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Siefried KJ, Bascombe F, Clifford B, Liu Z, Middleton P, Kay-Lambkin F, Freestone J, Herman D, Millard M, Steele M, Acheson L, Moller C, Bath N, Ezard N. Effect of a Smartphone App (S-Check) on Actual and Intended Help-Seeking and Motivation to Change Methamphetamine Use Among Adult Consumers of Methamphetamine in Australia: Randomized Waitlist-Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e55663. [PMID: 38959499 PMCID: PMC11255525 DOI: 10.2196/55663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/23/2024] [Accepted: 05/10/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Interventions are required that address delays in treatment-seeking and low treatment coverage among people consuming methamphetamine. OBJECTIVE We aim to determine whether a self-administered smartphone-based intervention, the "S-Check app" can increase help-seeking and motivation to change methamphetamine use, and determine factors associated with app engagement. METHODS This study is a randomized, 28-day waitlist-controlled trial. Consenting adults residing in Australia who reported using methamphetamine at least once in the last month were eligible to download the app for free from Android or iOS app stores. Those randomized to the intervention group had immediate access to the S-Check app, the control group was wait-listed for 28 days before gaining access, and then all had access until day 56. Actual help-seeking and intention to seek help were assessed by the modified Actual Help Seeking Questionnaire (mAHSQ), modified General Help Seeking Questionnaire, and motivation to change methamphetamine use by the modified readiness ruler. χ2 comparisons of the proportion of positive responses to the mAHSQ, modified General Help Seeking Questionnaire, and modified readiness ruler were conducted between the 2 groups. Logistic regression models compared the odds of actual help-seeking, intention to seek help, and motivation to change at day 28 between the 2 groups. Secondary outcomes were the most commonly accessed features of the app, methamphetamine use, feasibility and acceptability of the app, and associations between S-Check app engagement and participant demographic and methamphetamine use characteristics. RESULTS In total, 560 participants downloaded the app; 259 (46.3%) completed eConsent and baseline; and 84 (32.4%) provided data on day 28. Participants in the immediate access group were more likely to seek professional help (mAHSQ) at day 28 than those in the control group (n=15, 45.5% vs n=12, 23.5%; χ21=4.42, P=.04). There was no significant difference in the odds of actual help-seeking, intention to seek help, or motivation to change methamphetamine use between the 2 groups on the primary logistic regression analyses, while in the ancillary analyses, the imputed data set showed a significant difference in the odds of seeking professional help between participants in the immediate access group compared to the waitlist control group (adjusted odds ratio 2.64, 95% CI 1.19-5.83, P=.02). For participants not seeking help at baseline, each minute in the app increased the likelihood of seeking professional help by day 28 by 8% (ratio 1.08, 95% CI 1.02-1.22, P=.04). Among the intervention group, a 10-minute increase in app engagement time was associated with a decrease in days of methamphetamine use by 0.4 days (regression coefficient [β] -0.04, P=.02). CONCLUSIONS The S-Check app is a feasible low-resource self-administered intervention for adults in Australia who consume methamphetamine. Study attrition was high and, while common in mobile health interventions, warrants larger studies of the S-Check app. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12619000534189; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377288&isReview=true.
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Affiliation(s)
- Krista J Siefried
- The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Randwick, Australia
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- The National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia
| | - Florence Bascombe
- The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Randwick, Australia
- Institute for Global Health, University College London, London, United Kingdom
- Central and North-West London NHS Foundation Trust, London, United Kingdom
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Brendan Clifford
- The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Randwick, Australia
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- The National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Ministry of Health, Sydney, Australia
| | - Zhixin Liu
- Healthdirect Australia, Sydney, Australia
| | - Peter Middleton
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Ministry of Health, Sydney, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Jack Freestone
- ACON, Sydney, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, Australia
| | - Maureen Steele
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
| | - Liam Acheson
- The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Randwick, Australia
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- The National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia
| | - Carl Moller
- The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Randwick, Australia
| | - Nicky Bath
- LGBTIQ+ Health Australia, Sydney, Australia
| | - Nadine Ezard
- The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Randwick, Australia
- St Vincent's Hospital Alcohol and Drug Service, Sydney, Australia
- The National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Ministry of Health, Sydney, Australia
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Oesterle TS, Hall-Flavin DK, Bormann NL, Loukianova LL, Fipps DC, Breitinger SA, Gilliam WP, Wu T, da Costa SC, Arndt S, Karpyak VM. Therapeutic Content of Mobile Phone Applications for Substance Use Disorders: An Umbrella Review. MAYO CLINIC PROCEEDINGS. DIGITAL HEALTH 2024; 2:192-206. [PMID: 38983444 PMCID: PMC11232654 DOI: 10.1016/j.mcpdig.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Mobile phone applications (MPAs) for substance use disorder (SUD) treatment are increasingly used by patients. Although pilot studies have shown promising results, multiple previous systematic reviews noted insufficient evidence for MPA use in SUD treatment-many of the previously published reviews evaluated different trials. Subsequently, we aimed to conduct an umbrella review of previously published reviews investigating the efficacy of MPAs for SUD treatment, excluding nicotine/tobacco because umbrella reviews have been done in this population and the nicotine/tobacco MPA approach often differs from SUD-focused MPAs. No previous reviews have included a statistical meta-analysis of clinical trials to quantify an estimated overall effect. Seven reviews met inclusion criteria, and 17 unique studies with available data were taken from those reviews for the meta-analysis. Overall, reviews reported a lack of evidence for recommending MPAs for SUD treatment. However, MPA-delivered recovery support services, cognitive behavioral therapy, and contingency management were identified across multiple reviews as having promising evidence for SUD treatment. Hedges g effect size for an MPA reduction in substance use-related outcomes relative to the control arm was insignificant (0.137; 95% CI, -0.056 to 0.330; P=.16). In subgroup analysis, contingency management (1.29; 95% CI, 1.088-1.482; τ 2=0; k=2) and cognitive behavioral therapy (0.02; 95% CI, 0.001-0.030; τ 2=0; k=2) were significant. Although contingency management's effect was large, both trials were small (samples of 40 and 30). This review includes an adapted framework for the American Psychiatric Association's MPA guidelines that clinicians can implement to review MPAs critically with patients.
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Affiliation(s)
- Tyler S Oesterle
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Daniel K Hall-Flavin
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Nicholas L Bormann
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Larissa L Loukianova
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - David C Fipps
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Scott A Breitinger
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Wesley P Gilliam
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Tiffany Wu
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Sabrina Correa da Costa
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Stephan Arndt
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Victor M Karpyak
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
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Fuhrmann LM, Weisel KK, Harrer M, Kulke JK, Baumeister H, Cuijpers P, Ebert DD, Berking M. Additive effects of adjunctive app-based interventions for mental disorders - A systematic review and meta-analysis of randomised controlled trials. Internet Interv 2024; 35:100703. [PMID: 38225971 PMCID: PMC10788289 DOI: 10.1016/j.invent.2023.100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 01/17/2024] Open
Abstract
Background It is uncertain whether app-based interventions add value to existing mental health care. Objective To examine the incremental effects of app-based interventions when used as adjunct to mental health interventions. Methods We searched PubMed, PsycINFO, Scopus, Web of Science, and Cochrane Library databases on September 15th, 2023, for randomised controlled trials (RCTs) on mental health interventions with an adjunct app-based intervention compared to the same intervention-only arm for adults with mental disorders or respective clinically relevant symptomatology. We conducted meta-analyses on symptoms of different mental disorders at postintervention. PROSPERO, CRD42018098545. Results We identified 46 RCTs (4869 participants). Thirty-two adjunctive app-based interventions passively or actively monitored symptoms and behaviour, and in 13 interventions, the monitored data were sent to a therapist. We found additive effects on symptoms of depression (g = 0.17; 95 % CI 0.02 to 0.33; k = 7 comparisons), anxiety (g = 0.80; 95 % CI 0.06 to 1.54; k = 3), mania (g = 0.2; 95 % CI 0.02 to 0.38; k = 4), smoking cessation (g = 0.43; 95 % CI 0.29 to 0.58; k = 10), and alcohol use (g = 0.23; 95 % CI 0.08 to 0.39; k = 7). No significant effects were found on symptoms of depression within a bipolar disorder (g = -0.07; 95 % CI -0.37 to 0.23, k = 4) and eating disorders (g = -0.02; 95 % CI -0.44 to 0.4, k = 3). Studies on depression, mania, smoking, and alcohol use had a low heterogeneity between the trials. For other mental disorders, only single studies were identified. Only ten studies had a low risk of bias, and 25 studies reported insufficient statistical power. Discussion App-based interventions may be used to enhance mental health interventions to further reduce symptoms of depression, anxiety, mania, smoking, and alcohol use. However, the effects were small, except for anxiety, and limited due to study quality. Further high-quality research with larger sample sizes is warranted to better understand how app-based interventions can be most effectively combined with established interventions to improve outcomes.
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Affiliation(s)
- Lukas M. Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Kiona K. Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mathias Harrer
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Jennifer K. Kulke
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - David D. Ebert
- Department of Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
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Ghosh A, Singh GK, Yadav N, Singh P, Kathiravan S. Brief interventions for alcohol misuse among people living with HIV: a meta-analysis. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:766-786. [PMID: 37921633 DOI: 10.1080/00952990.2023.2248647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/13/2023] [Indexed: 11/04/2023]
Abstract
Background: One-third of people living with HIV (PLHIV) have alcohol misuse or alcohol use disorders which negatively affect course and outcome of HIV.Objectives: The meta-analysis sought to evaluate the effectiveness of brief interventions (BI) on alcohol and HIV outcomes in PLHIV with alcohol misuse.Methods: We included clinical trials published between 1990 and September 2022 on adults with harmful/hazardous alcohol use; only randomized clinical trials (RCTs) were included in the meta-analysis. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Clinical Trials.Gov, and the World Health Organization's International Clinical Trials Registry Platform databases. Cochrane's risk-of-bias assessment was used.Results: Eighteen studies were included in the narrative synthesis, and a meta-analysis could be performed on 13 studies. Among the included RCTs, seven showed a low risk and two showed a high risk of bias; others showed some concerns. There was no evidence of publication bias. Compared to the control, BI significantly reduces the drinks per drinking day (N = 5, Hedge's g= -0.45, 95%CI = -0.58, -0.32) and the number of heavy drinking days (N = 4, Hedge'sg = -0.81, 95% CI= -0.94, -0.67) between 3-6 months post-intervention. BI also reduces the odds of mortality by 42% (N = 7, OR = 0.58, 95% CI = 0.34, 0.99) in 6-12 months. BI does not change the alcohol risk scores and transition to harmful alcohol use; it does not improve adherence to Anti-Retroviral Therapy and increase viral suppression.Conclusion: Policymakers must introduce and scale up integrated screening and brief intervention services within HIV clinics and primary care.
