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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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Farren C, Farrell A, Hagerty A, McHugh C. A 6-Month Randomized Trial of a Smartphone Application, UControlDrink, in Aiding Recovery in Alcohol Use Disorder. Eur Addict Res 2022; 28:122-133. [PMID: 34802002 DOI: 10.1159/000519945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Alcohol use disorder (AUD) is a substantial problem, causing early death and great economic burden. Research has highlighted the potential positive impact of technological interventions, such as smartphone applications (app) in treatment of AUD. The aim of this study was to explore the effectiveness of a smartphone app, incorporating computerized cognitive behavioural therapy and text messaging support, on alcohol outcomes over 6 months in a post-rehabilitation setting. METHODS A total of 111 participants with AUD were recruited into this randomized controlled trial, following completion of a 30-day rehabilitation programme. The intervention group (n = 54) used the smartphone app "UControlDrink" (UCD) over 6 months with treatment as usual (TAU), and the control group (n = 57) received TAU. All subjects suffered from AUD as the primary disorder, with other major psychiatric disorders excluded. All intervention subjects used the UCD smartphone app in the treatment trial, and all subjects underwent TAU consisting of outpatient weekly support groups. Drinking history in the previous 90 days was measured at baseline and at 3- and 6-month follow-ups. Additional measurements were made to assess mood, anxiety, craving, and motivation. Results were analysed using intention-to-treat analyses. RESULTS Retention in the study was 72% at 3 months and 52% at 6 months. There was a significant reduction in heavy drinking days in the intervention group relative to TAU over the 6 months, p < 0.02. CONCLUSIONS The UCD smartphone app demonstrates a significant benefit to reducing heavy drinking days over a 6-month post-rehabilitation period in AUD.
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Affiliation(s)
- Conor Farren
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland
| | - Aoife Farrell
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland
| | - Aisling Hagerty
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland
| | - Cliodhna McHugh
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland
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Caselli G, Gemelli A, Ferrari C, Beltrami D, Offredi A, Ruggiero GM, Sassaroli S, Spada MM. The effect of desire thinking on facilitating beliefs in alcohol use disorder: An experimental investigation. Clin Psychol Psychother 2020; 28:355-363. [PMID: 32881148 DOI: 10.1002/cpp.2511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/06/2022]
Abstract
Permissive beliefs relate to the acceptability of engaging in alcohol use in spite of obvious potential negative consequences. They are considered the most proximal and precipitating cognitive factor in the decision to use alcohol and/or the activation of strategies to obtain it. Recent research suggested that 'desire thinking' may be involved in the escalation of craving and addictive behaviours and can play a role in strengthening permissive beliefs. The current study tested whether the induction of desire thinking would have a stronger effect on rate of conviction in permissive beliefs compared to a control cognitive response in the form of neutral thinking and whether this effect would be specific for patients with alcohol use disorder (AUD). Thirty AUD patients and 30 social drinkers (SD) were randomly allocated to two thinking manipulation tasks (desire thinking and neutral thinking). Current permissive beliefs were measured before and after manipulation and after a resting phase. Findings showed that desire thinking increased the level of current permissive beliefs after manipulation relative to the neutral thinking condition for the AUD group but not for the SD group. This effect was not purely dependent on the concurrent level of perceived craving. This study supports a causal relationship between the induction of desire thinking and rate of conviction in permissive beliefs and highlights the relevance of targeting desire thinking in the treatment for AUD patients.
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Affiliation(s)
- Gabriele Caselli
- Studi Cognitivi, Milan, Italy.,Faculty of Psychology, Sigmund Freud University, Milan, Italy
| | | | | | | | - Alessia Offredi
- Studi Cognitivi, Milan, Italy.,Faculty of Psychology, Sigmund Freud University, Milan, Italy
| | - Giovanni M Ruggiero
- Studi Cognitivi, Milan, Italy.,Faculty of Psychology, Sigmund Freud University, Milan, Italy
| | - Sandra Sassaroli
- Studi Cognitivi, Milan, Italy.,Faculty of Psychology, Sigmund Freud University, Milan, Italy
| | - Marcantonio M Spada
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
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Kiluk BD, Ray LA, Walthers J, Bernstein M, Tonigan JS, Magill M. Technology-Delivered Cognitive-Behavioral Interventions for Alcohol Use: A Meta-Analysis. Alcohol Clin Exp Res 2019; 43:2285-2295. [PMID: 31566787 PMCID: PMC6824956 DOI: 10.1111/acer.14189] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) has long-standing evidence for efficacy in the treatment of alcohol use, yet implementation in clinical practice has been challenging. Delivery of CBT through technology-based platforms, such as web-based programs and mobile applications, has the potential to provide widespread access to this evidence-based intervention. While there have been reviews indicating the efficacy of technology-based delivery of CBT for various psychiatric conditions, none have focused on efficacy for alcohol use. The current meta-analysis was conducted to fill this research gap. METHODS Descriptive data were used to characterize the nature of the literature on technology-delivered, CBT-based interventions for alcohol use ("CBT Tech"). Inverse-variance-weighted effect sizes were calculated, and random effects, effect sizes were pooled in 4 subgroups. RESULTS Fifteen published trials conducted primarily with at-risk or heavy drinkers were identified. Of these studies, 60% explicitly targeted alcohol use moderation. The content of CBT Tech programs varied, ranging from 4 to 62 sessions/exercises, with many programs combining elements of motivational interviewing (47%). With respect to efficacy, CBT Tech as a stand-alone treatment in contrast to a minimal treatment control showed a positive and statistically significant, albeit small effect (g = 0.20: 95% CI = 0.22, 0.38, kes = 5). When CBT Tech was compared to treatment as usual (TAU), effects were nonsignificant. However, when CBT Tech was tested as an addition to TAU, in contrast to TAU only, the effect size was positive, significant (g = 0.30: 95% CI = 0.10, 0.50, kes = 7), and stable over 12-month follow-up. Only 2 studies compared CBT Tech to in-person CBT, and this pooled effect size did not suggest superior efficacy. CONCLUSIONS These results show a benefit for technology-delivered, CBT-based interventions as a stand-alone therapy for heavy drinking or as an addition to usual care in specialty substance use settings.
