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Gex KS, Leone RM, Aungst J, Branson K, Gray KM, Tomko RL. Identifying brief intervention factors to improve cannabis related outcomes in adolescents and young adults: A systematic review of sample characteristics and intervention components. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209335. [PMID: 38490335 PMCID: PMC11090745 DOI: 10.1016/j.josat.2024.209335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/19/2023] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Prior systematic and meta-analytic reviews observed mixed evidence for the efficacy of cannabis brief interventions (BIs). Inconsistent support for cannabis BIs may be the result of intersecting methodological factors, including intervention structure and content, participant eligibility criteria, and outcome assessment measures. The current systematic review of cannabis BI studies narratively synthesizes these data to guide intervention development decision-making in future cannabis BI studies (PROSPERO CRD42022285990). METHODS We searched PubMed/MEDLINE, PsycINFO, and CINAHL databases in January 2022 and again in June 2023 to capture newly published studies. Studies were included if they were a randomized trial, enrolled adolescents (13-17) and/or young adults (18-30), specified cannabis use and/or problems inclusion criteria, and evaluated a cannabis BI (defined as ≤4 sessions). We extracted and synthesized data on intervention characteristics (e.g., components, length/duration, modality), cannabis inclusion criteria and recruitment setting, baseline cannabis use descriptives and treatment-seeking status, and outcome assessment measures to discern if/how they may intersect to determine intervention efficacy. The Cochrane Risk of Bias Tool 2 assessed study quality. RESULTS Our search resulted in a final sample of 25 study records including 4094 participants. Recruitment setting seemed to provide an influential backdrop for how well inclusion criteria determined baseline cannabis use level, as well as for the type/length of the BI evaluated. Motivational interviewing (MI) and personalized feedback (PF) were the most frequently used BI components overall; however, some differences were observed in the proportion of BIs with reported intervention effects using MI vs. PF. Frequency of use days was the most commonly used outcome measure, although this may not be the most sensitive measure for assessing cannabis BI efficacy. CONCLUSIONS Our systematic review indicates that cannabis BI studies require greater precision in their design, giving special attention to matching the content and structure of the BI to the needs of the target population and selecting outcomes commensurate to the goals of the BI and the target population to more accurately reflect the efficacy of the BI. However, consistent with prior reviews, all included studies demonstrated at least some concerns for risk of bias, and most were at high risk.
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Affiliation(s)
- Kathryn S Gex
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Ruschelle M Leone
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Jenna Aungst
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, United States
| | - Kevin Branson
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
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Conner BT, Thompson K, Prince MA, Bolts OL, Contreras A, Riggs NR, Leadbeater BJ. Results of a randomized controlled trial of the cannabis eCHECKUP TO GO personalized normative feedback intervention on reducing cannabis use, cannabis consequences, and descriptive norms. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209267. [PMID: 38103837 DOI: 10.1016/j.josat.2023.209267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/01/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The prevalence of cannabis use disorder and its negative consequences among young adults has highlighted the need for prevention and early intervention programs. However, low treatment prevalence persists due to factors such as lack of perceived need, concerns about stigma, and limited access to treatment. To address these barriers, web-based cannabis interventions have been developed, but their efficacy remain limited. This study aims to evaluate the cross-site efficacy of the Cannabis eCHECKUP TO GO program, a web-based Personalized Normative Feedback and Protective Behavioral Strategies intervention for reducing cannabis use frequency and consequences in college students with willingness to change. METHODS Participants were 781 students from three universities (two in Canada, one in the US) who reported using cannabis in the past month and expressed interest in reducing or engaging in safer cannabis use. The study randomly assigned them to either an experimental group that received personalized normative feedback or a control group that received information on healthy stress management. The study collected follow-up data 4 weeks after the initial intervention and measured participants' frequency of cannabis use, number of cannabis consequences, descriptive and injunctive norms at both time points. RESULTS The results showed no significant reductions in cannabis use or negative consequences of use. However, students who received personalized normative feedback experienced a significant reduction in descriptive norms related to cannabis use, to be more in line with actual use. CONCLUSION This study suggests that more targeted interventions may be necessary for university students who are already using and seeking help to reduce their use.
