Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys

Islands in the stream: a qualitative study on the accessibility of mental health care for persons with substance use disorders in Belgium

Introduction

Persons with substance use disorders (SUD) make up a considerable proportion of mental health care service users worldwide. Since 2010, Belgian mental health care has undergone a nationwide reform ('Title 107') aiming to realize a mental health care system that fosters more intensive collaboration, strengthens the cohesion and integration across and between different services, and is more responsive to the support needs of all service users. Although persons with SUD were named as a prioritized target group, how this reform impacted the lives and recovery journeys of persons with SUD remains understudied. This study aims to investigate how persons with SUD, regardless of whether they have co-occurring mental health issues, experience the accessibility of mental health care in light of the 'Title 107' reform.

Methods

Data were collected by means of in-depth interviews with a heterogeneous sample of persons with SUD (n=52), recruited from five regional mental health networks in Belgium. In-depth interviews focused on experiences regarding (history of) substance use, accessibility of services and support needs, and were analyzed thematically.

Results

Five dynamic themes came to the fore: fragmentation of care and support, the importance of "really listening", balancing between treatment-driven and person-centered support, the ambivalent role of peers, and the impact of stigma.

Discussion

Despite the 'Title 107' reform, persons with SUD still experience mental health care services as 'islands in the stream', pointing to several pressing priorities for future policy and practice development: breaking the vicious cycles of waiting times, organizing relational case management, tackling stigma and centralizing lived experiences, and fostering recovery-promoting collaboration.

Healthcare use of young finnish adults with mental disorders - profiles and profile membership determinants

BACKGROUND

Comprehensive, timely, and integrated primary care services have been proposed as a response to the increased demand for mental health and substance use services especially among young people. However, little is known about the care utilization patterns of young people with mental and substance use disorders. Our aim was to characterize profiles of care use in young Finnish adults with mental or substance use disorders, and the potential factors associated with the service use profiles.

METHODS

Primary and specialized care visits of young adults (16-29 years) diagnosed with a psychiatric or a substance use disorder (n = 7714) were retrieved from the national health care register from years 2020 and 2021. K-Means clustering was used to detect different profiles based on the utilization of care services. Multinomial logistic regression was used to analyze the factors associated with different profiles of care use.

RESULTS

Five different profiles were identified: low care use (75%), and use of principally primary health care (11%), student health services (9%), psychiatric services (5%), or substance use services (1%). Female gender was associated with membership in the primary health care focused profiles (OR 2.58 and OR 1.99), and patients in the primary health care and student health services profiles were associated with a better continuity of care (OR 1.04 and OR 1.05). Substance use disorders were associated with psychiatric service use (OR: 2.51) and substance use services (OR: 58.91). Living in smaller municipalities was associated with lower service use when comparing to the largest city.

CONCLUSIONS

Young adults diagnosed with a psychiatric or a substance use disorder had remarkably different and heterogeneous care patterns. Most of the participants had low care utilization, indicating potential gaps in service use and care needs. Measures should be taken to ensure equal access to and availability of mental health services. The profiles that utilized the most services highlights the importance of integrated services and patient-oriented improvement of treatment.

The knowledge of primary health care professionals regarding mental health: diagnosis by mhGAP

OBJECTIVE

To analyze knowledge about priority topics in mental health care of strategic actors who work in regions where the Health Care Planning (PAS) methodology is used.

METHODS

This is a quantitative, descriptive, cross-sectional, and observational study carried out with professionals from six health regions, distributed in three Brazilian states (Goiás, Rondônia and Maranhão) and linked to the project "Saúde mental na APS" (Mental health in PHC) of the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (Proadi-SUS - Institutional Development Support Program of the Brazilian Unified Health System). The sample was made up of professionals who participated in the intervention guide multiplier training stage for mental, neurological and alcohol and other drug use disorders in the primary health care network, from July to September 2022. Data collection was through a self-administered instrument, in electronic format, consisting of a block with socioeconomic items and a structured questionnaire to assess participants' knowledge about priority topics in mental health. Descriptive analyses and comparison of proportions were conducted to analyze the data.

RESULTS

A total of 354 health professionals participated in the study. Regarding the percentage of correct answers in the questionnaire on priority topics in mental health, the highest medians were identified in the "Depression" module. On the other hand, the content referring to the modules "Essential care and practices" and "Other important complaints" presented the lowest values. Furthermore, some participant characteristics were found to be associated with the percentage of correct answers in the questionnaire modules.

CONCLUSIONS

The findings reveal opportunities for improvement, mainly in knowledge related to communication skills and the approach to emotional and physical distress without diagnostic criteria for a specific disease, offering support for planning actions aimed at intensifying the consideration of these themes during the operational stages of PAS.

Substance use in the correctional settings: A qualitative exploration of individual and contextual characteristics and intervention strategies using the behavior change wheel framework

BACKGROUND AND OBJECTIVES

Planning and implementing prison-based substance use disorder (SUD) interventions are challenging. We wanted to understand why and how people in correctional settings (CS) use drugs and to explore what policies, environmental, and interpersonal factors influence substance use among incarcerated people. Using the Behavior Change Wheel (BCW) framework, we proposed a thematic map with intervention functions to reduce substance use in CS.

METHODS

We used the Framework Method of qualitative analysis. We did snowball sampling for the incarcerated people with drug use (PWD) and convenience sampling for the staff. The in-depth interview sample comprised 17 adult PWD, three prison administrative, and two healthcare staff. We determined the sample size by thematic data saturation. We followed a mixed coding approach for generating categories, i.e., deductive (based on the BCW framework) and inductive. The study constructed the final theoretical framework by determining the properties of the categories and relationships among the categories.

RESULTS

We identified eleven categories aligned with the BCW framework. The themes were prison routine, interpersonal dynamics of the incarcerated population, exposure to substance use, attitude of staff towards PWD, experience with prison healthcare, willingness (to reduce drug use) and coping, compassion, drug use harms, conflict between staff and residents, stigma, and family/peer support. The BCW framework aided the identification of potential intervention functions and their interactions with the organizational policies that could influence PWD's capability-opportunity-motivation (COM) and drug use behavior (B).

CONCLUSION

There is a need to raise awareness of SUD prevention and intervention among decision-makers and revisit the prison policies.

Predictors of treatment outcome for individuals with alcohol use disorder with a goal of controlled drinking

BACKGROUND

Research is lacking on predictors of outcome for the treatment of alcohol use disorder (AUD) with a goal of controlled drinking (CD). The aim of the study was to investigate one-year outcomes of an RCT, investigating Behavioral Self-Control Training (BSCT) and Motivational Enhancement Therapy (MET) and predictors of positive outcome for weekly alcohol consumption, CD and symptom reduction in AUD.

METHODS

This study is based on secondary analyses from a randomized controlled trial including 250 individuals with AUD (52% men) recruited from three specialized addiction clinics in Stockholm, Sweden. Linear and logistic mixed regression models were used for outcomes at 52 weeks, and linear and logistic regression models for the predictor analyses.

RESULTS

BSCT was superior to MET for the change between baseline to 52 weeks for the outcome of CD, defined as low-risk drinking below ten standard drinks per week for both genders (p = 0.048). A total of 57% of individuals in BSCT attained a level of CD, as opposed to 43% in MET. Females were significantly better in attaining low-risk drinking levels compared to men. The predictor for obtaining CD and reducing weekly alcohol consumption, was a lower baseline alcohol consumption. Predictors of symptom reduction in AUD were lower baseline level of AUD, and a lower self-rated impaired control over alcohol consumption.

CONCLUSIONS

BSCT was superior to MET in obtaining CD levels, and women were superior to men for the same outcome. The study corroborated baseline consumption levels as an important predictor of outcome in CD treatments. The study contributes with important knowledge on key treatment targets, and knowledge to support and advice patients in planning for treatment with a goal of controlled drinking.

TRIAL REGISTRATION

The original study was registered retrospectively at isrtcn.com (14539251).

Redevelopment of mental health first aid guidelines for substance use problems: a Delphi study

BACKGROUND

Substance use problems have a major impact on the physical and mental health of individuals, families and communities. Early intervention may have a positive effect on recovery and treatment outcomes for those with substance use problems, reducing related risk and harm. Separate mental health first aid guidelines on how a member of the public could assist someone experiencing or developing alcohol use and drug use problems in high income Western countries were developed using Delphi expert consensus in 2009 and 2011, respectively. This study aimed to synthesise and update these two original guidelines to reflect current evidence and best practice.

METHODS

The Delphi expert consensus method was used to determine the inclusion of statements in the redeveloped guidelines. A questionnaire was developed using previously endorsed helping statements from the original guidelines on alcohol and drug use problems, as well as relevant content identified in systematic searches of academic and grey literature. Three panels of experts (people with lived experience, support people and professionals) rated statements over three consecutive online survey rounds to determine the importance of their inclusion in the guidelines. Statements endorsed by at least 80% of each panel were included.

RESULTS

103 panellists completed all three survey rounds. They rated 469 statements and endorsed 300 of these for inclusion in the redeveloped guidelines.

CONCLUSIONS

This study has developed a broader and more comprehensive set of guidelines for how to support a person experiencing or developing a substance use problem. The redeveloped guidelines provide more detail on knowledge about and recognition of substance use problems, approaching and assisting people who want to change or are not ready to change, harm reduction, community-based supports and professional help, but have less on physical first aid actions. Mental Health First Aid International will use these guidelines in future updates of their training courses.

