Choosing internet-based treatment for problematic alcohol use—why, when and how? Users’ experiences of treatment online

Ekström, Veronica; Johansson, Magnus

doi:10.1186/s13722-020-00196-5

Cited by 24 publications

(32 citation statements)

References 30 publications

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“…One of the leading obstacles to seeking treatment is reported to be stigma; for example, because patients feel ashamed to be associated with the clinic and worry about what others might think [ 9 , 11 , 51 , 52 ]. This points to the relevance of offering an anonymous version of internet-based alcohol treatment as it might reach a group of non–treatment seekers not otherwise reached, for example, owing to stigma, as also suggested elsewhere [ 53 ].…”

Section: Discussionsupporting

confidence: 58%

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

Tarp¹,

Rasmussen²,

Mejldal³

et al. 2022

JMIR Form Res

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Background In Denmark, approximately 150,000 people have alcohol use disorder (AUD). However, only approximately 10% seek AUD treatment, preferably outside conventional health care settings and opening hours. The AUD treatment area experiences low adherence to treatment, as well as high numbers of no-show and premature dropouts. Objective The purpose of the Blend-A (Blended Treatment for Alcohol Use Disorder) feasibility and pilot study was to describe the process of translating and adapting the Dutch treatment protocol into Danish and Danish culture with a high amount of user involvement and to report how patients and therapists perceived the adapted version, when trying it out. Methods The settings were 3 Danish public municipal outpatient alcohol clinics. Study participants were patients and therapists from the 3 settings. Data consisted of survey data from the System Usability Scale, individual patient interviews, and therapist group interviews. Statistical analyses were conducted using the Stata software and Excel. Qualitative analysis was conducted using a theoretical thematic analysis. Results The usability of the treatment platform was rated above average. The patients chose to use the blended treatment format because it ensured anonymity and had a flexible design. Platform use formed the basis of face-to-face sessions. The use of the self-determined platform resulted in a more thorough process. Patient involvement qualified development of a feasible system. Managerial support for time use was essential. Guidance from an experienced peer was useful. Conclusions This study indicates that, during the processes of translating, adapting, and implementing blended, guided, internet-based, and face-to-face AUD treatment, it is relevant to focus on patient involvement, managerial support, and guidance from experienced peers. Owing to the discrete and flexible design of the blended offer, it appears that it may reach patient groups who would not otherwise have sought treatment. Therefore, blended treatment may increase access to treatment and contribute to reaching people affected by excessive alcohol use, who would not otherwise have sought treatment. In addition, it seems that the blended offer may enhance the participants’ perceived satisfaction and the effect of the treatment course. Thus, it appears that Blend-A may be able to contribute to existing treatment offers. Such findings highlight the need to determine the actual effect of the Blend-A offer; therefore, an effectiveness study with a controlled design is warranted.

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Section: Discussionsupporting

confidence: 58%

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

Tarp¹,

Rasmussen²,

Mejldal³

et al. 2022

JMIR Form Res

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“…One important challenge for future studies is to improve follow-up rates and adherence to interventions without reducing the willingness to use the interventions. Increased demands on users to identify themselves or have contact with a professional might make people who wish to remain anonymous or feel ashamed or stigmatized more reluctant to seek support [ 81 ]. Treatment-seeking increases the rates of recovery from alcohol dependence [ 82 ], and internet-based interventions seem to be a possible way to reach individuals currently not seeking treatment [ 83 ]; however, it is still unclear whether internet-based interventions actually increase treatment-seeking.…”

Section: Discussionmentioning

confidence: 99%

Effects of Internet-Based Cognitive Behavioral Therapy for Harmful Alcohol Use and Alcohol Dependence as Self-help or With Therapist Guidance: Three-Armed Randomized Trial

