Download Web-Based Interventions

Saskatchewan DTFP Project to Review Current Research
Literature on Web-Based Interventions for Risky Alcohol
and other Drug Use
Summary
Prepared by
David Brown PhD
Pathways Research
May 2014
Background
Challenge
There is an emerging body of evidence that the identification and provision of subsequent
treatment of depression can be augmented by web-based technologies in ways that are
efficacious and cost-effective. The evidence comes from projects within Canada, including the
online therapy project led by Dr. Heather Hadjistavropoulos at the University of Regina in
Saskatchewan, as well as from large scale implementation in Australia.
However, similar technologies to augment identification and provision of subsequent treatment
of alcohol and other drug use problems have not been as widely implemented or tested. The
potential cost-savings and increased capacity to help a larger segment of the population are
significant. Online and related technologies might be used by individuals as either stand-alone
self-help tools for self-screening and self-directed behavioral change, or used to support formal
treatment processes.
Objectives
In order to determine next steps in this area, the Saskatchewan Ministry of Health
commissioned this brief study with the support of Health Canada’s Drug Treatment Funding
Program. The study aims to provide an overview of what has been learned about the use of
online tools in the area of substance use, to gauge the perceived potential for implementing
such tools in Canada, and to make recommendations regarding useful next steps.
Methods Used
Literature Search
Terms related to technology and substance abuse in various combinations were searched in
PubMed. Fifty articles were located dating back to 2006. Articles were sorted based on
relevance and forward and backward searches from identified papers were conducted to find
related articles. Google Scholar and Research Gate were used to locate new articles identified
from the initial article search. A grey area search was conducted to find programs that are not
in the academic and professional literature that have been created or are being used.
We located 9 review articles and 29 single study articles that met the criteria of technologybased interventions for substance abuse (see Appendix 1). The reviews and single studies vary
in which types of substances and technologies they include and how they define a technologybased intervention. The articles encompass computer-based interventions, web-based phone
programs, interactive voice response phone programs, text-message programs, smartphone
apps, video-conferencing, and tablet programs.
Survey of Experts
An online survey was conducted with a sample of experts from across Canada in the area of
problem substance use screening and treatment. A snow-ball sampling process was used.
Initially, approximately 20 individuals were invited to participate. These individuals were also
asked to share the invitation with any of their peers whom they felt might offer useful insights.
The sampling processes yielded 28 respondents. (see Appendix 2)
Scan for Examples
In addition to reviewing the research literature and consulting with Canadian experts, we
conducted a scan for examples of web-based resources for augmenting substance use problem
screening and interventions (see Appendix 3).
Summary of Findings
Literature Overview
Research conducted on computer-based interventions for alcohol or other drug problems show
that these therapies can be effective. Some studies concluded that these therapies are as
effective as traditional in-person treatment and others showed that these treatments are more
effective than in-person treatment (Gainsbury& Blaszcynski 2011, Moore 2011, Tait &
Christensen 2010). Studies showed that these effects can last through follow-up of 6 and 12
months (Kypri 2008, Riper 2009, Klein 2012, Carroll 2008).
One study found that more intensive technology-based interventions are more efficacious than
briefer technology-based interventions (Litvin 2013). Another study found that minimal contact
interventions, with fewer sessions and that can be accessed from home, may be as effective as
high-cost, labour-intensive interventions (Rooke 2010).
One study found that technology-based interventions for marijuana are effective but less so
than in-person interventions (Tait). Another showed that interventions to reduce marijuana use
may be affective if they are applied and reinforced through interpersonal aspects of treamtent
(Shrier 2013).
A computer-screening program in an emergency department had very good results with 98% of
interviews completed without being interrupted by other clinical care activities (Murphy 2013).
Interactive Voice Response telephone programs were found to be effective for alcohol and drug
use patients as follow-up care and reduced their use compared to those not using the program
(Tucker 2012, Moore 2013).
However, technology-based brief alcohol interventions may not be as effective in cases of
concurrent substance use and mental health problems (Cucciare 2013).
Computer-based interventions showed high levels of client satisfaction and had levels of
engagement and retention similar to those in therapist-provided treatment (Moore 2011). This
can potentially improve treatment response by promoting client satisfaction (Newman 2011).
