Online and Mobile Interventions for Problem Gambling, Alcohol, and Drugs: A Systematic Review

Effect of a Smartphone App (S-Check) on Actual and Intended Help-Seeking and Motivation to Change Methamphetamine Use Among Adult Consumers of Methamphetamine in Australia: Randomized Waitlist-Controlled Trial

BACKGROUND

Interventions are required that address delays in treatment-seeking and low treatment coverage among people consuming methamphetamine.

OBJECTIVE

We aim to determine whether a self-administered smartphone-based intervention, the "S-Check app" can increase help-seeking and motivation to change methamphetamine use, and determine factors associated with app engagement.

METHODS

This study is a randomized, 28-day waitlist-controlled trial. Consenting adults residing in Australia who reported using methamphetamine at least once in the last month were eligible to download the app for free from Android or iOS app stores. Those randomized to the intervention group had immediate access to the S-Check app, the control group was wait-listed for 28 days before gaining access, and then all had access until day 56. Actual help-seeking and intention to seek help were assessed by the modified Actual Help Seeking Questionnaire (mAHSQ), modified General Help Seeking Questionnaire, and motivation to change methamphetamine use by the modified readiness ruler. χ2 comparisons of the proportion of positive responses to the mAHSQ, modified General Help Seeking Questionnaire, and modified readiness ruler were conducted between the 2 groups. Logistic regression models compared the odds of actual help-seeking, intention to seek help, and motivation to change at day 28 between the 2 groups. Secondary outcomes were the most commonly accessed features of the app, methamphetamine use, feasibility and acceptability of the app, and associations between S-Check app engagement and participant demographic and methamphetamine use characteristics.

RESULTS

In total, 560 participants downloaded the app; 259 (46.3%) completed eConsent and baseline; and 84 (32.4%) provided data on day 28. Participants in the immediate access group were more likely to seek professional help (mAHSQ) at day 28 than those in the control group (n=15, 45.5% vs n=12, 23.5%; χ21=4.42, P=.04). There was no significant difference in the odds of actual help-seeking, intention to seek help, or motivation to change methamphetamine use between the 2 groups on the primary logistic regression analyses, while in the ancillary analyses, the imputed data set showed a significant difference in the odds of seeking professional help between participants in the immediate access group compared to the waitlist control group (adjusted odds ratio 2.64, 95% CI 1.19-5.83, P=.02). For participants not seeking help at baseline, each minute in the app increased the likelihood of seeking professional help by day 28 by 8% (ratio 1.08, 95% CI 1.02-1.22, P=.04). Among the intervention group, a 10-minute increase in app engagement time was associated with a decrease in days of methamphetamine use by 0.4 days (regression coefficient [β] -0.04, P=.02).

CONCLUSIONS

The S-Check app is a feasible low-resource self-administered intervention for adults in Australia who consume methamphetamine. Study attrition was high and, while common in mobile health interventions, warrants larger studies of the S-Check app.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12619000534189; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377288&isReview=true.

Artificial Intelligence and Healthcare: A Journey through History, Present Innovations, and Future Possibilities

Artificial intelligence (AI) has emerged as a powerful tool in healthcare significantly impacting practices from diagnostics to treatment delivery and patient management. This article examines the progress of AI in healthcare, starting from the field's inception in the 1960s to present-day innovative applications in areas such as precision medicine, robotic surgery, and drug development. In addition, the impact of the COVID-19 pandemic on the acceleration of the use of AI in technologies such as telemedicine and chatbots to enhance accessibility and improve medical education is also explored. Looking forward, the paper speculates on the promising future of AI in healthcare while critically addressing the ethical and societal considerations that accompany the integration of AI technologies. Furthermore, the potential to mitigate health disparities and the ethical implications surrounding data usage and patient privacy are discussed, emphasizing the need for evolving guidelines to govern AI's application in healthcare.

Dissociative experiences reduce online problem gambling treatment effectiveness

AIMS

To determine whether dissociative experiences moderate online problem gambling treatment effectiveness, and to characterize the temporal persistence of the relationship between dissociation and problem gambling.

DESIGN

Repeatedly measured self-report data on a guided online cognitive behavioral therapy for problem gambling collected on four occasions: before treatment, after treatment, and at 6- and 12-month follow-ups.

SETTING AND PARTICIPANTS

The data (N = 1243, 59.2% males) were collected in Finland between 2019 and 2021.

MEASUREMENTS

The primary outcome variable was the self-reported level of problem gambling. The predictors were the treatment phase and dissociative experiences, their interaction, and the demographic covariates of age, education, income, and gender.

FINDINGS

Problem gambling scores and dissociative experiences declined significantly following treatment and remained low through the follow-ups (retention rates: 52.6% [post-treatment], 26.3% [at the 6-month follow-up], and 16.1% [at the 12-month follow-up]). However, the treatment was significantly less effective in reducing problem gambling for individuals who kept experiencing dissociation after the treatment.

CONCLUSIONS

Dissociation is an integral sign of problem gambling severity and sustained dissociative experiences may significantly reduce the long-term effectiveness of online problem gambling treatments. Treatment efforts should be customized to account for individual differences in dissociative tendencies, and future research should broaden the study of dissociative experiences to other behavioral addictions.

Digital interventions to moderate alcohol consumption in young people: a Cancer Prevention Europe overview of systematic reviews

Background

Strategies to reduce alcohol consumption would contribute to substantial health benefits in the population, including reducing cancer risk. The increasing accessibility and applicability of digital technologies make these powerful tools suitable to facilitate changes in behaviour in young people which could then translate into both immediate and long-term improvements to public health.

Objective

We conducted a review of systematic reviews to assess the available evidence on digital interventions aimed at reducing alcohol consumption in sub-populations of young people [school-aged children, college/university students, young adults only (over 18 years) and both adolescent and young adults (<25 years)].

