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Galanter M, White WL, Hunter B, Khalsa J. Internet-based, continuously available Narcotics Anonymous meetings: a new resource for access to Twelve Step support for abstinence. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:321-327. [PMID: 38557160 DOI: 10.1080/00952990.2024.2309648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 04/04/2024]
Abstract
Background: A Zoom-based website was developed in 2020 that offers continuous access to online Narcotics Anonymous (NA) meetings for the first time. This website provides immediate access for persons with substance use disorder to support abstinence from substance-related addictive disorders.Objectives: This study is designed to characterize attendees employing this online format; to evaluate their experiences for gaining support to maintain abstinence; and to compare the 24/7 experience to face-to-face (FF) meetings they attend.Methods: An anonymous 33-item survey was made available on the 24/7 NA website that links to the 24/7 meetings. Persons accessing the site could choose to fill out the survey.Results: 530 respondents completed the survey (64.9% female/35.1% male). Most had stable prior involvement in NA. They had attended more 24/7 meetings (14.9, SD 19.7) than FF meetings (4.6, SD 7.8) in the previous month. 86% had previously attended FF meetings, 48% had served as sponsors, and 92% reported that the 24/7 meetings were more comfortable for them than the FF meetings (p < .001, Cohen's d = 0.65) and more supportive of abstinence (p < .001, Cohen's d = 0.91). Of the respondents, 8% were still using drugs, of whom 52% had previously completed some of the Twelve Steps.Conclusions: The 24/7 format provides a new and easily accessible way for NA members to gain support for abstinence and is positively rated by attendees seeking support for recovery from substance use disorders. It may serve as a valuable adjunct to the traditional FF format.
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Affiliation(s)
- Marc Galanter
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - William L White
- Lighthouse Department, Chestnut Health Systems, Punta Gorda, FL, USA
| | - Brooke Hunter
- Lighthouse Department, Chestnut Health Systems, Normal, IL, USA
| | - Jag Khalsa
- National Institute on Drug Abuse, National Institute of Health, Bethesda, MD, USA
- Department of Psychiatry, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Chakrabarti S. Digital psychiatry in low-and-middle-income countries: New developments and the way forward. World J Psychiatry 2024; 14:350-361. [PMID: 38617977 PMCID: PMC11008387 DOI: 10.5498/wjp.v14.i3.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/28/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Low- and middle-income countries (LMICs) bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap. The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap. Digital psychiatry in LMICs has always lagged behind high-income countries, but there have been encouraging developments in the last decade. There is increasing research on the efficacy of digital psychiatric interventions. However, the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs. A striking development has been the rise in mobile and smartphone ownership in LMICs, which has driven the increasing use of mobile technologies to deliver mental health services. An innovative use of mobile technologies has been to optimize task-shifting, which involves delivering mental healthcare services in community settings using non-specialist health professionals. Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious. Despite these promising developments, many barriers such as service costs, underdeveloped infrastructure, lack of trained professionals, and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs. To overcome these barriers, digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services, ensure collaboration between different stakeholders, and focus on reducing the digital divide.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
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Scheibein F, Caballeria E, Taher MA, Arya S, Bancroft A, Dannatt L, De Kock C, Chaudhary NI, Gayo RP, Ghosh A, Gelberg L, Goos C, Gordon R, Gual A, Hill P, Jeziorska I, Kurcevič E, Lakhov A, Maharjan I, Matrai S, Morgan N, Paraskevopoulos I, Puharić Z, Sibeko G, Stola J, Tiburcio M, Tay Wee Teck J, Tsereteli Z, López-Pelayo H. Optimizing Digital Tools for the Field of Substance Use and Substance Use Disorders: Backcasting Exercise. JMIR Hum Factors 2023; 10:e46678. [PMID: 38085569 PMCID: PMC10751634 DOI: 10.2196/46678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/14/2023] [Accepted: 08/12/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Substance use trends are complex; they often rapidly evolve and necessitate an intersectional approach in research, service, and policy making. Current and emerging digital tools related to substance use are promising but also create a range of challenges and opportunities. OBJECTIVE This paper reports on a backcasting exercise aimed at the development of a roadmap that identifies