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Brar MK, Sarkar S. Refining smart healthcare care for mental health and substance use disorders: A patient-centred, evidence-based approach. World J Psychiatry 2025; 15:100438. [DOI: 10.5498/wjp.v15.i6.100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 01/01/2025] [Accepted: 03/11/2025] [Indexed: 05/29/2025] Open
Abstract
In this article, we comment on the article by Zhang et al, which explores the familiarity, awareness, and usage of smart medical care and its correlation with mental health and personality traits. The use of intelligent healthcare technologies in treating mental disorders and substance use disorders shows significant promise, but involves certain challenges, such as limited access, low technological literacy, and privacy concerns. These barriers disproportionately affect deprived populations and individuals with severe mental health conditions. We highlight the positive impact of smart healthcare solutions, such as telemedicine and wearable technologies, on patient engagement, remote monitoring, and treatment adherence. To overcome these challenges, we propose strategies, such as improving user-friendliness, ensuring equitable access to digital interventions, enhancing cybersecurity, and integrating smart healthcare into clinical workflows. Training healthcare providers and developing policies to ensure the ethical use of patient data are essential. When implemented thoughtfully, smart healthcare technologies can revolutionize mental health and substance use disorder treatment, improve patient outcomes, and reduce healthcare inequities.
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Affiliation(s)
- Manmeet Kaur Brar
- National Drug Dependence Treatment Centre (NDDTC) and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
- Department of Psychiatry, All India Institute of Medical Sciences, Jammu 184120, India
| | - Siddharth Sarkar
- National Drug Dependence Treatment Centre (NDDTC) and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
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Lo B, Durocher K, Charow R, Kimball S, Pham Q, Sockalingam S, Wiljer D, Strudwick G. Application of a Sociotechnical Framework to Uncover Factors That Influence Effective User Engagement With Digital Mental Health Tools in Clinical Care Contexts: Scoping Review. J Med Internet Res 2025; 27:e67820. [PMID: 40293798 PMCID: PMC12070020 DOI: 10.2196/67820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 01/14/2025] [Accepted: 02/07/2025] [Indexed: 04/30/2025] Open
Abstract
BACKGROUND Digital health tools such as mobile apps and patient portals continue to be embedded in clinical care pathways to enhance mental health care delivery and achieve the quintuple aim of improving patient experience, population health, care team well-being, health care costs, and equity. However, a key issue that has greatly hindered the value of these tools is the suboptimal user engagement by patients and families. With only a small fraction of users staying engaged over time, there is a great need to better understand the factors that influence user engagement with digital mental health tools in clinical care settings. OBJECTIVE This review aims to identify the factors relevant to user engagement with digital mental health tools in clinical care settings using a sociotechnical approach. METHODS A scoping review methodology was used to identify the relevant factors from the literature. Five academic databases (MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO) were searched to identify pertinent articles using key terms related to user engagement, mental health, and digital health tools. The abstracts were screened independently by 2 reviewers, and data were extracted using a standardized data extraction form. Articles were included if the digital mental health tool had at least 1 patient-facing component and 1 clinician-facing component, and at least one of the objectives of the article was to examine user engagement with the tool. An established sociotechnical framework developed by Sittig and Singh was used to inform the mapping and analysis of the factors. RESULTS The database search identified 136 articles for inclusion in the analysis. Of these 136 articles, 84 (61.8%) were published in the last 5 years, 47 (34.6%) were from the United States, and 23 (16.9%) were from the United Kingdom. With regard to examining user engagement, the majority of the articles (95/136, 69.9%) used a qualitative approach to understand engagement. From these articles, 26 factors were identified across 7 categories of the established sociotechnical framework. These ranged from technology-focused factors (eg, the modality of the tool) and the clinical environment (eg, alignment with clinical workflows) to system-level issues (eg, reimbursement for physician use of the digital tool with patients). CONCLUSIONS On the basis of the factors identified in this review, we have uncovered how the tool, individuals, the clinical environment, and the health system may influence user engagement with digital mental health tools for clinical care. Future work should focus on validating and identifying a core set of essential factors for user engagement with digital mental health tools in clinical care environments. Moreover, exploring strategies for improving user engagement through these factors would be useful for health care leaders and clinicians interested in using digital health tools in care.
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Affiliation(s)
- Brian Lo
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Keri Durocher
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Rebecca Charow
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Sarah Kimball
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Quynh Pham
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Wiljer
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Day E, Pechey LC, Roscoe S, Kelly JF. Recovery support services as part of the continuum of care for alcohol or drug use disorders. Addiction 2025. [PMID: 39873444 DOI: 10.1111/add.16751] [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] [Received: 07/08/2024] [Accepted: 11/26/2024] [Indexed: 01/30/2025]
Abstract
BACKGROUND The definition of 'recovery' has evolved beyond merely control of problem substance use to include other aspects of health and wellbeing (known as 'recovery capital') which are important to prevent relapse to problematic alcohol or other drug (AOD) use. Developing a Recovery Oriented System of Care (ROSC) requires consideration of interventions or services (Recovery Support Services, RSS) designed to build recovery capital which are often delivered alongside established treatment structures. Lived experience and its application to the process of engaging people, changing behaviour and relapse prevention is an essential part of these services. AIM To map out the evidence base for RSS as part of guidance for commissioners of addiction services in each of the 152 local authorities in England. METHODS The authors updated the findings of a 2017 systematic review of RSS through a further rapid scoping review, aiming to map out the extent, range and nature of research under six headings: (1) Peer-based recovery support services (P-BRSS); (2) Employment support approaches; (3) Recovery housing; (4) Continuing care and recovery check-ups; (5) Recovery community centres (RCC); and (6) Recovery support services in educational settings. A systematic search of the PubMed, Embase, CINAHL, CENTRAL and PsychINFO databases was conducted. The abstracts of all articles published since 2017 were reviewed by two of the authors, and the full text versions of all relevant articles were obtained and relevant data extracted. A narrative review of the findings was then prepared, mapping them on to the ROSC continuum of care. The review was restricted to adults (over 18 years), but all substances and available outcomes were included. RESULTS Four of the six forms of RSS were well supported by evidence. RCTs of interventions to increase levels of employment demonstrated large effect sizes, and continuing care interventions that extend treatment intervention into the early recovery phase have shown small but significant benefit. Peer-delivered interventions to link people to ongoing support were associated with decreased rates of relapse and re-admission, increased engagement, and increased social support for change. However, the variability in the design of these studies means that further work is required to clarify the effective components of the intervention. Studies of recovery housing have also shown positive results, including significant differences from standard care. No controlled studies exist to support RCCs or RSS in educational settings, but the complexity of these interventions and the wide range of potential outcome measures mean that other study designs may be more relevant. CONCLUSIONS This monograph provides a structure to help policy makers, commissioners and service providers describe and understand an emerging field of research. Recovery Support Services (RSS) are proving to have clinical, public health and cost utility. A rational social and fiscal response to endemic alcohol or other drug challenges should therefore include the more intensive acute care clinical services linked with more extensive community-based RSS.