Exploring ecosocial contexts of alcohol use and misuse during the COVID-19 pandemic among urban refugee youth in Kampala, Uganda: Multi-method findings

Urban refugees may be disproportionately affected by socio-environmental stressors that shape alcohol use, and this may have been exacerbated by additional stressors in the COVID-19 pandemic. This multi-method study aimed to understand experiences of, and contextual factors associated with, alcohol use during the pandemic among urban refugee youth in Kampala, Uganda. We conducted a cross-sectional survey (n = 335), in-depth individual interviews (IDI) (n = 24), and focus groups (n = 4) with urban refugee youth in Kampala. We also conducted key informant interviews (n = 15) with a range of stakeholders in Kampala. We conducted multivariable logistic regression analyses with survey data to examine socio-demographic and ecosocial (structural, community, interpersonal) factors associated with ever using alcohol and alcohol misuse. We applied thematic analyses across qualitative data to explore lived experiences, and perceived impacts, of alcohol use. Among survey participants (n = 335, mean age= 20.8, standard deviation: 3.01), half of men and one-fifth of women reported ever using alcohol. Among those reporting any alcohol use, half (n = 66, 51.2 %) can be classified as alcohol misuse. In multivariable analyses, older age, gender (men vs. women), higher education, and perceived increased pandemic community violence against women and children were associated with significantly higher likelihood of ever using alcohol. In multivariable analyses, very low food security, relationship status, transactional sex, and lower social support were associated with increased likelihood of alcohol misuse. Qualitative findings revealed: (1) alcohol use as a coping mechanism for stressors (e.g., financial insecurity, refugee-related stigma); and (2) perceived impacts of alcohol use on refugee youth health (e.g., physical, mental). Together findings provide insight into multi-level contexts that shape vulnerability to alcohol mis/use among urban refugee youth in Kampala and signal the need for gender-tailored strategies to reduce socio-environmental stressors.

Virtual agents among participants with methamphetamine use disorders: Acceptability and usability study

INTRODUCTION

While the potential future role of virtual agents (VAs) in treating addiction is promising, participants' attitudes toward the use of VAs in psychotherapy remain insufficiently investigated. This lack of investigation could pose barriers to the adoption of VA-led psychotherapy for people with substance use disorders (SUD). This research aims to explore the acceptability and usability of VAs for people with methamphetamine use disorder.

METHODS

Following a single session of psychotherapy led by VAs through the Echo-app, a group of 49 individuals actively seeking treatment for current DSM-V substance dependence (with a mean age of 39.06 ± 8.02) completed self-administered questionnaires and participated in focus group interviews. These questionnaires aimed to investigate participants' preference regarding the type of psychotherapy and their willingness to engage in VA-led psychotherapy, taking into account their diverse psychological needs.

RESULTS

Quantitative data were subjected to analysis through both descriptive and inferential statistical methods. Interestingly, participants exhibited a significantly higher acceptability for traditional face-to-face psychotherapy compared to email-based psychotherapy (p = 0.042), but there was no statistically significant difference between their acceptance of traditional psychotherapy and VA-led psychotherapy (p = 0.059). The questionnaire outcomes indicated participants' willingness to engage in VA-led psychotherapy for purposes such as relapse prevention intervention, addressing emotional issues, managing somatic experiences, and facilitating social and family functional recovery. Furthermore, the participants' attitudes toward VA-led psychotherapy were predicted by factors including the need for anxiety-focused psychotherapy (p = 0.027; OR [95%CI] = 0.14[0.03,0.80]), the presence of chronic somatic diseases (p = 0.017; OR [95%CI] = 13.58[1.59,116.03]), and marital status (p = 0.031; OR [95%CI] = 5.02[1.16,21.79]).

DISCUSSION

Through the interviews, the study uncovered the factors that either supported or hindered participants' experiences with VA-led psychotherapy, while also gathering suggestions for future improvements. This research highlights the willingness and practicality of individuals with SUD in embracing VA-led psychotherapy. The findings are anticipated to contribute to the refinement of VA-led tools to better align with the preferences and needs of the users.

Residential and inpatient treatment of substance use disorders in Sub-Saharan Africa: a scoping review

BACKGROUND

With substance use rates increasing in Sub-Saharan Africa (SSA), an understanding of the accessibility and effectiveness of rehabilitative services for people who use alcohol and other drugs (AOD) is critical in the global efforts to diagnose and treat substance use disorders (SUD). This scoping review seeks to address the gaps in knowledge related to the types of research that have been conducted regarding inpatient or residential SUD treatment in SSA, the settings in which the research was conducted, and the study countries.

METHODS

A search of three databases, PubMED, Scopus, and African Index Medicus, was conducted for publications related to the treatment of SUD in inpatient or residential settings in SSA. Articles were screened at the title/abstract level and at full text by two reviewers. Articles eligible for inclusion were original research, conducted in SSA, published in English, included populations who received or were currently receiving treatment for SUD in inpatient or residential settings, or documented demand for SUD services.

RESULTS

This scoping review included 82 studies originating from 6 countries in SSA. Three themes emerged within the literature: access and demand for inpatient and residential SUD treatment, quality and outcomes of SUD treatment, and descriptions of the services offered and staffing of these facilities. Barriers to access include financial barriers, limited availability of services, and geographic concentration in cities. Women were shown to access residential and inpatient SUD treatment at lower rates than men, and certain racial groups face unique language and financial barriers in accessing services. Studies indicate mixed success of inpatient and residential SUD treatment in sustained SUD remission for patients.

CONCLUSION

There are significant gaps in the literature, driven by a lack of longitudinal studies focused on patient outcomes following treatment and the use of a narrow definition of treatment success. Both structural and non-structural barriers, such as stigma and discrimination, are barriers to access. Further research is needed to evaluate approaches to mitigate these barriers and expand access to residential and inpatient SUD treatment.

Behavioural self-control training versus motivational enhancement therapy for individuals with alcohol use disorder with a goal of controlled drinking: A randomized controlled trial

BACKGROUND AND AIMS

Controlled drinking (CD) is an attractive treatment goal for a large proportion of individuals with alcohol use disorder (AUD), but the availability of treatment methods supporting a goal of CD is scarce. We tested if behavioural self-control training (BSCT) was superior to motivational enhancement therapy (MET) for individuals with AUD with a treatment goal of CD.

DESIGN

Randomized controlled two-group trial. Follow-ups were conducted at 12 and 26 weeks (primary end-point) after inclusion.

SETTING

Three specialized dependency care clinics in Stockholm, Sweden.

PARTICIPANTS

Two hundred and fifty self-referred adults (52% men) fulfilling criteria of AUD (DSM-5) and a stated treatment goal of CD.

INTERVENTION AND COMPARATOR

BSCT (n = 125), a five-session treatment based on cognitive behavioural therapy versus the active comparator, MET (n = 125), containing four sessions based on Motivational Interviewing.

MEASUREMENTS

Primary outcome measure was mean weekly alcohol consumption at the 26-week follow-up, adjusted for baseline consumption.

CONCLUSIONS

A randomized controlled trial found no evidence of a difference between behavioural self-control training and motivational enhancement therapy in reducing weekly alcohol consumption. Both groups substantially reduced consumption and behavioural self-control training was superior in reducing hazardous drinking.

Alcohol Dependence, Treatment Seeking, and Treatment Preferences Among Elderly: A Qualitative Study

INTRODUCTION

In Sweden, alcohol consumption has increased among people aged 65 years and older. Among older adults, 2.7% of men and 1.6% of women fulfill criteria for alcohol dependence. The large majority do not seek treatment. Little is known about treatment seeking among older adults with alcohol dependence.

AIM

The aim of this study was to describe elderly's views on alcohol dependence, treatment seeking, and treatment preferences. Possible gender differences will also be explored.

METHODS

Between December 2017 and March 2018, two focus group interviews and 10 individual interviews were conducted, using semistructured interviews. In total, 13 elderly participated. Data were analyzed using the framework approach.

RESULTS

Two themes and five subthemes were identified: (a) "regret and feelings of shame when losing control" consisting of two subthemes, namely, (1) loss of control over your alcohol consumption and (2) regret and feelings of shame, and (b) "taking back control over your life" consisting of three subthemes, namely, (1) becoming aware that you have problematic alcohol use, (2) to seek help for alcohol dependence, and (3) views on treatment options and treatment settings.

CONCLUSIONS

Increased alcohol use was attributed to a decrease in responsibility and belonging. Alcohol dependence was associated with shame and stigma, which was especially strong for women. Preferred treatments were tailored for the individual, rather than to general factors such as age or gender. Moreover, important components of treatment were to be met with respect, continuity, and controlled drinking as a treatment goal. Future research should focus on interventions to reduce stigma and the development of patient-centered treatments.

Stigmatization of people with addiction by health professionals: Current knowledge. A scoping review

Background

Stigma of people with substance and non-substance use disorders (SNSUD) is a long-known phenomenon. The aim of this review was to assess the stigmatization, by health professionals, of people with SNSUD, its characteristics and change over time.

Methods

A scoping review of literature reviews was conducted with systematic search of PubMed, Scopus and PsycINFO databases.

