Overcoming Addictions, a web-based application, & SMART Recovery: Outcomes of a randomized clinical trial

This week's entry comes from Dr Reid K Hester, PhD. He is Director of the Research Division at Behavior Therapy Associates, LLC, where they have been conducting some exciting new research using a web-based application, Overcoming Addictions. Thank you, Dr Hester, for the guest post:

Overcoming Addictions, a web-based application, & SMART Recovery: Outcomes of a 

randomized clinical trial

My research staff and I recently published the early outcomes of a new web app, Overcoming Addictions in the Journal of Medical Internet Research (http://www.jmir.org/2013/7/e134). Overcoming Addictions (OA, www.overcomingaddictions.net) is an abstinence-oriented, cognitive behavioral program based on the protocol of SMART Recovery. SMART Recovery (www.smartrecovery.org) is an organization that has adapted empirically supported treatment strategies for use in a mutual help framework with in-person meetings, online meetings, a forum and other resources.

A firm believer of “In God we trust, everyone else has to show their data,” we evaluated the effectiveness of OA and SMART Recovery (SR) with problem drinkers in a randomized clinical trial. We recruited 189 heavy problem drinkers primarily through SMART Recovery’s web site and their online and in-person meetings. We randomly assigned them to: (1) OA alone, (2) OA+ attend SMART Recovery meetings (OA +SR), or to (3) attend SMART Recovery meetings (SR) only. Outcome measures included self-reported percent days abstinent, mean drinks per day when they did drink , and alcohol/drug related consequences. We also interviewed significant others to corroborate the participant’s self-report.

We predicted that: (1) All groups would reduce their drinking and alcohol/drug related consequences at follow-up compared to their baseline levels; (2) the OA groups would reduce their drinking and alcohol/drug related consequences more than the control group (SR).

There were several striking features of our participants. First, 60% of them were female. While this is consistent with the clinical trials of our other web applications like the Drinker’s Check-up (www.drinkerscheckup.com) and Moderate Drinking (www.moderatedrinking.com), it is significantly more than what one would predict given the prevalence of problem drinking in women versus men (35 vs. 65% respectively) in the epidemiological data. Second, this was a highly educated group with an average of 16 years of education. Third, while these folks were not seeking formal treatment, they had a level of alcohol problems comparable to the outpatient arm of Project MATCH.

At the 3 month follow-up both the intent-to-treat analyses and the actual use analyses showed highly significant improvement from baseline to follow-ups.  Mean within-subject effect sizes were large (d > .8) overall. There were, however, no significant differences between groups. Participants in all groups significantly increased their percent days abstinent from 44% to 72% (P<.001), decreased their mean drinks per drinking day from 8.0 to 4.6 (P<.001), and decreased their alcohol/drug-related problems (P<.001) by about 50%. These are clinically meaningful improvements in outcomes.

These outcomes indicate that both our Overcoming Addictions web app and attending SMART Recovery meetings and using their resources online (www.smartrecovery.org) were effective in helping people recover from their problem drinking.

These graphs reflect outcomes of the actual use analyses.

Navy Offers On-Line Help for Addictions

Now, if only they'd offer CBT and medications as well... (sigh)

MW

October 3, 2010



Navy Offers Sailors Online Help to Quit Addictions



By THE ASSOCIATED PRESS

Filed at 1:13 p.m. ET



RICHMOND, Va. (AP) — The Navy is teaming up with a highly regarded addiction treatment center to provide Web-based support for thousands of sailors, their families and retired personnel struggling with alcohol and drug abuse.



The $3.25 million program is intended to keep sailors with addiction problems on the road to recovery and links them to support programs anywhere in the world, at anytime, even when they're deployed. It is tailored primarily to younger sailors, who are at greater risk and are comfortable navigating the Internet and social programs.



It was developed in collaboration with Hazelden, a nonprofit alcohol and drug addiction treatment center based in Minnesota, and aimed at the 10,000 patients who receive primary treatment annually under the Navy's Substance Abuse and Rehabilitation Services program. While families and retired Navy also receive treatment, the majority of patients are on active duty.



