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Khan BN, Chu C, Brual J, Dang-Nguyen M, Oladimeji A, Kthupi A, Bolea-Alamañac B, Tadrous M, O'Riordan A, Rubenstein D, Carlin K, Longum P, Gibson D, Abejirinde IOO. An Observational Study of a Digital Substance Use and Recovery Program. Psychiatr Serv 2024:appips20230427. [PMID: 38982834 DOI: 10.1176/appi.ps.20230427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
OBJECTIVE Digital substance use treatment programs present an opportunity to provide nonresidential care for people with problematic substance use. In June 2021, the provincial government in Ontario provided free access to Breaking Free Online (BFO), a digital behavioral change program for people with substance use disorders. METHODS An observational study was conducted with retrospective data to characterize clients' use and engagement patterns in BFO and examine changes in self-reported outcomes. RESULTS In total, 6,370 individuals registered for BFO between June 2021 and October 2022, of whom 3,650 completed the intake assessment. Most of these clients were self-referred (64%), with 37% having been referred by health service providers. More than one-half of the clients (52%) resided in Ontario West or East regions. Support for addressing problematic alcohol use was the most requested program (40%). By October 2022, about 44% of the clients had completed between one and four of 12 program strategies. Analysis revealed significant changes in pre-post scores across four validated scales (p<0.001), indicating a decrease in anxiety and depression, an increase in quality of life, an improvement in recovery progression, and a decrease in severity of symptoms associated with substance use disorders. CONCLUSIONS BFO clients with higher completion rates had the most improvement across the scales used; however, clients with lower and medium completion rates also had improvements. Because of the shame and stigma associated with substance use, digital supports with low barriers to entry can help support the autonomy, privacy, and preferences of individuals seeking help for problematic substance use.
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Affiliation(s)
- Bilal Noreen Khan
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Cherry Chu
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Janette Brual
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Marlena Dang-Nguyen
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Adetola Oladimeji
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Altea Kthupi
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Blanca Bolea-Alamañac
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Mina Tadrous
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Anne O'Riordan
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Donna Rubenstein
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Kathleen Carlin
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Philip Longum
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Daryn Gibson
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
| | - Ibukun-Oluwa Omolade Abejirinde
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto (Khan, Chu, Brual, Dang-Nguyen, Oladimeji, Bolea-Alamañac, Tadrous, O'Riordan, Rubenstein, Carlin, Longum, Gibson, Abejirinde); Dalla Lana School of Public Health, University of Toronto, Toronto (Khan, Kthupi, Abejirinde); Women's College Research Institute, Toronto (Kthupi); Department of Psychiatry, University of Toronto, Toronto (Bolea-Alamañac); Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto (Tadrous); Patient Advisors Network, Toronto (O'Riordan, Rubenstein, Carlin)
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Elison-Davies S, Pittard L, Myton T, Jones A, Ward J, Davies G. Examining outcomes for service users accessing the Breaking Free Online computer-assisted therapy program for substance use disorders via a 'telehealth' approach: protocol for a two arm, parallel group randomized controlled trial. Addict Sci Clin Pract 2023; 18:39. [PMID: 37269012 DOI: 10.1186/s13722-023-00391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/19/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Breaking Free Online (BFO), a computer-assisted therapy (CAT) program for substance use disorders (SUD), has been available across UK treatment services for the past decade and has demonstrated efficacy. The Covid-19 pandemic has contributed to digital and 'telehealth' approaches to healthcare delivery becoming more common and accepted, and has in parallel, increased numbers of referrals to SUD services because of the impact pandemic-related stress has had on substance using habits in the general population. Digital and telehealth approaches, such as BFO, have the potential to support the treatment system to meet this increased demand for SUD services. METHODS Parallel-group randomized controlled trial of eight-week BFO as an adjunct to standard treatment for SUD, in comparison to standard treatment only, at a National Health Service (NHS) Mental Health Trust in North-West England. Participants will be service users aged 18 years and over with demonstrable SUD for at least 12-months. Interventional and control groups will be compared on multiple measures from baseline to post-treatment assessment at eight-weeks, and then three and six-months follow-up. Primary outcome will be self-reported substance use, with secondary outcomes being standardized assessments of substance dependence, mental health, biopsychosocial functioning and quality of life. DISCUSSION This study will examine whether BFO and telehealth support, when delivered as an adjunct to standard SUD interventions, improves outcomes for services users receiving NHS SUD treatment. Findings from the study will be used to inform both developments to the BFO program and guidance around augmenting the delivery of CAT programs via telehealth. Trial registration registered with ISRCTN on 25th May 2021-registration number: 13694016. PROTOCOL VERSION 3.0 05th April 2022. TRIAL STATUS This trial is currently open to recruitment-estimated to be completed in May 2023.