Results

From the 19 selected reviews, all focused on people with SUD (PWSUD) only and 20 % to 51 % of health professionals had negative attitudes/beliefs about SUD. Addiction training and clinical experience with PWSUD were associated with a less negative attitude. Health professionals' negative beliefs, lack of time or support were associated with less involvement in addiction care. Tobacco use disorder, SUDs other than alcohol and tobacco, relapse, psychiatric comorbidity or criminal records were associated with a more negative attitude. The influence of several variables potentially related to stigmatization was inconsistent across selected reviews. The evolution of stigmatization over time was not systematically assessed and showed mixed results.

Conclusions

The stigmatization of PWSUD has an impact on their care, and a change in some variables could reduce its importance: moral model of addiction, health professionals' negative beliefs, lack of training, time, and role support. Teaching what addiction is according to the medical chronic disease model, and developing stigma-focused training could improve caregivers' attitudes and further reduce stigma. Further studies are needed to determine whether stigma of PWSUD by health professionals has changed over time and to characterize stigma for people with non-substance use disorders.

Analysis of YouTube content on substance use disorder treatment and recovery

BACKGROUND AND AIM

Emerging literature suggests the role of social media in substance use disorders (SUD). This study aimed to explore the content of YouTube videos for persons on SUD treatment/recovery, describing the users' exposure and engagement metrics and understanding viewers' perspectives.

METHODS

We generated a set of 10 key phrases to search on YouTube. Eighty eligible videos were analyzed using a mixed-methods approach. Content analysis of all videos and thematic analysis of 30 videos were done using the three most viewed videos from each key phrase. The reliability of videos was assessed using a modified DISCERN. The total number of views, likes, dislikes, and comments were noted and created engagement metrics. The linguistic analysis of viewers' comments was done to assess their perspectives.

RESULTS

Sixty-three (78.8%) videos were from the US, and 59 (73.8%) were intended for persons or families with substance misuse. Persons in recovery uploaded 23 (28.7%) videos. We identified five themes - reasons for using drugs, symptoms of addiction, consequences of drug use, how to stop drug use, and expressed tone in the language. The positivity and relative positivity ratios were highest for videos developed by persons in recovery. There was a negative correlation between the relative positivity ratio and content fostering internalized stigma. Words with negative emotional experiences dominated the viewers' comments.

CONCLUSION

YouTube content on SUD treatment and recovery is popular and revolves around the biopsychosocial understanding of addiction. There is an urgent need for a language policy and regulation of non-scientific content.

Alcohol use disorder treatment via video conferencing compared with in-person therapy during COVID-19 social distancing : A non-inferiority comparison of three cohorts

BACKGROUND

Social distancing measures during the COVID-19 pandemic forced an abrupt transformation of treatment delivery for mental health care. In mid-March 2020, nearly all in-person contact was replaced with video conferencing. The pandemic thus offered a natural experiment and a unique opportunity to conduct an observational study of whether alcohol use disorder treatment through video conferencing is non-inferior to in-person treatment.

METHODS

In a large urban substance use disorder treatment center in the Netherlands, treatment evaluation is routine practice. Outcome data are regularly collected to support shared decision making and monitor patient progress. For this study, pre-test and post-test data on alcohol use (Measurements in the Addictions for Triage and Evaluation), psychopathology (Depression Anxiety Stress Scales), and quality of life (Manchester Short Assessment of Quality of Life) were used to compare outcomes of cognitive behavioral therapy treatment for three cohorts: patients who received treatment for a primary alcohol use disorder performed prior to (n = 628), partially during (n = 557), and entirely during (n = 653) the COVID-19 lockdown.

RESULTS

Outcome was similar across the three cohorts: No inferior outcomes were found for treatments that were conducted predominantly through video conferencing during lockdown or treatments that started in-person, but were continued through video conferencing, compared to in-person treatments that were conducted prior to COVID-19. The number of drop-outs were also similar between cohorts. However, there was a difference in average treatment intensity between cohorts, with treatment partially or fully conducted during the COVID-19 pandemic lasting longer.

CONCLUSIONS

Treatment for a primary alcohol use disorder, provided partially or predominantly through video conferencing during the COVID-19 pandemic resulted in abstinence rates and secondary outcomes similar to traditional in-person care, in spite of the potentially negative effects of the COVID-related lockdown measures themselves. These results from everyday clinical practice corroborate findings of randomized controlled studies and meta-analyses in which video conferencing appeared non-inferior to in-person care in clinical effectiveness.

Effects of media campaign videos on stigma and attitudes towards treatment seeking for alcohol use disorder: a randomized controlled study

BACKGROUND

Alcohol Use Disorder (AUD) is one of the most stigmatized diagnosis, and stigma imposes a major barrier to treatment seeking. There is a need to develop interventions that can reduce stigma and increase treatment seeking. Little is known about the effects of video materials. The aim of this study was to investigate effects of different videos. The primary outcome was public stigma, and secondary outcomes were: self-stigma, and motivation to change own alcohol use; talking to someone else about their alcohol use; seeking information about AUD treatment or seeking AUD treatment.

METHODS

This is a three-armed double blind randomized controlled study. The study included 655 Danish adults. Data was collected at a study webpage, and the survey could be completed anywhere with Internet access. After informed consent and completing baseline measures, participants were randomized, 1:1:1 ratio, to a video (video 1 n = 228; video 2 n = 198; video 3 n = 229). Video 1 and 2 have been used in a national mass media campaign and video 3 was recorded for use in the present study. Immediately after exposure, follow-up measures were completed. Outcomes were analyzed with mixed effects linear regression.

RESULTS

In total n = 616 completed follow-up (video 1 n = 215; video 2 n = 192; video 3 n = 209). Randomization to video 1 and 3 decreased public stigma measured with "Difference, Disdain & Blame Scales", while video 2 increased stigma. Video 2 compared to 1: 2.262 (95% CI 1.155; 3.369) p < 0.001. Video 3 compared to 1: -0.082 (95% CI -1.170; 1.006) p = 0.882. Video 3 compared to 2: -2.344 (95% CI -3.455; -1.233) p = 0.882. All videos reduced motivation to change own alcohol use. Participants with hazardous alcohol use, were more sensitive to the different videos, compared to low-risk alcohol use. Video 2 decreased motivation to seek information about treatment. No effects were seen on motivation to seek treatment, motivation to talk to someone else or self-stigma.

CONCLUSIONS

Videos can have an immediate effect on level of public stigma. Other types of interventions are needed to increase motivation and reduce self-stigma. To avoid adverse effects in future interventions, the use of theoretical frameworks and stakeholder involvement is emphasized.

Identifying factors associated with user retention and outcomes of a digital intervention for substance use disorder: a retrospective analysis of real-world data

Objectives

Successful delivery of digital health interventions is affected by multiple real-world factors. These factors may be identified in routinely collected, ecologically valid data from these interventions. We propose ideas for exploring these data, focusing on interventions targeting complex, comorbid conditions.

Materials and Methods

This study retrospectively explores pre-post data collected between 2016 and 2019 from users of digital cognitive behavioral therapy (CBT)-containing psychoeducation and practical exercises-for substance use disorder (SUD) at UK addiction services. To identify factors associated with heterogenous user responses to the technology, we employed multivariable and multivariate regressions and random forest models of user-reported questionnaire data.

Results

The dataset contained information from 14 078 individuals of which 12 529 reported complete data at baseline and 2925 did so again after engagement with the CBT. Ninety-three percent screened positive for dependence on 1 of 43 substances at baseline, and 73% screened positive for anxiety or depression. Despite pre-post improvements independent of user sociodemographics, women reported more frequent and persistent symptoms of SUD, anxiety, and depression. Retention-minimum 2 use events recorded-was associated more with deployment environment than user characteristics. Prediction accuracy of post-engagement outcomes was acceptable (Area Under Curve [AUC]: 0.74-0.79), depending non-trivially on user characteristics.

Discussion

Traditionally, performance of digital health interventions is determined in controlled trials. Our analysis showcases multivariate models with which real-world data from these interventions can be explored and sources of user heterogeneity in retention and symptom reduction uncovered.

Conclusion

Real-world data from digital health interventions contain information on natural user-technology interactions which could enrich results from controlled trials.

International monitoring of capacity of treatment systems for alcohol and drug use disorders: Methodology of the Service Capacity Index for Substance Use Disorders

OBJECTIVES

We aimed to develop a Service Capacity Index for Substance Use Disorders (SCI-SUD) that would reflect the capacity of national health systems to provide treatment for alcohol and drug use disorders, in terms of the proportion of available service elements in a given country from a theoretical maximum.

METHODS

Data were collected through the WHO Global Survey on Progress with Sustainable Development Goals (SDG) Health Target 3.5, conducted between December 2019 and July 2020 to produce the SCI-SUD, based on 378 variables overall.

RESULTS

The SCI-SUD was directly derived for 145 countries. We used multiple imputation to produce comparable SCI-SUD estimates for countries that did not submit data (40 countries) or had very high level of missingness (9 countries). The final SCI-SUD demonstrates considerable consistency and internal stability and is strongly associated with the macro-level economic, healthcare-related and epidemiologic (such as prevalence rates) variables.

CONCLUSION

The presented methodology represents a step forward in monitoring the global situation in regard to the development of treatment systems for SU disorders, however, further work is warranted to improve the external validity of the measure (e.g., in-depth data generation in countries) and ensure its feasibility for regular reporting (e.g., reducing the number of variables).

A guided digital intervention to reduce cannabis use: The ICan randomized controlled trial

AIMS

To test the effectiveness of a digital intervention to reduce cannabis use (ICan) with adherence-focused guidance compared with educational cannabis information.

