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

    • 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
    • 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
    • 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
    • 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)
    • 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
    • Current OnTrack programs
      Alcohol
      Alcohol & Depression
      Depression (recurrences)
      Get Real—psychosis-like experiences
      Family & Friends
    • app to track drinking
    • Coming soon...
      Drug diversion (practitioner-assisted)
      Substance use program for clients
      “Say when” (binge drinking) for Better Health Channel
      Indigenous version of alcohol/drug program
      Likely
      Substance use tools for CRC Youth Health & Wellbeing
    • Usage
      >35,000 Australian visits over 1st 20 months
      5.2 pages/visit; 5.0 min
      2299 users; 1314 in alcohol programs
      They do come back to the programs
      Alcohol: Brief Full
      # logins: 10.4 16.4 ns
      Duration of use (days) 42.6 69.6 <.10
      Alcohol + Depression Brief Full
      # logins: 7.8 10.6 ns
    • What do they use?Alcohol & Depression 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
    • So…don’t choose to do allAre they correct?
    • Alcohol pilot trial (n = 56)Abstinent Days/Wk
      Time
      Time x Gender
    • Drinks per week
      Time
      Time x Gender
    • Days/week over 6 drinks
      Time
      Time x Gender
      Time x Gender x Condition
    • For greatest reach: Internet only
    • Internet survey (3008)
      If a problem with alcohol, would want
      Internet only 19%
      Therapist support + internet
      18% telephone
      22% face-to-face
      35% email
    • Similar responses from 9 focus groups
      Cautious, somewhat negative re internet treatment
      Impersonal
      Skeptical re validity of assessment, effects of treatment
      Need for ongoing support
      Positive comments re
      Initial step—e.g. screening
      Anonymity
      Likely to require more motivation
    • …and in interviews with participants of an internet-based alcohol trial
      I found it hard to get motivated to follow the program being web-based
      I found it hard doing it on my own
      I wasn’t challenged if I didn’t do the steps
      Some sort of external accountability might help
      Maybe you need to have a face-to-face [element]…
      I think I’m more of a person that needs more of a one-on-one person…
    • ...and might expect therapists to be important
      Alliance argued to account for substantial variance in face-to-face treatment outcomes
    • Brands & Kavanagh (in submission)
      RCTs directly comparing no/less vs. more contact
      Psychological treatment for a health problem
      Not solely preventive
      Contact not solely involving support groups
      Paper in English
      Computer not just an adjunct to face to face
      Not confound between contact/other elements
      Presented sufficient data for analysis
      Prior to December 2010
    • Low vs. high contact
    • Alcohol and Depression trial
      Brief intervention based on
      Motivational interview—pros & cons, self-efficacy
      Building social support
      Concrete goal, plan
      Full intervention
      Wide range of CBT, mindfulness elements
      Full intervention + therapist/coach
      Regular emails, modified according to progress/issues
    • Current data suggest-no effect of therapist-brief initially not as effective, but catches up
    • Since a therapist is preferred by usersdoes it aid retention in program?
    • Alcohol & Depression (n = 203)
      Full program: No therapist Therapist
      Number of logins 10.6 15.4*
      % program completed 27% 41%
    • Need to examine further, whether
      impacts on initial engagement
      impacts on retention when going badly
      more important if depression is higher
      there are better ways to boost coaches’ impact
      preference, expectancies are modified by marketing
    • Some strategies flow from epidemiology
      Co-occurrence is common
      Often complex problems
      Similar risk factors to rest of population
      Substantial impact on mortality, symptoms, functioning
      In severe disorder, may have symptomatic impact from small amount
      Substances compound any cognitive effects of disorder