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Affiliation(s)
- Ed Day
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Laura Charlotte Pechey
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
| | - Suzie Roscoe
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
| | - John F Kelly
- Harvard Medical School and Center for Addiction Medicine, Recovery Research Institute, at Massachusetts General Hospital, Boston, MA, USA
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Link K, Christians S, Hoffmann W, Grabe HJ, van den Berg N. Telemedicine treatment of patients with mental disorders during and after the first COVID-19 pandemic lockdown in Germany - an observational study on feasibility and patient satisfaction. BMC Psychiatry 2023; 23:654. [PMID: 37670236 PMCID: PMC10478407 DOI: 10.1186/s12888-023-05140-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION In response to the COVID-19 pandemic, a general lockdown was enacted across Germany in March 2020. As a consequence, patients with mental health conditions received limited or no treatment in day hospitals and outpatient settings. To ensure continuity of care, the necessary technological preparations were made to enable the implementation of telemedical care via telephone or video conferencing, and this option was then used as much as possible. The aim of this study was to investigate the satisfaction and acceptance with telemedical care in a heterogeneous patient group of psychiatric outpatients in Germany during the first COVID-19 lockdown. METHODS In this observational study, patients in ongoing or newly initiated outpatient psychiatric therapy as well as those who had to be discharged from the day clinic ahead of schedule received telemedical treatment via telephone. Data collection to assess the patients' and therapists' satisfaction with and acceptance of the telemedical care was adjusted to the treatment setting. RESULTS Of 60 recruited patients, 57 could be included in the analysis. 51.6% of the patients and 52.3% of their therapists reported that the discussion of problems and needs worked just as well over the phone as in face-to-face consultations. In the subgroup of patients who were new to therapy due to being discharged from hospital early, acceptance was higher and telemedicine was rated as equally good in 87.5% of contacts. Both patients and therapists felt that telemedicine care during lockdown was an alternative for usual therapy in the outpatient clinic and that the option of telemedicine care should continue for the duration of the coronavirus pandemic. DISCUSSION The results show a clear trend towards satisfaction with and acceptance of telemedicine care in a heterogeneous group of unselected psychiatric patients. Although the number of patients is small, the results indicate that the mostly positive results of telemedicine concepts in research projects can probably be transferred to real healthcare settings. CONCLUSIONS Telemedicine can be employed in healthcare for psychiatric patients either an alternative treatment option to maintain continuity of care or as a potential addition to regular care.
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Affiliation(s)
- Karsten Link
- Institut Für Community Medicine, Universitätsmedizin Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany.
| | - Svenja Christians
- Klinik Und Poliklinik Für Psychiatrie Und Psychotherapie, Universitätsmedizin Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
| | - Wolfgang Hoffmann
- Institut Für Community Medicine, Universitätsmedizin Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
| | - Hans Jörgen Grabe
- Klinik Und Poliklinik Für Psychiatrie Und Psychotherapie, Universitätsmedizin Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
| | - Neeltje van den Berg
- Institut Für Community Medicine, Universitätsmedizin Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
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Kistner S, Kramer D. Erste Erfahrungen mit einer Selbstmanagement-App in der stationären Suchtbehandlung. SUCHT 2022. [DOI: 10.1024/0939-5911/a000789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Zusammenfassung: Zielsetzung: Um die Möglichkeiten smartphonebasierter Interventionen für die stationäre Entwöhnungstherapie in einer Rehabilitationsklinik zu nutzen, wurde die MeinSalus-App entwickelt. Ziel der Studie ist es, (1) die Akzeptanz (Nutzungsabsicht) der App bei Patienten sowie beim therapeutischen Personal zu untersuchen, (2) Prädiktoren der Akzeptanz auf der Grundlage eines erweiterten UTAUT (Unified Theory of Acceptance and Use of Technology-)Modells zu bestimmen und (3) Aufschlüsse über das Nutzungsverhalten zu bekommen. Methodik: 193 von 282 stationären Patienten (68,4 %) sowie 18 von 34 Therapeuten (52,9 %) beantworteten Fragebögen zur Akzeptanz (Nutzungsabsicht) der App und deren einzelnen Funktionen, zu UTAUT- und mHealth-bezogenen Variablen sowie zu ihrem Nutzungsverhalten. Ergebnisse: Die mittlere Nutzungsabsicht (Range 1–5) für die App insgesamt lag für Patienten bei 4.65 ( SD = 0.83) und für Therapeuten bei 4.07 ( SD = 0.62). Alter, mobile Internetnutzung, erwarteter Nutzen sowie Vorbehalte gegenüber der App erwiesen sich als signifikante Prädiktoren der Akzeptanz. Beim Nutzungsverhalten ergab sich ein differenziertes Bild für die unterschiedlichen Funktionen. Schlussfolgerungen: Es zeigte sich sowohl in der Patientenstichprobe als auch beim teilnehmenden therapeutischen Personal eine hohe Akzeptanz der App, was auf eine akzeptable Grundlage für eine Implementierung in der stationären Suchtbehandlung hindeutet. Studien zu Effekten der App sollten sich anschließen.
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Affiliation(s)
- Saskia Kistner
- salus klinik Friedrichsdorf, Deutschland
- MainPVZ, Offenbach, Deutschland
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Graser Y, Stutz S, Rösner S, Wopfner A, Moggi F, Soravia LM. Different Goals, Different Needs: The Effects of Telephone- and Text Message-Based Continuing Care for Patients with Different Drinking Goals After Residential Treatment for Alcohol Use Disorder. Alcohol Alcohol 2022; 57:734-741. [PMID: 35909224 DOI: 10.1093/alcalc/agac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/13/2022] [Accepted: 06/18/2022] [Indexed: 11/15/2022] Open
Abstract
AIMS Drinking goal has emerged as a promising predictor variable for alcohol-related outcomes. Many patients with alcohol use disorder (AUD) choose another drinking goal than abstinence after residential AUD treatment program. We aimed to examine the effects of an abstinent drinking goal (ADG) and conditional abstinence drinking goal (CADG) 6 months after residential treatment on drinking outcomes in patients with severe AUD and investigate the effectiveness of telephone-based (TEL) or text message-based (TEX) continuing care according to the individual drinking goal. METHODS A total of 240 patients from two specialized residential treatment programs for AUD were included in the study. Patients were randomly assigned to high-frequency (nine contacts) or low-frequency (two contacts) TEL, TEX (nine contacts), or control group (no contact) from treatment discharge to the 6-month follow-up. RESULTS Patients with an ADG were significantly more often abstinent (58%) at the 6-month follow-up compared to patients with a CADG (32.1%), and in the case of relapse, showed a significantly longer time to the first drink. Patients with a CADG of the high-frequency TEL showed a tendency to be more abstinent at the 6-month follow-up and reported significantly higher alcohol-related self-efficacy compared to the CADG patients of the control group. CONCLUSIONS Patients with CADG are more vulnerable to relapse, and therefore may benefit more from high-frequency telephone contacts to deal with alcohol-related problems and reach their goal. In the case of relapse, the high-frequent contacts may help patients stay connected to health services, preventing chronification and facilitating recovery from AUD.
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Affiliation(s)
- Yolanda Graser
- Research, Suedhang Clinic, Südhang 1, 3038 Kirchlindach, Switzerland
| | - Sonja Stutz
- Research and Developement, Forel Clinic, Islikonerstrasse 5, 8548 Ellikon, Switzerland
| | - Susanne Rösner
- Research and Developement, Forel Clinic, Islikonerstrasse 5, 8548 Ellikon, Switzerland
| | - Alexander Wopfner
- Research, Suedhang Clinic, Südhang 1, 3038 Kirchlindach, Switzerland
| | - Franz Moggi
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Departement of Psychology, Bolligenstrasse 111, 3072 Bern, Switzerland
| | - Leila M Soravia
- Research, Suedhang Clinic, Südhang 1, 3038 Kirchlindach, Switzerland.,Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Departement of Psychology, Bolligenstrasse 111, 3072 Bern, Switzerland
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Digital approaches to continuing care. Curr Opin Psychiatry 2022; 35:259-264. [PMID: 35781465 PMCID: PMC9260953 DOI: 10.1097/yco.0000000000000801] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an update of studies on the effectiveness of digital and telephonic approaches to providing remote continuing care for substance use disorders. RECENT FINDINGS Effective continuing care can be provided via smartphone apps, text messaging, interactive voice response, and structured telephone counseling. The remote continuing care interventions with the strongest evidence of efficacy are the Addiction Comprehensive Health Enhancement Support System app and Telephone Monitoring and Counseling. Positive effects for these intervention on drinking outcomes in patients with alcohol use disorders were replicated in a recent randomized controlled study. SUMMARY Continuing care is widely believed to be an important component of treatment for substance use disorders, especially for sustaining positive outcomes. However, many individuals do not attend clinic-based continuing care, due to a variety of reasons, including competing work and family responsibilities, disabilities, transportation challenges, and recently the COVID-19 pandemic. Remote continuing care, provided via smartphone apps, text messaging, and various telephonic approaches, has been shown to be effective, and could be used to provide continuing care to patients who would otherwise not receive it. Further work is needed to determine how to effectively combine more traditional continuing care with newer digitized and telephonic approaches.
