Spartan Daily February 2, 2011

Volume 136, Issue 3https://scholarworks.sjsu.edu/spartandaily/1110/thumbnail.jp

Application of synchronous text-based dialogue systems in mental health interventions: Systematic review

© Simon Hoermann, Kathryn L McCabe, David N Milne, Rafael A Calvo. Background: Synchronous written conversations (or "chats") are becoming increasingly popular as Web-based mental health interventions. Therefore, it is of utmost importance to evaluate and summarize the quality of these interventions. Objective: The aim of this study was to review the current evidence for the feasibility and effectiveness of online one-on-one mental health interventions that use text-based synchronous chat. Methods: A systematic search was conducted of the databases relevant to this area of research (Medical Literature Analysis and Retrieval System Online [MEDLINE], PsycINFO, Central, Scopus, EMBASE, Web of Science, IEEE, and ACM). There were no specific selection criteria relating to the participant group. Studies were included if they reported interventions with individual text-based synchronous conversations (ie, chat or text messaging) and a psychological outcome measure. Results: A total of 24 articles were included in this review. Interventions included a wide range of mental health targets (eg, anxiety, distress, depression, eating disorders, and addiction) and intervention design. Overall, compared with the waitlist (WL) condition, studies showed significant and sustained improvements in mental health outcomes following synchronous text-based intervention, and post treatment improvement equivalent but not superior to treatment as usual (TAU) (eg, face-to-face and telephone counseling). Conclusions: Feasibility studies indicate substantial innovation in this area of mental health intervention with studies utilizing trained volunteers and chatbot technologies to deliver interventions. While studies of efficacy show positive post-intervention gains, further research is needed to determine whether time requirements for this mode of intervention are feasible in clinical practice

Addressing Youth Perceptions of Harm in Marijuana Prevention Programming

The inverse relationship between perception of harm and substance use is clearly supported by decades of research – youth are less likely to engage in substance use when it is seen as harmful. However, despite strong theoretical and practical reasons to focus on perception of harm as a change-producer in prevention programming, little is known about what is effective in impacting perception of harm for youth marijuana use. To investigate the impact of existing prevention efforts designed to influence youth perception of harm and, consequently, youth marijuana use, we reviewed seven privately- or federally-funded online registries (e.g., Blueprints for Healthy Youth Development, Substance Abuse and Mental Health Administration’s National Registry of Evidence Based Programs and Practices) to identify evidence-based programs with marijuana-related outcomes for youth. We found 36 registry-identified programs with demonstrated impact on youth marijuana use. Although many of these programs may have actively or passively sought to alter perception of harm, only ten measured marijuana- or drug-related perception of harm as an intermediate outcome. Drawing on the commonalities of evidence-based programs with significant impacts on youth marijuana perception of harm, as well as lessons learned from other health behavior change efforts, we recommend best practices to provide state and local decision-makers with information on altering youth perception of harm for marijuana and on evaluating the impact of these efforts

Comparing a mindfulness- and CBT-based guided self-help Internet- and mobile-based intervention against a waiting list control condition as treatment for adults with frequent cannabis use: a randomized controlled trial of CANreduce 3.0

Background: Though Internet- and mobile-based interventions (IMIs) and mindfulness-based interventions (generally delivered in-situ) appear effective for people with substance use disorders, IMIs incorporating mindfulness are largely missing, including those targeting frequent cannabis use. Methods: This paper details the protocol for a three-arm randomized controlled trial comparing a mindfulness-based self-help IMI (arm 1) and cognitive-behavioral therapy (CBT)-based self-help IMI (arm 2) versus being on a waiting list (arm 3) in their effectiveness reducing cannabis use in frequent cannabis users. Predictors of retention, adherence and treatment outcomes will be identified and similarities between the two active intervention arms explored. Both active interventions last six weeks and consist of eight modules designed to reduce cannabis use and common mental health symptoms. With a targeted sample size of n = 210 per treatment arm, data will be collected at baseline immediately before program use is initiated; at six weeks, immediately after program completion; and at three and six months post baseline assessment to assess the retention of any gains achieved during treatment. The primary outcome will be number of days of cannabis use over the preceding 30 days. Secondary outcomes will include further measures of cannabis use and use of other substances, changes in mental health symptoms and mindfulness, client satisfaction, intervention retention and adherence, and adverse effects. Data analysis will follow ITT principles and primarily employ (generalized) linear mixed models. Discussion: This RCT will provide important insights into the effectiveness of an IMI integrating mindfulness to reduce cannabis use in frequent cannabis users. Trial registration: International Standard Randomized Controlled Trial Number Registry: ISRCTN14971662 ; date of registration: 09/09/2021. Keywords: Cannabis; Cognitive-behavioral therapy; Internet-based intervention; Mindfulness; Randomized controlled trial; Self-help

