| 1. |
- Andersson, Claes, et al.
(författare)
-
Automated telephone interventions for problematic alcohol use in clinical and population samples : a randomized controlled trial
- 2017
-
Ingår i: BMC Research Notes. - : BioMed Central. - 1756-0500. ; 10
-
Tidskriftsartikel (refereegranskat)abstract
- Objective The primary objective was to evaluate 6-month outcomes for brief and extensive automated telephony interventions targeting problematic alcohol use, in comparison to an assessment-only control group. The secondary objective was to compare levels of problematic alcohol use (hazardous, harmful or probable dependence), gender and age among study participants from clinical psychiatric and addiction outpatient settings and from population-based telephone helpline users and Internet help-seeker samples. Results The Alcohol Use Disorders Identification Test (AUDIT) was used for screening of problematic alcohol use and 6-month follow-up assessment. A total of 248 of help-seekers with at least hazardous use (AUDIT scores of ≥ 6/≥ 8 for women/men) were recruited from clinical and general population settings. Minor recruitment group differences were identified with respect to AUDIT scores and age at baseline. One hundred and sixty persons (64.5%) did not complete the follow-up assessment. The attrition group had a higher proportion of probable dependence (71% vs. 56%; p = 0.025), and higher scores on the total AUDIT, and its subscales for alcohol consumption and alcohol problems. At follow up, within-group problem levels had declined across all three groups, but there were no significant between-group differences. Trial registration ClinicalTrials.gov NCT01958359, Registered October 9, 2013. Retrospectively registered
|
|
| 2. |
- Berman, Anne H., et al.
(författare)
-
Digital Paths to Changing Problematic alcohol Use : Effectiveness of Unguided and Guided Interventions in a Stepped Care Model
- 2018
-
Ingår i: International Journal of Behavioral Medicine. - : Springer. - 1070-5503 .- 1532-7558. ; 25:Supplement 1, s. S43-S44
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction & Purpose: Digital interventions for changing problematic alcohol use have shown small effect sizes in relation to control groups. A meta-analysis (Riper et al., 2014) found an overall effect size of 0.20, with slightly higher effect sizes of 0.23 for interventions with a human guide, compared to 0.20 for unguided interventions. This presentation describes five different interventions, from unguided low-intensity to high-intensity guided interventions, evaluated in separate randomized controlled trials (RCT). Methods: Target groups included internet help-seekers and university students, with hazardous drinking according to the Alcohol Use Disorders Identification Test (AUDIT), excessive drinking based on national public health guidelines, or diagnosed alcohol use disorder (AUD). Study 1 evaluated eScreen.se, offering minimal screening and personal feedback, and alkoholhjalpen.se, a self-help program, with 633 internetbased participants reporting hazardous drinking. Study 2 evaluated the PartyPlanner and Promillekoll smartphone apps with 1932 university students reporting hazardous drinking. Study 3 evaluated the TeleCoach skills-based app with 186 university students who drank excessively. For studies 1-3 assessment-only controls were comparison groups. Study 4 compared the unguided eChange 10-week program to a guided version with 80 internet-based participants having at least hazardous use. Study 5 with 166 participants compared the high-intensity ePlus 13-week program to the unguided eChange program in a 13-week version, and a small wait-list control group. Results: Studies 1-5 are compared with one another in terms of baseline characteristics and results. Although inclusion criteria varied, baseline AUDIT levels out of a maximum of 40 points for studies 1-5 respectively were 20.82 (SD 6.93), 10.55 (3.90); 13.46 (4.69); 21.00 (4.90) and 23.70 (1.40). Within-group and between-group results are compared, showing greater effects for more intensive interventions. Conclusions: Effects vary by target groups, severity levels and interventions, but it is clear that digital interventions contribute to reduced problematic alcohol use.
|
|
| 3. |
|
|
| 4. |
- Berman, Anne H., et al.