DESIGN

This was a single-blind randomized controlled trial. Follow-up clinical outcome measurements took place 3 and 6 months after randomization.

SETTING

The trial was conducted in the Netherlands. The intervention and guidance took place on-line, with recruitment via Facebook/Instagram advertisement campaigns.

PARTICIPANTS

Inclusion criteria were ≥ 18 years, cannabis use on ≥ 3 days/week, the desire to reduce/quit cannabis and using a smartphone. Participants were allocated to either ICan (n = 188) or control (n = 190) (69% male, mean age = 27.5 years).

INTERVENTION AND COMPARATOR

ICan is a mobile (web-)application based on motivational interviewing and cognitive behavioural therapy and includes three main components: screening, brief intervention (six modules) and referral to treatment. The control condition consisted of non-interactive educational cannabis information.

MEASUREMENTS

Primary outcome was the number of cannabis use days in the 7 days prior to the 6-month follow-up measurement. Secondary outcome measures at 3- and 6-month follow-up were the number of grams of cannabis used and attitudes towards seeking professional help for cannabis use related problems.

FINDINGS

Intention-to-treat analysis showed that 6 months after randomization the mean number of cannabis use days in the past 7 days was reduced in both conditions (time P < 0.001), with no significant group × time interaction effect [ICan = 4.17 days, control = 4.31 days, Cohen's dbetween  = 0.06, 95% confidence interval (CI) = -0.15, 0.26, P = 0.93]. Three months after randomization the mean number of grams used in the past 7 days was reduced in both conditions, with a significantly larger reduction in the ICan condition (P = 0.009, Cohen's dbetween  = 0.15). At 6-month follow-up the significant group × time interaction effect was no longer present (P = 0.30). In both conditions, attitudes towards seeking professional help remained virtually unchanged over time.

CONCLUSIONS

A digital intervention to reduce cannabis use (ICan) was more effective than non-interactive educational cannabis information in reducing grams of cannabis used over 3 months, but not more effective at reducing cannabis use days at 6-month follow-up. Cannabis use reductions were maintained in both conditions between 3 and 6 months' follow-up.

Can alcohol policy prevent harms to women and children from men's alcohol consumption? An overview of existing literature and suggested ways forward

The World Health Organization's list of cost-effective alcohol control policies is a widely-used resource that highlights strategies to address alcohol-related harms. However, there is more evidence on how recommended policies impact harms to people who drink alcohol-such as physical health problems caused by heavy alcohol use-than on secondhand harms inflicted on someone other than the person drinking alcohol, i.e., alcohol's harms to others. In this essay, we describe evidence of impacts of alcohol policy on harms to women and children resulting from men's alcohol consumption, as well as options for making policies more relevant for reducing intimate partner violence and child abuse. We begin with an overview of harms to women and children resulting from men's alcohol consumption and review cost-effective alcohol policies with potential to reduce these harms based on likely mechanisms of action. Next, we present a rapid review of reviews to describe existing evidence of impacts of these policies on the outcomes of physical violence, sexual violence, and child abuse and neglect. We found little evidence of systematic evaluation of impacts of these important alcohol policies on harms to women and children. Thus, we advocate for increased attention in evaluation research to the impacts of alcohol policies on harms experienced by women and children who are exposed to men who drink alcohol. We also argue for more consideration of a broader range of policies and interventions to reduce these specific types of harm. Finally, we present a conceptual model illustrating how alcohol policies may be supplemented with other interventions specifically tailored to reduce alcohol-related harms commonly experienced by women and children as a result of men's alcohol use.

High- versus low-intensity internet interventions for alcohol use disorders (AUD): A two-year follow-up of a single-blind randomized controlled trial

Alcohol Use Disorders (AUD) are widespread and have serious consequences, but are among the most undertreated mental disorders. Internet interventions have been found effective in treating AUD, but we know little about long-term outcomes, two years or more after treatment. This study explored 12- and 24-month outcomes in alcohol consumption following initial 6-month improvements after a therapist-guided high-intensity internet intervention and an unguided low-intensity internet intervention among individuals with alcohol use disorder. Between-group comparisons were analyzed, as well as within-group comparisons with (1) pre-treatment measurements (2) post-treatment measurements. Participants consisted of a general population sample of internet help-seekers in Sweden. A total of 143 adults (47% men) with a score of 14 (women)/16 (men) or more on the Alcohol Use Disorders Identification Test, alcohol consumption of 11 (women)/14 (men) or more standard drinks the preceding week and ≥ 2 DSM-5 alcohol use disorder (AUD) criteria based on a diagnostic interview were included. The high- and low-intensity internet interventions (n = 72 and n = 71 respectively) consisted of modules based on relapse prevention and cognitive-behavioral therapy. The primary outcome was self-reported alcohol consumption in the preceding week measured as (1) number of standard drinks and (2) number of heavy drinking days. Attrition from self-reported questionnaires was 36% at the 12-month follow-up and 53% at the 24-month follow-up. No significant between-group differences occurred in outcomes at either long-term follow-up. Regarding within-group differences, compared to pre-treatment, alcohol consumption was lower in both high- and low-intensity interventions at both long-term follow-ups [within-group standard drinks effect sizes varied between g = 0.38-1.04 and heavy drinking days effect sizes varied between g = 0.65-0.94]. Compared to post-treatment, within-group alcohol consumption in the high intensity intervention increased at both follow-ups; for the low-intensity intervention, within-group consumption decreased at 12-month follow-up, but did not differ compared to post-treatment at 24 months. Both high- and low-intensity internet interventions for AUD were thus associated with overall reductions in alcohol consumption at long term follow-ups, with no significant differences between the two. However, conclusions are hampered by differential and non-differential attrition.

Alcohol and other drug use patterns and services in an integrated refugee settlement in Northern Zambia: a formative research study

BACKGROUND

Evidence on patterns of alcohol and other drug (AOD) use and how to effectively deliver services to address AOD use in humanitarian settings is limited. This study aimed to qualitatively explore the patterns of AOD use among Congolese refugees in Mantapala Refugee Settlement and members of the surrounding host community and identify potential appropriate intervention and implementation approaches to address AOD use disorders among conflict-affected populations.

METHODS

Fifty free listing interviews, 25 key informant interviews, and four focus group discussions were conducted among refugees, host community members, humanitarian implementing agency staff, and refugee incentive workers. These participants were selected based on their knowledge of AOD use and related problems in the settlement and the surrounding host community in northern Zambia.

RESULTS

Cannabis and home-brewed alcohol were the substances that were perceived to be most commonly used and have the greatest impact on the community. Participants reported that self-medication, boredom, and relief of daily stressors associated with lack of housing, safety, and employment were reasons that people used AODs. Participants recommended that programming include components to address the underlying causes of AOD use, such as livelihood activities. Stigma due to the criminalization of and societal ideals and religious beliefs regarding AOD use was identified as a substantial barrier to accessing and seeking treatment.

CONCLUSIONS

Our study's findings indicate the need for services to address AOD use in Mantapala Refugee Settlement. Interventions should consider the social and structural determinants of AOD use.

The associations between public stigma and support for others' help-seeking for alcohol use disorder: a cross sectional study in the general Danish population

BACKGROUND

A minority of all individuals with alcohol use disorders (AUD) seek treatment, where stigma is one prominent barrier. Social support is important to facilitate health and increase treatment-seeking. Whether there is an association between stigma and attitudes towards others' help-seeking for AUD is unknown. The aim of this study was to investigate the associations between stigma and support towards others' help-seeking for AUD, also to explore possible gender differences.

METHOD

Cross-sectional study, n = 2895, including Danish adults aged 30-65 in the general population. Year 2020, an online questionnaire was administrated, which covered demographics, attitudes towards others' help-seeking for AUD, and stigma measured with the Difference, Disdain & Blame Scales. Analyses were performed with Restricted Cubic Spline models, and odds ratios were calculated.

RESULTS

Lower level of stigma was associated with a higher probability for endorsing an "active support strategy". Level of stigma was not associated with "not knowing what to say or do" or "sharing my concern with others". There were few gender differences: among men, higher level of stigma was associated with a higher probability of "avoidance". Among women, lower level of stigma was associated with a lower probability of "avoidance".

CONCLUSION

There is a clear association between stigma and attitudes towards supporting others' help-seeking for AUD. The results highlight the need to reduce stigma and promote engagement towards others' treatment-seeking.

Prevalence, incidence, deaths, and disability-adjusted life-years of drug use disorders for 204 countries and territories during the past 30 years

Drug use disorders are increasingly recognized as the main cause of public health issues worldwide. The current analysis aims to provide the most comprehensive, updated estimates of the burden from drug use disorders at global, regional, and national levels during the past three decades. Prevalence, incidence, deaths, and disability-adjusted life-years (DALYs) were estimated from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 by age and sex for drug use disorder as well as its four main categories (opioid use disorders, cocaine use disorders, amphetamine use disorders, and cannabis use disorders) in 204 countries and territories between 1990 and 2019. DisMod-MR 2.1, and Bayesian meta-regression were used to analyze prevalence and incidence, while the Cause of Death Ensemble model (CODEm) was used to estimate death of diseases. Globally, the burden of drug use disorders, as measured by the average annual percentage change (AAPC) of deaths and DALYs, continues to increase. The patterns by regions of DALYs due to drug use disorders varied significantly, and it is mainly in developed countries and concentrated among young people and males. Programs for drug use disorders management should be improved, particularly in opioid use disorders. Governments will face increasing demand for treatment and support services, and effective prevention as well as control strategies are required to reduce the burden from these causes.

