Mobile Health for Medication Adherence in Polish Addiction Treatment: Evidence and Implementation

Executive Summary

This policy paper examines the potential of mobile health (mHealth) technologies to address medication adherence challenges in Polish addiction treatment. Poland faces significant substance use disorder (SUD) challenges, with alcohol dependence representing a particularly pressing concern and a substantial treatment gap persisting despite recognition in national health programs. The paper analyzes Poland's digital health landscape, regulatory framework, and implementation considerations for mHealth solutions in addiction treatment.

Poland has established foundational digital health infrastructure through its Patient's Internet Account (IKP) and e-prescription systems, with smartphone penetration reaching 85.2% in 2023. However, the country lacks a structured pathway for digital therapeutics in addiction care, creating barriers to clinical adoption even when research demonstrates efficacy. Current approaches to medication adherence rely predominantly on in-person monitoring, family involvement, and limited telephone follow-up, which are often insufficient to address the multifaceted nature of non-adherence.

The evidence base for mHealth in addiction treatment is promising, with studies showing mobile applications can improve medication adherence, reduce substance use and cravings, and enhance treatment engagement. For specific medications like naltrexone, acamprosate, methadone, and buprenorphine, smartphone applications can provide automated reminders, educational content about medication benefits, and motivational messaging that contribute to improved outcomes.

Analysis of international implementation models reveals valuable lessons. Estonia's integration of mHealth with national e-health infrastructure demonstrates the importance of centralized development with standardized protocols. The Czech Republic's regional pilots showcase the value of iterative development and local adaptation. Sweden's comprehensive model highlights the benefits of integrating medication adherence applications with virtual support and peer communities. Portugal's health-centered approach to addiction emphasizes the importance of comprehensive services and social support.

The paper recommends a phased implementation approach for Poland:

1. Phase 1 (Years 1-2): Establish 3-5 regional pilots representing diverse contexts, focusing on evidence-based interventions and leveraging Poland's e-prescription system while conducting workforce assessment and training.
2. Phase 2 (Year 3): Evaluate pilot outcomes, refine interventions based on feedback, develop sustainable reimbursement frameworks, and establish regulatory guidelines.
3. Phase 3 (Years 4-5+): Implement a phased national rollout prioritizing high-need regions, fully integrate with IKP and P1 platforms, develop provider incentive structures, and establish monitoring systems.

Critical policy considerations include creating a tiered classification system for mHealth applications, establishing certification standards for security and effectiveness, developing data governance frameworks, integrating mHealth competencies into professional training, and modifying existing treatment guidelines. Funding mechanisms should include initial implementation funding through the National Health Fund (NFZ), EU structural funds, value-based reimbursement models, public-private partnerships, and sustainable maintenance funding.

Implementation challenges include regulatory uncertainty, data privacy concerns, workforce shortages, interoperability issues, the digital divide, stigma, and the need for ongoing research. By addressing these challenges through evidence-informed policy development, Poland can harness the potential of mHealth technologies to transform addiction treatment and improve outcomes for individuals with SUDs.

Mobile Health for Medication Adherence in Polish Addiction Treatment: Evidence and Implementation

Current State of Addiction Treatment in Poland

Poland confronts substantial public health challenges related to substance use disorders (SUDs), clinically recognized as mental health conditions where problematic substance use results in significant impairment or distress (American Psychiatric Association, 2022). The prevalence of alcohol dependence represents a particularly pressing concern, with current estimates indicating that a considerable portion of the adult population meets diagnostic criteria (Ministerstwo Zdrowia, 2023a). This alarming statistic reflects broader patterns of substance misuse across the country, including emerging threats from illicit drugs and new psychoactive substances (NPS), which remain under active surveillance by the National Bureau for Drug Prevention (Krajowe Biuro ds. Przeciwdziałania Narkomanii, 2023).

Despite recognition of these challenges, a substantial treatment gap persists in Poland. National reports consistently demonstrate that a significant proportion of individuals identified as requiring addiction treatment fail to receive appropriate care (Instytut Psychiatrii i Neurologii, 2022). This gap underscores fundamental systemic challenges within the Polish healthcare infrastructure regarding the provision of accessible and effective interventions for SUDs. While Poland's National Health Programme (2021-2025) explicitly aims to address these shortcomings, progress remains insufficient. The COVID-19 pandemic further exacerbated these challenges, simultaneously increasing treatment demand while disrupting traditional service delivery models—though it also catalyzed innovation in remote care approaches (European Monitoring Centre for Drugs and Drug Addiction [EMCDDA], 2022a).

The structural framework of Poland's addiction treatment system primarily comprises outpatient addiction clinics, inpatient rehabilitation centers, and specialized detoxification units often situated within general hospitals (Państwowa Agencja Rozwiązywania Problemów Alkoholowych, 2022). The National Health Fund (NFZ) largely manages funding and oversight for these services through established statutory regulations and health service contracts (Narodowy Fundusz Zdrowia, 2023a). Despite ongoing system reforms, medication adherence within addiction treatment remains critically problematic. Polish clinical studies suggest that between 40-60% of patients struggle with consistent adherence to prescribed pharmacotherapy for conditions such as alcohol use disorder (AUD) and opioid use disorder (OUD) (Badania Kliniczne w Polsce, 2022).

The World Health Organization defines medication adherence as the extent to which a person's behavior aligns with agreed recommendations from healthcare providers (World Health Organization, 2003). This factor is paramount in addiction treatment, as non-adherence fundamentally undermines therapeutic efficacy, leading to elevated relapse rates, increased healthcare expenditures, and diminished long-term outcomes (Sabaté, 2003). Medications for opioid use disorder (MOUD)—including methadone, buprenorphine, and naltrexone, all of which are approved in Poland though with varying accessibility (Urząd Rejestracji Produktów Leczniczych, Wyrobów Medycznych i Produktów Biobójczych, 2023)—demonstrate high effectiveness when properly administered and adhered to (NIDA, 2020). Recent research continues to explore innovative interventions supporting adherence, such as specialized medication adherence therapy for individuals receiving extended-release naltrexone (XR-NTX) (PGY1 et al., 2024). Poland's current National Mental Health Protection Programme emphasizes the critical need for integrated and accessible care, which necessarily includes addressing adherence challenges (Rozporządzenie Rady Ministrów w sprawie Narodowego Programu Ochrony Zdrowia Psychicznego, 2017).

Treatment Access Disparities

A fundamental barrier to effective addiction treatment in Poland lies in the pronounced disparities in service access, particularly along geographic dimensions. Rural regions experience significant underservice, with substantially fewer addiction specialists per capita compared to urban centers (Główny Urząd Statystyczny, 2022). These disparities create formidable obstacles to both initiating and maintaining treatment, especially for interventions requiring regular medication monitoring and adherence support. Patients in rural areas frequently encounter prohibitive travel times and increased associated costs, often resulting in greater reliance on general practitioners who may lack specialized training in SUD management (Polska Platforma Medyczna, 2023).

While geographic disparities remain prominent, multiple intersecting factors—including socioeconomic status, age, gender, and co-occurring mental health conditions—further compound access barriers (EMCDDA, 2022b). Individuals with dual diagnoses (co-occurring SUD and other mental health disorders) typically require more complex, integrated care approaches that may be unavailable outside specialized treatment centers (Instytut Psychiatrii i Neurologii, 2023). Polish research has documented the lived experiences of addiction patients, highlighting both their rights and the systemic barriers they encounter (Klingemann et al., 2017; Moskalewicz et al., 2020).

These access challenges directly impact the implementation of evidence-based treatments, particularly medication-assisted treatment (MAT), which represents a cornerstone of contemporary addiction care by combining pharmacotherapy with counseling and behavioral interventions (SAMHSA, 2023). Cultural factors, including varying levels of stigma associated with substance use and treatment-seeking across different Polish communities, further influence individuals' willingness and ability to access care (CBOS, 2021). Non-governmental organizations (NGOs) and recovery communities play vital roles in Poland's treatment landscape, often bridging critical gaps in formal services, particularly in underserved regions or for specific vulnerable populations (Fundacja Praesterno, 2022).

Current Medication Adherence Approaches

Traditional approaches to fostering medication adherence within Polish addiction treatment have predominantly relied on in-person monitoring, family involvement, and limited telephone follow-up (Raport o Stanie Narkomanii w Polsce, 2022). In-person monitoring typically encompasses scheduled appointments for medication dispensing, directly observed therapy (particularly for medications like methadone), and collection of patient self-reports. While family involvement can provide valuable support, it necessitates careful consideration of family dynamics and explicit patient consent (Ośrodek Terapii Uzależnień, 2023). Telephone follow-ups, though offering some remote support capability, frequently lack the systematic intensity required to comprehensively address complex adherence challenges. These conventional methods face significant limitations in scalability and reach, particularly for patients in remote areas or those with mobility constraints.

These established approaches often prove insufficient to address the multifaceted nature of non-adherence, which can be influenced by diverse factors including medication side effects, mental health comorbidities, inadequate understanding of treatment protocols, and broader social determinants of health (Polskie Towarzystwo Badań nad Uzależnieniami, 2022). It is essential to recognize that pharmacotherapy achieves optimal effectiveness when integrated within comprehensive psychosocial support frameworks, including cognitive-behavioral therapy (CBT), motivational interviewing, and group therapy—all standard components of care in many Polish treatment centers (Polskie Towarzystwo Psychiatryczne, 2021). Current Polish clinical guidelines for SUDs emphasize this integrated approach (Agencja Oceny Technologii Medycznych i Taryfikacji, 2022), aligning with international standards such as those from the European Medicines Agency and updated national guidelines from various European countries (European Medicines Agency, 2021).

