druginfo seminar: ontrack internet and smart phone approaches to alcohol misuse
DESCRIPTION
David Kavanagh, DrugInfo seminar: Information and communication technology. 22 August 2011TRANSCRIPT
![Page 1: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/1.jpg)
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
![Page 2: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/2.jpg)
• 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
![Page 3: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/3.jpg)
• 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)
![Page 4: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/4.jpg)
• 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
![Page 5: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/5.jpg)
• 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
![Page 6: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/6.jpg)
![Page 7: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/7.jpg)
![Page 8: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/8.jpg)
![Page 9: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/9.jpg)
![Page 10: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/10.jpg)
![Page 11: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/11.jpg)
Current OnTrack programs
• Alcohol
• Alcohol & Depression
• Depression (recurrences)
• Get Real—psychosis-like experiences
• Family & Friends
![Page 12: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/12.jpg)
app to track drinking
![Page 13: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/13.jpg)
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
![Page 14: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/14.jpg)
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
![Page 15: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/15.jpg)
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
![Page 16: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/16.jpg)
So…don’t choose to do all
Are they correct?
![Page 17: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/17.jpg)
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
![Page 18: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/18.jpg)
Drinks per week
BL 2 6 120
10
20
30
40
50
60
70
80
Men BriefMen FullWomen BfWomen Fl
TimeTime x Gender
![Page 19: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/19.jpg)
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
![Page 20: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/20.jpg)
For greatest reach: Internet only
![Page 21: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/21.jpg)
If a problem with alcohol, would want
• Internet only 19%
• Therapist support + internet– 18% telephone– 22% face-to-face– 35% email
Internet survey (3008)
![Page 22: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/22.jpg)
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
![Page 23: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/23.jpg)
…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…
![Page 24: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/24.jpg)
...and might expect therapists to be important
• Alliance argued to account for substantial variance in face-to-face treatment outcomes
![Page 25: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/25.jpg)
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
![Page 26: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/26.jpg)
Low vs. high contact
![Page 27: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/27.jpg)
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
![Page 28: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/28.jpg)
Current data suggest
-no effect of therapist
-brief initially not as effective, but catches up
![Page 29: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/29.jpg)
Since a therapist is preferred by users
does it aid retention in program?
![Page 30: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/30.jpg)
Alcohol & Depression (n = 203)
Full program: No therapist Therapist
Number of logins 10.6 15.4*
% program completed 27% 41%
![Page 31: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/31.jpg)
• 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
![Page 32: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/32.jpg)
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
![Page 33: DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse](https://reader033.vdocuments.us/reader033/viewer/2022042814/55559e38d8b42a8e1f8b5146/html5/thumbnails/33.jpg)