Suchergebnisse

Fragestellung: Wird das Internetprogramm Selbsthilfe Alkohol (ISA) von Problemtrinkern genutzt? Wie wird das Programm von den Teilnehmern bewertet? Welchen Effekt hat das Programm auf das Trinkverhalten? </p><p> Methodik: In einer naturalistischen retrospektiven Kohortenstudie wurden die vorhandenen Daten des Internetprogramms (n = 3154) und der Fragebogenerhebung (n = 290) evaluiert. </p><p> Ergebnisse: Monatlich finden 150 Teilnehmer Zugang zu dem Internetprogramm ISA. Die Haltequote liegt bei 4 %. Die Teilnehmer schätzen die Flexibilität, Anonymität und die Zugänglichkeit. Die Reduktion des Alkoholkonsums liegt bei zwei Gläsern pro Tag. </p><p> Schlussfolgerungen: Die Reduzierung des Alkoholkonsums durch das ISA entspricht den Ergebnissen der ersten randomisierten kontrollierten Studie zur Internetselbsthilfe für Problemtrinker. Selbsthilfe über das Internet bietet neue Möglichkeiten und ist eine Herausforderung für das Suchthilfesystem.

<b><i>Background:</i></b> In this article, we present an evaluation of online psychoactive substance trade via Telegram, a free encrypted social media messenger service. The evaluation took place during the COVID-19 pandemic, which allowed us to monitor the effects of the spring 2020 lockdown in the Netherlands on substance trade via Telegram. <b><i>Objective:</i></b> The objective of this study was to evaluate whether changes in psychoactive substance trade on Telegram markets in the Netherlands can be observed during the COVID-19 pandemic. <b><i>Results:</i></b> Between December 2, 2019, and June 29, 2020, a total of 70,226 posts appeared in two analyzed Telegram groups. A total of 5,643 posts were psychoactive substance related. Based on the analyzed posts, Telegram is mostly a '"sellers" market as only a minority of the posts (6.3%) could be identified as a request for a substance. The proportion of posts related to specific substances varied between the periods before, during, and after the lockdown. The proportion of posts on the stimulants ecstasy, cocaine, and amphetamine was lower during the lockdown than before and after. For psychedelics – ketamine, lysergic acid diethylamide (LSD), and 2,5-dimethoxy-4-bromophenethylamine (2C-B) – and other substances, there was a relative increase in the number of posts during the lockdown, which was maintained after the lockdown. <b><i>Conclusions:</i></b> Telegram analysis shows that in the Netherlands, online psychoactive substance trade may have been affected during the COVID-19 pandemic. The direction of this effect was different for different classes of substances.

<b><i>Background:</i></b> The majority of people with cannabis use disorder do not seek treatment. If we were able to gain more insight into different subgroups of cannabis users based on help-seeking preferences, we could use this information to inform the development and promotion of interventions targeted at specific subgroups of cannabis users, to ultimately narrow the treatment gap. <b><i>Methods:</i></b> An online survey was conducted among 1,015 Dutch frequent cannabis users (18–72 years) to assess their cannabis use, help-seeking preferences, psychopathology, and psychological distress. Latent class analysis was used to identify classes of cannabis users based on their help-seeking preferences. Differences between the identified classes in terms of sociodemographics, cannabis use, and psychopathology were examined. <b><i>Results:</i></b> We identified four classes with distinct preferences for support. Class 1 ("no support/only social," <i>n</i> = 548) had a low probability of finding any form of support appealing other than social support. Class 2 ("online help," <i>n</i> = 170) had relatively high probabilities of finding online help appealing. Class 3 ("GP/outpatient," <i>n</i> = 208) had a relatively high probability of finding support from the general practitioner and outpatient substance use disorder treatment appealing. Class 4 ("all sources," <i>n</i> = 89) had moderate to high probabilities for all sources of support. In terms of sociodemographics, differences between the classes were found with regard to gender and level of education. The classes were fairly similar with regard to cannabis use, only the "online help" class scored significantly lower on both cannabis use frequency and quantity compared to most of the other classes. In terms of psychopathology, the "GP/outpatient" class and the "all sources" class experienced more cannabis use-related problems and were more likely to report multiple past quit attempts than the "online help" class and the "no support/only social" class. <b><i>Conclusions:</i></b> Our study shows that there is a lot of inter-individual variation in how appealing various forms of help are to cannabis users. Our findings emphasize the importance of promoting a variety of treatment modalities for cannabis users, including real-life and digital options, and indicate what might appeal to whom.

