| 1. |
- Gajecki, Mikael, et al.
(författare)
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Mobile phone brief intervention applications for risky alcohol use among university students : a randomized controlled study
- 2014
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Ingår i: Addiction science & clinical practice. - : BioMed Central. - 1940-0632 .- 1940-0640. ; 9:11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Brief interventions via the internet have been shown to reduce university students' alcohol intake. This study tested two smartphone applications (apps) targeting drinking choices on party occasions, with the goal of reducing problematic alcohol intake among Swedish university students. METHODS: Students were recruited via e-mails sent to student union members at two universities. Those who gave informed consent, had a smartphone, and showed risky alcohol consumption according to the Alcohol Use Disorders Identification Test (AUDIT) were randomized into three groups. Group 1 had access to the Swedish government alcohol monopoly's app, Promillekoll, offering real-time estimated blood alcohol concentration (eBAC) calculation; Group 2 had access to a web-based app, PartyPlanner, developed by the research group, offering real-time eBAC calculation with planning and follow-up functions; and Group 3 participants were controls. Follow-up was conducted at 7 weeks. RESULTS: Among 28574 students offered participation, 4823 agreed to join; 415 were excluded due to incomplete data, and 1932 fulfilled eligibility criteria for randomization. Attrition was 22.7-39.3 percent, higher among heavier drinkers and highest in Group 2. Self-reported app use was higher in Group 1 (74%) compared to Group 2 (41%). Per-protocol analyses revealed only one significant time-by-group interaction, where Group 1 participants increased the frequency of their drinking occasions compared to controls (p = 0.001). Secondary analyses by gender showed a significant difference among men in Group 1 for frequency of drinking occasions per week (p = 0.001), but not among women. Among all participants, 29 percent showed high-risk drinking, over the recommended weekly drinking levels of 9 (women) and 14 (men) standard glasses. CONCLUSIONS: Smartphone apps can make brief interventions available to large numbers of university students. The apps studied using eBAC calculation did not, however, seem to affect alcohol consumption among university students and one app may have led to a negative effect among men. Future research should: 1) explore ways to increase user retention, 2) include apps facilitating technical manipulation for evaluation of added components, 3) explore the effects of adapting app content to possible gender differences, and 4) offer additional interventions to high-risk users. TRIAL REGISTRATION: clinicaltrials.gov: NCT01958398.
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| 2. |
- Berman, Anne H, et al.
(författare)
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Smartphone apps targeting risky and excessive drinking patterns among university students show differing subgroup effects over 20 weeks
- 2017
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Ingår i: Addiction science & clinical practice. - : BioMed Central. - 1940-0632 .- 1940-0640. ; 12:Suppl 1, s. 19-20
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background and Aims: University students with risky drinking are a clear target group for intervention via smartphone apps. This study compared three different apps over a 20-week period, for university students with hazardous and excessive drinking patterns. Materials and Methods: Students from six campuses were invited to a three-armed trial (A). Those with hazardous alcohol use (n = 2166) were randomly assigned to one of two smartphone apps offer- ing feedback on real-time estimated blood alcohol concentration (eBAC) levels, or to a control group, with three follow-ups at 6, 12 and 20 weeks. At 6 weeks, participants in the app groups with excessive weekly alcohol consumption of >9 (women) or >14 (men) drinks per week (n = 257), were offered participation in a second trial (B); con-senters (n = 186) were randomly assigned to a skills-based app or a waitlist group, and compared with an assessment-only control group. Results: Six-week analyses (n = 2166) replicated our earlier trial from 2014, re-confirming earlier results: the Promillekoll app was associated with higher quantity and frequency of drinking compared to controls, and a higher risk for excessive drinking; the PartyPlanner group did not differ from controls. Lower-risk drinkers from trial A (n = 1177) up to 20 weeks did not differ from controls on main outcomes. However, sub-analyses showed that individuals with higher consumption had higher motivation to reduce intake. In both intervention groups, con-sumption was lower for more highly motivated participants compared to controls at 6- and 20-week follow-ups. Latent class analysis of par- ticipants in both trials (n = 2166) revealed a class (n = 146) that drank several days a week and that differed significantly from the remain- ing cohort in gender, age, and alcohol consumption. For this class, access to the Promillekoll app appeared marginally associated with lower quantity over time; access to the skills-based TeleCoach app was clearly associated with fewer drinking days up to 20 weeks. Conclusions: Smartphone apps targeting eBAC can influence drink-ing levels up to 20 weeks for university students with hazardous use and higher motivation to reduce their drinking. A skills-based app that reduces intake among students with excessive weekly consumption can be particularly effective for students with daily drinking habits.