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Uhl S, Bloschichak A, Moran A, McShea K, Nunemaker MS, McKay JR, D'Anci KE. Telehealth for Substance Use Disorders: A Rapid Review for the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Management of Substance Use Disorders. Ann Intern Med 2022; 175:691-700. [PMID: 35313116 DOI: 10.7326/m21-3931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Approximately 20.4 million Americans met criteria for a substance use disorder (SUD) in 2019; however, only about 12.2% of persons with an SUD receive specialty care. Telehealth offers alternatives to traditional forms of substance use treatment. PURPOSE To synthesize recent findings on the efficacy of telehealth for SUDs. DATA SOURCES MEDLINE, Embase, PubMed, and the Cochrane Library from January 2015 through August 2021 (English language only). STUDY SELECTION Randomized controlled trials (RCTs) of adults with a diagnosis of SUD based on the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases. DATA EXTRACTION One investigator abstracted data and assessed study quality, and a second checked for accuracy. DATA SYNTHESIS This rapid review synthesized evidence from 17 RCTs. Evidence is very uncertain that telehealth provided as videoconference therapy (1 RCT) or web-based cognitive behavioral therapy (CBT) (3 RCTs) has similar effects to in-person therapy for improving abstinence from alcohol or cannabis. Low-strength evidence suggests that web-based CBT has similar effects for improving abstinence in multiple SUDs (2 RCTs). Low-strength evidence suggests that adding supportive text messaging to follow-up care improves abstinence and amount of alcohol per day (2 RCTs) but does not improve emergency department visits or frequency of consumption (2 RCTs). Enhanced telephone monitoring likely reduces readmissions for SUD detoxification compared with usual follow-up alone (1 RCT) but does not reduce days of substance use (low-strength evidence). LIMITATION Narrative synthesis, heterogeneity of telehealth interventions, no assessment of publication bias, and study methodology. CONCLUSION Evidence is very uncertain that telehealth is similar to in-person care for SUD outcomes. Limited evidence suggests some benefit of adding telehealth to usual SUD care. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs Veterans Health Administration.
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Affiliation(s)
- Stacey Uhl
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - Aaron Bloschichak
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - Amber Moran
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - Kristina McShea
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - Megan S Nunemaker
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
| | - James R McKay
- University of Pennsylvania, Philadelphia, Pennsylvania (J.R.M.)
| | - Kristen E D'Anci
- Center for Clinical Excellence, ECRI, Plymouth Meeting, Pennsylvania (S.U., A.B., A.M., K.M., M.S.N., K.E.D.)
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Lucht M, Quellmalz A, Mende M, Broda A, Schmiedeknecht A, Brosteanu O, Höppner-Buchmann J, Langosch J, Stuppe M, Schomerus G, Klauer T, Grabe HJ, Freyberger HJ, John U, Meyer C. Effect of a 1-year short message service in detoxified alcohol-dependent patients: a multi-center, open-label randomized controlled trial. Addiction 2021; 116:1431-1442. [PMID: 33155711 DOI: 10.1111/add.15313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/11/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Existing evidence suggests that text message interventions can help people to reduce their alcohol consumption. However, studies with alcohol-dependent patients are lacking. In this study a 1-year automatic mobile phone-based short messaging service (SMS) intervention on alcohol consumption in patients after alcohol detoxification in hospital was compared with treatment as usual. DESIGN Multi-center, randomized, controlled, two parallel-group, observer-blinded trial. SETTING AND PARTICIPANTS Primary and secondary care: four hospitals and community (1 million residents, 7600 km2 area in Germany). A total of 462 patients with alcohol dependence (ICD-10) were included during inpatient detoxification treatment. Patients were randomly assigned (1 : 1) to an SMS intervention and treatment as usual (SMS + TAU; n = 230; mean age: 45.4 years; 22.6% women) or TAU alone (n = 232 mean age: 44.5 years; 22.8% women). Planned, automated messages were sent to patients over 1 year to record assistance needs. A 'yes' or missing response triggered a telephone call from a hospital therapist. Outcome was assessed by an independent survey center. MEASUREMENTS The primary end-point was a three-category alcohol consumption measure covering months 10-12 after discharge: abstinence, non-heavy drinking, heavy drinking [men > 60 g/day; women > 40 g/day equal to World Health Organization (WHO) criteria: high risk and very high risk, mean consumption]. Secondary end-points were number of abstinent days over 12 months and frequency of abstinence. RESULTS The arms differed primarily in the heavy drinking category (intervention group 22.2%, TAU-only group 32.3%) in months 9-12. This is reflected by an odds ratio (OR) = 1.68, 95% confidence interval (CI) = 1.11-2.54, P = 0.015 for heavy drinking versus non-heavy drinking/abstinence. No difference between treatments was found with respect to any drinking versus abstinence (OR = 1.13). These results were confirmed by models adjusting for randomization strata. CONCLUSIONS In Germany, a 12-month mobile phone short messaging service-based intervention enhanced the reduction in heavy drinking for 1 year in routine care among adults with alcohol dependence discharged from inpatient alcohol detoxification.