The limitations of traditional adherence strategies in Poland underscore the urgent need for innovative, scalable, and evidence-based solutions. Mobile health (mHealth) interventions represent a particularly promising avenue, though their effective implementation in Poland requires addressing several challenges: ensuring digital literacy, promoting equitable technology access, addressing data privacy concerns under both GDPR and national legislation, and developing culturally adapted and validated tools (Centrum e-Zdrowia, 2023).

Professional training for addiction specialists in Poland, regulated by the Ministry of Health, must evolve to incorporate emerging therapeutic modalities, including digital health interventions (Ministerstwo Zdrowia, 2023b). A balanced policy approach, incorporating patient-reported outcomes and lived experiences, remains crucial when evaluating and implementing new adherence strategies (Rzecznik Praw Pacjenta, 2023). Economic considerations, including insurance coverage for various treatment modalities and potential out-of-pocket costs for patients, significantly influence treatment access and adherence, warranting dedicated investigation within the Polish context (Narodowy Fundusz Zdrowia, 2023b). Finally, aligning these efforts with Poland's commitments under broader EU drug strategies and public health initiatives is essential for developing a cohesive and effective national approach to addressing substance use disorders (Council of the European Union, 2021).

Mobile Health Technology Landscape in Poland: Implications for Addiction Policy

Digital Health Evolution and Addiction Context

Poland's digital health landscape has undergone remarkable transformation in recent years, creating fertile ground for mobile health (mHealth) adoption in addiction treatment. With smartphone penetration reaching 85.2% in 2023 (Urząd Komunikacji Elektronicznej - UKE, 2024), the technological infrastructure for delivering mobile interventions is firmly established. The government's strategic commitment to digital transformation, initially through the "Digital Poland" strategy (2014-2020) and now through the "Digital Poland for 2021-2027" program, demonstrates alignment with broader EU digital health priorities and the World Health Organization's global strategy on digital health (Council of Ministers, 2021; WHO, 2021). The COVID-19 pandemic served as a catalyst, accelerating telehealth adoption and forcing rapid adaptation in healthcare delivery systems nationwide (Naczelna Izba Lekarska, 2022). Furthermore, Poland's National Recovery and Resilience Plan has allocated substantial funding toward digital transformation, including e-health infrastructure development (Official Journal of the EU, 2022).

This digital evolution coincides with pressing addiction challenges that demand innovative policy solutions. Alcohol dependence remains a significant public health concern, accounting for 27% of addiction treatment cases (Chmielewski et al., 2022). While tobacco addiction has extremely high prevalence, it is often addressed through different treatment pathways (National Bureau for Drug Prevention [KBPN], 2023a). Stimulants, particularly methamphetamine, represent another substantial challenge at 9% of treatment cases (Chmielewski et al., 2022). Emerging behavioral addictions, including gambling and internet gaming disorders, further complicate the addiction landscape and present new opportunities for mHealth interventions (KBPN, 2023b).

Traditional addiction treatment approaches in Poland often combine psychotherapy and pharmacotherapy, particularly for tobacco addiction, which is recognized as a chronic relapsing condition (Zatoński & Zatoński, 2021). However, treatment outcomes remain suboptimal across substance use disorders, creating an imperative for policy innovation. Mobile health technologies offer promising supplements to conventional care, particularly for craving reduction and lapse prevention in alcohol and stimulant use disorders (Chmielewski et al., 2022; Gacia, Misiak, & Szcześniak, 2024).

Policy considerations must acknowledge that high smartphone penetration does not automatically translate to effective mHealth utilization among vulnerable populations with addiction disorders. Issues of digital literacy, trust, and access to appropriate devices persist, especially among those with limited resources (Polish Society of Psychiatry, 2023). Urban-rural disparities in digital access further complicate equitable mHealth deployment, necessitating targeted policy interventions to prevent widening health inequalities (Central Statistical Office [GUS], 2023a).

Existing Infrastructure and Application Landscape

Poland has established foundational digital health infrastructure that could effectively support addiction-focused mHealth integration. The Patient's Internet Account (Internetowe Konto Pacjenta - IKP) provides citizens with centralized access to their medical data, e-prescriptions, e-referrals, and vaccination records (Ministry of Health, 2023a). Usage of these digital services increased substantially during the COVID-19 pandemic and has maintained momentum (Centrum e-Zdrowia, 2023a). E-prescriptions have become standard practice, streamlining medication management (Ministry of Health, 2023b). These systems, managed by Centrum e-Zdrowia, offer promising infrastructure for addiction treatment applications, particularly for supporting medication adherence in pharmacotherapy for opioid use disorder or alcohol dependence.

Interoperability represents a critical policy consideration for addiction treatment technologies. Effective interoperability enables different systems, devices, and applications to exchange and use data cooperatively (Centers for Medicare & Medicaid Services [CMS], 2023a; Behave Health, 2023). For addiction treatment specifically, interoperability facilitates care coordination across providers and settings—essential for addressing the complex, multifaceted nature of substance use disorders. Standards like HL7® FHIR® provide technical frameworks that could guide Polish policy development in this area (CMS, 2023a).

Research initiatives in Poland are actively exploring mHealth applications for addiction treatment. Protocols by Chmielewski et al. (2022) and Gacia, Misiak, & Szcześniak (2024) describe promising investigations into mobile applications based on Ecological Momentary Assessment and Cognitive Behavioral Therapy principles to reduce craving and prevent relapse in alcohol and stimulant use disorders. While final outcomes from these studies are pending, they highlight the potential for mHealth to deliver self-guided interventions that complement traditional treatment approaches.

Unlike Germany's comprehensive DiGA directory, Poland lacks an officially curated list of Polish-language mHealth applications for addiction. Market research indicates several general wellness and mental health applications available in Polish, some including modules for habit change or stress reduction that could support addiction recovery (Market Research Poland, 2023). However, applications specifically developed for addiction treatment in Poland typically emerge from research projects or smaller private initiatives rather than coordinated public health deployments (Polish Psychiatric Association, 2022). University-led projects have developed prototype applications for smoking cessation and alcohol misuse monitoring, but their widespread availability and sustained support remain limited (University Research Reports, 2023). This fragmentation represents a significant policy gap that could be addressed through centralized evaluation and promotion mechanisms.

Regulatory Framework and International Comparisons

Poland's regulatory approach to mHealth applications is primarily shaped by European Union frameworks, including the Medical Device Regulation (MDR 2017/745) and the General Data Protection Regulation (GDPR, EU 2016/679). The MDR establishes requirements for medical devices, including certain mHealth applications with clear medical purposes such as diagnosis, prevention, monitoring, or treatment of disease (European Commission, 2021a). GDPR provides stringent protections for personal data processing, particularly relevant for sensitive health information collected by addiction treatment applications (European Commission, 2021b). The proposed European Health Data Space regulation will further influence mHealth governance in Poland, facilitating secure health data sharing while maintaining strong privacy protections (European Commission, 2022).

A significant policy challenge lies in the underdevelopment of specific national regulations, guidelines, and reimbursement pathways for addiction treatment applications in Poland. This regulatory ambiguity creates uncertainty for developers regarding compliance requirements beyond general MDR/GDPR provisions. Healthcare providers face similar uncertainty about integrating these tools into care pathways and securing reimbursement through the National Health Fund (NFZ). The current NFZ funding model primarily supports traditional healthcare services, with limited mechanisms for valuing and reimbursing digital interventions in addiction care (NFZ, 2023a). While some telehealth services received temporary funding codes during the pandemic, systematic coverage for digital therapeutics in addiction treatment remains absent (Ministry of Health, 2022).

International comparisons highlight alternative policy approaches that could inform Polish strategy. Germany has pioneered a structured pathway for digital health applications through its Digital Healthcare Act, enabling prescription and reimbursement of approved applications (DiGAs) by statutory health insurance (BfArM, 2023a). Several DiGAs targeting substance use, including smoking cessation and alcohol reduction, have successfully navigated this pathway (BfArM, 2023b). While Germany's system has faced challenges with lengthy approval processes and ensuring sustained patient engagement, it provides a clear route to market that fosters innovation.

The United States has established a regulatory framework for software as a medical device through the Food and Drug Administration, including authorization of prescription digital therapeutics for opioid use disorder (FDA, 2023). However, market viability challenges persist, as evidenced by Pear Therapeutics' bankruptcy despite regulatory approval for its reSET-O application (Company Bankruptcy Filings, 2023). Reimbursement in the U.S. involves complex interactions between various payers and evolving service codes (CMS, 2023b; DHCS, 2022). Prescription Drug Monitoring Programs represent another digital approach to substance use policy, tracking controlled substance prescriptions to prevent misuse (NYS Department of Health, 2021).

The United Kingdom has developed evidence standards frameworks through the National Institute for Health and Care Excellence (NICE) to guide assessment and adoption of digital health technologies (NICE, 2022). Despite these frameworks, the UK continues to address challenges in integrating digital tools effectively into National Health Service pathways and ensuring equitable access across regions (The King's Fund, 2023).

Poland's lack of a structured pathway similar to Germany's DiGA system creates significant barriers to clinical adoption of mHealth applications for addiction, even when research demonstrates efficacy. This regulatory and reimbursement gap represents a critical policy priority for enabling broader implementation of digital therapeutics in addiction care.

Evidence-Based Approaches and Implementation Challenges

Evidence-based approaches must form the foundation of mHealth policy for addiction treatment. Cognitive Behavioral Therapy represents a well-established intervention for substance use disorders that can be effectively adapted for mobile delivery (NIDA, 2020). Polish research protocols demonstrate promising applications of CBT principles through mobile platforms to address craving and prevent relapse (Chmielewski et al., 2022; Gacia, Misiak, & Szcześniak, 2024). Ecological Momentary Assessment enables real-time sampling of behaviors and experiences in natural environments, making it particularly suitable for mobile delivery in addiction contexts (Chmielewski et al., 2022).