The online program launched in August is called Navy MORE, an acronym for My Ongoing Recovery Experience. An estimated 1,000 patients are expected to use the program in its first year.



"It's patient-centered care," said Master Chief Michael P. Brown, a Navy recovery coach for the Pacific Northwest, the Great Lakes and Hawaii. "We just assist them along the way.



Capt. Richard D. Bergthold, a clinical psychologist with the Navy, said the program is tailored to military use but also provides the continuing, immediately accessible support and resources that anyone overcoming addiction needs.



"We know it's the investment in the continuing care that makes or breaks a successful treatment," said Bergthold, chief of staff for the Navy's Wounded, Ill and Injured directorate. "We recognize more and more the importance of maintaining continuous engagement with an individual's recovery plan."



A 2005 Department of Defense study found that all military personnel between the ages of 18-25 were more likely to drink heavily than their civilian counterparts. Seventeen percent of Navy personnel described themselves as heavy drinkers, defined as someone who consumes five or more alcoholic drinks at one sitting at least once a week. Illicit drug use has trended down over the past few decades, according to the Pentagon.



Hazelden, which has worked with the Navy for 10 years and already trains Navy counselors, developed MORE over several years to help sailors who have struggled with addiction problems to stay clean and sober once they have gone through the Navy's treatment program.



"One of the main reasons for relapse is the loss of that connectivity during early recovery," said Nick Motu, a Hazelden vice president who worked with the Navy on the program. "We believe that if you can maintain a real solid recovery platform for the first 18 months, the chances of your success and long-term recovery are much higher."



Navy MORE extends this connectivity by putting Navy-specific programs online, including 12-step recovery approaches and a suicide hotline as well as treatment programs tailored to sailors or retirees who are suffering from post traumatic stress disorder.



Sailors, their families and retirees also will have access to a virtual "recovery coach" to manage their post-treatment progress; an online library of recovery topics; and online support groups, including real-time connections with counselors.



"They don't have access to the traditional recovery communities that someone on the outside world would have," Motu said of sailors who are deployed around the world.



While a sailor assigned to an aircraft carrier would have access to program counselors, other military personnel including Marines in a carrier group might not have the same access to services, Bergthold said.



The Web program's key benefits are immediacy and the ability to access resources with the click of a mouse.



"It's when they go back to their homes, when they go back to their ships, when they go into the increasingly stressful environments in which they work that they require these continuing care services," he said.



Brown, who is based at Naval Hospital Bremerton in Washington, said it's in the Navy's interest to return "productive sailors to the fleet."



"Everyone in life has their bumps. We're here to assist them and we're here to help them on their path," he said.



The program is free to its users and the Navy has signed a five-year contract. Motu said Hazelden is in discussions with other branches of the military to develop similar programs.



___



Online:



Navy MORE: http://www.navymore.org/home.html

Do computerized assessments and interventions work?

Here's a recent review of internet based assessment and intervention sites:

Journal of Substance Abuse Treatment

Volume 38, Issue 3, April 2010, Pages 203-211

Regular article

A review of computer-based alcohol problem services designed for the general public

Michael L. Vernon Ph.D., a,

a Alcohol Research Group, Emeryville, CA, USA

Abstract

This review summarizes the literature on computer-based drinking assessment and intervention programs evaluated using members of the general public. The primary aim was to summarize the demand, usage, and effectiveness of these services. A systematic search of the literature identified seven online drinking assessments and eight computerized interventions that were evaluated using members of the general public. Internet assessment users tend to be in their early 30s, are more often male, tend to be at risk for or are experiencing alcohol-related problems, more fully explore assessment sites, and are more likely to enroll in interventions linked to these sites when their drinking problem is more severe. Although dropout from computer-based interventions is often very high and treatment models vary widely, program completers appear to show improvements.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T90-4XY3KB6-4&_user=10843&_coverDate=04%2F30%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000000150&_version=1&_urlVersion=0&_userid=10843&md5=a4af488b2a9d2006da9fd4d063ed948c