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Affiliation(s)
- Bradley T Conner
- Department of Psychology, Colorado State University, United States of America.
| | - Kara Thompson
- Department of Psychology, Francis Xavier University, Antogonish, NS, Canada
| | - Mark A Prince
- Department of Psychology, Colorado State University, United States of America
| | - Olivia L Bolts
- Department of Psychology, Colorado State University, United States of America
| | | | - Nathaniel R Riggs
- Department of Human Development and Family Studies, CSU Prevention Research, United States of America
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Langwerden RJ, Morris SL, Fernandez SB, Contreras-Pérez ME, Hospital MM, Wagner EF. Preliminary Effects of a Guided Self-Change Intervention on Perceived Risk and Self-Efficacy in University Students Engaging in Cannabis or Alcohol Misuse. CANNABIS (ALBUQUERQUE, N.M.) 2023; 6:127-138. [PMID: 38035169 PMCID: PMC10683752 DOI: 10.26828/cannabis/2023/000173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Guided Self-Change (GSC) is a Motivational Interviewing (MI)-based early intervention program, infused with Cognitive Behavioral Therapy (CBT), for individuals with substance use problems. In this study, we implemented a 4-session GSC program with the innovative addition of mindfulness-based techniques at a minority-serving institution to reduce substance use and negative consequences among self-referred university students. We investigated processes that may be associated with behavior change, including perceived risk of use and self-efficacy ratings among university students who reported their primary substance of choice was cannabis (n = 18) or alcohol (n = 18). The sample of 36 participants (Mage = 24.4, SDage = 5, range 18-37) mostly identified as female (58.3%), then male (41.7%); 52.8% identified as Hispanic/Latine, 22.2% as Black or African American, and 19.5% as a sexual minority. Among cannabis primary using students, results indicated that the perceived risk of weekly cannabis use, confidence to change, and readiness to change showed statistically significant increases from pre- to post-assessment. Among alcohol primary using students, confidence to change and readiness to change showed statistically significant increases from pre- to post-assessments. All results yielded large effect sizes, which may be inflated due to the small sample size. Findings suggest that over the course of participation in a brief, 4-session targeted GSC program, there were significant increases in perceived risk and self-efficacy among minority university students who engage in primary cannabis or primary alcohol use.
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Affiliation(s)
- Robbert J Langwerden
- Community Based Research Institute, Florida International University, Miami, FL, USA
- Research Center in a Minority Institution, Florida International University, Miami, FL, USA
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
| | - Staci L Morris
- Community Based Research Institute, Florida International University, Miami, FL, USA
- Research Center in a Minority Institution, Florida International University, Miami, FL, USA
- School of Social Work, Florida International University, Miami, FL, USA
| | - Sofia B Fernandez
- Research Center in a Minority Institution, Florida International University, Miami, FL, USA
- School of Social Work, Florida International University, Miami, FL, USA
| | - María Eugenia Contreras-Pérez
- Community Based Research Institute, Florida International University, Miami, FL, USA
- Research Center in a Minority Institution, Florida International University, Miami, FL, USA
- School of Social Work, Florida International University, Miami, FL, USA
| | - Michelle M Hospital
- Community Based Research Institute, Florida International University, Miami, FL, USA
- Research Center in a Minority Institution, Florida International University, Miami, FL, USA
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Eric F Wagner
- Community Based Research Institute, Florida International University, Miami, FL, USA
- Research Center in a Minority Institution, Florida International University, Miami, FL, USA
- School of Social Work, Florida International University, Miami, FL, USA