The impact of an annual mass media campaign on treatment seeking for alcohol use disorders in the Danish population: An interrupted time-series analysis

INTRODUCTION

A minority of individuals with alcohol use disorder (AUD) seek treatment. In Denmark, a mass media campaign, "RESPEKT", aiming to increase treatment seeking, has been broadcasted nationwide since 2015. The campaign is unique from an international perspective. Similar interventions have, up until now, not been scientifically evaluated.

AIM

To investigate whether there was an association between campaign periods and treatment seeking for AUD. A secondary aim was to investigate possible gender differences. The hypotheses were that treatment seeking would increase during the campaign periods, and that men would increase their treatment seeking more compared to women.

METHOD

Study design: Interrupted time-series analysis.

PARTICIPANTS

Adults aged 18 years and above in the Danish population seeking AUD treatment.

EXPOSURE

Campaign periods year 2015-2018.

OUTCOME

Changes in treatment seeking defined as treatment entry respectively filled prescription of AUD pharmacotherapy.

DATA

National Alcohol Treatment Register on treatment entries for specialist addiction care and National Prescription Registry for filled prescriptions on AUD pharmacotherapies 2013-2018.

ANALYSIS

Segmented negative binomial regression, including the full cohort and stratified by sex.

RESULTS

The results show no association between campaign periods and treatment seeking. Nor were there any gender differences in treatment seeking. The hypotheses were not confirmed.

CONCLUSION

The campaign periods showed no association with treatment seeking. Eventual future campaigns should possibly focus on earlier steps of the treatment seeking process, as problem recognition, to increase treatment seeking. There is a great need to develop other ways to narrow the treatment gap for AUD.

Perceived barriers to seeking treatment for alcohol use disorders among the general Danish population - a cross sectional study on the role of severity of alcohol use and gender

BACKGROUND

A minority of all individuals with alcohol use disorders (AUD) seek treatment. Since the suffering from AUD has severe consequences for both the individual and for society, it is important to improve the understanding of barriers to seeking treatment. Most studies of barriers thus far have been conducted in the United States of America or the United Kingdom. There is a need for studies from other contexts. The overall aim is to investigate barriers to treatment seeking for AUD. The specific aims are to: 1) describe barriers to AUD treatment at different levels of alcohol use. 2) compare gender differences regarding barriers to AUD treatment.

METHODS

Study design: Cross-sectional.

PARTICIPANTS

1594 representative Danish adults from the general population aged 30-65 years. An online questionnaire was administrated by a market research company. The questionnaire covered demographic data, barriers to treatment and level of alcohol use. Analyses were performed by means of chi-2 test and logistic regression.

RESULTS

The most common barriers were related to stigma and shame: admitting to others of having a problem, being labelled, fear of the consequences and that others would find out. Participants with higher severity of alcohol use were more likely to endorse a wish to handle alcohol problems themselves and to report barriers related to treatment services. Women with high severity of alcohol use, endorsed higher level of fear of the consequences than men.

CONCLUSIONS

There is an urgent need to reduce stigma around AUD. Individuals with higher severity of alcohol use report a lower willingness to seek professional treatment if a problem occurs. Especially among individuals with high severity of alcohol use there is a need to address gender specific barriers.

Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with significant morbidity, but efficacious pharmacotherapy and psychotherapy are available. Data from the World Mental Health Surveys were used to investigate extent and predictors of treatment coverage for PTSD in high-income countries (HICs) as well as in low- and middle-income countries (LMICs).

METHODS

Seventeen surveys were conducted across 15 countries (9 HICs, 6 LMICs) by the World Health Organization (WHO) World Mental Health Surveys. Of 35,012 respondents, 914 met DSM-IV criteria for 12-month PTSD. Components of treatment coverage analyzed were: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) effective treatment coverage. Regression models investigated predictors of treatment coverage.

RESULTS

12-month PTSD prevalence in trauma exposed individuals was 1.49 (S.E., 0.08). A total of 43.0% (S.E., 2.2) received any mental health services, with fewer receiving adequate pharmacotherapy (13.5%), adequate psychotherapy (17.2%), or effective treatment coverage (14.4%), and with all components of treatment coverage lower in LMICs than HICs. In a multivariable model having insurance (OR = 2.31, 95 CI 1.17, 4.57) and severity of symptoms (OR = .35, 95% CI 0.18, 0.70) were predictive of effective treatment coverage.

CONCLUSION

There is a clear need to improve pharmacotherapy and psychotherapy coverage for PTSD, particularly in those with mild symptoms, and especially in LMICs. Universal health care insurance can be expected to increase effective treatment coverage and therefore improve outcomes.

Bi-stability and critical transitions in mental health care systems: a model-based analysis

BACKGROUND

Delayed initiation and early discontinuation of treatment due to limited availability and accessibility of services may often result in people with mild or moderate mental disorders developing more severe disorders, leading to an increase in demand for specialised care that would be expected to further restrict service availability and accessibility (due to increased waiting times, higher out-of-pocket costs, etc.).

METHODS

We developed a simple system dynamics model of the interaction of specialised services capacity and disease progression to examine the impact of service availability and accessibility on the effectiveness and efficiency of mental health care systems.

RESULTS

Model analysis indicates that, under certain conditions, increasing services capacity can precipitate an abrupt, step-like transition from a state of persistently high unmet need for specialised services to an alternative, stable state in which people presenting for care receive immediate and effective treatment. This qualitative shift in services system functioning results from a 'virtuous cycle' in which increasing treatment-dependent recovery among patients with mild to moderate disorders reduces the number of severely ill patients requiring intensive and/or prolonged treatment, effectively 'releasing' services capacity that can be used to further reduce the disease progression rate. We present an empirical case study of tertiary-level child and adolescent mental health services in the Australian state of South Australia demonstrating that the conditions under which such critical transitions can occur apply in real-world services systems.

CONCLUSIONS

Policy and planning decisions aimed at increasing specialised services capacity have the potential to dramatically increase the effectiveness and efficiency of mental health care systems, promoting long-term sustainability and resilience in the face of future threats to population mental health (e.g., economic crises, natural disasters, global pandemics).

Assessing suicidality during the SARS-CoV-2 pandemic: Lessons learned from adaptation and implementation of a telephone-based suicide risk assessment and response protocol in Malawi

The SARS-CoV-2 pandemic led to the rapid transition of many research studies from in-person to telephone follow-up globally. For mental health research in low-income settings, tele-follow-up raises unique safety concerns due to the potential of identifying suicide risk in participants who cannot be immediately referred to in-person care. We developed and iteratively adapted a telephone-delivered protocol designed to follow a positive suicide risk assessment (SRA) screening. We describe the development and implementation of this SRA protocol during follow-up of a cohort of adults with depression in Malawi enrolled in the Sub-Saharan Africa Regional Partnership for Mental Health Capacity Building (SHARP) randomized control trial during the COVID-19 era. We assess protocol feasibility and performance, describe challenges and lessons learned during protocol development, and discuss how this protocol may function as a model for use in other settings. Transition from in-person to telephone SRAs was feasible and identified participants with suicidal ideation (SI). Follow-up protocol monitoring indicated a 100% resolution rate of SI in cases following the SRA during this period, indicating that this was an effective strategy for monitoring SI virtually. Over 2% of participants monitored by phone screened positive for SI in the first six months of protocol implementation. Most were passive risk (73%). There were no suicides or suicide attempts during the study period. Barriers to implementation included use of a contact person for participants without personal phones, intermittent network problems, and pre-paid phone plans delaying follow-up. Delays in follow-up due to challenges with reaching contact persons, intermittent network problems, and pre-paid phone plans should be considered in future adaptations. Future directions include validation studies for use of this protocol in its existing context. This protocol was successful at identifying suicide risk levels and providing research assistants and participants with structured follow-up and referral plans. The protocol can serve as a model for virtual SRA development and is currently being adapted for use in other contexts.

Using recovery management checkups for primary care to improve linkage to alcohol and other drug use treatment: a randomized controlled trial three month findings

BACKGROUND AND AIMS

Recovery management checkups (RMC) have established efficacy for linking patients to substance use disorder (SUD) treatment. This study tested whether using RMC in combination with screening, brief intervention, and referral to treatment (SBIRT), versus SBIRT alone, can improve linkage of primary care patients referred to SUD treatment.

DESIGN

A randomized controlled trial of SBIRT as usual (n = 132) versus SBIRT plus recovery management checkups for primary care (RMC-PC) (n = 134) with follow-up assessments at 3 months post-baseline.

SETTING

Four federally qualified health centers in the United States serving low-income populations.

PARTICIPANTS

Primary care patients (n = 266, 64% male, 80% Black, mean age, 48.3 [range, 19-53]) who were referred to SUD treatment after SBIRT.

INTERVENTIONS

SBIRT alone (control condition) compared with SBIRT + RMC-PC (experimental condition).

MEASUREMENT

The primary outcome was any days of SUD treatment in the past 3 months. Key secondary outcomes were days of SUD treatment overall and by level of care, days of alcohol and other drug (AOD) abstinence, and days of using specific substances, all based on self-report.

