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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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Lang C, Weisel KK, Saur S, Fuhrmann LM, Schoenleber A, Reichl D, Enewoldsen N, Steins-Loeber S, Berking M. Support after return to alcohol use: a mixed-methods study on how abstinence motivation and app use change after return to alcohol use in an app-based aftercare intervention for individuals with alcohol use disorder. Addict Sci Clin Pract 2024; 19:35. [PMID: 38711152 PMCID: PMC11071226 DOI: 10.1186/s13722-024-00457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/25/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND As the return to alcohol use in individuals with alcohol use disorder (AUD) is common during treatment and recovery, it is important that abstinence motivation is maintained after such critical incidences. Our study aims to explore how individuals with AUD participating in an app-based intervention with telephone coaching after inpatient treatment perceived their abstinence motivation after the return to alcohol use, whether their app use behavior was affected and to identify helpful factors to maintain abstinence motivation. METHODS Using a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. The interviews were recorded, transcribed and coded using qualitative content analysis. App use behavior was additionally examined by using log data. RESULTS Of the ten interviewees, seven reported their abstinence motivation increased after the return to alcohol use. Reasons included the reminder of negative consequences of drinking, the desire to regain control of their situation as well as the perceived support provided by the app. App data showed that app use remained stable after the return to alcohol use with an average of 58.70 days of active app use (SD = 25.96, Mdn = 58.50, range = 24-96, IQR = 44.25) after the return to alcohol use which was also indicated by the participants' reported use behavior. CONCLUSIONS The findings of the study tentatively suggest that the app can provide support to individuals after the return to alcohol use to maintain and increase motivation after the incidence. Future research should (1) focus on specifically enhancing identification of high risk situations and reach during such critical incidences, (2) actively integrate the experience of the return to alcohol use into app-based interventions to better support individuals in achieving their personal AUD behavior change goals, and (3) investigate what type of support individuals might need who drop out of the study and intervention and discontinue app use altogether. TRIAL REGISTRATION The primary evaluation study is registered in the German Clinical Trials Register (DRKS, registration number DRKS00017700) and received approval of the ethical committee of the Friedrich-Alexander University Erlangen-Nuremberg (193_19 B).
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Affiliation(s)
- Catharina Lang
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany.
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Sebastian Saur
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Lukas M Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Antonie Schoenleber
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Daniela Reichl
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Niklas Enewoldsen
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
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Palfai TP, Morone NE, Kratzer MPL, Murray GE, Otis JD, Maisto SA, Rowland BHP. Mobile health intervention to address chronic pain among those who engage in hazardous drinking: A pilot study. Drug Alcohol Depend 2024; 256:111121. [PMID: 38367537 PMCID: PMC11056789 DOI: 10.1016/j.drugalcdep.2024.111121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/28/2024] [Accepted: 02/04/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Hazardous drinking has been associated with chronic pain in community and medical samples. The purpose of this study was to develop a novel, integrated mobile health intervention that improves pain management and reduces hazardous drinking that may be implemented in primary care settings. METHODS Forty-eight participants with moderate or greater chronic pain and hazardous drinking were recruited from primary care clinics and through social media sites. Following baseline assessment, participants were randomized to a counselor-supported smartphone app intervention (INTV) or a counselor delivered treatment-as-usual control condition (CTL). RESULTS Results supported the feasibility and acceptability of the smartphone app intervention. Participants found it easy to use, reported high levels of satisfaction, and showed high levels of engagement with the app. Between-group effect size estimates at follow-up showed small effects for the intervention on pain ratings. However, using clinically meaningful change thresholds of 30% and 50% improvement in pain scores, 38% and 25% respectively of those in the INTV condition showed reductions compared to 20% and 12.5% respectively in the CTL condition. Effect size estimates did not indicate intervention superiority on alcohol outcomes as participants in both conditions showed considerable reductions in drinking over the course of the study. CONCLUSIONS Results supported the view that a mobile health intervention delivered via smartphone with electronic coaching is a feasible and acceptable method of addressing chronic pain among those who engage in hazardous drinking. Future work should test the efficacy of this approach in a fully powered trial.
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Affiliation(s)
- Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA.
| | - Natalia E Morone
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA
| | - Maya P L Kratzer
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
| | - Grace E Murray
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
| | - John D Otis
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, 801 430 Huntington Hall, Syracuse NY 13210, USA
| | - Bonnie H P Rowland
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
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Johansson M, Romero D, Jakobson M, Heinemans N, Lindner P. Digital interventions targeting excessive substance use and substance use disorders: a comprehensive and systematic scoping review and bibliometric analysis. Front Psychiatry 2024; 15:1233888. [PMID: 38374977 PMCID: PMC10875034 DOI: 10.3389/fpsyt.2024.1233888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/08/2024] [Indexed: 02/21/2024] Open
Abstract
Addictive substances are prevalent world-wide, and their use presents a substantial and persistent public health problem. A wide range of digital interventions to decrease use and negative consequences thereof have been explored, differing in approach, theoretical grounding, use of specific technologies, and more. The current study was designed to comprehensively map the recent (2015-2022) extant literature in a systematic manner, and to identify neglected and emerging knowledge gaps. Four major databases (Medline, Web of Science Core Collection, and PsychInfo) were searched using database-specific search strategies, combining terms related to clinical presentation (alcohol, tobacco or other drug use), technology and aim. After deduplication, the remaining n=13,917 unique studies published were manually screened in two stages, leaving a final n=3,056 studies, the abstracts of which were subjected to a tailored coding scheme. Findings revealed an accelerating rate of publications in this field, with randomized trials being the most common study type. Several meta-analyses on the topic have now been published, revealing promising and robust effects. Digital interventions are being offered on numerous levels, from targeted prevention to specialized clinics. Detailed coding was at times made difficult by inconsistent use of specific terms, which has important implications for future meta-analyses. Moreover, we identify several gaps in the extant literature - few health economic assessments, unclear descriptions of interventions, weak meta-analytic support for some type of interventions, and limited research on many target groups, settings and new interventions like video calls, chatbots and artificial intelligence - that we argue are important to address in future research.
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Affiliation(s)
- Magnus Johansson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Center for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Danilo Romero
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Center for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Miriam Jakobson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Center for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Nelleke Heinemans
- Center for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Philip Lindner
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Center for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Holtz BE, Mitchell K. Best Practices for Developing a Diabetes mHealth App. J Diabetes Sci Technol 2024; 18:39-45. [PMID: 37644831 PMCID: PMC10899849 DOI: 10.1177/19322968231195849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The widespread use of smartphones in the United States has led to a surge in mHealth apps designed to support people with various health issues. Yet the effectiveness and long-term impacts of these apps still need to be determined. This article presents a case study of the development of MyT1DHero, an mHealth app for people with type 1 diabetes, to identify best practices for app development. We propose four essential best practices based on the insights gained from this case study: incorporating theoretical frameworks, prioritizing user feedback, engaging key stakeholders, and establishing a robust data-collection foundation. These findings have practical implications for researchers and developers seeking to create effective mHealth interventions. Furthermore, we suggest future research directions to advance the development and implementation of innovative health technologies.