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| 3. |
- Ekström, Veronica, 1975-, et al.
(författare)
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Choosing internet-based treatment for problematic alcohol use - why, when and how? : Users’ experiences of treatment online
- 2020
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Ingår i: Addiction science & clinical practice. - : Springer Science and Business Media LLC. - 1940-0632 .- 1940-0640. ; 15, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Internet-based treatment has emerged as a cost-effective option for reaching people who for different reasons are not reached by traditional treatment. Internet-based treatment for problematic alcohol use, specifically, has been found to show results on par with other forms of treatment. However, in-depth knowledge of users’ experiences is required to understand what works, and what needs further development. The aim of this study is to investigate the help-seeking motives among users of an internet-based service for problematic alcohol use, as well as the users’ experiences of the support available through the service.Method: The study consists of a thematic analysis of interviews with 38 former users of the internet-based intervention Alkoholhjälpen.Results: The analysis shows that health and relationship factors, as well as feelings of shame, were important motives for the users’ decisions to reduce their drinking. Availability and anonymity seem to have been important reasons for choosing internet-based support. The different treatment components, i.e. ICBT program, therapist support and discussion forum, were each perceived as helpful by some users but not by others. Treatment components were described as more useful when users were able to personally identify with the content, and when it helped them reflect on their own alcohol consumption.Conclusions: There are several aspects that are relevant, beyond the comparison between components, if we want to understand what works and for whom in internet-based treatment. Internet-based treatment services should be generous in terms of options for the users.
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| 4. |
- Ekström, Veronica, 1975-, et al.
(författare)
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Sort of a nice distance : a qualitative study of the experiences of therapists working with internet-based treatment of problematic substance use
- 2019
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Ingår i: Addiction science & clinical practice. - : Springer Science and Business Media LLC. - 1940-0632 .- 1940-0640. ; 14, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Internet interventions have been developed and tested for several psychiatric and somatic conditions. Few people with substance use disorders receive treatment and many drug users say that they would prefer getting help from online tools. Internet interventions are effective for reducing alcohol and cannabis use. The aim of the current study is to understand differences between internet-based and face-to-face treatment of problematic substance use. The concept of alliance will be used as a theoretical frame for understanding differences between internet-based treatment and face-to-face treatment, as perceived by therapists.Method: The study has a qualitative design and is based on 3 focus group interviews with 12 therapists working with internet-based treatment for alcohol or cannabis use problems within five different programs.Results: The analysis revealed five themes in the differences between internet-based and face-to-face treatment: communication, anonymity, time, presence and focus. Treatment online in written and asynchronous form creates something qualitatively different from regular face-to-face meetings between patients and therapists. The written form changes the concept of time in treatment, that is, how time can be used and how it affects the therapist’s presence. The asynchronous (i.e. time delayed) form of communication and the lack of facial expressions and body language require special skills.Conclusions: There are important differences between internet-based treatment and face-to-face treatment. Different aspects of the alliance seem to be important in internet-based treatment compared to face-to-face.
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| 5. |
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| 6. |
- Hammarberg, Stina Ingesson, et al.
(författare)
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A qualitative interview study of patient experiences of receiving motivational enhancement therapy in a Swedish addiction specialist treatment setting
- 2023
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Ingår i: Addiction science & clinical practice. - : Springer Nature. - 1940-0632 .- 1940-0640. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Motivational enhancement therapy (MET) has shown to be efficacious as treatment of alcohol use disorder (AUD), in reducing alcohol consumption and related consequences. However, qualitative research on how patients perceive this treatment is lacking. The aim of this study was to explore how patients experience MET as a treatment for AUD.Methods: Fifteen patients (8/7 female/male) participated in semi-structured interviews after receiving MET at a specialized addiction outpatient clinic in Sweden. Data were analyzed by thematic analysis.Results: Five themes were identified: the therapist conveyed the MI-spirit, the therapist did not guide on how to reach the goal, participants were committed to change before starting treatment, participants were uncertain if treatment was enough to maintain change, and significant others were not wanted in sessions. Participants appreciated the supportive relationship with their therapist, but some experienced therapy as overly positive, with no room to talk about failure. Further, they experienced a low level of guidance in goal-setting. For some, this was empowering, while others requested more direction and advice. Participants perceived their motivational process to have started before treatment. MET was considered to be too brief. None of the participants brought a significant other to a session.Conclusions: Therapist behaviors in line with MI spirit were emphasized as key to the development of a positive therapeutic relationship. More specific advice on goal-setting may be effective for supporting change in some patients. Longer treatment is requested among patients to support the patient's self-efficacy for change. Significant others can support change without necessarily being present in sessions.