Policy development must acknowledge the challenge of high attrition rates in mHealth interventions, where users frequently discontinue use after short periods (Eysenbach, 2005; Lin et al., 2019). Effective policies should incentivize design approaches that promote sustained engagement while maintaining therapeutic integrity.

For opioid use disorder specifically, Medication-Assisted Treatment combining medications with counseling and behavioral therapies represents the gold standard approach (SAMHSA, 2023; Manchikanti et al., 2024). Mobile health technologies can potentially enhance MAT through medication adherence support, remote monitoring, behavioral interventions, and peer support facilitation. However, implementing these approaches effectively in Poland requires dedicated research and pilot programs to establish evidence in local contexts (Polish Society for Addiction Treatment, 2023).

Several implementation challenges must be addressed through comprehensive policy approaches. The regulatory and reimbursement uncertainty surrounding digital therapeutics in Polish addiction care represents a primary barrier to adoption (NFZ, 2023b). Data privacy and security concerns are particularly acute for addiction-related information, requiring robust implementation of GDPR principles and potentially specific national guidance to ensure patient trust (Polish Data Protection Office [UODO], 2022).

Clinical validation and quality assurance mechanisms are essential but currently underdeveloped in Poland. Unlike the UK's NICE, Poland lacks a clear national process for evaluating and endorsing mHealth applications for addiction treatment (Agency for Health Technology Assessment and Tariff System [AOTMiT], 2023). The current evidence base relies heavily on study protocols rather than completed large-scale efficacy trials, limiting confidence in implementation.

Digital divide considerations must inform equitable policy development. Despite high overall smartphone penetration, significant disparities persist in digital literacy and access among vulnerable populations, including older individuals, those with severe co-occurring mental illness, homeless individuals, and rural residents (GUS, 2023b). These disparities risk exacerbating existing inequalities in addiction treatment access without targeted policy interventions.

Successful implementation also requires seamless integration into clinical workflows, necessitating healthcare professional training, interoperability with existing health information technology systems, and clear protocols (Behave Health, 2023; CMS, 2023a). Provider attitudes toward digital tools vary considerably, with some expressing skepticism or concerns about increased workload (Polish Medical Chamber, 2023). Policy approaches should address these concerns through education, incentives, and workflow optimization.

The absence of a specific national strategy for mHealth in addiction treatment represents a significant gap. While "Digital Poland for 2021-2027" supports e-health broadly (Council of Ministers, 2021), a dedicated action plan for leveraging mHealth in addiction treatment could accelerate progress by establishing clear goals, roles, funding mechanisms, and evaluation metrics (KBPN, 2023c).

Limited evidence from Polish treatment centers regarding current mHealth utilization, effectiveness in local contexts, and implementation barriers further complicates policy development (Addiction Treatment Journal PL, 2023). Research initiatives specifically examining these factors could inform more effective policy approaches.

Finally, policy development must consider potential negative consequences of mHealth implementation, including over-reliance on technology, privacy risks, potential for misdiagnosis, delayed access to in-person care, and the possibility of exacerbating health disparities (Bioethics Committee Reports, 2022). Comprehensive risk assessment and mitigation strategies should be integral to policy frameworks.

By addressing these multifaceted challenges through evidence-informed policy development, Poland can harness the potential of mobile health technologies to transform addiction prevention, treatment, and recovery support. Learning from both domestic experiences and international models will be essential to developing effective, equitable, and sustainable approaches that improve outcomes for individuals struggling with substance use disorders.

Evidence Base for mHealth in Addiction Treatment

The global burden of substance use disorders (SUDs) necessitates innovative and accessible treatment modalities. The United Nations Office on Drugs and Crime (UNODC, 2023) reported that in 2021, around 296 million people used drugs, an increase of 23% over the previous decade, with nearly 39.5 million suffering from drug use disorders. Treatment coverage remains alarmingly low; globally, only about one in five people with drug use disorders received treatment in 2021 (UNODC, 2023). In Europe, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA, 2024) highlights high-risk opioid use affecting an estimated 0.4% of the adult population, with significant treatment gaps persisting despite established evidence-based interventions. Mobile health (mHealth) interventions, leveraging the ubiquity of smartphones and mobile technology, present a promising avenue to bridge these gaps, enhance treatment engagement, and improve outcomes in addiction treatment contexts.

International research demonstrates promising outcomes for mHealth interventions in addiction treatment. A systematic review by Tofighi et al. (2019) found that mobile phone apps for SUDs can lead to reductions in substance use and cravings, and improvements in treatment adherence and engagement, although they also noted variability in app content and research quality. Another meta-analysis found that mobile phone text messaging interventions can significantly improve medication adherence for chronic diseases (Thakkar et al., 2016). The evidence base continues to mature, with ongoing research focused on identifying the most effective components and long-term impacts of mHealth interventions (SAMHSA, 2021). However, it is important to acknowledge limitations in the current evidence, including heterogeneity in study designs, outcome measures, and the need for more long-term follow-up studies (Tofighi et al., 2019).

The integration of mHealth into primary care settings is also gaining traction. A study by Acosta et al. (2018) reported on the effects of implementing an mHealth system for addiction in primary care, highlighting its potential to support both patients and clinicians. Successful implementation, however, hinges on addressing stakeholder values and concerns. Research by Krawczyk et al. (2019) emphasized using stakeholder values to promote the implementation of evidence-based mHealth interventions for addiction treatment in primary care, suggesting that co-design and iterative feedback are crucial. Implementation science frameworks, such as the Consolidated Framework for Implementation Research (CFIR) (Damschroder et al., 2009), can provide a valuable structure for identifying barriers and facilitators to mHealth adoption in clinical settings, guiding strategies to integrate these technologies effectively.

Effectiveness for Specific Medications

Medication adherence is a cornerstone of effective treatment for many SUDs, particularly for alcohol use disorder (AUD) and opioid use disorder (OUD). mHealth tools offer unique advantages in supporting adherence through reminders, educational content, symptom tracking, motivational support, and interactive exercises.

Pharmacotherapies for AUD, such as naltrexone and acamprosate, are effective but often underutilized, partly due to adherence challenges (Jonas et al., 2014). Studies examining naltrexone and acamprosate adherence show that smartphone applications can improve adherence and outcomes. For example, a study by Dulin et al. (2014) found that a smartphone-based intervention for individuals with AUD, which included features like self-monitoring of drinking, coping skills training, and social support access, led to significant reductions in risky drinking days compared to a control group. The principle that mHealth can enhance engagement and adherence is supported by research indicating that features such as automated medication reminders, educational modules about medication benefits and side-effect management, and motivational messaging can contribute to improved outcomes (McTavish et al., 2017; Dulin et al., 2014). These improvements are often associated with reduced drinking days and increased treatment retention (McTavish et al., 2017).

In the United States, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) supports research into technologies that can improve AUD treatment outcomes, recognizing the potential of mHealth (NIAAA, 2022). Comparatively, countries like the UK, through the National Health Service (NHS), are increasingly exploring digital health tools, including apps for mental health and substance use (NHS, 2023). However, widespread, standardized adoption for AUD medication adherence specifically via mHealth is still evolving, often requiring more localized evidence and integration into existing care pathways.

Opioid Substitution Therapy (OST), also known as Medications for Opioid Use Disorder (MOUD), typically involves methadone or buprenorphine. These medications are highly effective in reducing illicit opioid use, overdose deaths, and improving overall health and social functioning (CDC, 2024; NIDA, 2023). Adherence to OST is critical for its success. For patients receiving methadone or buprenorphine, mHealth applications have demonstrated potential in improving medication adherence. The synergy between mHealth and Contingency Management (CM) is well-documented. CM is an evidence-based behavioral therapy that provides tangible rewards for positive behavioral change, such as verified abstinence or medication adherence (Petry et al., 2017; Lussier et al., 2019). Integrating CM into mHealth apps, where patients might receive digital vouchers or points for confirmed medication intake (e.g., via video-observed dosing or smart pill dispensers), can automate and scale this effective intervention (Marzilli et al., 2020; Weeks, 2017).

Policy in the United States strongly supports MOUD. The Substance Abuse and Mental Health Services Administration (SAMHSA) promotes MOUD and is increasingly open to digital health solutions that can expand access and improve outcomes (SAMHSA, 2024). The COVID-19 pandemic significantly accelerated the adoption of telehealth and mHealth for SUD treatment, with regulatory flexibilities allowing for remote MOUD induction and monitoring (Krawczyk et al., 2022). In contrast, some countries may have stricter regulations or slower adoption curves for digital health in addiction treatment, often due to concerns about data privacy, security, or the need for more localized evidence. For example, while Australia has a National Drug Strategy that emphasizes harm minimization and treatment (Australian Government Department of Health and Aged Care, 2017), and Canada has seen increased digital health adoption (Canada Health Infoway, 2023), the specific integration and reimbursement of mHealth for OST adherence is an area of ongoing development, with pilot programs and research exploring its feasibility and effectiveness.

Cost-Effectiveness Considerations

The economic burden of untreated or poorly managed SUDs is substantial, encompassing healthcare costs, lost productivity, and criminal justice expenses (National Drug Intelligence Center, 2011). Interventions that improve treatment outcomes, even with an initial investment, can be highly cost-effective. The general principle is that interventions improving adherence to effective treatments are often cost-effective. For instance, a study by Gowing et al. (2015) found opioid substitution treatment upon release from prison to be cost-effective. Another analysis by Fairley et al. (2023) estimated that providing addiction treatment in US primary care clinics is a valuable investment. Furthermore, interventions like naloxone distribution, often coupled with linkage to treatment, have been shown to be cost-saving (Townsend et al., 2018).