Background: Alcohol moderation (AM) interventions may contribute to better treatment outcomes and the general well-being of cancer survivors. Objective: This study evaluates the effectiveness, cost-effectiveness, and cost-utility of MyCourse, a digital AM intervention, compared with a noninteractive digital information brochure for cancer survivors. Methods: A health economic evaluation alongside a pragmatic 2-arm parallel-group randomized controlled trial was conducted with follow-ups at 3, 6, and 12 months after randomization. The study was conducted on the web in the Netherlands from 2016 to 2019. Participants were adult 10-year cancer survivors drinking over the Dutch-recommended drinking guidelines (<= 7 standard units [10 g of alcohol] per week) with the intention to moderate or quit drinking. Overall, 103 participants were randomized and analyzed: 53 (51.5%) in the MyCourse group and 50 (48.5%) in the control group. In the MyCourse group, participants had access to a newly developed, digital, minimally guided AM intervention, MyCourse Moderate Drinking. The primary outcome was the self-reported number of standard drinks (10 g of ethanol) consumed in the past 7 days at the 6-month follow-up. The secondary outcome measures were alcohol-related problems as measured by the Alcohol Use Disorders Identification Test (AUDIT) and treatment satisfaction. For the health economic evaluation, health care costs, costs because of productivity losses, and intervention costs were assessed over a 12-month horizon. Results: Alcohol use at the 6-month follow-up decreased by 38% in the MyCourse group and by 33% in the control group. No difference in 7-day alcohol use was found between the groups (B=2.1, 95% CI -7.6 to 3.1; P=.22) at any of the follow-ups. AUDIT scores for alcohol-related problems decreased over time in both groups, showing no significant difference between the groups (Cohen d=0.3, 95% CI -0.1 to 0.6; P=.21). Intervention costs per participant were estimated at US $279 for the MyCourse group and US $74 for ...

Abstract

Aims
This systematic review and meta-analysis assessed the effectiveness of digital interventions addressing depressive symptoms and alcohol use simultaneously among people with co-occurring depression and problematic alcohol use.


Methods
Seven databases were searched for trials evaluating digital interventions aimed at depression and alcohol use. Random-effects meta-analyses were conducted to pool effects on depressive symptoms and alcohol use up to 3-month and 6-month follow-up. Overall quality for every outcome was assessed with GRADE (Grading of Recommendations Assessment, Development and Evaluation).


Results
The pooled effect of digital interventions compared to their comparators was in favour of digital interventions. Small but significant effects on depressive symptoms at 3-month follow-up were found (g = 0.34, 95% confidence interval (CI): 0.06–0.62, P = 0.02, k = 6) and non-significant effects at 6-month follow-up (g = 0.29, 95% CI: −0.16 to 0.73, P = 0.15, k = 5). For alcohol use, the pooled effect of digital interventions was small and non-significant at 3-month follow-up (g = 0.14, 95% CI: −0.02 to 0.30, P = 0.07, k = 6) and significant at 6-month follow-up (g = 0.14, 95% CI: 0.07–0.20, P = 0.005, k = 5). Sensitivity analysis indicated the latter finding to be sensitive to statistical estimator choice. Quality of evidence was moderate, except for depressive symptoms at 6-month follow-up for which it was low.


Conclusion
Based on the literature, digital interventions are effective in reducing depressive symptoms at 3-month follow-up and alcohol use at 6-month follow-up among people with comorbid depression and problematic alcohol use. More high-quality trials are needed to confirm the current findings.

