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| 2. |
- Eék, Niels, 1980, et al.
(author)
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Efficacy of an Internet-Based Community Reinforcement and Family Training Program to Increase Treatment Engagement for AUD and to Improve Psychiatric Health for CSOs: A Randomized Controlled Trial
- 2020
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In: Alcohol and alcoholism (Oxford, Oxfordshire). - : Oxford University Press (OUP). - 1464-3502 .- 0735-0414. ; 55:2, s. 187-195
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Journal article (peer-reviewed)abstract
- AIMS: Community Reinforcement Approach and Family Training (CRAFT) is a support program for concerned significant others (CSOs) to identified persons (IPs) with alcohol use disorders, with the purpose of engaging IPs to treatment and to improve CSO functioning. The purpose of the present study was to investigate the efficacy of an internet-based version of CRAFT (iCRAFT). METHODS: Randomized controlled trial comparing iCRAFT with a wait-list (WL) condition with a nation-wide uptake in Sweden. A total of 94 CSOs to a treatment refusing IP, who described the IP according to DSM-IV criteria for alcohol dependence or abuse, were included in the study. iCRAFT consisted of five weekly administered therapist-guided modules with the following content: (a) improve CSOs' own mental health, (b) improve the CSOs skills in asking the IP to seek treatment, (c) positive communication skills training, (d) contingency management of IP drinking behavior. Main outcome measure was IPs initiative to seek treatment measured at 24weeks. Secondary outcomes were IP's daily alcohol consumption, CSOs mental health, quality of life and relational satisfaction. RESULTS: Of 94 participants, 15 CSOs reported IP treatment initiative during the study period. Of these, 10 belonged to the iCRAFT condition and five to the WL condition. The difference between conditions was nonsignificant, and the results were inconclusive. Participants in iCRAFT showed short-term improvements regarding depressive symptoms, quality of life and relational happiness. CONCLUSION: This study was unable to demonstrate substantial changes in the iCRAFT program regarding IP treatment seeking or CSO mental health. © The Author(s) 2020. Medical Council on Alcohol and Oxford University Press.
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- Eék, Niels, 1980, et al.
(author)
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High- versus low-intensity internet interventions for alcohol use disorders (AUD) : A two-year follow-up of a single-blind randomized controlled trial
- 2023
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In: Internet Interventions. - : Elsevier. - 2214-7829. ; 33
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Journal article (peer-reviewed)abstract
- Alcohol Use Disorders (AUD) are widespread and have serious consequences, but are among the most undertreated mental disorders. Internet interventions have been found effective in treating AUD, but we know little about long-term outcomes, two years or more after treatment. This study explored 12- and 24-month outcomes in alcohol consumption following initial 6-month improvements after a therapist-guided high-intensity internet intervention and an unguided low-intensity internet intervention among individuals with alcohol use disorder. Between-group comparisons were analyzed, as well as within-group comparisons with (1) pre-treatment measurements (2) post-treatment measurements. Participants consisted of a general population sample of internet help-seekers in Sweden. A total of 143 adults (47% men) with a score of 14 (women)/16 (men) or more on the Alcohol Use Disorders Identification Test, alcohol consumption of 11 (women)/14 (men) or more standard drinks the preceding week and & GE; 2 DSM-5 alcohol use disorder (AUD) criteria based on a diagnostic interview were included. The high- and low-intensity internet interventions (n = 72 and n = 71 respectively) consisted of modules based on relapse prevention and cognitive-behavioral therapy. The 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. Attrition from self-reported questionnaires was 36% at the 12-month follow-up and 53% at the 24month follow-up. No significant between-group differences occurred in outcomes at either long-term follow-up. Regarding within-group differences, compared to pre-treatment, alcohol consumption was lower in both highand low-intensity interventions at both long-term follow-ups [within-group standard drinks effect sizes varied between g = 0.38-1.04 and heavy drinking days effect sizes varied between g = 0.65-0.94]. Compared to posttreatment, within-group alcohol consumption in the high intensity intervention increased at both follow-ups; for the low-intensity intervention, within-group consumption decreased at 12-month follow-up, but did not differ compared to post-treatment at 24 months. Both high- and low-intensity internet interventions for AUD were thus associated with overall reductions in alcohol consumption at long term follow-ups, with no significant differences between the two. However, conclusions are hampered by differential and non-differential attrition.
