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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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
JMIR Publications
2021
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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 |
format | Online Article Text |
id | pubmed-8122293 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | JMIR Publications |
record_format | MEDLINE/PubMed |
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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