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Chun-Hung L, Guan-Hsiung L, Wu-Chuan Y, Yu-Hsin L. Chatbot-assisted therapy for patients with methamphetamine use disorder: a preliminary randomized controlled trial. Front Psychiatry 2023; 14:1159399. [PMID: 37484677 PMCID: PMC10359989 DOI: 10.3389/fpsyt.2023.1159399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
Background Methamphetamine (MA) use disorder is associated with a large public health burden. Despite the therapeutic effects of psychosocial interventions based on current evidence, finding an approach to retain patients in treatment remains a real-world challenge. The rapid development of mobile health (mHealth) systems suggests the potential to provide real-time personalized care at any time and from any location, minimize barriers to treatment, maximize use, and promote the dissemination of accessible therapeutic tools in at-risk populations. Our study aimed to investigate the feasibility and effectiveness of chatbots for the treatment of MA use disorder. Method The inclusion criteria were (a) a diagnosis of MA use disorder as defined by the DSM-5, (b) age between 18 and 65 years, (c) no acute exacerbation of severe mental illness during the initial assessment, such as schizophrenia or bipolar I disorder, (d) willingness to participate in standard outpatient treatment for ≥ 6 months, and (e) an Android phone. Participants were randomly allocated to either a chatbot-assisted therapy via smartphone (CAT) group or a control group following simple randomization procedures (computerized random numbers) without blinding. All participants were followed up for 6 months. Treatment retention and monthly urine test results were analyzed as outcome measures. Participants' satisfaction with CAT was also assessed. Results In total, 50 and 49 participants were allocated to the CAT and control groups, respectively. There were no significant differences in retention time between the two treatment groups (df = 1, p = 0.099). The CAT group had fewer MA-positive urine samples than the control group (19.5% vs. 29.6%, F = 9.116, p = 0.003). The proportion of MA-positive urine samples was positively correlated with the frequency of MA use (r = 0.323, p = 0.001), severity of MA use disorder (r = 0.364, p < 0.001), and polysubstance use (r = 0.212, p = 0.035), and negatively correlated with readiness to change (r = -0.330, p = 0.001). Totally 55 participants completed the study at the 6-month follow-up and 60% reported relative satisfaction. Conclusion Participants in this study had favorable acceptance and generally positive outcomes, which indicates that chatbot is feasible for treating people who use MA.
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Affiliation(s)
- Lee Chun-Hung
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
- Jianan Psychiatric Center, Ministry of Health and Welfare (MOHW), Tainan, Taiwan
| | - Liaw Guan-Hsiung
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Yang Wu-Chuan
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Liu Yu-Hsin
- King's College London, Florence Nightingale School of Nursing & Midwifery, London, United Kingdom
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2
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Shams F, Tai AM, Kim J, Boyd M, Meyer M, Kazemi A, Krausz RM. Adherence to e-health interventions for substance use and the factors influencing it: Systematic Review, meta-analysis, and meta-regression. Digit Health 2023; 9:20552076231203876. [PMID: 37780062 PMCID: PMC10540609 DOI: 10.1177/20552076231203876] [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: 03/29/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023] Open
Abstract
Background Substance use disorders affect 36 million people globally, but only a small proportion of them receive the necessary treatment. E-health interventions have been developed to address this issue by improving access to substance use treatment. However, concerns about participant engagement and adherence to these interventions remain. This review aimed to evaluate adherence to e-health interventions targeting substance use and identify hypothesized predictors of adherence. Methods A systematic review of literature published between 2009 and 2020 was conducted, and data on adherence measures and hypothesized predictors were extracted. Meta-analysis and meta-regression were used to analyze the data. The two adherence measures were (a) the mean proportion of modules completed across the intervention groups and (b) the proportion of participants that completed all modules. Four meta-regression models assessed each covariate including guidance, blended treatment, intervention duration and recruitment strategy. Results The overall pooled adherence rate was 0.60 (95%-CI: 0.52-0.67) for the mean proportion of modules completed across 30 intervention arms and 0.47 (95%-CI: 0.35-0.59) for the proportion of participants that completed all modules across 9 intervention arms. Guidance, blended treatment, and recruitment were significant predictors of adherence, while treatment duration was not. Conclusion The study suggests that more research is needed to identify predictors of adherence, in order to determine specific aspects that contribute to better exposure to intervention content. Reporting adherence and predictors in future studies can lead to improved meta-analyses and the development of more engaging interventions. Identifying predictors can aid in designing effective interventions for substance use disorders, with important implications for e-health interventions targeting substance use.
