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Explore how people change their behavior, the tools clinicians use to motivate change, and the effectiveness of online interventions for addiction treatment. Discover the benefits of online self-help materials and the potential of the internet to reach individuals who do not access traditional treatment.
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Online Treatment for Addictions John Cunningham
What I’m interested in • How do people change their behaviour? • What tools do clinicians use to motivate this change? • Can these tools be applied in different settings to help motivate people who do not come to treatment? • How do we demonstrate that these tools are effective?
Why is this important? • Many people do not come to treatment • Waiting lists • Treatment dropout • Many people with gambling and other addictions concerns are interested in self-help materials
Why the Internet? • Brief self-help interventions well suited to the Internet • Problem Gamblers (NODS past year probable pathological gambler) • 73% had home access to the Internet • Adult population, Ontario, Canada, 2007
Why the Internet? • Why participants choose online help: • I have easy access to a computer (69%) • It is important to me to be able to access MM at any time of day (38%) • I like the privacy (38%) • It is easier for me to write about my feelings and experiences than to speak about them in front of a group (25%; Females = 35%, Males = 13%) • Online participation is easier than attending meetings due to my busy work schedule (23%)
Why the Internet? • Online participation as a step to seeking treatment • Pathways disclosure model • No evidence that people are using Internet instead of treatment
Today’s talk • What do they look like? • Alcohol intervention as main example • What evidence exists? • Research interludes • Note: My conflict of interest • Dr. Cunningham has acted as a paid consultant to V-CC Systems Inc., the owner of the Alcohol Help Center and the Check Your Gambling software.
What do they look like? • Common elements: • Self-test to check levels of problems • Cognitive behavioural tools • Support group
Check Your Gambling screener • www.CheckYourGambling.net • Screener Survey Contains: • Frequency of different gambling behaviours • CPGI • Amount of money spent on gambling • Gambling Cognitions Questionnaire • Demographics • Normative comparison data from Canadian Community Health Survey
Research interlude • Evaluation of the Check Your Drinking screener
Research designs • Research where program is given face-to-face • Problem – external validity • Studies where respondents are recruited over the Internet • Studies with no randomly assigned control group • Problem – low follow-up rates • Recruiting by email, mail, telephone • Problem – will the person access the intervention?
Recruitment by telephone • Use RDD telephone survey to identify at-risk drinkers • Identify those who are hypothetically interested in an Internet program that provides a summary of the person’s drinking and compares it to the drinking of other Canadians • Home access to the Internet • Ask these people if they are interested in taking part in a study to help us revise and evaluate self-help materials • Send description and consent form • Randomly assign to receive or not receive intervention • Follow-up to assess differences at three-, six- and twelve-month follow-up
Subject recruitment • RDD screening survey of 8,467 respondents • Excluded: • AUDIT-C < 4: 5,721 • Not interested in online self-help materials: 1,936 • No home internet: 100 • Did not agree to view consent form: 316 • Viewed consent form but did not sign and return: 209 • Randomized to condition: 185 • Complete 3 and 6 month follow-up data available for 91% of sample
AUDIT > 11: Drinks per week 30% reduction in weekly drinking
Issues running the study • One-third of people assigned to experimental condition are not accessing the website • Study becomes one testing the impact of providing access to the intervention
Back to the content • The Alcohol Help Center • www.AlcoholHelpCentre.net or www.AlcoholHelpCenter.net Toolbox • Contains common cognitive behavioural and relapse prevention tools used in treatment and self-help books • Moderated Support Group
Complexities with evaluations • Content is research-based, however: • Translating face-to-face interventions to an online format • Difference of participant behaviour in online and face-to-face settings
Process research • How do people use online interventions? • Examples from online moderated support groups
Research interlude • Online support groups as social support networks for problem drinkers
Content of messages • The most common content (N = 647): • Introductions/greetings/thanks for support (30%) • General messages of encouragement (17%) • Questions about site/go to IM buddies (13%) • Specific suggestions/what worked for me (12%) • Experiencing urges/concern about future event (8%) • From support specialists: • General encouragement (17%) • Specific suggestions for what might help (18%)
Summary • AHC just starting up • Does not appear to be self-sustaining as of yet • Discussions clustered around ‘nodes’ of one or two active users • Support staff playing essential role • Keeping discussions active by ‘seeding’ • Providing support when others not online • High quality content
Research interlude • How quickly do people respond?
Methods • StopSmokingCenter.net (SSC) version 5.0 • Lifecycle of version 5.0: Nov 6 2004 – May 15, 2007 • 16,764 registrations • 15% post on the support group
How long does it take to get a reply? • 25% of first posts have a reply within 12 minutes • 50% of first posts have a reply within 29 minutes • 75% of first posts have a reply within 1 hour 27 min • 81.8% of replies by members, rest by moderator • only 68/2562 did not get a reply at all.
What’s next? • More research • Understanding why these interventions work • What other tools might be helpful?
New tools • Tools to promote engagement • Text messages and emails • Personal Profile • YouTube Videos • Blogs
Collaborators and Funding • Collaborators: Joanne Cordingley, David Hodgins, Keith Humphreys, Anja Koski-Jännes, Trevor van Mierlo, Cameron Wild • Sources of Funding: Centre for Addiction and Mental Health Canadian Institutes of Health Research National Institute on Alcohol Abuse and Alcoholism Ontario Problem Gambling Research Centre V-CC Systems Inc. Contact: John_Cunningham@camh.net