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Jaffe AE, Blayney JA, Graupensperger S, Stappenbeck CA, Bedard-Gilligan M, Larimer M. Personalized normative feedback for hazardous drinking among college women: Differential outcomes by history of incapacitated rape. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023; 37:863-874. [PMID: 34435831 PMCID: PMC8881529 DOI: 10.1037/adb0000657] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Personalized normative feedback (PNF) interventions are effective at reducing hazardous drinking in college. However, little is known about who is most receptive to PNF. College women with a history of alcohol-related incapacitated rape (IR) are at elevated risk for hazardous drinking, but it is unclear what impact intervention messaging may have on this group and how their outcomes compare to those without past IR. To address this gap, this study involved secondary data analysis of a large web-based clinical trial. METHOD Heavy drinking college women (N = 1,188) were randomized into PNF (n = 895) or control conditions (n = 293). Postintervention, women reported their reactions to intervention messaging. Hazardous drinking outcomes (typical drinking, heavy episodic drinking [HED], peak estimated blood alcohol content [eBAC], blackout frequency) were assessed at baseline and 12 months. RESULTS Past IR was reported by 16.3% (n = 194) of women. Women with a history of IR reported more baseline hazardous drinking and greater readiness to change than women without IR. For those who received PNF, history of IR related to greater perceived impact of the intervention, but no difference in satisfaction with the message. After controlling for baseline drinking, regressions revealed the effect of PNF was moderated by IR for frequency of HED at 12 months. Simple main effects revealed PNF was associated with lower levels of hazardous drinking at follow-up among women with past IR. CONCLUSIONS This initial investigation suggests PNF is a low resource and easily disseminated intervention that can have a positive impact on college women with past IR. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Anna E Jaffe
- Department of Psychology, University of Nebraska-Lincoln
| | - Jessica A Blayney
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | | | | | - Mary Larimer
- Department of Psychiatry and Behavioral Sciences, University of Washington
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O'Grady MA, Tross S, Cohall A, Wilson P, Cohall R, Campos S, Lee S, Dolezal C, Elkington KS. Readiness to change among justice-involved young adults in an alternative sentencing program who screened positive for alcohol or drug risk. Addict Behav Rep 2022; 16:100456. [PMID: 36147454 PMCID: PMC9485898 DOI: 10.1016/j.abrep.2022.100456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/05/2022] [Accepted: 08/28/2022] [Indexed: 11/26/2022] Open
Abstract
Justice-involved young adults are in need of tailored substance use interventions. Readiness to change is a key component of substance use behavioral change. Many justice-involved young adults were ready to change their substance use. Personal reasons to quit using drugs are a potential intervention target.
Introduction Readiness to change is a key component of substance use behavioral change; yet little is known about readiness to change among justice-involved young adults. This study 1) describes readiness to change alcohol and drug use and 2) examines predictors of readiness to change alcohol and drug use among justice-involved young adults. Method Justice-involved young adults (18–24 years; n = 137) who were positive on a validated alcohol and/or drug screening tool completed an interview assessing substance use, readiness to change, and reasons to quit. A multivariable linear regression model examined whether reasons to change and substance use severity, and interactions between these, predicted readiness. Results More than half of participants were contemplating or had decided to quit/cut down substance use. Personal reasons to quit were positively related to readiness to change; interpersonal reasons were negatively associated. Conclusions This study contributes information needed to design motivational interventions for substance use among justice-involved young adults. Personal reasons to quit using drugs are a potential intervention target.
