Computer-based programmes for the prevention and management of illicit recreational drug use: A systematic review Sara K. Wood, Lindsay Eckley, Karen Hughes, Katherine A. Hardcastle, Mark A. Bellis, Jochen Schrooten, Zsolt Demotrovics, Lotte Voorham PII: DOI: Reference:
S0306-4603(13)00269-4 doi: 10.1016/j.addbeh.2013.09.010 AB 4035
To appear in:
Addictive Behaviors
Please cite this article as: Wood, S.K., Eckley, L., Hughes, K., Hardcastle, K.A., Bellis, M.A., Schrooten, J., Demotrovics, Z. & Voorham, L., Computer-based programmes for the prevention and management of illicit recreational drug use: A systematic review, Addictive Behaviors (2013), doi: 10.1016/j.addbeh.2013.09.010
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ACCEPTED MANUSCRIPT Title: Computer-based programmes for the prevention and management of illicit
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recreational drug use: a systematic review.
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Authors: Sara K. Wood1*, Lindsay Eckley1, Karen Hughes1, Katherine A. Hardcastle1, Mark A. Bellis1, Jochen Schrooten2, Zsolt Demotrovics3 and Lotte Voorham4.
Centre for Public Health, Liverpool John Moores University 15-21 Webster Street, Liverpool L3 2ET, UK
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VAD (Vereniging voor Alcohol en andere Drugproblemen) Vanderlindenstraat 15, 1030 Brussels, Belgium
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Sara K. Wood (Senior Researcher) MSc; Lindsay Eckley (Senior Researcher) PhD; Karen Hughes (Reader in Behavioural Epidemiology) PhD; Katherine A. Hardcastle (Researcher) MSc; Mark A. Bellis (Director, Centre for Public Health and North West Public Health Observatory) DSc.
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Jochen Schrooten (Staff Officer), MSc Institute of Psychology, Eötvös Loránd University Budapest H-1064, Hungary
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Zsolt Demotrovics (Director, Institute of Psychology), PhD Trimbos Institute. Da Costakade 45, 3521 VS Utrecht, The Netherlands Lotte Voorham (Researcher), MSc
* Corresponding author Sara K Wood, Centre for Public Health, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK. E-mail: [email protected] Tel: 0151 231 4511; Fax: 0151 231 4552
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ACCEPTED MANUSCRIPT Abstract
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The last few decades have seen increasing use of computer-based programmes to address
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illicit recreational drug use but knowledge about their effectiveness is limited. We conducted
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a systematic review to examine evidence on these programmes. Eight electronic databases were searched to identify primary research studies evaluating computer-based programmes to prevent or reduce use of illicit recreational drugs. From an initial 3,413 extracted studies, 10
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were identified for inclusion, covering a range of intervention types, target groups and
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settings. Universal drug prevention programmes were effective in reducing the frequency of recreational drug use in the mid-term (12 months) and explore the use of programmes outside of English speaking countries. While it
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ACCEPTED MANUSCRIPT seems likely that computer-based programmes can be just as effective as professional led interventions, more research is needed to better understand the value of human contact in
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health interventions and to determine optimal levels of professional input.
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ACCEPTED MANUSCRIPT Role of funding sources The research leading to these results has received funding from the European Community's
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Drug Prevention and Information Programme under grant agreement no.
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JUST/2009/DPIP/AG/0930 - eSBIRTes (Electronic Screening, Brief Intervention and
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Referral to Treatment for (poly) drug users in Emergency Services. The funders had no role in the study design, collection, analysis or interpretation of data, writing the manuscript, or
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the decision to submit the paper for publication.
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Contributors
JS, ZD, LV, KH, SKW, MAB designed the study. LE, SKW, KH conducted literature
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searches, study selection, data extraction and quality assessment with input from KAH. SKW,
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KAH, KH, MAB wrote the manuscript with input from JS, ZD and LV. All authors reviewed
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the study findings and read and approved the final version before submission.
Conflict of Interest
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All authors declare that they have no conflicts of interest.
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ACCEPTED MANUSCRIPT Figure 1: sample search strategy (Medline)
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13. 14. 15. 16. 17. 18.
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10. 11. 12.
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8. 9.
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4. 5. 6. 7.
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3.