(författare)
-
Mobile phone apps for university students with hazardous alcohol use : study protocol for two consecutive randomized controlled trials
- 2015
-
Ingår i: JMIR Research Protocols. - : JMIR Publications. - 1929-0748. ; 4:4
-
Tidskriftsartikel (refereegranskat)abstract
- Background: About 50% of university students overconsume alcohol, and drinking habits in later adulthood are to some extent established during higher educational studies. Several studies have demonstrated that Internet-based interventions have positive effects on drinking habits among university students. Our recent study evaluated two mobile phone apps targeting drinking choices at party occasions via personalized feedback on estimated blood alcohol concentration (eBAC) for students with hazardous drinking. No changes in drinking parameters were found over a seven-week period apart from an increase in number of drinking occasions among men for one of the apps tested. Up to 30% of the study participants drank at potentially harmful levels: higher than the national recommended number of standard drinks per week (a maximum of 9 for women and 14 for men) in Sweden. Objective: (1) To evaluate improved versions of the two mobile phone apps tested in our prior trial, in a new, 3-armed randomized controlled trial among university students with at least hazardous drinking habits according to the Alcohol Use Disorders Identifications Test (AUDIT; Study 1). (2) After 6 weeks, to target study participants showing alcohol consumption higher than the national recommended levels for standard drinks per week by offering them participation in a second, 2-armed randomized trial evaluating an additional mobile phone app with skill enhancement tasks (Study 2). (3) To follow participants at 6, 12 and 18 weeks after recruitment to Study 1 and at 6 and 12 weeks after recruitment to Study 2. Methods: Two randomized controlled trials are conducted. Study 1: Students are recruited at four Swedish universities, via direct e-mail and advertisements on Facebook and student union web sites. Those who provide informed consent, have a mobile phone, and show at least hazardous alcohol consumption according to the AUDIT (≥6 for women; ≥8 points for men) are randomized into three groups. Group 1 has access to the Swedish government alcohol monopoly’s app, Promillekoll, offering real-time estimated eBAC calculation; Group 2 has 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 are controls. Follow-up is conducted at 6, 12 and 18 weeks. Study 2. Participants who at the first 6-week follow-up show drinking levels higher than 9 (W) or 14 (M) standard drinks (12 g alcohol) per week, are offered participation in Study 2. Those who consent are randomized to either access to a skills training app, TeleCoach or to a wait-list control group. Results: Latent Markov models for Study 1 and mixed models analyses for Study 2 will be performed. Study 2 data will be analyzed for publication during the spring of 2016; Study 1 data will be analyzed for publication during the fall of 2016. Conclusions: If mobile phone interventions for reducing hazardous alcohol use are found to be effective, the prospects for positively influencing substance use-related health among university students can considerably improve.
|
|
| 5. |
- Berman, Anne H, et al.
(författare)
-
Mobile phone brief intervention applications for risky alcohol use among university students : Three randomized controlled studies
- 2015
-
Ingår i: The 13th International Conference on Treatment of Addictive Behaviors, 31st of May-4th of June 2015, Odense, Denmark. - : The University of New Mexico, CASAA. ; , s. 17-17
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Most university students overconsume alcohol and have smartphones. Brief online interventions reduce students’ alcohol intake. Delivering brief interventions to students via smartphone apps should be investigated. Method: Students at several Swedish universities were invited to the 3 studies described via e-mails and online ads. Students with a smartphone and risky alcohol consumption according to the Alcohol Use Disorders Identification Test (AUDIT) were included, following informed consent. Three apps were tested, two targeting individual drinking choices on party occasions (Promillekoll and PartyPlanner), and one targeting high-risk users (TeleCoach™). Study 1 offered randomization into 3 groups: Promillekoll (1), offering real-time estimated blood alcohol concentration (eBAC) calculation; PartyPlanner (2), a web-based app with real-time eBAC calculation and additional planning/follow-up functions; a control group (3). Follow-up occurred at 7 weeks. Study 2 replicated Study 1; changes included improved apps based on Study 1 results, and follow-up times extended from 7 to 14 and 21 weeks (T1, T2 & T3). Study 3 offered participants at T1 from Study 2, who drank over 9 (women) and 14 (men) standard drinks/week, randomization into an intervention group (TeleCoach™) and a wait-list control group (intervention offered at T2). Results: For Study 1, 1932 fulfilled eligibility criteria for randomization. Attrition was 22.7–39.3 percent, higher among heavier drinkers and highest in Group 2. Per-protocol analyses revealed one significant timeby- group interaction, where Group 1 participants increased the frequency of their drinking occasions compared to controls (p = 0.001). Among all participants, 29 percent showed high-risk drinking, over the recommended weekly drinking levels of 9 (women) and 14 (men) standard glasses. Preliminary results will be reported for Studies 2 and 3. Discussion: Mobile phone apps offer a huge potential for making brief interventions available to more university students than ever before. Research is needed to identify effective app content.
|
|
| 6. |
- Berman, Anne H., et al.