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Affiliation(s)
- Farhud Shams
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andy M.Y. Tai
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jane Kim
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marisha Boyd
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Maximilian Meyer
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, University of Basel Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Alireza Kazemi
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Reinhard Michael Krausz
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Takano A, Ono K, Nozawa K, Sato M, Onuki M, Sese J, Yumoto Y, Matsushita S, Matsumoto T. Wearable Sensor and Mobile App-based mHealth Approach for Investigating Substance Use and Related Factors in Daily Life: Protocol for an Ecological Momentary Assessment Study (Preprint). JMIR Res Protoc 2022; 12:e44275. [PMID: 37040162 PMCID: PMC10131735 DOI: 10.2196/44275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Digital health technologies using mobile apps and wearable devices are a promising approach to the investigation of substance use in the real world and for the analysis of predictive factors or harms from substance use. Moreover, consecutive repeated data collection enables the development of predictive algorithms for substance use by machine learning methods. OBJECTIVE We developed a new self-monitoring mobile app to record daily substance use, triggers, and cravings. Additionally, a wearable activity tracker (Fitbit) was used to collect objective biological and behavioral data before, during, and after substance use. This study aims to describe a model using machine learning methods to determine substance use. METHODS This study is an ongoing observational study using a Fitbit and a self-monitoring app. Participants of this study were people with health risks due to alcohol or methamphetamine use. They were required to record their daily substance use and related factors on the self-monitoring app and to always wear a Fitbit for 8 weeks, which collected the following data: (1) heart rate per minute, (2) sleep duration per day, (3) sleep stages per day, (4) the number of steps per day, and (5) the amount of physical activity per day. Fitbit data will first be visualized for data analysis to confirm typical Fitbit data patterns for individual users. Next, machine learning and statistical analysis methods will be performed to create a detection model for substance use based on the combined Fitbit and self-monitoring data. The model will be tested based on 5-fold cross-validation, and further preprocessing and machine learning methods will be conducted based on the preliminary results. The usability and feasibility of this approach will also be evaluated. RESULTS Enrollment for the trial began in September 2020, and the data collection finished in April 2021. In total, 13 people with methamphetamine use disorder and 36 with alcohol problems participated in this study. The severity of methamphetamine or alcohol use disorder assessed by the Drug Abuse Screening Test-10 or the Alcohol Use Disorders Identification Test-10 was moderate to severe. The anticipated results of this study include understanding the physiological and behavioral data before, during, and after alcohol or methamphetamine use and identifying individual patterns of behavior. CONCLUSIONS Real-time data on daily life among people with substance use problems were collected in this study. This new approach to data collection might be helpful because of its high confidentiality and convenience. The findings of this study will provide data to support the development of interventions to reduce alcohol and methamphetamine use and associated negative consequences. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44275.
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Affiliation(s)
- Ayumi Takano
- Department of Mental Health and Psychiatric Nursing, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koki Ono
- Department of Clinical Information Engineering, The University of Tokyo, Tokyo, Japan
| | - Kyosuke Nozawa
- Department of Mental Health and Psychiatric Nursing, Osaka University, Osaka, Japan
| | | | | | | | - Yosuke Yumoto
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Sachio Matsushita
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Toshihiko Matsumoto
- Department of Drug Dependence Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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4
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Takano A, Miyamoto Y, Shinozaki T, Matsumoto T, Kawakami N. Effects of a web‐based relapse prevention program on abstinence: Secondary subgroup analysis of a pilot randomized controlled trial. Neuropsychopharmacol Rep 2022; 42:362-367. [PMID: 35689457 PMCID: PMC9515705 DOI: 10.1002/npr2.12272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/01/2022] Open
Abstract
Aim The effect of a web‐based relapse prevention program might vary depending on a specific population if the study participants included drug users with various characteristics. This secondary analysis explored subgroups among Japanese drug users that may benefit from a web‐based relapse prevention program. Methods Outpatients with drug use disorder (n = 48) were randomly assigned to an 8‐week, six‐session web‐based relapse prevention program (intervention group) or web‐based self‐monitoring only (control group). We tested the effects of the intervention on abstinence in different subgroups divided by a primary abused drug (methamphetamine vs other drugs), previous face‐to‐face relapse prevention (received vs not received), and outpatient treatment term (long‐term: ≥3 years vs short‐term: <3 years). Consecutive abstinence duration from the primary abused drug was compared in the subgroups, and the interaction between the intervention condition and the subgroup condition was assessed. Results In the subgroup with short‐term outpatient treatment, the intervention group maintained better abstinence than the control group. For those who used methamphetamine or those who had previously received a face‐to‐face relapse prevention program, the intervention group showed larger effect sizes than the results from all the participants. However, the interaction between the intervention condition and the subgroup condition was not significant for any subgroup. Conclusions This study suggests that patients with short‐term treatment may benefit from a web‐based relapse prevention program as an alternative treatment. We need to recruit and allocate patients considering their treatment term in a future definitive trial.