(MH "Substance-Related Disorders+") AB/TI (substance N2 abuse*) or (substance N2 use*) or (substance N2 misuse) or (substance N2 dependen*) or (substance N2 disorder*) or (substance N2 addict*) or (substance N2 volatile) or (substance N2 poly) AB/TI (Drug N2 abuse*) or (drug N2 use*) or (drug N2 misuse) or (drug N2 dependen*) or (drug N2 disorder*) or (drug N2 addict*) or (drug N2 volatile) or (drug N2 poly) cannabis or hashish or marijuana N-Methyl-3,4-methylenedioxyamphetamine or ecstasy or MDMA crack cocaine or cocaine GHB or gamma-Hydroxybutyric acid or gammahydroxybutyrate or gamma hydroxybutyrate or gamma hydroxyl butyrate or sodium oxybate Or/1-7 AB/TI (screening N2 tool*) or (screening N2 instrument*) or (screening N2 test) or (identify* N2 tool*) or (identify* N2 instrument*) or (identify* N2 test) AB/TI (brief N2 advice) or (brief N2 intervention*) or (brief N2 interview*) AB/TI (motivational N2 advice) or (motivational N2 intervention*) or (motivational N2 interview*) AB/TI (referral N2 guide*) or (referral N2 guidance) or (referral N2 tool*) or (referral N2 protocol*) or (referral N2 instrument) or (referral N2 pathway) AB/TI (referral N2 treatment) AB/TI (self-help or self-edu* or edu* or guid* or program* or module*) AB/TI (goal AND setting) Or/9-15 8 and 16 AB/TI (online or internet or web or world wide web or electronic or web site or web page or technology or computer*) 17 and 18
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1. 2.
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Figure 2: flow chart of search process
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5,272 references retrieved for title/abstract review
1 unpublished study identified from research group
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1,860 duplicates excluded 3,238 excluded; not relevant in answering the research questions
175 identified as potentially relevant and full-text reviewed
182 excluded: 129 not a computer based intervention 22 do not include drug related outcomes 15 targeted pregnant women or dependent substance users 5 included parental involvement 7 full paper not available 2 no control group for comparison 2 duplicated results from included paper
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17 additional relevant studies identified through checking reference lists
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10 included in review
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Confounders
Blinding
Budney et al (2011)
1
3
3
2
Deitz et al (2011)
1
3
1
Gilbert et al (2008)
1
3
3
Kay-Lambkin et al (2009)
1
3
1
Lee et al (2010)
1
3
3
Marsch et al (2006)
2
3
1
Newton et al (2010)
2
3
1
Schwinn et al (2010)
1
3
Tossman et al (2011)
1
3
Williams et al (2005)
2
3
OVERALL RATING
1
2
12
2
1
3
11
2
1
3
13
2
1
3
11
2
2
3
14
2
1
1
10
2
2
2
12
3
2
1
3
13
1
2
1
1
9
3
2
1
1
12
US MA N
Data collection
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Withdrawals
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Study design
CR
Selection bias
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Study and date
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Table 1: Study quality
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Quality assessments were made using the Quality Assessment Tool for Quantitative Studies (Effective Public Health Practice Project). Ratings were assessed as follows: 1 = weak; 2 = moderate; 3 = strong. A higher score indicates a better quality.
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Intervention
CR
Study design CT
Computer delivered nine session individual therapy including MET, CBT and CM. This included feedback report, goal setting exercises, and skills training (e.g. problem solving, coping, managing thoughts and drug refusal). Included three 15-30 min sessions with therapist. Duration: 12W.
CT
Web-based interactive program consisting of: medication facts; safe administration of prescription medicines; avoidance of drug abuse and alternatives to medications. Contained self assessments on current or anticipated drug use. Duration: 4W. Computer programme showing Video Doctor clips that delivered interactive risk reduction messages and educational worksheets. The programme produced a cue sheet for medical providers suggesting counselling statements. Booster video clip session at 3M. Duration: Brief session lasting 24 minutes, plus additional booster session at 3M. Brief intervention for depression and substance misuse, nine sessions of MI and CBT delivered by computer, and brief 10-15 minute weekly psychologist input. Duration: 3M
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Age 18+; DSM-IV diagnosis of cannabis abuse, use cannabis on >=50D in past 90D; no dependence on alcohol/other drugs; no treatment for drug use; no emotional distress. Access to a computer with internet.
Workplace; female employees of a hospital.