FINDINGS

At 3-month follow-up, those assigned to SBIRT + RMC-PC (n = 134) had higher odds of receiving any SUD treatment (46% vs 20%; adjusted odds ratio = 4.50 [2.49, 8.48]) compared with SBIRT only, including higher rates of entering residential and intensive outpatient treatment. They also reported more days of treatment (14.45, vs 7.13; d = +0.26), more days abstinent (41.3 vs 31.9; d = +0.22), and fewer days of using alcohol (27.14, vs 36.31; d = -0.25) and cannabis (19.49, vs 28.6; d = -0.20).

CONCLUSIONS

Recovery management checkups in combination with screening, brief intervention, and referral to treatment are an effective strategy for improving linkage of primary care patients in need to substance use disorder treatment over 3 months.

Expanding mental health services in low- and middle-income countries: A task-shifting framework for delivery of comprehensive, collaborative, and community-based care

This paper proposes a framework for comprehensive, collaborative, and community-based care (C4) for accessible mental health services in low-resource settings. Because mental health conditions have many causes, this framework includes social, public health, wellness and clinical services. It accommodates integration of stand-alone mental health programs with health and non-health community-based services. It addresses gaps in previous models including lack of community-based psychotherapeutic and social services, difficulty in addressing comorbidity of mental and physical conditions, and how workers interact with respect to referral and coordination of care. The framework is based on task-shifting of services to non-specialized workers. While the framework draws on the World Health Organization's Mental Health Gap Action Program and other global mental health models, there are important differences. The C4 Framework delineates types of workers based on their skills. Separate workers focus on: basic psychoeducation and information sharing; community-level, evidence-based psychotherapeutic counseling; and primary medical care and more advanced, specialized mental health services for more severe or complex cases. This paper is intended for individuals, organizations and governments interested in implementing mental health services. The primary aim is to provide a framework for the provision of widely accessible mental health care and services.

The efficacy of an internet-based cognitive behavioral program added to treatment-as-usual for alcohol-dependent patients in primary care: a randomized controlled trial

BACKGROUND AND AIMS

Most alcohol-dependent people have a moderate level of dependence. General practitioners (GPs) hesitate to engage in this area, and need to have access to treatment they find applicable and feasible to use. The aim of this present study was to test if an open-ended internet-based cognitive-behavioral therapy (iCBT) program added to treatment-as-usual (TAU) is more effective than TAU-only for alcohol-dependent patients in primary care.

DESIGN, SETTING AND PARTICIPANTS

The present study was a two-group, parallel, randomized controlled superiority trial comparing iCBT+TAU versus TAU-only at 3- and 12-month follow-ups. TAU was delivered at 14 primary care centers in Stockholm, Sweden. A total of 264 patients (mean age 51 years, of whom 148 were female and 116 were male) with alcohol dependence and hazardous alcohol consumption were enrolled between September 2017 and November 2019.

MEASUREMENTS

Participants were randomized at a ratio of 1:1 to iCBT, as a self-help intervention added to TAU (n = 132) or to TAU-only (n = 132). The GPs gave participants in both treatment arms feedback on the assessments and biomarkers and offered TAU at the primary care center. Primary outcome was weekly alcohol consumption in g/week at 12-month follow-up, analyzed according to intention-to-treat (n = 132 + 132). The per-protocol analysis included participants who completed at least one module of iCBT (n = 102 + 132).

FINDINGS

There was no significant difference in weekly alcohol consumption between iCBT+TAU and TAU in the intention-to-treat (ITT) analysis at 12-month follow-up [iCBT+TAU = 133.56 (95% confidence interval, CI = 100.94-166.19) and TAU = 176.20 (95% CI = 144.04-208.35), P = 0.068, d = 0.23]. In the per-protocol analysis, including only those who initiated iCBT, the iCBT+TAU group showed lower mean weekly alcohol consumption compared with TAU [iCBT+TAU = 107.46 (95% CI = 71.17-143.74), TAU = 176.00 (95% CI = 144.21-207.80), P = 0.010, d = 0.42].

CONCLUSIONS

In Sweden, an internet-based cognitive-behavioral program added to treatment-as-usual to reduce alcohol consumption showed weak evidence of a benefit at 12 months in the intention-to-treat analysis and good evidence of a benefit in the per-protocol analysis.

Public stigma and treatment preferences for alcohol use disorders

BACKGROUND

Alcohol use disorders (AUD) are among the most highly stigmatized medical conditions. Only a minority of individuals with AUD seek treatment, and stigma is one of the most prominent barriers to treatment-seeking. However, there is a lack of knowledge about the associations between stigma and preferences for help-seeking, and the associations between stigma and preferences for treatment seeking.

AIM

to investigate the associations between stigma and preferences for where to seek help and treatment for AUD. As sub-analyses, associations between stigma, level of alcohol use and preferences for help-seeking and treatment preferences will be analyzed.

METHOD

Cross-sectional design, including n = 3037 participants aged 30 - 65 years, living in Denmark.

DATA

In 2020, an online questionnaire was administered by a market research company. The questionnaire covered demographics, preferences for help-seeking and treatment for AUD, stigma measured with the Difference, Disdain & Blame Scales for Public Stigma, and alcohol use measured with the Alcohol Use Disorder Test (AUDIT).

ANALYSES

restricted cubic spline models were applied to model outcomes. Odds ratios were calculated.

RESULTS

A lower level of stigma was associated with a higher probability of preferring formal and informal help-seeking for AUD. Both high and low levels of stigma were associated with a higher probability of preferring to consult general practitioners. Stigma was not associated with other preferences for treatment-seeking, nor trying to change oneself or a passive strategy. The sub-analyses, grouped by level of alcohol use, showed similar results.

CONCLUSION

Stigma is associated with lower preferences for formal and informal help-seeking, however not type of treatment preferred. Future studies should address stigma in relation to other factors of the treatment-seeking process.

Self-Assessment of Addiction Medicine Core Competencies in Four Year Groups of Psychiatrists in Training: Efficacy of the Addiction Medicine Training Needs Assessment Scale in a Local Training Context

BACKGROUND

In addiction medicine training, self-assessment is increasingly used to support self-regulation learning by identifying standards of excellence, competence gaps, and training needs. To ensure psychiatrists in Lithuania also develop specific addiction competencies, the Lithuanian Health Sciences University faculty in Kaunas developed an addiction psychiatry curriculum.

OBJECTIVES

The aim of this research is to explore the efficacy of the AM-TNA scale to measure individual and group differences in proficiency in the core competencies of addiction medicine. A cross-sectional study and a convenience sample were used.

METHOD

We studied the differences in performance in addiction medicine competencies between 4 successive year groups and analysed the variance to determine the statistical differences between the means of 4 year groups with biases, resulting from repeated measurement statistically corrected-for.

RESULTS

Of the psychiatrists in training, 41% or 59% completed the scale. The assessment of competencies suggested that all but 2 competencies differ significantly (p < 0.05) between the 4 groups. The post hoc analyses indicated that mean scores for 24 of the 30 core competencies differed significantly between the year groups (p < 0.05) and showed a gradual increase in scores of self-assessed competencies over the 4 year groups. We found adequate scale variance and a gradual increase in self-assessed competencies between the 4 year groups, suggesting a positive association between the results of incremental professional training and improved self-assessed substance use disorders (SUD) competency scores.

CONCLUSIONS

This study illustrates the efficacy of the AM-TNA scale as an assessment instrument in a local training context. Future research should aim to have larger sample sizes, be longitudinal in design, assess individual progress, and focus on comparing and combining self-reported competencies with validated objective external assessment and feedback.

"It was Very Liberating". Dialogic Literary Gatherings Supporting Mental Health Literacy

Mental health is being reframed as a fundamental right for all people, and mental health literacy is a tool that can enable patients to gain the knowledge, personal skills, and confidence to take action to improve their mental health, and their lives overall. This exploratory study analysed the power of dialogic literary gatherings (DLGs) to foster it in a group of patients with mental health disorders who gathered for 1 h once a week to share their readings of literature masterpieces. During the year-long study, a total of 140 patients participated in the DLGs in groups of 12 to 15 people. Results suggest that DLGs promoted the development of the participants' mental health literacy and produced gains in emotional and social wellbeing by strengthening reading, speaking, and listening skills, fostering supportive relations, contributing to overcoming stigma, and enhancing agency. The transferability of DLGs to mental health care is discussed.

Retention in treatment and therapeutic adherence: How are these associated with therapeutic success? An analysis using real-world data

INTRODUCTION

Treatment retention and adherence are used as outcomes in numerous randomized clinical trials and observational studies conducted in the addiction field. Although usual criteria are 3/6 months of treatment retention or number of sessions attended, there is not a methodological support for conclusions using these criteria. This study analyzed the usefulness of retention and adherence to predict therapeutic success.

METHODS

Retrospective observational study using real-world data from electronic health records of 11,907 patients in treatment diagnosed with cocaine, alcohol, cannabis and opiate use disorders or harmful use.

RESULTS

Moderate effect size relations were found between the different type of clinical discharge and months in retention (η²  = 0.12) and proportion of attendance (η²  = 0.10). No relationship was found with the number of sessions attended. Using cut-off points (i.e., 3 or 6 months in treatment or attending 6 therapy sessions) worsens the ability to predict the type of discharge.

DISCUSSIONS/CONCLUSION

Treatment retention and adherence are indicators moderately related to therapeutic success. Research using these indicators to assess the effectiveness of therapies should complement their results with other clinical indicators and quality of life measures.

