents of the phone’s memory (SD card).

Reliability

+-

This appears to be the only app on the market from the app maker (Myrecek), which is from the Czech Republic. With 500k-1M downloads and a recent update in Sept 2016, the app appears to have good speed. No emergency instructions given, even if user’s calculated BAC is estimated to be at a “critically high” level.

Accessibility

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App is available for free in English on the Android platform only. Users would need to understand standard units of measurement for drinks as well as the concept of blood alcohol content and have a general idea of how alcohol builds up in and then is cleared from their bodies. No disability accommodations.

I Am Sober

3 stars3 stars3 stars3 stars3 stars

This app, first released in 2013 and featured in Netflix’s original series “Love!”, is an aesthetically appealing and simple app designed to help users track the number of consecutive days they have been “sober”. Sobriety is defined by the user and could include use of any substance including alcohol and cocaine. The app sends alerts to users flagging “milestones” — 1 day sober, 1 week sober — which can be easily shared with others via text, email, etc. When the user relapses, he/she must simply click a button and the app resets to day 1 (a motivational quote is displayed when this happens). The app also tracks how much money the user has saved since being sober. However, what really distinguishes this app from others in the field are the “Sober Clubs,” which are essentially online peer support groups. I Am Sober is leveraging social media much more than any other app I found on the market – if you’re into social media, this could be the app for you.

This app has no clear security or privacy policy.

Detailed Review View All

Features

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The app is simple and easy to use and can be adopted to multiple substances, giving it greater versatility compared to other apps on the market. The addition of “Sober Clubs” – online peer support networks – gives the app an added dimension not seen in competitors. Aside from motivational alerts and Twitter links, the app doesn’t have any educational material for users. No clinical integration or data export available.

Effectiveness

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For the app to be effective, users will really need to be motivated by maintaining sobriety, seeing how much money they have saved by being sober and getting support from the “Sober Clubs”. The app is not linked to any credible health care organization, does not reference any evidence-based guidelines and has a very narrow treatment focus.

Usability

+-

Because of its simplicity, this app is very straightforward and intuitive. It has an aesthetically appealing colour scheme and layout. Users can get set up in less than a minute. Users can set the time at which they would like to receive motivational alerts, which is a nice customizable feature.

Privacy & Security

+-

No security or privacy policy is noted. The app asks for permission to access cellular data, perhaps for integration into the “Sober Clubs”. However, it isn’t clear why this access is needed if the user isn’t engaging in the social media aspect of this app. Although the user is allowed to select a substance of abuse, it isn’t clear what this information is used for.

Reliability

+-

App is fast and reliable. The app maker, Hungry Wasp LLC, is moderately credible, having produced two other apps with reasonable ratings. The app has been recently updated (July 2016) and has had multiple updates since its launch in 2013. Does not have any emergency instructions for users.

Accessibility

+-

This app is free and available on both iOS and Android platforms. The language used in the app is simple and inoffensive and should not pose a barrier for most users. No accommodations for disabilities are noted and the app is only available in English.

Nomo – Sobriety Clocks

3 stars3 stars3 stars3 stars3 stars

Available for free in 16 different languages on on both iOS and Android platforms, Nomo-Sobriety Clocks (“Nomo”) appears to have been a long-term labour of love for its creators, both of whom identify as being “in recovery” from an addiction. Nomo enables users to track how long they have been “sober” from an addiction and how much money they have saved as a result of their sobriety. The app enables the user to have multiple sobriety clocks at once in order to track multiple addictions. The interface is aesthetically appealing and easy to use. Compared to other apps on the market, Nomo is loaded with user features, ranging from fun mini-games designed to take users minds off of acting out on their addiction — “Refocusing Activities” — to on-line “Accountability Partners” who can support app users during difficult times. Like other apps, Nomo falls down on its privacy and security policy disclosures, its lack of easy clinical integration and lack of other educational materials for users.

No clear security or privacy policies noted in this app.

Detailed Review View All

Features

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Users earn “chips” for each day of sobriety and can share these with others. Users can also track length of sobriety and money saved with multiple addictions at once. Users can interact with on-line “Accountability Partners”. The app also includes “Refocusing Activities”, essentially small games to take users’ minds off of using. No educational material.

Effectiveness

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Tracking of length of sobriety and links to an online community in the form of motivational quotes written by other users and “Accountability Partners” may be helpful for some users. Creators both refer to themselves as “in recovery”; however no links to credible addictions treatment organization.

Usability

+-

Visually appealing layout with nice blue and white colour scheme. Straightforward to setup and use.

Privacy & Security

+-

No clear security or privacy policies. No information about whether user data is collected, where it is stored or whether user data is shared. Transparent about permissions and user can create a password to access the app.

Reliability

+-

No performance issues noted while running the app. The company has a website for the app — meetnomo.com — with support information and a FAQ section. App has been through many updates since initial launch in ~2008. App makers have only produced one other app and this is a noted “side project” for the creators. No emergency instructions.

Accessibility

+-

This is a free app that is remarkably available in 16 different languages (iOS). Available on iOS, Android, and tablets. Language in the app is straight-forward and inclusive; user-generated motivational comments do not appear to be filtered for language content and may be offensive to some.

