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Guertler D, Baumann S, Moehring A, Krause K, Freyer-Adam J, Ulbricht S, Bischof G, Batra A, Rumpf HJ, Wurm S, Lucht M, John U, Meyer C. E-health intervention for co-occurring at-risk alcohol use and depressive symptoms: Reach, adherence, and two-year effects of a randomized controlled trial. J Affect Disord 2025; 382:355-365. [PMID: 40280429 DOI: 10.1016/j.jad.2025.04.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 04/07/2025] [Accepted: 04/18/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND This randomized controlled trial explored reach, adherence, and two-year effects of a proactive e-health intervention for co-occurring at-risk alcohol use and depressive symptoms (ITE). METHODS German medical care patients were screened for at-risk alcohol use and subthreshold depression. Over 6 months, ITE participants received 6 individualized feedback letters and weekly text messages. Primary outcome was change in a composite measure including problematic alcohol use (Alcohol Use Disorders Identification Test consumption questions) and depressive symptoms (two subscales of the Patient-Health-Questionnaire-8) from baseline to 6, 12, and 24 months. Analyses were adjusted for education, setting, major depression, and baseline differences. RESULTS Among eligible patients invited, 51 % agreed to participate; 40 % completed the baseline interview and were randomized to ITE (n = 64) or assessment only (n = 68). Within ITE participants, 73 % received all intervention components. A latent change model revealed a small, insignificant impact of study group on the composite measure at 6 (d = -0.49, β = -0.41, p = 0.06) and 12 months (d = -0.26, β = -0.22, p = 0.35), diminishing at 24 months (d = -0.06, β = -0.04, p = 0.88). Secondary analyses showed a non-significant trend at 6 months, suggesting possible effect modification by baseline major depression (β = 0.80, p = 0.098), with larger effects in those without major depression. LIMITATIONS Self-reported outcomes; psychotherapy status unknown. DISCUSSION ITE showed high adherence and overall small, although non-significant, intervention effects up to month 12. The potential effect moderation warrants further investigation in larger samples.
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Affiliation(s)
- D Guertler
- Institute for Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany; Institute for Community Medicine, Department of Methods in Community Medicine, University Medicine Greifswald, Greifswald, Germany.
| | - S Baumann
- Institute for Community Medicine, Department of Methods in Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - A Moehring
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany; Institute for Community Medicine, Department of Methods in Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - K Krause
- Center for Psychological Psychotherapy, University of Greifswald, Greifswald, Germany
| | - J Freyer-Adam
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany; Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - S Ulbricht
- Institute for Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | - G Bischof
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - A Batra
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
| | - H J Rumpf
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - S Wurm
- Institute for Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany
| | - M Lucht
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - U John
- Institute for Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - C Meyer
- Institute for Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
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Jonathan GK, Guo Q, Arcese H, Evins AE, Wilhelm S. Digital Integrated Interventions for Comorbid Depression and Substance Use Disorder: Narrative Review and Content Analysis. JMIR Ment Health 2025; 12:e67670. [PMID: 40094744 PMCID: PMC12102630 DOI: 10.2196/67670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 01/07/2025] [Indexed: 03/19/2025] Open
Abstract