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Affiliation(s)
- Abhishek Ghosh
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Geetesh K Singh
- Department of Psychology, SCBS, Rashtriya Raksha University (An Institute of National Importance) Lavad, Gandhinagar, India
| | - Nidhi Yadav
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranshu Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjana Kathiravan
- Drug Deaddiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Starbird LE, Gutkind S, Teixeira P, Murphy S, Aharonovich E, Zingman BS, Hasin D, Schackman BR. Economic Cost of the HealthCall Smartphone Intervention to Reduce Heavy Alcohol Drinking in Adults With HIV. J Stud Alcohol Drugs 2023; 84:814-822. [PMID: 37449954 PMCID: PMC10765982 DOI: 10.15288/jsad.22-00377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/10/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE Alcohol use among people living with HIV (PLWH) can reduce adherence and worsen health outcomes. We evaluated the economic cost of an effective smartphone application (HealthCall) to reduce drinking and improve antiretroviral adherence among heavy-drinking PLWH participating in a randomized trial. METHOD Participants were randomized to receive a brief drinking-reduction intervention, either (a) the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Clinician's Guide (CG-only, n = 37), (b) CG enhanced by HealthCall to monitor daily alcohol consumption (CG+HealthCall, n = 38), or (c) motivational interviewing delivered by a nonclinician enhanced by HealthCall (MI+HealthCall, n = 39). We used micro-costing techniques to evaluate start-up costs and incremental costs per participant incurred from the health care sector perspective in 2018 U.S. dollars. We also investigated potential cost offsets using participant-reported health care utilization. RESULTS Participants attended three intervention visits, and each visit cost on average $29 for CG-only, $32 for CG+HealthCall, and $15 for MI+HealthCall. The total intervention cost per participant was $94 for CG-only, $114 for CG+HealthCall, and $57 for MI+HealthCall; the incremental cost of CG+HealthCall compared with CG-only was $20 per participant, and the incremental savings of MI+HealthCall compared with CG-only was $37 per participant. No significant differences in health care utilization occurred among the three groups over 12 months. CONCLUSIONS The cost of enhancing CG with the HealthCall application for heavy-drinking PLWH was modestly higher than using the CG alone, whereas MI enhanced with HealthCall delivered by a nonclinician had a lower cost than CG alone. HealthCall may be a low-cost enhancement to brief interventions addressing alcohol use and antiretroviral adherence among PLWH.
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Affiliation(s)
- Laura E. Starbird
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Sarah Gutkind
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Paul Teixeira
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Sean Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Efrat Aharonovich
- Mailman School of Public Health, Columbia University, New York State Psychiatric Institute, New York, New York
| | - Barry S. Zingman
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Deborah Hasin
- Mailman School of Public Health, Columbia University, New York State Psychiatric Institute, New York, New York
| | - Bruce R. Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
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BİLKAY Hİ, GÜRHAN N, ŞİRİN B. Use of Mobile Applications in Smoking, Alcohol and Substance Use Disorders. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1181096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
Currently, technology and mobile health applications are developing and being applied in different fields every day. Especially the use of mobile technology in many health fields offers various opportunities for the use of mobile applications in smoking, alcohol and substance use disorders, which is an important public mental health problem. The aim of this review study was to examine 16 mobile applications designed for the treatment and monitoring of smoking, alcohol and substance use. It was concluded that self-monitoring, notification and warning systems, location services, peer and expert support services were frequently used in the analyzed mobile applications. As a result of the studies, the use of mobile applications as a preventive intervention in the prevention of addiction and as an additional treatment option in addiction treatment is promising. However, this situation brings along various harms, risks and obstacles. This review of the relevant literature provides a critical update of mobile applications used in smoking, alcohol and substance use disorders. This review is expected to be an important guide for mental health professionals and mobile application designers working on addiction.
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Liu SW, You CW, Fang SC, Chang HM, Huang MC. A smartphone-based support system coupled with a bluetooth breathalyzer in the treatment of alcohol dependence: A 12-week randomized controlled trial. Internet Interv 2023; 33:100639. [PMID: 37435041 PMCID: PMC10331416 DOI: 10.1016/j.invent.2023.100639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023] Open
Abstract
Background Our prior open trial showed the feasibility of a smartphone-based support system coupled with a Bluetooth breathalyzer (SoberDiary) in assisting recovery for patients with alcohol dependence (AD). In this 24-week follow-up study, we further explored the efficacy of supplementing SoberDiary to treatment as usual (TAU) over 12 weeks of intervention and whether the efficacy persisted in the post-intervention 12 weeks. Methods 51 patients who met the DSM-IV criteria of AD were randomly assigned to the technological intervention group (TI group, receiving technology intervention of SoberDiary plus TAU, n = 25) or those receiving only TAU (TAU group, n = 26). After 12 weeks of intervention (Phase I), all participants were followed for another post-intervention 12 weeks (Phase II). We collected the drinking variables and psychological assessment data every 4 weeks (i.e., weeks 4, 8, 12, 16, 20, and 24). In addition, the cumulative abstinence days and retention rates were recorded. We used mixed-model analysis to compare the difference in outcomes between groups. Results In Phase I or Phase II, we did not find differences in drinking variables, alcohol craving, depression, or anxiety severity between the two groups. However, the TI group showed greater self-efficacy for drinking refusal in Phase II than the TAU group. Conclusions Although our system (SoberDiary) did not demonstrate benefits in drinking or emotional outcomes, we found the system holds promise to enhance self-efficacy on drinking refusal. Whether the benefit in promoting self-efficacy persists longer than 24 weeks requires further investigation.
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Affiliation(s)
- Shu-Wei Liu
- Department of Addiction Sciences, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chuang-Wen You
- Graduate Institute of Art and Technology, National Tsing Hua University, Hsinchu City, Taiwan
| | - Su-Chen Fang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Hu-Ming Chang
- Department of Addiction Sciences, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Ming-Chyi Huang
- Department of Addiction Sciences, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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8
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Taylor E, Patel D, Marconi V, Whitmire A, Hansen N, Kershaw T, Fiellin D, Lauckner C. Pilot Trial of a Smartphone-Based Intervention to Reduce Alcohol Consumption among Veterans with HIV. MILITARY BEHAVIORAL HEALTH 2023; 11:66-77. [PMID: 38405355 PMCID: PMC10888529 DOI: 10.1080/21635781.2023.2221465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Veterans engage in disproportionate levels of alcohol use, which can impact treatment outcomes among veterans with HIV. The TRAC (Tracking and Reducing Alcohol Consumption) intervention, which combines smartphones, mobile breathalyzers, and motivational interviewing (MI), was developed to help reduce alcohol use among this population. This study reports results of an 8-week pilot trial of TRAC among veterans with HIV (N = 10). Participants attended weekly MI sessions conducted via videoconferencing or phone and completed twice-daily self-monitoring of alcohol consumption using breathalyzers and surveys. They also completed pre- and post-intervention questionnaires and a qualitative interview. Analyses explored adherence to self-monitoring tasks, perceptions of the intervention, and preliminary effects of TRAC on alcohol use and readiness to change drinking behavior. Participants completed 76% of breathalyzer readings and 73% of surveys and completed more daytime than evening monitoring tasks. AUDIT hazardous drinking scores significantly decreased between baseline and post-test. Qualitative interviews revealed positive attitudes toward the technologies and MI sessions. Overall, this pilot demonstrated that the TRAC intervention has potential to reduce alcohol use among veterans with HIV, though additional effort is needed to improve adherence to mobile monitoring. Results were used to refine the intervention in preparation for a randomized controlled trial.
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Affiliation(s)
- Erica Taylor
- Department of Health Promotion & Behavior, University of Georgia College of Public Health, Athens, Georgia, USA
| | - Darshti Patel
- Department of Health Promotion & Behavior, University of Georgia College of Public Health, Athens, Georgia, USA
| | - Vincent Marconi
- Atlanta VAMC, Emory University School of Medicine, Rollins School of Public Health, Atlanta, GA, USA
| | | | - Nathan Hansen
- Department of Health Promotion & Behavior, University of Georgia College of Public Health, Athens, Georgia, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - David Fiellin
- Program in Addiction Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Medicine, Yale School of Public Health, New Haven, Connecticut, USA
| | - Carolyn Lauckner
- Center for Health Equity Transformation, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Thompson RG, Bollinger M, Mancino MJ, Hasin D, Han X, Bush KA, Kilts CD, James GA. Smartphone intervention to optimize medication-assisted treatment outcomes for opioid use disorder: study protocol for a randomized controlled trial. Trials 2023; 24:255. [PMID: 37016394 PMCID: PMC10071730 DOI: 10.1186/s13063-023-07213-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/01/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Opioids accounted for 75% of drug overdoses in the USA in 2020, with rural states particularly impacted by the opioid crisis. While medication-assisted treatment (MAT) with Suboxone remains one of the more efficacious treatments for opioid use disorder (OUD), approximately 40% of people receiving Suboxone for outpatient MAT for OUD (MOUD) relapse within the first 6 months of treatment. We developed the smartphone app-based intervention OptiMAT as an adjunctive intervention to improve MOUD outcomes. The aims of this study are to (1) evaluate the efficacy of adjunctive OptiMAT use in reducing opioid misuse among people receiving MOUD and (2) evaluate the role of specific OptiMAT features in reducing opioid misuse, including the use of GPS-driven just-in-time intervention. METHODS We will conduct a two-arm, single-blind, randomized controlled trial of adults receiving outpatient MOUD in the greater Little Rock AR area. Participants are English-speaking adults ages 18 or older recently enrolled in outpatient MOUD at one of our participating study clinics. Participants will be allocated via 1:1 randomized block design to (1) MOUD with adjunctive use of OptiMAT (MOUD+OptiMAT) or (2) MOUD without OptiMAT (MOUD-only). Our blinded research statistician will evaluate differences between the two groups in opioid misuse (as determined by quantitative urinalysis conducted by clinical lab staff blinded to group membership) during the 6-months following study enrolment. Secondary analyses will evaluate if OptiMAT-usage patterns within the MOUD+OptiMAT group predict opioid misuse or continued abstinence. DISCUSSION This study will test if adjunctive use of OptiMAT improve MOUD outcomes. Study findings could lead to expansion of OptiMAT into rural clinical settings, and the identification of OptiMAT features which best predict positive clinical outcome could lead to refinement of this and similar smartphone app-based interventions. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05336188 , registered March 21, 2022.
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mary Bollinger
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael J Mancino
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Deborah Hasin
- Department of Epidemiology, Columbia University, New York City, NY, USA
| | - Xiaotong Han
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Keith A Bush
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Clint D Kilts
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - G Andrew James
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Shmulewitz D, Stohl M, Greenstein E, Roncone S, Walsh C, Aharonovich E, Wall MM, Hasin DS. Validity of the DSM-5 craving criterion for alcohol, tobacco, cannabis, cocaine, heroin, and non-prescription use of prescription painkillers (opioids). Psychol Med 2023; 53:1955-1969. [PMID: 35506791 PMCID: PMC9096712 DOI: 10.1017/s0033291721003652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although the DSM-5 was adopted in 2013, the validity of the new substance use disorder (SUD) diagnosis and craving criterion has not been investigated systematically across substances. METHODS Adults (N = 588) who engaged in binge drinking or illicit drug use and endorsed at least one DSM-5 SUD criterion were included. DSM-5 SUD criteria were assessed for alcohol, tobacco, cannabis, cocaine, heroin, and opioids. Craving was considered positive if "wanted to use so badly that could not think of anything else" (severe craving) or "felt a very strong desire or urge to use" (moderate craving) was endorsed. Baseline information on substance-related variables and psychopathology was collected, and electronic daily assessment queried substance use for the following 90 days. For each substance, logistic regression estimated the association between craving and validators, i.e. variables expected to be related to craving/SUD, and whether association with the validators differed for DSM-5 SUD diagnosed with craving as a criterion v. without. RESULTS Across substances, craving was associated with most baseline validators (p values<0.05); neither moderate nor severe craving consistently showed greater associations. Baseline craving predicted subsequent use [odds ratios (OR): 4.2 (alcohol) - 234.3 (heroin); p's ⩽ 0.0001], with stronger associations for moderate than severe craving (p's < 0.05). Baseline DSM-5 SUD showed stronger associations with subsequent use when diagnosed with craving than without (p's < 0.05). CONCLUSION The DSM-5 craving criterion as operationalized in this study is valid. Including craving improves the validity of DSM-5 SUD diagnoses, and clinical relevance, since craving may cause impaired control over use and development and maintenance of SUD.