Poland's willingness-to-pay (WTP) threshold for a QALY is generally considered to be up to three times its GDP per capita (WHO, 2014), which would place it well above many illustrative ICER figures for similar interventions. However, precise WTP thresholds are subject to national policy decisions and specific health technology assessments.

mHealth interventions can contribute to cost-effectiveness by improving adherence, leading to better treatment outcomes and reducing relapses, which are costly (Gustafson et al., 2014). They can reduce healthcare utilization through fewer emergency department visits or hospitalizations due to complications of SUDs (Acosta et al., 2018). These interventions also increase reach, potentially lowering the cost per patient reached compared to traditional face-to-face interventions, especially in remote or underserved areas (SAMHSA, 2021). Additionally, they automate certain processes, such as reminders or CM reward delivery, freeing up clinician time (Marzilli et al., 2020).

However, realizing this cost-effectiveness requires upfront investment in technology development, implementation, training, and ensuring equitable access. Policy decisions must consider these initial costs against long-term savings and health gains. For example, the UK's NHS has a framework for assessing the value of digital health technologies, considering clinical effectiveness, cost-effectiveness, and patient experience (NHS England, 2021).

Current Challenges and Balanced Perspectives in mHealth for Addiction Policy

Despite the promise, several challenges hinder the widespread and effective implementation of mHealth in addiction policy. A balanced perspective acknowledges not only the potential benefits but also the limitations, risks, and practical hurdles.

The digital divide and equity concerns represent significant challenges. Access to smartphones, reliable internet, and digital literacy is not universal. Policies must address how to ensure mHealth interventions do not exacerbate existing health disparities (Campos-Castillo & Anthony, 2021; Figueroa & Aguilera, 2020). This includes considering populations such as older adults, those with severe mental illness, or those experiencing homelessness. Policymakers must prioritize strategies that bridge this divide, potentially through subsidized device programs, public Wi-Fi initiatives, and digital literacy training specifically tailored to vulnerable populations.

Data privacy and security present another critical concern. Addiction treatment data is highly sensitive. Robust regulatory frameworks (e.g., GDPR in Europe, HIPAA in the US) and technological safeguards are needed to protect patient privacy and ensure data security (Office for Civil Rights, 2013). Potential harms include privacy breaches and misuse of sensitive data, which can have severe consequences for individuals seeking addiction treatment. Policy approaches should include clear standards for encryption, authentication, and data storage, along with transparent consent processes that empower patients to understand how their information will be used.

The market is flooded with health apps, many of which lack an evidence base or rigorous testing (Torous et al., 2018). Clear regulatory pathways for validating and approving mHealth interventions for addiction are needed to ensure safety, efficacy, and quality (FDA, 2022). Policies should establish frameworks for evaluating mHealth tools, potentially through a tiered approach based on risk level, with higher-risk applications requiring more stringent evidence requirements. Certification programs or curated app libraries could help clinicians and patients identify evidence-based options.

mHealth tools are most effective when integrated into broader care pathways, rather than as standalone solutions. This requires interoperability with electronic health records, training for healthcare providers, and clear clinical workflows (SAMHSA, 2021; Acosta et al., 2018). Clinician resistance can stem from concerns about increased workload, lack of training, skepticism about efficacy, or disruption to established practices (Gagnon et al., 2016). Effective policies should mandate interoperability standards, provide resources for implementation support, and create incentives for healthcare systems to adopt integrated approaches to mHealth.

Engaging patients, clinicians, and policymakers in the co-design and implementation process is crucial for adoption and sustainability (Krawczyk et al., 2019). Patient perspectives are vital; mHealth tools must be user-friendly, relevant, and meet the perceived needs of individuals with SUDs (Alqahtani & Orji, 2020). Qualitative research highlights the importance of features that foster a sense of connection, provide personalized support, and are easy to navigate (Schueller et al., 2018). Policy frameworks should require meaningful stakeholder engagement throughout the development and implementation process, with particular emphasis on including the voices of those with lived experience of addiction.

Sustainable funding models and clear reimbursement pathways for mHealth services are often lacking. Payers and policymakers need to recognize mHealth as a legitimate and reimbursable component of addiction care (American Medical Association, 2023). Policies should establish clear coding and payment mechanisms for mHealth services, potentially through value-based payment models that reward improved outcomes rather than simply service delivery. Public funding for research and development of evidence-based mHealth tools, particularly for underserved populations, is also essential.

While promising, the evidence base for specific mHealth features (e.g., gamification, AI-driven personalization, integrated biosensors) and for long-term outcomes continues to evolve. More large-scale, rigorous trials are needed across diverse populations and settings (Tofighi et al., 2019). Not all mHealth interventions are successful; failures can result from poor app design, low user engagement, technical difficulties, or inadequate implementation support (Liverpool et al., 2020). There is a need for more research on "what works for whom" and under what conditions. Policy should prioritize funding for this research while establishing mechanisms for rapid translation of findings into practice.

Beyond privacy, concerns include the risk of technology dependence, potential for mHealth to replace crucial human interaction if not implemented as a supplement, app fatigue, and the possibility of inaccurate information or harmful advice from unregulated apps (Lustgarten et al., 2020). The ethical implications of data collection, algorithmic bias, and ensuring informed consent in digital environments also require careful consideration. Policies should establish ethical guidelines specific to addiction mHealth, addressing issues such as appropriate use of persuasive design elements, safeguards against exploitation of vulnerable individuals, and requirements for transparency in algorithms.

The COVID-19 pandemic catalyzed the use of telehealth for SUD treatment. mHealth can be a powerful adjunct to telehealth, providing continuous support, monitoring, and data collection between virtual appointments (Krawczyk et al., 2022). However, ensuring seamless integration and addressing digital literacy gaps for both telehealth and mHealth remains a challenge. Policies should support the continued integration of telehealth and mHealth beyond the pandemic, with attention to creating sustainable models that combine the benefits of both approaches.

Addressing these challenges requires a multi-pronged policy approach involving investment in digital infrastructure, development of clear regulatory and ethical guidelines, promotion of high-quality research and development, workforce training, strategies to ensure equitable access, and active engagement with patient and clinician groups to ensure mHealth solutions are practical, acceptable, and effective. By thoughtfully navigating these complexities, policymakers can help realize the potential of mHealth to transform addiction treatment while mitigating potential risks and ensuring equitable benefit.

Comparative Analysis of International Implementation Models

The global landscape of addiction treatment reflects a diverse array of strategies adopted by nations addressing substance use disorders (SUDs). For countries like Poland seeking to enhance their addiction policy frameworks, examining international implementation models provides invaluable insights. These models showcase innovative applications of technology, integrated care pathways, harm reduction strategies, and approaches tailored to specific population needs. Understanding their successes, challenges, and supporting evidence can inform the development of effective, contextually appropriate strategies in Poland.

Substance use disorders continue to present a significant global burden. According to the United Nations Office on Drugs and Crime (UNODC, 2023), approximately 296 million people worldwide used drugs in 2021, representing a 23% increase over the previous decade. More concerning is the 45% rise in individuals suffering from drug use disorders, now totaling 39.5 million people. In Europe, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA, 2023a) identifies opioids—particularly heroin and synthetic variants—as major contributors to drug-related deaths and treatment demand, though stimulant and cannabis use also present substantial public health challenges. Treatment coverage remains woefully inadequate; globally, only one in five people with drug use disorders received treatment in 2021 (UNODC, 2023). This treatment gap underscores the urgent need for innovative, evidence-based, and equitably implemented models.

The Estonian Model: Leveraging National e-Health Infrastructure

Estonia's integration of mHealth solutions into its established national e-health infrastructure demonstrates a comprehensive approach to digital health. The country's e-Health system features nationwide e-prescribing, electronic health records, and patient portals (Kruse et al., 2017), creating significant potential for addiction treatment applications to leverage this infrastructure for remote monitoring and adherence support, aligning with broader trends in digital health (World Health Organization [WHO], 2021).

The success of Estonia's approach stems from several key factors. Their centralized development with standardized protocols facilitates interoperability and ensures consistent quality of care. This standardization is crucial for effective data exchange and clinical practice guidance (Kalra et al., 2005), similar to the standardized data needed in Prescription Drug Monitoring Programs to maximize utility (Finley et al., 2017). By integrating with existing healthcare IT infrastructure, Estonia enables potentially seamless data flow between mHealth applications, e-prescription databases, and electronic health records (Kruse et al., 2017), reducing medication errors and improving care coordination (AMCP, 2019).

Comprehensive provider training programs represent another critical element, as effective technology adoption requires thorough preparation to overcome skepticism and ensure competence (Ross et al., 2016). Implementation science emphasizes the importance of training and technical assistance when adopting new practices (Powell et al., 2015). Equally important are clear reimbursement pathways—Estonia has established these for many e-health services through national health insurance, creating financial incentives for adoption (Kattel et al., 2020).

Despite these strengths, implementation challenges exist. Initial provider resistance is common with new technologies; Estonia's broader e-health success involved significant stakeholder engagement and utility demonstration (Kierkegaard, 2013)—strategies equally vital for addiction-specific mHealth. Patient privacy concerns must be addressed through robust data governance, transparent policies, and adherence to regulations like GDPR (European Commission, n.d.). Perhaps most critically, ensuring equitable access to mHealth tools for all populations, including those with limited digital literacy or technology access, remains an ongoing challenge (Litchfield et al., 2021).

