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

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

  1. 1. OnTrack substance use programs<br />David Kavanagh<br />Jennifer Connolly<br />Dawn Proctor<br />Leanne Hides<br />Steven Edge<br />Jeremy Gibson<br />Institute of Health & Biomedical Innovation<br />Queensland University of Technology<br />Britt Klein<br />Swinburne University of Technology<br />Frances Kay-Lambkin, Judy Proudfoot<br />University of NSW<br />Angela White<br />University of Queensland<br />August, 2011<br />
  2. 2. Our programs based on<br />Successful studies using mailed treatments<br /> Pre-Post SD units<br /> Full Info/Monitoring<br /> .85,.85,.88 .65,.50,.49 (Diff .20-.39)<br />Internet trials by others (vs. controls) <br />College samples (mainly normative feedback, preventive)<br /> .13 -.17 (Diff .30<br />Riper et al. (2007) community sample<br /> .69 .13 (Diff .56)<br />Our research with potential users <br />
  3. 3. Internet survey (n = 3008)<br />Important web features<br />Easy navigation/search<br />Open access<br />Right amount of information <br />Easy to understand language <br />Does not require extra software <br />Interesting pages<br />Trustworthy<br />
  4. 4. Likely use<br />Portal giving advice on websites<br />Online tests/self-assessments with feedback<br />Downloadable fact sheets<br />Systems tailoring information to user<br />Observation of free search—max 6.5 min on a site<br />Less if<br />young<br />not 1st site (2 min)<br />
  5. 5. Implications<br />Rapid access to key elements<br />and within program, a strong initial module<br />Screening, feedback, information without login<br />Self-tailoring, self-pacing within the program<br />but with advice on order, pace<br />Attractive, easy to use<br />Minimised text entry; pictorial icons<br />Brief videos to explain concepts<br />Summary pages to refer to<br />Diary, progress summaries<br />
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  11. 11. Current OnTrack programs<br />Alcohol<br />Alcohol & Depression<br />Depression (recurrences)<br />Get Real—psychosis-like experiences<br />Family & Friends<br />
  12. 12. app to track drinking<br />
  13. 13. Coming soon...<br />Drug diversion (practitioner-assisted)<br />Substance use program for clients<br />“Say when” (binge drinking) for Better Health Channel<br />Indigenous version of alcohol/drug program<br />Likely<br />Substance use tools for CRC Youth Health & Wellbeing<br />
  14. 14. Usage<br />>35,000 Australian visits over 1st 20 months<br />5.2 pages/visit; 5.0 min<br />2299 users; 1314 in alcohol programs<br />They do come back to the programs<br />Alcohol: Brief Full<br /># logins: 10.4 16.4 ns<br />Duration of use (days) 42.6 69.6 <.10<br />Alcohol + Depression Brief Full <br /># logins: 7.8 10.6 ns<br />
  15. 15. What do they use?Alcohol & Depression studyMost frequent “Signpost” /6 and Tool<br />1 Making Plans Introduction<br />0 Welcome To OnTrack<br />1 Deciding What to Do<br />1 Monitoring<br />1 Feeling Confident<br />1 Building My Support Team<br />1 Making a Plan<br />1 Planning tool<br />2 First Steps Introduction<br />1 Making Plans Feedback<br />2 Mindfulness Intro<br />1 Making Plans Summary<br />2 Activities I Enjoy<br />2 Mindfulness Practice<br />2 Mindfulness Sensations<br />2 Fun Activity Planning<br />2 What I've Got Already<br />3 Closing a Risky Track Introduction<br />
  16. 16. So…don’t choose to do allAre they correct?<br />
  17. 17. Alcohol pilot trial (n = 56)Abstinent Days/Wk<br />Time<br />Time x Gender<br />
  18. 18. Drinks per week<br />Time<br />Time x Gender<br />
  19. 19. Days/week over 6 drinks<br />Time<br />Time x Gender<br />Time x Gender x Condition<br />
  20. 20. For greatest reach: Internet only<br />
  21. 21. Internet survey (3008)<br />If a problem with alcohol, would want <br />Internet only 19% <br />Therapist support + internet<br />18% telephone<br />22% face-to-face<br />35% email<br />
  22. 22. Similar responses from 9 focus groups<br />Cautious, somewhat negative re internet treatment<br />Impersonal<br />Skeptical re validity of assessment, effects of treatment<br />Need for ongoing support<br />Positive comments re<br />Initial step—e.g. screening<br />Anonymity <br />Likely to require more motivation<br />
  23. 23. …and in interviews with participants of an internet-based alcohol trial<br />I found it hard to get motivated to follow the program being web-based<br />I found it hard doing it on my own<br />I wasn’t challenged if I didn’t do the steps<br />Some sort of external accountability might help<br />Maybe you need to have a face-to-face [element]…<br />I think I’m more of a person that needs more of a one-on-one person…<br />
  24. 24. ...and might expect therapists to be important<br />Alliance argued to account for substantial variance in face-to-face treatment outcomes<br />
  25. 25. Brands & Kavanagh (in submission)<br />RCTs directly comparing no/less vs. more contact<br />Psychological treatment for a health problem<br />Not solely preventive<br />Contact not solely involving support groups<br />Paper in English<br />Computer not just an adjunct to face to face<br />Not confound between contact/other elements<br />Presented sufficient data for analysis<br />Prior to December 2010<br />
  26. 26. Low vs. high contact<br />
  27. 27. Alcohol and Depression trial<br />Brief intervention based on<br />Motivational interview—pros & cons, self-efficacy<br />Building social support<br />Concrete goal, plan<br />Full intervention<br />Wide range of CBT, mindfulness elements<br />Full intervention + therapist/coach<br />Regular emails, modified according to progress/issues<br />
  28. 28. Current data suggest-no effect of therapist-brief initially not as effective, but catches up<br />
  29. 29. Since a therapist is preferred by usersdoes it aid retention in program?<br />
  30. 30. Alcohol & Depression (n = 203)<br /> Full program: No therapist Therapist<br />Number of logins 10.6 15.4*<br />% program completed 27% 41%<br />
  31. 31. Need to examine further, whether<br />impacts on initial engagement<br />impacts on retention when going badly<br />more important if depression is higher<br />there are better ways to boost coaches’ impact<br />preference, expectancies are modified by marketing<br />
  32. 32. Some strategies flow from epidemiology<br />Co-occurrence is common<br />Often complex problems<br />Similar risk factors to rest of population<br />Substantial impact on mortality, symptoms, functioning<br />In severe disorder, may have symptomatic impact from small amount<br />Substances compound any cognitive effects of disorder<br />