values, challenges, facilitators, and milestones to achieve optimal use of digital tools in the substance use field by 2030. METHODS A backcasting exercise method was adopted, wherein the core elements are identifying key values, challenges, facilitators, milestones, cornerstones and a current, desired, and future scenario. A structured approach was used by means of (1) an Open Science Framework page as a web-based collaborative working space and (2) key stakeholders' collaborative engagement during the 2022 Lisbon Addiction Conference. RESULTS The identified key values were digital rights, evidence-based tools, user-friendliness, accessibility and availability, and person-centeredness. The key challenges identified were ethical funding, regulations, commercialization, best practice models, digital literacy, and access or reach. The key facilitators identified were scientific research, interoperable infrastructure and a culture of innovation, expertise, ethical funding, user-friendly designs, and digital rights and regulations. A range of milestones were identified. The overarching identified cornerstones consisted of creating ethical frameworks, increasing access to digital tools, and continuous trend analysis. CONCLUSIONS The use of digital tools in the field of substance use is linked to a range of risks and opportunities that need to be managed. The current trajectories of the use of such tools are heavily influenced by large multinational for-profit companies with relatively little involvement of key stakeholders such as people who use drugs, service providers, and researchers. The current funding models are problematic and lack the necessary flexibility associated with best practice business approaches such as lean and agile principles to design and execute customer discovery methods. Accessibility and availability, digital rights, user-friendly design, and person-focused approaches should be at the forefront in the further development of digital tools. Global legislative and technical infrastructures by means of a global action plan and strategy are necessary and should include ethical frameworks, accessibility of digital tools for substance use, and continuous trend analysis as cornerstones.
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Affiliation(s)
- Florian Scheibein
- School of Health Sciences, South East Technological University, Waterford, Ireland
| | - Elsa Caballeria
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Md Abu Taher
- United Nations Office of Drugs and Crime, Dhaka, Bangladesh
| | - Sidharth Arya
- Institute of Mental Health, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Angus Bancroft
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Lisa Dannatt
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charlotte De Kock
- Institute for Social Drug Research, Ghent University, Ghent, Belgium
| | - Nazish Idrees Chaudhary
- International Grace Rehab, Lahore School of Behavioral Sciences, The University of Lahore, Lahore, Pakistan
| | | | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Cees Goos
- European Centre for Social Welfare Policy and Research, Vienna, Austria
| | - Rebecca Gordon
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Antoni Gual
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Penelope Hill
- The National Centre for Clinical Research on Emerging Drugs, Randwick, Australia
- The National Drug and Alcohol Research Centre, University of New South Wales, Randwick, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Iga Jeziorska
- Correlation European Harm Reduction Network, Amsterdam, Netherlands
- Department of Public Policy, Institute of Social and Political Sciences, Corvinus University of Budapest, Budapest, Hungary
| | | | - Aleksey Lakhov
- Humanitarian Action Charitable Fund, St Petersburg, Russian Federation
| | | | - Silvia Matrai
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Nirvana Morgan
- Network of Early Career Professionals in Addiction Medicine, Seligenstadt, Germany
| | | | - Zrinka Puharić
- Faculty of Dental Medicine and Health Osijek, Bjelovar University of Applied Sciences, Bjelovar, Croatia
| | - Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jan Stola
- Youth Organisations for Drug Action, Warsaw, Poland
| | - Marcela Tiburcio
- Head of the Department of Social Sciences in Health, Directorate of Epidemiological and Psychosocial Research, Mexico City, Mexico
| | - Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St. Andrews, St Andrews, United Kingdom
| | - Zaza Tsereteli
- Alcohol and Substance Use Expert Group, Northern Dimension Partnership in Public Health and Social Well-Being, Tallinn, Estonia
| | - Hugo López-Pelayo
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Kiburi SK, Paruk S, Kwobah EK, Chiliza B. Exploring user experiences of a text message-delivered intervention among individuals on opioid use disorder treatment in Kenya: A qualitative study. PLOS DIGITAL HEALTH 2023; 2:e0000375. [PMID: 37930956 PMCID: PMC10627438 DOI: 10.1371/journal.pdig.0000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/23/2023] [Indexed: 11/08/2023]
Abstract