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Affiliation(s)
- Ayumi Takano
- Department of Mental Health and Psychiatric Nursing Tokyo Medical and Dental University Tokyo Japan
| | - Yuki Miyamoto
- Department of Psychiatric Nursing The University of Tokyo Tokyo Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering Tokyo University of Science Tokyo Japan
| | - Toshihiko Matsumoto
- Department of Drug Dependence Research National Center of Neurology and Psychiatry Tokyo Japan
| | - Norito Kawakami
- Department of Mental Health The University of Tokyo Tokyo Japan
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update of the recently published randomized controlled trials in the field of digital health interventions for substance use disorders. RECENT FINDINGS Over the past 2 years, five cannabis-specific and seven polysubstance-focused randomized controlled trials were published. No studies were found that focused on opioid or psychostimulant use disorders. Most studies examined feasibility but were underpowered to assess effectiveness. Given the optimistic results of the studies in regards to feasibility more fully powered trials should be conducted. In addition, the literature is in need for an increased focus on comorbidity and outcome standardization. SUMMARY Although the number of studies targeting new target groups, technologies and new delivery settings has increased - future studies should consider the identified gaps and suggestions to further strengthen the evidence of digital interventions targeting substance use disorders.
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Digital approaches to continuing care. Curr Opin Psychiatry 2022; 35:259-264. [PMID: 35781465 PMCID: PMC9260953 DOI: 10.1097/yco.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an update of studies on the effectiveness of digital and telephonic approaches to providing remote continuing care for substance use disorders. RECENT FINDINGS Effective continuing care can be provided via smartphone apps, text messaging, interactive voice response, and structured telephone counseling. The remote continuing care interventions with the strongest evidence of efficacy are the Addiction Comprehensive Health Enhancement Support System app and Telephone Monitoring and Counseling. Positive effects for these intervention on drinking outcomes in patients with alcohol use disorders were replicated in a recent randomized controlled study. SUMMARY Continuing care is widely believed to be an important component of treatment for substance use disorders, especially for sustaining positive outcomes. However, many individuals do not attend clinic-based continuing care, due to a variety of reasons, including competing work and family responsibilities, disabilities, transportation challenges, and recently the COVID-19 pandemic. Remote continuing care, provided via smartphone apps, text messaging, and various telephonic approaches, has been shown to be effective, and could be used to provide continuing care to patients who would otherwise not receive it. Further work is needed to determine how to effectively combine more traditional continuing care with newer digitized and telephonic approaches.
