Special Topics in Addiction: Brief Interventions

Transcription

1 Special Topics in Addiction: Brief Interventions Allyson Peller, M.P.H. Division on Addictions, Cambridge Health Alliance Harvard Medical School

2 Public Health Interventions for Addictive Behaviors Allocation of public health resources Limited federal resources Are brief interventions effective?

3 Types of Public Health Prevention Strategies Primary Secondary Tertiary

4 Primary Prevention An action taken to prevent the development of a disease in a person who is well and does not have the disease in question

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7 Trends in Illicit Drug Use Among US Teenagers

8 Trends in Binge Drinking Among US Teenagers

9 Trends in Binge Drinking Among US Teenagers

10 Trends in Marijuana Use Among US Teenagers

11 Trends in Marijuana Use Among US Teenagers

12 Trends in Marijuana Use Among US Teenagers

13 Trends in Inhalant Use Among US Teenagers

14 Trends in Inhalant Use Among US Teenagers

15 Trends in Sedative Use Among US Teenagers

16 Trends in Sedative Use Among US Teenagers

17 Trends in Sedative Use Among US Teenagers

18 Trends in Cocaine Use Among US Teenagers th Grade 10th Grade 12th Grade '

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20 Some Reactions to this Public Parodies: Service Announcement The Simpsons This is your brain on donuts Weird Al Yankovic 1992 album Nightmare on Elm Street Scary Movie 2

21 Trends in Crystal Meth Use

22 Methamphetamine crystal meth, meth, ice, crank, glass fast acting and shortlasting nervous system stimulant euphoria, paranoia, hallucination, unpredictable violent behavior

23 Crystal Meth News Headlines America s Most Dangerous Drug (Newsweek 2006) The Meth Epidemic: An Investigation of How and Why Meth Use Spiraled Out of Control (Frontline 2006) Experts Warn Crystal Meth Problem Heading East (CBS News 2006)

24 image shown on Frontine

25 Meth Mouth image shown on Frontine

26 Crystal Meth Use Across the US

27 Illicit Drug Use in the US average use Marijuana 11% Pain relievers (non-medical) 5% Cocaine 2% Tranquilizers 2% Hallucinogens 2% Methamphetamine < 1%

28 Meth Labs Home meth labs produce the drug using common household ingredients Toxic chemicals

29 Changes in Drug Regulations Tighter restrictions on chemicals used to produce meth

30 Meth Abuse Drops After Restriction on Chemical Ingredients. The Oregonian, ographics.html

31 Meth Abuse Drops After Restriction on Chemical Ingredients. The Oregonian, ographics.html

32 Treatment & Relapse Prevention Drug courts Efforts monitor methamphetamine offenders over time provide offenders resources for treatment

33 Primary Prevention Campaigns Montana Meth Project raise awareness about consequences of meth use and abuse targeted at teenagers but aims to reduce use among all population segments Are these ads effective? what assumptions do they make about risk factors? what effects of meth use are shown? what is the style of these ads?

34 How have primary prevention strategies changed over time? Need to adapt to cohort effect Use of different drugs Use of marijuana and ecstasy decreased while use of prescription drugs (e.g., sedatives, stimulants) has increased Increased exposure to violence and technology

35 Secondary Prevention A set of measures available to individuals and communities for the early detection and prompt intervention to control disease and minimize disability by the use of screening programs

36 Massachusetts Adolescent Gambling Screen Have you ever experienced social, psychological or financial pressure to start gambling or increase how much you gamble? Have you ever gotten into trouble at work or school because of your gambling Are you always able to stop gambling when you want to? Do you ever feel guilty about your gambling? Have you ever gone to anyone for help about your gambling? Shaffer, LaBrie and Scanlon 1996

37 Tertiary Prevention Consists of measures aimed at softening the impact of long-term disease and disability by eliminating or reducing impairments, disability and handicap Costs of treating chronic diseases can be expensive Do brief interventions work?

38 Self-Help Brief Interventions Untested initiatives, even if well-intended, can lead to adverse consequences Empirical evaluation is a necessary component of effective medical and public health initiatives Begin with least invasive efforts (e.g., relatively inexpensive and efficient primary and secondary interventions)

39 Interventions can target various stages of change Prochaska and DiClemente, 1983

40 Your First Step to Change: Gambling Toolkit Brief self-help problem gambling intervention Created by the Division on Addictions, the Massachusetts Council on Compulsive Gambling, and the Massachusetts Department of Public Health Designed to stimulate thinking about change among individuals who possibly are at-risk for or are experiencing gambling problems

41 Your First Step to Change: Gambling Toolkit Facts about gambling Understanding your Gambling Thinking about Change Websites for resources and additional reading

42 Your First Step to Change: Gambling Toolkit Reporting of gambling activities, past treatment seeking MAGS assessment of problem gambling Recent and planned gambling behavior modifications and irrational beliefs about gambling

43 Planned Behavior Modifications Professional treatment Attend gambling support group meeting Go to website about PG Additional reading about PG Avoid places with gambling Spend less time with gamblers Carry minimal amount of money Cancel credit cards because of gambling

44 Gambling Beliefs Questionnaire: Examples My knowledge and skill in gambling contribute to likelihood I will win If I am gambling and losing I should continue because I don t want to miss a win When I am gambling, near misses or times when I almost win remind me that if I keep playing I will win In the long run, I will win more money than I will lose gambling If I lose money gambling, I should try to win it back

45 Evaluation of Self-Help Gambling Toolkit Randomized controlled trial Guided Toolkit Toolkit Waitlist Participants recruited through newspaper ads Parallel studies conducted using Massachusetts (1 year follow-up) and Nevada samples (3 month follow-up)