Methods

Searches were conducted across relevant databases including KSR Evidence, Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE). Records were independently screened by title and abstract and those that met inclusion criteria were obtained for full text screening by two reviewers. Risk of bias (RoB) was assessed with the ROBIS checklist. We employed a narrative analysis.

Results

Twenty-seven systematic reviews were included that addressed relevant interventions in one or more of the sub-populations, but those reviews were mostly assessed as low quality. Definitions of "digital intervention" greatly varied across systematic reviews. Available evidence was limited both by sub-population and type of intervention. No reviews reported cancer incidence or influence on cancer related outcomes. In school-aged children eHealth multiple health behaviour change interventions delivered through a variety of digital methods were not effective in preventing or reducing alcohol consumption with no effect on the prevalence of alcohol use [Odds Ratio (OR) = 1.13, 95% CI: 0.95-1.36, review rated low RoB, minimal heterogeneity]. While in adolescents and/or young adults who were identified as risky drinkers, the use of computer or mobile device-based interventions resulted in reduced alcohol consumption when comparing the digital intervention with no/minimal intervention (-13.4 g/week, 95% CI: -19.3 to -7.6, review rated low RoB, moderate to substantial heterogeneity).In University/College students, a range of E-interventions reduced the number of drinks consumed per week compared to assessment only controls although the overall effect was small [standardised mean difference (SMD): -0.15, 95% CI: -0.21 to -0.09]. Web-based personalised feedback interventions demonstrated a small to medium effect on alcohol consumption (SMD: -0.19, 95% CI: -0.27 to -0.11) (review rated high RoB, minimal heterogeneity). In risky drinkers, stand-alone Computerized interventions reduced short (SMD: -0.17, 95% CI: -0.27 to -0.08) and long term (SMD: -0.17, 95% CI: -0.30 to -0.04) alcohol consumption compared to no intervention, while a small effect (SMD: -0.15, 95% CI: -0.25 to -0.06) in favour of computerised assessment and feedback vs. assessment only was observed. No short-term (SMD: -0.10, 95% CI: -0.30 to 0.11) or long-term effect (SMD: -0.11, 95% CI: -0.53 to 0.32) was demonstrated for computerised brief interventions when compared to counsellor based interventions (review rated low RoB, minimal to considerable heterogeneity). In young adults and adolescents, SMS-based interventions did not significantly reduce the quantity of drinks per occasion from baseline (SMD: 0.28, 95% CI: -0.02 to 0.58) or the average number of standard glasses per week (SMD: -0.05, 95% CI: -0.15 to 0.05) but increased the risk of binge drinking episodes (OR = 2.45, 95% CI: 1.32-4.53, review rated high RoB; minimal to substantial heterogeneity). For all results, interpretation has limitations in terms of risk of bias and heterogeneity.

Conclusions

Limited evidence suggests some potential for digital interventions, particularly those with feedback, in reducing alcohol consumption in certain sub-populations of younger people. However, this effect is often small, inconsistent or diminishes when only methodologically robust evidence is considered. There is no systematic review evidence that digital interventions reduce cancer incidence through alcohol moderation in young people. To reduce alcohol consumption, a major cancer risk factor, further methodologically robust research is warranted to explore the full potential of digital interventions and to form the basis of evidence based public health initiatives.

Effectiveness of a Mobile App to Increase Risk Perception of Tobacco, Alcohol, and Marijuana Use in Mexican High School Students: Quantitative Study

BACKGROUND

Young people have the highest rate of drug use worldwide. Recent data from Mexico in this population show that the prevalence of illicit drug use doubled between 2011 and 2016 (2.9%-6.2%), with marijuana being the one with the highest increase (2.4%-5.3%), but also point out that alcohol and tobacco use have remained steady or decreased. Mexican adolescents are at high risk for drug use owing to a low perception of risk and the availability of drugs. Adolescence is an ideal period to reduce or prevent risky behaviors using evidence-based strategies.

OBJECTIVE

In this study, we aimed to test the short-term effectiveness of a mobile intervention app ("What Happens if you Go Too Far?" ["¿Qué pasa si te pasas?"]) that seeks to increase risk perception of tobacco, alcohol, and marijuana use in a sample of Mexican high school students.

METHODS

A nonexperimental evaluation based on pretest-posttest design was used to measure the effectiveness of a preventive intervention using a mobile app, "What Happens If You Go Too Far?" The dimensions analyzed were knowledge of drugs and their effects, life skills, self-esteem, and risk perception. The intervention was conducted on a high school campus with 356 first-year students.

RESULTS

The sample included 359 first-year high school students (mean 15, SD 0.588 years; women: 224/359, 62.4% men: 135/359, 37.6%). The intervention increased the overall risk perception of tobacco (χ²₄=21.6; P<.001) and alcohol use (χ²₄=15.3; P<.001). There was no significant difference in the perception that it is dangerous to smoke 5 cigarettes, and there was a marginal difference in the perception that it is very dangerous to smoke 1 cigarette or to use alcohol or marijuana. We used a generalized estimating equation method to determine the impact of the variables on risk perception. The results showed that knowledge about smoking increased the risk perception of smoking 1 cigarette (odds ratio [OR] 1.1065, 95% CI 1.013-1.120; P=.01), and that knowledge about marijuana use (OR 1.109, 95% CI 1.138-1.185; P=.002) and self-esteem (OR 1.102, 95% CI 1.007-1.206; P=.04) produced significant increases in the risk perception of consuming 5 cigarettes. Resistance to peer pressure and assertiveness also increased the perceived risk of using tobacco and alcohol.

CONCLUSIONS

The intervention has the potential to increase the perception of risk toward drug use in high school students by providing knowledge about the effects and psychosocial risks of drug use and by strengthening life skills that are associated with increased risk perception. The use of mobile technologies in intervention processes may broaden the scope of preventive work for adolescents.

