A Web-Based Self-Help Intervention With and Without Chat Counseling to Reduce Cannabis Use in Problematic Cannabis Users: Three-Arm Randomized Controlled Trial

Abstract

BackgroundAfter alcohol and tobacco, cannabis is the most widely used psychoactive substance in many countries worldwide. Although approximately one in ten users develops serious problems of dependency, only a minority attend outpatient addiction counseling centers. A Web-based intervention could potentially reach those users who hesitate to approach such treatment centers.ObjectiveTo test the efficacy of a Web-based self-help intervention with and without chat counseling—Can Reduce—in reducing the cannabis use of problematic cannabis users as an alternative to outpatient treatment services.MethodsAltogether, 436 participants were recruited by various online and offline media for the Web-based trial. A total of 308 of these were eligible for study participation and were randomly allocated in an unblinded manner to either self-help with chat (n=114), self-help without chat (n=101), or a waiting list control group (n=93). The fully automated self-help intervention consisted of eight modules designed to reduce cannabis use, and was based on the principles of motivational interviewing, self-control practices, and methods of cognitive behavioral therapy. Additional individual chat counseling sessions were based on the same therapeutic principles. The sessions were conducted by trained counselors and addressed participants' personal problems. The main outcomes were the frequency (number of days) and quantity of cannabis use (number of standardized joints) per week, as entered into the consumption diary at baseline and at the 3-month follow-up. Secondary outcomes included self-reported symptoms of cannabis use disorder, severity of cannabis dependence, risky alcohol use, and mental health symptoms. Intervention participation and retention were extracted from the user progress data and the consumption diary, respectively.ResultsCan Reduce participants were older (U=2.296, P=.02) and reported a greater number of cannabis use days at baseline than patients who entered outpatient treatment with cannabis as their main problem substance (data from the Swiss treatment demand monitoring statistics were used; chi-square [df 2]=4.0, P=.046). Participants in the self-help with chat study arm completed a mean of 3.2 modules and 27 out of 114 (23.7%) of the participants received at least one chat session. Participants in the self-help without chat study arm completed similar numbers of self-help modules. A total of 117 of 308 participants (38.0%) completed the 3-month follow-up assessment. The change in the mean number of cannabis use days per week at 3 months differed between self-help without chat (mean change 0.7, SD -0.2) and self-help with chat (mean change 1.4, SD -0.5; beta=-0.75, SE=0.32, t=-2.39, P=.02, d=0.34, 95% CI 0.07-0.61), as well as between self-help with chat and waiting list (mean change 1.0, SD -0.8; beta=0.70, SE=0.32, t=2.16, P=.03, d=0.20, 95% CI -0.07 to 0.47). However, there were no differences between self-help without chat and waiting list (beta=-0.05, SE=0.33, t=-0.16, P=.87, d=-0.14, 95% CI -0.43 to 0.14...

A Revision of Preventive Web-based Psychotherapies in Subjects at Risk of Mental Disorders

“…It could reach a variety of population: from those who present difficulties for the access of health promotion and prevention (those with mobility troubles and geographical barriers, lack of economic resources, stigma, special personality traits…), symptomatic patients, but also at risk individuals or people just interested in the improvement of their quality of life. This psychotherapy format could work for non-clinic intervention, such as counselling or coaching [43].…”

“…An online intervention (Can Reduce) with self-help intervention was achieved to reduce cannabis use comparing the inclusion or absence of chat counselling in a group of risky heavycannabis users. Conclusions suggested a reduction of the amount of cannabis use in those participants who also used the online chat [43]. This team also is currently analyzing the same online intervention in participants with cocaine use.…”

Guided web-based treatment program for reducing cannabis use: a randomized controlled trial

“…The chat group completed a mean of 3.2 out of 8 modules and 23.7% received at least one chat session. At 3 months 117 out of 308 (38.0%) participants could be followed up [11].…”

“…Importantly, GEE estimate population-average parameters and are generally robust to miss-specified correlation structures and overdispersion [30]. In previous similar studies, participants who received other professional help were not included [11] or excluded after randomization [8,10]. In order to highlight the effects of the web-based intervention in this study, secondary analyses were performed excluding participants in both groups who had received other professional help between baseline and follow-up.…”

Incorporating services for common mental disorders and substance use disorders for people living with HIV along the HIV treatment cascade

“…SUDs can be addressed in a health care setting with interventions, such as screening and brief interventions with recovery management to reduce harmful use, as well as by therapies such as cognitive-behavioral therapy (CBT)/ motivational enhancement therapy (MET), or through pharmacotherapy and medical management [46][47][48][49][50][51][52]. For people living with HIV with opioid dependence, treatment with medication assisted treatment (MAT) in HIV primary care improves the HIV-related outcomes of mortality, quality of life, retention in care, and antiretroviral treatment adherence [53].…”