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Uhl S, Bloschichak A, Moran A, McShea K, Nunemaker MS, McKay JR, D'Anci KE. Telehealth for Substance Use Disorders: A Rapid Review for the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Management of Substance Use Disorders. Ann Intern Med 2022; 175:691-700. [PMID: 35313116 DOI: 10.7326/m21-3931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Approximately 20.4 million Americans met criteria for a substance use disorder (SUD) in 2019; however, only about 12.2% of persons with an SUD receive specialty care. Telehealth offers alternatives to traditional forms of substance use treatment. PURPOSE To synthesize recent findings on the efficacy of telehealth for SUDs. DATA SOURCES MEDLINE, Embase, PubMed, and the Cochrane Library from January 2015 through August 2021 (English language only). STUDY SELECTION Randomized controlled trials (RCTs) of adults with a diagnosis of SUD based on the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases. DATA EXTRACTION One investigator abstracted data and assessed study quality, and a second checked for accuracy. DATA SYNTHESIS This rapid review synthesized evidence from 17 RCTs. Evidence is very uncertain that telehealth provided as videoconference therapy (1 RCT) or web-based cognitive behavioral therapy (CBT) (3 RCTs) has similar effects to in-person therapy for improving abstinence from alcohol or cannabis. Low-strength evidence suggests that web-based CBT has similar effects for improving abstinence in multiple SUDs (2 RCTs). Low-strength evidence suggests that adding supportive text messaging to follow-up care improves abstinence and amount of alcohol per day (2 RCTs) but does not improve emergency department visits or frequency of consumption (2 RCTs). Enhanced telephone monitoring likely reduces readmissions for SUD detoxification compared with usual follow-up alone (1 RCT) but does not reduce days of substance use (low-strength evidence). LIMITATION Narrative synthesis, heterogeneity of telehealth interventions, no assessment of publication bias, and study methodology. CONCLUSION Evidence is very uncertain that telehealth is similar to in-person care for SUD outcomes. Limited evidence suggests some benefit of adding telehealth to usual SUD care. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs Veterans Health Administration.
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Affiliation(s)
- Stacey Uhl
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - Aaron Bloschichak
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - Amber Moran
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - Kristina McShea
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - Megan S Nunemaker
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - James R McKay
- University of Pennsylvania, Philadelphia, Pennsylvania (J.R.M.)
| | - Kristen E D'Anci
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
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8
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Kotajima‐Murakami H, Takano A, Hirakawa S, Ogai Y, Funada D, Tanibuchi Y, Ban E, Kikuchi M, Tachimori H, Maruo K, Kawashima T, Tomo Y, Sasaki T, Oi H, Matsumoto T, Ikeda K. Ifenprodil for the treatment of methamphetamine use disorder: An exploratory, randomized, double‐blind, placebo‐controlled trial. Neuropsychopharmacol Rep 2022; 42:92-104. [PMID: 35068087 PMCID: PMC8919120 DOI: 10.1002/npr2.12232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/03/2021] [Accepted: 12/28/2021] [Indexed: 01/10/2023] Open
Abstract
Aim No effective pharmacological interventions have been developed for patients with methamphetamine use disorder. Ifenprodil is a blocker of G protein‐activated inwardly rectifying potassium channels, which play a key role in the mechanism of action of addictive substances. We conducted a randomized, double‑blind, exploratory, dose‐ranging, placebo‐controlled trial to examine the clinical efficacy of ifenprodil for the treatment of methamphetamine use disorder. Methods Participants were assigned to three groups: placebo, 60 mg/d ifenprodil, or 120 mg/d ifenprodil. The drug administration period was 84 days. The primary outcome was the use or nonuse of methamphetamine during the drug administration period in the placebo group vs 120 mg/d ifenprodil group. We also assessed drug use status, relapse risk based on the Stimulant Relapse Risk Scale (SRRS), drug craving, and methamphetamine in urine as secondary outcomes. We further evaluated drug use status and SRRS subscale scores in patients who were not taking addiction medications during the study. Results Ifenprodil did not affect the primary or secondary outcomes. However, the additional analyses showed that the number of days of methamphetamine use during the follow‐up period and scores on the emotionality problems subscale of the SRRS improved in the 120 mg/d ifenprodil group. The safety of ifenprodil was confirmed in patients with methamphetamine use disorder. Conclusion The present findings did not confirm the efficacy of ifenprodil for methamphetamine use disorder treatment based on the primary or secondary outcomes, but we found evidence of its safety and efficacy in reducing emotionality problems. Clinical trial registration The study was registered at the University Hospital Medical Information Network Clinical Trial Registry (no. UMIN000030849) and Japan Registry of Clinical Trials (no. jRCTs031180080). The main registration site is jRCT (https://jrct.niph.go.jp/). We conducted an exploratory, randomized, double‐blind, placebo‐controlled trial to investigate the clinical safety and efficacy of ifenprodil for the treatment of methamphetamine use disorder in Japanese patients. Our findings confirmed the safety of ifenprodil, and ifenprodil at the highest dose exerted slight efficacy.![]()