Patients had a preference for receiving information about reducing substances using newer
technologies rather than traditional formats (Choo 2012). The most commonly cited reasons for
this preference being 24-hour availability, ease of access to a computer, anonymity and privacy,
not having to attend face-to-face meetings and counselor credentials (White 2010, Newman
2011, King 2009).
Only 10-20% of risky or problem drinkers seek or engage treatment (Riper 2009). This is the
case even though concern about the harm of alcohol in those with risky alcohol use who have
never sought treatment was comparable to that of traditional treatment-seekers. An
opportunity may therefore exist to use technology for engaging those who do not usually seek
help (Liberman & Huang 2008).
Technology-based interventions could be especially useful for groups less likely to access
traditional alcohol-related services, such as women, young people, and at-risk users. Traditional
substance use treatment programs have gender-specific barriers and do not adequately meet
the needs of women. These barriers include lack of childcare, lack of family treatment, and
discomfort in male-dominated groups. (Liberman & Huang 2008) Women and parents were
more likely to access technology-based interventions. (VanDeMark 2010, White 2010)
Attrition levels with internet-based treatments were often high and in one review ranged from
22% to 65% (Newman 2011). Individuals will often drop out or discontinue using technologybased interventions that are not highly engaging or that lack the ability to freely explore and
access all available content at any time with clear therapeutic goals (Litvin 2013).
To make the best use of technology-based interventions, clients should be allowed to set the
pace of their treatment and they should be able to determine when and how long to engage in
the assigned intervention (Neman 2011).
Internet-based treatments should take advantage of the potential for highly tailored, unlimited,
constantly available content that adapts and responds in a dynamic, iterative manner to
fluctuations in individuals’ environmental and social contexts and emotional and physiological
states (Litvin 2013).
Patients and clients have voiced concerns and need reassurances about the confidentiality of
technology-based interactions. It is important that patients perceive and are reassured of the
security and privacy of technology-based interventions (Newman 2011, Choo 2012).
Consultation with Experts
Of the 28 respondents 13 (just under half) were aware of web-based screening or assessment
tools for AOD issues currently used in Canada. Only four (4) respondents were aware of plans or
opportunities in Canada to set up web-based screening or assessment tools for AOD issues.
Eighty-five percent were not aware of any.
The majority of respondents were not aware of any web-based tools available for individuals to
do cognitive or behavioral change work relating to AOD currently being used in Canada. The
majority of respondents were not aware of any plans or opportunities in Canada to set up webbased tools for individuals to do cognitive or behavior change work relating to AOD issues.
When asked to comment on the importance of development technology-supported
approaches, all who commented (22) felt it was important and also described it as helpful,
valuable, useful, and beneficial. The following themes emerged from their comments on
strengths:

Respondents indicated that such tools will be helpful to provide information, allow for
self-reflection and ‘open doors’ to treatment for individuals. They will be a valuable,
easily accessible resource for health care providers and professionals to use in a variety
of settings.

It was felt that tools for addictions would likely be successful due to the success of web
based mental health tools in Australia. One person commented that all information
online is American and/or not regulated or appropriate.

One respondent commented that many people may prefer to work with web-based
tools and use the internet as a first place to seek information on challenges they are
facing. Respondents felt this would be particularly beneficial for youth and those not
situated, do not have resources in their community or are not prepared to meet face to
face.

Respondents like the idea of mobile applications, supports with someone live attached
to them 24/7 (e.g. moderated online support groups), and using strength based
language for both addictions and co-occurring disorders.

Respondents felt that web-based screening is “a promising practice” and “important
strategy” to identify and contribute to moderate to high risk drinkers considering
change and taking action. Someone felt this should be promoted as society’s cultural
norms around alcohol are changing in favor of risky drinking. Another indicated there is
research to support web based tools helps people be linked into assistance for highly
stigmatized behaviour of drinking when pregnant.

One respondent commented that the computer will likely replace face to face clinical
experiences in the future and feels this is worthy of investigation and research. This
respondent commented on these tools will make things easier for the client (or
potential client), ease clinical administrative paperwork and steer/guide clinical decision
making and will be a huge improvement.

Evidence supports that these are an important part of an overall strategy. Web-based
tools with normative feedback are as effective as face-to-face interventions. This means
that this is potentially a very important population health strategy.