Peer support and online cognitive behavioural therapy for substance use concerns: protocol for a randomised controlled trial

INTRODUCTION

Hazardous alcohol and drug use is associated with substantial morbidity, mortality and societal cost worldwide. Yet, only a minority of those struggling with substance use concerns receive specialised services. Numerous barriers to care exist, highlighting the need for scalable and engaging treatment alternatives. Online interventions have exhibited promise in the reduction of substance use, although studies to date highlight the key importance of patient engagement to optimise clinical outcomes. Peer support may provide a way to engage patients using online interventions. The goal of this study is to evaluate the efficacy and cost-effectiveness of Breaking Free Online (BFO), an online cognitive-behavioural intervention for substance use, delivered with and without peer support.

METHODS AND ANALYSIS

A total of 225 outpatients receiving standard care will be randomised to receive clinical monitoring with group peer support, with BFO alone, or with BFO with individual peer support, in an 8-week trial with a 6-month follow-up. The primary outcome is substance use frequency; secondary outcomes include substance use problems, depression, anxiety, quality of life, treatment engagement and cost-effectiveness. Mixed effects models will be used to test hypotheses, and thematic analysis of qualitative data will be undertaken.

ETHICS AND DISSEMINATION

The protocol has received approval by the Centre for Addiction and Mental Health Research Ethics Board. Results will help to optimise the effectiveness of structured online substance use interventions provided as an adjunct to standard care in hospital-based treatment programmes. Findings will be disseminated through presentations and publications to scholarly and knowledge user audiences.

TRIAL REGISTRATION NUMBER

NCT05127733.

Online 12-step groups during the Covid-19 pandemic: A patient's perspective

BACKGROUND

Following the Covid-19 pandemic, lockdown strategies have been adopted by many Governments worldwide to stop the spread of the virus. Twelve-step programs for people with substance use disorders (SUDs) as Narcotics Anonymous (NA) experienced forced interruption as well, in some cases organizing online meetings to continue their activities. The purpose of this article is to reflect on concerns and advantages of online setting for 12-step groups.

METHODS

We report the experience of an Italian NA participant attending for the first time an online NA group during the Covid-19 pandemic.

RESULTS

The strengths and limitations of the online setting, showing up from the living voice of this participant, are expressed in the light of the present pandemic situation. Together with the general advantages derived from telehealth technologies, specific benefits of the virtual setting for 12-step programs are shown. Concerns are also discussed, as those related to privacy and social presence.

CONCLUSIONS

The case highlights many possibilities of the online setting for 12-step programs. On the other hand, it suggests the critical importance of in-person groups to accompany the recovery process. Future outcome research is needed about the combination of these approaches.

Affected other interventions: a systematic review and meta-analysis across addictions

BACKGROUND AND AIMS

Individuals impacted by someone else's alcohol, illicit drug, gambling and gaming problems (affected others) experience extensive harms. To our knowledge, this is the first systematic review and meta-analysis to determine the effectiveness of psychosocial interventions delivered to affected others across addictions.

METHODS

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. An electronic database search (PsycInfo, Medline, Cinahl and EMBASE) of randomized controlled trials (RCTs) published until August 2021 was conducted. RCTs with passive control groups, evaluating psychosocial tertiary interventions delivered to affected others of people with addictions (problematic alcohol use, substance use, gambling or gaming) that did not require the involvement of the addicted person, were included.

RESULTS

Twenty included studies, published in 22 articles, mainly evaluated interventions for alcohol use, followed by gambling and illicit drugs, with none investigating gaming interventions. The interventions mainly targeted partners/spouses and focused upon improving affected other outcomes, addicted person outcomes or both. Meta-analyses revealed beneficial intervention effects over control groups on some affected other (depressive symptomatology [standardized mean difference (SMD) = -0.48, 95% confidence interval (CI) = -0.67, -0.29], life satisfaction (SMD = -0.37, 95% CI = -0.71, -0.03) and coping style (SMD = -1.33, 95% CI = -1.87, -0.79), addicted person [treatment entry, risk ratio (RR) = 0.86, 95% CI = 0.75-0.98] and relationship functioning outcomes (marital discord, SMD = -0.40, 95% CI = -0.61, -0.18) at post-intervention. No beneficial intervention effects were identified at short-term follow-up (4-11 months post-treatment). The beneficial intervention effects identified at post-treatment remained when limiting to studies of alcohol use and therapist-delivered interventions.

CONCLUSIONS

Psychosocial interventions delivered to affected others of people with addictions (problematic alcohol use, substance use, gambling or gaming) may be effective in improving some, but not all, affected other (depression, life satisfaction, coping), addicted person (treatment) and relationship functioning (marital discord) outcomes for affected others across the addictions, but the conclusion remains tentative due to limited studies and methodological limitations.

User engagement with technology-mediated self-guided interventions for addictions: scoping review protocol

INTRODUCTION

Technology-mediated self-guided interventions (TMSGIs) for addictive disorders represent promising adjuncts and alternatives to traditional treatment approaches (eg, face-to-face psychotherapy). However, meaningful evaluation of such interventions remains elusive given the lack of consistent terminology and application. Preliminary findings suggest that TMSGIs are useful but engagement remains modest for various reasons reported by users, including lack of personalisation. The aim of this review is to explore how TMSGIs have been defined and applied in addictions populations with an emphasis on technical and logistical features associated with greater user engagement.

METHODS AND ANALYSIS

This scoping review protocol was developed in accordance with the Arksey and O'Malley framework. Articles from electronic databases (ie, PsycINFO, Embase, MEDLINE and CINAHL) will be included if they targeted adolescents or adults with one or more substance or behavioural addictions, excessive behaviours or aspects thereof (eg, cravings) using a privately accessible technology-mediated intervention. Two independent reviewers will screen titles and abstracts for relevance before commencing full-text reviews. Extracted data will be presented in descriptive, tabular and graphical summaries as appropriate.