(författare)
-
Reducing Risky Alcohol Use via Smartphone App Skills Training Among Adult Internet Help-Seekers : A Randomized Pilot Trial
- 2020
-
Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 11
-
Tidskriftsartikel (refereegranskat)abstract
- Alcohol is one of the leading risk factors for global disease burden and overconsumption leads to a wide variety of negative consequences in everyday life. Digital interventions have shown small positive effects in contributing to reductions in problematic use. Specific research on smartphone apps is sparse and the few studies published indicate effects ranging from negative or null to small or moderate. TeleCoach™, a web-based skills training smartphone app, has shown positive effects in non-treatment-seeking university students with excessive drinking. This pilot trial aimed to evaluate app effects in a sample of internet help-seekers from the general population in Sweden. A total of 89 participants were recruited via online advertisement. Following baseline assessment for hazardous use, they were randomized to TeleCoach or a web-based control app offering brief information and advice regarding problematic alcohol use. The primary outcome was number of standard drinks per week; secondary outcomes included drinking quantity and frequency, binge drinking and blood alcohol count measures as well as app user data and comorbidity related to depression, anxiety, and drug use. Analysis of baseline and 6-week follow-up outcomes showed significant within-group effects on alcohol consumption but no significant between-group differences. Effect sizes for the within-group changes in the primary outcome over time were significant [F(1, 55)=43.98; p < 0.001], with a Cohen's d of 1.37 for the intervention group and 0.92 for the control group. This difference in effect sizes indicated that continuation of the study as a large randomized, controlled trial with up to 1,000 participants could be worthwhile.
|
|
| 7. |
- Berman, Anne H., et al.
(författare)
-
Skills Training for Reducing Risky Alcohol Use in App Form Among Adult Internet Help-seekers
- 2020
-
Ingår i: Annals of Behavioral Medicine. - : Oxford University Press. - 0883-6612 .- 1532-4796. ; 54:S1, s. S417-S417
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Problematic alcohol use in Sweden occurs among 16 % of the adult population. Digital interventions of varying intensity have shown positive effects in contributing to reductions in problematic use, and the TeleCoach app has shown positive effects in non-treatment-seeking university students with excessive drinking (Gajecki et al., 2017). This pilot study evaluated the app among adult internet help-seekers, and motivated continued data collection in the current target group. Methods: Adult internet-help seekers, recruited via advertisement, were included if they scored ³6 (women) or ³8 (men) on the Alcohol Use Disorders Identification Test (AUDIT). Those with depression scores of ³31 on the Montgomery Åsberg Depression Rating Scale (MADRS-S) or problematic drug use scores of ³8 on the Drug Use Disorders Identification Test (DUDIT) were contacted for a telephone interview and included following clinical assessment; if not reached they were excluded. Participants randomized at a 1:1 ratio to the TeleCoach™ web-based app or to a web-based app with information texts from primary care-based self-help material for changing problematic alcohol use. At six-week follow-up, the primary outcome was the number of standard drinks per past week (Timeline-Followback). Results: Of 147 persons assessed for eligibility, 89 were assigned to the intervention group (n=42) or control group (n=47). Average AUDIT levels at baseline were ³18.The baseline number of standard drinks per week was 32.73 (SD 21.16) for the intervention group, and 26 (4.08) for the control group; at 6-week follow-up it was 12.73 (10.52) and 13.48 (11.13) for the intervention and control groups, respectively. No significant between-groups effects occurred, but withingroup changes over time were significant (F(1, 55)=43.98; p< 0.000), with an effect size of 1.37 for the intervention group and 0.92 for the control group. Conclusions: The results suggest that web-based apps can be of help to internet help-seekers motivated to reduce problematic alcohol use. We have proceeded with the planned larger randomized, controlled study and will present 6-week follow-up data for the entire study sample (n=∼1000) in this presentation.
|
|
| 8. |
- Berman, Anne H., et al.