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Affiliation(s)
| | - Lara A. Ray
- University of California at Los Angeles, Los Angeles, CA
| | - Justin Walthers
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI
| | - Michael Bernstein
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI
| | | | - Molly Magill
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI
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Hadjistavropoulos HD, Mehta S, Wilhelms A, Keough MT, Sundström C. A systematic review of internet-delivered cognitive behavior therapy for alcohol misuse: study characteristics, program content and outcomes. Cogn Behav Ther 2019; 49:327-346. [PMID: 31599198 DOI: 10.1080/16506073.2019.1663258] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Alcohol misuse is a common, disabling and costly issue worldwide. Internet-delivered cognitive behavior therapy (ICBT) has the potential to reduce the harms of alcohol misuse, particularly for individuals who are unable or unwilling to access face-to-face therapy. A systematic review was conducted using Medline, CINAHL, EMBASE and PsycINFO databases for all relevant articles published from 1980 to January 2019. Randomized controlled trials (RCTs) were included if (i) an ICBT intervention targeting alcohol misuse was delivered; (ii) participants were aged 18 years or older; and (iii) primary outcomes were quantity of drinking. A qualitative analysis was conducted on the content of the ICBT programs. Fourteen studies met inclusion criteria. Most studies included participants from the general population, while studies conducted within clinic settings with diagnosed individuals were rare. The programs were similar in terms of included modules. Small effects were seen in studies on self-guided ICBT, while therapist-guided ICBT rendered small to large effects. The current review indicates that ICBT has a significant effect in reducing alcohol consumption. Larger studies evaluating ICBT compared to active control groups especially within clinic settings are warranted.
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Affiliation(s)
| | - Swati Mehta
- Department of Physical Medicine and Rehabilitation, Western University , London, Ontario, Canada.,Parkwood Institute Research, Lawson Health Research Institute , London, Ontario, Canada
| | - Andrew Wilhelms
- Department of Psychology, University of Regina , Regina, Saskatchewan, Canada
| | - Matthew T Keough
- Department of Psychology, York University , Toronto, Ontario, Canada
| | - Christopher Sundström
- Department of Psychology, University of Regina , Regina, Saskatchewan, Canada.,Department of Clinical Neuroscience, Center for Psychiatric Research, Karolinska Institutet , Stockholm, Sweden
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Caselli G, Martino F, Spada MM, Wells A. Metacognitive Therapy for Alcohol Use Disorder: A Systematic Case Series. Front Psychol 2018; 9:2619. [PMID: 30619014 PMCID: PMC6305730 DOI: 10.3389/fpsyg.2018.02619] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/05/2018] [Indexed: 01/28/2023] Open
Abstract
Alcohol Use Disorder (AUD) is a debilitating condition with serious adverse effects on health and psycho-social functioning. The most effective psychological treatments for AUD show moderate efficacy and return to dysregulated alcohol use after treatment is still common. The aim of the present study was to evaluate Metacognitive Therapy (MCT) as applied to AUD. Five patients were treated using a non-concurrent multiple baseline design with follow-up at 3- and 6-months time points. Each patient received 12 one-hour sessions of MCT. Following MCT all patients demonstrated large and clinically meaningful reductions in weekly alcohol use and number of binge drinking episodes that were upheld at follow-up in almost all cases. Metacognitive beliefs, as secondary outcome, also changed substantially. The findings from this study offer preliminary evidence of positive effects associated with MCT in AUD and support the need for a definitive trial of MCT in addictive behaviors.
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Affiliation(s)
- Gabriele Caselli
- Studi Cognitivi, Cognitive Psychotherapy School, Milan, Italy.,School of Applied Sciences, London South Bank University, London, United Kingdom.,Sigmund Freud University Milano, Milan, Italy
| | - Francesca Martino
- Studi Cognitivi, Cognitive Psychotherapy School, Milan, Italy.,School of Applied Sciences, London South Bank University, London, United Kingdom.,Department of Medical and Surgical Sciences DIMEC, University of Bologna, Bologna, Italy
| | - Marcantonio M Spada
- School of Applied Sciences, London South Bank University, London, United Kingdom.,Sigmund Freud University Milano, Milan, Italy
| | - Adrian Wells
- Division of Clinical and Health Psychology, University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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