Introducing: Saying When An Innovative Knowledge Tool for Moderate Drinking
About CAMH HPRC Identifying evidence needs and developing system responses Fostering system-level conversations Developing system-level implementation tools
About PSSP Supports Ontario s Comprehensive Mental Health and Addictions Strategy, through system interventions. Provides capacity and expertise in: knowledge exchange information management implementation coaching equity and engagement evaluation
Alcohol Consumption in Ontario 24% of Ontario adults (past year drinkers) exceeded low-risk drinking guidelines 14% drank hazardously or harmfully in the past year
Building Blocks for Saying When: Findings from a 22-year Program of Clinical Research 1973-1996 Dr. Martha Sanchez-Craig March 10, 2016
Study 1: Rehabilitation of Chronic Alcoholics Long-term residential program Key program components Goal setting: vocational, leisure, future housing Developing cognitive and behavioural coping for triggers of heavy drinking and urges to drink
Study 1: Rehabilitation of Chronic Alcoholics Long-term residential program Findings: Identifying triggers of heavy drinking Negative emotions Drinking for pleasure Outcomes of "successful" residents Abstinent (15%) Moderate, problem-free drinking (8-10%) Socially Stable
Impetus for the next study The outcomes of successful residents prompted adaptation of the program to serve the larger population of "early-stage problem drinkers" for whom targeted treatments were just beginning to emerge.
Study 2: Program for Early-Stage Problem-Drinkers Evaluating the merit of giving choice of goal Recruitment method Newspaper ads offering individual outpatient treatment for those whose drinking was beginning to interfere with health, work or family responsibilities Treatment groups Abstinence: prescribed as the goal Choice: abstinence or moderation
Study 2: Program for Early-Stage Problem-Drinkers Evaluating the merit of giving choice of goal Key treatment components Goal setting Keeping track via Drinking Diary and Coping Diary Developing cognitive and behavioural coping for Activators, Urges & Social pressures
Study 2: Program for Early-Stage Problem-Drinkers Evaluating the merit of giving choice of goal Findings within treatment Identifying goal preference Abstinence was rejected by most clients Moderation was preferred by most given choice Identifying another Activator: Drinking out of habit Identifying 5 key strategies to stay on goal Keeping track Pacing drinking Planning ahead for risky situations Developing leisure activities Avoid drinking to cope No. of sessions: Six one-hour sessions on average (both groups)
Study 2: Program for Early-Stage Problem-Drinkers Evaluating the merit of giving choice of goal Findings at follow-up Identifying the importance of giving choice of goal Imposing abstinence was counter-productive and less cost-effective than offering choice Identifying cut-offs to set goals of moderation Max. 4 drinks a day (Men) and 3 (Women) Max. 12 drinks a week for both Benefit of maintaining use of the 5 key strategies Successful clients were more likely than unsuccessful clients to maintain use of the strategies
Impetus for the next study Evidence of the benefits of clients keeping records of their goals, their drinking, and coping (with activators, urges & social pressures) prompted development of manuals to facilitate the activities: Precursor of Saying When Guidelines in pamphlet form
Study 3: Incorporating Self-help Materials in Treatment Could we reduce therapist contact without loss of effectiveness? Recruitment method Newspaper ads offering brief, outpatient, individual treatment to quit or cut down for those concerned about their drinking and not seeing themselves as "alcoholics Treatment groups Therapist assisted (as many sessions as clients required) Three sessions + Self-help book Three sessions + Guidelines for Low-Risk Drinking
Study 3: Incorporating Self-help Materials in Treatment* Could we reduce therapist contact without loss of effectiveness? Findings The ads attracted many women to the study Treatments using self-help materials were the most cost-effective Women were a more successful group if treatment involved self-help materials *This study was replicated in a different setting with different therapists. It yielded identical outcomes.
Study 4: Gender-specific Guidelines for Low-risk Drinking Method Pool the 1-year outcome data of the three studies with early-stage problem-drinkers. Use discriminant analysis to differentiate the "problem-free" clients from those reporting one or more problems.
Study 4: Gender-specific Guidelines for Low-risk Drinking Findings: Upper Limits No daily drinking Men: no more than 4 drinks/day and 12/week Women: no more than 3 drinks/day and 9/week Advice Any drinking has risks. The lower your drinking, the lower the risks Never drink to cope with problems Avoid drinking in situations where any drinking poses risks to yourself and others
Impetus for the next study Publish Saying When Test Saying When in remote, underserved communities of Northern Ontario using telephone contact
Study 5: Telephone intervention Recruitment method Flyers distributed by Canada Post
Study 5: Telephone intervention Characteristics of the sample 99 male, 56 female Avg. Drinks/week: 22 on 4 days drinking English-Can. (67%), French Can. (11%), Aboriginal (8%), Other (14%) Study Groups 5-min. screening + mailed Saying When 30-min. assessment + mailed Saying When
Study 5: Telephone intervention Findings At 3-month follow-up, more of those receiving the telephone assessment were rated "moderate drinkers" (65% vs 43%) At one year, the groups did not differ significantly in drinking. But more females than males were rated "moderate drinkers" (71% vs 52%) Successful participants reported more regular use of key strategies
Conclusion The substantive components of the Saying When app have their basis in evaluated clinical research.
More information For a detailed report of the program of research consult Martha Sanchez-Craig (1996), A Therapist s Manual Secondary Prevention of Alcohol Problems. ARF, Toronto. For the self-help version of the program see Saying When: How to Quit Drinking or Cut Down
Saying When: From Publication to Mobile Application March 10, 2016
+ CAMH Publications A knowledge exchange program of the Centre for Addiction and Mental Health Founded within the Addiction Research Foundation, one of four organizations that came together to form CAMH in 1997 Capacity-building within the community-based treatment system, especially primary care, is a key goal of the program In 2016, CAMH Publications has evolved to include print, app development, e-books, print-ondemand and web (camh.ca and Porticonetwork.ca).
+ From publication to mobile application mhealth is an opportunity for CAMH to remove barriers to accessing information and tools Saying When is ideal as a mobile application because the book is interactive, and self-guided Built through Inter-professional collaboration: subject matter expertise, design, developmental editing, mobile development User experience testing at the Human Factors Lab at the University Health Network Originally released for ios in 2014, Saying When and sold for $1.99 Became free in late 2014 19,000+ downloads.
+ How does Saying When the app work? Tour the app! https://vimeo.com/105675631
+ Next steps: Outreach, research and quality improvement Improve our understanding of how people are using the app through anonymized analytics Introduce Saying When app and/or book to CAMH clients presenting with an alcohol use disorder (rather than alcohol dependence). Involve formal research. Actively offer Saying When to students seen at University of Toronto s Health & Wellness Centre. Involve formal research. Make the product known and accessible.
The Saying When App: A Tool for Public Health Thursday March 10, 2016
Why Saying When as Tool for Public Health?
Developing the Knowledge Exchange Plan
Increasing Awareness of the Saying When App
Who Should I Share the App With? Public health unit staff Allied service providers General public
How Can I Share the App? Posters Wallet-sized cards Order from CAMH HPRC
How Can I Share the App?
How About Social Media? Use hashtags (e.g., #Int lbeerday) Align with special events (e.g., May Long Wknd) Adapt the suggested messages from the flyer
Have some ideas to share? Contact: Monica Nunes Knowledge Broker CAMH Health Promotion Resource Centre monica.nunes@camh.ca 416-535-8501 ext 33935 https://www.porticonetwork.ca/web/camh-hprc
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