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- Eék, Niels, 1980
(author)
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Internet-based psychological interventions for alcohol use disorder. Treating addiction and supporting concerned significant others
- 2022
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Doctoral thesis (other academic/artistic)abstract
- The aim of this doctoral thesis was to investigate the efficacy of three internet interventions for alcohol problems: (1) high-intensity internet treatment (ePlus) compared to (2) an unguided low-intensity internet treatment (eChange) and waiting list (WL) conditions, for people with AUD (Study I, with a long-term follow-up in Study II), and (3) an internet-based version of CRAFT for concerned significant others (CSOs) to individuals with alcohol use disorder (AUD) (Study III). The primary outcomes in Study I and Study II were two measures of the participants’ alcohol consumption: number of standard drinks per week and number of heavy drinking days (HDDs) per week. The primary outcome in Study III was treatment engagement, as expressed in the IPs’ initiative to seek treatment. In Study I (N = 166), a significant reduction was seen in number of standard drinks as well as HDDs for both the ePlus and the eChange group compared to the WL group. The reduction in standard drinks per week was maintained after 6 months for both intervention groups. There was no statistically significant difference between ePlus and eChange in number of standard drinks, but participants in the ePlus program had significantly fewer HDDs compared to participants in the eChange program at post-treatment, but this difference was no longer seen at 6-month follow-up. Participants in the ePlus program displayed greater treatment satisfaction than did participants in the eChange program. The results in Study II (N = 143) showed that, compared to pre-treatment, both treatment groups had lower alcohol consumption at both long-term follow-ups (12 and 24 months). Compared to post-treatment, there was increased alcohol consumption in the ePlus group on both follow-up occasions, but lower alcohol consumption in the eChange group. Although one group had increased and the other group had decreased consumption at the 12-month follow-up compared to the end of treatment, comparisons of the two groups at both long-term follow-ups showed no statistically significant differences between them. In Study III (N = 94), the results showed that although twice as many CSOs in the iCRAFT condition reported IP treatment engagement, this difference was not statistically significant. The rate of treatment seeking reported for CSOs in the iCRAFT group was lower compared with previous studies. In summary, the results indicate that both ePlus and eChange is effective in reducing alcohol consumption in both short and long term, and ePlus is more effective in reducing HDDs immediately after treatment. In the long term, there were no significant differences between the two treatments. Both interventions may have potential as alternatives to traditional treatment forms, and their different structures (long vs. short, human guidance vs. no human guidance) open up for possibilities for clinics and patients to choose what suits them best. Results on iCRAFT were unexpected, as previous research on CRAFT using a face-to-face approach has shown substantial effects, which points to a need to further develop iCRAFT. Keywords: alcohol use disorder, internet-based treatment, Cognitive Behavioral Therapy, relapse prevention, Community Reinforcement and Family Training
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- Eék, Niels, 1980
(author)
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Internet-based psychological interventions for problematic alcohol use: Patient treatment and support for concerned significant others
- 2019
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Licentiate thesis (other academic/artistic)abstract