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Affiliation(s)
- D Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - M Stohl
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - E Greenstein
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - S Roncone
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - C Walsh
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - E Aharonovich
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - MM Wall
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - DS Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
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11
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Sharma AK, Shadakshari D, Chand P, Murthy P. Design, development and pilot testing of 'Quest', a smartphone-based relapse prevention app for patients with alcohol dependence. Asian J Psychiatr 2023; 83:103572. [PMID: 37019043 DOI: 10.1016/j.ajp.2023.103572] [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] [Received: 12/23/2022] [Revised: 03/15/2023] [Accepted: 03/25/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To design, develop and pilot the 'Quest' app for smartphone-based relapse prevention for patients diagnosed with alcohol dependence syndrome (ADS). METHODS Principles of relapse prevention and motivation enhancement were used to develop the Quest App. Four addiction psychiatrists reviewed the app using the "app evaluation framework". Thirty patients (> 18 yrs age) diagnosed with ADS, who had an Android smartphone, were fluent in writing and reading English and agreed to use the app regularly for the next three months were enrolled in this study. After initial treatment for intoxication/withdrawal and with written consent, patients in the study group (TAUQ) were requested to download the Quest application from a downloadable installation file. The usability and acceptability of Quest App amongst TAUQ patients was evaluated using the usability section of the mHealth App Usability Questionnaire (MAUQ). The short-term effectiveness at the end of three months was compared between TAUQ and comparison group who received Treatment as Usual (TAU). RESULTS Both acceptability (65 %) and usability (5.8 out of 7) of the app were high. The patient groups (with or without Quest app) showed a significant reduction in drinking at 30, 60, and 90 days follow-up compared with their baseline number of drinking days. There was no significant difference between the two groups (with or without Quest App) in the median number of lapses and the median number of days of heavy drinking. CONCLUSIONS This is the first attempt to develop a smartphone app and test its feasibility in preventing relapse among patients with ADS in the Indian population. Further validation of the app after incorporating feedback and testing on a larger sample size and multiple languages is required.
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Affiliation(s)
- Abhishek Kumar Sharma
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Darshan Shadakshari
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Prabhat Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India.
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
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12
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Thompson RG, Bollinger M, Mancino MJ, Hasin D, Han X, Bush KA, Kilts CD, James GA. Smartphone intervention to optimize medication assisted treatment outcomes for opioid use disorder: study protocol for a randomized controlled trial. RESEARCH SQUARE 2023:rs.3.rs-2511936. [PMID: 36824884 PMCID: PMC9949224 DOI: 10.21203/rs.3.rs-2511936/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Background: Opioids accounted for 75% of drug overdoses in the United States in 2020, with rural states particularly impacted by the opioid crisis. While medication assisted treatment (MAT) with Suboxone remains one of the more efficacious treatments for opioid use disorder (OUD), approximately 40% of people receiving Suboxone for outpatient MAT for OUD (MOUD) relapse within the first 6 months of treatment. We developed the smartphone app-based intervention OptiMAT as an adjunctive intervention to improve MOUD outcomes. The aims of this study are to (1) evaluate the efficacy of adjunctive OptiMAT use in reducing opioid misuse among people receiving MOUD; and (2) evaluate the role of specific OpitMAT features in reducing opioid misuse, including the use of GPS-driven just-in-time intervention. Methods: We will conduct a two-arm, single-blind, randomized controlled trial of adults receiving outpatient MOUD in the greater Little Rock AR area. Participants are English-speaking adults ages 18 or older recently enrolled in outpatient MOUD at one of our participating study clinics. Participants will be allocated via 1:1 randomized block design to (1) MOUD with adjunctive use of OptiMAT (MOUD+OptiMAT) or (2) MOUD without OptiMAT (MOUD-only). Our blinded research statistician will evaluate differences between the two groups in opioid misuse (as determined by quantitative urinalysis conducted by clinical lab staff blinded to group membership) during the 6-months following study enrolment. Secondary analyses will evaluate if OptiMAT-usage patterns within the MOUD+OptiMAT group predict opioid misuse or continued abstinence. Discussion: This study will test if adjunctive use of OptiMAT improve MOUD outcomes. Study findings could lead to expansion of OptiMAT into rural clinical settings, and the identification of OptiMAT features which best predict positive clinical outcome could lead to refinement of this and similar smartphone appbased interventions. Trial registration: ClinicalTrials.gov identifier: NCT05336188, registered March 21, 2022, https://clinicaltrials.gov/ct2/show/NCT05336188.
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13
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Schulte MH, Boumparis N, Kleiboer A, Wind TR, Olff M, Huizink AC, Riper H. The effectiveness of a mobile intervention to reduce young adults' alcohol consumption to not exceed low-risk drinking guidelines. Front Digit Health 2022; 4:1016714. [PMID: 36561923 PMCID: PMC9763894 DOI: 10.3389/fdgth.2022.1016714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
Background Young adults' drinking habits often exceed low-risk drinking guidelines. As young adults show increased access, use, and interest in personalized content related to physical and mental well-being, mobile applications might be a suitable tool to reach this target group. This study investigates the effectiveness of "Boozebuster", a self-guided mobile application incorporating various therapeutic principles to reduce young adults' alcohol consumption to not exceeding low-risk drinking guideline levels, compared to an educational website condition. Method Young adults aged 18-30 wanting to reduce their alcohol consumption entered a two-arm, parallel-group RCT. There were no minimum drinking severity inclusion criteria. Primary outcomes included alcohol consumption quantity and frequency. Secondary outcomes included binge drinking frequency and alcohol-related problem severity. Baseline, 6-week postbaseline, and 3-month post-baseline assessments were analyzed using linear mixed model analyses. Sex, treatment adherence, experienced engagement and motivation to change alcohol use behavior were investigated as moderators. Sub-group analyses contained problem drinkers and binge drinkers. Results 503 participants were randomized to the intervention or control condition. Results showed no intervention effects on primary or secondary outcomes compared to the control group. Both groups showed within-group reductions on all outcomes. Sub-group analyses in problem drinkers or binge drinkers showed similar results. Motivation to change drinking behavior and experienced engagement with the application significantly moderated the intervention effect regarding the quantity or frequency of alcohol consumption, respectively. Exploratory analyses showed that participants who indicated they wanted to change their drinking patterns during the initial PNF/MI module showed a significantly greater reduction in drinking quantity compared to those who indicated not wanting to change their drinking patterns. Conclusion The intervention group did not show a greater reduction in alcohol-related outcomes compared to the control group, but both groups showed a similar decrease. Potential explanations include similar effectiveness of both condition due to using a minimal active control in participants predominantly in the action stage of motivation to change. Future research should further explore the effectiveness of using mobile application to reduce young adults' drinking behavior to not exceed low-risk drinking guideline levels and identify factors that motivate participants to engage with such an intervention.
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Affiliation(s)
- Mieke H.J. Schulte
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands,Correspondence: Mieke H.J. Schulte
| | - Nikolaos Boumparis
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Tim R. Wind
- Foundation Centrum ‘45, partner in Arq Psychotrauma Expert Group, Diemen, Netherlands,Arq Psychotrauma Expert Group, Diemen, Netherlands
| | - Miranda Olff
- Arq Psychotrauma Expert Group, Diemen, Netherlands,Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, Netherlands
| | - Anja C. Huizink
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands,Department of Psychiatry, Amsterdam UMC-VUmc, Vrije Universiteit, Amsterdam, Netherlands
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Woolf-King SE, Sheinfil AZ, Ramos J, Foley JD, Moskal D, Firkey M, Kellen D, Maisto SA. A conceptual model of alcohol use and adherence to antiretroviral therapy: systematic review and theoretical implications for mechanisms of action. Health Psychol Rev 2022; 16:104-133. [PMID: 32757813 PMCID: PMC8972079 DOI: 10.1080/17437199.2020.1806722] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alcohol consumption is one of the most prevalent correlates of antiretroviral therapy (ART) adherence, yet causal processes underlying this association remain largely unexplored. The goal of this systematic review was to develop a conceptual model that describes the causal effect of alcohol consumption on ART nonadherence. We reviewed 230 studies that examined the association between alcohol consumption and ART adherence with three primary aims: (1) to replicate and extend previous reviews of the literature, (2) to summarize and critique study designs capable of answering questions about temporal overlap and (3) to summarize potential mechanisms of action. A model of alcohol-associated ART nonadherence was proposed to guide future work, integrating general theories of ART adherence and theory on the psychological and behavioral effects of alcohol intoxication. The conceptual model describes two mechanistic processes-prospective memory impairment and interactive toxicity beliefs/avoidance behaviors-involved in alcohol-associated intentional and unintentional nonadherence, respectively. This model can be used to guide future research on the causal processes involved in the frequently observed correlation between alcohol consumption and adherence.
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Affiliation(s)
| | - Alan Z. Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jeremy Ramos
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jacklyn D. Foley
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Dezarie Moskal
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Madison Firkey
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - David Kellen
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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15
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Schulte MH, Boumparis N, Huizink AC, Riper H. Technological Interventions for the Treatment of Substance Use Disorders. COMPREHENSIVE CLINICAL PSYCHOLOGY 2022. [PMCID: PMC7500918 DOI: 10.1016/b978-0-12-818697-8.00010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Substance use disorders (SUDs) pose a major public health concern. In recent years, technological (i.e., e-health) interventions have emerged and are increasingly offered in a variety of settings, including substance use treatment. E-health interventions encompass a wide variety of advantages depending on the chosen delivery format. This chapter discusses existing interventions and the effectiveness of delivering them as an e-health intervention, with a focus on randomized controlled trials, for the treatment of alcohol, cannabis, opioid, psychostimulant, or poly-substance use, as well as in transdiagnostic interventions. Based on the literature, suggestions for future research and clinical implications are discussed.