The Czech Republic Approach: Regional Pilots and Iterative Development

The Czech Republic's strategy of utilizing regional pilots for mHealth in addiction treatment offers a model potentially adaptable to Poland's healthcare structure. This approach allows for iterative development and local tailoring before wider implementation.

Regional pilots with local adaptation provide flexibility to address specific needs, resources, and cultural contexts while identifying challenges on a smaller scale (Brownson et al., 2017). The Czech model leverages public-private partnerships between public health bodies and private technology developers, combining private sector innovation with public health alignment (Marwaha et al., 2022). These partnerships require careful management to ensure public interest remains paramount.

The stepped implementation approach, focusing initially on specific SUDs like alcohol use disorder, allows for refinement before expansion. Telemedicine has shown promise for AUD treatment (Lin et al., 2020). Importantly, these new mHealth interventions complement rather than replace existing evidence-based treatments, such as those outlined by the American Society of Addiction Medicine (ASAM, 2020) or national guidelines.

The principle of using mHealth to improve adherence is supported by broader research. mHealth interventions have demonstrated potential in improving medication adherence for various chronic conditions (Anglada-Martinez et al., 2015), addressing a major challenge in SUD treatment (Osterberg & Blaschke, 2005). Interventions improving adherence to medication-assisted treatment for opioid use disorder are known to improve outcomes (Sordo et al., 2017).

However, pilot programs may not always translate effectively to national scale due to varying contexts or lack of sustained funding. Ensuring interventions address health equity and reach underserved populations within these pilots is crucial (Baum et al., 2014).

The Swedish Comprehensive Model: Integrated Digital Ecosystem

Sweden has explored integrating mHealth within a broader digital health ecosystem for addiction treatment, emphasizing multi-faceted support systems. This approach combines medication adherence applications with virtual support, leveraging both technology and peer support. Recovery apps often include features like sobriety trackers and connections to support communities (DuBenske et al., 2020; Ashford et al., 2019).

The Swedish model integrates these tools with telehealth services, expanding access to specialists and addressing barriers of stigma and geography in addiction treatment (Lin et al., 2019). Automated escalation protocols detect non-adherence and alert providers, allowing for timely intervention, though the ethical implications and potential for over-surveillance require careful consideration (Kazemi et al., 2017). Moderated in-app communities provide accessible peer support, a valuable component of recovery (Fortuna et al., 2019), though moderation quality and ensuring safe spaces remain critical concerns.

The general premise that digital health can enhance efficiency is supported (WHO, 2021), but cost-effectiveness in addiction mHealth needs more rigorous, context-specific research (Garnett et al., 2022). Critical considerations include avoiding over-reliance on technology without addressing underlying social determinants of health, ensuring digital literacy, and providing human support (Horgan & Osterman, 2023). Perspectives from individuals with lived experience are vital in designing and evaluating such comprehensive systems to ensure they are user-centered and acceptable (Ness et al., 2021).

The Portuguese Model: Decriminalization and Health-Centered Approach

Portugal's decriminalization of low-level possession and use of all illicit drugs, implemented in 2001, represents a distinct and influential model. This approach shifted focus from criminal punishment to public health, channeling individuals caught with drugs towards dissuasion commissions rather than the criminal justice system (Hughes & Stevens, 2010). These commissions, comprising legal, health, and social work professionals, assess individual circumstances and can refer to voluntary treatment, impose fines, or take no further action.

It is important to note that Portugal implemented decriminalization, not legalization—the production and trafficking of drugs remain criminal offenses (Transform Drug Policy Foundation, 2021). The model emphasizes health and social reintegration, prioritizing access to treatment, harm reduction services, and social support (van der Poel et al., 2021). Crucially, decriminalization was accompanied by significant investment in and expansion of these services (Hughes & Stevens, 2012).

Outcomes associated with the Portuguese model include reductions in problematic drug use, drug-related deaths (particularly HIV infections among people who inject drugs), and the burden on the criminal justice system (Hughes & Stevens, 2010; Transform Drug Policy Foundation, 2021). While not a panacea and subject to ongoing debate regarding the direct causality of all observed positive trends (Goulão, 2015), the Portuguese experience provides a compelling case for considering health-centered, non-punitive approaches to drug use. Cultural and socio-political contexts are, however, critical when considering the transferability of such a model (Reuter & Stevens, 2007).

Overarching Considerations for Addiction Policy Development

Several critical themes emerge from these international models that should inform addiction policy development. Integration is fundamental but complex—successful models integrate digital tools with existing healthcare infrastructure and established treatment protocols (ASAM, 2020). However, truly integrating behavioral health into general medical care requires systemic change (Druss & Mauer, 2010).

Addressing medication adherence requires a holistic approach. While mHealth shows promise (Anglada-Martinez et al., 2015), adherence is influenced by social support, mental health, and socio-economic factors that technology alone cannot address (Osterberg & Blaschke, 2005). Digital health tools can expand access and support (Marwaha et al., 2022), but their evidence base varies by specific intervention and population (Kazemi et al., 2017). Concerns about the digital divide, data privacy, lack of regulation, and potential for replacing essential human contact must be addressed (Horgan & Osterman, 2023; Litchfield et al., 2021).

Robust stakeholder engagement, including individuals with lived experience, and comprehensive training are crucial for any new intervention (Powell et al., 2015; Ness et al., 2021). While leveraging data is vital, strong data governance, ethical oversight, and privacy safeguards are paramount (Mehraeen et al., 2022). Sustainable implementation requires supportive policies, clear reimbursement, and long-term funding for technology, infrastructure, and the human workforce (Olsen & Sharfstein, 2014).

Many effective international policies incorporate comprehensive harm reduction strategies, including needle and syringe programs, opioid agonist treatment, naloxone distribution, and supervised consumption services (EMCDDA, 2023b; WHO, 2020). These evidence-based interventions reduce drug-related harms and should be core components of addiction policy.

Policies and interventions must be adapted to the specific cultural, social, economic, and political context of a country or region (NIDA, 2020). They must actively address health disparities related to socioeconomic status, ethnicity, gender, geographic location, and other factors, ensuring accessibility and effectiveness for marginalized populations (Volkow et al., 2021). Beyond training for specific new tools, there's a broader need for developing a skilled and diverse addiction treatment workforce, including specialists, primary care providers, and peer support workers (SAMHSA, 2021).

Current Challenges in Addiction Policy Implementation

Despite promising models, several challenges persist globally. Pervasive stigma surrounding addiction remains a fundamental barrier to help-seeking, policy support, and resource allocation (UNODC, 2023; Livingston et al., 2012). Workforce shortages and maldistribution, particularly in rural and underserved areas, limit access to evidence-based care (SAMHSA, 2021). Securing adequate, sustained, and equitably distributed funding for comprehensive services remains a persistent challenge (Olsen & Sharfstein, 2014).

Fragmented systems often struggle to integrate addiction treatment with primary care, mental health, and social services, despite strong evidence supporting integration (Druss & Mauer, 2010). The rapid emergence of new psychoactive substances and changing drug use patterns require agile and adaptive policy responses (EMCDDA, 2023a). Robust, ethical data systems are needed to monitor trends, evaluate interventions, and guide policy, but these can be complex and require investment (Strang et al., 2012).

Finding the right balance between public health approaches and law enforcement responses to drug use remains contentious in many jurisdictions (Caulkins et al., 2021). The proliferation of mHealth apps for addiction often outpaces rigorous evaluation of their efficacy, safety, and data security (Radtke et al., 2021).

By critically examining diverse international models and acknowledging these overarching challenges, Poland can strategically develop and implement addiction policies that are evidence-based, technologically informed where appropriate, culturally sensitive, equitable, and tailored to its unique contexts. Incorporating perspectives from those with lived experience throughout this process is paramount for success (Ness et al., 2021).

Implementation Recommendations for Poland: A Modern Approach to Addiction Treatment

Based on current evidence, comparative analysis, and an understanding of the Polish context, a phased implementation approach is recommended for Poland. This approach aims to modernize addiction treatment by integrating evidence-based practices, leveraging Poland's digital health infrastructure, fostering robust stakeholder collaboration, and addressing specific national and regional needs. The ultimate goal is to improve access to care, treatment outcomes, and reduce the societal burden of addiction. Recent European data indicates that while cannabis remains prevalent, the harms associated with opioids, stimulants, and new psychoactive substances (NPS) are significant concerns in many member states, including Poland, underscoring the need for effective and comprehensive treatment strategies (EMCDDA, 2023a; KBPN, 2022). This plan also considers the need to integrate with Poland's ongoing mental health reform efforts (Narodowy Program Ochrony Zdrowia Psychicznego, 2023-2030).

Phase 1: Pilot Implementation (Years 1-2)

This initial phase is crucial for testing the proposed interventions in controlled, real-world settings within Poland, allowing for iterative learning and adaptation before a wider rollout. It will also involve a thorough assessment of workforce capacity and the development of targeted training.

Poland exhibits regional variations in drug use patterns, healthcare infrastructure, socioeconomic conditions, and the availability of existing treatment facilities (GUS, 2023; KBPN, 2022). Therefore, establishing 3-5 regional pilots representing diverse geographic and demographic contexts is essential. These pilots should be strategically selected in collaboration with Voivodeship authorities and the National Bureau for Drug Prevention (KBPN) to include a large urban center with higher population density and potentially more complex drug scenes; a rural or semi-rural area with documented challenges in access to specialist care; and a region with specific demographic or economic characteristics such as high unemployment or significant refugee populations requiring culturally sensitive services (Poprawski et al., 2021).

