1
|
Johansson M, Berman AH, Sinadinovic K, Lindner P, Hermansson U, Andréasson S. Effects of Internet-Based Cognitive Behavioral Therapy for Harmful Alcohol Use and Alcohol Dependence as Self-help or With Therapist Guidance: Three-Armed Randomized Trial. J Med Internet Res 2021; 23:e29666. [PMID: 34821563 PMCID: PMC8663526 DOI: 10.2196/29666] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Alcohol use is a major contributor to health loss. Many persons with harmful use or alcohol dependence do not obtain treatment because of limited availability or stigma. They may use internet-based interventions as an alternative way of obtaining support. Internet-based interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use; however, few studies have been conducted with a specific focus on harmful use or alcohol dependence. The importance of therapist guidance in internet-based cognitive behavioral therapy (ICBT) programs is still unclear. Objective This trial aims to investigate the effects of a web-based alcohol program with or without therapist guidance among anonymous adult help-seekers. Methods A three-armed randomized controlled trial was conducted to compare therapist-guided ICBT and self-help ICBT with an information-only control condition. Swedish-speaking adult internet users with alcohol dependence (3 or more International Classification of Diseases, Tenth Revision criteria) or harmful alcohol use (alcohol use disorder identification test>15) were included in the study. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of 5 main modules, as well as a drinking calendar with automatic feedback. Guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol-related problems measured using the total alcohol use disorder identification test-score, diagnostic criteria for alcohol dependence and alcohol use disorder, depression, anxiety, health, readiness to change, and access to other treatments or support. Follow-up was conducted 3 (posttreatment) and 6 months after recruitment. Results During the recruitment period, from March 2015 to March 2017, 1169 participants were included. Participants had a mean age of 45 (SD 13) years, and 56.72% (663/1169) were women. At the 3-month follow-up, the therapist-guided ICBT and control groups differed significantly in weekly alcohol consumption (−3.84, 95% Cl −6.53 to −1.16; t417=2.81; P=.005; Cohen d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between the self-help ICBT and the control group at 3 months, or between any of the groups at the 6-month follow-up. A limitation of the study was the large number of participants who were completely lost to follow-up (477/1169, 40.8%). Conclusions In this study, a therapist-guided ICBT program was not found to be more effective than the same program in a self-help ICBT version for reducing alcohol consumption or other alcohol-related outcomes. In the short run, therapist-guided ICBT was more effective than information. Only some internet help-seekers may need a multisession program and therapist guidance to change their drinking when they use internet-based interventions. Trial Registration ClinicalTrials.gov NCT02377726; https://clinicaltrials.gov/ct2/show/NCT02377726
Collapse
Affiliation(s)
- Magnus Johansson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Anne H Berman
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Kristina Sinadinovic
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Philip Lindner
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Ulric Hermansson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Sven Andréasson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Säfsten E, Forsell Y, Ramstedt M, Damström Thakker K, Galanti MR. A pragmatic randomised trial of two counselling models at the Swedish national alcohol helpline. BMC Psychiatry 2019; 19:213. [PMID: 31286906 PMCID: PMC6615184 DOI: 10.1186/s12888-019-2199-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 06/25/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Alcohol telephone helplines targeting alcohol consumers in the general population can extend the reach of brief interventions while preserving in-person counselling. So far, studies of client outcomes in the setting of alcohol helplines are scarce. This study aims to compare the 6-months alcohol-related outcomes of two counselling models delivered at the Swedish National Alcohol Helpline. METHODS A pragmatic randomised trial was set up at the Swedish National Alcohol Helpline. First-time callers with current hazardous or harmful alcohol use who contacted the helpline, from May 2015 to December 2017, were invited to participate. Clients were allocated with 1:1 ratio to two groups: (1) brief, structured intervention (n = 128), including self-help material and one counsellor-initiated call, and (2) usual care (n = 133), i.e. multiple-session counselling using Motivational Interviewing (MI). The primary outcome was a downward change in AUDIT risk-zone between baseline and 6-months follow-up. The analysis followed an intention-to-treat approach. RESULTS Recruitment ended in December 2017. At 6-months follow-up, 70% of the enrolled participants had data on the outcome. In the brief, structured intervention (n = 107) 68% changed to a lower risk-level, compared to 61% in the usual care group (n = 117), yielding a risk ratio (RR) of 1.12 (95% CI 0.93 to 1.37) and risk difference of 0.08 (95% CI -0.05 to 0.20). The total AUDIT score and the scores from the AUDIT consumption questions (AUDIT-C) did not reveal any between-group differences in the mean change at follow-up. CONCLUSIONS The counselling at the Swedish National Alcohol Helpline was followed by a significant decrease in alcohol use among clients, without clear superiority for either counselling model. TRIAL REGISTRATION This trial was retrospectively registered with ISRCNT.com (ID: ISRCTN13160878 ) 18/01/2016.