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Affiliation(s)
- Megan A O'Grady
- Department of Public Health Sciences, University of Connecticut, School of Medicine, USA
| | - Susan Tross
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA
| | - Alwyn Cohall
- Mailman School of Public Health, Columbia University, USA.,New York Presbyterian Hospital, USA
| | - Patrick Wilson
- Mailman School of Public Health, Columbia University, USA
| | - Renee Cohall
- Mailman School of Public Health, Columbia University, USA.,New York Presbyterian Hospital, USA
| | - Stephanie Campos
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA
| | - Sin Lee
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA
| | - Curtis Dolezal
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA.,HIV Center of Clinical and Behavioral Studies, USA
| | - Katherine S Elkington
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA.,HIV Center of Clinical and Behavioral Studies, USA
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Fetterling T, Parnes J, Prince MA, Conner BT, George MW, Shillington AM, Riggs NR. Moderated Mediation of the eCHECKUP TO GO College Student Cannabis Use Intervention. Subst Use Misuse 2021; 56:1508-1515. [PMID: 34126858 DOI: 10.1080/10826084.2021.1937225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Cannabis use rates are rising among college students, creating a need for effective and accessible intervention options. One such intervention, the Marijuana eCHECKUP TO GO (eCTG) program, has relatively few studies investigating mechanisms of change and related outcomes. This intervention provides users with personalized normative feedback to adjust user's normative perceptions and use patterns. The current study tested moderated mediation of program effects between the eCTG intervention condition and a healthy stress management (HSM) control condition in a college student sample of near-daily cannabis users. Protective behavioral strategies (PBS) were measured among the eCTG conditionMethods: Data were analyzed from a sample of 227 students who were randomly assigned to the eCTG intervention condition or HSM control condition. Change in cannabis use frequency was measured by re-administering the baseline survey at a six-week follow-up. Multi-group moderated mediation path analysis tested the effects of the eCTG intervention on change in cannabis use frequency through PBS, descriptive norms, and injunctive norms, with multi-group categories defined by sex.Results: Direct effects indicated the intervention predicted reduced descriptive norm perceptions and cannabis use frequency. An indirect effect was found for the intervention condition on reducing cannabis use frequency through change in descriptive norms in males. Similarly, an indirect effect was seen for intervention condition on reducing cannabis use frequency through change in injunctive norms for females.Conclusions: Findings suggest changes in descriptive norms played a sex-specific mediating role in the mechanisms of change for the eCTG intervention on reductions in cannabis use frequency.
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Affiliation(s)
- Theodore Fetterling
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Jamie Parnes
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Mark A Prince
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Bradley T Conner
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Melissa W George
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Audrey M Shillington
- College of Health and Human Sciences, San Jose State University, San Jose, California, USA
| | - Nathaniel R Riggs
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
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Stephens RS, Walker R, Fearer SA, Roffman RA. Reaching nontreatment-seeking cannabis users: Testing an extended marijuana check-up intervention. J Subst Abuse Treat 2020; 125:108269. [PMID: 34016293 DOI: 10.1016/j.jsat.2020.108269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/13/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022]
Abstract
Some adult cannabis users report negative consequences of use but do not seek treatment. Nonjudgmental, brief interventions incorporating motivational interviewing techniques may be able to reach users who otherwise would not seek treatment and increase their motivation to change use. Previous studies have shown brief interventions with this population are efficacious in reducing use, but the absolute amount of change has not clearly translated into meaningful reductions in associated negative consequences. The current study used a marijuana check-up (MCU) model to attract nontreatment-seeking adults who used cannabis at levels that may have caused negative consequences. The study randomly assigned participants to 2-session (n = 93) and 6-session (n = 93) versions of the intervention and followed them for 12 months. The study designed the extended 6-session condition to build on the efficacy of the previously tested 2-session intervention. The study hypothesized that the opportunity to continue to consider the consequences of cannabis use would have the greatest impact on those who were in earlier stages of readiness for change. We used cognitive behavioral techniques to assist with change efforts when indicated. Results showed significant reductions in the frequency and daily duration of cannabis use at all follow-ups in both intervention conditions. The extended 6-session condition produced greater change only on a measure of the number of periods of the day in which cannabis was used. Reductions in dependence symptoms and problems related to cannabis use occurred in both conditions, but there was no effect of intervention condition. Participants who were less ready to make changes at the outset decreased use and negative consequences the least. Results suggested that some benefit of the extended session format of the check-up in reducing daily use, but the lack of a corresponding reduction in consequences suggested that the original 2-session MCU may be more cost effective.
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Affiliation(s)
- Robert S Stephens
- Department of Psychology, Virginia Tech, 890 Drillfield Drive, 109 Williams Hall, Blacksburg, VA 24061, United States of America.
| | - Robrina Walker
- Department of Psychology, Virginia Tech, 890 Drillfield Drive, 109 Williams Hall, Blacksburg, VA 24061, United States of America.
| | - Stephanie A Fearer
- Department of Psychology, Virginia Tech, 890 Drillfield Drive, 109 Williams Hall, Blacksburg, VA 24061, United States of America.
| | - Roger A Roffman
- Innovative Programs Research Group, School of Social Work, University of Washington, 909 NE 43(rd) St. Suite, 304, Seattle, WA 98105, United States of America.