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| 7. |
- Månsson, Viktor, et al.
(författare)
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Treatment for problem gambling and counselors’ perception of their clinical competence : a national web survey in Sweden
- 2022
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Ingår i: Addiction science & clinical practice. - : Springer Science and Business Media LLC. - 1940-0632 .- 1940-0640. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite their crucial role in bridging science and practice, not much is known about counselors offer-ing treatment for Problem Gambling (PG). This study maps current treatment, the type of change techniques that areprioritized in treatment and how counselors perceive their clinical competence in their work with PG clients. Methods: A sample of PG counselors from the healthcare and social services (N = 188, mean age: 49 years, 67%women) completed an online survey. A principal component analysis was conducted to map prioritized typesof change techniques, and a multiple regression analysis was carried out to analyze predictors of counselors’ roleadequacy in their clinical work. Results: There was a large variation in the type of treatments offered for PG (mean 3.6). Cognitive Behavioral Therapy(CBT) and Motivational Interviewing were the most common treatments offered and motivation was rated as themost important type of change technique prioritized in the treatment of PG. A principal component analysis identi-fied four components reflecting different types of change techniques prioritized by the counselors: (1) standard CBT,e.g., gambling cognitions, craving management, and finding alternative activities, (2) assessment of PG, (3) fam-ily orientation, i.e., involvement of concerned significant others in treatment, and (4) focus on exposure strategies. Counseling more clients monthly was associated with higher levels of willingness, adequacy and legitimacy in theirclinical work with clients with PG. Additionally, offering CBT was a predictor for higher role adequacy and providingcounseling on the origins of and consequences of PG. Conclusion: There was a large heterogeneity among the treatments offered and what change techniques that wereprioritized among the PG counselors. Clinical experience is of importance for developing competence in treatingclients with PG. This finding suggests there could be benefits to establishing specialized, more visible treatment unitswhere PG counselors could gain adequate clinical experience, thus increasing clinical competence for treating PG.
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| 8. |
- Nehlin, Christina, 1958-, et al.
(författare)
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How do people with mood and anxiety disorders perceive and interpret the Drinking Motives Questionnaire? : A think-aloud study in a clinical setting
- 2018
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Ingår i: Addiction science & clinical practice. - : BIOMED CENTRAL LTD. - 1940-0632 .- 1940-0640. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Research has identified drinking motives as the final common pathway to alcohol use, and associations between specific drinking motives and drinking patterns have consistently been demonstrated. Data on drinking motives can be used for research, in the planning of prevention strategies and for treatment purposes. The Drinking Motives Questionnaire-Revised (DMQ-R) has become the most used measure of drinking motives. So far, the questionnaire has not been investigated with qualitative methods. The aim of this study was to investigate acceptability, accuracy and usability of the DMQ-R among persons receiving outpatient psychiatric care by studying how responders perceive and interpret the questionnaire.Method: A cognitive interviewing technique, the think-aloud method, was used to collect data from 16 non-alcohol dependent patients seeking outpatient psychiatric care (12 women, 4 men). To analyse data, Qualitative Content Analysis was applied in which themes were formed from data only and not from predetermined areas of interest.Results: Overall, acceptability of the DMQ-R was high although answers were sometimes given with low accuracy. Responders pointed out that they perceived the questionnaire as non-confrontational and exhaustive. Further, the DMQ-R seemed to launch processes of self-reflection.Conclusions: Taken together, the results suggest a support for the use of DMQ-R also in the group of psychiatric outpatients. Still, when interpreting the DMQ-R, a certain insecurity of the exactness of answers should be considered. The graphic design should be particularly clear in this group of patients.