Johansson¹,

Berman²,

Sinadinovic³

et al. 2021

J Med Internet Res

Self Cite

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Background Alcohol use is a major contributor to health loss. Many persons with harmful use or alcohol dependence do not obtain treatment because of limited availability or stigma. They may use internet-based interventions as an alternative way of obtaining support. Internet-based interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use; however, few studies have been conducted with a specific focus on harmful use or alcohol dependence. The importance of therapist guidance in internet-based cognitive behavioral therapy (ICBT) programs is still unclear. Objective This trial aims to investigate the effects of a web-based alcohol program with or without therapist guidance among anonymous adult help-seekers. Methods A three-armed randomized controlled trial was conducted to compare therapist-guided ICBT and self-help ICBT with an information-only control condition. Swedish-speaking adult internet users with alcohol dependence (3 or more International Classification of Diseases, Tenth Revision criteria) or harmful alcohol use (alcohol use disorder identification test>15) were included in the study. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of 5 main modules, as well as a drinking calendar with automatic feedback. Guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol-related problems measured using the total alcohol use disorder identification test-score, diagnostic criteria for alcohol dependence and alcohol use disorder, depression, anxiety, health, readiness to change, and access to other treatments or support. Follow-up was conducted 3 (posttreatment) and 6 months after recruitment. Results During the recruitment period, from March 2015 to March 2017, 1169 participants were included. Participants had a mean age of 45 (SD 13) years, and 56.72% (663/1169) were women. At the 3-month follow-up, the therapist-guided ICBT and control groups differed significantly in weekly alcohol consumption (−3.84, 95% Cl −6.53 to −1.16; t417=2.81; P=.005; Cohen d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between the self-help ICBT and the control group at 3 months, or between any of the groups at the 6-month follow-up. A limitation of the study was the large number of participants who were completely lost to follow-up (477/1169, 40.8%). Conclusions In this study, a therapist-guided ICBT program was not found to be more effective than the same program in a self-help ICBT version for reducing alcohol consumption or other alcohol-related outcomes. In the short run, therapist-guided ICBT was more effective than information. Only some internet help-seekers may need a multisession program and therapist guidance to change their drinking when they use internet-based interventions. Trial Registration ClinicalTrials.gov NCT02377726; https://clinicaltrials.gov/ct2/show/NCT02377726

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“…McCrabb et al [ 6 ] showed that internet-based interventions for smoking cessation can reach the majority of socially disadvantaged populations. Ekström et al [ 7 ] showed that, while introducing a new perception of distance between the patient and the clinician, internet-based treatment can offer a better sense of confidentiality and that offering diverse content for users to choose from (such as cognitive behavioral therapy modules, therapist support, and discussion forum) is appreciated by patients and may contribute to the attractivity of internet-based treatment [ 8 ].…”

Section: Special Issue Themesmentioning

confidence: 99%

Information technology and addiction science: promises and challenges

Bertholet

Cunningham

2021

Addict Sci Clin Pract

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Background Information technology can be used to advance addiction science and clinical practice. Main body This special issue, “Information technology (IT) interventions to advance treatment for opioid and other addictions” presents studies that expand our understanding of IT intervention efficacy, patients’ perspectives, and how IT can be used to improve substance use health care and research. This editorial introduces the topics addressed in the special issue and focuses on some of the challenges that the field is currently facing, such as attrition and treatment retention, transferability of intervention paradigms, and the challenge to keep pace with rapidly changing technologies. Conclusions Increasing treatment reach is particularly crucial in the addiction field. IT empowers researchers and clinicians to reach large portions of the population who might not otherwise access standard treatment modalities, because of geographical limitations, logistical constraints, stigma, or other reasons. The use of information technology may help reduce the substance use treatment gap and contribute to public health efforts to diminish the impact of substance use and other addictive behaviors on population health.

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Choosing internet-based treatment for problematic alcohol use—why, when and how? Users’ experiences of treatment online

Cited by 24 publications

References 30 publications

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

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

Effects of Internet-Based Cognitive Behavioral Therapy for Harmful Alcohol Use and Alcohol Dependence as Self-help or With Therapist Guidance: Three-Armed Randomized Trial

Information technology and addiction science: promises and challenges

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