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Shuper PA. The Role of Alcohol-Related Behavioral Research in the Design of HIV Secondary Prevention Interventions in the Era of Antiretroviral Therapy: Targeted Research Priorities Moving Forward. AIDS Behav 2021; 25:365-380. [PMID: 33987783 DOI: 10.1007/s10461-021-03302-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/17/2022]
Abstract
HIV secondary prevention focuses on averting onward HIV transmission, which can be realized when people living with HIV enact requisite HIV care continuum-related behaviors to achieve viral suppression, and engage in condom-protected sex when virally unsuppressed. Alcohol has been detrimentally linked to all aspects of HIV secondary prevention, and although a growing number of behavioral interventions account for and address alcohol use within this realm, further efforts are needed to fully realize the potential of such initiatives. The present article proposes a series of targeted priorities to inform the future design, implementation, and evaluation of alcohol-related behavioral intervention research within the scope of HIV secondary prevention. These priorities and corresponding approaches account for the challenges of resource-constrained clinic environments; capitalize on technology; and address key comorbidities. This framework provides the foundation for a range of alcohol-related behavioral interventions that could potentially enhance global HIV secondary prevention efforts in the years ahead.
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Affiliation(s)
- Paul A Shuper
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON, M5S 2S1, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Institute for Collaboration On Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA.
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa.
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17
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Aharonovich E, Scodes J, Wall MM, Hasin DS. The relationship of frequency of cocaine use to substance and psychiatric disorders in the U.S. general population. Drug Alcohol Depend 2021; 227:108933. [PMID: 34358768 PMCID: PMC8464522 DOI: 10.1016/j.drugalcdep.2021.108933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND In clinical trials of pharmacotherapy for substance use, abstinence is the primary endpoint accepted by regulatory agencies. However, this endpoint could be overly restrictive, impeding efforts to identify effective medications for cocaine use disorder. To examine non-abstinent gradations in cocaine use as potential indicators of improvement, we investigated the relationship of frequency of cocaine use to clinical correlates in national survey data. METHODS Lifetime cocaine users (n = 2501) were interviewed in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) in 2001-2002 and re-interviewed in 2004-2005. Adjusted odds ratios (aORs) indicated associations between heaviest frequency of cocaine use and use of other substances, DSM-IV substance use disorders, psychiatric disorders, and change between 2001-2002 and 2004-2005. The reference category for all aORs was non-users. RESULTS Greater lifetime cocaine use frequency was associated with lifetime cocaine, alcohol, and cannabis dependence (aOR for a linear trend = 2.80, 1.22, 1.22, respectively) and past-year cocaine, alcohol, and cannabis dependence (aOR = 1.78, 1.13, 1.16, respectively). Greater lifetime cocaine use frequency was associated with past-year depressive, panic, and generalized anxiety disorders (aOR = 1.07, 1.09, 1.12, respectively). Among cocaine users in 2001-2002, compared to the reference group using less than monthly, use ≥1x/week and use 1-3 times a month was associated with cocaine use disorder in 2004-2005 (aOR = 2.13 and aOR = 1.67, respectively). CONCLUSION Gradations in risk for dependence on cocaine, other substances and psychiatric disorders by frequency of cocaine use indicates a promising direction for more sensitive outcome measures of treatment effects on cocaine outcomes than binary indicators (e.g., any use vs. none). Study results add to findings suggesting that non-abstinent measures might be useful indicators of treatment efficacy in clinical trials.
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Affiliation(s)
- Efrat Aharonovich
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | | | - Melanie M Wall
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Drysdale K, Cama E, Botfield J, Bear B, Cerio R, Newman CE. Targeting cancer prevention and screening interventions to LGBTQ communities: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1233-1248. [PMID: 33316150 DOI: 10.1111/hsc.13257] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/13/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
Although some people within LGBTQ communities are at risk of developing some cancers at higher rates than non-LGBTQ people, there is limited evidence of the outcomes of targeted cancer prevention and screening interventions for these communities. This scoping review examined key findings regarding the feasibility, acceptability and efficacy of evaluated intervention studies conducted in high income settings and published in peer reviewed literature (2014-2020) by combining evidence of both cancer risk-reducing behavioural interventions and screening and preventative practice interventions. While there is limited evidence of stronger outcomes from targeted interventions with cohorts of gender and sexuality diverse communities, compared with the use of mainstream or untailored interventions, there is stronger evidence that targeted interventions are more acceptable to these communities and may be more feasible in some contexts. Thus, there is benefit in understanding what targeting entails in these interventions, and to understand what influences acceptability, to inform the design and delivery of such interventions.
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Affiliation(s)
- Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jessica Botfield
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | | | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Technology-based mental healthcare models: A systematic review of the literature. REVISTA COLOMBIANA DE PSIQUIATRÍA (ENGLISH ED.) 2021; 50 Suppl 1:30-41. [PMID: 34353780 DOI: 10.1016/j.rcpeng.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/18/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION This systematic review summarises the existing evidence on the implementation of technology-based mental healthcare models in the primary care setting. METHODS A systematic search was conducted (MEDLINE, Embase, CENTRAL) in August 2019 and studies were selected according to predefined eligibility criteria. The main outcomes were clinical effectiveness, adherence to primary treatment and cost of implementation. SELECTION CRITERIA Studies with an experimental or quasi-experimental design that evaluated the implementation of technology-based mental healthcare models were included. RESULTS Five articles met the inclusion criteria. The models included technological devices such as tablets, cellphones and computers, with programs and mobile apps that supported decision-making in the care pathway. These decisions took place at different times, from the universal screening phase to the follow-up of patients with specific conditions. In general, the studies showed a decrease in the reported symptoms. However, there was great heterogeneity in both the health conditions and the outcomes, which hindered a quantitative synthesis. The assessment of risk of bias showed low quality of evidence. CONCLUSION There is not enough evidence to support the implementation of a technology-based mental healthcare model. High quality studies that focus on implementation and effectiveness outcomes are needed to evaluate the impact of technology-based mental healthcare models in the primary care setting.
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Gorfinkel LR, Stohl M, Greenstein E, Aharonovich E, Olfson M, Hasin D. Is Cannabis being used as a substitute for non-medical opioids by adults with problem substance use in the United States? A within-person analysis. Addiction 2021; 116:1113-1121. [PMID: 33029914 PMCID: PMC8026758 DOI: 10.1111/add.15228] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/27/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Ecological studies have suggested that Cannabis legalization might have led to a decrease in opioid overdose deaths. Such studies do not provide information about whether individuals are substituting Cannabis for opioids at different points in time. The current study assessed the magnitude of the daily association between Cannabis and opioid use in individual adults with and without pain who use non-medical opioids. DESIGN Prospective cohort study. SETTING The greater New York area and a suburban inpatient addiction program. PARTICIPANTS Adults with problem substance use who use non-medical opioids, recruited from May 2016-June 2019. The analytical sample included 13 271 days of observation among 211 participants (64% male, 41% white, 78% unmarried, 80% unemployed, mean age 43 years). MEASUREMENTS Participants completed interviewer- and self-administered computerized surveys, and then responded to an interactive voice response (IVR) system daily for the following 90 days. The main exposures, Cannabis use and pain, were defined as responding affirmatively to the IVR question: 'Did you use Cannabis yesterday?' and endorsing moderate or severe pain at baseline, respectively. The main outcome, non-medical or illicit opioid use during 90-day follow-up, was defined as responding affirmatively to IVR question: 'Did you use heroin yesterday?' or 'Did you use prescription opioids more than prescribed or without a prescription yesterday?'. FINDINGS The mean IVR completion rate was 70%. The unadjusted odds ratio (aOR) indicating same-day use of Cannabis and opioids was 2.00 [95% confidence interval (CI) = 1.54-2.59]. Controlling for demographic characteristics, recruitment method, opioid types at baseline and pain, the aOR was 1.86 (95% CI = 1.44-2.41). A test of interaction between pain and Cannabis use to determine if the association of Cannabis with opioid use differed between people with moderate-to-severe pain and less-than-moderate pain was inconclusive. CONCLUSIONS Among US adults with problem substance use who use non-medical opioids, the odds of opioid use appear to be approximately doubled on days when Cannabis is used. This relationship does not appear to differ between people with moderate or more severe pain versus less than moderate pain, suggesting that Cannabis is not being used as a substitute for illegal opioids.
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Affiliation(s)
- Lauren R. Gorfinkel
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Malki Stohl
- New York State Psychiatric Institute, New York, NY, USA
| | | | - Efrat Aharonovich
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mark Olfson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Deborah Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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21
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Machine learning prediction of blood alcohol concentration: a digital signature of smart-breathalyzer behavior. NPJ Digit Med 2021; 4:74. [PMID: 33879844 PMCID: PMC8058037 DOI: 10.1038/s41746-021-00441-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 03/10/2021] [Indexed: 11/08/2022] Open
Abstract
Excess alcohol use is an important determinant of death and disability. Machine learning (ML)-driven interventions leveraging smart-breathalyzer data may help reduce these harms. We developed a digital phenotype of long-term smart-breathalyzer behavior to predict individuals' breath alcohol concentration (BrAC) levels trained on data from a smart breathalyzer. We analyzed roughly one million datapoints from 33,452 users of a commercial smart-breathalyzer device, collected between 2013 and 2017. For validation, we analyzed the associations between state-level observed smart-breathalyzer BrAC levels and impaired-driving motor vehicle death rates. Behavioral, geolocation-based, and time-series-derived features were fed to an ML algorithm using training (70% of the cohort), development (10% of the cohort), and test (20% of the cohort) sets to predict the likelihood of a BrAC exceeding the legal driving limit (0.08 g/dL). States with higher average BrAC levels had significantly higher alcohol-related driving death rates, adjusted for the number of users per state B (SE) = 91.38 (15.16), p < 0.01. In the independent test set, the ML algorithm predicted the likelihood of a given user-initiated BrAC sample exceeding BrAC ≥ 0.08 g/dL, with an area under the curve (AUC) of 85%. Highly predictive features included users' prior BrAC trends, subjective estimation of their BrAC (or AUC = 82% without the self-estimate), engagement and self-monitoring, time since the last measure, and hour of the day. In conclusion, an ML algorithm successfully quantified a digital phenotype of behavior, predicting naturalistic BrAC levels exceeding 0.08 g/dL (a threshold associated with alcohol-related harm) with good discrimination capability. This result establishes a foundation for future research on precision behavioral medicine digital health interventions using smart breathalyzers and passive monitoring approaches.
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22
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Rosas JC, Gómez-Ayala MC, Marroquín-Rivera A, Botero-Rodríguez F, Cepeda M, Suárez-Obando F, Bartels SM, Gómez-Restrepo C. Technology-based mental healthcare models: A systematic review of the literature. ACTA ACUST UNITED AC 2021. [PMID: 33875241 DOI: 10.1016/j.rcp.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION This systematic review summarises the existing evidence on the implementation of technology-based mental healthcare models in the primary care setting. METHODS A systematic search was conducted (MEDLINE, Embase, CENTRAL) in August 2019 and studies were selected according to predefined eligibility criteria. The main outcomes were clinical effectiveness, adherence to primary treatment and cost of implementation. SELECTION CRITERIA Studies with an experimental or quasi-experimental design that evaluated the implementation of technology-based mental healthcare models were included. RESULTS Five articles met the inclusion criteria. The models included technological devices such as tablets, cellphones and computers, with programs and mobile apps that supported decision-making in the care pathway. These decisions took place at different times, from the universal screening phase to the follow-up of patients with specific conditions. In general, the studies showed a decrease in the reported symptoms. However, there was great heterogeneity in both the health conditions and the outcomes, which hindered a quantitative synthesis. The assessment of risk of bias showed low quality of evidence. CONCLUSION There is not enough evidence to support the implementation of a technology-based mental healthcare model. High quality studies that focus on implementation and effectiveness outcomes are needed to evaluate the impact of technology-based mental healthcare models in the primary care setting.