The following themes emerged from respondent comments on potential barriers:

In developing the tool it must be a quality tool that is simple, relatively short and not too
complicated so it is easily accessible to everyone. It should include different versions
(e.g. a computer, iPad, smartphone app). Localized pathways to care would need to be
established for the referral and treatment that might be needed as a follow-up to the
screening.

Barriers identified include lack of evidence of effectiveness, cost, language diversity,
privacy, access to the internet, perceived lack of time to use the resource, interpretation
of the instruments, and awareness and ability to get information out to potential users
(e.g. LRADG and inconsistent messaging with risks for alcohol and chronic disease
(cancer).

Some concerns raised for service providers include fear of change, the ability for
agencies to have permission to set up these tools, lack of follow-up support in the
community to support moderate to high-risk drinkers and lack of knowledge/time
among primary healthcare professionals to value web-based screening and face-to-face
brief intervention for alcohol.

Negative stigma in Mental Health and Addictions regarding addictions. Most believe
that if the Mental Health problems go away then there is no need to address addictions.
Proper assessment of what needs to happen first.
References
Bordreaux, E.D., Abar, B., Baumann, B.M., Grissom, G. (2013). A randomized clinical trial of the Health
Evaluation and Referral Assistant (HERA): Research methods. Contemporary Clinical Trials 35(2013) 8796.
Carroll, K.M., Ball, S.A., Martino, S., Charla, N., Babuscio, T.A., Rounsaville, B.J. (2008). Enduring effects
of a computer-assisted training program for cognitive behavioral therapy: A 6-month follow-up of
CBT4CBT. Journal of Drug and Alcohol Dependence.
Choo, E.K., Ranney, M.L., Wong, Z., Mello, M.J.(2012). Attitudes towars technology-based health
information among adult emergency department patients with drug or alcohol misuse. Journal of
Substance Abuse Treatment 43(2012) 397-401.
Cucciare, M.A., Weingardt, K.R., Ghaus, S., Boden, M.T., Frayne, S.M. (2013). A randomized controlled
trial of a web-delivered brief alcohol intervention in veteran’s affairs primary care.
Gainsbury, S., Blaszczynski, A. (2011). A systematic review of Internet-based therapy for the treatment
of additions. Clinical Psychology Review 31(2011) 490-498.
Gates, P., Copeland, J., Swift, W., Martin, G. (2012). Barriers and facilitators to cannabis treatment. Drug
and Alcohol Review May 2012, 31, 311-319.
Hester, R.K., Lenberg, K.L., Campbell, W., Delaney, H.D. (2013). Overcoming Addictions, a web-based
application, and SMART recovery, an online and in-person mutual help group for problem drinkers, part
1: Three-month outcomes of a randomized control trial.
Hester, R.K., Miller, J.H. (2006). Economic Perspectives: Screening and Intervention. Computer-based
tools for diagnosis and treatment of alcohol problems. Alcohol Research & Health.
King, V.L., Stoller, K.B., Kidorf, M. Kindom, K., Hursh, S., Brady, T., Brooner, R.K. (2009). Assessing the
effectiveness of an Internet-based videoconferencing platform for delivering intensified substance
abuse counseling. Journal of Substance Abuse Treatment 36(2009) 331-338.
Klein, A.A., Slaymaker, V.J., Dugosh, K.L., McKay, J.R. (2012). Computerized continuing care support for
alcohol and drug dependence: A preliminary analysis of usage and outcomes. Journal of Substance
Abuse Treatment 42(2012) 25-34.
Kypry, K., Langley, J.D., Saunders, J.B., Cashell-Smith, M.L., Herbison, P. (2008). Randomized Controlled
Trial of Web-Based Alcohol Screening and Brief Intervention in Primary Care. Arch Intern Med/Vol 168
(No. 5).
Lieberman, D.Z., Huang, S.W. (2008). A Technological Approach to Reaching a Hidden Population of
Problem Drinkers. Psychiatric Services March 2008, Vol. 59, No. 3.
Litvin, E.B., Abrantes, A.M., Brown, R.A. (2013). Computer and Mobile technology-based interventions
for substance use disorders: An organizing framework, Addictive Behaviors 38(2013) 1747-1756.
Lustria, M.L.A., Cortese J., Noar, S.M., Glueckauf. (2009). Computer-tailored health interventions
delivered over the web: Review and analysis of key components. Patient Education and Counseling
74(2009) 156-173.
