A Randomized Trial to Reduce Problematic Use of Amphetamine Type Stimulants Robert Tait, Rebecca...
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Transcript of A Randomized Trial to Reduce Problematic Use of Amphetamine Type Stimulants Robert Tait, Rebecca...
A Randomized Trial to Reduce Problematic Use of Amphetamine Type
Stimulants
Robert Tait, Rebecca McKetin, Frances Kay-Lambkin, Bradley Carron-Arthur, Anthony Bennett, Kylie Bennett,
Helen Christensen, Kathleen M. Griffiths
Burden of diseaseSystematic reviewsbreakingtheice
Burden of diseaseSubstance Global Australia
Alcohol
DALYs (%)harm
deaths (n)
4.01 787000
2.31084
Illicit drugs
DALYs (%)
deaths (n)
0.8223000
2.01705
BoD Rehm, Taylor & Room Addiction 2006: Begg AIHW 2007
Amphetamine type stimulants (ATS)
UNODC 2010
Amphetamine type stimulants (ATS)
Primary drug of concernAfrica 5%Asia 20% (>80% Cambodia, Korea, Thailand)Australia 21%Europe 9% (Czech 61%, Iceland 39%: Sweden
35%)N. America 13% (Guatemala 42%, Canada 3%, USA
13%)
UNODC 2010
Alcohol interventionsBrief in person interventions (Moyer Addiction 2002)
BI versus Control (non-treatment seeking - excluding severe problems) • Small – medium effects (e.g. d ≈ .26 at 12 months)• Alcohol and composite measures improved• Effective to 12 months
Alcohol: self-guided interventions for adult problem drinkers (Riper 2011)
•Overall g = .39 •Single session g = .27 (typically normative feedback)•Multi session g = .61•Max follow-up 9 monthsOnline alcohol interventions (White et al 2010)
•Overall d =.42•Attracted young (early 20s) people•Higher % of women than face-to-face studies
Online cannabis interventions (Tait et al 2013)
10 studies: n = 4125Prevention n = 5‘Treatment’ n = 570% < 6 months follow-up: only 1 study >12
monthsRetention 16%-95%(High retention in mother-daughter dyad trials)•Overall g = .16
BreakingtheiceDesign: RCT Intervention versus wait list controlTarget: users of amphetamine type stimulants (ATS)Program: three modules, fully automated and self-guided
Baseline Control (79) Intervention (81)
Sex male n (%) 57 (72)a 64 (79)Age mean (SD) 22.5 (7.1) 22.2 (5.5)Age 1st ATS use mean (SD) 18.6 (4.2) 17.7 (2.6)SDS mean (SD) [threshold > 5] 3.8 (3.3) [42%] 3.7 (3.5) [30%]ATS Fq last 3 months 1-2 n (%) 27 (34) 20 (25)
monthly n (%) 18 (23) 33 (41)weekly n (%) 23 (29) 21 (26)
daily / almost daily n (%) 11 (14) 7 (9)ASSIST ATS score mean (SD) 16.8 (11.1) 17.0 (10.1)
BreakingtheiceSecondary outcomes•Kessler-10 (Psychological distress)
•EUROHIS (Quality of Life)
•Poly-drug use (number of ASSIST categories)
•Intended help-seeking (for ATS use)
•Actual help-seeking (for ATS use)
•Days out of role
•Days partially out of role
•Readiness to change (category)
Study cohort
Baseline 3 months 6 months
BreakingtheiceResults
AS
SIS
T A
TS
sco
re
d=0.07 (control favoured)
BreakingtheiceD
ays
out
of r
ole
K-1
0 m
ean
scor
e
d=0.12 d=0.12 (control favoured)
BreakingtheiceIn
tend
ed H
elp-
seek
ing
Act
ual H
elp-
seek
ing
d=0.32d=0.45
RR. 2.33, 95% CI, 1.07-5.10
Breakingtheice‘Exposure’ completing > 1 modules (n=51): 0 modules (n=30): control (n=79)
N.B. No longer RCT• Intended help-seeking (p=.014)• Actual help-seeking (p=.034)• Days out of role (p=.007)
DiscussionFindings 1st intervention designed for ATS users
Improves actual help seekingMay reduce days out of role & increase help-seeking intentions
Limitations Attrition 51%Representativeness of all ATS users?Type 1 errors
Implications Still in its infancy
Modules focus: motivation versus quitting
Adjunct to face-to-face interventions?
AcknowledgementsThis study was funded by The Commonwealth of
Australia, Department of Health and Ageing
Helen Christensen is funded by NHMRC Fellowship 1056964 Kathleen Griffiths is funded
by NHMRC Fellowship 525413 Frances Kay-Lambkin is funded by NHMRC
Fellowship 1008972.
Robert Tait is funded by a Curtin University Research Fellowship