ETHICS AND DISSEMINATION

Ethics committee approval is not required for this study. Review findings will be used to guide the development of preliminary recommendations for real-time addiction intervention development and provision. Emphasis will be placed on practical considerations of user engagement, accessibility, usability and cost. Knowledge users, including clinicians, researchers and people with lived experience, will be engaged for development of one such intervention following publication of review findings.

REGISTRATION

This scoping review was registered with the Open Science Framework on 15 April 2022 and can be located at http://www.osf.io/3utp9/.

Psychological online interventions for problem gambling and gambling disorder - A meta-analytic approach

OBJECTIVE

The Covid-19 pandemic has reignited discussions about the prevalence of and treatment options for problem gambling and gambling disorder (PGGD). Since affected persons seldom seek professional help, online interventions can improve accessibility. Thus, this study aimed to investigate the effectiveness of psychological online interventions on PGGD.

METHODS

We conducted a systematic review and meta-analysis and searched in PubMed, PsycINFO, and Google Scholar for peer-reviewed experimental and quasi-experimental research published between 2010 and 2021. We calculated two meta-anlyses, one for treatment control comparisons (TCC), and one for pre-post-comparisons (PCC).

RESULTS

We included six studies (ten TCC and n = 2076) in meta-analysis 1 and five studies (six PCC and n = 781) in meta-analysis 2. Online interventions turned out to be effective in both analyses with Hedges g = 0.41, 95% confidence interval = [0.22 to 0.60], p < .001, for meta-anaylsis 1 and Hegdes g = 1.28, 95% confidence interval = [0.85 to 1.71], p < .001, for meta-analysis 2.

CONCLUSIONS

We identified significant effects of online interventions on PGGD in both analyses, indicating the potential of online applications. We discuss methodological aspects and further research directions.

Designing an online intervention for adults with addictive eating: a qualitative integrated knowledge translation approach

INTRODUCTION

Codesign is a meaningful end-user engagement in research design. The integrated knowledge translation (IKT) framework involves adopting a collaborative research approach to produce and apply knowledge to address real-world needs, resulting in useful and useable recommendations that will more likely be applied in policy and practice. In the field of food addiction (FA), there are limited treatment options that have been reported to show improvements in FA symptoms.

OBJECTIVES

The primary aim of this paper is to describe the step-by-step codesign and refinement of a complex intervention delivered via telehealth for adults with FA using an IKT approach. The secondary aim is to describe our intervention in detail according to the TIDieR checklist.

DESIGN

This study applies the IKT process and describes the codesign and refinement of an intervention through a series of online meetings, workshops and interviews.

PARTICIPANTS

This study included researchers, clinicians, consumers and health professionals.

PRIMARY OUTCOME MEASURE

The primary outcome was a refined intervention for use in adults with symptoms of FA for a research trial.

RESULTS

A total of six female health professionals and five consumers (n=4 female) with lived overeating experience participated in two interviews lasting 60 min each. This process resulted in the identification of eight barriers and three facilitators to providing and receiving treatment for FA, eight components needed or missing from current treatments, telehealth as a feasible delivery platform, and refinement of key elements to ensure the intervention met the needs of both health professionals and possible patients.

CONCLUSION

Using an IKT approach allowed for a range of viewpoints and enabled multiple professions and disciplines to engage in a semiformalised way to bring expertise to formulate a possible intervention for FA. Mapping the intervention plan to the TIDieR checklist for complex interventions, allowed for detailed description of the intervention and the identification of a number of areas that needed to be refined before development of the finalised intervention protocol.

Patterns of Alcohol Use Among Italian Young Adults Before and During a COVID-19 Lockdown: A Latent Class Analysis Study

Two not mutually exclusive theories explain the effects of the COVID-19 pandemic on alcohol use. The Availability hypothesis contends that reduced opportunities to drink due to the closure of outlets and consumption sites should lead to decreases in alcohol use, whereas the Stress and Coping hypothesis argues that those exposed to stressful situations may increase drinking. The primary aim of this study was to examine changes—separately by gender—in the prevalence of drinking patterns among Italian young adults (18–34 years) before and during a COVID-19 lockdown. Study design was a repeated cross-sectional study, whereby data collected in 2015 and 2020 from nationally representative samples were analyzed. Latent class analysis identified five, fully invariant for women and partially invariant for men, drinking pattern classes among both cohorts: current non-drinkers (CND), weekend risky (WRD) and weekend non-risky drinkers (WnRD), daily non-risky (DnRD) and daily risky drinkers (DRD). In support of the Availability hypothesis, increases in abstaining and moderate drinking women and men were observed from 2015 to 2020. Concomitantly, among men only there were also increases in the prevalence of patterns characterized by risky drinking, coping drinking motives and related harm (Stress and Coping hypothesis). The pandemic and the three-tier lockdown imposed by the Italian government likely reduced overall alcohol use in the general population who drink moderately. However, there was a substantial increase in the prevalence of a small but significant group of men who drank daily and heavily to cope. Outreach and prevention efforts should target primarily this group, but also consider the opportunities that the exceptional circumstances of a quarantine offer to any individuals to reshape their lifestyle and health-related behaviors.