BACKGROUND Integrated digital interventions for the treatment of comorbid depression and substance use disorder have been developed, and evidence of their effectiveness is mixed. OBJECTIVE This study aimed to explore potential reasons for mixed findings in the literature on integrated digital treatments. We described the methodologies and core characteristics of these interventions, identified the presence of evidence-based treatment strategies, examined patterns across digital modalities, and highlighted areas of overlap as well as critical gaps in the existing evidence base. METHODS In June 2024, a literature search was conducted in Google Scholar to identify digital integrated interventions for comorbid major depressive disorder and substance use disorder. Articles were included if they described interventions targeting both conditions simultaneously; were grounded in cognitive behavioral therapy, motivational interviewing, or motivational enhancement therapy; and were delivered at least in part via digital modalities. In total, 14 studies meeting these criteria were coded using an open-coding approach to identify intervention characteristics and treatment strategies (n=25). Statistical analyses summarized descriptive statistics to capture the frequency and overlap of these strategies. RESULTS Studies included a range of digital modalities: internet (n=6, 43%), computer (n=3, 21%), smartphone (n=2, 14%), and supportive text messaging interventions (n=3, 21%). Half (n=7, 50%) of the studies included participants with mild to moderate depression symptom severity and hazardous substance use. Only 36% (n=5) of the studies required participants to meet full diagnostic criteria for major depressive disorder for inclusion and 21% (n=3) required a substance use disorder diagnosis. Most interventions targeted adults (n=11, 79%), with few targeting young or emerging adults (n=4, 29%), and only 36% (n=5) reported detailed demographic data. Treatment duration averaged 10.3 (SD 6.8) weeks. Internet-based interventions offered the widest range of treatment strategies (mean 11.7), while supportive text messaging used the fewest (mean 4.6). Common treatment strategies included self-monitoring (n=11, 79%), psychoeducation (n=10, 71%), and coping skills (n=9, 64%). Interventions often combined therapeutic strategies, with psychoeducation frequently paired with self-monitoring (n=9, 64%), assessment (n=7, 50%), coping skills (n=7, 50%), decisional balance (n=7, 50%), feedback (n=7, 50%), and goal setting (n=7, 50%). CONCLUSIONS Among integrated digital interventions for comorbid depression and substance use, there was noteworthy variability in methodology, inclusion criteria, digital modalities, and embedded treatment strategies. Without standardized methods, comparison of the clinical outcomes across studies is challenging. These results emphasize the critical need for future research to adopt standardized approaches to facilitate more accurate comparisons and a clearer understanding of intervention efficacy.
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Affiliation(s)
- Geneva K Jonathan
- Center for Digital Mental Health, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Qiuzuo Guo
- Department of Psychological Science, University of California, Irvine, CA, United States
| | - Heyli Arcese
- Center for Digital Mental Health, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Sabine Wilhelm
- Center for Digital Mental Health, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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Ogeil RP, McGrath M, Grigg J, Peart A, Meddings JI, Greenwood CJ, Nehme Z, Lubman DI. Diverging trends in alcohol-related harms: The role of comorbid mental health, suicide and self-harm behaviors in ambulance attendances for alcohol intoxication during the COVID-19 pandemic in Victoria, Australia. J Affect Disord 2025; 371:170-176. [PMID: 39505021 DOI: 10.1016/j.jad.2024.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 10/28/2024] [Accepted: 11/03/2024] [Indexed: 11/08/2024]
Abstract
BACKGROUND Alcohol harms changed significantly during COVID-19, but did not affect the population equally. Vulnerable groups including people with pre-existing mental health or suicidal behaviors may be at greater risk of alcohol-related harms, yet limited public health data are able to assess these. METHODS The present study utilised a novel, statewide surveillance system to examine ambulance attendances for alcohol intoxication over a four-year period prior to, and during the strictest lockdowns in Victoria, Australia. RESULTS While there was an overall reduction in alcohol-related attendances during lockdown (n = 15,064) compared to the 2018-19 period (n = 16,989), alcohol- intoxication attendances involving mental health symptoms increased by 40 % in Melbourne (IRR: 1.40 [1.30-1.51], p < 0.001), and by 25 % in regional Victoria (IRR: 1.25 [1.07-1.44], p = 0.005).There was also a 7 % increase in alcohol-intoxication attendances with co-morbid suicidal behaviors in Melbourne (IRR: 1.07 95%CI [1.02-1.13], p = 0.006), and a 21 % increase in regional Victoria (IRR: 1.21 [1.08-1.35], p = 0.001). CONCLUSIONS These findings suggest that extra services and supports for individuals with co-morbid alcohol-related harms are required to ensure their clinical care needs are being met.