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Affiliation(s)
- Bree E. Holtz
- Department of Advertising and
Public Relations, Michigan State University, East Lansing, MI, USA
| | - Katharine Mitchell
- Department of Advertising and
Public Relations, Michigan State University, East Lansing, MI, USA
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Campbell ANC, Rieckmann T, Pavlicova M, Choo TH, Molina K, McDonell M, West AE, Daw R, Marsch LA, Venner KL. Culturally tailored digital therapeutic for substance use disorders with urban Indigenous people in the United States: A randomized controlled study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209159. [PMID: 37690525 PMCID: PMC10872747 DOI: 10.1016/j.josat.2023.209159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/15/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Indigenous people experience health disparities, including higher rates of substance use disorders (SUDs). Digital therapeutics are a growing platform for treatment services and have the potential to expand access to culturally responsive interventions for Indigenous people. As one of the first randomized controlled trials for SUDs for American Indian and Alaska Native (AI/AN) adults, the aim of this study was to pilot test the efficacy of a culturally tailored intervention among urban Indigenous adults. METHODS The study used a randomized controlled parallel design of 12 weeks of treatment-as-usual (TAU) (n = 26) versus TAU + Therapeutic Education System-Native Version (TES-NAV) (n = 27) with follow-up assessments at end of treatment and week 24 in an urban outpatient addiction treatment program for Native American adults. TAU consisted of individual/group counseling and cultural activities. The TES-NAV arm comprised TAU + 26 self-directed culturally tailored digital skills-based modules grounded in the community reinforcement approach with contingency management for abstinence and module completion. Primary outcome was longest consecutive weeks of abstinence from drugs and heavy drinking measured using self-report (Timeline Followback) and urine alcohol and drug toxicology screen during 12 weeks of treatment. Secondary outcomes were percent days abstinence during and posttreatment, coping strategies, social connectedness, and substance use and sexual risk behaviors. RESULTS The study enrolled fifty-three (52.8 % male) AI/AN adults seeking treatment for a SUD. Although the study did not detect a benefit of TAU+TES-NAV over TAU on the primary outcome (Median = 2 consecutive weeks of abstinence for both arms) at end of treatment (treatment effect: Z = -0.78, p = 0.437), TAU+TES-NAV participants did demonstrate significantly greater percent days of abstinence at the week 24 follow-up (69.3 % versus 49.0 % for TAU; t = 2.08, p = 0.045) and significantly greater change in social connectedness mean score, baseline to week 12 (Z = -2.66, p = 0.011), compared to TAU. The study detected no differences between treatment arms for coping strategies or risk behaviors. CONCLUSION The addition of TES-NAV to TAU did not significantly improve consecutive weeks of abstinence from drugs or heavy drinking; however, several secondary findings suggest promise for a culturally tailored digital therapeutic SUD intervention among urban Indigenous people. CLINICAL TRIALS GOV REGISTRATION: #NCT03363256.
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Affiliation(s)
- Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive Box 120, New York, NY 10032, USA.
| | - Traci Rieckmann
- School of Medicine, Oregon Health & Science University, 3015 NE 44th Ave, Portland, OR 97213, USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168th St, 6th floor, Room 635, New York, NY 10032, USA
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive Box 120, New York, NY 10032, USA
| | - Kelly Molina
- Native American Rehabilitation Association of the Northwest, Inc., 1631 SW Columbia St, Portland, OR 97201, USA
| | - Michael McDonell
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA 99202, USA
| | - Amy E West
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4640 W. Sunset Blvd, Los Angeles, CA 90027, USA
| | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd, Hanover, NH 03755, USA
| | - Kamilla L Venner
- Department of Psychology and Center on Alcohol Substance use & Addiction (CASAA), University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131, USA
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Donato S, Ray LA. Neurobiology and the Treatment of Alcohol Use Disorder: A Review of the Evidence Base. Subst Abuse Rehabil 2023; 14:157-166. [PMID: 38026786 PMCID: PMC10657770 DOI: 10.2147/sar.s409943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Alcohol use disorder (AUD) is a significant public health concern, accounting for a majority of substance use disorder cases in the United States. Treatment for AUD is complex, with multiple intervention points that may be further complicated by genotype and phenotype, resulting in diverse outcomes. In order to better understand the current landscape of AUD treatment, the present review considers different etiological models of AUD and assesses the evidence base of current treatment options. The first section of this review summarizes various etiological models of AUD and presents different approaches to classifying the disorder. Various theories, including neurobiological models, are discussed. The second section presents a comprehensive analysis of available treatment options for AUD, encompassing behavioral and pharmacological interventions and their current evidence base. Finally, this review discusses the ongoing treatment gap and significant factors contributing to low treatment utilization. Together, this review provides an overview of different etiological processes and mechanisms of AUD, as well as summarizes the literature on key treatment approaches. By integrating historical, theoretical, and empirical data, this review aims to inform both researchers and providers with valuable insights to advance AUD treatment approaches and narrow the treatment gap.
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Affiliation(s)
- Suzanna Donato
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Brain Research Institute, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Edelman EJ, Rojas-Perez OF, Nich C, Corvino J, Frankforter T, Gordon D, Jordan A, Paris M, Weimer MB, Yates BT, Williams EC, Kiluk BD. Promoting alcohol treatment engagement post-hospitalization with brief intervention, medications and CBT4CBT: protocol for a randomized clinical trial in a diverse patient population. Addict Sci Clin Pract 2023; 18:55. [PMID: 37726823 PMCID: PMC10510167 DOI: 10.1186/s13722-023-00407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/15/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) commonly causes hospitalization, particularly for individuals disproportionately impacted by structural racism and other forms of marginalization. The optimal approach for engaging hospitalized patients with AUD in treatment post-hospital discharge is unknown. We describe the rationale, aims, and protocol for Project ENHANCE (ENhancing Hospital-initiated Alcohol TreatmeNt to InCrease Engagement), a clinical trial testing increasingly intensive approaches using a hybrid type 1 effectiveness-implementation approach. METHODS We are randomizing English and/or Spanish-speaking individuals with untreated AUD (n = 450) from a large, urban, academic hospital in New Haven, CT to: (1) Brief Negotiation Interview (with referral and telephone booster) alone (BNI), (2) BNI plus facilitated initiation of medications for alcohol use disorder (BNI + MAUD), or (3) BNI + MAUD + initiation of computer-based training for cognitive behavioral therapy (CBT4CBT, BNI + MAUD + CBT4CBT). Interventions are delivered by Health Promotion Advocates. The primary outcome is AUD treatment engagement 34 days post-hospital discharge. Secondary outcomes include AUD treatment engagement 90 days post-discharge and changes in self-reported alcohol use and phosphatidylethanol. Exploratory outcomes include health care utilization. We will explore whether the effectiveness of the interventions on AUD treatment engagement and alcohol use outcomes differ across and within racialized and ethnic groups, consistent with disproportionate impacts of AUD. Lastly, we will conduct an implementation-focused process evaluation, including individual-level collection and statistical comparisons between the three conditions of costs to providers and to patients, cost-effectiveness indices (effectiveness/cost ratios), and cost-benefit indices (benefit/cost ratios, net benefit [benefits minus costs). Graphs of individual- and group-level effectiveness x cost, and benefits x costs, will portray relationships between costs and effectiveness and between costs and benefits for the three conditions, in a manner that community representatives also should be able to understand and use. CONCLUSIONS Project ENHANCE is expected to generate novel findings to inform future hospital-based efforts to promote AUD treatment engagement among diverse patient populations, including those most impacted by AUD. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05338151.
