Web-Based Intervention and Email-Counseling for Problem Gamblers: Results of a Randomized Controlled Trial.

Web-based interventions have the potential to reduce the treatment gap for problem gambling. In the past years, several web-based help options were made available to the public. However, only few studies were conducted to test their effects. This study investigated the efficacy of two interventions for problem gamblers provided online by the German Federal Center for Health Education (BZgA). The first intervention is the guided program "Check Out" (CO), the second is email counselling (EC). A web-based randomized controlled trial with follow-up surveys after 3, 6 and 12 months was conducted. Participants were allocated to CO, to EC or to a waitlist (WL). Outcomes were the degree of problem gambling according to the Problem Gambling Severity Index, the number of days gambled in past 30 days, the highest stake during the past 30 days and the subjective well-being (WHO-5). 167 individuals were included in the trial. In comparison to the WL at the 3 months follow-up, participants of CO showed significant improvements with moderate to strong effect sizes in all outcomes. Strongest effects were found in the problem gambling severity (d = 0.91; p = 0.023), followed by the well-being (d = 0.70; p = 0.011), the gambling days (d = 0.59; p = 0.001) and the highest stake (d = 0.55; p = 0.012). Improvements were sustained until last follow-up. Compared to the WL, users of EC had beneficiary results in the problem gambling severity (d = 0.74; p = 0.022). No significant effect differences were found between CO and EC. However, according to process evaluation, users of CO reported a significantly stronger working alliance than users of EC (d = 0.70; p = 0.019) and used the intervention considerably longer (d = 0.84; p = 0.004). CO helps treatment-seeking individuals to sustainably reduce their gambling behavior and to increase their general well-being. Compared to EC, CO seems a better support option, since its effects include a wider range of outcomes. Possible reasons are the more engaging program structure and elements of CO, as well as the closer interaction between client and counselor.

Correction to: Web-Based Intervention and Email­Counseling for Problem Gamblers: Results of a Randomized Controlled Trial.

The article "Web-Based Intervention and Email-Counseling for Problem Gamblers: Results of a Randomized Controlled Trial" was written by Benjamin Jonas, Fabian Leuschner, Anna Eiling, Christine Schoelen, Renate Soellner and Peter Tossmann.

Predictors of treatment response in a web-based intervention for cannabis users.

BACKGROUND: Trials demonstrate the effectiveness of web-based interventions for cannabis-related disorders. For further development of these interventions, it is of vital interest to identify user characteristics which predict treatment response. METHODS: Data from a randomized factorial trial on a web-based intervention for cannabis-users (n = 534) was reanalyzed. As potential predictors for later treatment response, 31 variables from the following categories were tested: socio-demographics, substance use and cognitive processing. The association of predictors and treatment outcome was analyzed using unbiased recursive partitioning and represented as classification tree. Predictive performance of the tree was assessed by comparing its cross-validated results to models derived with all-subsets logistic regression and random forest. RESULTS: Goal commitment (p < .001), the extent of self-reflection (p < .001), the preferred effect of cannabis (p = .005) and initial cannabis use (p = .015) significantly differentiate between successful and non-successful participants in all three analysis methods. The predictive accuracy of all three models is comparable and modest. CONCLUSIONS: Participants who commit to quit using cannabis, who at least have moderate levels of self-reflection and who prefer mild intoxicating effects were most likely to respond to treatment. To predict treatment response on an individual level, the classification tree should only be used as one of several sources of information.Trial registration: http://www.isrctn.com/ISRCTN99818059.

Effects of Treatment Length and Chat-Based Counseling in a Web-Based Intervention for Cannabis Users: Randomized Factorial Trial.

BACKGROUND: Digital interventions show promise in reducing problematic cannabis use. However, little is known about the effect of moderators in such interventions. The therapist-guided internet intervention Quit the Shit provides 50 days of chat-based (synchronous) and time-lagged (asynchronous) counseling. OBJECTIVE: In the study, we examined whether the effectiveness of Quit the Shit is reduced by shortening the program or by removing the chat-based counseling option. METHODS: We conducted a purely Web-based randomized experimental trial using a two-factorial design (factor 1: real-time-counseling via text-chat: yes vs no; factor 2: intervention duration: 50 days vs 28 days). Participants were recruited on the Quit the Shit website. Follow-ups were conducted 3, 6, and 12 months after randomization. Primary outcome was cannabis-use days during the past 30 days using a Timeline Followback procedure. Secondary outcomes were cannabis quantity, cannabis-use events, cannabis dependency (Severity of Dependence Scale), treatment satisfaction (Client Satisfaction Questionnaire), and working alliance (Working Alliance Inventory-short revised). RESULTS: In total, 534 participants were included in the trial. Follow-up rates were 47.2% (252/534) after 3 months, 38.2% (204/534) after 6 months, and 25.3% (135/534) after 12 months. Provision of real-time counseling (factor 1) was not significantly associated with any cannabis-related outcome but with higher treatment satisfaction (P=.001, d=0.34) and stronger working alliance (P=.008, d=0.22). In factor 2, no significant differences were found in any outcome. The reduction of cannabis use among all study participants was strong (P<.001, d≥1.13). CONCLUSIONS: The reduction of program length and the waiver of synchronous communication have no meaningful impact on the effectiveness of Quit the Shit. It therefore seems tenable to abbreviate the program and to offer a self-guided start into Quit the Shit. Due to its positive impact on treatment satisfaction and working alliance, chat-based counseling nevertheless should be provided in Quit the Shit. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number ISRCTN99818059; http://www.isrctn.com/ISRCTN99818059 (Archived by WebCite at http://www.webcitation.org/6uVDeJjfD).