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Affiliation(s)
- Juan Camilo Rosas
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - María Camila Gómez-Ayala
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Arturo Marroquín-Rivera
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Felipe Botero-Rodríguez
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Magda Cepeda
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernando Suárez-Obando
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Sophie M Bartels
- Center for Technology and Behavioral Health, Departamento de Psiquiatría, Geisel School of Medicine at Dartmouth College, New Hampshire, EE. UU
| | - Carlos Gómez-Restrepo
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
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23
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Gass JC, Funderburk JS, Shepardson R, Kosiba JD, Rodriguez L, Maisto SA. The use and impact of self-monitoring on substance use outcomes: A descriptive systematic review. Subst Abus 2021; 42:512-526. [PMID: 33617740 DOI: 10.1080/08897077.2021.1874595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Self-Monitoring (SM), the act of observing ones' own behavior, has been used in substance use treatment because SM may bring conscious awareness to automatized substance use behaviors. Empirical findings regarding SM's effectiveness are mixed. The aim of this study was to synthesize the literature for the efficacy of SM on substance use. Method: A literature search was conducted using MEDLINE/PubMed. Results: Out of 2,659 citations, 41 studies with 126 analyses were included. Among analyses from studies rated Moderate (n = 24) or Strong (n = 3) quality, SM was shown to have a helpful effect (e.g., reducing substance use) 29% of the time; to have no effect 63.0% of the time; and to be detrimental in 8.0% of analyses. SM's helpful effects were associated with methodological characteristics including longer monitoring and Phone/IVR and EMA/Computer methodologies compared to Paper/Pencil. SM was more helpful in non-treatment-seekers (35.0% of analyses showed SM to be helpful compared to 25.0% of analyses with treatment-seekers). Conclusions: Results of this study suggest that SM, under certain circumstances, as the potential to be a low-cost, low-risk research and early intervention strategy for substance users.
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Affiliation(s)
- Julie C Gass
- VA Center for Integrated Healthcare, Western New York VA Healthcare System, Buffalo, NY, USA.,Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA.,Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - Robyn Shepardson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - Jesse D Kosiba
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - Lauren Rodriguez
- VA Center for Integrated Healthcare, Western New York VA Healthcare System, Buffalo, NY, USA.,Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
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24
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Madhombiro M, Kidd M, Dube B, Dube M, Mutsvuke W, Muronzie T, Zhou DT, Derveeuw S, Chibanda D, Chingono A, Rusakaniko S, Hutson A, Morse GD, Abas MA, Seedat S. Effectiveness of a psychological intervention delivered by general nurses for alcohol use disorders in people living with HIV in Zimbabwe: a cluster randomized controlled trial. J Int AIDS Soc 2020; 23:e25641. [PMID: 33314786 PMCID: PMC7733606 DOI: 10.1002/jia2.25641] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION There have been very few randomized clinical trials of interventions for alcohol use disorders (AUD) in people living with HIV (PLWH) in African countries. This is despite the fact that alcohol use is one of the modifiable risk factors for poor virological control in PLWH on antiretroviral therapy. METHODS Sixteen clinic clusters in Zimbabwe were selected through stratified randomization and randomized 1: 1 to Intervention and Control arms. Inclusion criteria for individual participants were being adult, living with HIV and a probable alcohol use disorder as defined by a score of 6 (women) or 7 (men) on the Alcohol Use Disorders Identification Test (AUDIT). In the Intervention clusters, participants received 8 to 10 sessions of Motivational Interviewing blended with brief Cognitive Behavioural Therapy (MI-CBT). In the control clusters, participants received four Enhanced Usual Care (EUC) sessions based on the alcohol treatment module from the World Health Organisation mhGAP intervention guide. General Nurses from the clinics were trained to deliver both treatments. The primary outcome was a change in AUDIT score at six-month post-randomization. Viral load, functioning and quality of life were secondary outcomes. A random-effects analysis-of-covariance model was used to account for the cluster design. RESULTS Two hundred and thirty-four participants (n = 108 intervention and n = 126 control) were enrolled across 16 clinics. Participants were recruited from November 2016 to November 2017 and followed through to May 2018. Their mean age was 43.3 years (SD = 9.1) and 78.6% (n = 184) were male. At six months, the mean AUDIT score fell by -6.15 (95% CI -6.32; -6.00) in the MI-CBT arm, compared to a fall of - 3.09 95 % CI - 3.21; -2.93) in the EUC arm (mean difference -3.09 (95% CI -4.53 to -1.23) (p = 0.05). Viral load reduced and quality of life and functioning improved in both arms but the difference between arms was non-significant. CONCLUSIONS Interventions for hazardous drinking and AUD comprising brief, multiple alcohol treatment sessions delivered by nurses in public HIV facilities in low-income African countries can reduce problematic drinking among PLWH. Such interventions should be integrated into the primary care management of AUD and HIV and delivered by non-specialist providers. Research is needed on cost-effectiveness and implementation of such interventions, and on validation of cut-points for alcohol use scales in low resource settings, in partnership with those with lived experience of HIV and AUD.
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Affiliation(s)
- Munyaradzi Madhombiro
- Department of PsychiatryUniversity of ZimbabweHarareZimbabwe
- SUNY University at BuffaloBuffaloNYUSA
| | - Martin Kidd
- Centre for Statistical ConsultationStellenbosch UniversityStellenboschSouth Africa
| | - Bazondlile Dube
- Department of PsychiatryUniversity of ZimbabweHarareZimbabwe
| | - Michelle Dube
- Department of PsychiatryUniversity of ZimbabweHarareZimbabwe
| | - Wilson Mutsvuke
- Department of PsychiatryUniversity of ZimbabweHarareZimbabwe
| | | | - Danai Tavonga Zhou
- Department of PsychiatryUniversity of ZimbabweHarareZimbabwe
- Department of Medical Laboratory SciencesUniversity of ZimbabweHarareZimbabwe
| | - Sarah Derveeuw
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUnited Kingdom
| | - Dixon Chibanda
- Department of PsychiatryUniversity of ZimbabweHarareZimbabwe
| | - Alfred Chingono
- Department of PsychiatryUniversity of ZimbabweHarareZimbabwe
| | | | - Alan Hutson
- Department of Biostatistics and BioinformaticsRoswell Park Comprehensive Cancer CenterBuffaloNYUSA
| | | | - Melanie A Abas
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUnited Kingdom
- Lewisham HospitalSouth London and MaudsleyNHS Foundation TrustLondonUnited Kingdom
| | - Soraya Seedat
- Faculty of Medicine and Health SciencesStellenbosch UniversityStellenboschSouth Africa
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25
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Staiger PK, O'Donnell R, Liknaitzky P, Bush R, Milward J. Mobile Apps to Reduce Tobacco, Alcohol, and Illicit Drug Use: Systematic Review of the First Decade. J Med Internet Res 2020; 22:e17156. [PMID: 33231555 PMCID: PMC7723745 DOI: 10.2196/17156] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
Background Mobile apps for problematic substance use have the potential to bypass common barriers to treatment seeking. Ten years following the release of the first app targeting problematic tobacco, alcohol, and illicit drug use, their effectiveness, use, and acceptability remains unclear. Objective This study aims to conduct a systematic literature review of trials evaluating mobile app interventions for problematic tobacco, alcohol, and illicit drug use. Methods The review was conducted according to recommended guidelines. Relevant databases were searched, and articles were included if the mobile app study was a controlled intervention trial and reported alcohol, tobacco, or illicit drug consumption as outcomes. Results A total of 20 studies met eligibility criteria across a range of substances: alcohol (n=11), tobacco (n=6), alcohol and tobacco (n=1), illicit drugs (n=1), and illicit drugs and alcohol (n=1). Samples included the general community, university students, and clinical patients. The analyzed intervention sample sizes ranged from 22 to 14,228, and content was considerably diverse, from simple stand-alone apps delivering self-monitoring or psychoeducation to multicomponent apps with interactive features and audio content, or used as adjuncts alongside face-to-face treatment. Intervention duration ranged from 1 to 35 weeks, with notifications ranging from none to multiple times per day. A total of 6 of the 20 app interventions reported significant reductions in substance use at post or follow-up compared with a comparison condition, with small to moderate effect sizes. Furthermore, two other app interventions reported significant reductions during the intervention but not at post treatment, and a third reported a significant interaction of two app intervention components. Conclusions Although most app interventions were associated with reductions in problematic substance use, less than one-third were significantly better than the comparison conditions at post treatment. A total of 5 out of the 6 apps that reported intervention effects targeted alcohol (of those, one targeted alcohol and illicit drugs and another alcohol and tobacco) and 1 targeted tobacco. Moreover, 3 out of 6 apps included feedback (eg, personalized) and 2 had high risk of bias, 1 some risk, and 3 low risk. All 6 apps included interventions of 6 weeks or longer. Common study limitations were small sample sizes; risk of bias; lack of relevant details; and, in some cases, poorly balanced comparison conditions. Appropriately powered trials are required to understand which app interventions are most effective, length of engagement required, and subgroups most likely to benefit. In sum, evidence to date for the effectiveness of apps targeting problematic substance use is not compelling, although the heterogeneous comparison conditions and trial designs across studies limit the ability to compare efficacy between apps. We discuss potential approaches that can help ascertain whether the promise of mobile app interventions for problematic substance use can be fulfilled.
