The effectiveness of electronic approaches to substance abuse prevention for adolescents

Serious games supporting the prevention and treatment of alcohol and drugs consumption in youth: a scoping review (Preprint)

Background

The consumption of alcohol and drugs, particularly in adolescents and young adults, has increased worldwide in the last several years, representing a significant public health challenge. Serious games have the potential to support preventive and treatment interventions for substance use, facilitating the acquisition of relevant knowledge and the motivation for changes in attitudes and behaviors regarding substance consumption.

Objective

This scoping review aims to analyze a set of 7 relevant characteristics of current serious games designed to support the prevention and treatment of alcohol and drug consumption in adolescents and young adults—the substance addressed, the type of intervention, the theoretical basis, the computational techniques used, the mechanism for data security and privacy, the evaluation procedure followed, and the main results obtained.

Methods

The review was performed by following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Data were retrieved from January 2010 to May 2022, using PubMed, Scopus (Elsevier), IEEE Xplore, and ACM Digital as data sources. The eligibility criteria included studies that described serious games designed to support the prevention or treatment of alcohol and drug consumption, targeted a population aged between 12 and 30 years, and included an evaluation procedure. Authors (JMM and IEEC) individually screened the titles and abstracts, and then full articles were reviewed for a final inclusion decision.

Results

A total of 629 records were obtained, and 29 (4.6%) fulfilled the inclusion criteria. Most of the serious games (14/29, 48%) were focused on the prevention or treatment of alcohol use. The type of intervention that was the most supported was prevention (18/29, 62%), and most studies mentioned the theory, theoretical construct, or therapeutic technique used as a foundation (22/29, 76%). Most of the studies only provided information about the platform for execution (23/29, 79%), and few described the use of computational techniques, such as virtual reality or motion-based interaction (5/29, 17%). A small set of studies (10/29, 34%) explicitly mentioned how data security and privacy were addressed. Most of the reported evaluation protocols were pilot studies (11/29, 38%), followed by randomized controlled trials (10/29, 34%), and the reported results were positive in terms of acceptability, usability, and efficacy. However, more research is needed to assess long-term effects.

Conclusions

Given the increasing interest in the use of serious games as digital interventions to support the prevention or treatment of substance use, knowing their main features is highly important. This review highlights whether and how current serious games incorporate 7 key features that are useful to consider for the further development of the area.

[Technology-based interventions for alcohol prevention among children and adolescents]

BACKGROUND

Early onset and excessive alcohol use in childhood and adolescence is associated with an elevated risk of experiencing short-, mid-, and long-term negative consequences caused by, e.g., accidents, violent acts, and conflicts. Face-to-face prevention approaches show significant effects on the reduction of alcohol use. However, service utilization is often low among children and adolescents. Technology-based alcohol prevention has the potential to reach this target group with potentially cost-effective, standardized, and low-threshold measures.

AIM AND METHOD

This narrative review provides an overview of different approaches of technology-based interventions for the prevention and early intervention of risky alcohol use among children and adolescents, their effectiveness, and settings for implementation.

RESULTS

Technology-based alcohol prevention can be implemented in a variety of settings, e.g., school, community, primary care, or hospital. Implementation is often realized via websites with or without embedding face-to-face modules, apps, or SMS messages. While the cumulative evidence of the effectiveness of technology-based alcohol prevention is strong for adults and young adults, evidence for the effectiveness among children and adolescents is heterogeneous.

DISCUSSION

Technology-based alcohol prevention has great theoretical potential with regards to reach, cost-effectiveness, and user engagement. Study replications are needed and evaluations of the effects of single elements, such as the individualization of content, user engagement through multiple contacts, and the use of multimedia elements and functions, should be addressed by future research.

Implementation and Evaluation of a Text Message-Based Addiction Counseling Program (Text4Hope-Addiction Support): Protocol for a Questionnaire Study

Background

With the emergence of the COVID-19 pandemic, providing counseling to people with drug or alcohol addiction while maintaining physical distance has been challenging. This protocol describes the use of text messaging (as used in the Text4Hope-Addiction Support program) as a convenient, evidence-based, cost-effective, and accessible population-level mental health intervention with high user satisfaction proven in prior research.