46 Gambling Toolkit Research Design Guided Toolkit Intervention Mailing 1 Toolkit Remuneration ($10) Interaction 2 Guided interview with toolkit Mailing 2 Remuneration ($10) Reminder Mailing 3 Remuneration ($25) Advertising Interaction 1 Consent Screening Baseline Survey Toolkit Intervention Mailing 1 Toolkit Remuneration ($10) Interaction 2 Confirm receipt of toolkit/remuneration Interaction 3 1 Month Follow-up Survey Mailing 2 Remuneration ($10) Reminder Interaction 4 3 Month Follow-up Survey Mailing 3 Remuneration ($25) Delayed Intervention Mailing 1 Remuneration ($10) Interaction 2 Confirm receipt of remuneration only Mailing 2 Remuneration ($10) Reminder Mailing 3 Toolkit Remuneration ($25)

47 UNLV Baseline Demographics Measure Total (180) Guided(60) Unguided (60) Control (60) Demographics Male (%) White (%) Hispanic (%) Las Vegas (%) Reno (%) Rural (%)

48 UNLV Baseline Demographics Measure Total (180) Guided(60) Unguided (60) Control (60) Prior Treatment Mental/emotional (%) Drug/alcohol (%) Gambling (%) Help Seeking Total Strategies Mean (SD) 1.9 (1.2) 1.9 (1.2) 1.8 (1.4) 1.9 (1.1)

49 UNLV Baseline Demographics Measure Total (180) Guided(60) Unguided (60) Control (60) Past Month Gambling Abstained 7+ days (%) Heavy 7+ days (%) Days Mean (SD) 15 (9) 14 (8) 15 (9) 15 (9) Planned Behavior Changes Index Score Mean (SD) 13 (3) 12 (3) 13 (3) 13 (3)

50 UNLV Baseline Demographics Measure Total (180) Guided(60) Unguided (60) Control (60) Gambling Attitude Total Mean (SD) 32 (7) 34 (7) 31 (8) 33 (7) Severity (MAGS) Not disordered (%) Transition (%) Pathological (%)

51 Change from Baseline to Month 1: Continuous Measures Significance of Effects (p) Measure Group Time Interaction Past month Help Seeking NS* <.001 NS Planned Strategies NS.001 NS Gambling Attitudes NS <.001 NS Days Gambled Past Month NS <.001 NS Within-group Change Base to Month 1 Mean Change (p) Guided Unguided Control Total N = 55 N = 50 N = 52 N = (.005) (.004) (.01) (<.001) (.001) (.02) NS (<.001) (<.001) (<.001) (<.001) (<.001) (<.001) (<.001) (<.001)

52 Global Measures Measure Abstained for 7+ days Heavy play for 7+ days Effect Group Guided N = 55 Percentages by Group Unguided N = 50 Control N = 52 NS NS

53 Global Measures Measure Group Guided N = 55 Unguided N = 50 Control N = 52 Global Toolkit Assessment Used Complete Toolkit NS NA Helpful? NS NA Help understand: gambling? NS NA Help understand: your gambling/ NS NA Make you feel Bad? NS NA Recommend to Others? NS NA

54 Change from Baseline to 3-month: continuous measures Significance of Effects (p) Measure Group Time Interaction Past month Help Seeking NS* <.001 NS Planned Strategies NS <.001 NS Gambling Attitudes NS <.001 NS Days Gambled Past Month NS <.001 NS Within-group Change Base to Month 3 Mean Change (p) Guided Unguided Control Total N = 56 N = 50 N = 52 N = < < NS < <.001 <.001 <.001 < <.001 <.001 <.001 <.001

55 Change Over Time Continuous Measures: Toolkit vs. Control Significance of Effects (p) Toolkit N = 98 Controls N = 48 Measure Group Time G by T 1 Month 3 Months 1 Month 3 Months Past month Help Seeking NS* <.001 NS Planned Strategies NS.001 NS Gambling Attitudes NS < Days Gambled Past Month NS <

56 Abstaining From and Heavy Gambling by Experimental Group Measure Abstained for 7+ days Heavy play for 7+ days 1 Month (%) 3 Months (%) Toolkit Control Sig. Toolkit Control Sig NS NS 7 13 NS

57 Massachusetts Baseline Characteristics Measure Effect Total (164) Guided (53) Unguided (54) Control (57) Demographics Male (%) NS White (%) NS Black (%) NS Other (%) NS

58 Massachusetts Baseline Characteristics Measure Effect Total (164) Guided (53) Unguided (54) Control (57) Prior Treatment Mental/emotional (%)* Drug/ alcohol (%) NS Gambling (%) NS

59 Massachusetts Baseline Characteristics Measure Effect Total (164) Guided (53) Unguided (54) Control (57) Total Strategies Mean (SD) Help Seeking NS 1.7 (1.4) 1.6 (1.4) 1.4 (1.2) 1.9 (1.5) Past month gambling Abstained 7+ days (%) NS Heavy 7+ days (%) NS Days Mean (SD) NS 19.5 (9.9) 19.2 (10.4) 19.0 (9.3) 20.3 (10.0)

60 Massachusetts Baseline Characteristics Measure Effect Total (164) Guided (53) Unguided (54) Control (57) Severity (MAGS) Not disordered (%) NS Transition (%) NS Pathological (%) NS

61 Massachusetts Toolkit follow-up data Preliminary results show some significant differences among groups at 6 months

62 Discussion What makes a brief intervention effective? What sorts of problems might brief interventions be most effective? Are brief interventions as effective as longterm care?