Online dialectical behavioral therapy for adults with internet addiction: A quasi-experimental trial during the COVID-19 pandemic.

The pathological use of the Internet has surged during the pandemic, even though service provisions were negatively impacted. Telepsychiatry can be used as a solution to maintain psychiatric addiction services. This study examined the efficacy of online group dialectical behavioral therapy (DBT) for Internet addiction (IA), compared to cognitive behavioral therapy (CBT). Participants were divided into two arms for 8 weeks: the experimental arm received eight sessions of online DBT skill group training (n = 20), and the control arm received four sessions of online individual CBT (n = 20). All participants were required to complete a sociodemographic and Internet use survey, the Internet Addiction Test (IAT), and the University of Rhode Island Change Assessment (URICA). All participants completed the therapy. Of the 40 participants, six (15%) perceived the need for therapy and one (2.5%) participant had a history of seeking IA therapy. In the pre-post comparison, significant improvements were noted in the IAT and URICA scores as well as Internet use duration for both arms. No significant differences were observed across the arms and in the time-by-arm interaction. Online group DBT is a viable alternative to online CBT in an acute constrained setting, although further studies are required to scrutinize its long-term efficacy. Trial Registration: ISRCTN17273762.

Insights Into Adolescents' Substance Use in a Low-Middle-Income Country During the COVID-19 Pandemic.

Introduction: The COVID-19 pandemic and its lockdown have been a significant life event for many individuals, particularly adolescents. The immense psychological pressure could drive risky behavior, e.g., substance use, while lockdown might lead to decreased use. This study aimed to observe the change in substance use among adolescents in Indonesia and the moderating variables to consumption during the COVID-19 lockdown period. Methods: This study utilized an online survey from April 28, 2020 to June 30, 2020. The hyperlink was disseminated to school administrators and parenting groups through social media and direct messages. A total of 2,932 adolescents (17.4 ± 2.24 and 78.7% females) submitted valid responses. The survey was comprised of a sociodemographic section, substance use details, and psychometric sections, including the Alcohol Use Disorders Identification Test (AUDIT), Cigarette Dependence Scale 12 (CDS-12), Pittsburgh Sleep Quality Index (PSQI), and Strength and Difficulties Questionnaire (SDQ). Results: Overall, adolescent alcohol use during the pandemic was 5.1%, cigarette smoking was 3.1%, and drug consumption was 0.4%. Over half (53.4%) of alcohol drinkers reported increased drinking, and 33.1% had harmful or dependence-like drinking behavior; in contrast, 44.4% of adolescent smokers disclosed reduced cigarette consumption. Around 37.8% of the drug users indicated increased use. During the pandemic, adolescent alcohol use was associated with higher education [adjusted odds ratio (AOR) = 2.67, 95% confidence interval (CI) 1.02-4.86, p = 0.04], higher AUDIT scores (AOR = 1.33, 95% CI 1.25-1.42, p < 0.001), and very low prosocial behavior (AOR = 2.46, 95% CI 1.52-3.88, p < 0.001). Cigarette smoking was correlated with male sex (AOR = 9.56, 95% CI 5.64-16.62, p < 0.001), age (AOR = 1.40, 95% CI 1.14-1.75, p < 0.001), and higher CDS score (AOR = 1.17, 95% CI 1.13-1.20, p < 0.001). Conclusions: Rates of adolescent substance use were significant, with sizeable proportions reporting higher usage. This appeared to occur predominantly in specific demographics and those with a lower protective psychosocial attribute, i.e., prosocial behavior, during the lockdown. These findings should urge the strengthening of adolescent addiction care during and after the pandemic.

Relapse prevention group therapy via video-conferencing for substance use disorder: protocol for a multicentre randomised controlled trial in Indonesia.

BACKGROUND: Substance use disorder (SUD) is a leading contributor to the global burden of disease. In Indonesia, the availability of formal treatment for SUD falls short of the targeted coverage. A standardised therapeutic option for SUD with potential for widespread implementation is required, yet evidence-based data in the country are scarce. In this study, we developed a cognitive behavioural therapy (CBT)-based group telemedicine model and will investigate effectiveness and implementability in a multicentre randomised controlled trial. METHODS: A total of 220 participants will be recruited from the social networks of eight sites in Indonesia: three hospitals, two primary healthcare centres and three rehabilitation centres. The intervention arm will participate in a relapse prevention programme called the Indonesia Drug Addiction Relapse Prevention Programme (Indo-DARPP), a newly developed 12-week module based on CBT and motivational interviewing constructed in the Indonesian context. The programme will be delivered by a healthcare provider and a peer counsellor in a group therapy setting via video-conferencing, as a supplement to participants' usual treatments. The control arm will continue treatment as usual. The primary outcome will be the percentage increase in days of abstinence from the primarily used substance in the past 28 days. Secondary outcomes will include addiction severity, quality of life, motivation to change, psychiatric symptoms, cognitive function, coping, and internalised stigma. Assessments will be performed at baseline (week 0), post-treatment (week 13), and 3 and 12 months post-treatment completion (weeks 24 and 60). Retention, participant satisfaction, and cost-effectiveness will be assessed as the implementation outcomes. ETHICS AND DISSEMINATION: The study protocol was reviewed and approved by the Ethics Committees of Universitas Indonesia and Kyoto University. The results will be disseminated via academic journals and international conferences. Depending on trial outcomes, the treatment programme will be advocated for adoption as a formal healthcare-based approach for SUD. TRIAL REGISTRATION NUMBER: UMIN000042186.