Moore, B.A., Fazzino, T., Garnet, B., Cutter, C.J., Barry, D.T. (2011). Computer-based interventions for
drug use disorders: A systematic review. Journal of Substance Abuse Treatment 40(2011) 215-223.
Moore, B.A., Fazzino, T., Barry, D.T., Fiellin D.A., Cutter, C.J., Schottenfeld , R.S, Ball, S.A. (2013). The
Recovery Line: A pilot of automated, telephone-based treatment for continued drug use in methadone
maintenance. Journal of Substance Abuse Treatment 45(2013) 63-69.
Murphy, M.K., Bijur, P.E., Rosenbloom, D., Bernstein, S.L., Gallaher, E. (2013). Feasibility of a computerassisted alcohol SBIRT program in an urban emergency department patient and research staff
perspectives. Addiction Science & Clinical Practice 2013,812.
Newman, M.G., Szkodny, L.E., Llera, S.J., Przeworski, A. (2011). A review of technology-assisted self-help
and minimal contact therapies for drug and alcohol abuse and smoking addiction: Is human contact
necessary for therapeutic efficacy? Clinical Psychology Review 31(2011) 178-186.
Ondersma, S.J., Grekin, E.R., Svikis, D. (2011). The potential for technology in brief interventions for
substance use, and during session prediction of computer-delivered brief intervention response.
Substance Use & Misuse 46(2011) 77-86.
Ornstein, S.M, Miller, P.M., Wessell, A.M., Jenkins, R.G., Nemeth, L.S., Nietert, P.J. (2013). Integration
and sustainability of alcohol screening, brief intervention, and pharmacotherapy in primary care
settings. Journal of Studies on Alcohol and Drugs July 2013.
Riper, H., Kramer, J., Conijn, B., Smit, F., Schippers, G., Cuijipers, P. (2009). Translating Effective WebBased Self-Help for Problem Drinking Into the Real World. Alcoholism: Clinical and Experimental
Research Vol 33, No.8, 2009 1401-1408.
Rizvi, S.L., Dimeff, L.A., Skutch, J., Carroll, D., Linehan, M.M. (2011). A pilot study of the DBT Coach: AN
interactive mobile phone application for individuals with borderline personality disorder and substance
use disorder. Behavior Therapy 42(2011) 589-600.
Rooke, S., Thorsteinsson, E., Karin, a., Copeland, J., Allsop, D. (2010). Computer-delivered interventions
for alcohol and tobacco use: a meta-analysis. Addiction Review, 105, 1381-1390.
Schroder, K.E.E., Tucker, J.A., Simpson, C.A. (2013). Telephone-based self-change modules help stabilize
early natural recovery in problem drinkers. Journal of Studies on Alcohol and Drugs Nov 2013.
Shrier, L.A., Rhoads, A., Burke, P., Walls, C., Bloode, E.A. (2013). Real-time, contextual intervention using
mobile technology to reduce marijuana use among youth: A pilot study. Addictive Behaviors (2013).
Suffoletto, B., Callaway, C., Kristan, J., Monti, P., Clark, D.B. (2013). Mobile phone text message
intervention to reduce binge drinking among young adults: study protocol for randomized control trial.
Trials 2013, 14:93.
Suffoletto, B., Callaway, C., Kristan, J., Kraemer, K., Clark, D.B. (2012). Text-message-based drinking
assessments and brief interventions for young adults discharged from the emergency department.
Alcoholism: Clinical and Experimental Research 36(3) 552-560.
Tait, R.J., Spijkerman, R., Riper, H. (2013) Internet and computer based interventions for cannabis use: A
meta-analysis. Drug and Alcohol Dependence 133(2013) 295-304.
Tait, R.J., Christensen, H. (2010). Delivering Timely Intervention: the Impact of the Internet on Mental
Health. Internet-based interventions for young people with problematic substance use: a systematic
review. MJA, Vol.192 No.11.
Tucker, J.A., Roth, D.L., Huang, J., Crawford, M.S., Simpson C.A. (2012) Effects of interactive voice
response self-monitoring on natural resolution of drinking problems: Utilization and behavioral
economic factors. Journal of Studies on Alcohol and Drugs July 2012.
VanDeMark, N.R., Burrell, N.R., LaMendola, W.F., Hoich, C.A., Berg,N.P., Medina, E. (2010). An
exploratory study of engagement in a technology-supported substance abuse intervention. Substance
Abuse Treatment, Prevention, and Policy; 5:10.