Gambling disorder in the UK: key research priorities and the urgent need for independent research funding

Gambling in the modern era is pervasive owing to the variety of gambling opportunities available, including those that use technology (eg, online applications on smartphones). Although many people gamble recreationally without undue negative effects, a sizeable subset of individuals develop disordered gambling, which is associated with marked functional impairment including other mental health problems, relationship problems, bankruptcy, suicidality, and criminality. The National UK Research Network for Behavioural Addictions (NUK-BA) was established to promote understanding of, research into, and treatments for behavioural addictions including gambling disorder, which is the only formally recognised behavioural addiction. In this Health Policy paper, we outline the status of research and treatment for disordered gambling in the UK (including funding issues) and key research that should be conducted to establish the magnitude of the problem, vulnerability and resilience factors, the underlying neurobiology, long-term consequences, and treatment opportunities. In particular, we emphasise the need to: (1) conduct independent longitudinal research into the prevalence of disordered gambling (including gambling disorder and at-risk gambling), and gambling harms, including in vulnerable and minoritised groups; (2) select and refine the most suitable pragmatic measurement tools; (3) identify predictors (eg, vulnerability and resilience markers) of disordered gambling in people who gamble recreationally, including in vulnerable and minoritised groups; (4) conduct randomised controlled trials on psychological interventions and pharmacotherapy for gambling disorder; (5) improve understanding of the neurobiological basis of gambling disorder, including impulsivity and compulsivity, genetics, and biomarkers; and (6) develop clinical guidelines based on the best contemporary research evidence to guide effective clinical interventions. We also highlight the need to consider what can be learnt from approaches towards mitigating gambling-related harm in other countries.

Internet-based treatment of gambling problems: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

The effect of internet-based psychological treatment for gambling problems has not been previously investigated by meta-analysis. The present study is therefore a quantitative synthesis of studies on the effects of internet-based treatment for gambling problems. Given that effects may vary according to the presence of therapist support and control conditions, it was presumed that subgroup analyses would elucidate such effects.

METHODS

A systematic search with no time constraints was conducted in PsycINFO, MEDLINE, Web of Science, and the Cochrane Library. Two authors independently extracted data using a predefined form, including study quality assessment based on the Cochrane risk of bias tool. Effect sizes were calculated using random-effects models. Heterogeneity was indexed by Cochran's Q and the I 2 statistics. Publication bias was investigated using trim and fill.

RESULTS

Thirteen studies were included in the analysis. Random effects models at post-treatment showed significant effects for general gambling symptoms (g = 0.73; 95% CI = 0.43-1.03), gambling frequency (g = 0.29; 95% CI = 0.14-0.45), and amount of money lost gambling (g = 0.19; 95% CI = 0.11-0.27). The corresponding findings at follow-up were g = 1.20 (95% CI = 0.79-1.61), g = 0.36 (95% CI = 0.12-0.60), and g = 0.20 (95% CI = 0.12-0.29) respectively. Subgroup analyses showed that for general gambling symptoms, studies with therapist support yield larger effects than studies without, both post-treatment and at follow-up. Additionally, on general gambling symptoms and gambling frequency, there were lower effect sizes for studies with a control group compared to studies without a control group at follow-up. Studies with higher baseline severity of gambling problems were associated with larger effect sizes at both posttreatment and follow-up than studies with more lenient inclusion criteria concerning gambling problems.

DISCUSSION AND CONCLUSIONS

Internet-based treatment has the potential to reach a large proportion of persons with gambling problems. Results of the meta-analysis suggest that such treatments hold promise as an effective approach. Future studies are encouraged to examine moderators of treatment outcomes, validate treatment effects cross-culturally, and investigate the effects of novel developments such as ecological momentary interventions.

A Systematic Review of Internet Delivered Interventions for Gambling: Prevention, Harm Reduction and Early Intervention

Internet delivered interventions are accessible and easy to access and can be used to deliver brief interventions. These interventions can be tailored according to individual need for the prevention and minimisation of gambling harm or early intervention for those that are displaying some signs of problems. The objective of this review was to summarise the existing literature on the effectiveness of prevention, harm reduction and early intervention programs when delivered online. A systematic review was conducted for peer-reviewed studies that evaluated internet delivered interventions for the prevention, harm reduction or early intervention for gambling problems. Four electronic databases were consulted in the past 20 years (2000-2020) resulting in a total of 15 included studies. Across identified studies just one study provided prevention with 7 harm reduction and 7 early interventions. The quality of the literature was variable with just 8 randomised controlled trials with the remainder matched controls or longitudinal cohort studies. The target group was predominantly gamblers accessing betting and casino websites (n = 8). Studies administered four types of interventions which included personalised and normative feedback, limit setting, self-directed cognitive and behavioural therapy and self-exclusion. These were delivered via customer gaming accounts, email, and self-learning packages. The available literature shows promise in the effectiveness of internet delivered interventions. However, the limited number of studies included in this review highlight significant lost opportunities to leverage technology in the prevention and reduction of gambling harm.

A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study

Background

Misuse of substances is common, can be serious and costly to society, and often goes untreated due to barriers to accessing care. Woebot is a mental health digital solution informed by cognitive behavioral therapy and built upon an artificial intelligence–driven platform to deliver tailored content to users. In a previous 2-week randomized controlled trial, Woebot alleviated depressive symptoms.

Objective

This study aims to adapt Woebot for the treatment of substance use disorders (W-SUDs) and examine its feasibility, acceptability, and preliminary efficacy.

Methods

American adults (aged 18-65 years) who screened positive for substance misuse without major health contraindications were recruited from online sources and flyers and enrolled between March 27 and May 6, 2020. In a single-group pre/postdesign, all participants received W-SUDs for 8 weeks. W-SUDs provided mood, craving, and pain tracking and modules (psychoeducational lessons and psychotherapeutic tools) using elements of dialectical behavior therapy and motivational interviewing. Paired samples t tests and McNemar nonparametric tests were used to examine within-subject changes from pre- to posttreatment on measures of substance use, confidence, cravings, mood, and pain.

