Digital Treatment Paths for Substance Use Disorders (SUDs)

An Observational Study of a Digital Substance Use and Recovery Program

OBJECTIVE

Digital substance use treatment programs present an opportunity to provide nonresidential care for people with problematic substance use. In June 2021, the provincial government in Ontario provided free access to Breaking Free Online (BFO), a digital behavioral change program for people with substance use disorders.

METHODS

An observational study was conducted with retrospective data to characterize clients' use and engagement patterns in BFO and examine changes in self-reported outcomes.

RESULTS

In total, 6,370 individuals registered for BFO between June 2021 and October 2022, of whom 3,650 completed the intake assessment. Most of these clients were self-referred (64%), with 37% having been referred by health service providers. More than one-half of the clients (52%) resided in Ontario West or East regions. Support for addressing problematic alcohol use was the most requested program (40%). By October 2022, about 44% of the clients had completed between one and four of 12 program strategies. Analysis revealed significant changes in pre-post scores across four validated scales (p<0.001), indicating a decrease in anxiety and depression, an increase in quality of life, an improvement in recovery progression, and a decrease in severity of symptoms associated with substance use disorders.

CONCLUSIONS

BFO clients with higher completion rates had the most improvement across the scales used; however, clients with lower and medium completion rates also had improvements. Because of the shame and stigma associated with substance use, digital supports with low barriers to entry can help support the autonomy, privacy, and preferences of individuals seeking help for problematic substance use.

Mental Health for All: The Case for Investing in Digital Mental Health to Improve Global Outcomes, Access, and Innovation in Low-Resource Settings

Mental health disorders are an increasing global public health concern that contribute to morbidity, mortality, disability, and healthcare costs across the world. Biomedical and psychological research has come a long way in identifying the importance of mental health and its impact on behavioral risk factors, physiological health, and overall quality of life. Despite this, access to psychological and psychiatric services remains widely unavailable and is a challenge for many healthcare systems, particularly those in developing countries. This review article highlights the strengths and opportunities brought forward by digital mental health in narrowing this divide. Further, it points to the economic and societal benefits of effectively managing mental illness, making a case for investing resources into mental healthcare as a larger priority for large non-governmental organizations and individual nations across the globe.

Efficacy of psychosocial interventions to reduce alcohol use in comorbid alcohol use disorder and alcohol-related liver disease: a systematic review of randomized controlled trials

This systematic review (PROSPERO CRD42021234598) fills a gap in the literature by assessing the efficacy of psychosocial interventions in patients with alcohol use disorder and alcohol-related liver disease (ARLD), focusing on drinking reduction and abstinence as intervention goals. A systematic search for randomized controlled trials (RCTs) was conducted across various databases. Study screening and data extraction were conducted independently by two reviewers. The data were presented through narrative synthesis. Primary outcomes were alcohol reduction and abstinence at the longest follow-up. Ten RCTs were included, evaluating interventions such as cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), motivational interviewing, or peer support. The total population included 1519 participants. Four studies included a combination of more than one intervention, and two trialed an integrated approach, including medical and psychosocial management. A significant reduction was observed with MET, while abstinence was observed with peer support, MET, and CBT/MET within integrated treatment. The overall certainty of the evidence was moderate. Six studies presented a low risk of bias, one had some concerns, and three were high risk. The findings highlight the potential of psychosocial interventions, with MET being repeatedly associated with improved outcomes. Integrated treatment also demonstrated a promising role in ARLD. Future research should head toward improving the robustness and quality of the evidence. It should also aim to further tailor and trial new psychosocial interventions on this specific clinical population. This will enhance the translation of the evidence into real-world settings.

Italian University Students' Resilience during the COVID-19 Lockdown-A Structural Equation Model about the Relationship between Resilience, Emotion Regulation and Well-Being

Over the past two years, the consequences of the severe restrictions imposed by the rapid spread of COVID-19 among the global population have been a central focus of scientific research. The pandemic has been a singular and unexpected event that found people unprepared and vulnerable in responding to its emergence, resulting in substantial psychological distress. Scientific evidence has highlighted that adolescents and emerging adults have been among those populations at greatest risk of adverse psychological outcomes, even in the long term. In particular, more than one-third of young adults reported high levels of loneliness, and nearly half of 18- to 24-year-olds felt lonely during the pandemic, experiencing both psychological and emotional distress. The lockdown, the consequent suspension of face-to-face academic activities and the severe restriction of social life have disrupted the daily routines of students already involved in coping with developmental tasks related to identity formation and the relational experience. Under such conditions, emotions and emotional regulation skills are crucial in adapting behavior to reach academic goals and face mounting levels of distress. Therefore, several studies have investigated resilience mechanisms and coping strategies of emerging adults during the pandemic. The present study focuses on university students and explores the impact of resilience and emotional regulation on adverse psychological outcomes related to persistent distress conditions associated with the COVID-19 pandemic. Students were administered a self-report assessment battery through an online platform at the beginning (T0) and the end of the lockdown (T1). A structural equation model (SEM) was used to explore the relationship between resilience, emotional regulation difficulties and psychological distress (depression, anxiety and stress). The findings indicate that psychological resilience and emotion regulation are protective factors that buffer the extent of possible distress resulting from an adverse condition such as the COVID-19 pandemic.