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Affiliation(s)
- Sarah Elison-Davies
- TELUS Health, Williams House, Manchester Science Park, Lloyd Street North, Manchester, M15 6SE, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Achieve Bolton, 69-73 Manchester Road, Bolton, BL2 1ES, UK.
| | - Lauren Pittard
- TELUS Health, Williams House, Manchester Science Park, Lloyd Street North, Manchester, M15 6SE, UK
- Greater Manchester Mental Health NHS Foundation Trust, Achieve Bolton, 69-73 Manchester Road, Bolton, BL2 1ES, UK
| | - Tracey Myton
- Greater Manchester Mental Health NHS Foundation Trust, Achieve Bolton, 69-73 Manchester Road, Bolton, BL2 1ES, UK
| | - Andrew Jones
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M15 6JA, UK
| | - Jonathan Ward
- TELUS Health, Williams House, Manchester Science Park, Lloyd Street North, Manchester, M15 6SE, UK
| | - Glyn Davies
- TELUS Health, Williams House, Manchester Science Park, Lloyd Street North, Manchester, M15 6SE, UK
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Shams F, Wong JSH, Nikoo M, Outadi A, Moazen-Zadeh E, Kamel MM, Song MJ, Jang KL, Krausz RM. Understanding eHealth Cognitive Behavioral Therapy Targeting Substance Use: Realist Review. J Med Internet Res 2021; 23:e20557. [PMID: 33475520 PMCID: PMC7861997 DOI: 10.2196/20557] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/10/2020] [Accepted: 12/05/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is a growing body of evidence regarding eHealth interventions that target substance use disorders. Development and funding decisions in this area have been challenging, due to a lack of understanding of what parts of an intervention work in which context. OBJECTIVE We conducted a realist review of the literature on electronic cognitive behavioral therapy (eCBT) programs for substance use with the goal of answering the following realist question: "How do different eCBT interventions for substance use interact with different contexts to produce certain outcomes?" METHODS A literature search of published and gray literature on eHealth programs targeting substance use was conducted. After data extraction, in order to conduct a feasible realist review in a timely manner, the scope had to be refined further and, ultimately, only included literature focusing on eCBT programs targeting substance use. We synthesized the available evidence from the literature into Context-Mechanism-Outcome configurations (CMOcs) in order to better understand when and how programs work. RESULTS A total of 54 papers reporting on 24 programs were reviewed. Our final results identified eight CMOcs from five unique programs that met criteria for relevance and rigor. CONCLUSIONS Five strategies that may be applied to future eCBT programs for substance use are discussed; these strategies may contribute to a better understanding of mechanisms and, ultimately, may help design more effective solutions in the future. Future research on eCBT programs should try to understand the mechanisms of program strategies and how they lead to outcomes in different contexts.
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Affiliation(s)
- Farhud Shams
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - James S H Wong
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Ava Outadi
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | - Ehsan Moazen-Zadeh
- Addiction Institute of Mount Sinai, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Mostafa M Kamel
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, Tanta University, Tanta, Egypt
| | - Michael Jae Song
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerry L Jang
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Reinhard Michael Krausz
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
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