Polysubstance use in young people accessing residential and day-treatment services for substance use: substance use profiles, psychiatric comorbidity and treatment completion

BACKGROUND AND AIMS

People with substance use disorders (SUDs) frequently present to treatment with polysubstance use and mental health comorbidities. Different combinations of substance use and mental health problems require different treatment approaches. Our study aimed to: (i) identify the shared substance use classes among young people at treatment admission, (ii) determine which mental health symptoms, quality of life (QoL) and service types were associated with the identified substance use classes, and (iii) prospectively determine which substance use classes and service types were more likely to complete treatment.

DESIGN

Cross-sectional and prospective study using service and outcome data.

SETTING

Substance use treatment services in Queensland and New South Wales, Australia.

PARTICIPANTS

De-identified service and outcome measure data were extracted from the files of 744 clients aged 18-35 years (48% male) admitted into seven residential and four day-treatment programmes.

MEASUREMENTS

Substance use and severity among tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, opioids, sedatives and inhalants. Other variables included: depression, anxiety, post-traumatic stress and psychotic symptoms, as well as QoL.

FINDINGS

Latent class analysis identified three polysubstance use classes: wide-ranging polysubstance users (WRPU; 22.45%), primary amphetamine users (56.45%) and alcohol and cannabis users (21.10%). The WRPU class had higher odds of psychotic symptoms than the alcohol and cannabis use class [odds ratio (OR) = 1.30; 95% confidence interval (CI) = 1.11-1.11]; and double the odds of residential programme enrolment than those in the amphetamine use class (OR = 2.35; 95% CI = 1.50-3.68). No other class differences on mental health or QoL variables were found. Clients enrolled in day-programmes had higher odds of completing treatment.

CONCLUSIONS

There appear to be high levels of polysubstance use among young people entering substance use treatment in Australia. Wide-ranging polysubstance users were more likely to report psychotic symptoms and be enrolled into a residential programme than primary amphetamine users and alcohol and cannabis users.

The opioid epidemic

An opioid epidemic has been happening across the world since the 1990s and continues impact individuals, families, communities and societies around the globe. The epidemic has evolved from heroin misuse to the use of synthetic opioids that are easily manufactured and are readily available. Reasons for the continuing opioid epidemic are complex, and include factors related to mental health, addiction, chronic pain relief, and, now, the COVID-19 pandemic. Women have been disproportionally affected by the opioid epidemic and the physical and biosocial effects of opioid use specific to women are an important consideration for healthcare providers. Recent data show that the effects of the opioid epidemic on rates of opioid use disorder (OUD), overdoses, and the economy continue to rise, despite global efforts to understand the drivers and develop effective prevention and intervention strategies, programs, and policies.

Trends in cannabis or cocaine-related dependence and alcohol/drug treatment in Argentina, Chile, and Uruguay

BACKGROUND

In the context of changing cannabis and other drug policy and regulation, concerns may arise regarding drug treatment access and use. We assessed cannabis/cocaine-related dependence and treatment in Argentina, Chile, and Uruguay.

METHODS

Nationally representative cross-sectional household surveys of people ages 15-64 in Argentina (4 surveys, 2006-2017), Chile (7 surveys, 2006-2018), and Uruguay (4 surveys, 2006-2018) were harmonized. We estimated weighted prevalences of cannabis or cocaine-related (cocaine or cocaine paste) dependence, based on meeting 3+ past-year ICD-10 dependence criteria. We estimated weighted prevalences of past-year alcohol/drug treatment use (Argentina, Chile) or use/seeking (Uruguay) among people with past-year cannabis/cocaine-related dependence. We tested model-based prevalence trends over time and described individual-level treatment correlates by country.

RESULTS

Cannabis/cocaine dependence prevalence increased in the region starting in 2010-2011, driven by cannabis dependence. Adjusted cannabis dependence prevalence increased from 0.7% in 2010 to 1.5% in 2017 in Argentina (aPD=0.8, 95% CI= 0.3, 1.2), from 0.8% in 2010 to 2.8% in 2018 in Chile (aPD=2.0, 95% CI= 1.4, 2.6), and from 1.4% in 2011 to 2.4% in 2018 in Uruguay (aPD=0.9, 95% CI= 0.2, 1.6). Cocaine-related dependence increased in Uruguay, decreased in Argentina, and remained stable in Chile. Among people with past-year cannabis/cocaine dependence, average alcohol/drug treatment use prevalence was 15.3% in Argentina and 6.0% in Chile, while treatment use/seeking was 14.7% in Uruguay. Alcohol/drug treatment prevalence was lower among people with cannabis dependence than cocaine-related dependence. Treatment correlates included older ages in all countries and male sex in Argentina only.

CONCLUSION

Alcohol/drug treatment use among people with cannabis/cocaine-related dependence remained low, signaling an ongoing treatment gap in the context of growing cannabis dependence prevalence in the region. Additional resources may be needed to increase treatment access and uptake. Future studies should assess contributors of low treatment use, including perceived need, stigma, and service availability.

Blended-eLearning Improves Alcohol Use Care in Kenya: Pragmatic Randomized Control Trial Results and Parallel Qualitative Study Implications

Alcohol use is the 5th most important risk factor contributing to the global burden of diseases, with stigma and a lack of trained health workers as the main barriers to adequate care. This study assesses the impact of providing blended-eLearning courses teaching the alcohol, smoking, and substance involvement screening test (ASSIST) screening and its linked brief intervention (BI). In public and private facilities, two randomized control trials (RCTs) showed large and similar decreases in alcohol use in those receiving the BI compared to those receiving only the ASSIST feedback. Qualitative findings confirm a meaningful reduction in alcohol consumption; decrease in stigma and significant practice change, suggesting lay health workers and clinicians can learn effective interventions through blended-eLearning; and significantly improve alcohol use care in a low- and middle-income country (LMIC) context. In addition, our study provides insight into why lay health workers feedback led to a similar decrease in alcohol consumption compared to those who also received a BI by clinicians.

Efficacy of screening and brief intervention for hazardous alcohol use in patients with mood disorders: A randomized clinical trial from a psychiatric out-patient clinic in India

AIM

To determine the efficacy of individual-based, face-to-face screening and brief intervention (SBI) for hazardous alcohol use among treatment-seeking outpatients with mood disorders.

METHODS

It was a parallel-group, single-blind, randomized controlled trial of 84 participants who met the selection criteria for hazardous alcohol use, defined by alcohol use disorder identification test (AUDIT) score 8-19. Participants were randomly allocated to either SBI or general advice group. Both groups had received a standard care for mood disorders. The outcome was assessed after 3 months. The primary outcome was a change in the mean AUDIT score and the secondary outcomes were a change in frequency of heavy episodic drinking and stages of motivation.

RESULTS

Majority (60%) had major depressive episodes. There was no significant difference in baseline demography and clinical variables between the groups. Both intention to treat and per-protocol analyses showed a small but significant effect of SBI on mean AUDIT score. Age, baseline AUDIT, and motivation did not moderate the effect. SBI was associated with a significant decrease in the frequency of heavy drinking and improvement in stages of motivation.

CONCLUSION

SBI among patients with mood disorders had a small but significant effect on alcohol use.

Does Online Newsmedia Portrayal of Substance Use and Persons with Substance Misuse Endorse Stigma? A Qualitative Study from India

Media provides and shapes public knowledge, perceptions, and attitude towards people with substance misuse. We aimed to explore the content and specific themes of Indian online news articles on substance use or persons with substance misuse. We followed an exploratory qualitative design to analyze online news media reports published between July 1 2020 and June 30 2021. Hundred articles met the selection criteria. Our content analysis was based on a checklist. Thematic analysis was done by the coding, categorization, and theme generation after meticulous data immersion and triangulation. Sixty percent of articles had pessimistic headlines and portrayed substance use or persons with substance use negatively. Fifty-one percent articles were on alcohol. Twenty-seven percent articles focussed supply reduction, whereas only 5% positively discussed the role of treatment. We identified seven themes. Most frequent themes were legal-criminal aspects of substance use (n = 39), psychosocial and health hazards of substance use (n = 30), and propagation of public stigma (n = 25). Two other prevalent themes were the business and marketing of alcohol (n = 20) and sociocultural aspects of substance use (n = 9). The theme, treatment strategy, appeared in only five articles. There is an urgent need for media guidelines for responsible reporting of substance misuse. We suggested a set of recommendations for media reporting.

Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial

BACKGROUND

There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services.

DESIGN

In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists.

DISCUSSION

This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04282915 . Date of registration: February 25, 2020.

'There is nowhere to take the child': a qualitative study of community members' views on managing early childhood substance use in Mbale, Uganda

Background

Harmful alcohol use by 5–8-year-old children has been identified in Mbale District, Uganda. To further examine this finding, the present study explores the experiences and perceptions of community members regarding how childhood substance use (before age 10) is managed in this area.

Methods

We conducted eight focus group discussions with 48 parents of children aged < 10 years and 26 key informant interviews with teachers, health workers, child protection workers, police, local stakeholders, brewers, and others. Thematic content analysis was performed.

Results

Three main themes were identified:

‘We don’t talk about it’: Despite concern, childhood substance use was not addressed in the community. Participants attributed this to three main factors related to a lack of leadership in addressing it, changing acceptability for peer parental interference, and uncertainty about repercussions related to children’s rights.