(författare)
-
Smartphone Apps Targeting Hazardous Drinking Patterns among University Students Show Differential Subgroup Effects over 20 Weeks : Results from a Randomized, Controlled Trial.
- 2019
-
Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 8:11
-
Tidskriftsartikel (refereegranskat)abstract
- Overconsumption of alcohol, from hazardous to excessive, heavy, and harmful levels, is common among university students. Consenting Swedish students were assigned to one of two smartphone apps offering feedback on estimated blood alcohol concentration (eBAC; Promillekoll/PartyPlanner) or assessment only (n = 2166; 1:1:1 ratio). App participants with excessive drinking according to public health criteria (>9/>14 drinks/week for women/men, respectively) at a 7 week follow-up were additionally assigned to the skills-based TeleCoach app or waitlist (n = 186; 1:1 ratio). All participants were followed at 14 and 20 weeks. At 7 weeks, Promillekoll users showed higher risk of excessive drinking (odds ratio (OR) = 1.83; p
|
|
| 9. |
- Berman, Anne H, et al.
(författare)
-
Smartphone apps targeting risky and excessive drinking patterns among university students show differing subgroup effects over 20 weeks
- 2017
-
Ingår i: Addiction science & clinical practice. - : BioMed Central. - 1940-0632 .- 1940-0640. ; 12:Suppl 1, s. 19-20
-
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.
|
|
| 10. |
|
|
| 11. |
|
|
| 12. |
- Gajecki, Mikael, et al.
(författare)
-
Mobile phone brief intervention applications for risky alcohol use among university students : a randomized controlled study
- 2014
-
Ingår i: Addiction science & clinical practice. - : BioMed Central. - 1940-0632 .- 1940-0640. ; 9:11
-
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.
|
|
| 13. |
- Gajecki, Mikael
(författare)
-
Problematic substance use and digital interventions : researching intervention efficacy among Internet help-seekers, university students and patients in psychiatry
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Digital technologies are ever more present in our lives, and are being applied in numerous areas of our existence including the area of health care and health information. Problematic alcohol and drug use impose a major global burden on health, and it is of interest to find new ways of reaching out to those affected by the problem. Interventions delivered over the Internet and in the form of smartphone apps have the potential to be readily available at all times and places. Many apps are publicly available, but only a tiny proportion have been evaluated. Also, there are many evaluated self-help applications for the Internet, but research on the addition of counselor guidance over the Internet is very scarce. There is a need for scientific scrutiny before being able to either recommend or implement these applications into regular care. Aims: The aims of this doctoral project were: to carry out a preliminary evaluation of an Internet-based program for problematic use with guidance among Internet help-seekers; to investigate effects of three smartphone apps, two with estimated blood alcohol concentration (eBAC) feedback and a skills-training app, among university students; and to determine the prevalence of problematic substance use in a psychiatric population receiving treatment over the Internet, and to explore whether that substance use was associated with treatment outcomes. Methods: An Internet-based eight-module program was tested in a randomized controlled pilot study with 80 participants. Participants were randomized to: no guidance, guidance over secure email messaging, or choice between guidance over asynchronous secure email messaging or synchronous chat messaging (STUDY I). Effects of two smartphone apps, Promillekoll and PartyPlanner, both with real-time eBAC feedback, and one, PartyPlanner, offering the possibility to simulate a drinking event beforehand and compare afterwards to the real event, were tested in a randomized controlled trial with 1929 university students having problematic alcohol consumption. Both app groups were compared to assessment-only controls (STUDY II). The effects of offering university students with excessive drinking, already enrolled in an ongoing study similar to STUDY II, an additional app focused on skills training were investigated (STUDY III). One hundred and eighty six students were randomly assigned to either an intervention group, receiving access to the app immediately, or a waitlist group given access to the app after six weeks. Both groups were compared to each other and also to a group of assessment-only controls (n=144) from the ongoing study. In the final study, data from 1581 patients having been treated at the internet-based cognitive behavioral therapy (ICBT) clinic in Stockholm, Sweden for major