This diversity will ensure interventions are tested across various settings, providing insights into adaptability. For instance, France's expansion of buprenorphine access through general practitioners demonstrated feasibility beyond specialized centers, a model that could inform primary care engagement in Poland (Vignau et al., 2001). The specific nature of existing treatment centers, such as those run by MONAR or public psychiatric hospitals, will be mapped in these pilot regions (MONAR, n.d.; Ministry of Health Poland, 2023).

The initial focus should be on evidence-based pharmacological and psychosocial interventions. Medications for Opioid Use Disorder (MOUD), such as buprenorphine and naltrexone, are recognized as the gold standard of care (WHO, 2023; SAMHSA, 2024). Methadone, another key medication, should be utilized and its accessibility improved, particularly within the existing network of substitution programs in Poland, ensuring adherence to updated national and international guidelines (KBPN, 2021; WHO, 2023). Alongside MOUD, structured psychosocial interventions must be co-delivered, as combination treatment yields superior outcomes (NIDA, 2020; NICE, 2007). The pilot will also explore best practices for treating stimulant use disorders and NPS, emphasizing evidence-based behavioral therapies where pharmacological options are more limited (UNODC & WHO, 2020).

Poland's national e-prescription system (e-recepta) and the broader P1 e-health platform offer robust infrastructure that should be leveraged (Centrum e-Zdrowia, n.d.). Integration protocols should allow authorized providers to prescribe MOUD and other relevant medications electronically via e-recepta. Additionally, the feasibility of developing a secure, GDPR-compliant Prescription Drug Monitoring Program-like functionality within the P1 system should be explored to prevent harmful polypharmacy, identify patients at risk, and support clinical decision-making. This would require careful consideration of data privacy under RODO (Polish GDPR implementation) and could draw lessons from systems like Kentucky's KASPER (CHFS Kentucky, n.d.) or New York's I-STOP (NYS Department of Health, 2013), while being adapted to Polish legal and ethical frameworks.

Effective implementation requires a well-trained and adequately staffed workforce. An initial assessment of current addiction specialists, GPs, nurses, and psychologists in pilot regions will inform training needs (NIPiP, 2023; NIL, 2023). Comprehensive provider training programs at pilot sites should be implemented, covering pharmacology and clinical use of MOUD, evidence-based psychosocial interventions, Screening, Brief Intervention, and Referral to Treatment (SBIRT) techniques, addressing stigma associated with addiction among healthcare professionals, use of new digital tools, patient-centered communication, and harm reduction principles. Portugal's successful approach involved extensive training for primary care providers (Transform Drug Policy Foundation, 2021), a model Poland could adapt.

A robust evaluation framework, designed with academic partners and KBPN, is essential. This should include baseline data collection on current prevalence rates and treatment capacity, standardized assessment tools like the Addiction Severity Index (ASI) or WHO ASSIST, outcome measures such as treatment retention rates and psychosocial functioning improvements, process measures including fidelity to treatment protocols, and cost-effectiveness analysis comparing new models versus existing care.

Phase 2: Evaluation and Refinement (Year 3)

This phase focuses on critically analyzing data and experiences from the pilot programs to inform national scaling, ensuring alignment with Polish healthcare system realities and patient needs.

A comprehensive evaluation of pilot outcomes should be conducted, involving analysis of quantitative data and qualitative feedback through in-depth interviews and focus groups with patients, families, providers, and administrators. The evaluation should identify successes, challenges (e.g., low uptake in certain demographics, technical glitches, workforce shortages), and unintended consequences. Lessons from Canadian evaluations emphasizing flexible service delivery and integrated psychosocial supports are relevant (Socias et al., 2021). Polish patient advocacy groups (e.g., MONAR, JUMP'93) must be consulted for their perspectives (MONAR, n.d.).

Based on user feedback and outcome data, interventions and digital applications should be refined. Treatment protocols may need adjustments in MOUD dosage guidelines, types and intensity of psychosocial support, integration with other health services, and pathways for co-occurring disorders, reflecting Polish clinical realities. If mobile health apps for recovery support are piloted, user feedback from Polish patients on usability, language, features, and impact will be critical. Any tools must be fully RODO compliant, with accessibility for older users or those with disabilities as a key refinement criterion.

Sustainable MOUD and comprehensive addiction treatment programs require adequate and consistent funding from the National Health Fund (NFZ) (NFZ, n.d.). Developing sustainable reimbursement frameworks involves establishing clear billing codes and appropriate reimbursement rates for MOUD, associated evidence-based psychosocial therapies, care coordination, and peer support services. Reimbursement levels should incentivize provider participation, particularly in primary care, covering time and complexity. This may require revising existing NFZ contracts for addiction services (NFZ, 2023). Poland can learn from funding models in other European public healthcare systems, such as Germany or the Czech Republic, which have comparable structures (Commonwealth Fund, 2020; European Observatory on Health Systems and Policies, 2021).

Clear regulatory and ethical guidelines for addiction treatment applications and data management must be established. These include data privacy and security standards fully compliant with RODO and national laws, updated clinical guidelines for MOUD and psychosocial interventions adapted from international best practices, clear licensing and credentialing requirements for providers, and ethical guidelines for data collection and use.

Based on lessons learned from Polish pilots, comprehensive implementation toolkits should be created for nationwide scaling. These should contain standardized, Polish-language training curricula and materials, clinical protocols reflecting Polish healthcare pathways, technical guides for e-health integration, templates for patient consent forms in Polish and other relevant languages, and adaptable checklists and standard operating procedures for different clinical settings.

Phase 3: National Implementation (Years 4-5+)

This phase involves the systematic, evidence-informed expansion of the refined model across Poland, with continuous monitoring and adaptation.

A phased national rollout should prioritize regions with documented high need and limited specialist access. This approach, guided by KBPN data and regional health assessments (KBPN, 2022; GUS, 2023), allows for capacity building and problem-solving while promoting health equity. This strategy mirrors efforts in countries like Canada to expand access to remote communities (Health Canada, 2023), adapted to Polish geography and infrastructure, and must be coordinated with Voivodeship-level health planning.

The Patient's Internet Account (IKP) system and P1 platform should be fully integrated with addiction treatment services. The IKP is a key component of Poland's e-health infrastructure (Centrum e-Zdrowia, n.d.), and deeper integration could allow patients to securely view their addiction treatment plans and medication history, communicate with providers, access curated educational resources, and potentially report outcomes or side effects. Estonia's e-Health system provides a benchmark for patient data access (e-Estonia, n.d.), though Poland's implementation must fit its own legal and technical framework.

To encourage widespread adoption and high-quality care, sustainable provider incentive structures should be developed. Financial incentives should include appropriate NFZ reimbursement for MOUD provision, complex case management, and evidence-based psychosocial interventions. Pay-for-performance bonuses could be explored, tied to quality indicators rather than just volume. Non-financial incentives should include professional recognition, access to advanced training and supervision, reduced administrative burden through efficient digital tools, support from multidisciplinary teams, and clear referral pathways. Research into effective service delivery models, such as those explored by the NIH HEAL Initiative, can offer insights (NIH, n.d.).

Addiction treatment is dynamic, requiring ongoing monitoring, quality improvement (QI), and research processes. This involves continuous collection and analysis of anonymized data, regular audits of service quality and adherence to guidelines, robust feedback mechanisms, and a dedicated national body to oversee QI, research, and policy adaptation using Plan-Do-Check-Act cycles (Langley et al., 2009).

A secure, RODO-compliant national, confidential addiction treatment registry should be created for outcome tracking and research. This can monitor long-term treatment outcomes, track epidemiological trends, inform policy decisions and resource allocation, and facilitate Polish-led research on addiction treatment effectiveness. Data protection, patient confidentiality, and ethical use of data are paramount. The EMCDDA's Treatment Demand Indicator (TDI) provides a framework for standardized data collection that Poland already contributes to and can expand upon (EMCDDA, 2023b).

Key Implementation Considerations

Technical Requirements

End-to-end encryption and robust security for all patient data is non-negotiable, ensuring full compliance with RODO and national data protection laws under UODO oversight. While Poland's internet connectivity is generally good, disparities exist (UKE, 2022), so critical functionalities of digital tools should be available offline or in low-bandwidth modes to ensure equitable access. Seamless, secure data exchange between new addiction treatment applications and existing national e-health platforms is vital, adhering to Polish interoperability frameworks (Centrum e-Zdrowia, n.d.).

Given Poland's demographics, including a significant Ukrainian-speaking refugee population (Statistics Poland, 2023; UNHCR, 2023), providing key interfaces and patient materials in Polish and Ukrainian is essential. Digital tools must be designed in accordance with Web Content Accessibility Guidelines (WCAG) (W3C, 2018) and Polish accessibility laws to ensure usability for all.

Stakeholder Engagement

Broad-based support and active participation from all relevant Polish stakeholders are critical. A multidisciplinary national implementation committee should be established, potentially chaired by the Ministry of Health or KBPN, to guide implementation. This committee should include addiction specialists, primary care providers, nurses and pharmacists, patient representatives and peer support workers, technical experts, policymakers, researchers, and local government representatives responsible for regional health planning. The value of such multidisciplinary teams is well-established (ICH, n.d.).

Some providers may be hesitant due to stigma surrounding addiction (Okulicz-Kozaryn & Misiak, 2021), perceived lack of expertise, concerns about workload, or philosophical objections to MOUD. Patients may have privacy concerns or mistrust. Targeted engagement strategies for potentially resistant stakeholders should include educational workshops co-led by respected Polish clinicians and patient advocates, peer-to-peer advocacy from early adopters within the Polish medical community, demonstration of benefits through pilot data, transparent addressing of concerns regarding reimbursement and support systems, and public information campaigns to reduce societal stigma.

