BLEND-A: blending internet treatment into conventional face-to-face treatment for alcohol use disorder - a study protocol

Abstract

Background A major challenge to psychological treatment for alcohol use disorder (AUD) is patient non-compliance. A promising new treatment approach that is hypothesized to increase patient compliance is blended treatment, consisting of face-to-face contact with a therapist combined with modules delivered over the internet within the same protocol. While this treatment concept has been developed and proven effective for a variety of mental disorders, it has not yet been examined for AUD. Aims The study described in this protocol aims to examine and evaluate patient compliance with blended AUD treatment as well as the clinical and cost effectiveness of such treatment compared to face-to-face treatment only. Methods The study design is a pragmatic, stepped-wedge cluster randomized controlled trial. The included outpatient institutions (planned number of patients: n = 1800) will be randomized in clusters to implement either blended AUD treatment or face-to-face treatment only, i.e. treatment as usual (TAU). Both treatment approaches consist of motivational interviewing and cognitive behavioral therapy. Data on sociodemographics, treatment (e.g. intensity, duration), type of treatment conclusion (compliance vs. dropout), alcohol consumption, addiction severity, consequences of drinking, and quality of life, will be collected at treatment entry, at treatment conclusion, and 6 months after treatment conclusion. The primary outcome is compliance at treatment conclusion, and the secondary outcomes include alcohol consumption and quality of life at six-months follow-up. Data will be analyzed with an Intention-to-treat approach by means of generalized linear mixed models with a random effect for cluster and fixed effect for each step. Also, analyses evaluating cost-effectiveness will be conducted. Discussion Blended treatment may increase treatment compliance and thus improve treatment outcomes due to increased flexibility of the treatment course. Since this study is conducted within an implementation framework it can easily be scaled up, and when successful, blended treatment has the potential to become an alternative offer in many outpatient clinics nationwide and internationally. Trial registration Clinicaltrials.gov.: NCT04535258, retrospectively registered 01.09.20.

Perceived barriers to seeking treatment for alcohol use disorders among the general Danish population – a cross sectional study on the role of severity of alcohol use and gender

“…For example, patient centered treatment goals – abstinence or reduced alcohol use [ 31 , 36 , 37 ] could be offered. Furthermore, to offer a wider range of treatment options: via the Internet [ 38 ] or a blend of the Internet and face-to-face treatment [ 39 ], both of which also can be less time consuming and easier to access compared to traditional treatment. Internet interventions have also been shown to attract a larger proportion of women compared to traditional treatment options [ 38 ].…”

Blended Treatment for Alcohol Use Disorder (Blend-A): Explorative Mixed Methods Pilot and Feasibility Study

“…Therefore, whether the patients’ assessment of the usability of the platform develops over time should be interpreted with caution. In future upscaling, we will rely as much as possible on register data and on more routes for collecting patient data, that is telephone calls and the use of e-Boks (the Danish system for digital communication with the authorities) [ 63 ]. Moreover, some usability models are considered problematic, as theory to speculate about the relationship between measures may be lacking [ 64 ].…”

“…Our initial findings indicate that the blended treatment may enhance participants’ perceived satisfaction and the effect of the treatment course. However, we still need to determine the actual effect of Blend-A; therefore, an effectiveness study is currently being performed to evaluate the effect, compliance, and cost-effectiveness of implementing the blended treatment program [ 63 ].…”

A qualitative study of the implementation and organization of the national Greenlandic addiction treatment service

“…Implementation of a treatment strategy involving both new methods and a new organization nationwide in Greenland can be considered a huge task, which is a type of task that has not been studied before. Studies on the implementation of addiction treatment so far have primarily focused on, e.g., barriers toward the implementation of evidence-based treatment ( 13 ) and the implementation of new elements in the established treatment services, e.g., telemedicine ( 14 ) or services for an underserved target group ( 15 ); however, studies on the implementation of new addiction treatment services and implementation of new methods nationwide to our knowledge have not been performed yet. Furthermore, the treatment service in Greenland was particularly interesting because of the lack of evidence-based knowledge about treatment in Indigenous populations in general, because the methods of MI and cognitive behavioral therapy specifically were new to addiction treatment in Greenland when implemented, and because of the high impact of addiction on public health and to human suffering in Greenland ( 1 , 2 , 4 , 16 ).…”