depression, panic disorder or social anxiety disorder, were analyzed to identify the prevalence of problematic substance use at beginning of treatment. The association of problematic substance use with therapy outcomes was also analyzed (STUDY IV) Results: Study I: The guidance group (the secure email messaging and the choice of messaging mode groups were combined) had significantly lowered their alcohol consumption compared to the no-guidance group. Secure email messaging was the preferred mode of communication over chat for the choice group. Participants in the guidance group rated the program more favorably than participants in the no-guidance group. Study II: There were no differences between the apps and assessment-only controls on any alcohol related outcome, but one negative finding for the Promillekoll app, in that men in that group increased their drinking frequency. Study III: Both the intervention and the wait-list had lower proportions of excessive alcohol consumption compared to assessment-only controls at first follow-up. The intervention group lowered their drinking quantity at first follow-up and their drinking frequency at both follow-ups compared to controls. Study IV: Prevalence of problematic substance use was 32.4%. Exclusive problematic alcohol use was reported by 24.1%, 4.6% reported exclusive problematic drug use and 3.7% combined problematic alcohol and drug use. Problematic drug use among men and 25–34 year olds was associated with completing fewer treatment modules and combined substance use among women and 35–64 year olds negatively affected module completion. Baseline problematic substance use was not associated with worse therapy outcomes for patients treated for depression. However, hazardous alcohol use and probable dependence were associated with worse panic disorder treatment outcomes. Hazardous drug use as well as combined problematic alcohol use with either hazardous drug use or probable drug dependence were associated with worse social anxiety disorder outcomes. Conclusion: Using novel communications technology is effective for reaching individuals with problematic substance use. Adding counselor guidance to a web-based relapse prevention program has beneficial effects on problematic drinking. Smartphone apps relying on eBAC feedback do not show much promise at the moment. Skills-training smartphone apps may have a beneficial effect on excessive alcohol consumption. The prevalence of problematic substance use is high in ICBT-treated psychiatric outpatients, but for a variety of levels of baseline substance use, the negative effect on therapy outcomes seems limited.
|
|
| 14. |
- Gajecki, Mikael, et al.
(författare)
-
Skills Training via Smartphone App for University Students with Excessive Alcohol Consumption : a Randomized Controlled Trial
- 2017
-
Ingår i: International Journal of Behavioral Medicine. - : Springer. - 1070-5503 .- 1532-7558. ; 24:5, s. 778-788
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: University students in a study on estimated blood alcohol concentration (eBAC) feedback apps were offered participation in a second study, if reporting continued excessive consumption at 6-week follow-up. This study evaluated the effects on excessive alcohol consumption of offering access to an additional skills training app. METHOD: A total of 186 students with excessive alcohol consumption were randomized to an intervention group or a wait list group. Both groups completed online follow-ups regarding alcohol consumption after 6 and 12 weeks. Wait list participants were given access to the intervention at 6-week follow-up. Assessment-only controls (n = 144) with excessive alcohol consumption from the ongoing study were used for comparison. RESULTS: The proportion of participants with excessive alcohol consumption declined in both intervention and wait list groups compared to controls at first (p < 0.001) and second follow-ups (p = 0.054). Secondary analyses showed reductions for the intervention group in quantity of drinking at first follow-up (-4.76, 95% CI [-6.67, -2.85], Z = -2.09, p = 0.037) and in frequency of drinking at both follow-ups (-0.83, 95% CI [-1.14, -0.52], Z = -2.04, p = 0.041; -0.89, 95% CI [-1.16, -0.62], Z = -2.12, p = 0.034). The odds ratio for not having excessive alcohol consumption among men in the intervention group compared to male controls was 2.68, 95% CI [1.37, 5.25] (Z = 2.88, p = 0.004); the figure for women was 1.71, 95% CI [1.11, 2.64] (Z = 2.41, p = 0.016). CONCLUSION: Skills training apps have potential for reducing excessive alcohol use among university students. Future research is still needed to disentangle effects of app use from emailed feedback on excessive alcohol consumption and study participation. TRIAL REGISTRATION:NCT02064998.
|
|
| 15. |
- Johansson, Magnus, et al.
