Opinion

Those seeking treatment for alcohol or other drug (AOD) use problems typically encounter a range of barriers including geographical accessibility of services, social stigma and long-waiting lists. In addition, there is a perception that existing services focus on the needs of alcohol or opiate using clients and may not be appropriate or appealing to users of other substances. One approach to increasing the reach of AOD services and providing both anonymous and ready access, has been the development of online interventions, generally targeting users of specific substances.

Most of the interventions are based either on normative feedback or techniques drawn from cognitive behavioural therapy and motivational enhancement. Internet interventions either take a fully automated (‘unguided’) approach with the client progressing through the program at his or her own pace or use a ‘guided’ format where there is some interaction with a clinician, counsellor or technician via messaging or telephone contact.

The evidence

There have been numerous trials of online interventions for problematic alcohol consumption. Meta-analyses show that outcomes in the general population and in adult samples excluding tertiary students produce effect sizes that are similar to or larger than those for brief face-to-face alcohol interventions. Multiple component interventions produce larger effects than single session (e.g. normative feedback) interventions. Although meta-analyses of guided interventions have produced better outcomes than unguided interventions for those with depression, this has not been demonstrated with AOD programs. Nevertheless, a cost effectiveness evaluation conducted as part of a randomised trial found that although the automated intervention was less expensive to set up and disseminate, greater benefits accrued from the guided intervention for alcohol problems.

To date there has been less research on the effectiveness of online interventions with users of illicit substances, other than cannabis, where there have been small effects demonstrated both in terms of preventing the initiation of cannabis use and in reducing the consumption of cannabis. The data on programs for other drugs including cocaine and amphetamine type stimulants are far more limited.

The research gaps

Psychosocial interventions lie at the heart of AOD treatment, with internet programs well suited to the delivery of this style of intervention. Yet, key questions remain. Across a range of health problems, most internet delivered interventions incur much greater levels of loss to follow-up than standard face-to-face interventions – although attrition is also common in conventional AOD settlings. Improving engagement is likely to be critical in improving outcomes. The provision of content in more accessible forms e.g. video / audio rather than text should become more feasible with enhanced internet capacity. A different approach that has shown benefits is the use of internet or computer delivered interventions in clinical settings to supplement conventional treatment. While this approach does not extend the geographical ‘reach’ of treatment services, it could improve efficiency in terms of the number of people treated or reduce demand for repeat treatment, thereby shortening waiting times. An area for further research is the potential to use internet interventions to support and prepare those waiting for treatment, with a principal focus on harm reduction during this period.

Current research

NDRI, in collaboration with NDARC and the Australian National University have just completed a randomised trial to evaluate a three module unguided intervention for users of amphetamine type stimulants (ATS). The initial results were promising with those who received the intervention having a reduction in days ‘out of role’ and engaging in greater help-seeking for their use of ATS than the control group. We are now seeking further funding to develop the intervention so that it can be made available as a viable treatment option.

See Publication Highlight 'Ice' users help themselves online for more information.

Bibliography

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Carroll KM, Ball SA, Martino S, Nich C, Babuscio TA, Rounsaville BJ. Enduring effects of a computer-assisted training program for cognitive behavioral therapy: A 6-month follow-up of CBT4CBT. Drug Alcohol Depend. 2009;100(1-2):178-81.

Riper H, Blankers M, Hadiwijaya H, Cunningham J, Clarke S, Wiers R, et al. Effectiveness of guided and unguided low-intensity internet interventions for adult alcohol misuse: A meta-analysis. PLoS ONE. 2014;9(6):e99912.

Tait RJ, Spijkerman R, Riper H. Internet and computer based interventions for cannabis use: A meta-analysis. Drug Alcohol Depend. 2013;133(2):295.

Tait RJ, McKetin R, Kay-Lambkin F, Carron-Arthur B, Bennett A, Bennett K, et al. Six month outcomes of a web-based intervention for users of amphetamine-type stimulants: Randomized controlled trial. J Med Internet Res. 2015;17(4):e105.