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Affiliation(s)
- E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, ES Harkness Memorial Hall, Suite 401, New Haven, CT, 06510, USA.
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA.
- Department of Social and Behavioral Sciences, Yale School of Medicine, New Haven, CT, USA.
| | | | - Charla Nich
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Joanne Corvino
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Tami Frankforter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Derrick Gordon
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- The Consultation Center, New Haven, CT, USA
| | - Ayana Jordan
- Department of Psychiatry, NYU Langone Health, New York, NY, USA
| | - Manuel Paris
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Hispanic Clinic, Connecticut Mental Health Center, New Haven, CT, USA
| | - Melissa B Weimer
- Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, ES Harkness Memorial Hall, Suite 401, New Haven, CT, 06510, USA
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Brian T Yates
- Department of Psychology, American University, Washington, DC, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Health Services Research and Development Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration (VA), Seattle, WA, USA
| | - Brian D Kiluk
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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9
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Stüben N, Franke AG, Soyka M. Evaluation of a Primary E-Health Intervention for People with Alcohol Use Disorder: Clinical Characteristics of Users and Efficacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6514. [PMID: 37569054 PMCID: PMC10418680 DOI: 10.3390/ijerph20156514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/12/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023]
Abstract
In Germany, only about 10% of patients with alcohol use disorder (AUD) are treated by the professional help system. "The First 30 Days without Alcohol", an interactive e-health intervention, was developed to support people with "alcohol problems" to abstain from alcohol. The aim of this study was to examine the feasibility of the approach, the program's target group, if and why it is effective. In March 2022 an email was sent to all users who had completed the program. A link to a web-based survey regarding the target group's characteristics, its alcohol-use patterns, former attempts to change the problematic drinking behavior and experience with the program was introduced. The Alcohol Use Disorders Identification Test (AUDIT) was used prior and post intervention. A total of 718 participants completed the questionnaire. Of these, 99.2% suffered from AUD; 81.6% of participants were females, and about one third reported some form of psychiatric comorbidity; 46.6% did not use any additional help or assistance apart from the program; 78.3% reported to be abstinent after participation in the 30-day program, and the data show a significant AUDIT score reduction. Primary e-health interventions may contribute to the established addiction-help system. The intervention seems to reach predominantly highly educated and high-functioning females because of their characteristics.
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Affiliation(s)
- Nathalie Stüben
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig Maximilian University of Munich, Nußbaumstr. 7, 80336 Munich, Germany;
| | - Andreas Guenter Franke
- University of Applied Labour Studies, Seckenheimer Landstr. 16, 68163 Mannheim, Germany;
| | - Michael Soyka
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig Maximilian University of Munich, Nußbaumstr. 7, 80336 Munich, Germany;
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10
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Boness CL, Votaw VR, Schwebel FJ, Moniz-Lewis DI, McHugh RK, Witkiewitz K. An Evaluation of Cognitive Behavioral Therapy for Substance Use Disorder: A Systematic Review and Application of the Society of Clinical Psychology Criteria for Empirically Supported Treatments. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2023; 30:129-142. [PMID: 37840853 PMCID: PMC10572095 DOI: 10.1037/cps0000131] [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] [Indexed: 10/17/2023]
Abstract
Cognitive behavioral therapy (CBT) is a commonly used treatment for substance use disorders (SUDs) but has not been evaluated using the American Psychological Association's "Tolin Criteria" for determining the empirical basis of psychological treatments. The current systematic review evaluated five meta-analyses of CBT for SUD. One meta-analysis had sufficient quality to be considered in the evaluation of effect sizes. CBT produced small to moderate effects on substance use when compared to inactive treatment and was most effective at early follow-up (1-6 months post-treatment) compared to late follow-up (8+ months post-treatment). Sensitivity analyses including all five meta-analyses found similar results. A "strong recommendation" was provided for CBT as an empirically supported treatment for SUD, based on effects on substance use, quality of evidence, and consideration of contextual factors (e.g., efficacy in diverse populations).
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Affiliation(s)
- Cassandra L. Boness
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico
| | - Victoria R. Votaw
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico
- Department of Psychology, University of New Mexico
| | - Frank J. Schwebel
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico
| | | | | | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico
- Department of Psychology, University of New Mexico
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11
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Eysenbach G, Quintana Y. Social Media is Addictive and Influences Behavior: Should it Be Regulated as a Digital Therapeutic? J Med Internet Res 2023; 25:e43174. [PMID: 36701180 PMCID: PMC9912146 DOI: 10.2196/43174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 01/27/2023] Open
Abstract
Recently, we were deeply saddened by the findings of the coroner investigating the death of 14-year-old Molly Russell. Deeply saddened and angry but not surprised. This case should be seen as a sentinel event, given that this is the first time social media was directly implicated as a cause of death. We should use this opportunity to advance proposals for the regulations of the health effects of social media.
