Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA, United States.
Department of Psychiatry & Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States.
J Med Internet Res. 2021 Mar 23;23(3):e24850. doi: 10.2196/24850.
Misuse of substances is common, can be serious and costly to society, and often goes untreated due to barriers to accessing care. Woebot is a mental health digital solution informed by cognitive behavioral therapy and built upon an artificial intelligence-driven platform to deliver tailored content to users. In a previous 2-week randomized controlled trial, Woebot alleviated depressive symptoms.
This study aims to adapt Woebot for the treatment of substance use disorders (W-SUDs) and examine its feasibility, acceptability, and preliminary efficacy.
American adults (aged 18-65 years) who screened positive for substance misuse without major health contraindications were recruited from online sources and flyers and enrolled between March 27 and May 6, 2020. In a single-group pre/postdesign, all participants received W-SUDs for 8 weeks. W-SUDs provided mood, craving, and pain tracking and modules (psychoeducational lessons and psychotherapeutic tools) using elements of dialectical behavior therapy and motivational interviewing. Paired samples t tests and McNemar nonparametric tests were used to examine within-subject changes from pre- to posttreatment on measures of substance use, confidence, cravings, mood, and pain.
The sample (N=101) had a mean age of 36.8 years (SD 10.0), and 75.2% (76/101) of the participants were female, 78.2% (79/101) were non-Hispanic White, and 72.3% (73/101) were employed. Participants' W-SUDs use averaged 15.7 (SD 14.2) days, 12.1 (SD 8.3) modules, and 600.7 (SD 556.5) sent messages. About 94% (562/598) of all completed psychoeducational lessons were rated positively. From treatment start to end, in-app craving ratings were reduced by half (87/101, 86.1% reporting cravings in the app; odds ratio 0.48, 95% CI 0.32-0.73). Posttreatment assessment completion was 50.5% (51/101), with better retention among those who initially screened higher on substance misuse. From pre- to posttreatment, confidence to resist urges to use substances significantly increased (mean score change +16.9, SD 21.4; P<.001), whereas past month substance use occasions (mean change -9.3, SD 14.1; P<.001) and scores on the Alcohol Use Disorders Identification Test-Concise (mean change -1.3, SD 2.6; P<.001), 10-item Drug Abuse Screening Test (mean change -1.2, SD 2.0; P<.001), Patient Health Questionnaire-8 item (mean change 2.1, SD 5.2; P=.005), Generalized Anxiety Disorder-7 (mean change -2.3, SD 4.7; P=.001), and cravings scale (68.6% vs 47.1% moderate to extreme; P=.01) significantly decreased. Most participants would recommend W-SUDs to a friend (39/51, 76%) and reported receiving the service they desired (41/51, 80%). Fewer felt W-SUDs met most or all of their needs (22/51, 43%).
W-SUDs was feasible to deliver, engaging, and acceptable and was associated with significant improvements in substance use, confidence, cravings, depression, and anxiety. Study attrition was high. Future research will evaluate W-SUDs in a randomized controlled trial with a more diverse sample and with the use of greater study retention strategies.
ClinicalTrials.gov NCT04096001; http://clinicaltrials.gov/ct2/show/NCT04096001.
物质滥用很常见，对社会来说既严重又昂贵，而且由于获得护理的障碍，往往得不到治疗。Woebot 是一种心理健康数字解决方案，它基于认知行为疗法，并建立在人工智能驱动的平台上，为用户提供量身定制的内容。在之前的为期 2 周的随机对照试验中，Woebot 缓解了抑郁症状。
本研究旨在改编 Woebot 以治疗物质使用障碍（W-SUDs），并检验其可行性、可接受性和初步疗效。
从在线资源和传单中招募了年龄在 18-65 岁之间、有物质滥用但没有重大健康禁忌症的美国成年人，并于 2020 年 3 月 27 日至 5 月 6 日之间入组。在单组前后设计中，所有参与者都接受了为期 8 周的 W-SUDs 治疗。W-SUDs 通过使用辩证行为疗法和动机访谈的元素来提供情绪、渴望和疼痛跟踪以及模块（心理教育课程和心理治疗工具）。使用配对样本 t 检验和 McNemar 非参数检验来检查从治疗前到治疗后的物质使用、信心、渴望、情绪和疼痛等方面的变化。
样本（N=101）的平均年龄为 36.8 岁（SD 10.0），75.2%（76/101）的参与者为女性，78.2%（79/101）为非西班牙裔白人，72.3%（73/101）为在职人员。参与者的 W-SUDs 使用平均为 15.7 天（SD 14.2），12.1 个模块和 600.7 个消息。大约 94%（562/598）的心理教育课程得到了积极评价。从治疗开始到结束，应用程序中的渴望评分降低了一半（87/101，86.1%的人在应用程序中报告了渴望；比值比 0.48，95%置信区间 0.32-0.73）。治疗结束时的评估完成率为 50.5%（51/101），初始筛查中物质滥用程度较高的患者保留率更好。从治疗前到治疗后，抵抗使用物质的冲动的信心显著增加（平均得分增加+16.9，SD 21.4；P<.001），而过去一个月的物质使用次数（平均变化-9.3，SD 14.1；P<.001）和酒精使用障碍识别测试简明版（平均变化-1.3，SD 2.6；P<.001）、10 项药物滥用筛查测试（平均变化-1.2，SD 2.0；P<.001）、患者健康问卷-8 项（平均变化 2.1，SD 5.2；P=.005）、广泛性焦虑症-7 项（平均变化-2.3，SD 4.7；P=.001）和渴望量表（68.6%比 47.1%中度至重度；P=.01）显著下降。大多数参与者会向朋友推荐 W-SUDs（39/51，76%），并报告收到了他们所需要的服务（41/51，80%）。较少的人认为 W-SUDs 满足了他们的大部分或全部需求（22/51，43%）。
W-SUDs 易于实施、参与度高、可接受，与物质使用、信心、渴望、抑郁和焦虑的显著改善相关。研究失访率很高。未来的研究将在一个更具多样性的样本中，使用更多的研究保留策略，对 W-SUDs 进行随机对照试验评估。
ClinicalTrials.gov NCT04096001；http://clinicaltrials.gov/ct2/show/NCT04096001。
