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首页> 外文期刊>Journal of medical Internet research >A Web-Based Self-Help Intervention With and Without Chat Counseling to Reduce Cannabis Use in Problematic Cannabis Users: Three-Arm Randomized Controlled Trial
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A Web-Based Self-Help Intervention With and Without Chat Counseling to Reduce Cannabis Use in Problematic Cannabis Users: Three-Arm Randomized Controlled Trial

机译：基于Web的自助干预，有和没有聊天咨询功能，可减少有问题的大麻用户中的大麻使用：三臂随机对照试验

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Background: After alcohol and tobacco, cannabis is the most widely used psychoactive substance in many countries worldwide. Although approximately one in ten users develops serious problems of dependency, only a minority attend outpatient addiction counseling centers. A Web-based intervention could potentially reach those users who hesitate to approach such treatment centers.Objective: To test the efficacy of a Web-based self-help intervention with and without chat counseling—Can Reduce—in reducing the cannabis use of problematic cannabis users as an alternative to outpatient treatment services.Methods: Altogether, 436 participants were recruited by various online and offline media for the Web-based trial. A total of 308 of these were eligible for study participation and were randomly allocated in an unblinded manner to either self-help with chat (n=114), self-help without chat (n=101), or a waiting list control group (n=93). The fully automated self-help intervention consisted of eight modules designed to reduce cannabis use, and was based on the principles of motivational interviewing, self-control practices, and methods of cognitive behavioral therapy. Additional individual chat counseling sessions were based on the same therapeutic principles. The sessions were conducted by trained counselors and addressed participants' personal problems. The main outcomes were the frequency (number of days) and quantity of cannabis use (number of standardized joints) per week, as entered into the consumption diary at baseline and at the 3-month follow-up. Secondary outcomes included self-reported symptoms of cannabis use disorder, severity of cannabis dependence, risky alcohol use, and mental health symptoms. Intervention participation and retention were extracted from the user progress data and the consumption diary, respectively.Results: Can Reduce participants were older (U=2.296, P=.02) and reported a greater number of cannabis use days at baseline than patients who entered outpatient treatment with cannabis as their main problem substance (data from the Swiss treatment demand monitoring statistics were used; chi-square [df 2]=4.0, P=.046). Participants in the self-help with chat study arm completed a mean of 3.2 modules and 27 out of 114 (23.7%) of the participants received at least one chat session. Participants in the self-help without chat study arm completed similar numbers of self-help modules. A total of 117 of 308 participants (38.0%) completed the 3-month follow-up assessment. The change in the mean number of cannabis use days per week at 3 months differed between self-help without chat (mean change 0.7, SD -0.2) and self-help with chat (mean change 1.4, SD -0.5; beta=-0.75, SE=0.32, t=-2.39, P=.02, d=0.34, 95% CI 0.07-0.61), as well as between self-help with chat and waiting list (mean change 1.0, SD -0.8; beta=0.70, SE=0.32, t=2.16, P=.03, d=0.20, 95% CI -0.07 to 0.47). However, there were no differences between self-help without chat and waiting list (beta=-0.05, SE=0.33, t=-0.16, P=.87, d=-0.14, 95% CI -0.43 to 0.14). Self-reported abstinence was significantly different in the self-help without chat study arm (2.0%) than in the self-help with chat study arm (8.8%; beta=-1.56, SE=0.79, P=.05, odds ratio [OR]=0.21, 95% CI 0.02-2.33). There were no significant differences between the study arms with respect to the secondary outcomes.Conclusions: Web-based self-help interventions supplemented by brief chat counseling are an effective alternative to face-to-face treatment and can reach a group of cannabis users who differ in their use and sociodemographic characteristics from those who enter outpatient addiction treatment.Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 59948178; http://www.isrctn.com/ISRCTN59948178 (Archived by WebCite at http://www.webcitation.org/6bt01gfIr)
机译：背景：在烟酒之后，大麻是全世界许多国家中使用最广泛的精神活性物质。尽管大约十分之一的用户出现严重的依赖性问题，但只有少数人参加门诊成瘾咨询中心。基于Web的干预措施可能会吸引那些犹豫不决的此类治疗中心用户。目的：测试有无聊天咨询（可以减少）的基于Web的自助干预措施的效果，以减少有问题的大麻的使用方法：总共有436名参与者被各种在线和离线媒体招募到基于Web的试验中。其中共有308位有资格参加研究，并以盲人方式随机分配给有聊天的自助（n = 114），无聊天的自助（n = 101）或等待列表对照组（ n = 93）。全自动自助干预措施由旨在减少大麻使用的八个模块组成，并基于动机访谈，自我控制做法和认知行为治疗方法的原则。额外的个人聊天咨询课程均基于相同的治疗原则。这些会议由训练有素的顾问进行，并解决了参与者的个人问题。主要结果是每周在基线和三个月随访中输入到消费日记中的频率（天数）和大麻使用量（标准关节数）。次要结局包括自我报告的大麻使用障碍症状，大麻依赖严重程度，高危饮酒和心理健康症状。结果：可减少参与者的年龄较大（U = 2.296，P = .02），并且报告的基线大麻使用天数比进入患者多，可减少参与者的参与和保留日志。以大麻作为主要问题物质的门诊治疗（使用了来自瑞士治疗需求监测统计数据;卡方[df 2] = 4.0，P = .046）。自助聊天研究小组的参与者平均完成了3.2个模块，其中114名参与者（23.7％）中的27名接受了至少一次聊天。无需聊天学习小组的自助人员则完成了类似数量的自助模块。 308名参与者中的117名（38.0％）完成了为期3个月的随访评估。 3个月每周平均大麻使用天数的变化在无聊天的自助（平均变化0.7，SD -0.2）和有聊天的自助（平均变化1.4，SD -0.5; beta = -0.75）之间有所不同，SE = 0.32，t = -2.39，P = .02，d = 0.34，95％CI 0.07-0.61），以及在聊天的自助服务和等待名单之间（平均更改1.0，SD -0.8; beta = 0.70，SE = 0.32，t = 2.16，P = .03，d = 0.20、95％CI -0.07至0.47）。但是，没有聊天的自助服务和等待列表之间没有区别（beta = -0.05，SE = 0.33，t = -0.16，P = .87，d = -0.14、95％CI -0.43至0.14）。没有聊天研究组的自助的自我报告戒欲（2.0％）与有聊天研究组的自助的自我戒断（8.8％; beta = -1.56，SE = 0.79，P = .05，优势比[OR] ＝ 0.21，95％CI 0.02-2.33）。研究小组之间在次要结局方面没有显着差异。结论：基于Web的自助干预措施加上简短的聊天咨询是面对面治疗的有效替代方法，可以覆盖一群大麻使用者，试验注册：国际标准随机对照试验编号（ISRCTN）：59948178;临床注册与接受门禁成瘾治疗的人群有所不同。 http://www.isrctn.com/ISRCTN59948178（由WebCite存档，网址为http://www.webcitation.org/6bt01gfIr）

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