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Online personalized feedback intervention for cannabis-using college students reduces cannabis-related problems among women. Addict Behav 2019; 98:106040. [PMID: 31302314 DOI: 10.1016/j.addbeh.2019.106040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/24/2019] [Accepted: 06/30/2019] [Indexed: 11/21/2022]
Abstract
There is growing evidence that college cannabis use is associated with use-related problems, yet efforts to reduce cannabis-related problems via online personalized feedback interventions (PFIs) have had limited success in significantly reducing risky cannabis use among college students. However, men and women may respond differently to such interventions and failure to examine effects of gender may obfuscate intervention effects. Thus, the current study tested intervention effects (moderated by gender) of an online, university-specific PFI for high-risk cannabis users (i.e., past-month cannabis users with at least one recent cannabis-related problem) who were randomly assigned to an online PFI (n = 102) or an online personalized normative feedback-only condition (PNF-only; n = 102). Gender moderated the relationship between condition and one-month follow-up problems, such that women in the PFI condition reported fewer cannabis-related problems at follow-up than women in the PNF-only condition. Men in the PFI condition did not significantly differ from men in the PNF-only condition on use-related problems at follow-up. Cannabis PFIs may be efficacious for reducing cannabis use-related problems among undergraduate women (but not men) and women may benefit from online interventions that include problem-focused components.
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4/20 Cannabis Use is Greater than Other High-Risk Events: Identification of Psychosocial Factors Related to 4/20 Use. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10019-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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Jonas B, Tensil MD, Leuschner F, Strüber E, Tossmann P. Predictors of treatment response in a web-based intervention for cannabis users. Internet Interv 2019; 18:100261. [PMID: 31890614 PMCID: PMC6926274 DOI: 10.1016/j.invent.2019.100261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/08/2019] [Accepted: 07/23/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Trials demonstrate the effectiveness of web-based interventions for cannabis-related disorders. For further development of these interventions, it is of vital interest to identify user characteristics which predict treatment response. METHODS Data from a randomized factorial trial on a web-based intervention for cannabis-users (n = 534) was reanalyzed. As potential predictors for later treatment response, 31 variables from the following categories were tested: socio-demographics, substance use and cognitive processing. The association of predictors and treatment outcome was analyzed using unbiased recursive partitioning and represented as classification tree. Predictive performance of the tree was assessed by comparing its cross-validated results to models derived with all-subsets logistic regression and random forest. RESULTS Goal commitment (p < .001), the extent of self-reflection (p < .001), the preferred effect of cannabis (p = .005) and initial cannabis use (p = .015) significantly differentiate between successful and non-successful participants in all three analysis methods. The predictive accuracy of all three models is comparable and modest. CONCLUSIONS Participants who commit to quit using cannabis, who at least have moderate levels of self-reflection and who prefer mild intoxicating effects were most likely to respond to treatment. To predict treatment response on an individual level, the classification tree should only be used as one of several sources of information.Trial registration: http://www.isrctn.com/ISRCTN99818059.
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Affiliation(s)
- Benjamin Jonas
- Delphi - Gesellschaft, Berlin, Germany,Corresponding author at: Delphi-Gesellschaft für Forschung, Beratung und Projektentwicklung mbH, Kaiserdamm 8, 14057 Berlin, Germany.
| | | | | | - Evelin Strüber
- Federal Centre for Health Education (BZgA), Cologne, Germany
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Lüdtke T, Pult LK, Schröder J, Moritz S, Bücker L. A randomized controlled trial on a smartphone self-help application (Be Good to Yourself) to reduce depressive symptoms. Psychiatry Res 2018; 269:753-762. [PMID: 30273901 DOI: 10.1016/j.psychres.2018.08.113] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 07/10/2018] [Accepted: 08/28/2018] [Indexed: 02/01/2023]
Abstract
Depressive symptoms are common, yet only a subgroup of individuals receive adequate treatment. To reduce the treatment gap, several online self-help programs have been developed, yielding small to moderate effects. We developed a smartphone self-help application addressing depressive symptoms. We sought to evaluate its feasibility and efficacy in participants reporting a subjective need for help (a diagnosis of depression was not mandatory). We conducted a randomized controlled trial (N = 90). The primary outcome was a reduction of depressive symptoms measured with the Patient Health Questionnaire-9 (PHQ-9). Secondary outcomes included improved self-esteem (Rosenberg Self-Esteem Scale) and quality of life (WHOQOL-BREF). The intervention group obtained access to the application for four weeks, the wait-list group received access after the post assessment. No group differences emerged in either outcome in intention-to-treat analyses. Per protocol analyses with frequent users (i.e., several times a week or more) yielded a small effect size (η2p = 0.049) at trend level on the reduction of depressive symptoms in favor of the treatment group. However, 39% of the participants did not use the application frequently. Mobile self-help applications represent a promising addition to existing treatments, but it is important to increase patients' motivation to use them.