Polysubstance Use Patterns among Outpatients Undergoing Substance Use Disorder Treatment: A Latent Class Analysis

Substance Use Disorders (SUDs) pose significant challenges to both individuals and society at large. The primary focus of existing research with clinical SUD populations has been on individual substances, but research is required to better understand the profiles of individuals who use different substances simultaneously. The purpose of the current study was, therefore, to identify patterns of use among subjects (n = 1025) who reported using multiple substances by adopting a Latent Class Analysis (LCA) methodology. The Addiction Severity Index (ASI-lite) was included as a measure of substance misuse, we performed LCA to identify patterns of substance use through the administration of the ASI-Lite. Responses were collected from the following substances: alcohol, cannabis/cannabinoids, opioids and heroin, and cocaine. Results identified two latent classes: (1) alcohol use dominant, and (2) poly-abuser use dominants. Class 1 represented 60.0% of the sample and refers to individuals with the dominant use of alcohol, of those a higher proportion (47%) reported low-frequency use (1 to 7 days per month) and 26% reported a frequency of use of 24 to 30 days per month. Furthermore, 18% used alcohol in combination with cocaine. Class 2 represents 40.0% of the sample. This class is characterized by low-frequency and high-frequency users of several substances. The results obtained highlight the importance of deepening the study of the concomitant use of substances in individuals with SUDs to better understand the health risk of the combined use of two or more substances.

Dealing with Loved Ones' Addiction: Development of an App to Cope with Caregivers' Stress

Caregivers remain the primary source of attachment, nurturing, and socialization for human beings in our current society. Family caregivers provide 11 to 100 h of care per week to their loved ones, including emotional and social support, assistance with transportation, home care, and so on. However, caregivers find the workload challenging due to fatigue, burnout, depression, anxiety, and sleep disturbances, and sometimes also from an excessive burden. Caregiver burden and stress ultimately negatively affect family members and caregivers. The caregiver is then at risk of developing deleterious physical, psychological, social, and emotional problems such as mood and anxiety disorders. Mobile health applications (mHealth applications) can be a solution to help family caregivers care for their loved ones and also for themselves. In this study, we present the development of an mHealth application for caregivers of persons with substance use and tested its usability. We used a user-centered design and intervention (UCDI) approach to develop the app by conducting a focus group with parents of individuals with addiction problems. Four key themes were identified during the focus group: (i) information section, (ii) self-care section, (iii) how-to: stress-reduction section, and (iv) chat section. The final app was developed with the software vendor and divided into several sections that were useful for managing psychological problems (such as stress or anxiety), informing about addiction and behavioral dependency problems, and helping users find a professional or services nearby. An analysis of the results of a usability test related to the app administered to a subsample of the focus group showed that the app provided ease of use, usefulness, and satisfaction.

Digital Help for Substance Users (SU): A Systematic Review

The estimated number of Substance Users (SU) globally has currently reached a very high number and is still increasing. This aspect necessitates appropriate interventions for prevention and specific treatments. The literature shows that digital treatments can be useful in the context of health services and substance abuse. This systematic review focuses mainly on research on the effectiveness of digital treatments for SU. Data sources included studies found on PsycINFO, PubMed, SCOPUS, and WebOfScience (WOS) database searches. The following keywords were used: TITLE (digital OR computer OR software OR tablet OR app OR videogame OR seriousgame OR virtualreality) AND ABSTRACT((mental AND health) AND (addiction OR dependence OR substance OR drug)). We focused on peer-reviewed articles published from 2010 through 2021 using PRISMA guidelines. A total of 18 studies met the inclusion criteria (i.e., type of intervention, efficacy in terms of misuse of substances and scored outcomes from questionnaire or toxicology tests, study methodology). The studies included investigations of specific digital treatments for SU of various kinds of drugs. The interventions were administered using personal computers, smartphones, or, in a few cases, tablets. Most of the interventions focused on the cognitive behavior therapy (CBT) model and/or on the use strategies, tips, or feedback. A minority provided information or training programs. The current review shows that digital treatments and interventions are effective in reducing the frequency of use, augmenting abstinence, or reducing the gravity of dependence for most of the studies at post-treatment. However, due to the heterogeneity of the variables (i.e., substance type, digital tool used, and treatment administered), there was a reduced generalizability of the results. This review highlights the need to continue the research in this field, and above all, to create effective digital protocols.