Collapse
Affiliation(s)
- Eleonor Säfsten
- Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Yvonne Forsell
- 0000 0004 1937 0626grid.4714.6Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden ,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm County Council, 104 31 Stockholm, Sweden
| | - Mats Ramstedt
- 0000 0004 1937 0626grid.4714.6Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden ,The Swedish Council for Information on Alcohol and Other Drugs (CAN), 107 25 Stockholm, Sweden
| | - Kerstin Damström Thakker
- Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm County Council, 104 31 Stockholm, Sweden
| | - Maria Rosaria Galanti
- 0000 0004 1937 0626grid.4714.6Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden ,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm County Council, 104 31 Stockholm, Sweden
| |
Collapse
|
3
|
Wittleder S, Kappes A, Oettingen G, Gollwitzer PM, Jay M, Morgenstern J. Mental Contrasting With Implementation Intentions Reduces Drinking When Drinking Is Hazardous: An Online Self-Regulation Intervention. HEALTH EDUCATION & BEHAVIOR 2019; 46:666-676. [PMID: 30836781 DOI: 10.1177/1090198119826284] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction. Drinking alcohol has detrimental health consequences, and effective interventions to reduce hazardous drinking are needed. The self-regulation intervention of Mental Contrasting with Implementation Intentions (MCII) promotes behavior change across a variety of health behaviors. In this study, we tested if online delivery of MCII reduced hazardous drinking in people who were worried about their drinking. Method. Participants (N = 200, female = 107) were recruited online. They were randomized to learn MCII or solve simple math problems (control). Results. Immediately after the intervention, participants in the MCII condition (vs. control) reported an increased commitment to reduce drinking. After 1 month, they reported having taken action measured by the Readiness to Change drinking scale. When drinking was hazardous (Alcohol Use Disorders Identification Test ≥ 8, n = 85), participants in the MCII condition indicated a decreased number of drinking days, exp(β) = 0.47, CI (confidence interval) [-1.322, -.207], p = .02, and drinks per week, exp(β) = 0.57, CI [0.94, 5.514], p = .007, compared with the control condition. Discussion. These findings demonstrate that a brief, self-guided online intervention (Mdn = 28 minutes) can reduce drinking in people who worry about their drinking. Our findings show a higher impact in people at risk for hazardous drinking. Conclusion. MCII is scalable as an online intervention. Future studies should test the cost-effectiveness of the intervention in real-world settings.
Collapse
Affiliation(s)
- Sandra Wittleder
- 1 University of Hamburg, Hamburg, Germany.,2 New York University, New York, NY, USA
| | | | - Gabriele Oettingen
- 1 University of Hamburg, Hamburg, Germany.,2 New York University, New York, NY, USA
| | - Peter M Gollwitzer
- 2 New York University, New York, NY, USA.,4 University of Konstanz, Konstanz, Germany
| | | | | |
Collapse
|
4
|
Babac A, Frank M, Pauer F, Litzkendorf S, Rosenfeldt D, Lührs V, Biehl L, Hartz T, Storf H, Schauer F, Wagner TOF, Graf von der Schulenburg JM. Telephone health services in the field of rare diseases: a qualitative interview study examining the needs of patients, relatives, and health care professionals in Germany. BMC Health Serv Res 2018; 18:99. [PMID: 29426339 PMCID: PMC5807836 DOI: 10.1186/s12913-018-2872-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rare diseases are, by definition, very serious and chronic diseases with a high negative impact on quality of life. Approximately 350 million people worldwide live with rare diseases. The resulting high disease burden triggers health information search, but helpful, high-quality, and up-to-date information is often hard to find. Therefore, the improvement of health information provision has been integrated in many national plans for rare diseases, discussing the telephone as one access option. In this context, this study examines the need for a telephone service offering information for people affected by rare diseases, their relatives, and physicians. METHODS In total, 107 individuals participated in a qualitative interview study conducted in Germany. Sixty-eight individuals suffering from a rare disease or related to somebody with rare diseases and 39 health care professionals took part. Individual interviews were conducted using a standardized semi-structured questionnaire. Interviews were analysed using the qualitative content analysis, triangulating patients, relatives, and health care professionals. The fulfilment of qualitative data processing standards has been controlled for. RESULTS Out of 68 patients and relatives and 39 physicians, 52 and 18, respectively, advocated for the establishment of a rare diseases telephone service. Interviewees expected a helpline to include expert staffing, personal contact, good availability, low technical barriers, medical and psychosocial topics of counselling, guidance in reducing information chaos, and referrals. Health care professionals highlighted the importance of medical topics of counselling-in particular, differential diagnostics-and referrals. CONCLUSIONS Therefore, the need for a national rare diseases helpline was confirmed in this study. Due to limited financial resources, existing offers should be adapted in a stepwise procedure in accordance with the identified attributes.