Gilbert et al (2008) USA
Outpatient clinics; HIV affected outpatients
Aged 18+; HIV+ for 3M or longer;
RCT
KayLambkin et al (2009) Australia
Community; members of the community or those referred from alcohol treatment, mental health or primary health care settings with comorbid depression and substance
Score of 17+ Beck Depression Inventory II; lifetime diagnosis of major depressive disorder, current problematic alcohol disorder/weekly use of cannabis; absence of brain injury or cognitive impairment; aged 16+; ability to
RCT
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Deitz et al (2011) USA
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Community; Members of the local community seeking treatment for cannabis use disorder.
Eligibility criteria
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Setting and target sample
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Author year and country Budney et al (2011) USA
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Table 2: Study characteristics
Control or comparison
Mean age (range) I: 32.9 C: 32.7
N
% male
Retenti on
Therapist delivered nine session individual therapy involving the same components as the computer intervention. Duration: 12W. Wait-list control group.
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47%
362
0%
44 (21-75)
95%
Usual care
476
79%
I: 43.9 C: 44.3
82-83%
1) Brief intervention plus no further treatment. 2) Brief intervention plus nine sessions of MI and CBT delivered by psychologist. Duration: 3M
97
46%
35.4 (18-61)
85%
61%
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Eligibility criteria
Lee et al (2010) USA
misuse. College; first year marijuana using students at a US university.
understand English. Aged between 17 and 19; use of any marijuana in the last 3M.
School; 7th grade students in four public schools across the state of Vermont. School; Year 8 students from 10 independent schools across Sydney.
NR
CT
NR
RCT
Schwinn et al USA& Canada
Internet; 7th, 8th and 9th grade girls accessing the website kiwibox.com
NR
RCT
Tossman et al (2011) Germany
Internet; “Quit the Shit” website users wishing to reduce/ cease cannabis use School; 6th and 7th grade students from public schools in New York
NR
RCT
NR
RCT
Williams et al (2005) USA
N
% male
Mean age (range)
No intervention
341
45%
18.0
92% 6M follow up
Drug abuse prevention (15 sessions) given by teacher. Duration: academic year. Usual health classes, most including syllabusbased drug education. Duration: academic year No intervention
272
55%
I:12.5 C:12.2
NR
764
60%
13.1
79% 12M follow up.
236
0%
14
91% 6M follow up
Online counselling programme including 50 minute online chat with psychotherapist, online cannabis use diary and detailed personal feedback by counsellor each week Duration: 50 days
Wait list control group
129 2
71%
24.7
48%
10 session computer based substance abuse prevention programme using interactive audio and video content. Included knowledge and skill based components for resisting social influences and reducing motivation to use substances. Duration: 6W
No intervention (wait list control group)
230
50%
NR (12-13)
53%
Personalised computerised feedback intervention based on MI. Included feedback on marijuana use, perceived and actual norms, perceived pros/cons of using, and training for avoiding/changing use of marijuana. Duration: not reported Interactive computer based drug prevention programme (15 sessions) promoting protective factors, training in drug refusal skills, social competency and attitudes against drug use. Duration: academic year Alcohol and cannabis prevention programme; 12 lessons including reasons for using cannabis and its consequences, and drug refusal skills. Lessons comprised a 15-20 minute internet component followed by a teacher-delivered activity. Duration: 6M
CR
US
MA N
TE D
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Newton et al (2010) Australia
RCT
Control or comparison
Intervention
12 internet based sessions covering personal and social skills and skills specific to dealing with drug use opportunities, e.g. goal setting, decision making, coping, self esteem, peer pressure and drug facts. Duration: 6 weeks
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Marsch et al (2006) USA
Study design
T
Setting and target sample
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Author year and country
Retenti on
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ACCEPTED MANUSCRIPT
