DrugInfo seminar: OnTrack internet and smart phone approaches to alcohol misuse

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David Kavanagh, DrugInfo seminar: Information and communication technology. 22 August 2011 …

David Kavanagh, DrugInfo seminar: Information and communication technology. 22 August 2011

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  • 1. OnTrack substance use programs
    David Kavanagh
    Jennifer Connolly
    Dawn Proctor
    Leanne Hides
    Steven Edge
    Jeremy Gibson
    Institute of Health & Biomedical Innovation
    Queensland University of Technology
    Britt Klein
    Swinburne University of Technology
    Frances Kay-Lambkin, Judy Proudfoot
    University of NSW
    Angela White
    University of Queensland
    August, 2011
  • 2. Our programs based on
    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
  • 3. Internet survey (n = 3008)
    Important web features
    Easy navigation/search
    Open access
    Right amount of information
    Easy to understand language
    Does not require extra software
    Interesting pages
    Trustworthy
  • 4. Likely use
    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)
  • 5. Implications
    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
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11. Current OnTrack programs
    Alcohol
    Alcohol & Depression
    Depression (recurrences)
    Get Real—psychosis-like experiences
    Family & Friends
  • 12. app to track drinking
  • 13. 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
  • 14. 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
  • 15. What do they use?Alcohol & Depression studyMost 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
  • 16. So…don’t choose to do allAre they correct?
  • 17. Alcohol pilot trial (n = 56)Abstinent Days/Wk
    Time
    Time x Gender
  • 18. Drinks per week
    Time
    Time x Gender
  • 19. Days/week over 6 drinks
    Time
    Time x Gender
    Time x Gender x Condition
  • 20. For greatest reach: Internet only
  • 21. Internet survey (3008)
    If a problem with alcohol, would want
    Internet only 19%
    Therapist support + internet
    18% telephone
    22% face-to-face
    35% email
  • 22. 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
  • 23. …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…
  • 24. ...and might expect therapists to be important
    Alliance argued to account for substantial variance in face-to-face treatment outcomes
  • 25. 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
  • 26. Low vs. high contact
  • 27. 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
  • 28. Current data suggest-no effect of therapist-brief initially not as effective, but catches up
  • 29. Since a therapist is preferred by usersdoes it aid retention in program?
  • 30. Alcohol & Depression (n = 203)
    Full program: No therapist Therapist
    Number of logins 10.6 15.4*
    % program completed 27% 41%
  • 31. 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
  • 32. 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