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Affiliation(s)
- Hiroko Kotajima‐Murakami
- Addictive Substance Project Tokyo Metropolitan Institute of Medical Science Tokyo Japan
- Department of Drug Dependence Research National Institute of Mental Health National Centre of Neurology and Psychiatry Tokyo Japan
| | - Ayumi Takano
- Department of Drug Dependence Research National Institute of Mental Health National Centre of Neurology and Psychiatry Tokyo Japan
- Department of Mental Health and Psychiatric Nursing Tokyo Medical and Dental University Tokyo Japan
| | - Shinya Hirakawa
- Department of Clinical Data Science Clinical Research & Education Promotion Division National Centre of Neurology and Psychiatry Tokyo Japan
| | - Yasukazu Ogai
- Social Psychiatry and Mental Health Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Daisuke Funada
- Department of Psychiatry National Centre Hospital National Centre of Neurology and Psychiatry Tokyo Japan
| | - Yuko Tanibuchi
- Department of Drug Dependence Research National Institute of Mental Health National Centre of Neurology and Psychiatry Tokyo Japan
- Department of Psychiatry Chiba Hospital Chiba Japan
| | - Eriko Ban
- Department of Drug Dependence Research National Institute of Mental Health National Centre of Neurology and Psychiatry Tokyo Japan
| | - Minako Kikuchi
- Department of Drug Dependence Research National Institute of Mental Health National Centre of Neurology and Psychiatry Tokyo Japan
| | - Hisateru Tachimori
- Department of Clinical Data Science Clinical Research & Education Promotion Division National Centre of Neurology and Psychiatry Tokyo Japan
| | - Kazushi Maruo
- Department of Biostatistics Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Takahiro Kawashima
- Department of Clinical Data Science Clinical Research & Education Promotion Division National Centre of Neurology and Psychiatry Tokyo Japan
| | - Yui Tomo
- Department of Clinical Data Science Clinical Research & Education Promotion Division National Centre of Neurology and Psychiatry Tokyo Japan
| | - Tsuyoshi Sasaki
- Department of Child Psychiatry Chiba‐University Hospital Chiba Japan
| | - Hideki Oi
- Department of Clinical Research Promotion Translational Medical Centre National Centre of Neurology and Psychiatry Tokyo Japan
| | - Toshihiko Matsumoto
- Department of Drug Dependence Research National Institute of Mental Health National Centre of Neurology and Psychiatry Tokyo Japan
| | - Kazutaka Ikeda
- Addictive Substance Project Tokyo Metropolitan Institute of Medical Science Tokyo Japan
- Department of Drug Dependence Research National Institute of Mental Health National Centre of Neurology and Psychiatry Tokyo Japan
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Rubenis AJ, Baker AL, Arunogiri S. Methamphetamine use and technology-mediated psychosocial interventions: A mini-review. Addict Behav 2021; 121:106881. [PMID: 33896672 DOI: 10.1016/j.addbeh.2021.106881] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/04/2021] [Accepted: 02/13/2021] [Indexed: 02/06/2023]
Abstract
Engagement with face-to-face psychosocial interventions is often compromised in people using methamphetamine (MA), in the context of high rates of polysubstance use, mental health disorders, cognitive impairment and geographic isolation. Technology-mediated interventions offer flexible ways of engaging with treatment and are readily accessible. This mini-review evaluates evidence from eight studies for the effectiveness of telephone, mHealth (text-messaging and apps) and computer-based interventions for MA use. Two papers from one telephone counselling study showed a small improvement in MA-related outcomes, particularly for individuals in active use. However, a directive counselling style was associated with a higher likelihood of MA use during recovery for those higher in resistance to authority. Text-messaging interventions generally showed small but significant reductions in MA use in non-treatment seekers. When compared, there was no significant difference in level of MA use reduction between interactive, automated and self-monitoring text messages. Studies in other modalities (smartphone app, one trial; computer-based interventions, two trials) did not confer statistically significant reductions in MA use, though were likely impacted by app design and participant characteristics. Preliminary findings hint at the potential effectiveness of telephone counselling in aftercare and the capacity for text-messaging to reach those who are not in treatment. Given the small amount of existing literature, this review discusses the potential value of emerging interventions, the importance of adapting interventions to the characteristics of people who use MA and suggests specific directions for research in each technology modality.
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Affiliation(s)
- Adam J Rubenis
- Turning Point, Eastern Health, 110 Church St., Richmond, VIC 3121, Australia; National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; The National Centre for Clinical Research on Emerging Drugs (NCCRED), University of New South Wales, Sydney, NSW 2052, Australia.