MET = motivational enhancement therapy; CBT = cognitive behavioural therapy; CM = contingency management; MI = motivational interviewing; NR = not reported; CT = controlled trial;
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MA N
US
CR
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RCT = randomised controlled trial; I = intervention; C=control; M = months; W = weeks; D = days
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NR
No intervention (wait-list control)
Nonmedical sedative use (Yes/No)
NR
No intervention (wait-list control)
Nonmedical tranquiliser use (Yes/No) Nonmedical stimulants use (Yes/No) Marijuana use (frequency scale)
NR
Last 30 days
No intervention
≈ -0.23 ≈ 0.19 ≈ 0.41 ≈ 1.03 ≈
Polydrug use (frequency scale)
Last 30 days
No intervention
≈
Drug use (frequency scale)
Current
No intervention (wait-list control)
≈
Newton et al (2010)
Past 3 months
Usual health classes
≈ 0.17
Alternative drug prevention training
≈
Cannabis use (frequency scale)
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Williams et al (2005)
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Schwinn et al (2010)
NR
CR
Comparison group
UNIVERSAL PROGRAMMES Nonmedical analgesic use (Yes/No)
Deitz et al (2011)
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Marijuana use (frequency scale) Current Marsch et al (2006) PROGRAMMES TARGETING RECREATIONAL DRUG USERS Marijuana use (days) Past 3 months Lee et al (2010) Tossman et al (2011)
No intervention (wait-list control) No intervention (wait-list control)
Kay-Lambkin et al (2009) Kay-Lambkin et al
12 M
-0.32 -0.34 -0.17
≈ 0.01
No intervention
≈ -0.22
≈ -0.05
-0.23
Cannabis use (days)
Last 30 days
No intervention (wait-list control)
Drug use (yes/no)
Current
Usual care
Drug use (days) Cannabis use (% days used)
Past month Last 90 days
Usual care Therapist delivered therapy
Cannabis use (occasions per day)
Past month
Brief intervention only
Cannabis use (occasions per day)
Past month
Therapist delivered intervention
≈
Gilbert et al (2008) Budney et al (2011)
Follow up period, effect and effect size PI 40D 3M 6M 9M
Time frame
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Outcome
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Study
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Table 3: Observed effects of interventions on drug behaviours, effect and effect size (where calculable)
-0.46 ≈ ≈ -0.10
-0.88 ≈
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Study
Outcome
Time frame
Comparison group
12 M
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(2009)
Follow up period, effect and effect size PI 40D 3M 6M 9M
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MA N
US
CR
PI=post intervention; D=days; M=months; NR=not reported; ≈=no significant difference between groups; =significant improvement for intervention group vs. comparison.
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ACCEPTED MANUSCRIPT Highlights
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We conducted a systematic review of computer-based programmes to address recreational drug use. Universal programmes reduced the frequency of use in the mid-term only (
S0306-4603(13)00269-4 doi: 10.1016/j.addbeh.2013.09.010 AB 4035
To appear in:
Addictive Behaviors
Please cite this article as: Wood, S.K., Eckley, L., Hughes, K., Hardcastle, K.A., Bellis, M.A., Schrooten, J., Demotrovics, Z. & Voorham, L., Computer-based programmes for the prevention and management of illicit recreational drug use: A systematic review, Addictive Behaviors (2013), doi: 10.1016/j.addbeh.2013.09.010
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ACCEPTED MANUSCRIPT Title: Computer-based programmes for the prevention and management of illicit
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recreational drug use: a systematic review.
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Authors: Sara K. Wood1*, Lindsay Eckley1, Karen Hughes1, Katherine A. Hardcastle1, Mark A. Bellis1, Jochen Schrooten2, Zsolt Demotrovics3 and Lotte Voorham4.
Centre for Public Health, Liverpool John Moores University 15-21 Webster Street, Liverpool L3 2ET, UK
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VAD (Vereniging voor Alcohol en andere Drugproblemen) Vanderlindenstraat 15, 1030 Brussels, Belgium
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Sara K. Wood (Senior Researcher) MSc; Lindsay Eckley (Senior Researcher) PhD; Karen Hughes (Reader in Behavioural Epidemiology) PhD; Katherine A. Hardcastle (Researcher) MSc; Mark A. Bellis (Director, Centre for Public Health and North West Public Health Observatory) DSc.