<b><i>Background:</i></b> Clinicians in the field of drug addiction have started to exploit the growth of Technology-Based Interventions (TBIs). However, there is little information on how health personnel evaluate them. <b><i>Methods:</i></b> Semi-structured interviews were conducted among 20 European experts. <b><i>Results:</i></b> All of the interviewees recognised TBIs as a valuable tool to improve the management of substance-use disorders (SUDs). Most interviewees indicated that combining both traditional face-to-face therapist-patient clinic appointment with TBIs is probably the most effective method. Most interviewees agree that TBIs are valuable tools to overcome both physical and social barriers, and hence significantly facilitate the access to treatment. Poor infrastructure and lack of digital literacy are recognised as major barriers to the diffusion of these tools. <b><i>Conclusions:</i></b> The application of various forms of technology in SUD treatment is an interesting development for the European Union. Technical and non-technical barriers exist and impede their full exploitation.

Background: Clinicians in the field of drug addiction have started to exploit the growth of Technology-Based Interventions (TBIs). However, there is little information on how health personnel evaluate them. Methods: Semi-structured interviews were conducted among 20 European experts. Results: All of the interviewees recognised TBIs as a valuable tool to improve the management of substance-use disorders (SUDs). Most interviewees indicated that combining both traditional face-to-face therapist-patient clinic appointment with TBIs is probably the most effective method. Most interviewees agree that TBIs are valuable tools to overcome both physical and social barriers, and hence significantly facilitate the access to treatment. Poor infrastructure and lack of digital literacy are recognised as major barriers to the diffusion of these tools. Conclusions: The application of various forms of technology in SUD treatment is an interesting development for the European Union. Technical and non-technical barriers exist and impede their full exploitation. (C) 2017 S. Karger AG, Basel

<b><i>Background:</i></b> Although substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) show significant symptomatic overlap, ADHD is often overlooked in SUD patients. <b><i>Objective:</i></b> The aim of the present study was to characterize aspects of attention and inhibition (as assessed by a continuous performance test [CPT]) in SUD patients with and without a comorbid diagnosis of ADHD and in healthy controls, expecting the most severe deficits in patients with a combined diagnosis. <b><i>Methods:</i></b> The MOXO-CPT version, which incorporates visual and auditory environmental distractors, was administered to 486 adults, including healthy controls (<i>n</i> = 172), ADHD (<i>n</i> = 56), SUD (<i>n</i> = 150), and combined SUD and ADHD (<i>n</i> = 108). <b><i>Results:</i></b> CPT performance of healthy controls was better than that of individuals in each of the 3 clinical groups. The only exception was that the healthy control group did not differ from the ADHD group on the Timing index. The 3 clinical groups differed from each other in 2 indices: (a) patients with ADHD (with or without SUD) showed increased hyperactivity compared to patients with SUD only and (b) patients with ADHD showed more responses on correct timing as compared with the SUD groups (with or without ADHD). <b><i>Conclusion:</i></b> The CPT is sensitive to ADHD-related deficits, such as disinhibition, poor timing, and inattention, and is able to consistently differentiate healthy controls from patients with ADHD, SUD, or both. Our results are in line with previous research associating both ADHD and SUD with multiple disruptions across a broad set of cognitive domains such as planning, working memory, decision-making, inhibition control, and attention. The lack of consistent differences in cognitive performance between the 3 diagnostic groups might be attributed to various methodological aspects (e.g., heterogeneity in severity, type, and duration of substances use). Our results support the view that motor activity should be considered a significant marker of ADHD.