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Affiliation(s)
| | - Yuri Quintana
- Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States.,Homewood Research Institute, Guelph, ON, Canada
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12
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Chen H, Feng J, Chen L, Huang J, Zhang P, Chen C, Lu L, Tang C. Acupoint stimulation for alcohol use disorder: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e32614. [PMID: 36607868 PMCID: PMC9829291 DOI: 10.1097/md.0000000000032614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND To assess the effect of acupoint stimulation for Alcohol use disorders (AUD). METHODS AUD is a complex disease that threatens the health of the global population. Acupoint stimulation, a sort of therapy applying stimulation on acupoints to produce a therapeutic effect without side effects, has been widely used in AUD patients, but its efficacy remains controversial. Electronic databases (the Cochrane Library, EMBASE, PubMed, CNKI, VIP, Wan-Fang) were systematically searched for randomized controlled trials (RCTs) on acupoint stimulation for AUD from database inception to September 30, 2022. A meta-analysis was performed using Review Manager 5.4 software. Continuous data (scales) were expressed as mean differences (MDs) or standardized mean difference (SMD) with 95% confidence intervals (95% CI). Study methodological quality was assessed according to the Cochrane risk-of-bias tool for trials. The grading of recommendations assessment, development and evaluation was used to assess the certainty of evidence for outcomes. RESULTS A total of 16 RCTs with 1097 participants were included. Compared to psychotherapy or drug therapy alone, the combination of acupoint stimulation and other sorts of therapies presented advantages in alleviating alcohol craving (SMD = -1.09, 95% CI = -1.40 to -0.77, df = 2, P < .00001, grading of recommendations assessment, development and evaluation very low certainty), (SMD = -2.25, 95% CI = -3.17 to -1.34, df = 3, P < .00001, low certainty) and the severity of alcohol withdrawal symptoms (MD = -1.21, 95% CI = -2.32 to -0.1, df = 2, P = .03, low certainty), as well as improving anxiety (MD = -3.41, 95% CI = -4.06 to -2.76, df = 4, P < .00001, very low certainty) and depression levels (MD = -3.27, 95% CI = -4.92 to -1.62, df = 4, P = .0001, very low certainty) on patients with AUD. In addition, a greater effect was also found with the 4-week treatment courses in reducing craving (SMD = -2.18, 95% CI = -2.61 to -1.75, P < .00001, low certainty). CONCLUSION Acupoint stimulation and its combined therapy may better relieve AUD symptoms effectively and the treatment duration should be set at more than 2 weeks. However, due to the low-quality of the included RCTs, high-quality studies are needed to further confirm it in the future.
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Affiliation(s)
- Huishan Chen
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, University Town, Panyu District, Guangzhou City, Guangdong Province, China
| | - Jiaxin Feng
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, University Town, Panyu District, Guangzhou City, Guangdong Province, China
| | - Li Chen
- Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, University Town, Panyu District, Guangzhou City, Guangdong Province, China
| | - Jiarong Huang
- Fuzhou Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine, Gulou District, Fuzhou City, Fujian Province, China
| | - Peiming Zhang
- Clinical Research and Big Data Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, University Town, Panyu District, Guangzhou City, Guangdong Province, China
| | - Chen Chen
- Clinical Research and Big Data Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, University Town, Panyu District, Guangzhou City, Guangdong Province, China
| | - Liming Lu
- Clinical Research and Big Data Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, University Town, Panyu District, Guangzhou City, Guangdong Province, China
| | - Chunzhi Tang
- Clinical Research and Big Data Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, University Town, Panyu District, Guangzhou City, Guangdong Province, China
- * Correspondence: Chunzhi Tang, Clinical Research and Big Data Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, University Town, Xiaoguwei Street, Panyu District, Guangzhou City, Guangdong Province 3215, China (e-mail )
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13
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Stüben N, Franke AG, Soyka M. [Acceptance and use of web-based interventions for alcohol abstinence]. DER NERVENARZT 2023; 94:1-7. [PMID: 36098784 PMCID: PMC9468517 DOI: 10.1007/s00115-022-01385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION In Germany, the prevalence rates for alcohol use disorders amount to approx. 6%, while about 3% are diagnosed as being alcohol dependent. Only 10% of the patients are undergoing treatment. There are apparent deficits with respect to early interventions. The internet presence of "Ohne Alkohol mit Nathalie" (OAmN) (Abstinence with Nathalie) ameliorates options for early treatment interventions using a web-based design; however, this intervention has not been evaluated to date, especially with respect to previous treatments. METHODS Over a 4-week period, 4 different channels of OAmN posted announcements for a survey participation introducing a link leading to a web-based survey questionnaire on the domain oamn.jetzt. The questionnaire offered open and closed as well as multiple choice questions regarding alcohol use patterns and attempts to change the problematic drinking behavior. RESULTS Out of 2022 participants 84.3% (n = 1705) stated to have or have had a problem with alcohol use, 17.7% (n = 302) had a diagnosis of alcohol dependence by a physician or psychologist and only 21% (n = 529) had been in therapy before. The majority of responders (85.5%, n = 1457) had stopped alcohol use before participating in the survey. Most of them (48.5%, n = 705) were assisted by OAmN, 97.5% (n = 1662) had been employed while having the abovementioned problem use of alcohol, 34.3% (n = 570) rated their job performance as "very good" and 43.2% (n = 718) as "good". DISCUSSION This pilot study revealed that OAmN can reach people affected by problematic drinking behavior who had not been in contact with the professional medical system for addiction treatment despite having a problematic alcohol use combined with the willingness to quit.
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Affiliation(s)
- Nathalie Stüben
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, Nußbaumstr. 7, 80336 München, Deutschland ,Nathalie Stüben GmbH, Spinnereiinsel 3a, 83059 Kolbermoor, Deutschland
| | - Andreas G. Franke
- Hochschule der Bundesagentur für Arbeit, Seckenheimer Landstr. 16, 68163 Mannheim, Deutschland
| | - Michael Soyka
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, Nußbaumstr. 7, 80336 München, Deutschland
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14
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Magill M, Kiluk BD, Ray LA. Efficacy of Cognitive Behavioral Therapy for Alcohol and Other Drug Use Disorders: Is a One-Size-Fits-All Approach Appropriate? Subst Abuse Rehabil 2023; 14:1-11. [PMID: 36844999 PMCID: PMC9948631 DOI: 10.2147/sar.s362864] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/28/2023] [Indexed: 02/20/2023] Open
Abstract
Purpose We provide an overview of Cognitive Behavioral Therapy (CBT) efficacy for adult alcohol or other drug use disorders (AOD) and consider some key variations in application as well as contextual (ie, moderators) or mechanistic (ie, mediators) factors related to intervention outcomes. Methods This work is a narrative overview of the review literature on CBT for AOD. Results Robust evidence suggests the efficacy of classical/traditional CBT compared to minimal and usual care control conditions. CBT combined with another evidence-based treatment such as Motivational Interviewing, Contingency Management, or pharmacotherapy is also efficacious compared to minimal and usual care control conditions, but no form of CBT consistently demonstrates efficacy compared to other empirically-supported modalities. CBT and integrative forms of CBT have potential for flexible application such as use in a digital format. Data on mechanisms of action, however, are quite limited and this is despite preliminary evidence that shows that CBT effect sizes on mechanistic outcomes (ie, secondary measures of psychosocial adjustment) are moderate and typically larger than those for AOD use. Conclusion CBT for AOD is a well-established intervention with demonstrated efficacy, effect sizes are in the small-to-moderate range, and there is potential for tailoring given the modular format of the intervention. Future work should consider mechanisms of CBT efficacy and key conditions for dissemination and implementation with fidelity.