Efficacy of an internet-based intervention for burnout: a randomized controlled trial in the German working population.

BACKGROUND AND OBJECTIVES: Internet-based interventions are a viable treatment option for various mental problems. However, their effects on the burnout syndrome yielded mixed results. In this paper, we examine the efficacy of a structured and therapist-guided internet intervention, based on solution-focused and cognitive-behavioral therapy, for individuals with symptoms of burnout. DESIGN: Two-arm, Internet-based, randomized, wait-list controlled trial (RCT). METHODS: Participants were recruited through in-house events and online advertising. They were randomly assigned to the intervention or a wait-list. Group comparison was conducted three months after randomization. Outcomes were the burnout level according to the Maslach Burnout Inventory (MBI-GS) and the levels of depression, anxiety and stress according to the DASS-21. RESULTS: Thirty-nine participants were included in the trial; 36 (92.3%) took part at the 3-months-follow-up. Intention-to-treat analyses revealed significant group differences in favor of the intervention group in depression (d = 0.66), cynicism (d = 0.87) and personal accomplishment (d = 0.75). CONCLUSIONS: The intervention helped ameliorate symptoms of work-related stress and burnout. Although limited by a small sample size, the study suggests that the program provides effective support for affected individuals. However, further studies with bigger sample sizes should be conducted to examine the effects of such programs more precisely.

Multidimensional family therapy decreases the rate of externalising behavioural disorder symptoms in cannabis abusing adolescents: outcomes of the INCANT trial.

BACKGROUND: US-based trials have shown that Multidimensional Family Therapy (MDFT) not only reduces substance abuse among adolescents, but also decreases mental and behavioural disorder symptoms, most notably externalising symptoms. In the INCANT trial, MDFT decreased the rate of cannabis dependence among Western European youth. We now focus on other INCANT outcomes, i.e., lessening of co-morbidity symptoms and improvement of family functioning. METHODS: INCANT was a randomised controlled trial comparing MDFT with individual therapy (IP) at and across sites in Berlin, Brussels, Geneva, The Hague, and Paris. We recruited 450 boys and girls aged 13 up to 18 years with a cannabis use disorder, and their parent(s), and followed them for 12 months. Mental and behavioural characteristics (classified as 'externalising' or 'internalising') and family conflict and cohesion were assessed. RESULTS: From intake through 12 months, MDFT and IP groups improved on all outcome measures. Models including treatment, site, and referral source showed that MDFT outperformed IP in reducing externalising symptoms.Adolescents were either self-referred to treatment (mostly on the initiative from people close to the teen) or referred under some measure of coercion by an external authority. These two groups reacted equally well to treatment. CONCLUSIONS: Both MDFT and IP reduced the rate of externalising and internalising symptoms and improved family functioning among adolescents with a cannabis use disorder. MDFT outperformed IP in decreasing the rate of externalising symptoms. Contrary to common beliefs among therapists in parts of Western Europe, the 'coerced' adolescents did at least as well in treatment as the self-referred adolescents.MDFT shows promise as a treatment for both substance use disorders and externalising symptoms. TRIAL REGISTRATION ISRNCT: ISRCTN51014277.

Multidimensional family therapy lowers the rate of cannabis dependence in adolescents: a randomised controlled trial in Western European outpatient settings.

BACKGROUND: Noticing a lack of evidence-based programmes for treating adolescents heavily using cannabis in Europe, government representatives from Belgium, France, Germany, The Netherlands, and Switzerland decided to have U.S.-developed multidimensional family therapy (MDFT) tested in their countries in a trans-national trial, called the International Need for Cannabis Treatment (INCANT) study. METHODS: INCANT was a 2 (treatment condition)×5 (time) repeated measures intent-to-treat randomised effectiveness trial comparing MDFT to Individual Psychotherapy (IP). Data were gathered at baseline and 3, 6, 9 and 12 months thereafter. Study participants were recruited at outpatient secondary level addiction, youth, and forensic care clinics in Brussels, Berlin, Paris, The Hague, and Geneva. Participants were adolescents from 13 through 18 years of age with a recent cannabis use disorder. 85% were boys; 40% were of foreign descent. One-third had been arrested for a criminal offence in the past 3 months. Three primary outcomes were assessed: (1) treatment retention, (2) prevalence of cannabis use disorder and (3) 90-day frequency of cannabis consumption. RESULTS: Positive outcomes were found in both the MDFT and IP conditions. MDFT outperformed IP on the measures of treatment retention (p<0.001) and prevalence of cannabis dependence (p=0.015). MDFT reduced the number of cannabis consumption days more than IP in a subgroup of adolescents reporting more frequent cannabis use (p=0.002). CONCLUSIONS: Cannabis use disorder was responsive to treatment. MDFT exceeded IP in decreasing the prevalence of cannabis dependence. MDFT is applicable in Western European outpatient settings, and may show moderately greater benefits than IP in youth with more severe substance use.