White, A., Kavanagh, D., Stallman, H., Klein, B., Kay-Lambkin, F., Droudfoot, Drennan, J., Connor, J.,
Baker, A., Hines, E., Young, R. (2010). Online alcohol interventions: A systematic review. J Med Internet
Res 2010 12 (5):e62.
Yu Rueger, S., Trela, C.J., Palmeri, M. (2013). Self- Administered Web-Based Timeline Follow-Back
Procedure for Drinking and Smoking Behaviors in Young Adults. Journal of Studies on Alcohol and Drugs.
Appendix 1 – Scope of Research Literature
Appendix 2 – Summary of Survey Responses (n=28)
Reported jurisdiction
Ontario
Manitoba
Canada
BC
Alberta
Yukon Territory
Not identified
8
7
5
4
1
1
2
Are you aware of any web-based screening or assessment tools (self-guided or not) for alcohol
or other drugs that are currently in use in Canada?
Yes
No
13
15
Are you aware of any plans or opportunities in Canada to set up web-based screening or
assessment tools (self-guided or not) for alcohol or other drugs?
Yes
No
4
24
Are you aware of any web-based tools for individuals to do cognitive or behaviour change work
(self-guided or not) relating to alcohol or other drug issues, that are currently in use in Canada?
Yes
No
5
23
Are you aware of any plans or opportunities in Canada to set up web-based tools for individuals
to do cognitive or behaviour change work (self-guided or not) relating to their alcohol or other
drug issues?
Yes
No
3
25
Please comment on the importance, if any, you would place on the development of web-based
screening and change work tools for individuals relating to alcohol or other drug issues?



















All this information online is American and/or not regulated and appropriate. I feel that it is important
that we push to have these tools available through the Web.
Any additional opportunities to reach this group of individuals is valuable to opening a door for treatment
and change in their lives
Especially important for those that do not have resources in their community. Moderated online support
groups give people an opportunity to communicate with others and a coach
Evidence supports that these are an important part of an overall strategy. Web-based tools with
normative feedback are as effective as face-to-face interventions. This means that this is potentially a very
important population health strategy.
I think these can be beneficial for those who are unable or unprepared to meet with a practitioner faceto-face, and can be useful in direct sessions too
I think this would be highly important - many people may prefer to work with web-based tools,
particularly youth.
I think web-based screening is important - it allows people to self-reflect on their health and come to their
own realizations and conclusions
Important to do, especially mobile applications. Australia has had success with web-based mental health
tools so I think options should be made available in Canada for addiction as they would likely be
successful.
It could be a great resource for all health care providers and professionals to utilize in a variety of settings
as it would be easily accessible, making it valuable.
Use of strength based language for both addictions and concurrent disorders. Language can create
barriers.
Very important (3 respondents)
Very important. Particularly for alcohol, web-based screening is a promising practice to identify and help
contribute to change among moderately risky and high-risk drinkers. We need to promote this tool as
much as possible as our society's cultural norms around alcohol are changing in favour of risky drinking.
Very important. Screening: anything to make this experience easier on the client (or potential client) and
to also ease the clinical administrative paperwork and to steer/guide clinical decision making - will be a
huge improvement. I also think the use/development of web-based tools is very important. The computer
will (for the most part) replace face to face clinical experiences in the future (in my opinion) so this is a
worthy of investigation and research.
Very much given how much individual work and live (literally) on-line. I like supports that have someone
live attached to them 24/7.
Web based tools are an important strategy, within a continuum of strategies to help people consider and
take action on drinking, and related harms. They may be particularly helpful as a link into assistance for
the highly stigmatized behaviour of drinking when pregnant. There is some research to this effect
Would be helpful for providing information for individuals
Would be very useful and well used.
Yes this would be helpful (2 respondents)
Youth and adults utilize the internet as a first place to seek information on any challenges they are
experiencing.
Please provide any comments that you feel would help us to understand major barriers to the
effective implementation of web-based screening or change work tools for individuals relating
to alcohol or other drug issues?













Barriers have to do with the cost of building these programs - which are proving effective in the literature
Do not make the technology too complicated so everyone can access it. Make sure there are computer,
iPad, app, etc. versions
Fear of change, cost, lack of research and evidence of effectiveness, etc.