The Social Cost of Pain: Rejection Sensitivity, Social Rejection, and Cannabis Use in Young Adults

Cannabis has been implicated in relieving distress and social pain, an important area of research in young adult samples, given the saliency of peer and social networks to addiction. Cannabis, via opioid pathways, has been shown to reduce, or potentially buffer, the effects of social pain and rejection. Thus, cannabis may be protective against the painful feelings of social stress, particularly for heavier or more frequent users. However, findings are not wholly positive, as other research indicates cannabis may blunt affective responses and impair social processing. The effects of cannabis use in young adults are understudied, as well as its relationship to rejection sensitivity (RS). In this translational pilot study, we investigated the relationship between RS, social rejection, and cannabis use in moderate (using 1-3 times per week; n = 21) and heavy (using 4 or more times per week; n = 25) young adult cannabis users, compared to healthy controls (no cannabis use in past year; n = 24); rejection was longitudinally assessed at three levels: self-report, experimental, and daily diaries completed in naturalistic settings. Seventy college-aged (M = 20.56, SD = 3.13) completed self-report measures assessing trait RS and cannabis use factors. Cyberball+, a laboratory-based manipulation of social exclusion that varies the rates of inclusion, was employed to investigate whether RS and cannabis use frequency influenced rejection distress to social exclusion. Ecological momentary assessment (EMA) in the form of an online daily diary delivered via text message prompts and completed four times per day over the course of seven days was used to assess factors related to cannabis use and craving in real-world settings. Multi-level regression models were used to predict real-world cannabis craving and use from experimental and ecological experiences of rejection. Results showed that while there were no significant group differences between moderate, heavy users, or controls on trait RS, controls reported significantly higher scores of the expectancy component of trait RS, reflecting the expectation of rejection may be more salient than the anxious rumination component and may maintain the fear that rejection will occur. A non-significant correlation between trait RS and rejection distress to social exclusion indicated these may be two distinct constructs where the former is related to emotional responses to rejection while the latter is associated with a greater desire for social attachment and a need to belong. In contrast to our hypothesis, trait RS and cannabis use frequency had no significant interaction effect on rejection distress. Notably, cannabis users reported a significantly greater increase in craving cannabis to achieve relief from negative mood and in anticipation of a positive outcome after social exclusion. Lastly, while experiences of real-world rejection were low during the one-week EMA period, heavy cannabis users reported more instances of rejection than moderate users. Results from mixed effects logistic regression models show increased rejection distress to experimental social exclusion is significantly associated with reduced odds (45%) of real-world cannabis craving but not use, while real-world experiences of rejection was not associated with craving or use. To our knowledge, this study is the first to assess RS\u27s relation to cannabis use and to provide converging evidence that experimentally induced rejection distress influences and is prospectively predictive of reduced real-world cannabis craving. Findings from this study have important research and clinical implications and can provide guidance for identifying and treating cannabis use and its related problems on college campuses. Clinicians would benefit from incorporating evaluating the impact of RS on traditional psychotherapy treatments. Results can inform the development of EMA and text-messaging based interventions as a tool for targeted, real time substance use treatment, particularly for young adult cannabis users

A systematic review and behaviour change technique analysis of remotely delivered alcohol and/or substance misuse interventions for adults