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Affiliation(s)
- Michael Lucht
- Department of Psychiatry and Psychotherapy at Helios Hanseklinikum Stralsund, Stralsund, Germany.,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Anne Quellmalz
- Department of Psychiatry and Psychotherapy at Helios Hanseklinikum Stralsund, Stralsund, Germany
| | - Meinhard Mende
- Clinical Trial Center (CTC) Leipzig, University of Leipzig, Leipzig, Germany
| | - Anja Broda
- Clinical Trial Center (CTC) Leipzig, University of Leipzig, Leipzig, Germany
| | | | - Oana Brosteanu
- Clinical Trial Center (CTC) Leipzig, University of Leipzig, Leipzig, Germany
| | - Jacqueline Höppner-Buchmann
- Hospital of Geriatric Psychiatry; Helios Hospital Schwerin, Schwerin, Germany and Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Jens Langosch
- Bethanien Hospital for Psychiatry, Psychosomatics, and Psychotherapy, Greifswald, Germany
| | - Markus Stuppe
- Hospital of Addiction Medicine; Helios Hospital Schwerin, Schwerin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Thomas Klauer
- Department of Psychiatry and Psychotherapy at Helios Hanseklinikum Stralsund, Stralsund, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Harald J Freyberger
- Department of Psychiatry and Psychotherapy at Helios Hanseklinikum Stralsund, Stralsund, Germany.,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Ulrich John
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Greifswald, Germany
| | - Christian Meyer
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Greifswald, Germany
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Livingston N, Ameral V, Hocking E, Leviyah X, Timko C. Interventions to Improve Post-Detoxification Treatment Engagement and Alcohol Recovery: Systematic Review of Intervention Types and Effectiveness. Alcohol Alcohol 2021; 57:136-150. [PMID: 33791782 DOI: 10.1093/alcalc/agab021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/15/2021] [Accepted: 03/09/2021] [Indexed: 01/28/2023] Open
Abstract
AIMS Most inpatient alcohol detoxification patients do not seek treatment post-discharge, which increases the risk of relapse and re-hospitalization. To date, there have been no efforts to synthesize the evidence supporting the broad range of available interventions for this critical transition. The current study is a systematic review and evaluation of interventions designed to promote treatment engagement and recovery following alcohol detoxification. METHODS The initial literature search yielded 6419 articles, published since 1999, from PubMed, CINAHL, PsycINFO, Psychology & Behavioral Sciences Collection and PsycARTICLES databases, 49 of which were eligible for full review. Data extraction included in-depth evaluation of intervention types, study and research design features, reported outcomes and study quality/bias indicators. All articles were coded by independent raters and final results were obtained through consensus. RESULTS Interventions included medical/medication, psychological/psychosocial, technological, mutual-help and combined approaches. On average, medical/medication interventions were less, and psychological/psychosocial and technological interventions were more likely to demonstrate efficacy with respect to treatment engagement and recovery. There was significant variability in study quality/bias but no significant differences across intervention types. Studies differed considerably across measured outcomes, internal and external validity, in/exclusion criteria and documentation of co-occurring psychiatric disorders. CONCLUSION Over half of studies reviewed reported empirical support for the intervention(s) evaluated. Although findings slightly favor non-medical interventions, the variability in study design and quality/bias requires more rigorous follow-up research. Recommendations from this review may guide future implementation and intervention development, which are critically needed to improve post-detoxification care and outcomes for patients with alcohol use disorder.
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Affiliation(s)
- Nicholas Livingston
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.,VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.,Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Room 906 Boston, MA 02118, USA
| | - Victoria Ameral
- Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road Bedford, MA 01730, USA
| | - Elise Hocking
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.,Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Room 906 Boston, MA 02118, USA
| | - Xenia Leviyah
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA
| | - Christine Timko
- VA Palo Alto Health Care System, 3801 Miranda AvenuePalo Alto, CA 94304, USA.,Stanford University School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA
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11
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Abstract
Continuing care is widely believed to be an important component of effective treatment for substance use disorder, particularly for those individuals with greater problem severity. The purpose of this review was to examine the research literature on continuing care for alcohol and drug use disorders, including studies that addressed efficacy, moderators, mechanisms of action, and economic impact. This narrative review first considered findings from prior reviews (published through 2014), followed by a more detailed examination of studies published more recently. The review found that research has generally supported the efficacy of continuing care for both adolescents and adults, but the picture is complex. Reviews find relatively small effects when results from individual studies are combined. However, continuing care of longer duration that includes more active efforts to keep patients engaged may produce more consistently positive results. Moreover, patients at higher risk for relapse may benefit to a greater degree from continuing care. Several newer approaches for the provision of continuing care show promise. These include incentives for abstinence and automated mobile health interventions to augment more conventional counselor-delivered interventions. Primary care can be used to provide medications for opioid and alcohol use disorders over extended periods, although more research is needed to determine the optimal mix of behavioral treatments and other psychosocial services in this setting. Regardless of the intervention selected for use, the status of most patients will change and evolve over time, and interventions need to include provisions to assess patients on a regular basis and to change or adapt treatment when warranted.
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Affiliation(s)
- James R McKay
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania. Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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12
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Graser Y, Stutz S, Rösner S, Moggi F, Soravia LM. Telephone- and Text Message-Based Continuing Care After Residential Treatment for Alcohol Use Disorder: A Randomized Clinical Multicenter Study. Alcohol Clin Exp Res 2020; 45:224-233. [PMID: 33245589 DOI: 10.1111/acer.14499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is characterized by extremely high rates of postresidential treatment relapse, and as such, continuing care to prevent relapse has become an important element in AUD treatment. In this regard, research has yielded heterogeneous evidence on telephone-based (TEL) and text message-based (TEX) continuing care. We aimed to compare the effectiveness of TEL and TEX continuing care provided in different frequencies by psychotherapists for patients from residential treatments in mitigating the occurrence of posttreatment relapse in patients who completed a 12-week abstinence-oriented residential treatment program for AUD. METHODS A total of 240 patients from 2 residential treatment programs for AUD were included in the study. Patients were randomly assigned to high- (10 contacts) or low-frequency (3 contacts) TEL, TEX (10 contacts) continuing care, or control group (1 contact) from discharge to 6-month follow-up. The TEL was intended to be supportive and consisted of several cognitive behavioral therapy components, whereas the TEX was based on behavioral self-monitoring techniques and additional calls in case of relapse or as needed. Sociodemographic, clinical, and alcohol-specific variables at residential treatment discharge and at 5-month follow-up were assessed through interviews and questionnaires. RESULTS Compared with the control group, patients in the high-frequency TEL were significantly more likely to be abstinent at 6-month follow-up and, in case of relapse, showed a tendency toward a longer time to first drink. Moreover, the high-frequency TEL and TEX groups had significantly higher alcohol-related self-efficacy 6 months after residential treatment. CONCLUSION High-frequency proactive telephone contact by psychotherapists known to the patient may help patients to surmount the vulnerable phase after residential treatment and, in case of relapse, might help patients stay connected to health services, which in turn prevents chronification and facilitates recovery from AUD.
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Affiliation(s)
- Yolanda Graser
- From the, Research, (YG, LMS), Suedhang Clinic, Kirchlindach, Switzerland
| | - Sonja Stutz
- Research and Development, (SS, SR), Forel Clinic, Ellikon, Switzerland
| | - Susanne Rösner
- Research and Development, (SS, SR), Forel Clinic, Ellikon, Switzerland
| | - Franz Moggi
- Translational Research Center, (FM, LMS), University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Leila M Soravia
- From the, Research, (YG, LMS), Suedhang Clinic, Kirchlindach, Switzerland.,Translational Research Center, (FM, LMS), University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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13
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Middleton M, Somerset S, Evans C, Blake H. Test@Work Texts: Mobile Phone Messaging to Increase Awareness of HIV and HIV Testing in UK Construction Employees during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7819. [PMID: 33114546 PMCID: PMC7672579 DOI: 10.3390/ijerph17217819] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/18/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022]
Abstract
Background: HIV poses a threat to global health. With effective treatment options available, education and testing strategies are essential in preventing transmission. Text messaging is an effective tool for health promotion and can be used to target higher risk populations. This study reports on the design, delivery and testing of a mobile text messaging SMS intervention for HIV prevention and awareness, aimed at adults in the construction industry and delivered during the COVID-19 pandemic. Method: Participants were recruited at Test@Work workplace health promotion events (21 sites, n = 464 employees), including health checks with HIV testing. Message development was based on a participatory design and included a focus group (n = 9) and message fidelity testing (n = 291) with assessment of intervention uptake, reach, acceptability, and engagement. Barriers to HIV testing were identified and mapped to the COM-B behavioural model. 23 one-way push SMS messages (19 included short web links) were generated and fidelity tested, then sent via automated SMS to two employee cohorts over a 10-week period during the COVID-19 pandemic. Engagement metrics measured were: opt-outs, SMS delivered/read, number of clicks per web link, four two-way pull messages exploring repeat HIV testing, learning new information, perceived usefulness and behaviour change. Results: 291 people participated (68.3% of eligible attendees). A total of 7726 messages were sent between March and June 2020, with 91.6% successfully delivered (100% read). 12.4% of participants opted out over 10 weeks. Of delivered messages, links were clicked an average of 14.4% times, max 24.1% for HIV related links. The number of clicks on web links declined over time (r = -6.24, p = 0.01). Response rate for two-way pull messages was 13.7% of participants. Since the workplace HIV test offer at recruitment, 21.6% reported having taken a further HIV test. Qualitative replies indicated behavioural influence of messaging on exercise, lifestyle behaviours and intention to HIV test. Conclusions: SMS messaging for HIV prevention and awareness is acceptable to adults in the construction industry, has high uptake, low attrition and good engagement with message content, when delivered during a global pandemic. Data collection methods may need refinement for audience, and effect of COVID-19 on results is yet to be understood.
