druginfo seminar: ontrack internet and smart phone approaches to alcohol misuse

OnTrack substance use programs

David KavanaghJennifer Connolly

Dawn ProctorLeanne HidesSteven Edge

Jeremy GibsonInstitute of Health & Biomedical Innovation

Queensland University of Technology

Britt KleinSwinburne University of Technology

Frances Kay-Lambkin, Judy ProudfootUniversity of NSW

Angela WhiteUniversity of Queensland

August, 2011

• Successful studies using mailed treatments Pre-Post SD units

Full Info/Monitoring .85,.85,.88 .65,.50,.49 (Diff .20-.39)

• Internet trials by others (vs. controls) – College samples (mainly normative feedback, preventive) .13 -.17 (Diff .30– Riper et al. (2007) community sample

.69 .13 (Diff .56)

• Our research with potential users

Our programs based on

• Important web features• Easy navigation/search• Open access• Right amount of information • Easy to understand language • Does not require extra software • Interesting pages• Trustworthy

Internet survey (n = 3008)

• Portal giving advice on websites

• Online tests/self-assessments with feedback

• Downloadable fact sheets

• Systems tailoring information to user

• Observation of free search—max 6.5 min on a site– Less if

• young• not 1st site (2 min)

Likely use

• Rapid access to key elements– and within program, a strong initial module

• Screening, feedback, information without login

• Self-tailoring, self-pacing within the program– but with advice on order, pace

• Attractive, easy to use– Minimised text entry; pictorial icons– Brief videos to explain concepts– Summary pages to refer to– Diary, progress summaries

Implications

Current OnTrack programs

• Alcohol

• Alcohol & Depression

• Depression (recurrences)

• Get Real—psychosis-like experiences

• Family & Friends

app to track drinking

Coming soon...

• Drug diversion (practitioner-assisted)– Substance use program for clients

• “Say when” (binge drinking) for Better Health Channel

• Indigenous version of alcohol/drug program

• Likely– Substance use tools for CRC Youth Health & Wellbeing

Usage

• >35,000 Australian visits over 1st 20 months– 5.2 pages/visit; 5.0 min

• 2299 users; 1314 in alcohol programs

• They do come back to the programs

– Alcohol: Brief Full– # logins: 10.4 16.4 ns– Duration of use (days) 42.6 69.6 <.10

– Alcohol + Depression Brief Full– # logins: 7.8 10.6 ns

What do they use?

Alcohol & Depression study

Most frequent “Signpost” /6 and Tool

1 Making Plans Introduction

0 Welcome To OnTrack

1 Deciding What to Do

1 Monitoring

1 Feeling Confident

1 Building My Support Team

1 Making a Plan

1 Planning tool

2 First Steps Introduction

1 Making Plans Feedback

2 Mindfulness Intro

1 Making Plans Summary

2 Activities I Enjoy

2 Mindfulness Practice

2 Mindfulness Sensations

2 Fun Activity Planning

2 What I've Got Already

3 Closing a Risky Track Introduction

So…don’t choose to do all

Are they correct?

Alcohol pilot trial (n = 56)Abstinent Days/Wk

BL 2 6 120

1

2

3

4

5

6

7

Men BriefMen FullWomen BfWomen Fl

TimeTime x Gender

Drinks per week

BL 2 6 120

10

20

30

40

50

60

70

80

Men BriefMen FullWomen BfWomen Fl

TimeTime x Gender

Days/week over 6 drinks

BL 2 6 120

2

4

6

8

10

12

Men BriefMen FullWomen BfWomen Fl

TimeTime x Gender

Time x Gender x Condition

For greatest reach: Internet only

If a problem with alcohol, would want

• Internet only 19%

• Therapist support + internet– 18% telephone– 22% face-to-face– 35% email

Internet survey (3008)

Similar responses from 9 focus groups

• Cautious, somewhat negative re internet treatment– Impersonal– Skeptical re validity of assessment, effects of treatment– Need for ongoing support

• Positive comments re– Initial step—e.g. screening– Anonymity

• Likely to require more motivation

…and in interviews with participants of an internet-based alcohol trial

• I found it hard to get motivated to follow the program being web-based

• I found it hard doing it on my own

• I wasn’t challenged if I didn’t do the steps

• Some sort of external accountability might help

• Maybe you need to have a face-to-face [element]…

• I think I’m more of a person that needs more of a one-on-one person…

...and might expect therapists to be important

• Alliance argued to account for substantial variance in face-to-face treatment outcomes

Brands & Kavanagh (in submission)

• RCTs directly comparing no/less vs. more contact• Psychological treatment for a health problem• Not solely preventive• Contact not solely involving support groups• Paper in English• Computer not just an adjunct to face to face• Not confound between contact/other elements• Presented sufficient data for analysis• Prior to December 2010

Low vs. high contact

Alcohol and Depression trial

• Brief intervention based on– Motivational interview—pros & cons, self-efficacy– Building social support– Concrete goal, plan

• Full intervention– Wide range of CBT, mindfulness elements

• Full intervention + therapist/coach– Regular emails, modified according to progress/issues

Current data suggest

-no effect of therapist

-brief initially not as effective, but catches up

Since a therapist is preferred by users

does it aid retention in program?

Alcohol & Depression (n = 203)

Full program: No therapist Therapist

Number of logins 10.6 15.4*

% program completed 27% 41%

• Need to examine further, whether– impacts on initial engagement– impacts on retention when going badly– more important if depression is higher– there are better ways to boost coaches’ impact– preference, expectancies are modified by marketing

Some strategies flow from epidemiology

• Co-occurrence is common

• Often complex problems

• Similar risk factors to rest of population

• Substantial impact on mortality, symptoms, functioning– In severe disorder, may have symptomatic impact from small amount– Substances compound any cognitive effects of disorder