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Affiliation(s)
- Molly Magill
- Brown University Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
- Correspondence: Molly Magill, Brown University Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box-G-S121-5, Providence, RI, 02913, USA, Email
| | - Brian D Kiluk
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Lara A Ray
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA
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15
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Abstract
Alcohol is one of the most widely consumed psychoactive drugs globally. Hazardous drinking, defined by quantity and frequency of consumption, is associated with acute and chronic morbidity. Alcohol use disorders (AUDs) are psychiatric syndromes characterized by impaired control over drinking and other symptoms. Contemporary aetiological perspectives on AUDs apply a biopsychosocial framework that emphasizes the interplay of genetics, neurobiology, psychology, and an individual's social and societal context. There is strong evidence that AUDs are genetically influenced, but with a complex polygenic architecture. Likewise, there is robust evidence for environmental influences, such as adverse childhood exposures and maladaptive developmental trajectories. Well-established biological and psychological determinants of AUDs include neuroadaptive changes following persistent use, differences in brain structure and function, and motivational determinants including overvaluation of alcohol reinforcement, acute effects of environmental triggers and stress, elevations in multiple facets of impulsivity, and lack of alternative reinforcers. Social factors include bidirectional roles of social networks and sociocultural influences, such as public health control strategies and social determinants of health. An array of evidence-based approaches for reducing alcohol harms are available, including screening, pharmacotherapies, psychological interventions and policy strategies, but are substantially underused. Priorities for the field include translating advances in basic biobehavioural research into novel clinical applications and, in turn, promoting widespread implementation of evidence-based clinical approaches in practice and health-care systems.
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16
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Kelemen A, Minarcik E, Steets C, Liang Y. Telehealth interventions for alcohol use disorder: A systematic review. LIVER RESEARCH 2022. [DOI: 10.1016/j.livres.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Lohoff FW. Targeting Unmet Clinical Needs in the Treatment of Alcohol Use Disorder. Front Psychiatry 2022; 13:767506. [PMID: 35757224 PMCID: PMC9218222 DOI: 10.3389/fpsyt.2022.767506] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Alcohol Use Disorder (AUD) is a chronic psychiatric disorder marked by impaired control over drinking behavior that poses a significant challenge to the individual, their community, the healthcare system and economy. While the negative consequences of chronic excessive alcohol consumption are well-documented, effective treatment for AUD and alcohol-associated diseases remains challenging. Cognitive and behavioral treatment, with or without pharmaceutical interventions, remain the most commonly used methods; however, their efficacy is limited. The development of new treatment protocols for AUD is challenged by difficulty in accurately measuring patterns of alcohol consumption in AUD patients, a lack of a clear understanding of the neuropsychological basis of the disorder, the high likelihood of AUD patients relapsing after receiving treatment, and the numerous end-organ comorbidities associated with excessive alcohol use. Identification and prediction of patients who may respond well to a certain treatment mechanism as well as clinical measurement of a patient's alcohol exposure are bottlenecks in AUD research which should be further addressed. In addition, greater focus must be placed on the development of novel strategies of drug design aimed at targeting the integrated neural pathways implicated in AUD pathogenesis, so that next-generation AUD treatment protocols can address the broad and systemic effects of AUD and its comorbid conditions.
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Affiliation(s)
- Falk W. Lohoff
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, United States
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18
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Philippe TJ, Sikder N, Jackson A, Koblanski ME, Liow E, Pilarinos A, Vasarhelyi K. Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review. JMIR Ment Health 2022; 9:e35159. [PMID: 35551058 PMCID: PMC9109782 DOI: 10.2196/35159] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. OBJECTIVE To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. METHODS We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. RESULTS Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. CONCLUSIONS Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.
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Affiliation(s)
- Tristan J Philippe
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | | | - Anna Jackson
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
| | - Maya E Koblanski
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Eric Liow
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andreas Pilarinos
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Krisztina Vasarhelyi
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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19
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Vangrunderbeek A, Raveel A, Matheï C, Claeys H, Aertgeerts B, Bekkering G. Effectiveness of guided and unguided online alcohol help: A real-life study. Internet Interv 2022; 28:100523. [PMID: 35330980 PMCID: PMC8938279 DOI: 10.1016/j.invent.2022.100523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/18/2022] [Accepted: 03/09/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Online interventions reduce the treatment gap between the number of people with alcohol misuse and people who actually receive help. This study investigated the effectiveness and predictors of success of a Belgian online help programme. METHODS A real-life retrospective open cohort study evaluating the guided and unguided internet intervention on the Belgian online platform alcoholhulp.be. The intervention consisted of a 12-week programme based upon cognitive behaviour therapy, motivational interviewing and acceptance and commitment therapy. Inclusion criteria are age above 18 years, recording of alcohol consumption in the daily journal for at least 2 weeks, and minimum 2 chat sessions in the guided group.Outcomes were weekly alcohol consumption after 6 and 12 weeks and treatment response (drinking less than 10 or 20 standard units (SU) per week). Additional analysis was done on predictors of success. RESULTS A total of 460 participants in the guided group and 968 in the self-help group met the inclusion criteria. Average baseline alcohol consumption in the two groups was 40 SU per week. Alcohol consumption decreased by 31 SU (Cohen's d 1.17, p < 0.001) after 12 weeks in the guided group and 23 SU (Cohen's d 0.83, p < 0.001) in the self-help group. The treatment response below 20 SU per week was 88% for the guided group and 73% for the self-help group. Significantly better results were obtained in the guided group compared to the self-help group (p < 0.005). Participants with a higher baseline alcohol consumption had a higher decrease in alcohol consumption in both groups. The personal goal to quit, the absence of drug use, a lower baseline alcohol consumption and a higher number of completed assignments predict a higher chance of treatment response. Attrition at 6 weeks was 26% in the guided group and 63% in the self-help group and increased to 59% and 82% respectively at 12 weeks. CONCLUSIONS Both guided and unguided internet interventions are effective in reducing alcohol consumption and achieving the guideline for participants motivated to use the platform on a regular base, with better results in guided intervention.
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Affiliation(s)
- Ans Vangrunderbeek
- Academic Centre for General Practice, KU Leuven, Kapucijnenvoer 7 bus 7001 blok h, 3000 Leuven, Belgium
| | - Ann Raveel
- Academic Centre for General Practice, KU Leuven, Kapucijnenvoer 7 bus 7001 blok h, 3000 Leuven, Belgium
| | - Catharina Matheï
- Academic Centre for General Practice, KU Leuven, Kapucijnenvoer 7 bus 7001 blok h, 3000 Leuven, Belgium
| | - Herwig Claeys
- Zorggroep Zin (Centre for Mental Health and Addiction), Salvatorstraat 25, 3500 Hasselt, Belgium
| | - Bert Aertgeerts
- Academic Centre for General Practice, KU Leuven, Kapucijnenvoer 7 bus 7001 blok h, 3000 Leuven, Belgium
| | - Geertruida Bekkering
- Academic Centre for General Practice, KU Leuven, Kapucijnenvoer 7 bus 7001 blok h, 3000 Leuven, Belgium,Corresponding author.