(författare)
-
Internet-based therapy versus face-to-face therapy for alcohol use disorder, a randomized controlled non-inferiority trial
- 2021
-
Ingår i: Addiction. - : John Wiley & Sons. - 0965-2140 .- 1360-0443. ; 116:5, s. 1088-1100
-
Tidskriftsartikel (refereegranskat)abstract
- Background and aimsMost people with alcohol use disorder (AUD) are never treated. Internet-based interventions are effective in reducing alcohol consumption and could help to overcome some of the barriers to people not seeking or receiving treatment. The aim of the current study was to compare internet-delivered and face-to-face treatment among adult users with AUD.DesignRandomized controlled non-inferiority trial with a parallel design, comparing internet-delivered cognitive–behavioural therapy (ICBT) (n = 150) with face-to-face CBT (n = 151), at 3- and 6-month follow-ups.SettingA specialized clinic for people with AUD in Stockholm, Sweden. Participants were recruited between 8 December 2015 and 5 January 2018.ParticipantsA total of 301 patients [mean age 50 years, standard deviation (SD) = 12.3] with AUD, of whom 115 (38%) were female and 186 (62%) were male.Intervention and comparatorParticipants were randomized in blocks of 20 at a ratio of 1 : 1 to five modules of therapist-guided ICBT or to five modules of face-to-face CBT, delivered over a 3-month period. The same treatment material and the same therapists were used in both groups.MeasurementsThe primary outcome was standard drinks of alcohol consumed during the previous week at 6-month follow-up, analysed according to intention-to-treat. The pre-specified non-inferiority limit was five standard drinks of alcohol and d = 0.32 for secondary outcomes.ResultsThe difference in alcohol consumption between the internet and the face-to-face group was non-inferior in the intention-to-treat analysis of data from the 6-month follow-up [internet = 12.33 and face-to-face = 11.43, difference = 0.89, 95% confidence interval (CI) = −1.10 to 2.88]. The secondary outcome, Alcohol Use Disorder Identification Test score, failed to show non-inferiority of internet compared with face-to-face in the intention-to-treat analysis at 6-month follow-up (internet = 12.26 and face-to-face = 11.57, d = 0.11, 95% CI = –0.11 to 0.34).ConclusionsInternet-delivered treatment was non-inferior to face-to-face treatment in reducing alcohol consumption among help-seeking patients with alcohol use disorder but failed to show non-inferiority on some secondary outcomes.
|
|
| 16. |
- Lindner, Philip, et al.
(författare)
-
Using alcohol consumption diary data from an internet intervention for outcome and predictive modeling : a validation and machine learning study
- 2020
-
Ingår i: BMC Medical Research Methodology. - : Springer Science and Business Media LLC. - 1471-2288. ; 20:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Alcohol use disorder (AUD) is highly prevalent and presents a large treatment gap. Self-help internet interventions are an attractive approach to lowering thresholds for seeking help and disseminating evidence-based programs at scale. Internet interventions for AUD however suffer from high attrition and since continuous outcome measurements are uncommon, little is known about trajectories and processes. The current study investigates whether data from a non-mandatory alcohol consumption diary, common in internet interventions for AUD, approximates drinks reported at follow-up, and whether data from the first half of the intervention predict treatment success.Methods: N = 607 participants enrolled in a trial of online self-help for AUD, made an entry in the non-mandatory consumption diary (total of 9117 entries), and completed the follow-up assessment. Using multiple regression and a subset of calendar data overlapping with the follow-up, scaling factors were derived to account for missing entries per participant and week. Generalized estimating equations with an inverse time predictor were then used to calculate point-estimates of drinks per week at follow-up, the confidence intervals of which were compared to that from the measurement at follow-up. Next, calendar data form the first half of the intervention were retained and summary functions used to create 18 predictors for random forest machine learning models, the classification accuracies of which were ultimately estimated using nested cross-validation.Results: While the raw calendar data substantially underestimated drinks reported at follow-up, the confidence interval of the trajectory-derived point-estimate from the adjusted data overlapped with the confidence interval of drinks reported at follow-up. Machine learning models achieved prediction accuracies of 64% (predicting non-hazardous drinking) and 48% (predicting AUD severity decrease), in both cases with higher sensitivity than specificity.Conclusions: Data from a non-mandatory alcohol consumption diary, adjusted for missing entries, approximates follow-up data at a group level, suggesting that such data can be used to reveal trajectories and processes during treatment and possibly be used to impute missing follow-up data. At an individual level, however, calendar data from the first half of the intervention did not have high predictive accuracy, presumable due to a high rate of missing data and unclear missing mechanisms.
|
|
| 17. |
|
|
| 18. |
- Sundström, Christopher, et al.