Objective

The project goal is to implement a program of daily supportive text messaging (Text4Hope-Addiction Support) to reduce drug or alcohol cravings as well as anxiety and depression, typically associated with alcohol and substance use disorders. The aim of this study is to evaluate the prevalence of cravings, anxiety, and depressive symptoms; demographic correlates of the same; and the outcomes of the Text4Hope-Addiction Support intervention in mitigating cravings, anxiety, and depressive symptoms.

Methods

Self-administered, anonymous, online questionnaires will be used to assess cravings for the primary substance of addiction (Brief Substance Craving Scale), anxiety (Generalized Anxiety Disorder-7), and depressive symptoms (Patient Health Questionnaire-9). Data will be collected at baseline (onset of receiving text messages), program midpoint (6 weeks), and program end (12 weeks).

Results

As of October 2020, data collection is in progress; and it is expected to be completed by fall 2021. Data analysis will include parametric and nonparametric techniques, focusing on primary outcomes (ie, cravings, anxiety, and depressive symptoms) and metrics of use, including the number of subscribers and user satisfaction.

Conclusions

This Text4Hope-Addiction Support project will provide key information regarding the prevalence rates of cravings, anxiety, and depressive symptoms among persons with alcohol and substance use disorders; demographic correlates of cravings, anxiety, and depression; and outcome data related to this scalable population-level intervention. Information from this study will be valuable for addiction care practitioners; it will inform the policy and decision making regarding population-level addiction treatment and support during emergencies.

International Registered Report Identifier (IRRID)

DERR1-10.2196/22047

Ethische Aspekte internet- und mobilgestützter Interventionen (IMIs) bei Suchtstörungen

Ziel der Studie Internet- und mobilgestützte Interventionen (IMIs) werden häufig bei Suchtstörungen eingesetzt. Für die Wirksamkeit von IMIs liegt eine umfangreiche Evidenz vor. Hinsichtlich der spezifischen ethischen Aspekte, die sich aus dem Einsatz von IMIs bei Suchtstörungen ergeben, fehlt es bislang an Forschung. Mit unserem Beitrag leisten wir die erste eingehende ethische Analyse von IMIs in der Suchttherapie. Dabei orientieren wir uns an normativen Aspekten, die spezifisch für die Behandlung von Suchtstörungen sind. Dazu gehören die besondere Stigmatisierung von Suchtkranken, die Zuschreibung von Schuld und Eigenverantwortung, die mangelnde Akzeptanz des Krankheitskonzepts Sucht sowie die daraus resultierende Ablehnung und Abwertung von Betroffenen.

Methode Als methodisches Instrument verwenden wir den 3 ACES-Ansatz von Thornicroft und Tansella. Dieses Instrument erlaubt eine umfassende ethische Analyse des Einsatzes von IMIs im konkreten Einzelfall sowie der Implementierung von IMIs im Versorgungssystem.

Ergebnisse Unsere Analyse zeigt, dass IMIs in der Suchttherapie das Potential haben, ein Empowerment von PatientInnen zu leisten, die Stigmatisierung zu umgehen und einen niedrigschwelligen Zugang zu Versorgungsleistungen zu ermöglichen. Kritisch zu sehen sind Aspekte der Passung von Anwendungen auf die Bedürfnisse einzelner Patientengruppen und individueller PatientInnen, der therapeutischen Verantwortung, des Datenschutzes, der Datensicherheit und Privatheit sowie der Vernetzung unterschiedlicher Anbieter von Versorgungsleistungen.

Schlussfolgerung Eine weitere Implementierung von IMIs in der Suchttherapie ist nur dann wünschenswert, wenn verbindliche Qualitätsstandards geschaffen und die patientenzentrierte Anwendung unter Berücksichtigung individueller Patientencharakteristika sichergestellt wird.

Consumer Health Information Technology in the Prevention of Substance Abuse: Scoping Review

BACKGROUND

Addiction is one of the most rapidly growing epidemics that currently plagues nations around the world. In the United States, it has cost the government more than US $700 billion a year in terms of health care and other associated costs and is also associated with serious social, physical, and mental consequences. Increasing efforts have been made to tackle this issue at different levels, from primary prevention to rehabilitation across the globe. With the use of digital technology rapidly increasing, an effort to leverage the consumer health information technologies (CHITs) to combat the rising substance abuse epidemic has been underway. CHITs are identified as patient-focused technological platforms aimed to improve patient engagement in health care and aid them in navigating the complex health care system.

OBJECTIVE

This review aimed to provide a holistic and overarching view of the breadth of research on primary prevention of substance abuse using CHIT conducted over nearly past five decades. It also aimed to map out the changing landscape of CHIT over this period.