<b><i>Introduction:</i></b> Polydrug use patterns among young adults using ecstasy vary, as well as their willingness to change them. Polydrug use patterns are likely associated with different adverse health outcomes. It is unknown whether polydrug use patterns of young adults who use ecstasy are similar in different countries. This study aims to identify and compare polydrug use patterns and willingness to change them of young adults that use ecstasy in the United Kingdom (UK) and the Netherlands (NL), two countries with a high prevalence of ecstasy use and a large electronic dance music (EDM) scene. <b><i>Methods:</i></b> The data from the online cross-sectional Electronic Music Scene Survey were used in a latent class analysis. The binary indicators used in the estimation were past-year substance use of 21 different substances. The sample consisted of young adult ecstasy users that regularly visit EDM events (age 18–34). <b><i>Results:</i></b> A total of 1,077 respondents from the UK (age <i>M</i> = 23.1) and 1,178 from the NL (age <i>M</i> = 23.7) that regularly visit EDM events were included in the analyses. In both countries, three polydrug use patterns of ecstasy users were identified based on Bayesian Information Criterion fit indices: a traditional polydrug use class (UK: 28%; NL: 40%), a stimulant and ketamine polydrug use class (UK: 48%; NL: 52%), and an extensive polydrug use class (UK: 24%; NL: 8%) characterized by substantial use of stimulants, depressant, and psychedelic substances. Overall, young adults that used ecstasy in the UK consumed 3,4-methylenedioxymeth-amphetamine (MDMA) more often as powder/crystalline and at higher dosages compared to young adults in the NL who preferred MDMA tablets. Regardless of polydrug class or country, most respondents indicated that they had the intention to reduce but not quit their use. <b><i>Conclusion:</i></b> In both countries, structurally similar polydrug use patterns among young adults that use ecstasy were found, while the use frequencies of individual substances and preferred MDMA form varied between the countries.

Background and Aims: Estonia has one of the highest alcohol-attributable mortality rates within the European Union. The aim of this study was to estimate the efficacy of an on-line self-help intervention to reduce problem drinking at the population level. Design: On-line open randomized controlled trial with an 8-week intervention and an active control group (intervention n = 303, control n = 286). Assessments took place at baseline and at 6 months follow-up. Setting: On- and offline channels were used for population-based recruitment within a nation-wide prevention campaign in Estonia. Participants: Inclusion criteria were age ≥ 18 years, heavy drinking [Alcohol Use Disorders Identification (AUDIT) test score ≥ 8], literacy in Estonian and at least weekly access to the internet; n = 589 participants were randomized (50% male, 1% other; mean age 37.86 years; 45% with higher level of education). Intervention and comparator: The intervention consisted of 10 modules based on principles of cognitive–behavioral therapy and motivational interviewing. The active control group received access to a website with a self-test including personalized normative feedback and information for standard alcohol treatment. Measurements: The primary outcome was AUDIT scores at 6 months follow-up adjusted for baseline scores. Findings: Intention-to-treat analyses were applied. Missing data were addressed by using baseline observation carried forward (BOCF) and multiple imputation by chained equations (MI); 175 completed follow-up in the intervention group and 209 in the control group. AUDIT score at follow-up was significantly smaller in the intervention [BOCF mean = 13.91, standard deviation (SD) = 7.61, MI mean = 11.03, SD = 6.55] than control group (BOCF mean = 15.30, SD = 7.31; MI mean = 14.30, SD = 7.21), with a group difference of −1.38 [95% confidence interval (CI) = –2.58, –0.18], P = 0.02 for BOCF and −3.26 (95% CI = –2.01, –4.51), P < 0.001 for MI. Conclusions: A randomized controlled trial has found that an on-line self-help intervention with minimal guidance was effective at reducing problem drinking in Estonia.

<b><i>Aims:</i></b> This study addressed the age of onset of conduct disorder (CD) and oppositional defiant disorder (ODD) in treatment-seeking substance use disorder (SUD) patients with and without adult attention-deficit/hyperactivity disorder (ADHD) and its association with early onset of SUD. <b><i>Methods:</i></b> We examined data from the 2nd <i>International ADHD in Substance Use Disorders Prevalence Study</i>, including 400 adults in SUD treatment from Puerto Rico, Hungary, and Australia. ADHD, SUD, and CD/ODD were assessed with the <i>Conners Adult ADHD Diagnostic Interview for DSM-IV</i>, the <i>MINI International Neuropsychiatric Interview</i>, and the K-SADS, respectively. Cox regression analyses modeled time to emergence of CD/ODD separately for SUD patients with and without adult ADHD. Linear regression models examined associations between age of onset of SUD and presence of ADHD and adjusted for sex, age, and country. To assess the mediating role of CD/ODD on the association of ADHD with onset of SUD, adjusted regression models were estimated. <b><i>Results:</i></b> Treatment-seeking SUD patients with ADHD presented an earlier onset of CD/ODD compared with those without ADHD. CD/ODD symptom loads were higher among the SUD and ADHD group. Age of first substance use and SUD were significantly earlier in SUD patients with ADHD, and these findings remained significant after adjustment for demographics and coexisting CD/ODD. <b><i>Conclusions:</i></b> ADHD is associated with earlier onset of SUD as well as with an earlier onset of more frequent and more severe disruptive behavioral disorders. These findings may inform preventive interventions to mitigate adverse consequences of ADHD.