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20
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Muncie HL, Anderson II G, Oge L. Care of the Alcoholic Patient. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Glass JE, Tiffany B, Matson TE, Lim C, Gundersen G, Kimbel K, Hartzler AL, Curran GM, McWethy AG, Caldeiro RM, Bradley KA. Approaches for implementing digital interventions for alcohol use disorders in primary care: A qualitative, user-centered design study. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221135264. [PMID: 37091101 PMCID: PMC9924279 DOI: 10.1177/26334895221135264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Digital interventions, such as smartphone apps, can be effective in treating alcohol use disorders (AUD). However, efforts to integrate digital interventions into primary care have been challenging. To inform successful implementation, we sought to understand how patients and clinicians preferred to use apps in routine primary care. Methods This study combined user-centered design and qualitative research methods, interviewing 18 primary care patients with AUD and nine primary care clinicians on topics such as prior experiences with digital tools, and design preferences regarding approaches for offering apps for AUD in primary care. Interviews were recorded and transcribed for template analysis whereby a priori codes were based on interview topics and refined through iterative coding. New codes and cross-cutting themes emerged from the data. Results Patient participants with AUD indicated they would be more likely to engage in treatment if primary care team members were involved in their use of apps. They also preferred to see clinicians “invested” and recommended that clinicians ask about app use and progress during follow-up appointments or check-ins. Clinician participants valued the opportunity to offer apps to their patients but noted that workflows would need to be tailored to individual patient needs. Time pressures, implementation complexity, and lack of appropriate staffing were cited as barriers. Clinicians proposed concrete solutions (e.g., education, tools, and staffing models) that could improve their ability to use apps within the constraints of primary care and suggested that some patients could potentially use apps without clinician support. Conclusions A user-centered approach to engaging patients in digital alcohol interventions in primary care may require personalized support for both initiation and follow-up. Meeting patients’ needs likely require increased staffing and efficient workflows in primary care. Health systems should consider offering multiple pathways for enrolling patients in apps to accommodate individual preferences and contextual barriers. Plain Language Summary Healthcare systems have begun using app-based treatments to help patients manage their health conditions, including alcohol use disorders. Some apps have been tested in research studies and appear to be effective. However, it is difficult for healthcare teams to offer apps to patients. Clinicians must engage in new activities that they have not done before, such as “teaching” patients to use apps and checking in on their use of the apps. Identifying how to use apps in routine healthcare is critical to their successful implementation. This study interviewed 27 people, including healthcare providers and patients in primary care, to uncover the most optimal ways to offer apps to patients with alcohol use disorders. The interviews combined the use of qualitative research methods and user-centered design. Results suggest that to use to address alcohol use disorders, primary care teams should be prepared to offer personalized support to patients. Both patient and clinician interviewees said that the steps required to use apps must be intuitive and simple. Patients could gain more benefits if clinicians introduced the apps and guided patients to use them, as opposed to making apps available for patients to download and use on their own. However, the exact approach to offering apps would depend on a given patient’s preferences and the extent that staffing was available in the clinic to support patients. Health systems should be prepared to offer and support patients in their use of apps, which should accommodate patient preferences and the constraints of the clinic.
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Affiliation(s)
- Joseph E. Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Brooks Tiffany
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Catherine Lim
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Kilian Kimbel
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Andrea L. Hartzler
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
| | - Geoffrey M. Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | | | - Ryan M. Caldeiro
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, USA
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22
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Zhang P, Zhan J, Wang S, Tang Y, Chen H, Wang Y, Wei X, Wen H, Pan T, Chen Z, Tang C, Xu N, Lu L. Psychological Interventions on Abstinence in Patients with Alcohol Use Disorder: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Neuropsychiatr Dis Treat 2022; 18:1815-1830. [PMID: 36039158 PMCID: PMC9419892 DOI: 10.2147/ndt.s372300] [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: 05/30/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Accumulating research suggests that psychotherapy helps improve abstinence but the difference in the efficacy of multiple psychotherapies in alcohol use disorder (AUD) remains to be explored. PATIENTS AND METHODS A systematic search of databases (Pubmed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and EBSCO) for studies (published from inception to April 10th.) of adults diagnosed with AUD accepting psychotherapies was conducted. Studies covering 9 countries and regions. The qualitative analysis pooled 2646 individuals from 34 randomized controlled trials (RCTs) and the networks included 1928 participants (23 RCTs). The outcomes included percentage of days abstinent (PDA), change in drinks per drinking day (change in DDD), and change in craving compared among individuals accepting various psychotherapies. The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and was registered on the International Prospective Register of Systematic Reviews (PROSPERO). RESULTS For the network of PDA, motivational enhancement treatment (MET) (35.44, 11.78 to 59.09, high-certainty) and couple therapy (CT) (28.89, 13.42 to 44.36, moderate-certainty) were significantly different from treatment as usual (TAU) with the surface under the cumulative ranking curve (SUCRA) mean rank 1.9 and 1.9 respectively. TAU+supportive psychotherapy (SP) was better than TAU for the change in DDD in the high-quality direct comparison. CONCLUSION The motivational enhancement and the couple therapy show potential amelioration for alcohol abstinence. Additionally, the preferred interventions are different for improving PDA and change in DDD. The evidence network remains to be strengthened.
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Affiliation(s)
- Peiming Zhang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, People's Republic of China
| | - Jie Zhan
- Postdoctoral Research Station, Department of Rehabilitation, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, People's Republic of China
| | - Shuting Wang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, People's Republic of China
| | - Yuyuan Tang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, People's Republic of China
| | - Huishan Chen
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, People's Republic of China
| | - Yiqiao Wang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, People's Republic of China
| | - Xiaojing Wei
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, People's Republic of China
| | - Hao Wen
- Department of Neurology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou City, Guangdong Province, People's Republic of China
| | - Ting Pan
- TCM Department, Foshan Fosun Chancheng Hospital, Foshan City, Guangdong Province, People's Republic of China
| | - Ze Chen
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, People's Republic of China
| | - Chunzhi Tang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, People's Republic of China
| | - Nenggui Xu
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, People's Republic of China
| | - Liming Lu
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, People's Republic of China
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Zamboni L, Centoni F, Fusina F, Mantovani E, Rubino F, Lugoboni F, Federico A. The Effectiveness of Cognitive Behavioral Therapy Techniques for the Treatment of Substance Use Disorders: A Narrative Review of Evidence. J Nerv Ment Dis 2021; 209:835-845. [PMID: 34698698 DOI: 10.1097/nmd.0000000000001381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
ABSTRACT Substance use disorders (SUDs) are characterized by a recurrent and maladaptive use of drugs and/or alcohol. Cognitive behavioral therapies (CBTs) comprise different types of interventions: traditional CBT and the more recent "third wave" behavior therapies, such as acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), mindfulness-based cognitive therapy (MBCT), and schema therapy (ST). We searched English-language articles published between 2014 and present. This review includes randomized controlled trials (RCTs), quasi-RCTs, pilot studies, and reviews of CBTs for SUDs available on PubMed. Results seem to indicate that CBT and MBCT are effective interventions for SUDs; however, the studies showed a high degree of heterogeneity, so no exhaustive conclusions could be outlined at this time. ACT and DBT in SUD management are limited to few studies and results are therefore inconclusive.