INCANT: a transnational randomized trial of multidimensional family therapy versus treatment as usual for adolescents with cannabis use disorder.

BACKGROUND: In 2003, the governments of Belgium, France, Germany, the Netherlands and Switzerland agreed that there was a need in Europe for a treatment programme for adolescents with cannabis use disorders and other behavioural problems. Based on an exhaustive literature review of evidence-based treatments and an international experts meeting, Multidimensional Family Therapy (MDFT) was selected for a pilot study first, which was successful, and then for a joint, transnational randomized controlled trial named INCANT (INternational CAnnabis Need for Treatment). METHODS/DESIGN: INCANT is a randomized controlled trial (RCT) with an open-label, parallel group design. This study compares MDFT with treatment as usual (TAU) at and across sites in Brussels, Berlin, Paris, The Hague and Geneva. Assessments are at baseline and at 3, 6, 9 and 12 months after randomization. A minimum of 450 cases in total is required; sites will recruit 60 cases each in Belgium and Switzerland, and a maximum of 120 each in France, Germany and the Netherlands.Eligible for INCANT are adolescents from 13 through 18 years of age with a cannabis use disorder (dependence or abuse), with at least one parent willing to take part in the treatment. Randomization is concealed to, and therefore beyond control by, the researcher/site requesting it. Randomization is stratified as to gender, age and level of cannabis consumption.Assessments focus on substance use; mental function; behavioural problems; and functioning regarding family, school, peers and leisure time.For outcome analyses, the study will use state of the art latent growth curve modelling techniques, including all randomized participants according to the intention-to-treat principle.INCANT has been approved by the appropriate ethical boards in Belgium, France, Germany, the Netherlands, Switzerland, and the University of Miami Miller School of Medicine. INCANT is funded by the (federal) Ministries of Health of Belgium, Germany, the Netherlands, Switzerland, and by MILDT: the Mission Interministerielle de Lutte Contra la Drogue et de Toximanie, France. DISCUSSION: Until recently, cannabis use disorders in adolescents were not viewed in Europe as requiring treatment, and the co-occurrence of such disorders with other mental and behavioural problems was underestimated. This has changed now.Initially, there was doubt that a RCT would be feasible in treatment sectors and countries with no experience in this type of study. INCANT has proven that such doubts are unjustified. Governments and treatment sites from the five participating countries agreed on a sound study protocol, and the INCANT trial is now underway as planned. TRIAL REGISTRATION: ISRCTN51014277.

[Determination of the concurrent validity of the CRAFT-d - a screening instrument for problematic alcohol consumption]. / Bestimmung der konkurrenten Validität des CRAFFT-d: Ein Screeninginstrument für problematischen Alkoholkonsum bei Jugendlichen.

AIM: The aim of this study was to determine the concurrent validity of the CRAFFT-d alcohol abuse screening test for adolescents. METHOD: This criterion-related validity study compared the decisions of the CRAFFT-d with the decisions of the concurrently administered Alcohol Use Disorders Identification Test (AUDIT). Data was obtained from an online questionnaire including CRAFFT-d and AUDIT. RESULTS: Of the 12250 participants, 54.2 % were found to have an alcohol use disorder due to the AUDIT. CRAFFT-d identifies 63.6 % with problematic alcohol consumption. The Phi-coefficient showed high agreement between AUDIT and CRAFFT-d classifications (Phi Phi = .57; chi(2) 3978.671**; df = 1, p > .001). At a score of 2 or higher, CRAFFT showed sensitivity of 88.8 % and specificity of 66.2 %. CONCLUSION: The CRAFFT-d is a valid instrument for screening adolescents for problematic alcohol consumption. However, further comparison of CRAFFT items with diagnostic criteria for adolescents is needed.

[The use of cannabis in the Federal Republic of Germany]. / Der Konsum von Cannabis in der Bundesrepublik Deutschland.

Since more than 30 years cannabis is the most common illicit drug in Germany and other European countries. According to different Studies conducted in representative community samples, it can be assumed, that every fifth woman and about every third man, aged 18 to 59 years had used cannabis at least once. Epidemiologic studies also show that cannabis use is strongly associated with adolescence and young adulthood, though. Thus, cannabis consumption significantly increases from age 15, while beginning with the age 23 the proportion of cannabis consumers continuously decreases. Following the results of current studies the majority of consumers uses cannabis rather occasional. Nevertheless about 10-15% of the current consumers show patterns of cannabis dependence according to international diagnostic criteria. Although counselling centres note an increasing demand for addiction specific treatment, cannabis users still remain a small group in treatment centre statistics.