3
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Jochen Schrooten (Staff Officer), MSc Institute of Psychology, Eötvös Loránd University Budapest H-1064, Hungary
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Zsolt Demotrovics (Director, Institute of Psychology), PhD Trimbos Institute. Da Costakade 45, 3521 VS Utrecht, The Netherlands Lotte Voorham (Researcher), MSc
* Corresponding author Sara K Wood, Centre for Public Health, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK. E-mail: [email protected] Tel: 0151 231 4511; Fax: 0151 231 4552
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ACCEPTED MANUSCRIPT Abstract
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The last few decades have seen increasing use of computer-based programmes to address
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illicit recreational drug use but knowledge about their effectiveness is limited. We conducted
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a systematic review to examine evidence on these programmes. Eight electronic databases were searched to identify primary research studies evaluating computer-based programmes to prevent or reduce use of illicit recreational drugs. From an initial 3,413 extracted studies, 10
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were identified for inclusion, covering a range of intervention types, target groups and
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settings. Universal drug prevention programmes were effective in reducing the frequency of recreational drug use in the mid-term (12 months) and explore the use of programmes outside of English speaking countries. While it
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ACCEPTED MANUSCRIPT seems likely that computer-based programmes can be just as effective as professional led interventions, more research is needed to better understand the value of human contact in
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health interventions and to determine optimal levels of professional input.
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ACCEPTED MANUSCRIPT Role of funding sources The research leading to these results has received funding from the European Community's
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Drug Prevention and Information Programme under grant agreement no.
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JUST/2009/DPIP/AG/0930 - eSBIRTes (Electronic Screening, Brief Intervention and
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Referral to Treatment for (poly) drug users in Emergency Services. The funders had no role in the study design, collection, analysis or interpretation of data, writing the manuscript, or
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the decision to submit the paper for publication.
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Contributors
JS, ZD, LV, KH, SKW, MAB designed the study. LE, SKW, KH conducted literature
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searches, study selection, data extraction and quality assessment with input from KAH. SKW,
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KAH, KH, MAB wrote the manuscript with input from JS, ZD and LV. All authors reviewed
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the study findings and read and approved the final version before submission.
Conflict of Interest
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All authors declare that they have no conflicts of interest.
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ACCEPTED MANUSCRIPT Figure 1: sample search strategy (Medline)
19.
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13. 14. 15. 16. 17. 18.
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10. 11. 12.
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8. 9.
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4. 5. 6. 7.
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3.
(MH "Substance-Related Disorders+") AB/TI (substance N2 abuse*) or (substance N2 use*) or (substance N2 misuse) or (substance N2 dependen*) or (substance N2 disorder*) or (substance N2 addict*) or (substance N2 volatile) or (substance N2 poly) AB/TI (Drug N2 abuse*) or (drug N2 use*) or (drug N2 misuse) or (drug N2 dependen*) or (drug N2 disorder*) or (drug N2 addict*) or (drug N2 volatile) or (drug N2 poly) cannabis or hashish or marijuana N-Methyl-3,4-methylenedioxyamphetamine or ecstasy or MDMA crack cocaine or cocaine GHB or gamma-Hydroxybutyric acid or gammahydroxybutyrate or gamma hydroxybutyrate or gamma hydroxyl butyrate or sodium oxybate Or/1-7 AB/TI (screening N2 tool*) or (screening N2 instrument*) or (screening N2 test) or (identify* N2 tool*) or (identify* N2 instrument*) or (identify* N2 test) AB/TI (brief N2 advice) or (brief N2 intervention*) or (brief N2 interview*) AB/TI (motivational N2 advice) or (motivational N2 intervention*) or (motivational N2 interview*) AB/TI (referral N2 guide*) or (referral N2 guidance) or (referral N2 tool*) or (referral N2 protocol*) or (referral N2 instrument) or (referral N2 pathway) AB/TI (referral N2 treatment) AB/TI (self-help or self-edu* or edu* or guid* or program* or module*) AB/TI (goal AND setting) Or/9-15 8 and 16 AB/TI (online or internet or web or world wide web or electronic or web site or web page or technology or computer*) 17 and 18
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1. 2.