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Affiliation(s)
| | - Francesco Centoni
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital
| | | | - Elisa Mantovani
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona
| | - Francesca Rubino
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital
| | - Fabio Lugoboni
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital
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24
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Park JW, Kim HS. The Effects of Group Counseling Utilizing Narrative Therapy on Self-esteem, Stress Response, and Insight for Individuals with Alcohol Dependency. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2021. [DOI: 10.1080/15401383.2021.1972885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jae Wan Park
- College of Nursing, the Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea
| | - Hee Sook Kim
- College of Nursing, the Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea
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25
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Alcohol Clin Exp ResALCOHOLISM, CLINICAL AND EXPERIMENTAL RESEARCH 2021. [PMID: 34287968 DOI: 10.1111/acer.14666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Alcohol use disorder (AUD) and family functioning are inextricably bound, and families are impacted negatively by AUD, but families show substantial improvements with AUD recovery. Family members can successfully motivate a person with AUD to initiate changes in drinking or to seek AUD treatment. During recovery, family members can provide active support for recovery. Several couple- or family-involved treatments for AUD have been developed and tested in rigorous efficacy trials. Efficacious treatments based in family systems theory or cognitive behavioral approaches focus on the concerned family member alone, or they engage the couple or family as a unit in the treatment. However, most treatments have been studied in fairly homogeneous, heterosexual, White, non-Hispanic populations, limiting the potential generalizability of these treatments. Substantial gaps remain in our understanding of family processes associated with the initiation and maintenance of AUD recovery among adults. This review outlines the existing literature and describes opportunities for future research to address knowledge gaps in understanding the mechanisms by which these treatments are efficacious, use of family-based treatments with diverse populations, integration of pharmacotherapies with family-involved treatment, role of families in recovery-oriented systems of care, and how to improve treatment development and dissemination.
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Affiliation(s)
- Barbara S. McCrady
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Julianne C. Flanagan
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
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27
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Pandemic-related mental health risk among front line personnel. J Psychiatr Res 2021; 137:673-680. [PMID: 33189356 DOI: 10.1016/j.jpsychires.2020.10.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 10/24/2022]
Abstract
The mental health of frontline workers is critical to a community's ability to manage crises and disasters. This study assessed risks for mental health problems (traumatic stress, depression, anxiety, alcohol use, insomnia) in association with pandemic-related stressors in a sample of emergency and hospital personnel (N = 571). Respondents completed self-report surveys online from April 1st to May 7th, 2020 in the Rocky Mountain region of the United States. Results showed that roughly fifteen to thirty percent of respondents screened positive for each disorder. Odds of screening positive were similar between groups for probable acute traumatic stress, depressive disorder, anxiety disorder, and alcohol use disorder; emergency personnel reported significantly higher rates of insufficient sleep than healthcare workers. Logistic regressions showed that respondents who reported having an immunocompromised condition had higher odds of acute traumatic stress, anxiety, and depression. Having an immunocompromised household member was associated with higher odds of insufficient sleep and anxiety. Being in a direct care provision role was associated with higher odds of screening positive for risky alcohol use. Being in a management role over direct care providers was associated with higher odds of screening positive for anxiety, risky alcohol use, and insufficient sleep. There was an inverse relationship between number of positive COVID-19 cases and anxiety, such that as positive cases went up, anxiety decreased. Overall, the mental health risks that we observed early in the COVID-19 pandemic are elevated above previous viral outbreaks (SARS) and comparable to rates shown in disasters (9/11 attacks; Hurricane Katrina).
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28
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Kacmarek CN, Yates BT, Nich C, Kiluk BD. A pilot economic evaluation of computerized cognitive behavioral therapy for alcohol use disorder as an addition and alternative to traditional therapy. Alcohol Clin Exp Res 2021; 45:1109-1121. [PMID: 33730384 PMCID: PMC8131237 DOI: 10.1111/acer.14601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 02/22/2021] [Accepted: 03/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Computer-based delivery of cognitive behavioral therapy (CBT) may be a less costly approach to increase dissemination and implementation of evidence-based treatments for alcohol use disorder (AUD). However, comprehensive evaluations of costs, cost-effectiveness, and cost-benefit of computer-delivered interventions are rare. METHODS This study used data from a completed randomized clinical trial to evaluate the cost-effectiveness and cost-benefit of a computer-based version of CBT (CBT4CBT) for AUD. Sixty-three participants were randomized to receive one of the following treatments at an outpatient treatment facility and attended at least one session: (1) treatment as usual (TAU), (2) CBT4CBT plus treatment as usual (CBT4CBT+TAU), or (3) CBT4CBT plus brief monitoring. RESULTS Median protocol treatment costs per participant differed significantly between conditions, Kruskal-Wallis H(2) = 8.40, p = 0.02, such that CBT4CBT+TAU and CBT4CBT+monitoring each cost significantly more per participant than TAU. However, when nonprotocol treatment costs were included, total treatment costs per participant did not differ significantly between conditions. Median incremental cost-effective ratios (ICERs) revealed that CBT4CBT+TAU was more costly and more effective than TAU. It cost $35.08 to add CBT4CBT to TAU to produce a reduction of one additional drinking day per month between baseline and the end of the 8-week treatment protocol: CBT4CBT+monitoring cost $33.70 less to produce a reduction of one additional drinking day per month because CBT4CBT+monitoring was less costly than TAU and more effective at treatment termination, though not significantly so. Net benefit analyses suggested that costs of treatment, regardless of condition, did not offset monthly costs related to healthcare utilization, criminal justice involvement, and employment disruption between baseline and 6-month follow-up. Benefit-cost ratios were similar for each condition. CONCLUSIONS Results of this pilot economic evaluation suggest that an 8-week course of CBT4CBT may be a cost-effective addition and potential alternative to standard outpatient treatment for AUD. Additional research is needed to generate conclusions about the cost-benefit of providing CBT4CBT to treatment-seeking individuals participating in standard outpatient treatment.