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Affiliation(s)
- Petra Karin Staiger
- School of Psychology, Deakin University, Faculty of Health, Geelong, Australia.,Centre for Drug Use, Addictive and Anti-social behaviour Research (CEDAAR), Deakin University, Geelong, Australia
| | - Renee O'Donnell
- Monash Centre of Health Research and Implementation, Monash University, Clayton, Australia
| | - Paul Liknaitzky
- School of Psychology, Deakin University, Faculty of Health, Geelong, Australia
| | - Rachel Bush
- School of Psychology, Deakin University, Faculty of Health, Geelong, Australia
| | - Joanna Milward
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
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26
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Dai W, Palmer R, Sunderrajan A, Durantini M, Sánchez F, Glasman LR, Chen FX, Albarracín D. More behavioral recommendations produce more change: A meta-analysis of efficacy of multibehavior recommendations to reduce nonmedical substance use. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:709-725. [PMID: 32309956 PMCID: PMC7572872 DOI: 10.1037/adb0000586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Death and morbidity associated with substance use have risen continuously over the last few decades, increasing the need for rigorous examination of promising programs. Interventions attempting to change multiple behaviors have been designed to address interconnected problems such as use of both alcohol and drugs. This meta-analysis aimed to examine the efficacy of multibehavior interventions to curb nonmedical substance use in relation to the theoretical relation among different substance use behaviors. Specifically, our synthesis aimed to estimate the optimal number of recommendations for intervention efficacy and evaluate the impact of different combinations of recommendations on intervention efficacy. A synthesis of multibehavior interventions addressing nonmedical substance use was conducted to measure behavioral changes between the pretest and the follow-up. These changes were then compared across different numbers of recommendations. Sixty-nine reports and 233 effect sizes (k of conditions = 155, n = 28,295) were included. A positive linear relation was found between the number of targeted behaviors and intervention efficacy, which was stronger for drug use than alcohol use. Furthermore, recommendations on drug use worked better when paired with recommendations targeting other behaviors, whereas recommendations on alcohol use worked more independently. Lastly, multibehavior interventions were especially efficacious when delivered by experts. Overall, our synthesis indicated that targeting multiple substances is beneficial for changing drug use outcomes, but less so for alcohol use outcomes. Therefore, in the current substance use epidemic, innovative multibehavior programs appear to hold promise, especially to combat nonmedical drug use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Wenhao Dai
- Department of Psychology, University of Illinois, Urbana-Champaign
| | - Ryan Palmer
- Department of Psychology, University of Illinois, Urbana-Champaign
| | | | - Marta Durantini
- Department of Psychology, University of Illinois, Urbana-Champaign
| | - Flor Sánchez
- Departamento de Psicología Social, Universidad Autónoma de Madrid
| | - Laura R. Glasman
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin
| | - Fan Xuan Chen
- Department of Psychology, University of Illinois, Urbana-Champaign
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27
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Carreiro S, Newcomb M, Leach R, Ostrowski S, Boudreaux ED, Amante D. Current reporting of usability and impact of mHealth interventions for substance use disorder: A systematic review. Drug Alcohol Depend 2020; 215:108201. [PMID: 32777691 PMCID: PMC7502517 DOI: 10.1016/j.drugalcdep.2020.108201] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/10/2020] [Accepted: 07/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Connected interventions use data collected through mobile/wearable devices to trigger real-time interventions and have great potential to improve treatment for substance use disorder (SUD). This review aims to describe the current landscape, effectiveness and usability of connected interventions for SUD. METHODS A systematic review was conducted to identify articles evaluating connected health interventions for SUD in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (PubMed, IEEE, and Scopus) were searched over a five-year period. Included articles described a connected health intervention targeting SUD and provided outcomes data. Data were extracted using a standardized reporting tool. RESULTS A total of 1676 unique articles were identified during the initial search, with 32 articles included in the final analysis. Seven articles of the 32 were derived from two large studies. The most commonly studied SUD was alcohol use disorder. Sixteen articles reported at least one statistically significant result with respect to reduced craving and/or substance use. The majority of articles used ecological momentary assessment to trigger interventions, while four used biologic/physiologic data. Two articles used a wearable device. Common intervention types included craving management, coping assistance, and tailored feedback. Twenty-three articles measured usability factors, and acceptability was generally reported as high. CONCLUSION Identified themes included a focus on AUD, use of smart phones, use of EMA for intervention delivery, positive effects on SUD related outcomes, and overall high acceptability. Wearables that directly monitor biologic data and predictive analytics using integrated data streams represent understudied opportunities for new research.
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Affiliation(s)
- Stephanie Carreiro
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Mark Newcomb
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Rebecca Leach
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Simon Ostrowski
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Edwin D Boudreaux
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Daniel Amante
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
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28
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Thompson RG, Aivadyan C, Stohl M, Aharonovich E, Hasin DS. Smartphone application plus brief motivational intervention reduces substance use and sexual risk behaviors among homeless young adults: Results from a randomized controlled trial. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:641-649. [PMID: 32175752 PMCID: PMC9997652 DOI: 10.1037/adb0000570] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Homeless young adults are more likely than their never-homeless counterparts to abuse substances and engage in sexual risk behaviors. This study evaluated the feasibility and preliminary effectiveness of OnTrack, a smartphone application to self-monitor substance use and sexual risk behaviors, plus a brief motivational intervention (BMI), in reducing substance use and sexual risk among homeless young adults. A randomized controlled pilot trial (N = 60) compared OnTrack + BMI to treatment as usual (TAU) at an inner-city crisis shelter for homeless young adults (aged 18-21 years). Participants were assessed at baseline and 2 weeks, 4 weeks, and 6 weeks after baseline to evaluate substance use and sexual risk behaviors. Kruskal-Wallis tests determined differences between baseline and postintervention assessments. Logistic regression models examined treatment effect on change in outcomes between baseline and postintervention follow-up assessment, controlling for baseline levels. Participants in OnTrack + BMI significantly reduced past 2-week number of drinks (p = .023), times used marijuana (p = .046), times engaged in unprotected sex (p = .012), and times used drugs before sexual activity (p = .019). No reductions of substance use or sexual risk behaviors were found among participants in TAU (all ps > .05). After adjusting for baseline levels of substance use and sexual risk, participants in OnTrack + BMI had significantly lower odds than those in TAU for drinking alcohol (adjusted OR = 0.14; p = .01) and having unprotected sex (adjusted OR = 0.151; p = .032). OnTrack + BMI is feasible and effective in reducing past 2-week alcohol use and unprotected sex among homeless young adults. A larger randomized trial is warranted to replicate and extend present results. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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29
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English K, May SB, Davila JA, Cully JA, Dindo L, Amico KR, Kallen MA, Giordano TP. Retention in Care and Viral Load Improvement After Discharge Among Hospitalized Out-of-Care People With HIV Infection: A Post Hoc Analysis of a Randomized Controlled Trial. Open Forum Infect Dis 2020; 7:ofaa193. [PMID: 32550239 PMCID: PMC7291684 DOI: 10.1093/ofid/ofaa193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Understanding factors influencing retention in care (RIC) and viral load improvement (VLI) in people with HIV (PWH) who are out of care and hospitalized will assist in intervention development for this vulnerable population. METHODS The study was a post hoc analysis of prospectively collected data. Hospitalized participants were enrolled if they were newly diagnosed with HIV during the hospitalization or out of HIV care. Participants completed surveys at baseline and 6 months postenrollment and laboratory studies of viral load (VL). Outcomes were RIC (2 completed visits, 1 within 30 days of discharge) and VLI (VL <400 or at least a 1-log10 decrease) 6 months after discharge. Univariate and multivariate regression analyses were conducted examining the contributions of predisposing, enabling, and need factors to outcomes. RESULTS The study cohort included 417 participants enrolled between 2010 and 2013. The population was 73% male, 67% non-Hispanic black, 19% Hispanic, and 70% uninsured. Sixty-five percent had a baseline CD4 <200 cells/mm3, 79% had a VL >400 copies/mL or missing, and the population was generally poor with low educational attainment. After discharge from the hospital, 60% did not meet the definition for RIC, and 49% did not have VLI. Modifiable factors associated with the outcomes include drug use (including marijuana alone and other drugs), life instability (eg, housing, employment, and life chaos), and using avoidance coping strategies in coping with HIV. CONCLUSIONS Hospitalized out-of-care PWH in the United States are at high risk of poor re-engagement in care after discharge. Interventions for this population should focus on improving socioeconomic stability and coping with HIV and reducing drug use.
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Affiliation(s)
- Kellee English
- School of Health Professions, Baylor College of Medicine, Houston, Texas, USA
| | - Sarah B May
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Jessica A Davila
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Jeffrey A Cully
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Lilian Dindo
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | | | - Michael A Kallen
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Thomas P Giordano
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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Hayaki J, Anderson BJ, Herman DS, Moitra E, Pinkston MM, Kim HN, Stein MD. Motivation to Quit Drinking in Individuals Coinfected with HIV and Hepatitis C. AIDS Behav 2020; 24:1709-1716. [PMID: 31642998 DOI: 10.1007/s10461-019-02709-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Alcohol consumption is common among individuals coinfected with HIV and hepatitis C (HCV) despite the uniquely harmful effects in this population. Limited research has examined factors that could influence drinking reduction or cessation among HIV/HCV coinfected persons; this study investigates motivation to quit. Participants were 110 alcohol-consuming HIV/HCV coinfected patients recruited from medical clinics. Participants self-reported 90-day drinking frequency and intensity; alcohol-related problems; reasons to quit drinking; reasons to drink; and motivation to quit drinking. Participants consumed alcohol on 54.1 (± 26.9) of the past 90 days. In a multivariate model that controlled for demographic variables, motivation to quit drinking was directly associated with alcohol-related problems (βy·x = 0.35, p = .007) and reasons to quit drinking (βy·x = 0.23, p = .021), and inversely associated with drinking for enhancement (βy·x = - 0.36, p = .004). This study identified several factors associated with motivation to quit drinking in a sample of alcohol-consuming HIV/HCV patients.
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Colbert S, Thornton L, Richmond R. Smartphone apps for managing alcohol consumption: a literature review. Addict Sci Clin Pract 2020; 15:17. [PMID: 32381062 PMCID: PMC7206704 DOI: 10.1186/s13722-020-00190-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 04/27/2020] [Indexed: 01/01/2023] Open
Abstract
Background Smartphone applications (apps) designed to assist users to reduce hazardous and harmful alcohol consumption show potential as an inexpensive alternative to traditional brief intervention in primary care. The aim of this paper is to provide an overview of the literature on alcohol reduction apps and the availability of evidenced-based apps on top commercial app stores. Methods We reviewed literature through to December 2019 using the databases PubMed, MEDLINE, PsycINFO and Google Scholar and keyword search terms smartphone/mobile/phone AND application/app AND alcohol. Articles were included if the primary intervention was a smartphone app and the study measured participant changes in frequency or volume of alcohol consumption. Results 21 relevant articles were identified that evaluated 19 unique smartphone apps. Of the 19 unique apps, seven were designed for use among youth and 12 in adult populations. The available evidence for the efficacy of alcohol reduction apps among youth is inconclusive, with results from these evaluations not showing a clear benefit in reducing alcohol consumption compared to control groups. The results of apps designed for adult populations appears more promising, but results are still mixed. Of the 19 alcohol reduction apps that have been evaluated only eight of these are currently publicly available in commercial app stores. Of these eight apps, only four were demonstrated in the literature to assist with reducing alcohol consumption. Conclusion The evidence for alcohol reduction apps is promising but inconclusive. Few apps that have been evaluated in the scientific literature are currently available for download in commercial app stores.
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Affiliation(s)
- Stephanie Colbert
- School Public Health and Community Medicine, University of New South Wales, Kensington, Australia
| | - Louise Thornton
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Robyn Richmond
- School Public Health and Community Medicine, University of New South Wales, Kensington, Australia.
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Stephenson A, Garcia-Constantino M, McDonough SM, Murphy MH, Nugent CD, Mair JL. Iterative four-phase development of a theory-based digital behaviour change intervention to reduce occupational sedentary behaviour. Digit Health 2020; 6:2055207620913410. [PMID: 32257366 PMCID: PMC7099670 DOI: 10.1177/2055207620913410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/21/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction As high amounts of occupational sitting have been associated with negative
health consequences, designing workplace interventions to reduce sedentary
behaviour (SB) is of public health interest. Digital technology may serve as
a cost-effective and scalable platform to deliver such an intervention. This
study describes the iterative development of a theory-based, digital
behaviour change intervention to reduce occupational SB. Methods The behaviour change wheel and The Behaviour Change Technique Taxonomy were
used to guide the intervention design process and form a basis for selecting
the intervention components. The development process consisted of four
phases: phase 1 – preliminary research, phase 2 – consensus workshops, phase
3 – white boarding and phase 4 – usability testing. Results The process led to the development and refinement of a smartphone application
– Worktivity. The core component was self-monitoring and feedback of SB at
work, complemented by additional features focusing on goal setting, prompts
and reminders to break up prolonged periods of sitting, and educational
facts and tips. Key features of the app included simple data entry and
personalisation based on each individual’s self-reported sitting time.
