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Internet-delivered therapy for alcohol misuse: engagement, satisfaction, and outcomes when patients select their preference for therapist- or self-guided treatment

Sapkota, Ram P; Lozinski, Tristen; Wilhems, Andrew; Nugent, Marcie; Schaub, Michael P; Keough, Matthew Thomas; Sundström, Christopher; Hadjistavropoulos, Heather D (2024). Internet-delivered therapy for alcohol misuse: engagement, satisfaction, and outcomes when patients select their preference for therapist- or self-guided treatment. Addiction science & clinical practice, 19(1):30.

Abstract

Background
Alcohol misuse is common and causes substantial harm. Internet-delivered cognitive behaviour therapy (ICBT) is effective in reducing alcohol misuse; however, the literature investigating how treatment outcomes are impacted by patients’ preferences for therapist- versus self-guided ICBT for alcohol misuse is sparse.

Methods
In this preference trial, 74 eligible patients (who reported ≥ 14 drinks in the previous week and obtained scores suggesting hazardous or harmful drinking) chose between enrolling in either therapist- or self-guided ICBT for alcohol misuse. We investigated whether those who chose therapist- versus self-guided ICBT differed in their (a) drinking outcomes—as measured by Timeline Follow-Back (TLFB) and heavy drinking days (HDD) at post-treatment and 3-month follow-up—and (b) post-treatment ICBT engagement and satisfaction.

Results
The majority (81.1%) of eligible patients chose therapist-guided ICBT. These patients reported higher psychotropic medication use, drinking difficulties, and anxiety symptoms. For both the therapist- and self-guided patients, a modified intention-to-treat analysis revealed large within-group treatment effects for TLFB (β =  − 2.64, SE 0.66; p < 0.001) and HDD (β =  − 0.34, SE 0.07; p < 0.001), with large pre-to-post-treatment Cohen’s effect sizes of d = 0.97 (95% CI [0.49, 1.45]) for TLFB and d = 1.19 (95% CI [0.69, 1.68]) for HDD. The interaction comparing the effects of therapist- to self-guided ICBT over time was not significant for TLFB (p = 0.34) or HDD (p = 0.06). With treatment, for both therapist- and self-guided patients, there was a significant improvement in drinking difficulties, cravings, and confidence with controlling cravings, as well as in anxiety, depression, and functional impairment. Further, the majority (75.7%) of patients completed five or more lessons, as well as reported overall satisfaction with the treatment (88.9%) and increased confidence in managing their symptoms (86.7%); these outcomes also did not differ between therapist- and self-guided patients.

Conclusions
The current study shows that ICBT for alcohol misuse is associated with reduced drinking and comorbid mental health difficulties over time, irrespective of whether patients chose to complete the course on their own or with therapist guidance.

Trial registration number: NCT04611854 (https://clinicaltrials.gov/ct2/show/NCT04611854).

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Swiss Research Institute for Public Health and Addiction
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Social Sciences & Humanities > Clinical Psychology
Health Sciences > Psychiatry and Mental Health
Language:English
Date:20 April 2024
Deposited On:01 Nov 2024 11:22
Last Modified:02 Nov 2024 21:00
Publisher:BioMed Central
ISSN:1940-0632
OA Status:Gold
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1186/s13722-024-00456-8
PubMed ID:38643242
Project Information:
  • Funder: Ministry of Health, Saskatchewan
  • Grant ID:
  • Project Title:
  • Funder: Saskatchewan Health Research Foundation
  • Grant ID:
  • Project Title:
  • Funder: Saskatchewan Centre for Patient-Oriented Research
  • Grant ID:
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