Associations between psychosocial risk factors, and changes in substance dependence and psychosocial functioning, during engagement with digital cognitive behavioral therapy for methamphetamine use: use of 'Breaking Free from Substance Abuse' by incarcerated people during the COVID-19 pandemic

Abstract

Background Methamphetamine use can be associated with involvement with correctional services and incarceration. Traditionally, treatments for methamphetamine use have been delivered in-person – however, lockdowns initiated during the COVID-19 pandemic significantly reduced access to such in-person support in prisons. Therefore, in May 2020 a digital cognitive-behavioral therapy (CBT) program for substance use disorders - 'Breaking Free from Substance Abuse' - was made available across prisons in Ohio in order to meet this treatment gap. This represents the first time this digital CBT intervention has been made widely available to incarcerated people residing in prisons or jails in the United States (US). This was a within-subjects study using data from 2187 Ohio prison residents who engaged with this digital CBT program to address their methamphetamine use. Results Participants reported multiple psychosocial risk factors, including moderate to severe substance dependence, depression and anxiety; interpersonal conflict; aggressive behavior; paranoia; and difficulties with work, education and accommodation. Significant reductions in substance dependence, depression/anxiety and biopsychosocial impairment, and improvements in quality of life, were identified in the sample. Risk factors were associated with less positive outcomes, specifically interpersonal conflict and poor mental health. Completion of specific components of the program were associated with more positive outcomes – a dose response was also identified. Conclusions Digital CBT can be delivered in secure US correctional settings and may help to fill unmet needs for in-person treatment. Specifically, this digital CBT program may support incarcerated individuals to address methamphetamine use, with outcomes being associated with psychosocial risk factors and program engagement.

A systematic review on psychological interventions for individuals with a history of offending behavior delivered by digital means

“…Most studies were conducted in the United States of America (USA) (n = 13), and only one study was conducted in the United Kingdom (UK). Several study designs were identified, namely randomized clinical trials (RCT; n = 8, 57.1 %; Alemagno et al, 2009;Cowell et al, 2018;Lee et al, 2017;Levesque et al, 2012;Rosen et al, 2020;Sporh et al, 2015Sporh et al, , 2017Walters et al, 2014), cohort studies (n = 4, 28.6 %; Elison et al, 2015;Elison-Davies et al, 2022;Levesque et al, 2008;Wilson et al, 2017), and open-label clinical trials (n = 2, 14.3 %; Chaple et al, 2014Chaple et al, , 2016.…”

“…Only three studies analyzed the acceptability (Levesque et al, 2008;Wilson et al, 2017) or feasibility of the digital intervention (Chaple et al, 2014). Two studies jointly analyzed acceptability/feasibility and effectiveness (Elison et al, 2015;Lee et al, 2017), one study performed the costeffectiveness analysis of the digital intervention (Cowell et al, 2018), and one last study reported on the participants' engagement with the digital intervention (Elison-Davies et al, 2022).…”

“…Also, three digital interventions with cognitive-behavioral approaches were identified targeting: (i) individuals on parole review or mandatory release within 4 to 6 months (Chaple et al, 2014(Chaple et al, , 2016Lee et al, 2017), (ii) prisoners released to the community (Elison et al, 2015;Elison-Davies et al, 2022), and (iii) first-offense criminal-justiceinvolved clients (Wilson et al, 2017). In terms of the duration and format, interventions ranged between a five-module-2 h-tailored online intervention to 48 interactive multimedia modules.…”

Cognitive behavioral therapy combined with head and face tuina/massage for negative emotions and sleep disorders in patients with protracted withdrawal symptoms: a study protocol for a randomized controlled trial

“…Moreover, it was found that CBT alone was not effective in producing a generalized reduction in the use of all types of harmful psychoactive substances [21]. Furthermore, nancial constraints and medical standards in certain areas and populations make it di cult to ensure the quality of CBT [23][24][25][26].…”

Examining outcomes for service users accessing the Breaking Free Online computer-assisted therapy program for substance use disorders via a ‘telehealth’ approach: protocol for a two arm, parallel group randomized controlled trial

“…Research around the efficacy of BFO has demonstrated significant reductions in substance use, substance dependence, depression and anxiety, and biopsychosocial impairment, and improvements in quality of life—these studies have been conducted with people using opiates [ 18 ], cannabis [ 19 ], alcohol [ 20 ] and methamphetamine [ 21 ]. BFO studies have also been conducted in multiple treatment settings, including eTherapy ‘dual diagnosis’ mental health services [ 22 , 23 ] and in UK [ 24 , 25 ] and US [ 21 ] prisons. Research has also indicated that users follow tailoring advice provided by the program [ 26 ] and has also demonstrated a ‘dose response’ [ 19 , 25 , 26 ].…”