Knowledge translation-getting the information about them out to potential users; access to technology
for users
Lack of language diversity. Lack of follow-up support in the community to support moderate to high-risk
drinkers. Lack of knowledge/time among primary healthcare professionals to value web-based screening
and face-to-face brief intervention for alcohol.
Localized pathways to care would need to be established for the referral and treatment that might be
needed as a follow-up to the screening.
LRADG and inconsistent messaging with risks for chronic disease (cancer) and alcohol
Making quality tools known and available over the background noise on the net
Negative stigma in Mental Health and Addictions regarding addictions. Most believe that if the Mental
Health problems go away then there is no need to address addictions. Proper assessment of what needs
to happen first.
Perception of lack of time to utilize resource, inability to access the internet, lack of awareness of tool
availability
Privacy and the ability for agencies to have permission to set up these tools.
Some questions can be pretty generic and will not cover special circumstances. A major barrier could be
the interpretation of the instruments.
They must be simple and relatively short
Appendix 3 – Examples of Resources
Canadian Resources
A number of Canadian websites were referenced by participants in our online survey of experts, including CAMH
(http://www.camh.ca), Chestnut Health Services and Physicians of Canada (www.cfpc.ca). Several Canadian
websites provide opportunity to assess drinking patterns (using tools like the AUDIT or e-CHUG), provide
comparisons to others and resources and information including on low risk drinking guidelines. These websites
provide feedback on responses given and encourage seeking support if needed.
http://carbc.ca/AlcoholRealityCheck.aspx
http://notes.camh.net/efeed.nsf/feedback
http://www.checkyourdrinking.net
http://www.rethinkyourdrinking.ca
http://www.everydrinkisachoice.com
In addition to all of the above the www.alcoholhelpcenter.net website also has tools to prepare for cutting back or
quitting and learning about triggers and planning for high risk situations, tracking use with a diary, setting goals,
connecting with others, receiving motivational emails and creating a blog or video.
American Resources
www.alcoholscreening.org provides screening, personalized feedback and resources available by state
or zip code.
Drugscreening.org www.drugscreening.org Provides screening, personalized feedback and resources.
This questionnaire is based on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST),
developed by the World Health Organization to screen for harmful or hazardous substance use.
http://www.alcoholcheckup.com –This website helps find treatment resources based on state and/or
zip code.
Drinkers Checkup www.drinkerscheckup.com is a computer based version of face to face brief MI
protocol by the same name developed by Miller and colleagues in 1988. There is also a follow up
program. Drinker’s Check Up is based on motivational enhancement therapy and consists of assessment
and personalized feedback, with advice tailored to the user’s readiness for change and helps resolve
ambivalence about changing drinking patterns. The Windows-based version also offers a follow-up
program (the Follow-up Drinker’s Check-Up [FDCU]) that allows providers to collect data at up to three
follow-up points. The FDCU can generate outcome reports for individual users, user subgroups, and the
total sample in a database, making it useful as a program evaluation tool.
College Drinker's Check-up (CDCU) www.collegedrinkerscheckup.com is a computer-based, brief
motivational interviewing intervention designed to help reduce the use of alcohol by college students
(ages 18-24). CDCU consists of an integrated set of screening, assessment, personalized feedback, and
decision making modules and is based on Drinker's Check-up for heavy-drinking adults. The feedback
module of CDCU is tailored to college-age participants with gender- and university-specific norms. As a
one-time, 35- to 45-minute intervention with optional, 15- to 20-minute follow-up sessions, CDCU can
be used as a stand-alone intervention or as a precursor to more intensive alcohol use treatment
interventions.
CDCU is available as a Web application (with a MySQL database) and as a Windows program for use in
colleges and universities. The program includes an administrator's module, which can be used to
conduct follow-up data collection and generate outcomes reports.
The Behavioral Self-Control Program for Windows (BSCPWIN) software is a skills-oriented program that
helps less severely dependent drinkers learn moderate drinking skills. It consists of eight modules that
focus on setting goals, self-monitoring, controlling the drinking rate, setting up rewards and penalties,
developing alternatives to drinking, identifying high-risk situations, preventing relapse, and a final
progress review and feedback. After users have completed the self-monitoring component, each time
users return to the program it asks them to enter their self-monitored alcohol consumption data and
gives them feedback on their drinking relative to the goals they set previously. The program then
continues with the next module in the sequence. Primary health care settings that screen patients for
alcohol problems may find the BSCPWIN helpful in a stepped-care model of treatment for their patients.
