Aims: This study aims to 1) categorize experiences with stress and craving during substance use disorder (SUD) treatment, 2) explore perceptions of both clients and treatment providers towards a digital detection system for stress and craving during recovery, and 3) identify barriers and facilitators to adopting this technology during SUD treatment.

Methods: This was a qualitative study of people in recovery from SUD (clients) and healthcare providers from outpatient treatment facilities in the northeast United States. Clients were asked to use a digital health tool that detects physiological biomarkers of stress and craving (RAE Health) for 30 days alongside their usual treatment and to engage in a semi-structured interview upon completion. Providers were asked to participate in a one-time focus group.

Results: Thirty-one clients completed a semi-structured interview, and eleven providers participated in two focus groups. Four core themes emerged from the qualitative data: categorization of experiences with stress and craving, perceptions of digital detection systems, perceived barriers and facilitators of the system, and desired features of the system. Overall, client and provider perception were positive, and acceptability of the digital health tool was high.

Conclusions: A digital detection system for stress and craving during SUD recovery was perceived favorably by both clients and providers, with clients citing heightened awareness and providers citing opportunities for personalized care as promising use cases. Future iterations of digital health systems for this population should consider the ideal "dose" of the intervention to maximize benefit.