Results

The sample (N=101) had a mean age of 36.8 years (SD 10.0), and 75.2% (76/101) of the participants were female, 78.2% (79/101) were non-Hispanic White, and 72.3% (73/101) were employed. Participants’ W-SUDs use averaged 15.7 (SD 14.2) days, 12.1 (SD 8.3) modules, and 600.7 (SD 556.5) sent messages. About 94% (562/598) of all completed psychoeducational lessons were rated positively. From treatment start to end, in-app craving ratings were reduced by half (87/101, 86.1% reporting cravings in the app; odds ratio 0.48, 95% CI 0.32-0.73). Posttreatment assessment completion was 50.5% (51/101), with better retention among those who initially screened higher on substance misuse. From pre- to posttreatment, confidence to resist urges to use substances significantly increased (mean score change +16.9, SD 21.4; P<.001), whereas past month substance use occasions (mean change −9.3, SD 14.1; P<.001) and scores on the Alcohol Use Disorders Identification Test-Concise (mean change −1.3, SD 2.6; P<.001), 10-item Drug Abuse Screening Test (mean change −1.2, SD 2.0; P<.001), Patient Health Questionnaire-8 item (mean change 2.1, SD 5.2; P=.005), Generalized Anxiety Disorder-7 (mean change −2.3, SD 4.7; P=.001), and cravings scale (68.6% vs 47.1% moderate to extreme; P=.01) significantly decreased. Most participants would recommend W-SUDs to a friend (39/51, 76%) and reported receiving the service they desired (41/51, 80%). Fewer felt W-SUDs met most or all of their needs (22/51, 43%).

Conclusions

W-SUDs was feasible to deliver, engaging, and acceptable and was associated with significant improvements in substance use, confidence, cravings, depression, and anxiety. Study attrition was high. Future research will evaluate W-SUDs in a randomized controlled trial with a more diverse sample and with the use of greater study retention strategies.

Trial Registration

ClinicalTrials.gov NCT04096001; http://clinicaltrials.gov/ct2/show/NCT04096001.

Evidence Synthesis of Digital Interventions to Mitigate the Negative Impact of the COVID-19 Pandemic on Public Mental Health: Rapid Meta-review

Background

Accumulating evidence suggests the COVID-19 pandemic has negative effects on public mental health. Digital interventions that have been developed and evaluated in recent years may be used to mitigate the negative consequences of the pandemic. However, evidence-based recommendations on the use of existing telemedicine and internet-based (eHealth) and app-based mobile health (mHealth) interventions are lacking.

Objective

The aim of this study was to investigate the theoretical and empirical base, user perspective, safety, effectiveness, and cost-effectiveness of digital interventions related to public mental health provision (ie, mental health promotion, prevention, and treatment of mental disorders) that may help to reduce the consequences of the COVID-19 pandemic.

Methods

A rapid meta-review was conducted. The MEDLINE, PsycINFO, and CENTRAL databases were searched on May 11, 2020. Study inclusion criteria were broad and considered systematic reviews and meta-analyses that investigated digital tools for health promotion, prevention, or treatment of mental health conditions and determinants likely affected by the COVID-19 pandemic.

Results

Overall, 815 peer-reviewed systematic reviews and meta-analyses were identified, of which 83 met the inclusion criteria. Our findings suggest that there is good evidence on the usability, safety, acceptance/satisfaction, and effectiveness of eHealth interventions. Evidence on mHealth apps is promising, especially if social components (eg, blended care) and strategies to promote adherence are incorporated. Although most digital interventions focus on the prevention or treatment of mental disorders, there is some evidence on mental health promotion. However, evidence on process quality, cost-effectiveness, and long-term effects is very limited.

Conclusions

There is evidence that digital interventions are particularly suited to mitigating psychosocial consequences at the population level. In times of physical distancing, quarantine, and restrictions on social contacts, decision makers should develop digital strategies for continued mental health care and invest time and efforts in the development and implementation of mental health promotion and prevention programs.

A Perspective on the Integration of eHealth in Treatment of Offenders: Combining Technology and the Risk-Need-Responsivity Model

While there are multiple ways in which eHealth interventions such as online modules, apps and virtual reality can improve forensic psychiatry, uptake in practice is low. To overcome this problem, better integration of eHealth in treatment is necessary. In this perspective paper, we describe how the possibilities of eHealth can be connected to the risk-need-responsivity (RNR) model. To account for the risk-principle, stand-alone eHealth interventions might be used to offer more intensive treatment to high-risk offenders. The need-principle can be addressed by connecting novel experience-based interventions such as VR and apps to stable and acute dynamic risk factors. Finally, using and combining personalized interventions is in line with the responsivity-principle. Based on research inside and outside of forensic psychiatry, we conclude that there are many possibilities for eHealth to improve treatment-not just based on RNR, but also on other models. However, there is a pressing need for more development, implementation and evaluation research.

Process Evaluation of a Personality Targeted Intervention for Addictive Eating in Australian Adults

Addictive eating prevalence is estimated at 15-20% in studied populations, and is associated with concurrent mental health conditions and eating disorders as well as overweight and obesity. However, few evidence-based interventions targeting addictive eating are available. The further development of evidence-based interventions requires assessment of intervention feasibility and efficacy. This study aimed to determine the feasibility, including intervention delivery and program acceptability, of FoodFix; a personality targeted intervention for the treatment of addictive eating behaviours in Australian adults. Participants (n = 52) were randomised to intervention (n = 26) or wait-list control groups (n = 26) and received three personalised telehealth sessions with an Accredited Practising Dietitian over seven weeks. Intervention delivery was assessed by tracking adherence to scheduled timing of intervention sessions. Program acceptability of participants was assessed via an online process evaluation survey and program acceptability of intervention providers was assessed via semi-structured phone interviews. In total, 79% of participants adhered to scheduled timing for session two and 43% for session three, defined as within one week (before/after) of the scheduled date. Further, 21% of participants completed the process evaluation survey (n = 11). The majority of participants were extremely/very satisfied with FoodFix (n = 7, 63%). Intervention providers (n = 2) expressed that they felt adequately trained to deliver the intervention, and that the overall session format, timing, and content of FoodFix was appropriate for participants. These findings highlight the importance of assessing intervention feasibility to further understand intervention efficacy.