In addition, the program may be useful for AOD abuse treatment providers whose patient population
includes less severely dependent drinkers.
MOMENT is an intervention to reduce youth marijuana use. The program used Ecological Momentary
Interventions (EMI) that combined brief motivational therapy, administered by a counselor in a clinic,
with mobile self-monitoring and responsive messaging, via an electronic device as a means of extending
clinic-based motivational counseling. This program was designed for use in primary care. Program
involves two in-person sessions.
DBT Coach – is a smartphone app.for DBT skills with people with Bipolar disorders and substance abuse
disorders. Ritzvi (2013) study indicates that the DBT Coach resulted in a significant decrease in the
intensity of the emotion identified as causing the most distress as well as the urges to use substances
following completion of the coaching session. There were significant reductions in emotional intensity.
Participants reported a decrease in overall depression symptomatology and psychological distress. (Rizvi
2013)
CBT4CBT www.cbt4cbt.com Computer-Based Training for Cognitive Behavioral Therapy is a web-based
program that teaches a variety of CBT skills that are specific for helping people to reduce substance
abuse. These include understanding patterns of substance use, learning to recognize and deal with
craving, addressing thoughts about substance use that can set you up to use, how to effectively say ‘No’
to offers of alcohol or drugs, and how to be more aware of patterns of thinking and decision making that
can lead to drug use. CBT4CBT is a self-guided web-based program that uses movies and examples to
teach skills. There are 7 modules, or content areas, and they each take about one hour to complete. At
this time, people using CBT4CBT must be enrolled in a clinical program or working with a psychiatrist or
psychologist who offers CBT4CBT to their clients. This is because CBT4CBT can enhance treatment, but
we have not yet tested whether it is effective for people who are not involved in treatment.
HERA (Health Evaluation and Referral Assistant) The Health Evaluation and Referral Assistant (HERA) is a
web-based program designed to facilitate screening, brief intervention, and referral to treatment
(SBIRT) for tobacco, alcohol, and drug abuse. After the patient completes a computerized substance
abuse assessment, the HERA produces a summary report with evidence-based recommended clinical
actions for the healthcare provider (the Healthcare Provider Report) and a report for the patient (the
Patient Feedback Report) that provides education regarding the consequences of use, personally
tailored motivational messages, and a tailored substance abuse treatment referral list. For those who
provide authorization, the HERA faxes the individual's contact information to a substance abuse
treatment provider matched to the individual's substance use severity and personal characteristics, like
insurance and location of residence (dynamic referral).
Overcoming Addictions (OA) based on SMART Recovery – interactive web application to help people
achieve and maintain abstinence from addictions. Activities to enhance motivation for change, track
urges over time, practice mindfulness exercises from preventing relapse, set goals and make change
plans. There are parallel but separate modules for various substances and gambling. People can set up
emails or text messages as reminders of reasons for changings, plans and other things.
MORE developed by Hazeldon – web based management program for continuing care support for
people leaving alcohol and drug treatment includes mixed media, interactive with video, and extensive
library of material and community forum. MORE provides tools, support and fellowship over 18 months
to help with recovery journey. MORE provides guidance from a recovery coach, a licensed addiction
counselor, both electronically and by phone, has online discussion boards, links to websites and
programs (e.g. AA, Hazeldon alumni activities/events).
E-TREAT is designed to sustain motivation to change in individuals with substance use disorders who
were waiting for treatment or in transition between treatment programs. The program provides
information, support and encouragement through recovery coaches. They conduct an initial face to face
assessment and assist in orientation to computer and electronic resources. Coaches use MI to provide
personalized coaching and support, feedback and motivational messages using a range of technologies
including telephone, text messaging, email and web-based communication.
AlcoholEdu – uses interactive strategies including personalized feedback to educate students about
alcohol and its effects. The course helps motivate students to make well informed decisions and help
better manage drinking behavior (their own and/or that which may happen around them) and helps link
choices about drinking to academic and personal success. AlcoholEdu is designed as a population-level
prevention program to be given to an entire population of students and is used on hundreds of
campuses by first year students. This program impacts both individual behavior and campus culture and
has produced the world’s largest database on college students and alcohol.