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Figure 2: flow chart of search process
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5,272 references retrieved for title/abstract review
1 unpublished study identified from research group
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1,860 duplicates excluded 3,238 excluded; not relevant in answering the research questions
175 identified as potentially relevant and full-text reviewed
182 excluded: 129 not a computer based intervention 22 do not include drug related outcomes 15 targeted pregnant women or dependent substance users 5 included parental involvement 7 full paper not available 2 no control group for comparison 2 duplicated results from included paper
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17 additional relevant studies identified through checking reference lists
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10 included in review
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Confounders
Blinding
Budney et al (2011)
1
3
3
2
Deitz et al (2011)
1
3
1
Gilbert et al (2008)
1
3
3
Kay-Lambkin et al (2009)
1
3
1
Lee et al (2010)
1
3
3
Marsch et al (2006)
2
3
1
Newton et al (2010)
2
3
1
Schwinn et al (2010)
1
3
Tossman et al (2011)
1
3
Williams et al (2005)
2
3
OVERALL RATING
1
2
12
2
1
3
11
2
1
3
13
2
1
3
11
2
2
3
14
2
1
1
10
2
2
2
12
3
2
1
3
13
1
2
1
1
9
3
2
1
1
12
US MA N
Data collection
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Withdrawals
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Study design
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Selection bias
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Study and date
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Table 1: Study quality
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Quality assessments were made using the Quality Assessment Tool for Quantitative Studies (Effective Public Health Practice Project). Ratings were assessed as follows: 1 = weak; 2 = moderate; 3 = strong. A higher score indicates a better quality.
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Intervention
CR
Study design CT
Computer delivered nine session individual therapy including MET, CBT and CM. This included feedback report, goal setting exercises, and skills training (e.g. problem solving, coping, managing thoughts and drug refusal). Included three 15-30 min sessions with therapist. Duration: 12W.
CT
Web-based interactive program consisting of: medication facts; safe administration of prescription medicines; avoidance of drug abuse and alternatives to medications. Contained self assessments on current or anticipated drug use. Duration: 4W. Computer programme showing Video Doctor clips that delivered interactive risk reduction messages and educational worksheets. The programme produced a cue sheet for medical providers suggesting counselling statements. Booster video clip session at 3M. Duration: Brief session lasting 24 minutes, plus additional booster session at 3M. Brief intervention for depression and substance misuse, nine sessions of MI and CBT delivered by computer, and brief 10-15 minute weekly psychologist input. Duration: 3M
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Age 18+; DSM-IV diagnosis of cannabis abuse, use cannabis on >=50D in past 90D; no dependence on alcohol/other drugs; no treatment for drug use; no emotional distress. Access to a computer with internet.
Workplace; female employees of a hospital.
Gilbert et al (2008) USA
Outpatient clinics; HIV affected outpatients
Aged 18+; HIV+ for 3M or longer;
RCT
KayLambkin et al (2009) Australia
Community; members of the community or those referred from alcohol treatment, mental health or primary health care settings with comorbid depression and substance
Score of 17+ Beck Depression Inventory II; lifetime diagnosis of major depressive disorder, current problematic alcohol disorder/weekly use of cannabis; absence of brain injury or cognitive impairment; aged 16+; ability to
RCT
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Deitz et al (2011) USA
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Community; Members of the local community seeking treatment for cannabis use disorder.
Eligibility criteria
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Setting and target sample
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Author year and country Budney et al (2011) USA
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Table 2: Study characteristics
Control or comparison
Mean age (range) I: 32.9 C: 32.7
N
% male
Retenti on
Therapist delivered nine session individual therapy involving the same components as the computer intervention. Duration: 12W. Wait-list control group.
38
47%
362
0%
44 (21-75)
95%
Usual care
476
79%
I: 43.9 C: 44.3
82-83%
1) Brief intervention plus no further treatment. 2) Brief intervention plus nine sessions of MI and CBT delivered by psychologist. Duration: 3M
97
46%
35.4 (18-61)
85%
61%
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Eligibility criteria
Lee et al (2010) USA
misuse. College; first year marijuana using students at a US university.
understand English. Aged between 17 and 19; use of any marijuana in the last 3M.
School; 7th grade students in four public schools across the state of Vermont. School; Year 8 students from 10 independent schools across Sydney.
NR
CT
NR
RCT
Schwinn et al USA& Canada
Internet; 7th, 8th and 9th grade girls accessing the website kiwibox.com
NR
RCT
Tossman et al (2011) Germany
Internet; “Quit the Shit” website users wishing to reduce/ cease cannabis use School; 6th and 7th grade students from public schools in New York
NR
RCT
NR
RCT
Williams et al (2005) USA
N
% male
Mean age (range)
No intervention
341
45%
18.0
92% 6M follow up
Drug abuse prevention (15 sessions) given by teacher. Duration: academic year. Usual health classes, most including syllabusbased drug education. Duration: academic year No intervention
272
55%
I:12.5 C:12.2
NR
764
60%
13.1
79% 12M follow up.