Clear communication channels should be created for implementation challenges and solutions, including regular meetings, newsletters, and a dedicated helpline or online portal for stakeholders to report issues, share best practices, and collaboratively problem-solve. Shared decision-making processes for application and policy refinement should involve end-users in the design, testing, and refinement of treatment protocols, digital tools, and service delivery models through co-design workshops, user surveys, and feedback sessions.

By systematically addressing these implementation phases and considerations, tailored to the Polish context and leveraging its existing strengths, Poland can significantly enhance its capacity to address addiction. This aligns with international best practices and EU drug strategies, ultimately improving public health outcomes. Long-term commitment to research, evaluation, adaptation, and sustainable funding through the NFZ will be key to enduring success. Consideration must also be given to integrating these efforts with broader public health initiatives, including mental health services and harm reduction programs already operating in Poland (KBPN, 2021).

Policy and Funding Considerations

The successful integration and scaling of mHealth solutions for addiction treatment within Poland necessitates robust, supportive policy frameworks and sustainable, diversified funding mechanisms. These must be carefully aligned with Poland's national healthcare priorities, existing legislative structures, and fiscal constraints, while also drawing lessons from international best practices and critically evaluating their transferability (World Health Organization [WHO], 2016). The overarching goal is to create an environment where innovative digital tools can effectively augment traditional addiction services, improve access, enhance treatment outcomes, and address the specific needs of the Polish population, while mitigating potential risks and ethical concerns (European Commission, 2018).

Policy Recommendations

Effective policy is the bedrock upon which successful mHealth implementation is built. This involves not only creating new regulations where necessary but also adapting existing frameworks to accommodate the unique aspects of digital health interventions, ensuring they are evidence-based, safe, and equitable (WHO, 2019).

Regulatory Classification for Addiction Treatment Applications

The capabilities and risks associated with mHealth applications vary significantly. Some function as wellness or self-management tools, while others deliver clinical interventions, provide therapeutic content, or facilitate direct communication with healthcare providers (Chandrashekar, 2018). A tiered classification system, reflecting the potential risk and level of clinical intervention, is crucial for applying appropriate regulatory oversight.

The U.S. Food and Drug Administration (FDA) has developed a risk-based framework for digital health technologies, distinguishing between low-risk wellness devices and those classified as medical devices requiring more stringent review, such as under its Digital Health Software Precertification Program (FDA, 2022). Similarly, the European Union's Medical Device Regulation (MDR - Regulation (EU) 2017/745) provides a comprehensive framework that applies to certain health apps, particularly those with a clear medical purpose and higher risk profile (European Commission, 2017). Poland, as an EU member, must align with the MDR, and could further develop national guidance for classifying apps that fall into borderline categories or are specific to addiction treatment.

Research into mobile phone-based interventions for substance use often involves academic and research institutions in their development and initial piloting, highlighting the need for clear regulatory pathways to transition effective tools from research settings to broader, regulated clinical use (Lüscher et al., 2021). The specific application of these frameworks to addiction-focused mHealth tools requires careful consideration of their intended use and claims (FDA, 2023).

Certification Standards for Application Security, Clinical Effectiveness, and Usability

To ensure patient safety, protect sensitive data, and build trust among users and clinicians, mHealth applications for addiction treatment must meet robust standards. These include technical security, data privacy (in line with GDPR), clinical or evidence-informed effectiveness, and user-centered design (Maramba et al., 2019).

Cybersecurity is a critical concern for all digital health tools, especially those handling highly sensitive addiction treatment data (FDA, 2023). Standards must address data encryption, secure storage, access controls, regular security audits, and full compliance with the General Data Protection Regulation (GDPR) (European Commission, n.d.-a).

Certification should involve review by an independent national body or an accredited third-party organization. This review should assess the app's underlying therapeutic principles against established clinical guidelines, evaluate available evidence of efficacy from well-designed studies, and assess usability to ensure the app is accessible and engaging for the target population (Baumel et al., 2019). While initiatives like the UK's NHS Apps Library have faced challenges, the principle of curating apps based on safety, effectiveness, and usability remains valuable (NHS, n.d.). Organizations like ORCHA provide independent reviews, which could serve as a model (ORCHA, n.d.).

The WHO (2019) emphasizes that digital health technologies must be safe, effective, and usable to strengthen health systems. A significant concern in the mHealth field is the proliferation of apps with limited or no rigorous evaluation of their effectiveness or safety (Henson et al., 2019).

Data Governance Frameworks and Sharing Agreements

Aggregated, anonymized data from mHealth apps can be invaluable for monitoring treatment trends, evaluating intervention effectiveness at a population level, improving service quality, and informing policy decisions (WHO, 2021). However, this potential must be carefully balanced with stringent patient privacy protections, especially given the stigma associated with addiction.

Data governance agreements must clearly define what data can be collected, the processes for robust anonymization or pseudonymization, who can access the data, and for what specific, ethically approved purposes. Explicit, informed consent mechanisms are paramount, and Poland's framework must be fully compliant with GDPR and any national data protection legislation (European Commission, n.d.-a). Consideration should be given to federated data models that allow for analysis without centralizing sensitive raw data.

Finland's Act on the Secondary Use of Health and Social Data (Findata) aims to enable secure and ethical use of health and social data for research, development, and knowledge-based management, offering a potential model for consideration (Findata, n.d.). The European Health Data Space (EHDS) initiative also aims to facilitate secure access to and sharing of health data for research and policy, which will influence Polish approaches (European Commission, n.d.-b).

Robust data governance is essential when dealing with sensitive SUD information (Office of the National Coordinator for Health Information Technology [ONC], 2020). Effective outcome evaluation is critical for demonstrating the value of mHealth interventions, which can then support arguments for sustained funding and wider adoption (Acion et al., 2021).

Integration of mHealth Competencies into Professional Training

Healthcare professionals require specific knowledge and skills to critically evaluate, ethically recommend, and effectively integrate mHealth tools into addiction treatment. This includes understanding the evidence base, data privacy and security implications, usability, ethical considerations, and how to support patients using these technologies (Hilty et al., 2020).

Curricula for medical students, psychiatry residents, addiction specialists, psychologists, social workers, and counselors should include dedicated modules on digital health. Continuing professional development (CPD) opportunities are also essential to keep pace with technological advancements and emerging best practices (Gordon & Catalini, 2018). Training should also address how to manage the therapeutic relationship in a digitally mediated environment.

Frameworks for digital health competencies in healthcare are emerging, emphasizing the need for structured training to ensure clinicians can use these tools responsibly and effectively (Shachak et al., 2019). The involvement of junior scientists experienced in mHealth to lead information sessions, as noted by Lüscher et al. (2021), underscores the value of specialized knowledge transfer.

Modification of Existing Treatment Guidelines

For mHealth to become an integral part of standard addiction care in Poland, it must be recognized and recommended within official national treatment guidelines. This signals legitimacy, encourages adoption by providers, and can facilitate reimbursement (National Institute for Health and Care Excellence [NICE], 2017).

National bodies in Poland responsible for issuing or endorsing treatment guidelines should systematically review the evidence for mHealth interventions. Where sufficient evidence of effectiveness, safety, and cost-effectiveness exists, guidelines should be updated to include recommendations for their use, perhaps as adjuncts to standard care, for relapse prevention, aftercare support, or for specific patient populations.

The National Institute on Drug Abuse (NIDA, 2020) in the U.S. emphasizes that effective treatments exist and can help individuals counteract addiction's disruptive effects. Integrating validated mHealth tools could enhance the reach, personalization, and effectiveness of these established treatment principles (Marsch et al., 2021).

Funding Mechanisms

Sustainable funding is critical for the initial development, rigorous evaluation, implementation, and long-term maintenance and updating of mHealth initiatives in addiction treatment. A diversified funding strategy, leveraging both public and private sources, and moving towards reimbursement for proven interventions, is often the most resilient approach (WHO, 2016).

Initial Implementation Funding

Poland's National Health Fund (Narodowy Fundusz Zdrowia - NFZ) is the primary public payer for healthcare services. Advocating for the allocation of specific funds from existing innovation budgets, or the creation of new pilot program funding streams within the NFZ, could kickstart mHealth initiatives in addiction treatment. This would allow for controlled testing, adaptation to the Polish context, and evidence generation before wider scaling (Garrido et al., 2019). Many health systems globally utilize innovation funds or pilot programs to test new models of care, including digital health, before committing to large-scale rollouts (OECD, 2019).

EU Structural and Health-Focused Funds

The European Union offers various funding mechanisms (e.g., Digital Europe Programme, EU4Health Programme, Cohesion Funds, Recovery and Resilience Facility) that can support the development of digital health infrastructure, interoperability projects, digital skills training, and research and innovation in health (European Commission, n.d.-c; European Commission, n.d.-d).

Poland can strategically apply for these funds to build foundational elements for a national mHealth strategy in addiction. This could include developing secure data platforms, enhancing telehealth capabilities, funding research on mHealth effectiveness in the Polish context, or supporting digital literacy programs for patients and providers. The WHO (2019) notes that digital health can help make health systems more efficient, accessible, and sustainable, aligning with the goals of many EU funding programs aimed at health system transformation and digitalization.

Value-Based Reimbursement Models

Shifting from traditional fee-for-service models towards value-based payment (VBP) can incentivize providers to adopt effective mHealth tools that improve patient engagement, adherence to treatment plans, and ultimately, health outcomes (Porter & Lee, 2013). Reimbursement could be linked to metrics such as sustained app engagement, completion of digital therapeutic modules, or, where ethically and practically feasible and with robust privacy safeguards, patient-reported outcomes or clinically verified improvements.