‘There is nowhere to take the child’: Schools, police, and remand homes were intuitively considered appropriate arenas for managing childhood substance use but were considered inaccessible, unresponsive, and inadequate due to insufficient resources, competence, and training. Since substance use was not considered a medical problem, help from the health sector was only sought for adverse consequences, such as injury. This left the participants with the experience that there was in effect nowhere to take the child.

‘The government has not done so much’: The participants called for government action and clear laws that would regulate the availability of alcohol and other substances to children, but they had limited trust in the capacity and commitment of the government to act.

Conclusions

The participants were concerned about childhood alcohol and substance use, but the complexity and magnitude of the problem left them feeling incapacitated in responding. Relevant factors were identified on the community, institutional, and the government level, such as a lack of leadership in addressing it, a loss of mandate to interfere in child-rearing, inadequate services, weak legal structures, and missing government action. A strengthening of collective agency and public policy is necessary to prevent and address childhood alcohol and substance use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13548-4.

Study protocol for pragmatic trials of Internet-delivered guided and unguided cognitive behavior therapy for treating depression and anxiety in university students of two Latin American countries: the Yo Puedo Sentirme Bien study

BACKGROUND

Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are highly prevalent among university students and predict impaired college performance and later life role functioning. Yet most students do not receive treatment, especially in low-middle-income countries (LMICs). We aim to evaluate the effects of expanding treatment using scalable and inexpensive Internet-delivered transdiagnostic cognitive behavioral therapy (iCBT) among college students with symptoms of MDD and/or GAD in two LMICs in Latin America (Colombia and Mexico) and to investigate the feasibility of creating a precision treatment rule (PTR) to predict for whom iCBT is most effective.

METHODS

We will first carry out a multi-site randomized pragmatic clinical trial (N = 1500) of students seeking treatment at student mental health clinics in participating universities or responding to an email offering services. Students on wait lists for clinic services will be randomized to unguided iCBT (33%), guided iCBT (33%), and treatment as usual (TAU) (33%). iCBT will be provided immediately whereas TAU will be whenever a clinic appointment is available. Short-term aggregate effects will be assessed at 90 days and longer-term effects 12 months after randomization. We will use ensemble machine learning to predict heterogeneity of treatment effects of unguided versus guided iCBT versus TAU and develop a precision treatment rule (PTR) to optimize individual student outcome. We will then conduct a second and third trial with separate samples (n = 500 per arm), but with unequal allocation across two arms: 25% will be assigned to the treatment determined to yield optimal outcomes based on the PTR developed in the first trial (PTR for optimal short-term outcomes for Trial 2 and 12-month outcomes for Trial 3), whereas the remaining 75% will be assigned with equal allocation across all three treatment arms.

DISCUSSION

By collecting comprehensive baseline characteristics to evaluate heterogeneity of treatment effects, we will provide valuable and innovative information to optimize treatment effects and guide university mental health treatment planning. Such an effort could have enormous public-health implications for the region by increasing the reach of treatment, decreasing unmet need and clinic wait times, and serving as a model of evidence-based intervention planning and implementation.

TRIAL STATUS

IRB Approval of Protocol Version 1.0; June 3, 2020. Recruitment began on March 1, 2021. Recruitment is tentatively scheduled to be completed on May 30, 2024.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04780542 . First submission date: February 28, 2021.

Prevalence of at-risk drinking recognition: A systematic review and meta-analysis

BACKGROUND

There is a prominent "treatment gap" in relation to at-risk drinking (ARD), whereby a minority of at-risk drinkers ever access treatment. Research suggests that recognition of problem drinking is a necessary precursor for help-seeking and treatment.

OBJECTIVE

This systematic review and meta-analysis aimed to estimate the prevalence of ARD recognition within those meeting criteria for ARD.

METHOD

PsycINFO, Web of Science, Scopus, and MEDLINE were searched using the terms: problem* AND (recogni* OR perceive* OR perception OR self-identif*) AND alcohol - to identify studies published in English between 2000 and 2022. Studies reported the frequency (weighted or unweighted) of participants meeting ARD criteria that also directly identified ARD, perceived a need for help, or endorsed a readiness to change. The prevalence of ARD recognition was estimated using a random-effects meta-analysis with 95% confidence intervals (CIs).

RESULTS

17 studies were included which provided data for 33,349 participants with ARD. Most (n = 14) were US studies. ARD was self-identified via a single indicator in 7 studies, whereas recognition was assessed via stages of change in 4 studies and need for help in 6 studies. The pooled prevalence of ARD recognition was 31% (95% CI: 25%-36%), and subgroup analyses indicated alcohol use severity, measure of recognition, and population type to be significant sources of heterogeneity.

CONCLUSIONS

Most individuals with ARD fail to recognise their drinking problem so preventive approaches that promote recognition may be helpful. However, we must be cautious of how inconsistency in question framing affects self-reported problem recognition.

The impact of digital interventions on help-seeking behaviour for mental health problems: a systematic literature review

PURPOSE OF REVIEW

Interventions that facilitate help-seeking could help individuals to get care earlier on which could also help avert some mental health crises. Delivering interventions via a digital format could mitigate some key barriers to mental healthcare. We reviewed the literature for digital interventions which facilitate formal or informal help-seeking for mental health problems. We examined the impact of identified interventions on actual and intended help-seeking and attitudes towards help-seeking.

RECENT FINDINGS

We identified 35 interventions. About half (51%) of studies showed an improvement in at least one help-seeking outcome with the greatest number showing an improvement in help-seeking intentions and the fewest studies showing an improvement in actual behaviour (29%). Findings suggest that interventions that promote active participation and personal involvement through sharing one's own narrative seem to be promising practices to facilitate help-seeking.

SUMMARY

Our findings suggest digital interventions can improve help-seeking for mental health problems among a range of populations. Given speciality mental health resources are scarce, further research needs to consider how these interventions could best target the most vulnerable groups to link them with mental healthcare and how these interventions might facilitate earlier intervention in a way that might reduce need for crisis care and support.

Clinical insight level predicts successful quit or control attempts during the first three months of outpatient addiction treatment

INTRODUCTION

Low clinical insight in psychiatry is defined as poor recognition of one's mental illness, including disability to self-evaluate symptom severity. It has been reported as common in addiction and is associated with lower treatment compliance. Longitudinal studies suggest that low clinical insight could be linked to more relapse. However, association with successful quit attempts remains unknown.

OBJECTIVE

Our objective was to examine the prospective link between baseline clinical insight level and self-reports of successful attempts to quit / control use during the first 3 months of outpatient addiction treatment.

METHODS

Participants were recruited from the ADDICTAQUI cohort at outpatient treatment intake for substance or behavioral addictions. They completed a baseline evaluation using the Addiction Severity Index (ASI), the Mini International Neuropsychiatric Interview (MINI), and the modified Hanil Alcohol Insight Scale (m-HAIS) with a follow-up ASI 3 months later. Data were analyzed using multiple logistic regression and non-parametric tests.

RESULTS

Lower clinical insight level at baseline was associated with less successful quit / control attempts during the first 3 months of outpatient treatment compared to a higher clinical insight level, controlling for sociodemographic factors, baseline addiction severity, and comorbidities (n = 54; exp(B) = 0.76; p (FDRcor) = 0.033).

CONCLUSION

Poor clinical insight may be a barrier to treatment success, and future studies should examine underlying mechanisms.

Blended Treatment for Alcohol Use Disorder (Blend-A): Explorative Mixed Methods Pilot and Feasibility Study

Background

In Denmark, approximately 150,000 people have alcohol use disorder (AUD). However, only approximately 10% seek AUD treatment, preferably outside conventional health care settings and opening hours. The AUD treatment area experiences low adherence to treatment, as well as high numbers of no-show and premature dropouts.

Objective

The purpose of the Blend-A (Blended Treatment for Alcohol Use Disorder) feasibility and pilot study was to describe the process of translating and adapting the Dutch treatment protocol into Danish and Danish culture with a high amount of user involvement and to report how patients and therapists perceived the adapted version, when trying it out.

Methods

The settings were 3 Danish public municipal outpatient alcohol clinics. Study participants were patients and therapists from the 3 settings. Data consisted of survey data from the System Usability Scale, individual patient interviews, and therapist group interviews. Statistical analyses were conducted using the Stata software and Excel. Qualitative analysis was conducted using a theoretical thematic analysis.

Results

The usability of the treatment platform was rated above average. The patients chose to use the blended treatment format because it ensured anonymity and had a flexible design. Platform use formed the basis of face-to-face sessions. The use of the self-determined platform resulted in a more thorough process. Patient involvement qualified development of a feasible system. Managerial support for time use was essential. Guidance from an experienced peer was useful.

Conclusions

This study indicates that, during the processes of translating, adapting, and implementing blended, guided, internet-based, and face-to-face AUD treatment, it is relevant to focus on patient involvement, managerial support, and guidance from experienced peers. Owing to the discrete and flexible design of the blended offer, it appears that it may reach patient groups who would not otherwise have sought treatment. Therefore, blended treatment may increase access to treatment and contribute to reaching people affected by excessive alcohol use, who would not otherwise have sought treatment. In addition, it seems that the blended offer may enhance the participants’ perceived satisfaction and the effect of the treatment course. Thus, it appears that Blend-A may be able to contribute to existing treatment offers. Such findings highlight the need to determine the actual effect of the Blend-A offer; therefore, an effectiveness study with a controlled design is warranted.