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, NSW 2300, Australia.
| | - Shalini Arunogiri
- Turning Point, Eastern Health, 110 Church St., Richmond, VIC 3121, Australia; Monash Alfred Psychiatry Research Centre, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004, Australia.
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10
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Yamada C, Siste K, Hanafi E, Ophinni Y, Beatrice E, Rafelia V, Alison P, Limawan A, Shinozaki T, Matsumoto T, Sakamoto R. Relapse prevention group therapy via video-conferencing for substance use disorder: protocol for a multicentre randomised controlled trial in Indonesia. BMJ Open 2021; 11:e050259. [PMID: 34489288 PMCID: PMC8422497 DOI: 10.1136/bmjopen-2021-050259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Substance use disorder (SUD) is a leading contributor to the global burden of disease. In Indonesia, the availability of formal treatment for SUD falls short of the targeted coverage. A standardised therapeutic option for SUD with potential for widespread implementation is required, yet evidence-based data in the country are scarce. In this study, we developed a cognitive behavioural therapy (CBT)-based group telemedicine model and will investigate effectiveness and implementability in a multicentre randomised controlled trial. METHODS A total of 220 participants will be recruited from the social networks of eight sites in Indonesia: three hospitals, two primary healthcare centres and three rehabilitation centres. The intervention arm will participate in a relapse prevention programme called the Indonesia Drug Addiction Relapse Prevention Programme (Indo-DARPP), a newly developed 12-week module based on CBT and motivational interviewing constructed in the Indonesian context. The programme will be delivered by a healthcare provider and a peer counsellor in a group therapy setting via video-conferencing, as a supplement to participants' usual treatments. The control arm will continue treatment as usual. The primary outcome will be the percentage increase in days of abstinence from the primarily used substance in the past 28 days. Secondary outcomes will include addiction severity, quality of life, motivation to change, psychiatric symptoms, cognitive function, coping, and internalised stigma. Assessments will be performed at baseline (week 0), post-treatment (week 13), and 3 and 12 months post-treatment completion (weeks 24 and 60). Retention, participant satisfaction, and cost-effectiveness will be assessed as the implementation outcomes. ETHICS AND DISSEMINATION The study protocol was reviewed and approved by the Ethics Committees of Universitas Indonesia and Kyoto University. The results will be disseminated via academic journals and international conferences. Depending on trial outcomes, the treatment programme will be advocated for adoption as a formal healthcare-based approach for SUD. TRIAL REGISTRATION NUMBER UMIN000042186.
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Affiliation(s)
- Chika Yamada
- Department of Environmental Coexistence, Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Kristiana Siste
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Enjeline Hanafi
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Youdiil Ophinni
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
| | - Evania Beatrice
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Vania Rafelia
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Peter Alison
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Albert Limawan
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Toshihiko Matsumoto
- Department of Drug Dependence Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ryota Sakamoto
- Department of Environmental Coexistence, Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
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11
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Takano A, Matsumoto T. A Mixed-Methods Evaluation of Usability and Acceptability of Web-Based Relapse Prevention and Self-Monitoring Program: Secondary Analysis of a Pilot Randomized Controlled Trial. Front Psychiatry 2021; 12:625480. [PMID: 33643096 PMCID: PMC7905227 DOI: 10.3389/fpsyt.2021.625480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
This secondary analysis of a pilot randomized controlled trial assessed the usability and acceptability of a web-based relapse prevention and self-monitoring program, which was newly developed for Japanese drug users. We analyzed quantitative and qualitative data using a mixed-method approach among 43 study participants. We assessed the usability of the programs using the Web Usability Scale (WUS) and satisfaction and acceptance using the Client Satisfaction Questionnaire 8-item version (CSQ-8). We also collected qualitative feedback using semi-structured open-ended questions. The results of WUS indicated that the usability of the programs was sufficient. According to the CSQ-8 results, the self-monitoring program had less satisfaction, while the web-based relapse prevention program met satisfaction. Some possible improvements for a future version of the web-based programs were suggested based on participants' feedback.
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Affiliation(s)
- Ayumi Takano
- Department of Mental Health and Psychiatric Nursing, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshihiko Matsumoto
- Department of Drug Dependence Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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