While the Centers for Medicare & Medicaid Services (CMS, 2023) in the U.S. has been actively promoting value-based programs, and SAMHSA (2023) has published guides on VBP for SUD services, the adoption and success of VBP models vary. Defining "value" and reliably measuring outcomes in addiction treatment, especially via digital means, is complex and can be controversial (Hussey et al., 2013). The feasibility and design of VBP models for mHealth in addiction would need careful consideration within the Polish healthcare financing system and regulatory environment.

Public-Private Partnerships

Pharmaceutical companies, particularly those producing medications for opioid use disorder (MOUD) or alcohol use disorder (AUD), as well as technology developers, may have an interest in improving medication adherence and overall treatment outcomes. Public-private partnerships could involve co-developing or funding adherence-focused apps, digital support programs, or research initiatives.

Transparency, robust ethical guidelines, and clear governance structures are paramount to manage potential conflicts of interest, ensure patient data privacy and ownership, and guarantee that public health objectives remain primary (WHO, 2016). Any such partnerships must avoid promoting specific products inappropriately and ensure clinical independence.

Sustainable Maintenance Funding

For long-term viability and mainstream adoption, proven mHealth services need to be integrated into the standard healthcare reimbursement system. This involves creating new, or adapting existing, billing codes that providers can use for delivering care or support via validated digital means.

This requires a multi-stakeholder collaborative process involving medical societies, regulatory bodies (including the Agency for Health Technology Assessment and Tariff System - AOTMiT in Poland), patient advocacy groups, and the NFZ to define the services, establish appropriate reimbursement rates based on evidence of effectiveness and cost-effectiveness, and develop clear billing procedures (Sanyal et al., 2019). This can be a lengthy and complex process, requiring robust evidence of clinical benefit, cost-effectiveness, and integration into clinical pathways. The rapid evolution of technology also means reimbursement systems need to be adaptable.

Legislative Considerations

Existing Polish legislation may need review and potential amendment to fully enable, regulate, and support the safe, effective, and equitable use of mHealth in addiction treatment.

Amendments to Existing Addiction Legislation

Poland's primary legislative framework for addiction is the Act of 29 July 2005 on Counteracting Drug Addiction. Explicitly acknowledging and defining digital interventions as legitimate components of prevention, treatment, harm reduction, and recovery support within this Act and other relevant health laws would provide a clear legal basis for their use, funding, and regulation. This can facilitate the integration of mHealth into national addiction strategies, programs, and public health initiatives.

Modifications to Healthcare Provider Regulations

As mHealth becomes more integrated into care, healthcare professionals working in addiction services should demonstrate a baseline level of digital literacy and competency in using these tools ethically, safely, and effectively (Hilty et al., 2020). Licensing bodies and professional associations could incorporate criteria related to digital health into initial qualification requirements and ongoing professional development or re-licensing standards. This could be fulfilled through accredited training programs focusing on evidence appraisal, ethical guidelines for digital practice, and data security.

Privacy and Data Protection Regulations

While GDPR provides a strong overarching data protection framework (European Commission, n.d.-a), specific national interpretations or supplementary regulations might be needed to clarify how health data from mHealth apps can be securely and ethically shared among a patient's multidisciplinary care team or used for de-identified research purposes without compromising patient confidentiality. This is particularly salient for highly sensitive addiction data.

The aim is to enable better, more coordinated care and robust research, not to weaken privacy protections. Clear national guidelines on consent processes for data sharing, robust anonymization/pseudonymization techniques, data security protocols for mHealth platforms, and patient data access rights are paramount. The role of Poland's Data Protection Authority (UODO) would be key here.

Ensuring Equitable Access

The benefits of mHealth should not exacerbate existing health disparities. Policies must proactively address the digital divide to ensure equitable access and benefit for all individuals needing addiction support (Latulippe et al., 2017). This could include public funding for community access points, provision of subsidized devices or data plans for low-income individuals, development of apps with simplified interfaces and multilingual support, co-designing solutions with target vulnerable groups, and offering human facilitation and support alongside digital tools (Friis-Healy et al., 2021).

Telehealth initiatives often highlight challenges in reaching rural, older, or socioeconomically disadvantaged populations, emphasizing the need for culturally competent and accessible solutions (Hilty et al., 2020). A significant portion of individuals within carceral settings, a particularly vulnerable population, have SUDs; while digital health is being explored for this group, specific attention to access, literacy, and ethical considerations is crucial (Krawczyk et al., 2023).

Current Challenges in Addiction Policy Implementation and mHealth Integration

Persistent societal and internalized stigma surrounding addiction remains a major barrier to help-seeking, policy prioritization, and adequate resource allocation in Poland, as in many countries (WHO, 2014; Domaradzki & Wąsiński, 2021). Shortages of trained addiction specialists, coupled with varying levels of digital literacy and comfort with new technologies among existing healthcare professionals, can impede the effective rollout and integration of mHealth solutions (SAMHSA, 2023; Hilty et al., 2020).

Ensuring interoperability between new mHealth platforms and Poland's existing electronic health record systems, patient portals, and healthcare workflows is a significant technical, logistical, and financial challenge (WHO, 2019; European Commission, 2018). Disparities in access to technology, digital literacy, and trust in digital services can mean that mHealth solutions inadvertently worsen health inequities if not implemented with specific strategies to support vulnerable and underserved populations in Poland (Latulippe et al., 2017).

Policymaking and regulatory processes often struggle to keep pace with rapid technological advancements in the mHealth space, making it difficult to establish timely, relevant, and adaptable standards for safety, efficacy, and data security (Price Waterhouse Coopers, 2020). While the evidence for mHealth in addiction is growing, the long-term effectiveness and cost-effectiveness of many specific interventions require further research, particularly studies conducted within or applicable to the Polish healthcare context (Marsch et al., 2021; Acion et al., 2021).

Resistance or skepticism from addiction treatment providers, concerns about increased workload, lack of clear clinical guidelines for mHealth use, or difficulties integrating these tools into established workflows can hinder adoption (Gagnon et al., 2016). Beyond data privacy, other ethical issues include ensuring informed consent for digital interventions, managing the therapeutic alliance in a digital context, potential for over-reliance on technology, and ensuring mHealth tools do not replace essential human interaction and support, especially for complex cases (Shaw et al., 2022).

By proactively and comprehensively addressing these policy, funding, legislative, and implementation challenges, drawing on both international evidence and a deep understanding of the Polish national and local context, Poland can create a fertile ground for mHealth innovations to significantly contribute to tackling the challenges of addiction. This requires a multi-stakeholder approach involving government, healthcare providers, researchers, technology developers, and, crucially, individuals with lived experience of addiction.

Conclusion

This comprehensive analysis of mobile health applications for medication adherence in Polish addiction treatment reveals both significant opportunities and substantial challenges. Poland's addiction treatment system faces pressing issues including high prevalence of substance use disorders, geographic disparities in service access, and inadequate medication adherence. Simultaneously, the country has developed robust digital health infrastructure and achieved high smartphone penetration, creating fertile ground for mHealth implementation.

The evidence base for mHealth in addiction treatment continues to mature, with promising results for improving medication adherence, reducing substance use, and enhancing treatment engagement. Studies examining specific medications for alcohol and opioid use disorders demonstrate that smartphone applications with features like automated reminders, educational content, and motivational messaging can contribute to improved outcomes. However, the evidence also highlights limitations, including high attrition rates and the need for more long-term studies in diverse populations.

International implementation models offer valuable lessons for Poland. Estonia's integration of mHealth with national e-health infrastructure demonstrates the importance of standardized protocols and interoperability. The Czech Republic's regional pilots showcase the value of iterative development and local adaptation. Sweden's comprehensive model highlights the benefits of integrating medication adherence applications with virtual support and peer communities. Portugal's health-centered approach emphasizes the importance of comprehensive services and social support alongside technological solutions.

The recommended phased implementation approach allows Poland to test interventions in controlled settings, refine them based on feedback, and systematically expand successful models nationwide. This approach recognizes the need to address regional variations in drug use patterns, healthcare infrastructure, and socioeconomic conditions while building capacity and solving problems incrementally.

Critical to successful implementation is addressing several key challenges. These include developing clear regulatory frameworks for mHealth applications, ensuring robust data privacy protections, bridging the digital divide to prevent exacerbating health inequities, integrating mHealth competencies into professional training, and establishing sustainable funding mechanisms. The persistent stigma surrounding addiction, workforce shortages, and interoperability issues must also be addressed.

Final recommendations for Polish policymakers include:

1. Establish a dedicated national strategy for mHealth in addiction treatment with clear goals, roles, funding mechanisms, and evaluation metrics.
2. Develop a tiered regulatory framework for addiction treatment applications, with certification standards for security, clinical effectiveness, and usability.
3. Create sustainable reimbursement pathways through the NFZ for evidence-based mHealth interventions.
4. Invest in workforce development, including digital literacy training for healthcare providers and specialized education in addiction medicine.
5. Implement targeted strategies to address the digital divide, ensuring equitable access for vulnerable populations.
6. Foster robust stakeholder engagement, including individuals with lived experience, throughout the development and implementation process.
7. Establish a national research agenda to evaluate the effectiveness, cost-effectiveness, and implementation challenges of mHealth interventions in the Polish context.
8. Integrate mHealth within comprehensive care models that address the biological, psychological, and social aspects of addiction.

By pursuing these recommendations with a commitment to evidence-based practice, equity, and patient-centered care, Poland can leverage mobile health technologies to transform its addiction treatment system, improving access, enhancing outcomes, and ultimately reducing the burden of substance use disorders on individuals, families, and society.

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