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Affiliation(s)
- Corinne N. Kacmarek
- American University, Department of Psychology, 4400 Massachusetts Avenue NW, Washington, DC 20016-8062 United States
| | - Brian T. Yates
- American University, Department of Psychology, 4400 Massachusetts Avenue NW, Washington, DC 20016-8062 United States
| | - Charla Nich
- Yale University School of Medicine, Department of Psychiatry, Temple Medical, Building, 40 Temple Street, Suite 6C, Room 618, New Haven, CT 06510 United States
| | - Brian D. Kiluk
- Yale University School of Medicine, Department of Psychiatry, Temple Medical, Building, 40 Temple Street, Suite 6C, Room 618, New Haven, CT 06510 United States
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29
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Calverley HLM, Petrass LA, Blitvich JD. A systematic review of alcohol education programs for young people: do these programs change behavior? HEALTH EDUCATION RESEARCH 2021; 36:87-99. [PMID: 33306789 DOI: 10.1093/her/cyaa049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 11/05/2020] [Indexed: 06/12/2023]
Abstract
Numerous education programs have addressed young peoples' alcohol use. To date, no peer-reviewed publication has evaluated the effectiveness of such programs delivered across a range of contexts to change alcohol-related behaviors, attitudes and/or knowledge. This systematic review aimed to identify alcohol education programs addressing young people, and determine whether they changed alcohol-related behavior, knowledge and attitudes; and, ascertain components of successful programs. Studies were identified, guided by the PRISMA review process, from the earliest records until June 2020. Included studies (N = 70) comprised an alcohol education program which focused on young people (15-24 years). Forty programs reported behavior changes, and these programs were the highest quality. Others impacted attitudes and/or knowledge only (n = 12); or reported no impacts (n = 17). Recent programs were more likely than older programs to feature online delivery and report behavior changes. To enhance alcohol education, future programs should include the identified quality criteria, alongside process and long-term outcome evaluations, to better monitor effectiveness. Findings indicated some education programs have capacity to positively change alcohol-related behavior; however, outcome consistency varied even in high-quality programs. Alcohol education programs should be designed alongside health education/promotion models and best-practice recommendations, to improve the likelihood of desirable behavior-related outcomes.
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Affiliation(s)
- Hannah L M Calverley
- School of Education, Federation University Australia, University Drive, Mt Helen, Victoria, 3350, Australia
| | - Lauren A Petrass
- School of Education, Federation University Australia, University Drive, Mt Helen, Victoria, 3350, Australia
| | - Jennifer D Blitvich
- School of Science, Psychology and Sport, Federation University Australia, University Drive, Mt Helen, Victoria, 3350, Australia
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30
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O'Grady MA, Conigliaro J, Levak S, Morley J, Kapoor S, Ritter M, Marini C, Morgenstern J. "I Felt I Was Reaching a Point with My Health": Understanding Reasons for Engagement and Acceptability of Treatment Services for Unhealthy Alcohol Use in Primary Care. J Prim Care Community Health 2021; 12:21501327211003005. [PMID: 33733921 PMCID: PMC7983431 DOI: 10.1177/21501327211003005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Despite increasing need, there are large gaps in provision of care for unhealthy alcohol use. Primary care practices have become increasingly important in providing services for unhealthy alcohol use, yet little is known about the reasons patients engage in these services and their views on acceptability of such programs. The purpose of this study was to examine primary care patients' reasons for engagement, experiences with, and acceptability of a primary care practice-based program for treating unhealthy alcohol use. METHODS This qualitative study was conducted in a primary care practice that was developing a collaborative care model for treating unhealthy alcohol use in primary care. Semi-structured interviews were conducted with 24 primary care patients. Data were analyzed using conventional qualitative content analysis. RESULTS Findings suggest that patients engaged for both internal (concerns about drinking and health) and external reasons (family or provider concern). Patient experiences in the program were shaped by their affective responses (enjoyable, enlightening), as well as therapeutic benefits (gaining new insights about drinking; staff/provider support). Acceptability was driven by core program elements (medication, therapy, integration) as well as positive impacts on drinking cognition and behavior and flexible, patient-centered approaches. CONCLUSIONS Offering flexible and comprehensive programs with mutiple elements and both abstinence and moderation goals could also improve patient engagement and views on acceptability. Primary care practices will need to be thoughtful about the resources needed to implement these programs in terms of staffing, training, and program support.
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Affiliation(s)
- Megan A O'Grady
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Joseph Conigliaro
- Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | | | - Jeanne Morley
- Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | - Sandeep Kapoor
- Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | | | | | - Jon Morgenstern
- Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
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Roos CR, Carroll KM, Nich C, Frankforter T, Kiluk BD. Short- and long-term changes in substance-related coping as mediators of in-person and computerized CBT for alcohol and drug use disorders. Drug Alcohol Depend 2020; 212:108044. [PMID: 32422538 PMCID: PMC7293942 DOI: 10.1016/j.drugalcdep.2020.108044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND No studies have examined long-term changes in substance-related coping skills as a statistical mediator of cognitive-behavioral therapy (CBT) for substance use disorders (SUD). METHODS We tested both short- and long-term changes in coping as mediators of treatment effects in two trials of in-person and/or computerized CBT for SUD. The first trial included 137 individuals (75 % male; 65.7 % non-White; mean age = 35.9) with drug and/or alcohol use disorders randomized to one of the following: in-person CBT, computer-delivered CBT (CBT4CBT) plus brief monitoring, or treatment-as-usual (TAU). The second trial included 68 individuals (65 % male; 66.2 % non-white; mean age = 42.7) with an alcohol use disorder randomized to one of the following: CBT4CBT plus brief monitoring, CBT4CBT plus TAU, or TAU only. Coping was assessed with the Coping Strategies Scale. Latent growth curve mediational models were conducted, with both short-term (baseline through end-of-treatment) and long-term (baseline through 3-month post-treatment follow-up) changes in coping. RESULTS There were no mediation effects for short-term changes in coping. However, in both trials, there were significant mediation effects for long-term changes in coping: In trial 1, the effect of CBT4CBT vs. TAU on substance use at the 6-month follow-up was mediated by long-term increases in coping. This same mediation effect was not found for in-person CBT vs. TAU. In trial 2, the effect of CBT4CBT vs. not receiving CBT4CBT on heavy drinking at the 6-month follow-up was mediated by long-term increases in coping. CONCLUSIONS Long-term increases in coping may be a mechanism of change in computerized CBT for SUD.
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Affiliation(s)
- Corey R Roos
- Yale University School of Medicine, New Haven, CT, 06510, United States.
| | | | - Charla Nich
- Yale University School of Medicine, New Haven, CT, 06510, United States
| | - Tami Frankforter
- Yale University School of Medicine, New Haven, CT, 06510, United States
| | - Brian D Kiluk
- Yale University School of Medicine, New Haven, CT, 06510, United States
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32
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Cognitive Training for the Treatment of Addictions Mediated by Information and Communication Technologies (ICT). FUTURE INTERNET 2020. [DOI: 10.3390/fi12020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This work constitutes a narrative review of the state of knowledge and advances in the intervention and treatment of addictions through the use of information and communication technologies, considering the growing demand for virtuality-mediated strategies that facilitate the approach of problems of public health such as addictions, which increase considerably year after year. To this end, the reader will be provided with a current overview of the drug use trend; subsequently, a conceptualization of the concept of addiction and its understanding from a neurobiological perspective and, finally, the progress in terms of intervention processes and therapeutic approach will be presented; which will imply an approach to the concept of e-health and rehabilitation mediated by information and communication technologies (ICT).
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33
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Care of the Alcoholic Patient. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_66-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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