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Affiliation(s)
- Matthew Middleton
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK;
| | - Sarah Somerset
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (S.S.); (C.E.)
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (S.S.); (C.E.)
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (S.S.); (C.E.)
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
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14
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Czyz EK, Arango A, Healy N, King CA, Walton M. Augmenting Safety Planning With Text Messaging Support for Adolescents at Elevated Suicide Risk: Development and Acceptability Study. JMIR Ment Health 2020; 7:e17345. [PMID: 32160150 PMCID: PMC7281145 DOI: 10.2196/17345] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Suicide is the second leading cause of death among adolescents. A critical need exists for developing promising interventions for adolescents after psychiatric hospitalization who are at a high risk of experiencing repeated suicidal behaviors and related crises. The high-risk period following psychiatric hospitalization calls for cost-effective and scalable continuity of care approaches to support adolescents' transition from inpatient care. Text messages have been used to improve a wide range of behavioral and health outcomes and may hold promise as an accessible continuity of care strategy for youth at risk of suicide. OBJECTIVE In this study of 40 adolescents at elevated suicide risk, we report on the iterative development and acceptability of a text-based intervention designed to encourage adaptive coping and safety plan adherence in the high-risk period following psychiatric hospitalization. METHODS Adolescents (aged 13-17 years) who were hospitalized because of last-month suicide attempts or last-week suicidal ideation took part in either study phase 1 (n=25; 19/25, 76% female), wherein message content was developed and revised on the basis of feedback obtained during hospitalization, or study phase 2 (n=15; 11/15, 73% female), wherein text messages informed by phase 1 were further tested and refined based on feedback obtained daily over the course of a month after discharge (n=256 observations) and during an end-of-study phone interview. RESULTS Quantitative and qualitative feedback across the 2 study phases pointed to the acceptability of text-based support. Messages were seen as having the potential to be helpful with the transition after hospitalization, with adolescents indicating that texts may serve as reminders to use coping strategies, contribute to improvement in mood, and provide them with a sense of encouragement and hope. At the same time, some adolescents expressed concerns that messages may be insufficient for all teens or circumstances. In phase 2, the passage of time did not influence adolescents' perception of messages in the month after discharge (P=.74); however, there were notable daily level associations between the perception of messages and adolescents' affect. Specifically, higher within-person (relative to adolescents' own average) anger was negatively related to liking text messages (P=.005), whereas within-person positive affect was associated with the perception of messages as more helpful (P=.04). CONCLUSIONS Text-based support appears to be an acceptable continuity of care strategy to support adolescents' transition after hospitalization. The implications of study findings are discussed. Future work is needed to evaluate the impact of text-based interventions on suicide-related outcomes.
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Affiliation(s)
- Ewa K Czyz
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Alejandra Arango
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Nathaniel Healy
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Cheryl A King
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Maureen Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
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15
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Bastola MM, Locatis C, Maisiak R, Fontelo P. The Effectiveness of Mobile Phone-Based Text Messaging to Intervene with Problem Drinking in Youth and Younger Adult Population: A Meta-Analysis. Telemed J E Health 2020; 26:270-277. [PMID: 30985258 PMCID: PMC7071024 DOI: 10.1089/tmj.2018.0307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Mobile phone-based text messages have been used to address alcohol use disorder in younger populations by promoting abstinence, decreased alcohol intake, and moderation. Methods: A meta-analysis was conducted to summarize the effectiveness of mobile phone text messaging to address problem drinking by youth and younger adults. Results: Authors systematically searched PubMed, Embase, CINAHL, Web of Science, APA PsycNET, and the Cochrane Central Registry of Controlled Trials for literature published in the past 8 years (2010-2018). Randomized control trials and pre-post studies of younger people that used the problem drinking criteria of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) were included in the meta-analysis. Conclusions: The meta-analysis suggests that text message-based interventions might not be effective in decreasing alcohol intake in the younger populations.
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Affiliation(s)
- Mrigendra M. Bastola
- National Library of Medicine, National Institutes of Health, Rockville, Maryland
| | - Craig Locatis
- National Library of Medicine, National Institutes of Health, Rockville, Maryland
| | - Richard Maisiak
- School of Medicine, University of Alabama, Birmingham, Alabama
| | - Paul Fontelo
- National Library of Medicine, National Institutes of Health, Rockville, Maryland
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16
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Klingemann H, Flückiger M, Bongard T, Büchi M, Carrara M. Design and Content Quality of Alcohol-Related German, French and Italian Self-Tracking Applications. Subst Use Misuse 2020; 55:851-859. [PMID: 31934803 DOI: 10.1080/10826084.2019.1708117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Research on the increasing use of mobile technology in the addiction field is mainly focused on data collection and brief interventions. The acceptance and outcomes of autonomous self-tracking and self-governance as key elements for behavior change are under-researched. Purpose/Objectives: The objective of the study was to conduct a quality assessment of design and content features of self-tracking smartphone applications related to alcohol use, available in German, Italian, or French. Methods: A total of 25 self-tracking applications were identified, of which 17 could be assessed with the Mobile App Rating Scale (MARS), the System Usability Scale (SUS), and an additional content quality checklist based on the theoretical self-change framework (n = 13). Results: The scale design analysis showed a rather positive picture. Using the SUS, only six cases were below the reference average (x = 68), and three were clearly above average. Application of the MARS showed higher scores among the self-tracking applications in this study than among the health applications reviewed in the original MARS study. Better design quality goes together with better basic content quality. However, a closer look at the "interactivity scores" and the "risk/information barometer," as well as at the individual subtopics of the 10-point content checklist revealed major shortcomings. Conclusions/Importance: Improvements are necessary for consumer information in app stores, increased availability of alcohol-related self-tracking applications, transparent quality assurance regarding evidence-based content, and user-friendly design quality, to provide guidance for potential users on how to successfully navigate a highly unstable digital environment.