- Alcohol has been a part of human history for thousands of years, for both good and bad. The average person in Sweden today is drinking 9 liters of pure alcohol per year, and it is estimated that 780,000 people in Sweden have such serious problems with alcohol that they would benefit from treatment for their problems. The diagnosis of alcohol problems used in this licentiate fol- lows DSM-5, Alcohol Use Disorder (AUD). In addition to being a common problem in Sweden and many parts of the world, AUD has a huge burden on disease, and approximately 3 million people die every year because of alco- hol, making it the third largest cause of death in the world. Alcohol also has a causal effect on more than 60 different diseases, where increased alcohol consumption counted from the first glass in most cases is more likely to cause the disease. Alcohol also has a high level of comorbidity with other psychiatric disorders, such as depression, bipolar disorder, hypomania, panic syndrome, personality disorders and schizophrenia. Despite the major illness burden that often accompanies AUD, there are estimations that as few as 10-20% of people with problematic alcohol use ever seek treatment. This may be due to various reasons, such as concern that treatment is not effective, a desire to take care of the problem by oneself, denial of having problems, and that it is associated with shame and stigma to have alcohol problems. Internet treat- ment an easier way to seek treatment for those who otherwise would not seek help. The overall aim of the two studies included in this thesis was to investigate the efficacy of two internet-based interventions for alcohol problems; (Study I) high-intensity internet treatment (the so called ePlus treatment) for people with alcohol use disorders (AUDs) and (Study II) internet-based version of Community Reinforcement and Family Training program (iCRAFT) for Con- cerned Significant Others (CSOs) to individuals with AUD. The aim of Study I was to evaluate the high-intensity internet treatment ePlus for people with a diagnosed AUD. This treatment was compared with a low-intensity internet treatment (eChange) and with a waiting list (WL). It was hypothesized that participants in ePlus would reduce their alcohol consump- tion significantly more than participants both in eChange and on the WL. A secondary aim was to evaluate the psychological negative effects of high- and low intensity internet treatment for AUD. Study II aimed to evaluate iCRAFT compared to a WL. It was hypothesized that participants receiving iCRAFT would increase Identified Persons’ (IPs) treatment engagement. An IP is the person with AUD, who is not receiving any treatment for his or hers problem- atic alcohol use at the time the CSO starts the intervention. Secondary aims were to investigate if iCRAFT had increased CSOs’ quality of life and decreased IPs’ alcohol use. Data was collected partly via self-report questionnaires administered over each study’s technical platform, and partly via telephone interviews. Data was collected from 166 participants in Study I and 94 participants from Study II. The primary outcomes in Study I were two measurements of the partici- pants’ alcohol consumption: number of standard drinks per week and number of heavy drinking days (HDD) per week. The primary outcome in Study II was treatment engagement, as expressed in the IP’s initiative to seek treatment. Each group reduced alcohol consumption from screening to post treat- ment within each group, and this reduction was more or less maintained after three months compared to screening. Comparison between ePlus versus WL showed no significant differences at screening for any of the primary outcome variables. A significant reduction of standard drinks as well as HDD for the ePlus group occurred compared to WL at post treatment. Participants in the ePlus condition also displayed greater treatment satisfaction than partici- pants in the eChange condition. The results showed that although twice as many Concerned Significant Others (CSOs) in the iCRAFT condition reported IP treatment engagement, this difference was not statistically significant. Results in Study I indicate that ePlus is both effective in reducing both standard drinks per day and heavy drinking days compared to WL and, compared to eChange, it is also effective in reducing heavy drinking days immediately after treatment. Results in Study II were unexpected, since previous research on CRAFT using a face-to-face approach has shown substantial effects. The lack of statistically significant ef- fect can possibly be due to an underpowered study, but also a need to further develop the program. In summary, the results in Study I indicate that ePlus is effective in reduc- ing both standard glasses per day and the number of high consumption days compared to waiting lists, and compared to eChange, it is also effective to reduce short-term high-consumption days, i.e. immediately after treatment. The results in Study II were unexpected, as earlier research on CRAFT face-to- face has shown significant effects. The lack of statistically significant effects may be due to the fact that there were too few participants in the study, but also a need for further development of the program.
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| 6. |
- Sundstrom, C., et al.
