Texting and Engagement: A Simple Way to Help People Initiate and Sustain Behavior Change


In a 2015 Pew report, a whopping 97% of smartphone owners sent or received text messages in a typical week. An astounding six billion text messages are sent each day in the US. 5 billion people globally use text messaging.  It is the preferred medium of communication for younger Americans.  98% of all text messages are opened. Unlike email, text messages are nearly guaranteed to get opened.  Through text messages, your people will definitely see what you send them.  90% of text messages get a reply within a minute. Since people are most likely to respond to a text over any other form of digital communication, you're most likely to be able to have actual conversations.  6x every hour, people check their phone. Their phones are always on and always on them which means important and urgent updates will be seen quickly.  Text messaging and cell phone use is ubiquitous. Text message is the most popular smartphone feature.

If you are interested in using technology to improve the engagement of your clients or participants, you don’t have to get much more sophisticated than texting.  In most areas of healthcare, text messaging is being applied to improve engagement and the outcomes of care by influencing behavior change. Text messaging campaigns have been used to increase engagement with healthy choice campaigns, enhance education about the individual’s condition,  help manage craving and other negative thoughts/moods and to motivate healthy behavior change such as nicotine cessation.  And, in a review of 162 studies applying text message reminders, Schwebel and Larimer (2018) found that in nearly 100% of cases, text messages increased appointment attendance and medical compliance.

So how can text messaging can be applied to the treatment of SUDs and co-occurring mental health conditions. The literature is clear about the power of text messaging to deploy simple engagement strategies for improving treatment completion, post care follow up and ongoing recovery support. In a study, young people who received a texting intervention proved significant in the reduction of relapse at 90 days after discharge, compared to young people who did not receive a texting intervention.

If you are a prevention, treatment, recovery services provider, or network serving them - you need to know about the benefits of text messaging as an intervention: 

  • They are passive. Once people have agreed to receive messages, they will continue to receive them unless they opt out. About 99% of text messages are opened, most within the first 5 seconds (Mobilesquared, 2010). 
  • They can reach a large number of people. Once a text message system is established, it can easily be scaled to a larger group; it is just as easy to reach 50 people as it is to to reach 5 people. 
  • It is convenient and efficient. Texting can be used to help people track their own behavior, to collect data, provide and send reminders, and deliver booster messages about treatment content (Pew Research Center, 2018). 
  • They are customizable to a variety of populations and segments. For instance, it is fairly simple to send messages based on gender, stage of change, length of sobriety, location, or treatment group content (Noar, Benac, & Harris, 2007). 
  • Text messages are in “real time” and may thus be more effective than treatment messages given in an artificial treatment environment (Spohr, Nandy, et al., 2015). 

Gloo is an advancing platform capabilities to leverage this technology.  We are partnering with industry leading organizations like R1 Learning and Commonly Well to deploy recovery capital tools and recovery content to serve prevention, treatment and recovery focused organizations. In doing so these organizations will get access to tools that simplify work and efficiently scale improved engagement and measurement of recovery growth and change over time.   In our work, we are providing core platform infrastructure that allows our partners to help behavioral health organizations better engage, measure and motivate their people. B.J Fogg refers to the three goals of “persuasive” technology.  They are motivation, ability, and trigger. When people struggle to initiate, gain, and sustain recovery capital, technology that motivates, builds up skill and ability, and triggers pro-recovery behavior could make all the difference. 


Walters, S. T. (2019). A Guide to Using Text Messages to Improve Substance Use Treatment Outcomes. Reno, NV: Mountain Plains Addiction Technology Transfer Center, University of Nevada, Reno.

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