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Affiliation(s)
- Harald Klingemann
- Institute of Design Research, Bern University of Applied Sciences - University of the Arts, Bern, Switzerland
| | - Michael Flückiger
- Institute of Design Research, Bern University of Applied Sciences - University of the Arts, Bern, Switzerland
| | - Thierry Bongard
- Institute of Design Research, Bern University of Applied Sciences - University of the Arts, Bern, Switzerland
| | - Marlen Büchi
- Institute of Design Research, Bern University of Applied Sciences - University of the Arts, Bern, Switzerland
| | - Marco Carrara
- Institute of Design Research, Bern University of Applied Sciences - University of the Arts, Bern, Switzerland
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17
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Pradhan AM, Park L, Shaya FT, Finkelstein J. Consumer Health Information Technology in the Prevention of Substance Abuse: Scoping Review. J Med Internet Res 2019; 21:e11297. [PMID: 30698526 PMCID: PMC6372939 DOI: 10.2196/11297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/08/2018] [Accepted: 10/20/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Addiction is one of the most rapidly growing epidemics that currently plagues nations around the world. In the United States, it has cost the government more than US $700 billion a year in terms of health care and other associated costs and is also associated with serious social, physical, and mental consequences. Increasing efforts have been made to tackle this issue at different levels, from primary prevention to rehabilitation across the globe. With the use of digital technology rapidly increasing, an effort to leverage the consumer health information technologies (CHITs) to combat the rising substance abuse epidemic has been underway. CHITs are identified as patient-focused technological platforms aimed to improve patient engagement in health care and aid them in navigating the complex health care system. OBJECTIVE This review aimed to provide a holistic and overarching view of the breadth of research on primary prevention of substance abuse using CHIT conducted over nearly past five decades. It also aimed to map out the changing landscape of CHIT over this period. METHODS We conducted a scoping review using the Arksey and O'Malley's modified methodological framework. We searched 4 electronic databases (PubMed, Cochrane, Scopus, and EMBASE). Papers were included if the studies addressed the use of CHIT for primary prevention of substance abuse and were published in English between 1809 and 2018. Studies that did not focus solely on primary prevention or assessed additional comorbid conditions were eliminated. RESULTS Forty-two papers that met our inclusion criteria were included in the review. These studies were published between 1970 and 2018 and were not restricted by geography, age, race, or sex. The review mapped studies using the most commonly used CHIT platforms for substance abuse prevention from mass media in the 1970s to mobile and social media in 2018. Moreover, 191 studies that were exclusively focused on alcohol prevention were excluded and will be addressed in a separate paper. The studies included had diverse research designs although the majority were randomized controlled trials (RCT) or review papers. Many of the RCTs used interventions based on different behavioral theories such as family interactions, social cognitive theories, and harm-minimization framework. CONCLUSIONS This review found CHIT platforms to be efficacious and cost-effective in the real-world settings. We also observed a gradual shift in the types and use of CHIT platforms over the past few decades and mapped out their progression. In addition, the review detected a shift in consumer preferences and behaviors from face-to-face interactions to technology-based platforms. However, the studies included in this review only focused on the aspect of primary prevention. Future reviews could assess the effectiveness of platforms for secondary prevention and for prevention of substance abuse among comorbid populations.
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Affiliation(s)
- Apoorva Milind Pradhan
- Department of Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Leah Park
- Department of Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Fadia T Shaya
- Department of Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
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18
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Song T, Qian S, Yu P. Mobile Health Interventions for Self-Control of Unhealthy Alcohol Use: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e10899. [PMID: 30694200 PMCID: PMC6371076 DOI: 10.2196/10899] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/02/2018] [Accepted: 10/30/2018] [Indexed: 12/22/2022] Open
Abstract
Background Unhealthy alcohol use (UAU) is one of the major causes of preventable morbidity, mortality, and associated behavioral risks worldwide. Although mobile health (mHealth) interventions can provide consumers with an effective means for self-control of UAU in a timely, ubiquitous, and cost-effective manner, to date, there is a lack of understanding about different health outcomes brought by such interventions. The core components of these interventions are also unclear. Objective This study aimed to systematically review and synthesize the research evidence about the efficacy of mHealth interventions on various health outcomes for consumer self-control of UAU and to identify the core components to achieve these outcomes. Methods We systematically searched 7 electronic interdisciplinary databases: Scopus, PubMed, PubMed Central, CINAHL Plus with full text, MEDLINE with full text, PsycINFO, and PsycARTICLES. Search terms and Medical Subject Headings “mHealth,” “text message,” “SMS,” “App,” “IVR,” “self-control,” “self-regulation,” “alcohol*,” and “intervention” were used individually or in combination to identify peer-reviewed publications in English from 2008 to 2017. We screened titles and abstracts and assessed full-text papers as per inclusion and exclusion criteria. Data were extracted from the included papers according to the Consolidated Standards of Reporting Trials-EHEALTH checklist (V 1.6.1) by 2 authors independently. Data quality was assessed by the Mixed Methods Appraisal Tool. Data synthesis and analyses were conducted following the procedures for qualitative content analysis. Statistical testing was also conducted to test differences among groups of studies. Results In total, 19 studies were included in the review. Of these 19 studies, 12 (63%) mHealth interventions brought significant positive outcomes in improving participants’ health as measured by behavioral (n=11), physiological (n=1), and cognitive indicators (n=1). No significant health outcome was reported in 6 studies (6/19, 32%). Surprisingly, a significant negative outcome was reported for the male participants in the intervention arm in 1 study (1/19, 5%), but no change was found for the female participants. In total, 5 core components reported in the mHealth interventions for consumer self-control of UAU were context, theoretical base, delivery mode, content, and implementation procedure. However, sound evidence is yet to be generated about the role of each component for mHealth success. The health outcomes were similar regardless of types of UAU, deployment setting, with or without nonmobile cointervention, and with or without theory. Conclusions Most studies reported mHealth interventions for self-control of UAU appeared to be improving behavior, especially the ones delivered by short message service and interactive voice response systems. Further studies are needed to gather sound evidence about the effects of mHealth interventions on improving physiological and cognitive outcomes as well as the optimal design of these interventions, their implementation, and effects in supporting self-control of UAU.
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Affiliation(s)
- Ting Song
- Centre for IT-Enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Siyu Qian
- Centre for IT-Enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Ping Yu
- Centre for IT-Enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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19
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Gullo MJ, Irvine K, Feeney GF, Connor JP. Short message service (SMS) reminders improve treatment attendance in alcohol dependence, but are less effective for patients high in impulsivity. Addict Behav 2018; 87:97-100. [PMID: 29975880 DOI: 10.1016/j.addbeh.2018.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIMS Poor attendance increases the likelihood of relapse in alcohol dependence treatment. Evidence for improved attendance rates following introduction of short message service (SMS) appointment reminders is available in other health care domains. Patients high in impulsivity, characterized by a lack of planning, may particularly benefit from reminders. The study investigated the impact of SMS reminders on outpatient treatment attendance for alcohol dependence, and whether effects were moderated by impulsivity. DESIGN Prospective natural history study, with historical case control. Alcohol-dependent outpatients attending treatment received SMS appointment reminders (n = 102). These were compared to a historical control group (n = 91) treated prior to the introduction of SMS (totalling 1149 scheduled sessions). SETTING A metropolitan university hospital alcohol and drug outpatient clinic. PARTICIPANTS 193 alcohol-dependent patients participated in a 12-week cognitive-behavioral therapy (CBT) program with a treatment goal of abstinence. MEASUREMENTS Trait impulsivity, severity of dependence, psychological distress at baseline. Attendance at each scheduled session. FINDINGS SMS reminders significantly increased probability of session attendance (0.90 versus 0.84, p = .02). The effect was qualified by a significant SMS x Impulsivity interaction whereby reminders became less effective with increasing patient impulsivity (p = .003). CONCLUSIONS SMS appointment reminders improve treatment attendance for alcohol-dependent outpatients. More impulsive patients benefited less from reminders, suggesting their non-attendance may be related more to motivational factors.