<b><i>Introduction:</i></b> Comorbid attention deficit/hyperactivity disorder (ADHD) is present in 15–25% of all patients seeking treatment for substance use disorders (SUDs). Some studies suggest that comorbid ADHD increases clinical severity related to SUDs, other psychiatric comorbidities, and social impairment, but could not disentangle their respective influences. <b><i>Objectives:</i></b> To investigate whether comorbid adult ADHD in treatment-seeking SUD patients is associated with more severe clinical profiles in these domains assessed altogether. <b><i>Methods:</i></b> Treatment-seeking SUD patients from 8 countries (<i>N =</i> 1,294: 26% females, mean age 40 years [SD = 11 years]) were assessed for their history of DSM-IV ADHD, SUDs, and other psychiatric conditions and sociodemographic data. SUD patients with and without comorbid ADHD were compared on indicators of severity across 3 domains: addiction (number of SUD criteria and diagnoses), psychopathological complexity (mood disorders, borderline personality disorder, lifetime suicidal thoughts, or behavior), and social status (education level, occupational and marital status, and living arrangements). Regression models were built to account for confounders for each severity indicator. <b><i>Results:</i></b> Adult ADHD was present in 19% of the SUD patients. It was significantly associated with higher SUD severity, more frequent comorbid mood or borderline personality disorder, and less frequent "married" or "divorced" status, as compared with the absence of comorbid ADHD. ADHD comorbidity was independently associated with a higher number of dependence diagnoses (OR = 1.97) and more psychopathology (OR = 1.5), but not marital status. <b><i>Conclusions:</i></b> In treatment-seeking SUD patients, comorbid ADHD is associated with polysubstance dependence, psychopathological complexity, and social risks, which substantiates the clinical relevance of screening, diagnosing, and treating ADHD in patients with SUDs.

<b><i>Aims:</i></b> To examine the role of attention deficit/hyperactivity disorder (ADHD) and impulsive personality disorders in nicotine addiction severity among treatment-seeking substance use disorder (SUD) patients. <b><i>Methods:</i></b> In a cross-sectional study, we examined data from the second <i>International ADHD in Substance Use Disorders Prevalence Study</i> (<i>IASP-2</i>) on 402 adults in SUD treatment from Puerto Rico, Hungary, and Australia using diagnostic interviews for ADHD, antisocial (ASP) and borderline (BPD) personality disorders, and the self-report Fagerström Test of Nicotine Dependence (FTND). We compared SUD patients with and without ADHD on nicotine addiction severity. We tested direct and indirect pathways from ADHD to nicotine addiction and mediation through ASP and BPD. <b><i>Results:</i></b> Overall, 81.4% of SUD patients reported current cigarette smoking. SUD patients with ADHD had higher FTND scores and smoked more cigarettes than those without ADHD, with an earlier onset and more years of smoking. ASP mediated the effect of ADHD on all aspects of nicotine addiction severity, whereas BPD did so only on some aspects of nicotine addiction severity. <b><i>Conclusions:</i></b> SUD patients with comorbid ADHD show more severe nicotine addiction than those without, which is largely explained by comorbid impulsive personality disorders. In SUD patients, it is important to screen for adult ADHD and other psychiatric disorders, especially those with impulse control deficits such as ASP and BPD.