Saying When: How to quit drinking or cut down

4 stars4 stars4 stars4 stars4 stars

Released in 2014 on iOS by the Centre for Addiction and Mental Health (CAMH), this app is an electronic version of a paper-based alcohol treatment program created by Dr. Martha Sanchez-Craig more than 25 years ago. When signing in to the app for the first time, users are prompted to “Take Stock” of their current alcohol use patterns, review Canada’s Low-Risk Drinking Guidelines and set goals for alcohol use. Users can then track their drinking by “filling up” user-friendly interactive graphics of alcohol containers (e.g., beer steins, wine glasses). Users can also track drinking urges and the success of various coping strategies employed in an attempt to overcome the urge to drink. Longer-term, e.g., monthly, summaries of drinking patterns are also available. Users are also enabled to “plan ahead” and chart future events where they will be exposed to alcohol and come up with coping strategies to reduce or avoid alcohol use in advance.

This is one of the few apps on the market that explicitly ensures users that their information is stored only on their devices and is not shared with anyone else (unless the user explicitly checks a box enabling data export to CAMH for research purposes only).

Detailed Review View All

Features

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This app has a clear target disease. It offers multiple useful features, such as goal setting, educational materials, drink tracking, urge tracking, coping strategies and planning for future events.

Effectiveness

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This app is directly based on a method that has proven to be beneficial to patients over the past 25 years. It was developed by CAMH, a leading institution on addiction treatment in Canada, and includes educational references to Canada’s Low-Risk Drinking Guidelines. It also has links to further treatment resources.

Usability

+-

This app is quite straight-forward to use, though it would be nice if drinks and urges could be input with fewer clicks or voice recognition software. The set-up period, with goal setting and background, although not overly lengthy, may be a deterrent to some users.

Privacy & Security

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Data is apparently stored only on the user’s phone and is not collected or forwarded to the app maker or other servers unless the user specifically enables data forwarding to CAMH for “research.” No clear security policy is noted.

Reliability

+-

Performance generally good without any long delays in responsiveness. CAMH has made several apps now. No clear technical support email address or contact information available.

Accessibility

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Free to download and use without any advertisements! However, is only available in English and on iOS. The language used is friendly and easy to understand. No clear accommodations for disabilities were noted.

What Experts Say

Watch our interview with leading specialist Dr. Selby regarding Alcohol Consumption.

Patient Experiences

It’s a hoary old joke.

“My doctor told me to stop drinking. So I got a new doctor.”

Less funny and probably more real is the reaction may patients have to warnings about their alcohol consumption. As one blogger confesses, when she was honest with her doctor about how much she was drinking “My doctor told me I had to cut back. So I tried. But ambiguous and uncertain future health dangers proved an insufficient incentive.”

Other patients report not finding the warning – or the help – they were expecting.

One reader of a sobriety blog reports “Every year I get a physical. Each year I would mention that I think I may drink too much. It was dismissed each time saying ‘you look so healthy, you have a perfect physical.’ Well, that was my excuse to get right back on the drinking path.”

Another reader wishes she could write her doctor a letter.

“If I could send an anonymous letter to my doctor, I would say this: Dear Doctor, when my sister was diagnosed with breast cancer, I learned that alcohol use could be a factor in getting this disease. So, each year at my annual physical, I asked you about alcohol use. Me: Should I be concerned about alcohol, Doctor? You: Are you a moderate drinker? Me: Yes (I lied). You: Just limit your drinks to 1–2 drinks per week.” She writes that in the following years at her annual exam, I complete a questionnaire answering “moderately to the drinking question. “You do not question me. I do not have the courage to tell you that I think I have a problem. So, I continue to drink ‘moderately’ which for me is every day.”

Another writes that “When I filled out the paperwork (at my annual physical exam), I honestly answered that I drank one bottle of wine per night, two on the weekends. My doctor didn’t even acknowledge that I had written anything about my alcohol consumption. It was a cry for help and she didn’t even say anything to me, not even, you have to cut back.”

For some patients, the anonymous environment of an online community provides the path to moderation.

“(In the past) When I did drink, I drank a lot,” according to Donna Dierker, a binge drinker interviewed by the U.S.–based NPR.

Ten years ago, she was concerned about her drinking even though she never drank during the work week. Weekends were different. “Fridays would be a six-pack,” she says. And Saturdays meant more drinking. “On Sundays I’d feel awful.”

Her blood pressure was going up; her weight was creeping up. And so she resolved to cut back.

“I had these good intentions, but then every time Friday rolled around, I’d lose my resolve,” Dierker said.

She connected with a moderation support group on the Internet and learned to use self-management tools. “I feel I’m in the driver’s seat again,” Dierker says. She no longer drinks out of habit. “I’ve gotten to the point where it’s a treat again and I look forward to it.”

References

  1. Canadian Alcohol and Drug Use Monitoring Survey, 2012. http://www.hc-sc.gc.ca/hc-ps/drugs-drogues/stat/_2012/summary-sommaire-eng.php
  2. Canadian Low-Risk Drinking Guidelines, 2010. http://www.ccsa.ca/Eng/topics/alcohol/drinking-guidelines/Pages/default.aspx
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