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CANreduce 2.0 Adherence-Focused Guidance for Internet Self-Help Among Cannabis Users: Three-Arm Randomized Controlled Trial

BACKGROUND: Despite increasing demand for treatment among cannabis users in many countries, most users are not in treatment. Internet-based self-help offers an alternative for those hesitant to seek face-to-face therapy, though low effectiveness and adherence issues often arise. OBJECTIVE: Through a...

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Autores principales: Baumgartner, Christian, Schaub, Michael Patrick, Wenger, Andreas, Malischnig, Doris, Augsburger, Mareike, Walter, Marc, Berger, Thomas, Stark, Lars, Ebert, David Daniel, Keough, Matthew T, Haug, Severin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122293/
https://www.ncbi.nlm.nih.gov/pubmed/33929333
http://dx.doi.org/10.2196/27463
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author Baumgartner, Christian
Schaub, Michael Patrick
Wenger, Andreas
Malischnig, Doris
Augsburger, Mareike
Walter, Marc
Berger, Thomas
Stark, Lars
Ebert, David Daniel
Keough, Matthew T
Haug, Severin
author_facet Baumgartner, Christian
Schaub, Michael Patrick
Wenger, Andreas
Malischnig, Doris
Augsburger, Mareike
Walter, Marc
Berger, Thomas
Stark, Lars
Ebert, David Daniel
Keough, Matthew T
Haug, Severin
author_sort Baumgartner, Christian
collection PubMed
description BACKGROUND: Despite increasing demand for treatment among cannabis users in many countries, most users are not in treatment. Internet-based self-help offers an alternative for those hesitant to seek face-to-face therapy, though low effectiveness and adherence issues often arise. OBJECTIVE: Through adherence-focused guidance enhancement, we aimed to increase adherence to and the effectiveness of internet-based self-help among cannabis users. METHODS: From July 2016 to May 2019, cannabis users (n=775; male: 406/575, 70.6%, female: 169/575, 29.4%; age: mean 28.3 years) not in treatment were recruited from the general population and were randomly assigned to (1) an adherence-focused guidance enhancement internet-based self-help intervention with social presence, (2) a similar intervention with an impersonal service team, and (3) access to internet as usual. Controls who were placed on a waiting list for the full intervention after 3 months underwent an assessment and had access to internet as usual. The primary outcome measurement was cannabis-use days over the preceding 30 days. Secondary outcomes included cannabis-dependence severity, changes in common mental disorder symptoms, and intervention adherence. Differences between the study arms in primary and secondary continuous outcome variables at baseline, posttreatment, and follow-up were tested using pooled linear models. RESULTS: All groups exhibited reduced cannabis-use days after 3 months (social presence: –8.2 days; service team: –9.8 days; internet as usual: –4.2 days). The participants in the service team group (P=.01, d=.60) reported significantly fewer cannabis-use days than those in the internet as usual group; the reduction of cannabis use in the social presence group was not significant (P=.07, d=.40). There was no significant difference between the 2 intervention groups regarding cannabis-use reduction. The service team group also exhibited superior improvements in cannabis-use disorder, cannabis-dependence severity, and general anxiety symptoms after 3 months to those in the internet as usual group. CONCLUSIONS: The adherence-focused guidance enhancement internet-based self-help intervention with an impersonal service team significantly reduced cannabis use, cannabis-use disorder, dependence severity, and general anxiety symptoms. TRIAL REGISTRATION: ISRCTN Registry ISRCTN11086185; http://www.isrctn.com/ISRCTN11086185