(author)
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High-intensity therapist-guided internet-based cognitive behavior therapy for alcohol use disorder: a pilot study
- 2017
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In: Bmc Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 17
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Journal article (peer-reviewed)abstract
- Background: A large proportion of individuals with alcohol problems do not seek psychological treatment, but access to such treatment could potentially be increased by delivering it over the Internet. Cognitive behavior therapy (CBT) is widely recognized as one of the psychological treatments for alcohol problems for which evidence is most robust. This study evaluated a new, therapist-guided internet-based CBT program (entitled ePlus) for individuals with alcohol use disorders. Methods: Participants in the study (n = 13) were recruited through an alcohol self-help web site (www.alkoholhjalpen.se) and, after initial internet screening, were diagnostically assessed by telephone. Eligible participants were offered access to the therapist-guided 12-week program. The main outcomes were treatment usage data (module completion, treatment satisfaction) as well as glasses of alcohol consumed the preceding week, measured with the self-rated Timeline Followback (TLFB). Participant data were collected at screening (T0), immediately pre-treatment (T1), post-treatment (T2) and 3 months post-treatment (T3). Results: Most participants were active throughout the treatment and found it highly acceptable. Significant reductions in alcohol consumption with a large within-group effect size were found at the three-month follow-up. Secondary outcome measures of craving and self-efficacy, as well as depression and quality of life, also showed significant improvements with moderate to large within-group effect sizes. Conclusions: Therapist-guided internet-based CBT may be a feasible and effective alternative for people with alcohol use disorders. In view of the high acceptability and the large within-group effect sizes found in this small pilot, a randomized controlled trial investigating treatment efficacy is warranted.
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| 7. |
- Sundström, Christopher, et al.
(author)
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High- versus low-intensity internet interventions for alcohol use disorders : results of a three-armed randomized controlled superiority trial
- 2020
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In: Addiction. - : John Wiley & Sons. - 0965-2140 .- 1360-0443. ; 115:5, s. 863-874
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Journal article (peer-reviewed)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.
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| 8. |
- Sundström, Christopher, et al.
(author)
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What Predicts Treatment Adherence and Low-Risk Drinking? An Exploratory Study of Internet Interventions for Alcohol Use Disorders
- 2023
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In: European Addiction Research. - : S. Karger AG. - 1022-6877 .- 1421-9891. ; 29:1
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Journal article (peer-reviewed)abstract
- Introduction: Internet interventions for alcohol problems are effective, but not all participants are helped. Further, the importance of adherence has often been neglected in research on internet interventions for alcohol problems. Prediction analysis can help in prospectively assessing participants' probability of success, and ideally, this information could be used to tailor internet interventions to individual needs. Methods: Data were obtained from a randomized controlled trial on internet interventions for alcohol use disorders. Twenty-nine candidate predictors were run in univariate logistic regressions with two dichotomous dependent outcomes: adherence (defined as completing at least 60% of the treatment modules) and low-risk drinking (defined as drinking within national public health guidelines) at two time points - immediately post-treatment and at the 6-month follow-up. Significant predictors were entered hierarchically into domain-specific logistic regressions. In the final models, predictors still showing significant effects were run in multiple logistic regressions. Results: One predictor significantly predicted adherence: treatment credibility (as in how logical the treatment is and how successful one perceives the treatment to be) assessed during the third week of the intervention. Four predictors significantly predicted low-risk drinking at the post-treatment follow-up: pre-treatment abstinence (i.e., not drinking during the 7 days before treatment started), being of the male gender, and two personality factors - a low degree of antagonism and a high degree of alexithymia. At the 6-month follow-up, pre-treatment abstinence was the only significant predictor. Conclusion: Adherence was not predictive of low-risk drinking. Personality variables may have predictive value and should be studied further. Those who abstain from alcohol during the week before treatment starts have a higher likelihood of achieving low-risk drinking than people who initially continue drinking.
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