Implications of COVID-19 and Lockdown on Internet Addiction Among Adolescents: Data From a Developing Country.

Introduction: Physical distancing policy during coronavirus disease 2019 (COVID-19) pandemic requires adolescents to spend most of their time at home, thus increasing Internet use duration. Limited social interaction with their peers may lead to loneliness and an increased risk of mental health among adolescents. This study aimed to assess the prevalence of Internet addiction (IA) among adolescents and analyze the influence of psychosocial factors toward the heightened risk of IA during the COVID-19 pandemic. Methods: An online survey comprising sociodemographic questionnaire, Internet Addiction Diagnostic Questionnaire (KDAI), Strengths and Difficulties Questionnaire (SDQ), and Pittsburgh Sleep Quality Index (PSQI) was distributed. Overall, a total of 2,932 adolescents (mean age, 17.38 ± 2.24 years old; female, 78.7%), originating from 33 of 34 provinces in Indonesia, completed the survey. Results: The point prevalence of IA among Indonesian adolescents during the COVID-19 outbreak was 19.3%. Increased Internet use duration, internalization, externalization, low prosocial behavior, and sleep disturbances were found as risk factors of IA, either directly or as mediating variables. Physical distancing, large-scale social restriction (PSBB), and health status were not correlated to IA. Discussion: Physical distancing was not established as a risk of IA. This could be due to other psychological factors such as internalization, externalization, prosocial, and sleep problems that had correlations to IA occurrence among adolescents in the COVID-19 pandemic. Sleep impairment might have resulted from the emotional and behavioral issues and directly contributed to IA development. Conclusion: The present study found the prevalence of IA among Indonesian adolescents to be higher than the adult during the COVID-19 pandemic. Several psychological measures were indicated to increase the risk of IA, while physical distancing did not elevate the risk. Thus, remote schooling is preferable in Indonesia along with proper parental supervision to minimize Internet use for entertainment purposes.

Alcohol- and Cigarette-Use Related Behaviors During Quarantine and Physical Distancing Amid COVID-19 in Indonesia.

Background: In light of the coronavirus disease 2019 (COVID-19) pandemic, Indonesia implemented large-scale social restrictions (pembatasan sosial berskala besar/PSBB) to combat the spread of COVID-19, which might influence addictive behaviors. The current study aimed to explore the fluctuation of substance use during the pandemic and association of physical distancing and related factors toward consumption of alcohol and cigarettes. Method: An online survey was conducted from April 28 to June 1, 2020. Data regarding sociodemographic information, physical distancing profile, alcohol and cigarette usages, Alcohol Use Disorders Identification Test (AUDIT), Cigarette Dependence Scale (CDS), Symptom Checklist-90, and Pittsburg Sleep Quality Index (PSQI) were collected. A total of 4,584 respondents from all 34 provinces in Indonesia completed the survey. Data were summarized descriptively and analyzed using chi-square, ANOVA, and multinomial regression on SPSS 23.0 for Windows. Results: This study found that during the COVID-19 pandemic in Indonesia alcohol consumption was 9.50% and daily cigarette smoking was 20.3%. Around 44.5% and 47.6% of respondents reported stable alcohol consumption and cigarette consumption, respectively. The mean AUDIT score was 3.52 ± 4.66 and the mean CDS score was 24.73 ± 8.86. Physical distancing was not correlated to any substance use changes. Increased alcohol consumption was negatively correlated with being unmarried and positively correlated with a higher PSQI score. Decreased alcohol use positively correlated with living in PSBB-implementing provinces and higher AUDIT scores when compared to stable alcohol drinking. Increased cigarette smoking was positively correlated with being male, unmarried, and higher CDS scores. Reduced cigarette smoking was negatively correlated with living in provinces implementing PSBB, higher CDS scores, and phobic anxiety, hostility, and psychoticism subscales of SCL-90. Discussion and Conclusion: The prevalence of alcohol and cigarette consumption changes showed a similar trend with other available studies in other countries. This study established that substance use was mainly sustained with a smaller proportion of respondents amplifying their substance usages. The changes were correlated with PSBB policy but not the practice of physical distancing. Psychiatry and addiction services in Indonesia should be strengthened to cope with the increased burden of psychological distress. Future studies should conduct more comparisons to determine whether the overall rising intensity of consumption was maintained post-pandemic and delineate acute psychopathologies' effects on substance use.