Effectiveness of a voluntary casino self-exclusion online self-management program

Despite evidence for effectiveness, only a small proportion of individuals with gambling disorder ever access treatment and support resources for their problem. Voluntary self-exclusion (VSE) programs are an ideal circumstance to engage individuals who are reluctant or have not yet sought formal treatment, given that individuals are already electing to prevent themselves from gambling through self-exclusion. The present study was a randomized controlled trial of a novel, online VSE self-management intervention. Individuals who chose to self-exclude at gambling venues (N = 201) were randomly assigned to participate in an online self-management program combined with VSE or to an in-person self-awareness educational workshop combined with VSE comparison group. Following a baseline assessment, participants were followed up at three, six, and twelve months via telephone interviews. Measured outcomes were gambling frequency and expenditure, problem gambling scores, problem drinking scores, type of goal set for gambling behaviour, quality of life, and treatment-seeking. The 12-month follow-up rate was 71% (n = 143). Participants in both VSE groups gambled less, spent less money gambling, and reported decreased need for formal treatment. However, there were no significant group differences on any of the primary or secondary outcomes. Only 30-35% of the participants completed their assigned workshop, depending on the group. Results from the online program satisfaction survey revealed that participants generally liked the program and rated the quality of the content highly, but thought there could be improvement regarding interactivity, variety, stimulation and greater clarity around registration steps and program objectives. The online VSE program is an effective alternative to the face-to-face VSE program. Although the outcomes between the two programs were not significantly different, the online program is easier to administer, able to reach more individuals since it only requires access to a computer and is based on motivational evidence-based principles of psychotherapy for gambling disorder.

Giving and receiving social support in online substance use disorder forums: How self-efficacy moderates effects on relapse

OBJECTIVE

Individuals in recovery for substance use disorders (SUDs) increasingly use online social support forums, necessitating research on how communicating through these forums can affect recovery. This study examines how giving and receiving support within an SUDs recovery forum predict substance use, and considers whether effects vary according to participants' self-efficacy.

METHODS

We applied content analysis to 3440 messages that were posted by 231 participants in an online SUDs forum. Surveys assessed social support reception and substance use at three timepoints. We assessed relationships between giving and receiving support and substance use (risky drinking days, illicit drug use days), and the interactions between self-efficacy and social support in predicting substance use outcomes.

RESULTS

Receiving more emotional support was associated with reduced illicit drug use at 6 and 12 months. For those with low self-efficacy, giving more emotional support predicted less risky drinking at month 12, whereas giving more informational support predicted more risky drinking at month 12.

CONCLUSION

These results suggest conditional benefits of exchanging support in an online SUDs forum, depending upon type of support (informational versus emotional), the participants' role (giver or receiver), and their self-efficacy.

PRACTICE IMPLICATIONS

We discuss implications for designing and using peer-to-peer support platforms.

Web-Based Intervention and Email-Counseling for Problem Gamblers: Results of a Randomized Controlled Trial

Web-based interventions have the potential to reduce the treatment gap for problem gambling. In the past years, several web-based help options were made available to the public. However, only few studies were conducted to test their effects. This study investigated the efficacy of two interventions for problem gamblers provided online by the German Federal Center for Health Education (BZgA). The first intervention is the guided program “Check Out” (CO), the second is email counselling (EC). A web-based randomized controlled trial with follow-up surveys after 3, 6 and 12 months was conducted. Participants were allocated to CO, to EC or to a waitlist (WL). Outcomes were the degree of problem gambling according to the Problem Gambling Severity Index, the number of days gambled in past 30 days, the highest stake during the past 30 days and the subjective well-being (WHO-5). 167 individuals were included in the trial. In comparison to the WL at the 3 months follow-up, participants of CO showed significant improvements with moderate to strong effect sizes in all outcomes. Strongest effects were found in the problem gambling severity (d = 0.91; p = 0.023), followed by the well-being (d = 0.70; p = 0.011), the gambling days (d = 0.59; p = 0.001) and the highest stake (d = 0.55; p = 0.012). Improvements were sustained until last follow-up. Compared to the WL, users of EC had beneficiary results in the problem gambling severity (d = 0.74; p = 0.022). No significant effect differences were found between CO and EC. However, according to process evaluation, users of CO reported a significantly stronger working alliance than users of EC (d = 0.70; p = 0.019) and used the intervention considerably longer (d = 0.84; p = 0.004). CO helps treatment-seeking individuals to sustainably reduce their gambling behavior and to increase their general well-being. Compared to EC, CO seems a better support option, since its effects include a wider range of outcomes. Possible reasons are the more engaging program structure and elements of CO, as well as the closer interaction between client and counselor.

Professionally delivered interventions for gambling disorder

PURPOSE OF REVIEW

To assess recent developments in professionally delivered interventions for gambling disorder.

RECENT FINDINGS

During the past 24 months a number of reviews and individual studies have been published. Collectively they assess the efficacy and effectiveness of a range of interventions and identify methodological and other shortcomings. These studies advance knowledge with respect to pharmacological and psychological treatments including brief interventions delivered face-to-face and in other ways. Increased attention has been given to patient diversity, comorbidity, relapse, and nongambling outcomes. A variety of novel interventions have been developed and assessed.

SUMMARY

CBT and brief interventions remain well supported and appear to be similarly effective across varied patient groups. A range of promising new and combination treatments have been developed that require further evaluation. Larger, more robust pragmatic trials are required with diverse populations. Increased attention needs to be given to mechanisms of change, therapy mediators, patient retention, comorbidities, long-term treatment outcome, and relapse prevention.