E-Check Up To Go (e-chug) www.echeckuptogo.com and E-TOKE (Electronic THC Online Knowledge
Experience) – these programs are interactive web surveys designed to motivate college and university
students to enter information about their drinking patterns and receive feedback to reduce their use
using personalized information about their use patterns and risk factors. These programs are used in
over 600 universities and colleges in 49 states, Canada, Australia and Ireland.
Websites recommended by the US National Council for Behavioral Health
The National Council for Behavioral Health has a contest running for tech innovations that meet the
need for on-demand mental health and addictions treatment and help improve access, support clinical
decision making, engage patients and encourage self-management. They announced the finalists and
people are encouraged to vote on Facebook by ‘liking’ the videos. The finalists include:
Big White Wall: Online peer community, guided self-management programs, and real-time therapy
— via text, audio, and video — for stress, depression, anxiety, alcohol use, weight management,
cancer, diabetes and hypertension. www.bigwhitewall.com
Cobalt Therapeutics: 5 in 1, a range of virtual Cognitive Behavioral Therapy programs — Restore for
insomnia; Shade for substance use and depression; Fearfighter for anxiety, phobia, and panic;
Moodcalmer for depression; and OCFighter Demo for OCD.
Ginger.io: Clinician views of how a patient is doing between office visits through — a smartphone app
that collects passive data and surveys patients; a behavioral analytics engine that aggregates patient
data; and a provider dashboard that triggers alerts for patients in need. www.ginger.io
LinkedWellness: Innovator behind SPARX — a video game that delivers Cognitive Behavioral Therapy
to youth and is proven to reduce depression and anxiety; meets young people where they are; used
as standalone or adjunct therapy for clinicians. www.linkedwellness.com
Mood 24/7: A mobile integrated electronic health diary — an app texts patients daily, asking them to
rank their mood so providers can accurately track mood fluctuations and medication responses and
receive alerts when mood dips low enough to require intervention. www.mood247.com
myStrength: “The health club for your mind,” that extends clinician treatment for depression and
anxiety in between and after therapy visits through evidence-based interactive coping tools, weekly
action plans, daily inspiration, and step-by-step learning modules. www.mystrength.com
International Resources
Down Your Drink internet intervention (http://www.downyourdrink.org.uk) is a web-based intervention
to encourage excessive drinkers to adopt a healthy pattern of drinking and reduce alcohol-associated
harm. The DYD website was structured as a 6-week programme, derived from a manual which included
elements of motivational approaches and cognitive behavioural therapy. It involves 3 phases: assesses
what changes a person might want to make; a plan on how to make the changes with supports
available; and skills to help to stick the goals and make changes.
Drinking Less (www.minderdrinken.nl) is a Dutch 24/7 free access anonymous interactive web-based
self-help intervention based on motivational, cognitive-behavioral and self-control training principles.
There is no therapeutic guidance. Participants assess their use and risk using the AUDIT, their
motivation to change and positive and negative consequences of their consumption. They are
prompted to make decisions about moderating use or quitting. The program provides information,
interactive exercises and an electronic drinking diary to achieve
The Other Talk (www.theothertalk.org.au) is a website for Australian parents to learn the facts about
alcohol and other drugs, safe partying, the law and to learn ways to open up the conversation. The
Australian Drug Foundation has a service Get the effects by txt! Parents can stay informed with reliable
information on different drugs and their effects. They can text the drug name to a number and then
receive an SMS about the effects as well as links to further information for help. Parents can text the
street names as well and receive information e.g. text ‘weed’ and will receive information on cannabis.
The Sunday Morning (hellosundaymorning.com.au) website provides individuals with an opportunity to
take a break from drinking. People sign up, commit to not drink, set goals and blog about their journey.
The Meth site (meth.org.au) site provides information on meth and uses a stepped care approach, based
on an initial screening questionnaire to direct users to the part of the site most appropriate for their
needs. Those who had significant problems or screened likely for dependence or high readiness to
change were directed to a self-help intervention based on a face-to-face brief intervention. Those with
lower level issues or low readiness to change were directed to harm reduction information.
Somazone (www.somazone.com.au) offers a safe space where young people can ask health related
questions, share stories and get help. They can find information on issues ranging from mental health,
sexual health, relationships, abuse, body image, and drug use. Information is free and the young people
remain anonymous.