236
0%
14
91% 6M follow up
Online counselling programme including 50 minute online chat with psychotherapist, online cannabis use diary and detailed personal feedback by counsellor each week Duration: 50 days
Wait list control group
129 2
71%
24.7
48%
10 session computer based substance abuse prevention programme using interactive audio and video content. Included knowledge and skill based components for resisting social influences and reducing motivation to use substances. Duration: 6W
No intervention (wait list control group)
230
50%
NR (12-13)
53%
Personalised computerised feedback intervention based on MI. Included feedback on marijuana use, perceived and actual norms, perceived pros/cons of using, and training for avoiding/changing use of marijuana. Duration: not reported Interactive computer based drug prevention programme (15 sessions) promoting protective factors, training in drug refusal skills, social competency and attitudes against drug use. Duration: academic year Alcohol and cannabis prevention programme; 12 lessons including reasons for using cannabis and its consequences, and drug refusal skills. Lessons comprised a 15-20 minute internet component followed by a teacher-delivered activity. Duration: 6M
CR
US
MA N
TE D
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Newton et al (2010) Australia
RCT
Control or comparison
Intervention
12 internet based sessions covering personal and social skills and skills specific to dealing with drug use opportunities, e.g. goal setting, decision making, coping, self esteem, peer pressure and drug facts. Duration: 6 weeks
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Marsch et al (2006) USA
Study design
T
Setting and target sample
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Author year and country
Retenti on
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MET = motivational enhancement therapy; CBT = cognitive behavioural therapy; CM = contingency management; MI = motivational interviewing; NR = not reported; CT = controlled trial;
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MA N
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CR
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RCT = randomised controlled trial; I = intervention; C=control; M = months; W = weeks; D = days
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NR
No intervention (wait-list control)
Nonmedical sedative use (Yes/No)
NR
No intervention (wait-list control)
Nonmedical tranquiliser use (Yes/No) Nonmedical stimulants use (Yes/No) Marijuana use (frequency scale)
NR
Last 30 days
No intervention
≈ -0.23 ≈ 0.19 ≈ 0.41 ≈ 1.03 ≈
Polydrug use (frequency scale)
Last 30 days
No intervention
≈
Drug use (frequency scale)
Current
No intervention (wait-list control)
≈
Newton et al (2010)
Past 3 months
Usual health classes
≈ 0.17
Alternative drug prevention training
≈
Cannabis use (frequency scale)
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Williams et al (2005)
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Schwinn et al (2010)
NR
CR
Comparison group
UNIVERSAL PROGRAMMES Nonmedical analgesic use (Yes/No)
Deitz et al (2011)
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Marijuana use (frequency scale) Current Marsch et al (2006) PROGRAMMES TARGETING RECREATIONAL DRUG USERS Marijuana use (days) Past 3 months Lee et al (2010) Tossman et al (2011)
No intervention (wait-list control) No intervention (wait-list control)
Kay-Lambkin et al (2009) Kay-Lambkin et al
12 M
-0.32 -0.34 -0.17
≈ 0.01
No intervention
≈ -0.22
≈ -0.05
-0.23
Cannabis use (days)
Last 30 days
No intervention (wait-list control)
Drug use (yes/no)
Current
Usual care
Drug use (days) Cannabis use (% days used)
Past month Last 90 days
Usual care Therapist delivered therapy
Cannabis use (occasions per day)
Past month
Brief intervention only
Cannabis use (occasions per day)
Past month
Therapist delivered intervention
≈
Gilbert et al (2008) Budney et al (2011)
Follow up period, effect and effect size PI 40D 3M 6M 9M
Time frame
US
Outcome
MA N
Study
IP
T
Table 3: Observed effects of interventions on drug behaviours, effect and effect size (where calculable)
-0.46 ≈ ≈ -0.10
-0.88 ≈
30
ACCEPTED MANUSCRIPT
Study
Outcome
Time frame
Comparison group
12 M
IP
T
(2009)
Follow up period, effect and effect size PI 40D 3M 6M 9M
AC
CE P
TE D
MA N
US
CR
PI=post intervention; D=days; M=months; NR=not reported; ≈=no significant difference between groups; =significant improvement for intervention group vs. comparison.
31
ACCEPTED MANUSCRIPT Highlights
T
IP
SC R NU MA D TE CE P
We conducted a systematic review of computer-based programmes to address recreational drug use. Universal programmes reduced the frequency of use in the mid-term only (
