Peter Tossma Benjamin Jon Marc Tens Peter La Evelin Strüb Berlin / Cologne, June 20 Quit the shit – An internet-based intervention program for cannabis users Bundeszentrale für gesundheitliche Aufklärung
Peter TossmannBenjamin Jonas
Marc TensilPeter Lang
Evelin StrüberBerlin / Cologne, June 2012
Quit the shit – An internet-based intervention program for cannabis users
Bundeszentrale fürgesundheitliche Aufklärung
Structure of the presentation
1. The programme “quit the shit“1.1. Basic facts1.2. Structure & content
2. Evaluation of the programme (RCT)2.1. Study design 2.2. Results
3. Conclusion
Development
› “quit the shit” was developed on behalf of the
Federal Centre of Health Education (FCHE / BZgA)
› Start: August 2004
› Embedded in “www.drugcom.de”
1.1. Basic facts
Bundeszentrale fürgesundheitliche Aufklärung
Allgemeine Informationen
Development
› “quit the shit” was developed on behalf of the
Federal Centre of Health Education (FCHE / BZgA)
› Start: August 2004
› Embedded in “www.drugcom.de”
Usage of “quit the shit”
› Until 15 June 2012, 3.900 users (approx. 40 – 50 per month)
Target group
› Cannabis-addicted adolescents and young adults
Aim of the programme
› To reduce cannabis consumption or to quit within 50 days
1.1. Basic facts
Bundeszentrale fürgesundheitliche Aufklärung
Brief intervention
› Clear timeframe (50 days)
› Target oriented approach
Counselling concept
› Social learning theory (Kanfer, 1986): Self-monitoring & self-regulation
› Solution-focussed strategy (Berg & Miller, 2000)
› Motivational Interviewing (Miller & Rollnik, 1999)
Additional Information for the users
› Section title: “How to control cannabis use”
1.1. Basic facts
1. Registration
› Registration questionnaire
› Current use of cannabis & other substances (quantity, frequency,
dependence etc.)
› Mental well-being (life satisfaction, psych. problems, social support etc.)
› Socio-demographics (age, gender, educational & employment status etc.)
› Registration with E-Mail-Address
› Appointment for the Admission-Chat
Admission-Chat
2Programme-Participation
3Concluding
Chat
4Registration
1
1.2. Structure & content of the programme
Registration1
2. Admission-Chat with trained psychologist
› Where? In the chat-room of “quit the shit”
› Duration: 50 minutes
› Aims:
› Establish a trustful relationship
› Elicit the personal situation of the client
› Define individual goals & coping strategies
1.2. Structure & content of the programme
Programme-Participation
3Concluding
Chat
4Registration
1Admission-
Chat
2
3. Programme Participation (I)
› Online diary for 50 days
› Cannabis-use for each day (yes / no):
› If “yes”: When? How much? Situational context? Reasons?
› If “no”: Reasons for abstinence? Which coping strategies?
› Daily resume
› Exercises
› Coping strategies, pleasurable activities & healthy lifestyle, self-efficacy &
problem solving etc.
1.2. Structure & content of the programme
Admission-Chat
2Concluding
Chat
4Registration
1Programme-Participation
3
3. Programme Participation (II)
› Weekly feedback from the counsellor
› Topics: Substance use, psychosocial situation, progress within the
programme
› Ideas & suggestions, exercises
› Answering questions etc.
1.2. Structure & content of the programme
Admission-Chat
2Concluding
Chat
4Registration
1Programme-Participation
3
4. Concluding Chat (30 min)
› Where? In the chat-room of “quit the shit”
› Topics:
› Which goals could be obtained? Which ones not?
› Which coping strategies worked? Which ones have to be improved?
› Future perspectives: Is there a need for additional support?
1.2. Structure & content of the programme
Admission-Chat
2Programme-Participation
3Registration
1Concluding
Chat
4
Is “quit the shit” helpful ....› to reduce cannabis use ?
› to improve psychological well-being ?
2. Evaluation of the programme
Structure of the survey
Registration-questionnaire
• Socio-demographics• Cannabis consumption (quantity, freq.)• Psychological well-being• etc.
Delay-conditionParticipation at QTS
3 M
onth
s
Follow-up• Cannabis consumption (quantity, freq.)• Psychological well-being• etc.
2.1. Study design: Randomised Control Trial (RCT)
Inclusion criteria fulfilled (n=1.292)
Participation at QTS(Intervention Group)
(n=863)
Waiting Condition (Control Group) (n=429)
Follow-up-data
(n=150)
Analysed Data (n=100)
Analysed Data (n=106)
Follow-up-data
(n=144)
Inclusion Programm (n=360)
Randomisation
exclusion: n=44professional help: n=44
response: 35% response: 39%
2.2. Results: Participants
Study population: N=206 participants
Cannabis: Consumption & dependence• On average on 25,5 days (SD=6,1) during the last 30 days• On average 20,4 grams (SD=18,1) during the last 30 days• 95% are addicted to cannabis (DSM IV)
Socio-demographic data• Significantly more male participants (74%)• Average age: 25 yrs. (MD) (youngest: 14 yrs.; oldest: 59 yrs.)• Relatively high education: 55% attend Gymnasium (grammar
school) or have reached Abitur (a-levels)
2.2. Results: Participants
Registration Follow up0
5
10
15
20
25
30
24.9
21.0
26.1
12.4
CG (n=106)
IG (n=100)
Day
s of
con
sum
ption
T(187,02)=6,593; p<.001; d = 0.98
3.2. Results: Days of consumption / past 30 days
Abstinence (Follow-up)
IG: 32,6%
CG: 5,4%
Odds Ratio: 8,5 (p<.001)
T(166,969)=5,174; p<.001; d = 0.74
3.2. Results: Amount (grams) / past 30 days
* State-Trait-Anxiety-Inventory, Trait-Subscale (Laux et al., 1981)
T(183)=3,747; p<.001; d = 0.45
3.2. Results: Anxiety (STAI-T)*
50,947,3
51,4
42,6
20
30
40
50
60
70
80
Registration Follow Up
STA
I-T sc
ore
80 = scale max.20 = scale min.
CG (n=99)
IG (n=86)
* Allgemeine Depressions-Skala, Kurzversion (Hautzinger & Bailer, 1993)
T(180)=1,907; p=.029; d = 0.26
3.2. Results: Depressiveness (ADS-K)*
* Satisfaction with Life Scale (Schumacher, 2003)
T(195)=-2,683; p=.004; d = 0.29
3.2. Results: Life satisfaction (SWLS)*
“Quit the shit” is one of the first internet-based treatment programmes for cannabis-related disorders in Europe
It was successfully established in Germany (3.900 users so far)
Extended and optimized continuously
Highly elaborated system (programme, user management)
It has been proven to be effective in reducing cannabis use and improving psychological well-being
4. Summary
Thank you!