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spelling pubmed-81222932021-06-02 CANreduce 2.0 Adherence-Focused Guidance for Internet Self-Help Among Cannabis Users: Three-Arm Randomized Controlled Trial Baumgartner, Christian Schaub, Michael Patrick Wenger, Andreas Malischnig, Doris Augsburger, Mareike Walter, Marc Berger, Thomas Stark, Lars Ebert, David Daniel Keough, Matthew T Haug, Severin J Med Internet Res Original Paper BACKGROUND: Despite increasing demand for treatment among cannabis users in many countries, most users are not in treatment. Internet-based self-help offers an alternative for those hesitant to seek face-to-face therapy, though low effectiveness and adherence issues often arise. OBJECTIVE: Through adherence-focused guidance enhancement, we aimed to increase adherence to and the effectiveness of internet-based self-help among cannabis users. METHODS: From July 2016 to May 2019, cannabis users (n=775; male: 406/575, 70.6%, female: 169/575, 29.4%; age: mean 28.3 years) not in treatment were recruited from the general population and were randomly assigned to (1) an adherence-focused guidance enhancement internet-based self-help intervention with social presence, (2) a similar intervention with an impersonal service team, and (3) access to internet as usual. Controls who were placed on a waiting list for the full intervention after 3 months underwent an assessment and had access to internet as usual. The primary outcome measurement was cannabis-use days over the preceding 30 days. Secondary outcomes included cannabis-dependence severity, changes in common mental disorder symptoms, and intervention adherence. Differences between the study arms in primary and secondary continuous outcome variables at baseline, posttreatment, and follow-up were tested using pooled linear models. RESULTS: All groups exhibited reduced cannabis-use days after 3 months (social presence: –8.2 days; service team: –9.8 days; internet as usual: –4.2 days). The participants in the service team group (P=.01, d=.60) reported significantly fewer cannabis-use days than those in the internet as usual group; the reduction of cannabis use in the social presence group was not significant (P=.07, d=.40). There was no significant difference between the 2 intervention groups regarding cannabis-use reduction. The service team group also exhibited superior improvements in cannabis-use disorder, cannabis-dependence severity, and general anxiety symptoms after 3 months to those in the internet as usual group. CONCLUSIONS: The adherence-focused guidance enhancement internet-based self-help intervention with an impersonal service team significantly reduced cannabis use, cannabis-use disorder, dependence severity, and general anxiety symptoms. TRIAL REGISTRATION: ISRCTN Registry ISRCTN11086185; http://www.isrctn.com/ISRCTN11086185 JMIR Publications 2021-04-30 /pmc/articles/PMC8122293/ /pubmed/33929333 http://dx.doi.org/10.2196/27463 Text en ©Christian Baumgartner, Michael Patrick Schaub, Andreas Wenger, Doris Malischnig, Mareike Augsburger, Marc Walter, Thomas Berger, Lars Stark, David Daniel Ebert, Matthew T Keough, Severin Haug. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.04.2021. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Baumgartner, Christian
Schaub, Michael Patrick
Wenger, Andreas
Malischnig, Doris
Augsburger, Mareike
Walter, Marc
Berger, Thomas
Stark, Lars
Ebert, David Daniel
Keough, Matthew T
Haug, Severin
CANreduce 2.0 Adherence-Focused Guidance for Internet Self-Help Among Cannabis Users: Three-Arm Randomized Controlled Trial
title CANreduce 2.0 Adherence-Focused Guidance for Internet Self-Help Among Cannabis Users: Three-Arm Randomized Controlled Trial
title_full CANreduce 2.0 Adherence-Focused Guidance for Internet Self-Help Among Cannabis Users: Three-Arm Randomized Controlled Trial
title_fullStr CANreduce 2.0 Adherence-Focused Guidance for Internet Self-Help Among Cannabis Users: Three-Arm Randomized Controlled Trial
title_full_unstemmed CANreduce 2.0 Adherence-Focused Guidance for Internet Self-Help Among Cannabis Users: Three-Arm Randomized Controlled Trial
title_short CANreduce 2.0 Adherence-Focused Guidance for Internet Self-Help Among Cannabis Users: Three-Arm Randomized Controlled Trial
title_sort canreduce 2.0 adherence-focused guidance for internet self-help among cannabis users: three-arm randomized controlled trial
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122293/
https://www.ncbi.nlm.nih.gov/pubmed/33929333
http://dx.doi.org/10.2196/27463
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