(författare)
-
Guided and Unguided Internet-Based Treatment for Problematic Alcohol Use - A Randomized Controlled Pilot Trial
- 2016
-
Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:7
-
Tidskriftsartikel (refereegranskat)abstract
- Background The Internet has increasingly been studied as mode of delivery for interventions targeting problematic alcohol use. Most interventions have been fully automated, but some research suggests that adding counselor guidance may improve alcohol consumption outcomes. Methods An eight-module Internet-based self-help program based on cognitive behavioral therapy (CBT) was tested among Internet help-seekers. Eighty participants with problematic alcohol use according to the Alcohol Use Disorders Identification Test (AUDIT; scores of >= 6 for women and >= 8 for men) were recruited online from an open access website and randomized into three different groups. All groups were offered the same self-help program, but participants in two of the three groups received Internet-based counselor guidance in addition to the self-help program. One of the guidance groups was given a choice between guidance via asynchronous text messages or synchronous text-based chat, while the other guidance group received counselor guidance via asynchronous text messages only. Results In the choice group, 65% (13 of 20 participants) chose guidance via asynchronous text messages. At the 10-week post-treatment follow-up, an intention-to-treat (ITT) analysis showed that participants in the two guidance groups (choice and messages) reported significantly lower past week alcohol consumption compared to the group without guidance; 10.8 (SD = 12.1) versus 22.6 (SD = 18.4); p = 0.001; Cohen's d = 0.77. Participants in both guidance groups reported significantly lower scores on the AUDIT at follow-up compared to the group without guidance, with a mean score of 14.4 (SD = 5.2) versus 18.2 (SD = 5.9); p = 0.003; Cohen's d = 0.68. A higher proportion of participants in the guidance groups said that they would recommend the program compared to the group without guidance (81% for choice; 93% for messages versus 47% for self-help). Conclusion Self-help programs for problematic alcohol use can be more effective in reducing alcohol consumption over a 10-week period when counselor guidance is added.
|
|
| 19. |
- Sundström, Christopher, et al.
(författare)
-
High- versus low-intensity internet interventions for alcohol use disorders : results of a three-armed randomized controlled superiority trial
- 2020
-
Ingår i: Addiction. - : John Wiley & Sons. - 0965-2140 .- 1360-0443. ; 115:5, s. 863-874
-
Tidskriftsartikel (refereegranskat)abstract
- Aims To test the efficacy of a therapist-guided high-intensity internet intervention compared with an unguided low-intensity internet intervention among individuals with alcohol use disorder. Design A three-group randomized controlled trial with follow-up assessments post-treatment (12 weeks) and 6 months post-randomization (primary end-point). Settings General population sample in Sweden. Participants A total of 166 on-line self-referred adults (49% males) with a score of 14 (females)/16 (males) or more on the Alcohol Use Disorders Identification Test, a preceding week alcohol consumption of 11 (females)/14 (males) or more standard drinks and an alcohol use disorder according to a diagnostic interview. Interventions and comparators Both the high- (n = 72) and low-intensity internet interventions (n = 71) consisted of modules based on relapse prevention. Controls were on a waiting-list (n = 23), and were only followed until the post-treatment follow-up. Participants were randomized at a 7 : 7 : 2 ratio. Measurements Primary outcome was self-reported alcohol consumption in the preceding week measured as (1) number of standard drinks and (2) number of heavy drinking days at the 6-month follow-up. Findings Alcohol use disorders were largely in the severe category (74.7%), with the majority of participants having had alcohol problems for more than 5 years. Attrition was 13 and 22% at the post-treatment and 6-month follow-up, respectively. At the 6-month follow-up, an intent-to-treat analysis showed no significant differences in alcohol consumption between the high- and low-intensity interventions [standard drinks d = -0.17, 95% confidence interval (CI) = -0.50 to 0.16; heavy drinking days: d = -0.07, 95% CI = -0.40 to 0.26]. Prevalence of negative effects was somewhat low (8-14%) in both intervention groups, as was deterioration (3-5%). Conclusions At 6-month follow-up, there were no significant differences between a therapist-guided high-intensity internet intervention and an unguided low-intensity internet intervention in reducing alcohol consumption among individuals with an alcohol use disorder.
|
|