Access to Healthcare and Harm Reduction Services During the COVID-19 Pandemic for People Who Use Drugs.

: Globally, there are concerns about access to healthcare and harm reduction services for people who use drugs (PWUD) during the coronavirus disease 2019 (COVID-19) pandemic. Members from the Network of Early Career Professionals working in Addiction Medicine shared their experiences of providing treatment to PWUD during the COVID-19 pandemic. Drawing on these qualitative reports, we highlight the similarities and discrepancies in access to services for PWUD in 16 countries under COVID-10 restrictions. In most countries reported here, efforts have been made to ensure continued access to services, such as mobilising opioid agonist maintenance treatment and other essential medicines to patients. However, due to travel restrictions and limited telemedicine services, several Network of Early Career Professionals working in Addiction Medicine members from lower-resourced countries experienced challenges with providing care to their patients during periods of COVID-19 lock-down. The insights provided in this commentary illustrate how the COVID-19 lock-down restrictions have impacted access to services for PWUD.

The Impact of Physical Distancing and Associated Factors Towards Internet Addiction Among Adults in Indonesia During COVID-19 Pandemic: A Nationwide Web-Based Study.

INTRODUCTION: Physical distancing has encouraged the public to utilize the Internet for virtually all daily activities during the COVID-19 pandemic. This study aimed to assess the impact of COVID-19 on Internet addiction (IA) prevalence and analyzed the correlated factors during quarantine and pandemic. METHODS: An online survey was generated, comprising of a sociodemographic section, Internet Addiction Diagnostic Questionnaire (KDAI), Symptoms Checklist-90, and Pittsburgh Sleep Quality Index. The hyperlink was disseminated through social media, companies, and universities. Overall, 4,734 adults, (mean age 31.84 ± 7.73 years old and 55.2% males) representing all 34 provinces of Indonesia, gave valid responses. RESULTS: Point prevalence of IA during the COVID-19 pandemic was 14.4% in Indonesian adults. Online duration increased by 52% compared to before the pandemic. Physical distancing was not established as a risk of IA. Increased daily online duration, specific motivations, types of application, and having confirmed/suspected COVID-19 cases within the household were predictive of IA. All subscales of SCL-90 and PSQI were higher in the group with positive/suspect cases of COVID-19 within households and were correlated to higher scores of IA. DISCUSSION: Physical distancing alone was not associated with an increased risk of IA. The prevalence of IA during COVID-19 was higher than the previously proposed rate among Indonesian adults, which might be related to digital activities associated with COVID-19 and the popularity of virtual socializing. Furthermore, psychopathologies and sleep disruptions were related to IA occurrences and especially prevalent in groups with proximity to COVID-19. Fear of COVID-19 contraction and rampant misinformation of COVID-19 probably contributed to these factors, which potentially harbor long-term consequences. CONCLUSION: The current study demonstrated a high point prevalence of IA and identified several preventable factors predictive of IA during home-quarantine and COVID-19, especially in adults with confirmed/suspected COVID-19 cases within the household. However, physical distancing did not increase the odds of IA. Public health agencies should maintain physical distancing advisory while providing adaptive psychiatric education and service.

The Changing Landscape of Alcohol Use and Alcohol Use Disorder During the COVID-19 Pandemic - Perspectives of Early Career Professionals in 16 Countries.

: Alcohol use is a major risk factor for infectious disease and reduction of harms associated with alcohol consumption are essential during times of humanitarian crises, such as the COVID-19 pandemic. As a network of early career professionals working in the area of addiction medicine, we provide our views with regards to national actions related to reducing alcohol-related harm and providing care for people with alcohol use disorder during COVID-19. We believe that COVID-19 related measures have affected alcohol consumption in the majority of countries represented in this commentary. Examples of these changes include changes in alcohol consumption patterns, increases in cases of alcohol withdrawal syndrome, disruptions in access to medical care for alcohol use disorder and increases in illegal production of alcohol. Our members urge that treatment for acute and severe conditions due to substance use should be considered as essential services in times of humanitarian crises like COVID-19.