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20
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Agyapong VIO, Juhás M, Mrklas K, Hrabok M, Omeje J, Gladue I, Kozak J, Leslie M, Chue P, Greenshaw AJ. Randomized controlled pilot trial of supportive text messaging for alcohol use disorder patients. J Subst Abuse Treat 2018; 94:74-80. [PMID: 30243421 DOI: 10.1016/j.jsat.2018.08.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/09/2018] [Accepted: 08/31/2018] [Indexed: 11/16/2022]
Abstract
AIMS To evaluate the effectiveness of an addiction-related supportive text messaging mobile intervention to improve treatment outcomes for patients with alcohol use disorder (AUD). METHODS A single-rater-blinded randomized trial was conducted involving 59 AUD patients who completed a residential addiction treatment program. Patients in the intervention group (n = 29) received supportive text messages for three months following discharge. Patients in the control group (n = 30) received a text message thanking them for participating in the study. The primary outcome of this study was the three months Cumulative Abstinence Duration (CAD); secondary outcomes (units of alcohol per drinking day, numbers of days to first drink) and exploratory outcomes (health utilization) were evaluated. Subgroup analyses were also done. The enrollment rate in the study was 84%, and of those who enrolled, 73% were retained. RESULTS When primary and secondary outcome measures were examined via effect size analysis, the number of days to first drink was longer in the intervention than control group (large effect size, although not statistically significant). The intervention group's mean first day to drink was over twice the length of the control group (e.g., approximately 60 vs. 26 days, respectively, with a mean difference of 34.97 and 95% CI of -5.87-75.81). Small to moderate effects were found for CAD and units of alcohol per drinking day. Small to negligible effects were found for health utilization. On subgroup analyses, the participants who received text messages, among those who did not attend follow-up outpatient counselling, showed a longer CAD. CONCLUSIONS The results suggest text messaging is a feasible and effective opportunity for follow-up care in patients discharged from residential AUD treatment.
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Affiliation(s)
- Vincent I O Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Department of Public Health, Alberta Health Services, Fort McMurray, Alberta, Canada.
| | - Michal Juhás
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Kelly Mrklas
- System Innovation and Programs, Strategic Clinical Networks™, Alberta Health Services, Alberta, Canada
| | - Marianne Hrabok
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Joy Omeje
- Department of Public Health, Alberta Health Services, Fort McMurray, Alberta, Canada
| | - Irene Gladue
- Northern Addiction Treatment Centre, Grande Prairie, Alberta, Canada
| | - Jody Kozak
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Maureen Leslie
- Northern Addiction Treatment Centre, Grande Prairie, Alberta, Canada
| | - Pierre Chue
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
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21
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Abstract
PURPOSE OF REVIEW This article systematically reviews studies examining remote measurement-based care (RMBC), defined as using technology to measure patients' psychiatric symptoms outside the context of a clinical encounter. RECENT FINDINGS Thirty-six studies were identified that measured patients' psychiatric symptoms remotely and provided feedback to treatment providers. The majority were single group designs. There was evidence supporting the short-term feasibility and acceptability of RMBC, although long-term sustainability was less clear. Thirteen randomized controlled trials were identified. RMBC was typically implemented as part of a multicomponent intervention (e.g., internet-based cognitive behavioral therapy with feedback to provider). Three studies experimentally isolated the clinical effects of RMBC, with two reporting no statistically significant differences between the RMBC and control conditions and one reporting greater symptom improvement associated with RMBC. RMBC appears feasible and acceptable and may be a promising intervention for improving mental health care, but additional experimental studies are needed.
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Nesvåg S, McKay JR. Feasibility and Effects of Digital Interventions to Support People in Recovery From Substance Use Disorders: Systematic Review. J Med Internet Res 2018; 20:e255. [PMID: 30139724 PMCID: PMC6127498 DOI: 10.2196/jmir.9873] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/01/2018] [Accepted: 06/18/2018] [Indexed: 12/18/2022] Open
Abstract
Background The development and evaluation of digital interventions aimed at preventing or treating substance use–related problems and disorders is a rapidly growing field. Previous reviews of such interventions reveal a large and complex picture with regard to targeted users, use, and efficacy. Objective The objective of this review was to investigate the feasibility and effects of interventions developed specifically for digital platforms. These interventions are focused on supporting people in recovery from substance use disorders by helping them achieve their substance use goals and develop a more satisfying life situation. Methods The review is based on a systematic search in MEDLINE, Embase, PsycInfo, and Cochrane Library databases. Of the 1149 identified articles, 722 were excluded as obviously not relevant. Of the remaining articles, 21 were found to be previous reviews, 269 were on interventions aimed at reducing hazardous alcohol or cannabis use, and 94 were on digitized versions of standard treatment methods. The remaining 43 articles were all read in full and systematically scored by both authors. Results The 43 articles cover 28 unique interventions, of which 33 have been published after 2013. The interventions are aimed at different target groups (defined by age, substance, or comorbidity). Based on the number of features or modules, the interventions can be categorized as simple or complex. Fourteen of the 18 simple interventions and 9 of the 10 complex interventions have been studied with quantitative controlled methodologies. Thirteen of the 18 simple interventions are integrated in other treatment or support systems, mainly delivered as mobile phone apps, while 6 of the 10 complex interventions are designed as stand-alone interventions, most often delivered on a platform combining desktop/Web and mobile phone technologies. The interventions were generally easy to implement, but in most cases the implementation of the complex interventions was found to be dependent on sustained organizational support. Between 70% and 90% of the participants found the interventions to be useful and easy to use. The rates of sustained use were also generally high, except for simple interventions with an open internet-based recruitment and some information and education modules of the complex interventions. Across all interventions, slightly more than half (55%) of the studies with control groups generated positive findings on 1 or more substance use outcomes, with 57% of the interventions also found to be efficacious in 1 or more studies. In the positive studies, effects were typically in the small to moderate range, with a few studies yielding larger effects. Largely due to the inclusion of stronger control conditions, studies of simple interventions were less likely to produce positive effects. Conclusions The digital interventions included in this review are in general feasible but are not consistently effective in helping people in recovery from substance use disorder reduce their substance use or achieving other recovery goals.
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Affiliation(s)
- Sverre Nesvåg
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - James R McKay
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Philadelphia VA Medical Center, Philadelphia, PA, United States
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Palmer M, Sutherland J, Barnard S, Wynne A, Rezel E, Doel A, Grigsby-Duffy L, Edwards S, Russell S, Hotopf E, Perel P, Free C. The effectiveness of smoking cessation, physical activity/diet and alcohol reduction interventions delivered by mobile phones for the prevention of non-communicable diseases: A systematic review of randomised controlled trials. PLoS One 2018; 13:e0189801. [PMID: 29304148 PMCID: PMC5755775 DOI: 10.1371/journal.pone.0189801] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/02/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We conducted a systematic review to assess the effectiveness of smoking cessation, physical activity (PA), diet, and alcohol reduction interventions delivered by mobile technology to prevent non-communicable diseases (NCDs). METHODS We searched for randomised controlled trials (RCTs) of mobile-based NCD prevention interventions using MEDLINE, EMBASE, Global Health, CINAHL (Jan 1990-Jan 2016). Two authors extracted data. FINDINGS 71 trials were included: smoking cessation (n = 18); PA (n = 15), diet (n = 3), PA and diet (n = 25); PA, diet, and smoking cessation (n = 2); and harmful alcohol consumption (n = 8). 4 trials had low risk of bias. The effect of SMS-based smoking cessation support on biochemically verified continuous abstinence was pooled relative risk [RR] 2.19 [95% CI 1.80-2.68], I2 = 0%) and on verified 7 day point prevalence of smoking cessation was pooled RR 1.51 [95% CI 1.06-2.15], I2 = 0%, with no reported adverse events. There was no difference in peak oxygen intake at 3 months in a trial of an SMS-based PA intervention. The effect of SMS-based diet and PA interventions on: incidence of diabetes was pooled RR 0.67 [95% CI 0.49, 0.90], I2 = 0.0%; end-point weight was pooled MD -0.99Kg [95% CI -3.63, 1.64] I2 = 29.4%; % change in weight was pooled MD -3.1 [95%CI -4.86- -1.3] I2 0.3%; and on triglyceride levels was pooled MD -0.19 mmol/L [95% CI -0.29, -0.08], I2 = 0.0%. The results of other pooled analyses of the effect of SMS-based diet and PA interventions were heterogenous (I2 59-90%). The effects of alcohol reduction interventions were inconclusive. CONCLUSIONS Smoking cessation support delivered by SMS increases quitting rates. Trials of PA interventions reporting outcomes ≥3 months showed no benefits. There were at best modest benefits of diet and PA interventions. The effects of the most promising SMS-based smoking, diet and PA interventions on morbidity and mortality in high-risk groups should be established in adequately powered RCTs.