Acceptability and feasibility of a computer-based application to help Aboriginal and Torres Strait Islander Australians describe their alcohol consumption

We examined acceptability and feasibility of a tablet application ("App") to record self-reported alcohol consumption among Aboriginal and Torres Strait Islander Australians. Four communities (1 urban; 3 regional/remote) tested the App, with 246 adult participants (132 males, 114 females). The App collected (a) completion time; (b) participant feedback; (c) staff observations. Three research assistants were interviewed. Only six (1.4%) participants reported that the App was "hard" to use. Participants appeared to be engaged and to require minimal assistance; nearly half verbally reflected on their drinking or drinking of others. The App has potential for surveys, screening, or health promotion.

Internet-Based Interventions for Problem Gambling: Scoping Review

BACKGROUND

This study seeks to give an overview of academic research on internet-based interventions that are used to address problem gambling. The rate of treatment seeking has been demonstrated to be low across several research environments. This is in part because of the systemic barriers that treatment seekers face to accessing traditional face-to-face treatment. Making treatment resources for problem gambling available through the internet is one way to reduce the impact of those systemic barriers. The use of internet-based resources to address problem gambling has been growing, and a field of research evaluating it has developed as well. However, little has been done to summarize this collection of research.

OBJECTIVE

This study aimed to provide a scoping review of the use of internet-based interventions for problem gambling treatment and prevention to provide an understanding of the current state of the field.

METHODS

A scoping review was performed for 6 peer-reviewed research databases (Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Social Science Abstracts, and Scopus) and 3 gray literature databases (MedEdPortal, Proquest: Dissertations, and OpenGrey). Article inclusion criteria were as follows: published over the 10-year period of 2007 to 2017, including an intervention for problem gambling, and involving the use of internet to deliver that intervention.

RESULTS

A total of 27 articles were found that met the review criteria. Studies were found from several different areas, with particularly strong representation for Australia, New Zealand, and Scandinavia. Cognitive behavioral therapy was the most common form of internet-based intervention. Internet-based interventions were generally shown to be effective in reducing problem gambling scores and gambling behaviors. A wide range of interventions that made use of internet resources included text-based interactions with counselors and peers, automated personalized and normative feedback on gambling behaviors, and interactive cognitive behavioral therapies. A lack of diversity in samples, little comparison with face-to-face interventions, and issues of changes in the treatment dynamic are identified as areas that require further investigation.

CONCLUSIONS

Internet-based interventions are a promising direction for treatment and prevention of problem gambling, particularly in reducing barriers to accessing professional help. The state of the current literature is sparse, and more research is needed for directly comparing internet-based interventions and their traditional counterparts.

Smartphone Apps About Crystal Methamphetamine ("Ice"): Systematic Search in App Stores and Assessment of Composition and Quality

Background

Amid considerable community concern about the prevalence and harms associated with the use of crystal methamphetamine (“ice”), the increased use of smartphones to access health information and a growing number of available smartphone apps related to crystal methamphetamine, no previous reviews have examined the content and quality of these apps.

Objective

This study aims to systematically review existing apps in the iTunes and Google Play Stores to determine the existence, composition, and quality of educational smartphone apps about methamphetamines, including ice.

Methods

The iTunes and Google Play Stores were systematically searched in April 2017 for iOS Apple and Android apps, respectively. English-language apps that provided educational content or information about methamphetamine were eligible for inclusion. Eligible apps were downloaded and independently evaluated for quality by 2 reviewers using the Mobile Application Rating Scale (MARS).

Results

A total of 2205 apps were initially identified, of which 18 were eligible and rated using the MARS. The mean MARS quality total score for all rated apps was 3.0 (SD 0.6), indicating poor to acceptable quality. Overall, mean scores were the highest for functionality (mean 4.0, SD 0.5) and lowest for engagement (mean 2.3, SD 0.7).

Conclusions

This study demonstrates a shortage of high-quality educational and engaging smartphone apps specifically related to methamphetamine. The findings from this review highlight a need for further development of engaging and evidence-based apps that provide educational information about crystal methamphetamine.

Mobile App Tools for Identifying and Managing Mental Health Disorders in Primary Care

PURPOSE OF REVIEW

Mental health apps are intriguing yet challenging tools for addressing barriers to treatment in primary care. In the current review, we seek to assist primary care professionals with evaluating and integrating mental health apps into practice. We briefly summarize two leading frameworks for evaluating mental health apps and conduct a systematic review of mental health apps across a variety of areas commonly encountered in primary care.

RECENT FINDINGS

Existing frameworks can guide professionals and patients through the process of identifying apps and evaluating dimensions such as privacy and security, credibility, and user experience. For specific apps, several problem areas appear to have relatively more scientific evaluation in the current app landscape, including PTSD, smoking, and alcohol use. Other areas such as eating disorders not only lack evaluation, but contain a significant subset of apps providing potentially harmful advice.

SUMMARY

Overall, individuals seeking mental health apps will likely encounter strengths such as symptom tracking and psychoeducational components, while encountering common weaknesses such as insufficient privacy settings and little integration of empirically-supported techniques. While mental health apps may have more promise than ever, significant barriers to finding functional, usable, effective apps remain for health professionals and patients alike.

Self-guided Change: The most common form of long-term, maintained health behavior change

Millions of people change risky, health-related behaviors and maintain those changes. However, they often take years to change, and their unhealthy behaviors may harm themselves and others and constitute a significant cost to society. A review-similar in nature to a scoping review-was done of the literature related to long-term health behavior change in six areas: alcohol, cocaine and heroin misuse, gambling, smoking, and overeating. Based on the limited research available, reasons for change and strategies for changing and for maintaining change were also reviewed. Fifty years of research clearly indicate that as people age, in the case of alcohol, heroin and cocaine misuse, smoking, and gambling, 80-90 percent moderate or stop their unhealthy behaviors. The one exception is overeating; only 20 percent maintain their weight loss. Most of these changes, when they occur, appear to be the result of self-guided change. More ways to accelerate self-guided, health-related behavior change need to be developed and disseminated.