Collapse
Affiliation(s)
- Ana Babac
- CHERH - Centre for Health Economics Research Hannover, Leibniz University Hannover, Otto-Brenner-Straße 1, 30159 Hannover, Germany
| | - Martin Frank
- CHERH - Centre for Health Economics Research Hannover, Leibniz University Hannover, Otto-Brenner-Straße 1, 30159 Hannover, Germany
| | - Frédéric Pauer
- CHERH - Centre for Health Economics Research Hannover, Leibniz University Hannover, Otto-Brenner-Straße 1, 30159 Hannover, Germany
| | - Svenja Litzkendorf
- CHERH - Centre for Health Economics Research Hannover, Leibniz University Hannover, Otto-Brenner-Straße 1, 30159 Hannover, Germany
| | - Daniel Rosenfeldt
- CHERH - Centre for Health Economics Research Hannover, Leibniz University Hannover, Otto-Brenner-Straße 1, 30159 Hannover, Germany
| | - Verena Lührs
- ZQ - Centre for Quality and Management in Healthcare, Medical Association of Lower Saxony, Berliner Allee 20, 30175 Hannover, Germany
| | - Lisa Biehl
- ACHSE – Alliance for Chronic Rare Diseases, DRK-Clinics Berlin, Drontheimer Straße 39, 13359 Berlin, Germany
| | - Tobias Hartz
- IMBEI - Institute for Medical Biometry, Epidemiology and Informatics, Obere Zahlbacher Str. 69, 55131 Mainz, Germany
| | - Holger Storf
- IMBEI - Institute for Medical Biometry, Epidemiology and Informatics, Obere Zahlbacher Str. 69, 55131 Mainz, Germany
| | - Franziska Schauer
- Department of Dermatology, Freiburg Center for Rare Diseases, University Medical Center, University of Freiburg, Hauptstraße 7, 79104 Freiburg, Germany
| | - Thomas O. F. Wagner
- University Centre for Thorax Oncology, University Clinic of the Johann Wolfgang-Goethe University, Theodor-Stern-Kai 7, 60559 Frankfurt am Main, Germany
| | | |
Collapse
|
5
|
Andersson C, Gajecki M, Öjehagen A, Berman AH. Automated telephone interventions for problematic alcohol use in clinical and population samples: a randomized controlled trial. BMC Res Notes 2017; 10:624. [PMID: 29183357 PMCID: PMC5704400 DOI: 10.1186/s13104-017-2955-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/21/2017] [Indexed: 01/14/2023] Open
Abstract
Objective The primary objective was to evaluate 6-month outcomes for brief and extensive automated telephony interventions targeting problematic alcohol use, in comparison to an assessment-only control group. The secondary objective was to compare levels of problematic alcohol use (hazardous, harmful or probable dependence), gender and age among study participants from clinical psychiatric and addiction outpatient settings and from population-based telephone helpline users and Internet help-seeker samples. Results The Alcohol Use Disorders Identification Test (AUDIT) was used for screening of problematic alcohol use and 6-month follow-up assessment. A total of 248 of help-seekers with at least hazardous use (AUDIT scores of ≥ 6/≥ 8 for women/men) were recruited from clinical and general population settings. Minor recruitment group differences were identified with respect to AUDIT scores and age at baseline. One hundred and sixty persons (64.5%) did not complete the follow-up assessment. The attrition group had a higher proportion of probable dependence (71% vs. 56%; p = 0.025), and higher scores on the total AUDIT, and its subscales for alcohol consumption and alcohol problems. At follow up, within-group problem levels had declined across all three groups, but there were no significant between-group differences. Trial registration ClinicalTrials.gov NCT01958359, Registered October 9, 2013. Retrospectively registered
Collapse
Affiliation(s)
- Claes Andersson
- Department of Criminology, Faculty of Health and Society, Malmö University, 205 06, Malmö, Sweden.
| | - Mikael Gajecki
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364, Stockholm, Sweden
| | - Agneta Öjehagen
- Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
| | - Anne H Berman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364, Stockholm, Sweden
| |
Collapse
|