© 2022 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)Background: There has been a lack of systematic exploration of remotely delivered intervention content and their effectiveness for behaviour change outcomes. This review provides a synthesis of the behaviour change techniques (BCT) contained in remotely delivered alcohol and/or substance misuse approaches and their association with intervention promise. Methods: Searches in MEDLINE, Scopus, PsycINFO (ProQuest), and the Cochrane Library, included studies reporting remote interventions focusing on alcohol and/or substance misuse among adults, with a primary behaviour change outcome (e.g., alcohol levels consumed). Assessment of risk of bias, study promise, and BCT coding was conducted. Synthesis focussed on the association of BCTs with intervention effectiveness using promise ratios. Results: Studies targeted alcohol misuse (52 studies) or substance misuse (10 studies), with predominantly randomised controlled trial designs and asynchronous digital approaches. For alcohol misuse studies, 16 were very promising, 17 were quite promising, and 13 were not promising. Of the 36 eligible BCTs, 28 showed potential promise, with seven of these only appearing in very or quite promising studies. Particularly promising BCTs were ‘Avoidance/reducing exposure to cues for behaviour’, ‘Pros and cons’ and ‘Self-monitoring of behaviour’. For substance misuse studies, three were very promising and six were quite promising, with all 12 BCTs showing potential promise. Conclusions: This review showed remotely delivered alcohol and substance misuse interventions can be effective and highlighted a range of BCTs that showed promise for improving services. However, concerns with risk of bias and the potential of promise ratios to inflate effectiveness warrant caution in interpreting the evidence.Peer reviewe

Effectiveness Bank Bulletin [Ultra-rapid opiate detoxification followed by nine months of naltrexone maintenance].

Ultra-rapid opiate detoxification followed by nine months of naltrexone maintenance therapy in Iran. Naderi-Heiden A., Naderi A., Naderi M.M. et al. Pharmacopsychiatry:2010, 43(4), p. 130–137. Further evidence from Iran that rapid withdrawal from opioids under anaesthesia followed by the opioid-blocking drug naltrexone can work for highly motivated caseloads with copious 'recovery capital'. For others this expensive and when not adequately controlled, potentially risky procedure generally ends in overdose-threatening relapse. Summary Ultra-rapid opiate detoxification typically involves a day or two of hospitalisation during which patients dependent on opiate-type ('opioid') drugs like heroin are anaesthetised or deeply sedated while the opiate-blocking drug naloxone is administered by infusion in to the blood stream to precipitate sudden withdrawal. Then patients are started on prescriptions of naltrexone tablets which (as long as they are taken) continue to block the effects of opiate-type drugs, an attempt to prevent the relapse to regular opioid use which commonly follows withdrawal. For the featured study records were analysed of 45 male patients admitted for such procedures between 2003 and 2005 to a surgical centre's department of anaesthesiology in Iran's capital Tehran. They were selected to be free of dependence on other drugs or alcohol except for cannabis, and free of severe physical or mental illness which might contraindicate general anaesthesia. For this and for other reasons they were relatively well placed to overcome their dependence via an abstinence-oriented route. Forty of the 45 were addicted to opium and just five injected. On average in their early 30s, they were committed to abstinence and had good family support. Over half were married and nearly 80% employed. They were attending an expensive private hospital so came predominantly from wealthy families, who (in the absence of a public welfare support system) can exert considerable pressure on opiate-dependent relatives, as can wives for whom such dependence is grounds for divorce. Also, in Iran familial solidarity is highly developed and can provide a high level of support and motivation for abstinence-oriented patients. On admission patients were detoxified by means of a six-hour infusion of naloxone under general anaesthesia; medications used were midazolam, propofol, clonidine and the muscle relaxant atracurium. For 24 hours after patients woke staff documented severity of withdrawal on a standard checklist of physical signs such as runny noses, sweating, cramps and dilated pupils. Usually discharge was scheduled for the day after detoxification. Then naltrexone (50mg/day) was prescribed for nine months with assessments every four weeks by a clinician with extensive experience in the treatment of dependence. At these consultations, naltrexone was re-prescribed and the patient's progress monitored, verified with the patients' agreement by talking to their families. For the purposes of the study, patients who missed these visits were considered relapsed