BACKGROUND AND OBJECTIVES: Managing substance use disorders (SUDs) is limited by the lack of longitudinal clinical data during active use and recovery. Wearable devices may help address this gap by capturing physiological and behavioral data in real-world settings. This review evaluated the feasibility and acceptability of wearable devices among individuals with SUDs.

METHODS: A systematic search of PubMed, PsycINFO, and MEDLINE identified peer-reviewed studies published between 2000 and 2023 examining wearable devices that passively measured physiological data among adults with SUDs or at-risk substance use.

RESULTS: Thirty-three studies met inclusion criteria and were grouped into feasibility and acceptability outcomes, sleep-related outcomes, and other clinical outcomes including craving, stress, and detection of substance use or overdose events. Most studies used wrist-worn devices and focused on opioid and alcohol use. The literature was heterogeneous and predominantly observational, with few experimental designs, and several studies included individuals with at-risk use rather than diagnosed SUDs. Short-term wearable use was generally feasible and acceptable when privacy and safety concerns were addressed. Wearables captured indicators such as sleep disruption, stress, and overdose risk. However, none of the included studies evaluated whether wearable use was associated with improved substance use outcomes over time.

DISCUSSION AND CONCLUSIONS: Wearable devices show promise as adjunct tools for monitoring clinically relevant indicators in SUDs, but evidence remains limited. Future research should prioritize longitudinal outcomes, validate clinically meaningful thresholds, and support equitable, patient-centered implementation.

SCIENTIFIC SIGNIFICANCE: This review provides a structured synthesis of an emerging and fragmented literature, offering a foundation to guide future hypothesis-driven, longitudinal, and implementation-focused research.