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Affiliation(s)
- Melissa Palmer
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Jennifer Sutherland
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sharmani Barnard
- King's Centre for Global Health and Health Partnerships, King’s College London, London, United Kingdom
| | - Aileen Wynne
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emma Rezel
- King's Centre for Global Health and Health Partnerships, King’s College London, London, United Kingdom
| | - Andrew Doel
- Division of Women's Health, King’s College London, London, United Kingdom
| | - Lily Grigsby-Duffy
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Sophie Russell
- Notre Dame Catholic Sixth Form College, Leeds, United Kingdom
| | | | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Rodda SN, Dowling NA, Knaebe B, Lubman DI. Does SMS improve gambling outcomes over and above access to other e-mental health supports? A feasibility study. INTERNATIONAL GAMBLING STUDIES 2017. [DOI: 10.1080/14459795.2017.1388831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S. N. Rodda
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland , Auckland, New Zealand
- Turning Point, Eastern Health , Fitzroy, Australia
- School of Psychology, Deakin University , Geelong, Australia
| | - N. A. Dowling
- School of Psychology, Deakin University , Geelong, Australia
- Melbourne Graduate School of Education , Melbourne, Australia
| | - B. Knaebe
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland , Auckland, New Zealand
| | - D. I. Lubman
- Turning Point, Eastern Health , Fitzroy, Australia
- Eastern Health Clinical School, Monash University , Melbourne, Australia
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25
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Tofighi B, Nicholson JM, McNeely J, Muench F, Lee JD. Mobile phone messaging for illicit drug and alcohol dependence: A systematic review of the literature. Drug Alcohol Rev 2017; 36:477-491. [DOI: 10.1111/dar.12535] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/30/2016] [Accepted: 01/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Babak Tofighi
- New York University School of Medicine; New York USA
- Department of Population Health; New York University School of Medicine; New York USA
| | - Joseph M. Nicholson
- Division of General Internal Medicine; New York University School of Medicine; New York USA
| | - Jennifer McNeely
- New York University School of Medicine; New York USA
- Department of Population Health; New York University School of Medicine; New York USA
| | - Frederick Muench
- Health Sciences Library; New York University School of Medicine; New York USA
- North Shore Health System; New York USA
| | - Joshua D. Lee
- New York University School of Medicine; New York USA
- Department of Population Health; New York University School of Medicine; New York USA
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Kazemi DM, Borsari B, Levine MJ, Li S, Lamberson KA, Matta LA. A Systematic Review of the mHealth Interventions to Prevent Alcohol and Substance Abuse. JOURNAL OF HEALTH COMMUNICATION 2017; 22:413-432. [PMID: 28394729 PMCID: PMC5616128 DOI: 10.1080/10810730.2017.1303556] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Substance abuse in young adults is a public health issue with costs to the individual and society. There is mounting evidence that the increased uses of mHealth approaches have promise as a way to facilitate reductions in substance use. This systematic review evaluated the recent body of research on mHealth-based interventions for substance use, with aims of (a) examining the functionality and effectiveness of these interventions, (b) evaluating the available research on the effectiveness of these interventions for substance use, and (c) evaluating the design, methodology, results, theoretical grounding, limitations, and implications of each study. We identified eligible studies by searching electronic databases using Boolean methods. The reviewed studies (N = 12) indicated that that a wide range of Internet-based, text messaging, and smartphone application interventions have been developed to address substance use. Interventions had an assortment of features; participants in each study highlighted the ease and convenience of the interventions; and the majority of studies provided support for the efficacy of mHealth in reducing substance use. Mobile technology is a promising tool for reducing substance use and warrants further development. Future practice including the use of mHealth interventions can be an integral part of reducing substance use.
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Affiliation(s)
- Donna M Kazemi
- a School of Nursing , University of North Carolina at Charlotte , Charlotte , North Carolina , USA
| | - Brian Borsari
- b Brown School of Public Health , Brown University , Providence , Rhode Island , USA
- c Department of Psychiatry , University of California, San Francisco , San Francisco , California , USA
| | - Maureen J Levine
- d Psychology Department , Central Michigan University , Mt. Pleasant , Michigan , USA
| | - Shaoyu Li
- e Department of Mathematics and Statistics , University of North Carolina at Charlotte , Charlotte , North Carolina , USA
| | - Katie A Lamberson
- f Department of Counseling , University of North Carolina at Charlotte , Charlotte , North Carolina , USA
| | - Laura A Matta
- a School of Nursing , University of North Carolina at Charlotte , Charlotte , North Carolina , USA
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27
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Haug S, Schaub MP. Treatment outcome, treatment retention, and their predictors among clients of five outpatient alcohol treatment centres in Switzerland. BMC Public Health 2016; 16:581. [PMID: 27422382 PMCID: PMC4947295 DOI: 10.1186/s12889-016-3294-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 07/12/2016] [Indexed: 11/11/2022] Open
Abstract
Background Few studies have reported on the outcomes of outpatient alcohol treatment or the factors associated with effective treatment. We investigated treatment outcome, treatment retention, and their predictors in clients receiving outpatient treatment for alcohol misuse. Methods Naturalistic, longitudinal multi-centre study in Switzerland that included 858 clients receiving outpatient treatment for alcohol misuse. Assessments were conducted at treatment admission, discharge, and 6- and 12-month follow-ups. Non-problem drinking was used as an indicator of positive treatment outcome. Results Clients admitted to outpatient alcohol treatment were highly heterogeneous in terms of pre-treatment alcohol use and drinking goals. 45 % of clients exhibiting problem drinking at the beginning of treatment showed non-problem drinking at discharge, and 41 % and 43 % showed non-problem drinking at the 6- and 12-month follow-up, respectively; 51 % were discharged regularly and 43 % were discharged irregularly. Non-problem drinking at the 12-month follow-up was more likely in clients with a higher life satisfaction, those with lower alcohol use, those aiming for alcohol abstinence, and those who had been admitted for the first time to a treatment institution, whereas it was less likely in clients with a higher educational level. Treatment retention was higher among older clients, clients with a higher life satisfaction, and clients who subsisted on their own income. Conclusion Irregular discharge is high in outpatient alcohol treatment; nevertheless, a substantial portion of clients can achieve and maintain non-problem drinking by a 12-month follow-up.
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Affiliation(s)
- Severin Haug
- Swiss Research Institute for Public Health and Addiction, Zurich University, Konradstrasse 32, CH- 8031, Zurich, Switzerland.
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, Zurich University, Konradstrasse 32, CH- 8031, Zurich, Switzerland
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Bekkering GE, Zeeuws D, Lenaerts E, Pas L, Verstuyf G, Matthys F, Aertgeerts B, Matheï C. Development and Validation of Quality Indicators on Continuing Care for Patients With AUD: A Delphi Study. Alcohol Alcohol 2016; 51:555-61. [DOI: 10.1093/alcalc/agw044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 06/07/2016] [Indexed: 01/22/2023] Open
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