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Affiliation(s)
- Thies Lüdtke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychology, UiT - The Arctic University of Norway, Hansine Hansens veg 18, 9019, Tromsø, Norway.
| | - Lilian Klara Pult
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Stein MD, Caviness CM, Morse EF, Grimone KR, Audet D, Herman DS, Moitra E, Anderson BJ. A developmental-based motivational intervention to reduce alcohol and marijuana use among non-treatment-seeking young adults: a randomized controlled trial. Addiction 2018; 113:440-453. [PMID: 28865169 PMCID: PMC5807100 DOI: 10.1111/add.14026] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/15/2017] [Accepted: 08/24/2017] [Indexed: 02/05/2023]
Abstract
AIMS To test the hypothesis that among non-treatment-seeking emerging adults (EA) who both use marijuana and have alcohol binges, a brief, longitudinally delivered, developmentally based motivational intervention would show greater reductions in the use of these two substances compared with a health education control condition. DESIGN Parallel, two-group, randomized controlled trial with follow-up interventions conducted at 1, 3, 6 and 9 months and final assessments at 12 and 15 months. SETTING Hospital-based research unit in the United States. PARTICIPANTS Community-based 18-25-year-olds who reported at least monthly binge drinking and at least weekly marijuana use. INTERVENTION Motivational intervention (EA-MI) focused primarily on themes of emerging adulthood (identity exploration, instability, self-focus, feeling in-between, a sense of possibilities) and the subjects' relationship to substance use (n = 110) compared with an attention-matched health education control condition (n = 116). MEASUREMENTS The primary outcomes were days of binge alcohol, marijuana and dual use day as measured using the timeline follow-back method analysing the treatment by time interaction to determine relative differences in the rate of change between intervention arms. FINDINGS At baseline, the mean rate (days/30) of binge drinking was 5.23 (± 4.31) of marijuana use was 19.4 (± 10.0) and of dual (same day) use was 4.11 (± 4.13). Relative to baseline, there were reductions in the rate of binge alcohol use, marijuana use and days of combined binge alcohol and marijuana use (P < 0.001) at all follow-up assessments. However, the treatment × time interaction was not statistically significant for alcohol (P = 0.37), for marijuana (P = 0.07) or for dual use (P = 0.55). Averaged over all follow-ups, mean reductions in binge, marijuana and dual use days were 1.16, 1.45 and 1.08, respectively, in the health education arm, and 1.06, 1.69 and 0.96 in EA-MI. Bayes factors were < 0.01 for frequency of binge alcohol use and frequency of dual binge alcohol and marijuana and 0.016 for marijuana use. CONCLUSIONS A brief, longitudinally delivered, developmentally based motivational intervention for young adults did not produce reductions in binge alcohol, marijuana use or dual use days relative to a control condition.