Opioid use disorder causes significant burden of disease and treatment comprises pharmacotherapy and psychosocial treatment. Cognitive behavioral therapy is an effective psychosocial intervention used in substance use disorders treatment and can be delivered using digital approach. There is limited use of digital treatment among individuals with opioid use disorder in Kenya. This study aimed to describe the experiences and feedback from participants with opioid use disorder enrolled in a text-message intervention in Kenya. Qualitative data was collected from participants in the intervention arm of a feasibility trial testing a text-message intervention based on cognitive behavioral therapy. Data was collected using open-ended questions in a questionnaire and structured in-depth interviews amongst those who received the intervention. Framework method was applied for analysis. Twenty-four participants (83.3% males) were enrolled with a mean age of 32.5 years (SD9.5). Five themes were identified namely: (1) Gain of cognitive behavioral therapy skills which included: identification and change of substance use patterns; drug refusal skills; coping with craving and self-efficacy; (2) Therapeutic alliance which included: development of a bond and agreement on treatment goals; (3) Feedback on intervention components and delivery such as: frequency, and duration of the text message intervention; (4) Challenges experienced during the intervention such as: technical problems with phones; and barriers related to intervention delivery; (5) Recommendations for improvement of intervention in future implementations. The findings demonstrated participants' satisfaction with intervention, gain of skills to change substance use patterns, highlighted challenges experienced and suggestions on improving the intervention among individuals with opioid use disorder. The feedback and recommendations provided by the participants can guide implementation of such interventions to allow acceptability, effectiveness and sustainability. Trial registration: This study was part of a randomized feasibility trial. Clinical trial registration: Pan African Clinical Trial Registry: Registration number: PACTR202201736072847. Date of registration: 10th January 2022.
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Affiliation(s)
- Sarah Kanana Kiburi
- Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
- Discipline of Psychiatry, University of KwaZulu Natal, Durban, South Africa
| | - Saeeda Paruk
- Discipline of Psychiatry, University of KwaZulu Natal, Durban, South Africa
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Bonginkosi Chiliza
- Discipline of Psychiatry, University of KwaZulu Natal, Durban, South Africa
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O'Logbon J, Wickersham A, Williamson C, Leightley D. The effectiveness of digital health technologies for reducing substance use among young people: a systematic review & meta-analysis. J Ment Health 2023:1-29. [PMID: 37664884 DOI: 10.1080/09638237.2023.2245902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/22/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Substance use amongst young people poses developmental and clinical challenges, necessitating early detection and treatment. Considering the widespread use of technology in young people, delivering interventions digitally may help to reduce and monitor their substance use. AIMS We conducted a systematic review and two meta-analyses to assess the effectiveness of digital interventions for reducing substance use (alcohol, smoking, and other substances) among young people aged 10 to 24 years old. METHOD Embase, Global Health, Medline, PsychINFO, Web of Science and reference lists of relevant papers were searched in November 2020. Studies were included if they quantitatively evaluated the effectiveness of digital health technologies for treating substance use. A narrative synthesis and meta-analysis were conducted. RESULTS Forty-two studies were included in the systematic review and 18 in the meta-analyses. Digital interventions showed small, but statistically significant reductions in weekly alcohol consumption compared to controls (SMD= -0.12, 95% CI= -0.17 to -0.06, I2=0%), but no overall effect was seen on 30-day smoking abstinence (OR = 1.12, 95% CI = 0.70 to 1.80, I2=81%). The effectiveness of digital interventions for reducing substance use is generally weak, however, promising results such as reducing alcohol use were seen. Large-scale studies should investigate the viability of digital interventions, collect user feedback, and determine cost-effectiveness. PRISMA/PROSPERO This systematic review was conducted following Cochrane methodology PRISMA guidelines. The review was registered with PROSPERO in November 2020 (CRD42020218442).
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Affiliation(s)
| | - Alice Wickersham
- Department of Psychological Medicine, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Charlotte Williamson
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
| | - Daniel Leightley
- Department of Psychological Medicine, King's College London, London, UK
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
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