Tait Robert J, McKetin Rebecca, Kay-Lambkin Frances, Carron-Arthur Bradley, Bennett Anthony, Bennett Kylie, Christensen Helen, Griffiths Kathleen M
National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.
J Med Internet Res. 2015 Apr 29;17(4):e105. doi: 10.2196/jmir.3778.
The use of amphetamine-type stimulants (ATS) places a large burden on health services.
The aim was to evaluate the effectiveness of a self-guided Web-based intervention ("breakingtheice") for ATS users over 6 months via a free-to-access site.
We conducted a randomized trial comparing a waitlist control with a fully automated intervention containing 3 modules derived from cognitive behavioral therapy and motivation enhancement. The main outcome was self-reported ATS use in the past 3 months assessed at 3- and 6-month follow-ups using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Secondary outcomes were help-seeking intentions (general help-seeking questionnaire), actual help seeking (actual help-seeking questionnaire), psychological distress (Kessler 10), polydrug use (ASSIST), quality of life (European Health Interview Survey), days out of role, and readiness to change. Follow-up data were evaluated using an intention-to-treat (ITT) analysis with a group by time interaction.
We randomized 160 people (intervention: n=81; control: n=79). At 6 months, 38 of 81 (47%) intervention and 41 of 79 (52%) control participants provided data. ATS scores significantly declined for both groups, but the interaction effect was not significant. There were significant ITT time by group interactions for actual help seeking (rate ratio [RR] 2.16; d=0.45) and help-seeking intentions (RR 1.17; d=0.32), with help seeking increasing for the intervention group and declining for the control group. There were also significant interactions for days completely (RR 0.50) and partially (RR 0.74) out of role favoring the intervention group. However, 37% (30/81) of the intervention group did not complete even 1 module.
This self-guided Web-based intervention encouraged help seeking associated with ATS use and reduced days out of role, but it did not reduce ATS use. Thus, this program provides a means of engaging with some sections of a difficult-to-reach group to encourage treatment, but a substantial minority remained disengaged.
Australian and New Zealand Clinical Trials Registry: ACTRN12611000947909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343307 (Archived by WebCite at http://www.webcitation.org/6Y0PGGp8q).
苯丙胺类兴奋剂（ATS）的使用给卫生服务带来了沉重负担。
旨在通过一个免费访问的网站，评估一项针对ATS使用者的为期6个月的基于网络的自我引导干预措施（“打破僵局”）的有效性。
我们进行了一项随机试验，将等待名单对照组与一项完全自动化的干预措施进行比较，该干预措施包含3个源自认知行为疗法和动机增强疗法的模块。主要结局是使用酒精、吸烟和物质使用筛查测试（ASSIST）在3个月和6个月随访时自我报告的过去3个月内ATS的使用情况。次要结局包括寻求帮助的意向（一般寻求帮助问卷）、实际寻求帮助的情况（实际寻求帮助问卷）、心理困扰（凯斯勒10项量表）、多药使用（ASSIST）、生活质量（欧洲健康访谈调查）、失能天数以及改变的意愿。随访数据采用意向性分析（ITT），并进行组间与时间的交互作用分析。
我们将160人随机分组（干预组：n = 81；对照组：n = 79）。6个月时，81名干预组参与者中的38名（47%）和79名对照组参与者中的41名（52%）提供了数据。两组的ATS得分均显著下降，但交互作用不显著。在实际寻求帮助（率比[RR] 2.16；d = 0.45）和寻求帮助意向（RR 1.17；d = 0.32）方面，存在显著的ITT组间与时间交互作用，干预组寻求帮助的情况增加，而对照组则下降。在完全（RR 0.50）和部分（RR 方0.74）失能天数方面也存在显著交互作用，有利于干预组。然而，37%（30/81）的干预组参与者甚至未完成1个模块。
这项基于网络的自我引导干预措施鼓励了与ATS使用相关的寻求帮助行为，并减少了失能天数，但并未减少ATS的使用。因此，该项目提供了一种与部分难以接触到的群体接触以鼓励治疗的方式，但仍有相当一部分人未参与。
澳大利亚和新西兰临床试验注册中心：ACTRN12611000947909；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343307（由WebCite存档于http://www.webcitation.org/6Y0PGGp8q）。