METHODS

We conducted a scoping review using the Arksey and O'Malley's modified methodological framework. We searched 4 electronic databases (PubMed, Cochrane, Scopus, and EMBASE). Papers were included if the studies addressed the use of CHIT for primary prevention of substance abuse and were published in English between 1809 and 2018. Studies that did not focus solely on primary prevention or assessed additional comorbid conditions were eliminated.

RESULTS

Forty-two papers that met our inclusion criteria were included in the review. These studies were published between 1970 and 2018 and were not restricted by geography, age, race, or sex. The review mapped studies using the most commonly used CHIT platforms for substance abuse prevention from mass media in the 1970s to mobile and social media in 2018. Moreover, 191 studies that were exclusively focused on alcohol prevention were excluded and will be addressed in a separate paper. The studies included had diverse research designs although the majority were randomized controlled trials (RCT) or review papers. Many of the RCTs used interventions based on different behavioral theories such as family interactions, social cognitive theories, and harm-minimization framework.

CONCLUSIONS

This review found CHIT platforms to be efficacious and cost-effective in the real-world settings. We also observed a gradual shift in the types and use of CHIT platforms over the past few decades and mapped out their progression. In addition, the review detected a shift in consumer preferences and behaviors from face-to-face interactions to technology-based platforms. However, the studies included in this review only focused on the aspect of primary prevention. Future reviews could assess the effectiveness of platforms for secondary prevention and for prevention of substance abuse among comorbid populations.

Novel technologies in detection, treatment and prevention of substance use disorders

Substance use disorders are a widely recognized problem, which affects various levels of communities and influenced the world socioeconomically. Its source is deeply embedded in the global population. In order to fight against such an adversary, governments have spared no efforts in implementing substance abuse treatment centers and funding research to develop treatments and prevention procedures. In this review, we will discuss the use of immunological-based treatments and detection kit technologies. We will be detailing the steps followed to produce performant antibodies (antigens, carriers, and adjuvants) focusing on cocaine and methamphetamine as examples. Furthermore, part of this review is dedicated to substance use detection. Owing to novel technologies such as bio-functional polymeric surfaces and biosensors manufacturing, detection has become a more convenient method with the fast and on-site developed devices. Commercially available devices are able to test substance use disorders in urine, saliva, hair, and sweat. This improvement has had a tremendous impact on the prevention of driving under influence and other illicit behaviors. Lastly, substance abuse became a major issue involving the cooperation of experts on all levels to devise better treatment programs and prevent abuse-based accidents, injury and death.

People, processes, and systems: An observational study of the role of technology in rural youth mental health services

The merits of technology-based mental health service reform have been widely debated among academics, practitioners, and policy makers. The design of new technologies must first be predicated on a detailed appreciation of how the mental health system works before it can be improved or changed through the introduction of new products and services. Further work is required to better understand the nature of face-to-face mental health work and to translate this knowledge to computer scientists and system designers responsible for creating technology-based solutions. Intensive observation of day-to-day work within two rural youth mental health services in South Australia, Australia, was undertaken to understand how technology could be designed and implemented to enhance young people's engagement with services and improve their experience of help seeking. Data were analysed through a lens of complexity theory. Results highlight the variety of professional roles and services that can comprise the mental health system. The level of interconnectedness evident in the system contrasted with high levels of service self-organization and disjointed information flow. A mental health professional's work was guided by two main constructs: risk and engagement. Most clients presented with a profile of disability, disadvantage, and isolation, so complex client presentations and decision-making were core practices. Clients (and frequently, their families) engaged with services in a crisis-dependent manner, characterized by multiple disengagements and re-engagements over time. While significant opportunities exist to integrate technology into existing youth mental health services, technologies for this space must be usable for a broad range of medical, psychological and cognitive disability, social disadvantage, and accommodate repeat cycles of engagement/disengagement over time.

Technology-based Interventions for Preventing and Treating Substance Use Among Youth

Preventing or mitigating substance use among youth generally involves 3 different intervention frameworks: universal prevention, selective prevention, and treatment. Each of these levels of intervention poses unique therapeutic and implementation challenges. Technology-based interventions provide solutions to many of these problems by delivering evidence-based interventions in a consistent and cost-effective manner. This article summarizes the current state of the science of technology-based interventions for preventing substance use initiation and mitigating substance use and associated consequences among youth.