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| 9. |
- Nordgren, Johan, et al.
(författare)
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Healthcare staff’s perspectives on long-acting injectable buprenorphine treatment : a qualitative interview study
- 2024
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Ingår i: Addiction science & clinical practice. - : BioMed Central (BMC). - 1940-0632 .- 1940-0640. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundLong-acting injectable buprenorphine (LAIB) formulations are a novel treatment approach in opioid agonist treatment (OAT), which provide patients with a steady dose administered weekly or monthly and thus reduce the need for frequent clinic visits. Several studies have analyzed patient experiences of LAIB but the perspective of OAT staff is unknown. This study aimed to explore how healthcare staff working in OAT clinics in Sweden perceive and manage treatment with LAIB.MethodsIndividual qualitative interviews were conducted with OAT physicians (n = 10) in tandem with nine focus group sessions with OAT nurses and other staff categories (n = 41). The data was analyzed with thematic text analysis.ResultsFive central themes were identified in the data: (1) advantages and disadvantages of LAIB, (2) patient categories that may or may not need LAIB, (3) patients’ degrees of medication choice, (4) keeping tabs, control and treatment alliance, and (5) LAIB’s impact on risk and enabling environments in OAT. Overall staff found more advantages than disadvantages with LAIB and considered that patients with ongoing substance use and low adherence were most likely to benefit from LAIB. However, less frequent visits were viewed as problematic in terms of developing a treatment alliance and being able to keep tabs on patients’ clinical status. Clinics differed regarding patients' degrees of choice in medication, which varied from limited to extensive. LAIB affected both risk and enabling environments in OAT.ConclusionsLAIB may strengthen the enabling environment in OAT for some patients by reducing clinic visits, exposure to risk environments, and the pressure to divert medication. A continued discussion about the prerequisites and rationale for LAIB implementation is needed in policy and practice.
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| 10. |
- Petersén, Elisabeth, et al.
(författare)
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Problematic substance use among patients in a Swedish outpatient psychiatry setting : staff and manager perceptions of digital options for increased intervention access
- 2023
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Ingår i: Addiction science & clinical practice. - : BioMed Central (BMC). - 1940-0632 .- 1940-0640. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundApproximately 50% of the patients who globally seek help in psychiatry have been assessed with problematic substance use or been diagnosed with substance use disorder (SUD). Given the high treatment gap for mental health care, in particular SUD, these individuals risk poorer treatment outcomes in psychiatry. Integrated treatment for psychiatric and SUD disorders has been proposed to reduce the treatment gap for SUD, but access to integrated treatment is low. Digital interventions addressing SUD in psychiatry could potentially make treatment available to patients who otherwise would not have access. In this study “digital interventions” comprise an umbrella term covering all kinds of interventions from minimal motivational app-based interventions to internet-based interventions with and without human guidance, up to remote sessions in telepsychiatry. This study aims to explore healthcare staff perceptions of referring patients to digital interventions for reducing problematic substance use, whether or not diagnosed as SUD, in the psychiatric outpatient setting.MethodThe study was exploratory with a qualitative design. Data were collected in the Swedish outpatient psychiatry setting, via individual semi-structured interviews with managers, and focus groups with healthcare staff. An adapted form of phenomenological hermeneutical analysis was used to analyze the data.ResultsThree themes emerged from the analysis. The first theme was Encountering obstacles on the path to future implementation of digital interventions, with sub-themes: Lacking resources and Feeling concerned about technical solutions. The second theme was Searching for ways forward to achieve increased access to care, with sub-themes: Blended care could facilitate integrated care and Addressing variations in patients’ technical skills. The third theme was Taking steps towards the future, with sub-themes: Wanting to know more about digital interventions and Formulating a vision for the future.ConclusionsThe study reveals a concern that implementing digital interventions in psychiatry will create additional work or be technically challenging. The staff see significant advantages from the patient perspective, but they feel that they themselves need training in implementing digital interventions. In order to establish constructive implementation of digital interventions for SUD in psychiatry, staff attitudes and concerns need to be considered and addressed. This study was conducted within the Swedish healthcare system and the findings may not generalize to other countries with differing healthcare systems.
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