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Affiliation(s)
- Rowan P Ogeil
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill 3128, Australia; Turning Point, Eastern Health, Richmond 3121, Australia.
| | - Michael McGrath
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill 3128, Australia; School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney 2052, Australia
| | - Jasmin Grigg
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill 3128, Australia; Turning Point, Eastern Health, Richmond 3121, Australia
| | - Annette Peart
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill 3128, Australia; Turning Point, Eastern Health, Richmond 3121, Australia
| | - Jonathan I Meddings
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill 3128, Australia; Turning Point, Eastern Health, Richmond 3121, Australia
| | - Christopher J Greenwood
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong 3220, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville 3052, Australia
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster 3108, Victoria, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Clayton 3168, Australia; Department of Paramedicine, Monash University, Clayton 3168, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill 3128, Australia; Turning Point, Eastern Health, Richmond 3121, Australia
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Schell C, Quilty LC, Cunningham JA. Investigating Alexithymia as a Moderator of Outcomes in a Randomized Controlled Trial of an Online Intervention for Co-Occurring Depression and Hazardous Alcohol Use: Enquête sur l'alexithymie en tant que modérateur des résultats dans un essai randomisé contrôlé d'une intervention en ligne pour la dépression concomitante et la consommation dangereuse d'alcool. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2025; 70:65-73. [PMID: 38682315 PMCID: PMC11572170 DOI: 10.1177/07067437241249412] [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] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Alexithymia is characterized by difficulty identifying and/or describing emotions, reduced imaginal processes, and externally oriented thinking. High levels of alexithymia may increase the challenge of supporting individuals with co-occurring depression and hazardous alcohol use. This secondary analysis sought to investigate whether or not alexithymia moderated the outcomes of an online intervention for depression and alcohol use. METHOD As part of a randomized controlled trial, 988 participants were randomly assigned to receive an intervention dually focused on depression and alcohol use, or an intervention only focused on depression. The pre-specified mediation hypothesis was that changes in drinking at 3 months follow-up would effect the association between the intervention and change in depression at 6 months. This secondary analysis extends the investigation by adding alexithymia as a moderator. RESULTS The current analysis demonstrated that including alexithymia as a moderator resulted in a conditional direct effect. Specifically, there was an intervention effect where participants who received the combined depression and alcohol intervention had larger improvements in their depression scores at 6 months, but this was only when their alexithymia score at baseline was also high (60.5 or higher). CONCLUSION These results suggest that treatment planning and intervention effectiveness could be informed and optimized by taking alexithymia severity into consideration. This is especially merited as alexithymia can contribute to the weaker therapeutic alliance, more distress and dysphoria, shorter periods of abstinence, and more severe depression, compounding the complexity of supporting individuals with comorbid conditions. More research is needed to systematically investigate these possible modifying effects. PLAIN LANGUAGE TITLE Does difficulty identifying/describing emotions or externally-oriented thinking influence the effectiveness of an intervention among people with both depression and hazardous alcohol use?
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Affiliation(s)
- Christina Schell
- Institute for Mental Health and Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - John A Cunningham
- Institute for Mental Health and Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Schell C, Godinho A, Cunningham JA. Examining Changes in Quality of Life as an Outcome Measure in Three Randomized Controlled Trials of Online Interventions That Included an Intervention for Hazardous Alcohol Use. Subst Use Misuse 2023; 59:50-57. [PMID: 37735801 DOI: 10.1080/10826084.2023.2259453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Quality of life (QOL) summarizes an individual's perceived satisfaction across multiple life domains. Many factors can impact this measure, but research has demonstrated that individuals with addictions, physical, and mental health concerns tend to score lower than general population samples. While QOL is often important to individuals, it is rarely used by researchers as an outcome measure when evaluating treatment efficacy. METHODS This secondary analysis used data collected during three separate randomized controlled trials testing the efficacy of different online interventions to explore change in QOL over time between treatment conditions. The first project was concerned with only alcohol interventions. The other two combined either a gambling or mental health intervention with a brief alcohol intervention. Males and females were analyzed separately. RESULTS This analysis found treatment effects among female participants in two projects. In the project only concerning alcohol, female quality of life improved more among those who received an extensive intervention for hazardous alcohol use compared to a brief intervention (p = .029). QOL among females who received only the mental health intervention improved more than those who also received a brief alcohol intervention (p = .049). CONCLUSION Poor QOL is often cited as a reason individuals decide to make behavior changes, yet treatment evaluations do not typically consider this patient-important outcome. This analysis found some support for different treatment effects on QOL scores in studies involving at least one intervention for hazardous alcohol use.