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Affiliation(s)
- Michael D. Stein
- Behavioral Medicine and Addictions Research Department, Butler Hospital, Providence, RI 02906
- Boston University School of Public Health, Boston, MA 02118
| | - Celeste M. Caviness
- Behavioral Medicine and Addictions Research Department, Butler Hospital, Providence, RI 02906
| | - Emily F. Morse
- Behavioral Medicine and Addictions Research Department, Butler Hospital, Providence, RI 02906
| | - Kristin R. Grimone
- Behavioral Medicine and Addictions Research Department, Butler Hospital, Providence, RI 02906
| | - Daniel Audet
- Behavioral Medicine and Addictions Research Department, Butler Hospital, Providence, RI 02906
| | - Debra S. Herman
- Behavioral Medicine and Addictions Research Department, Butler Hospital, Providence, RI 02906
- Warren Alpert Medical School of Brown University, Providence, RI 02912
| | - Ethan Moitra
- Behavioral Medicine and Addictions Research Department, Butler Hospital, Providence, RI 02906
- Warren Alpert Medical School of Brown University, Providence, RI 02912
| | - Bradley J. Anderson
- Behavioral Medicine and Addictions Research Department, Butler Hospital, Providence, RI 02906
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Readiness to change and therapy outcomes of an innovative psychotherapy program for surgical patients: results from a randomized controlled trial. BMC Psychiatry 2017; 17:417. [PMID: 29284443 PMCID: PMC5747166 DOI: 10.1186/s12888-017-1579-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Readiness to change is a pivotal construct for psychotherapy research and a major target of motivational interventions. Our primary objective was to examine whether pre-treatment readiness to change moderated therapy effects of Bridging Intervention in Anesthesiology (BRIA), an innovative psychotherapy approach for surgical patients. This stepped care program aims at motivating and supporting surgical patients with mental disorders to engage in psychosocial mental health care. METHODS The major steps of BRIA are two motivational interventions with different intensity. The first step of the program consists of preoperative computer-assisted psychosocial self-assessment including screening for psychological distress and automatically composed computerized brief written advice (BWA). In the second step, patients participate in postoperative psychotherapy sessions combining motivational interviewing with cognitive behavioural therapy (BRIA psychotherapy sessions). We performed regression-based moderator analyses on data from a recent randomized controlled trial published by our research group. The sample comprised 220 surgical patients with diverse comorbid mental disorders according to ICD-10. The most frequent disorders were mood, anxiety, substance use and adjustment disorders. The patients had a mean age of 43.31 years, and 60.90% were women. In a regression model adjusted for pre-treatment psychological distress, we investigated whether readiness to change moderated outcome differences between (1) the BRIA psychotherapy sessions and (2) no psychotherapy / BWA only. RESULTS Multiple regression analyses showed that readiness to change moderated treatment effects regarding the primary outcomes "Participation in psychosocial mental health care options at month 6" (p = 0.03) and "Having approached psychosocial mental health care options at month 6" (p = 0.048) but not regarding the secondary outcome "Change of general psychological distress between baseline assessment and month 6" (p = 0.329). Probing the moderation effect with the Johnson-Neyman technique revealed that BRIA psychotherapy sessions were superior to BWA in patients with low to moderate readiness, but not in those with high readiness. CONCLUSIONS Readiness to change may act as moderator of the efficacy of psychosocial therapy. Combinations of motivational interviewing and cognitive behavioural therapy may be effective particularly in patients with a variety of mental disorders and low readiness to change. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01357694.
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ONDERSMA STEVENJ, MARTINO STEVE, SVIKIS DACES, YONKERS KIMBERLYA. Commentary on Kim et al. (2017): Staying focused on non-treatment seekers. Addiction 2017; 112:828-829. [PMID: 28378329 PMCID: PMC6552680 DOI: 10.1111/add.13736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/20/2016] [Indexed: 11/27/2022]
Abstract
Negative results for screening, brief intervention and referral to treatment (SBIRT) trials continue to build. These findings should accelerate rather than suppress research regarding how best to identify and intervene proactively with non-treatment seeking samples.
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Affiliation(s)
- STEVEN J. ONDERSMA
- Wayne State University, Merrill-Palmer Skillman Institute
and Department of Psychiatry and Behavioral Neurosciences, Detroit, MA, USA
| | - STEVE MARTINO
- Yale University School of Medicine, Department of
Psychiatry; VA Connecticut Health System West Haven Campus, New Haven, CT,
USA
| | - DACE S. SVIKIS
- Virginia Commonwealth University, Department of Psychology
and Institute for Women’s Health, Richmond, VA, USA
| | - KIMBERLY A. YONKERS
- Yale University School of Medicine, Department of
Psychiatry, New Haven, CT, USA
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