Results from the ‘think-aloud’ interviews (n=5) suggest
Worktivity was well accepted and that users were positive about its
features. Conclusion This study led to the development of Worktivity, a theory-based and
user-informed mobile app intervention to reduce occupational SB. It is the
first app of its kind developed with the primary aim of reducing
occupational SB using digital self-monitoring. This paper provides a
template to guide others in the development and evaluation of
technology-supported behaviour change interventions.
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Affiliation(s)
- Aoife Stephenson
- Centre for Physical Activity and Health Research, Faculty of Life and Health Sciences, Ulster University, UK.,Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, UK
| | - Matias Garcia-Constantino
- School of Computing, Faculty of Computing, Engineering and the Built Environment, Ulster University, UK
| | - Suzanne M McDonough
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, UK.,School of Physiotherapy, University of Otago, New Zealand
| | - Marie H Murphy
- Centre for Physical Activity and Health Research, Faculty of Life and Health Sciences, Ulster University, UK
| | - Chris D Nugent
- School of Computing, Faculty of Computing, Engineering and the Built Environment, Ulster University, UK
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Knox J, Hasin DS, Larson FRR, Kranzler HR. Prevention, screening, and treatment for heavy drinking and alcohol use disorder. Lancet Psychiatry 2019; 6:1054-1067. [PMID: 31630982 PMCID: PMC6883141 DOI: 10.1016/s2215-0366(19)30213-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022]
Abstract
Heavy drinking and alcohol use disorder are major public health problems. Practitioners not specialising in alcohol treatment are often unaware of the guidelines for preventing, identifying, and treating heavy drinking and alcohol use disorder. However, a consensus exists that clinically useful and valuable tools are available to address these issues. Here, we review existing information and developments from the past 5 years in these areas. We also include information on heavy drinking and alcohol use disorder among individuals with co-occurring psychiatric disorders, including drug use disorders. Areas covered include prevention; screening, brief intervention, and referral for treatment; evidence-based behavioural interventions; medication-assisted treatment; technology-based interventions (eHealth and mHealth); and population-level interventions. We also discuss the key topics for future research.
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Affiliation(s)
- Justin Knox
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | | | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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Abstract
Abstract
Purpose
Only about 20% of people suffering from substance use disorders access available treatments due to various obstacles; digital interventions could potentially overcome some of these. Meta-analyses suggest the strongest evidence for interventions targeting alcohol use reduction, followed by cannabis and illicit substances. However, most randomized controlled trials (RCTs) used unguided standalone interventions compared to non-active controls, with limited follow-up periods and disregarded comorbidity. This review examines the literature published over the last three years (2016–2019), with a focus on recent RCTs and whether they addressed some of these gaps.
Recent findings
Except for digital interventions targeting alcohol use, the number of RCTs in the last three years is limited. Although there is considerable heterogeneity between the studies, most of them applied unguided add-on interventions compared to active control groups, and a limited number investigated guided interventions. In addition, there is a need for longer follow-up periods, active rather than non-active control groups, outcome standardization, and increased focus on comorbidity.
Summary
Although the number of studies using guided add-on or blended interventions compared to active controls has increased, future studies should consider our identified gaps and suggestions to further strengthen the evidence of digital interventions for reducing the use of alcohol and other substances.
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Madhombiro M, Musekiwa A, January J, Chingono A, Abas M, Seedat S. Psychological interventions for alcohol use disorders in people living with HIV/AIDS: a systematic review. Syst Rev 2019; 8:244. [PMID: 31661030 PMCID: PMC6819454 DOI: 10.1186/s13643-019-1176-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/27/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Alcohol use disorders (AUDs) in people living with HIV/AIDS (PLWH) are a significant impediment to achieving virological control. HIV non-suppression in PLWH with AUDs is mainly attributable to sub-optimal antiretroviral therapy adherence. Sub-optimal adherence makes control of the epidemic elusive, considering that effective antiretroviral treatment and viral suppression are the two key pillars in reducing new infections. Psychological interventions have been proposed as effective treatments for the management of AUDs in PLWH. Evidence for their effectiveness has been inconsistent, with two reviews (2010 and 2013) concluding a lack of effectiveness. However, a 2017 review that examined multiple HIV prevention and treatment outcomes suggested that behavioural interventions were effective in reducing alcohol use. Since then, several studies have been published necessitating a re-examination of this evidence. This review provides an updated synthesis of the effectiveness of psychological interventions for AUDs in PLWH. METHODS A search was conducted in the following databases: PubMed, Cochrane Central Register of Trials (CENTRAL), MEDLINE (Ovid), EMBASE, PsychInfo (Ovid) and Clinical trials.gov (clinicaltrials.gov) for eligible studies until August 2018 for psychotherapy and psychosocial interventions for PLWH with AUDs. Two reviewers independently screened titles, abstracts and full texts to select studies that met the inclusion criteria. Two reviewers independently performed data extraction with any differences resolved through discussion. Risk of bias was assessed by two independent reviewers using the Cochrane risk of bias tool, and the concordance between the first and second reviewers was 0.63 and between the first and third reviewers 0.71. Inclusion criteria were randomised controlled trials using psychological interventions in people aged 16 and above, with comparisons being usual care, enhanced usual care, other active treatments or waitlist controls. RESULTS A total of 21 studies (6954 participants) were included in this review. Studies had diverse populations including men alone, men and women and men who had sex with men (MSM). Use of motivational interviewing alone or blended with cognitive behavioural therapy (CBT) and technology/computer-assisted platforms were common as individual-level interventions, while a few studies investigated group motivational interviewing or CBT. Alcohol use outcomes were all self-report and included assessment of the quantity and the frequency of alcohol use. Measured secondary outcomes included viral load, CD4 count or other self-reported outcomes. There was a lack of evidence for significant intervention effects in the included studies. Isolated effects of motivational interviewing, cognitive behavioural therapy and group therapy were noted. However for some of the studies that found significant effects, the effect sizes were small and not sustained over time. Owing to the variation in outcome measures employed across studies, no meta-analysis could be carried out. CONCLUSION This systematic review did not reveal large or sustained intervention effects of psychological interventions for either primary alcohol use or secondary HIV-related outcomes. Due to the methodological heterogeneity, we were unable to undertake a meta-analysis. Effectiveness trials of psychological interventions for AUDs in PLWH that include disaggregation of data by level of alcohol consumption, gender and age are needed. There is a need to standardise alcohol use outcome measures across studies and include objective biomarkers that provide a more accurate measure of alcohol consumption and are relatively free from social desirability bias. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD 42017063856 .
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Affiliation(s)
- Munyaradzi Madhombiro
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
| | - Alfred Musekiwa
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James January
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Alfred Chingono
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Melanie Abas
- King's College London, Centre for Global Mental Health, David Goldberg Centre H1.12, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Francie van Zijl Avenue, 7505, Cape Town, South Africa
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Panlilio LV, Stull SW, Kowalczyk WJ, Phillips KA, Schroeder JR, Bertz JW, Vahabzadeh M, Lin JL, Mezghanni M, Nunes EV, Epstein DH, Preston KL. Stress, craving and mood as predictors of early dropout from opioid agonist therapy. Drug Alcohol Depend 2019; 202:200-208. [PMID: 31357121 PMCID: PMC6707374 DOI: 10.1016/j.drugalcdep.2019.05.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/09/2019] [Accepted: 05/18/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Treatment with opioid agonists is effective for opioid use disorder, but early discontinuation of treatment is a major obstacle to success. Intensive longitudinal methods - which take many repeated measurements over time, usually in the field- have provided unique insight into the effects of stress, mood and craving on drug use while people are being treated; these methods might also be useful for studying the processes that lead people to drop out of treatment. METHODS Ecological momentary assessment (EMA) was conducted for up to 17 weeks by obtaining multiple electronic diary entries per day from 238 participants being treated with methadone or buprenorphine-naloxone. Survival analysis was used to study two outcomes: dropping out of treatment and noncompliance with EMA self-report requirements. Self-reports of stress, craving, and mood were used as time-varying predictors. Demographic and psychosocial variables measured with the Addiction Severity Index at the start of treatment were used as time-invariant predictors. RESULTS Dropping out of treatment was more likely in participants with more reported hassles (a measure of stress), higher levels of cocaine craving, lower levels of positive mood, a recent history of emotional abuse, a recent history of being bothered frequently by psychological problems, and with buprenorphine rather than methadone as their medication. In contrast, study noncompliance was not significantly associated with any of the variables analyzed. CONCLUSIONS Assessment of stress, craving and mood during treatment might identify people who are at greater risk of dropping out, and therapeutic interventions targeting these processes might increase retention.
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Affiliation(s)
- Leigh V Panlilio
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Samuel W Stull
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - William J Kowalczyk
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Karran A Phillips
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | | | - Jeremiah W Bertz
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Massoud Vahabzadeh
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Jia-Ling Lin
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Mustapha Mezghanni
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Edward V Nunes
- Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, 10032, USA
| | - David H Epstein
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA
| | - Kenzie L Preston
- Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA.
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Song T, Qian S, Yu P. Mobile Health Interventions for Self-Control of Unhealthy Alcohol Use: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e10899. [PMID: 30694200 PMCID: PMC6371076 DOI: 10.2196/10899] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/02/2018] [Accepted: 10/30/2018] [Indexed: 12/22/2022] Open
Abstract
Background Unhealthy alcohol use (UAU) is one of the major causes of preventable morbidity, mortality, and associated behavioral risks worldwide. Although mobile health (mHealth) interventions can provide consumers with an effective means for self-control of UAU in a timely, ubiquitous, and cost-effective manner, to date, there is a lack of understanding about different health outcomes brought by such interventions. The core components of these interventions are also unclear. Objective This study aimed to systematically review and synthesize the research evidence about the efficacy of mHealth interventions on various health outcomes for consumer self-control of UAU and to identify the core components to achieve these outcomes. Methods We systematically searched 7 electronic interdisciplinary databases: Scopus, PubMed, PubMed Central, CINAHL Plus with full text, MEDLINE with full text, PsycINFO, and PsycARTICLES. Search terms and Medical Subject Headings “mHealth,” “text message,” “SMS,” “App,” “IVR,” “self-control,” “self-regulation,” “alcohol*,” and “intervention” were used individually or in combination to identify peer-reviewed publications in English from 2008 to 2017. We screened titles and abstracts and assessed full-text papers as per inclusion and exclusion criteria. Data were extracted from the included papers according to the Consolidated Standards of Reporting Trials-EHEALTH checklist (V 1.6.1) by 2 authors independently. Data quality was assessed by the Mixed Methods Appraisal Tool. Data synthesis and analyses were conducted following the procedures for qualitative content analysis. Statistical testing was also conducted to test differences among groups of studies. Results In total, 19 studies were included in the review. Of these 19 studies, 12 (63%) mHealth interventions brought significant positive outcomes in improving participants’ health as measured by behavioral (n=11), physiological (n=1), and cognitive indicators (n=1). No significant health outcome was reported in 6 studies (6/19, 32%). Surprisingly, a significant negative outcome was reported for the male participants in the intervention arm in 1 study (1/19, 5%), but no change was found for the female participants. In total, 5 core components reported in the mHealth interventions for consumer self-control of UAU were context, theoretical base, delivery mode, content, and implementation procedure. However, sound evidence is yet to be generated about the role of each component for mHealth success. The health outcomes were similar regardless of types of UAU, deployment setting, with or without nonmobile cointervention, and with or without theory. Conclusions Most studies reported mHealth interventions for self-control of UAU appeared to be improving behavior, especially the ones delivered by short message service and interactive voice response systems. Further studies are needed to gather sound evidence about the effects of mHealth interventions on improving physiological and cognitive outcomes as well as the optimal design of these interventions, their implementation, and effects in supporting self-control of UAU.