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Affiliation(s)
- Christina Schell
- Centre for Addiction and Mental Health, Institute for Mental Health and Policy Research, Toronto, Canada
| | - Alexandra Godinho
- Centre for Addiction and Mental Health, Institute for Mental Health and Policy Research, Toronto, Canada
- Research Office, Humber River Hospital, Toronto, Canada
| | - John A Cunningham
- Centre for Addiction and Mental Health, Institute for Mental Health and Policy Research, Toronto, Canada
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Peynenburg V, Sapkota RP, Lozinski T, Sundström C, Wilhelms A, Titov N, Dear B, Hadjistavropoulos H. The Impacts of a Psychoeducational Alcohol Resource During Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety: Observational Study. JMIR Ment Health 2023; 10:e44722. [PMID: 37071454 PMCID: PMC10155081 DOI: 10.2196/44722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Problematic alcohol use is common among clients seeking transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for depression or anxiety but is not often addressed in these treatment programs. The benefits of offering clients a psychoeducational resource focused on alcohol use during ICBT for depression or anxiety are unknown. OBJECTIVE This observational study aimed to elucidate the impacts of addressing comorbid alcohol use in ICBT for depression and anxiety. METHODS All patients (N=1333) who started an 8-week transdiagnostic ICBT course for depression and anxiety received access to a resource containing information, worksheets, and strategies for reducing alcohol use, including psychoeducation, reasons for change, identifying risk situations, goal setting, replacing drinking with positive activities, and information on relapse prevention. We assessed clients' use and perceptions of the resource; client characteristics associated with reviewing the resource; and whether reviewing the resource was associated with decreases in clients' alcohol use, depression, and anxiety at posttreatment and 3-month follow-up among clients dichotomized into low-risk and hazardous drinking categories based on pretreatment Alcohol Use Disorders Identification Test (AUDIT) scores. RESULTS During the 8-week course, 10.8% (144/1333) of clients reviewed the resource, and those who reviewed the resource provided positive feedback (eg, 127/144, 88.2% of resource reviewers found it worth their time). Furthermore, 18.15% (242/1333) of clients exhibited hazardous drinking, with 14.9% (36/242) of these clients reviewing the resources. Compared with nonreviewers, resource reviewers were typically older (P=.004) and separated, divorced, or widowed (P<.001). Reviewers also consumed more weekly drinks (P<.001), scored higher on the AUDIT (P<.001), and were more likely to exhibit hazardous drinking (P<.001). Regardless of their drinking level (ie, low risk vs hazardous), all clients showed a reduction in AUDIT-Consumption scores (P=.004), depression (P<.001), and anxiety (P<.001) over time; in contrast, there was no change in clients' drinks per week over time (P=.81). Reviewing alcohol resources did not predict changes in AUDIT-Consumption scores or drinks per week. CONCLUSIONS Overall, ICBT appeared to be associated with a reduction in alcohol consumption scores, but this reduction was not greater among alcohol resource reviewers. Although there was some evidence that the resource was more likely to be used by clients with greater alcohol-related difficulties, the results suggest that further attention should be given to ensuring that those who could benefit from the resource review it to adequately assess the benefits of the resource.
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