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Affiliation(s)
- Ting Song
- Centre for IT-Enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Siyu Qian
- Centre for IT-Enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Ping Yu
- Centre for IT-Enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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Aharonovich E, Hasin DS, Nunes EV, Stohl M, Cannizzaro D, Sarvet A, Bolla K, Carroll KM, Genece KG. Modified cognitive behavioral therapy (M-CBT) for cocaine dependence: Development of treatment for cognitively impaired users and results from a Stage 1 trial. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:800-811. [PMID: 30346186 DOI: 10.1037/adb0000398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cognitive impairments are associated with poor outcomes when treating cocaine dependent patients, but behavioral interventions to mitigate this impact have not been developed. In this Stage 1A/1B treatment development study, several compensatory strategies (e.g., content repetition, daily logs, diaries, visual presentation) were combined to create a modified cognitive behavioral therapy (M-CBT) for treating cocaine dependence. Initially, a select group of therapists, neuropsychology experts, and patients were asked to provide input on early drafts of the treatment manual and companion patient workbook. After an uncontrolled small trial (N = 15) and two rounds of manual development (Stage 1A), a pilot randomized clinical trial (N = 102) of cocaine dependent outpatients with and without cognitive impairments was conducted (Stage 1B). Participants were randomized to M-CBT (N = 52) or CBT (N = 50). Both treatments were individually delivered over 12 weeks with assessments conducted at baseline, end-of-treatment, and 3-month follow-up. The primary outcome was frequency of cocaine use, measured by number of days used in the prior 7 days. Participants in the two treatment groups did not differ significantly on drug use reduction or retention in treatment. However, among participants who completed at least 9 weeks of treatment, those in M-CBT showed a trend toward greater reduction in cocaine use compared to those in the CBT group. M-CBT is feasible for impaired and nonimpaired cocaine dependent participants. However, M-CBT treatment did not show significant superiority over standard CBT in the present sample. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | - Karen Bolla
- Department of Neurology, Bayview Medical Center, Johns Hopkins University
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Kim JY, Yang Y, Kim HK, Kim JY. The Impact of Alcohol Use on Antiretroviral Therapy Adherence in Koreans Living with HIV. Asian Nurs Res (Korean Soc Nurs Sci) 2018; 12:258-264. [PMID: 30316838 DOI: 10.1016/j.anr.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE This study aimed to examine the impact of alcohol use on the antiretroviral therapy (ART) adherence of Koreans living with human immunodeficiency virus (HIV). METHODS A total of 144 HIV-infected Koreans older than the age of 19 years who had been receiving antiretroviral drugs for at least 3 months were surveyed. Alcohol use was identified as nonhazardous, binge, hazardous, and alcohol dependent as determined by the Alchol Use Disorder Identification Test-Korea (AUDIT-K). ART adherence was defined according to the components of adherence motivation, adherence knowledge, and 95% medication adherence using the modified Morisky scale. Collected data were analyzed using logistic regression analysis for each component of therapy adherence. RESULTS Of all participants, 13.9% were binge drinkers, 17.4% were hazardous drinkers, and 4.2% were alcohol dependent. For low adherence motivation, the odds ratio for the hazardous drinkers was 7.47 [95% confidence interval (CI): 1.72-32.41; p = .007] and for the alcohol dependent, it was 12.61 (95% CI: 1.38-115.38; p = .025) when compared with the nonhazardous drinkers. For medication adherence under 95%, the odds ratio for binge drinkers was 4.65 (95% CI: 1.15-18.92; p = .032), for hazardous drinkers was 8.05 (95% CI: 2.08-31.20; p = .003), and for the alcohol dependent was 27.67 (95% CI: 2.12-360.51; p = .011). CONCLUSION It is recommended that Korean institutions and governments develop specific mediation and counseling programs that include alcohol use-related monitoring for the improvement of the ART adherence of people living with HIV.
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Affiliation(s)
- Ji Young Kim
- School of Nursing, Chonbuk National University, Jeonju, Republic of Korea
| | - Youngran Yang
- School of Nursing, Research Institute of Nursing Science, Chonbuk National University, Jeonju, Republic of Korea.
| | - Hyun Kyung Kim
- School of Nursing, Research Institute of Nursing Science, Chonbuk National University, Jeonju, Republic of Korea
| | - Ji Young Kim
- School of Nursing, Research Institute of Nursing Science, Chonbuk National University, Jeonju, Republic of Korea
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40
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Nesvåg S, McKay JR. Feasibility and Effects of Digital Interventions to Support People in Recovery From Substance Use Disorders: Systematic Review. J Med Internet Res 2018; 20:e255. [PMID: 30139724 PMCID: PMC6127498 DOI: 10.2196/jmir.9873] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/01/2018] [Accepted: 06/18/2018] [Indexed: 12/18/2022] Open
Abstract
Background The development and evaluation of digital interventions aimed at preventing or treating substance use–related problems and disorders is a rapidly growing field. Previous reviews of such interventions reveal a large and complex picture with regard to targeted users, use, and efficacy. Objective The objective of this review was to investigate the feasibility and effects of interventions developed specifically for digital platforms. These interventions are focused on supporting people in recovery from substance use disorders by helping them achieve their substance use goals and develop a more satisfying life situation. Methods The review is based on a systematic search in MEDLINE, Embase, PsycInfo, and Cochrane Library databases. Of the 1149 identified articles, 722 were excluded as obviously not relevant. Of the remaining articles, 21 were found to be previous reviews, 269 were on interventions aimed at reducing hazardous alcohol or cannabis use, and 94 were on digitized versions of standard treatment methods. The remaining 43 articles were all read in full and systematically scored by both authors. Results The 43 articles cover 28 unique interventions, of which 33 have been published after 2013. The interventions are aimed at different target groups (defined by age, substance, or comorbidity). Based on the number of features or modules, the interventions can be categorized as simple or complex. Fourteen of the 18 simple interventions and 9 of the 10 complex interventions have been studied with quantitative controlled methodologies. Thirteen of the 18 simple interventions are integrated in other treatment or support systems, mainly delivered as mobile phone apps, while 6 of the 10 complex interventions are designed as stand-alone interventions, most often delivered on a platform combining desktop/Web and mobile phone technologies. The interventions were generally easy to implement, but in most cases the implementation of the complex interventions was found to be dependent on sustained organizational support. Between 70% and 90% of the participants found the interventions to be useful and easy to use. The rates of sustained use were also generally high, except for simple interventions with an open internet-based recruitment and some information and education modules of the complex interventions. Across all interventions, slightly more than half (55%) of the studies with control groups generated positive findings on 1 or more substance use outcomes, with 57% of the interventions also found to be efficacious in 1 or more studies. In the positive studies, effects were typically in the small to moderate range, with a few studies yielding larger effects. Largely due to the inclusion of stronger control conditions, studies of simple interventions were less likely to produce positive effects. Conclusions The digital interventions included in this review are in general feasible but are not consistently effective in helping people in recovery from substance use disorder reduce their substance use or achieving other recovery goals.
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Affiliation(s)
- Sverre Nesvåg
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - James R McKay
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Philadelphia VA Medical Center, Philadelphia, PA, United States
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Aharonovich E, Sarvet A, Stohl M, DesJarlais D, Tross S, Hurst T, Urbina A, Hasin D. Reducing non-injection drug use in HIV primary care: A randomized trial of brief motivational interviewing, with and without HealthCall, a technology-based enhancement. J Subst Abuse Treat 2016; 74:71-79. [PMID: 28132704 DOI: 10.1016/j.jsat.2016.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/14/2016] [Accepted: 12/28/2016] [Indexed: 01/18/2023]
Abstract
AIMS In HIV-infected individuals, non-injection drug use (NIDU) compromises many health outcomes. In HIV primary care, the efficacy of brief motivational interviewing (MI) to reduce NIDU is unknown, and drug users may need greater intervention. We designed an enhancement to MI, HealthCall (HC), for daily patient self-monitoring calls to an interactive voice response (IVR) phone system, and provided participants with periodic personalized feedback. To reduce NIDU among HIV primary care patients, we compared the efficacy of MI+HealthCall to MI-only and an educational control condition. DESIGN Participants age >18 with >4days of NIDU during the prior 30days were recruited from large urban HIV primary care clinics. Of the 240 participants, 83 were randomly assigned to control, 77 to MI-only, and 80 to MI+HC. Counselors provided educational control, MI-only or MI+HC at baseline. At 30 and 60days (end-of-treatment), counselors briefly discussed drug use, moods and health behaviors, using HealthCall-generated graphs with MI+HC patients. Primary outcomes (last 30days) were number of days used primary drug (NumDU), and total quantity of primary drug used (dollar amount spent; QuantU), derived from the Time-Line Follow-Back. FINDINGS Across all groups, at end-of-treatment, frequency and quantity of NIDU decreased, with significantly greater reductions in the MI-Only group. A twelve-month post-treatment follow-up indicated sustained benefits of MI+HC and MI-only relative to control. CONCLUSIONS Brief interventions can be successfully used to reduce non-injection drug use in HIV primary care. IVR-based technology may not be sufficiently engaging to be effective. Future studies should investigate mobile technology to deliver a more engaging version of HealthCall to diverse substance abusing populations.
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Affiliation(s)
- Efrat Aharonovich
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Aaron Sarvet
- New York State Psychiatric Institute, New York, NY, USA
| | - Malki Stohl
- New York State Psychiatric Institute, New York, NY, USA
| | - Don DesJarlais
- Icahn School of Medicine, at Mount Sinai New York, New York, USA
| | - Susan Tross
- New York State Psychiatric Institute, New York, NY, USA; HIV Center for Clinical and Behavioral Studies/Division of Gender, Sexuality and Health, Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Teresa Hurst
- Institute for Advanced Medicine, Mount Sinai Health System, New York, NY, USA
| | - Antonio Urbina
- Institute for Advanced Medicine, Mount Sinai Health System, New York, NY, USA
| | - Deborah Hasin
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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