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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 controlled trial.

Hester RK, Lenberg KL, Campbell W, Delaney HD - J. Med. Internet Res. (2013)

Bottom Line: Six-month follow-ups have been completed, and the results are currently being analyzed.These results support our first experimental hypothesis but not the second or third.All groups significantly increased their PDA and decreased both their mean DDD and their alcohol-related problems, which indicates that both interventions being investigated were equally effective in helping people recover from their problem drinking.

View Article: PubMed Central - HTML - PubMed

Affiliation: Behavior Therapy Associates, LLC, Research Division, Albuquerque, NM 87111, United States. reidkhester@gmail.com

ABSTRACT

Background: Overcoming Addictions (OA) is an abstinence-oriented, cognitive behavioral, Web application based on the program of SMART Recovery. SMART Recovery is an organization that has adapted empirically supported treatment strategies for use in a mutual help framework with in-person meetings, online meetings, a forum, and other resources.

Objective: To evaluate the effectiveness of OA and SMART Recovery (SR) with problem drinkers who were new to SMART Recovery. Our experimental hypotheses were: (1) all groups will reduce their drinking and alcohol/drug-related consequences at follow-up compared to their baseline levels, (2) the OA condition will reduce their drinking and alcohol/drug-related consequences more than the control group (SR), and (3) the OA+SR condition will reduce their drinking and alcohol/drug-related consequences more than the control group (SR only).

Methods: We recruited 189 heavy problem drinkers primarily through SMART Recovery's website and in-person meetings throughout the United States. We randomly assigned participants to (1) OA alone, (2) OA+attend SMART Recovery (SR) meetings (OA+SR), or (3) attend SR only. Baseline and follow-ups were conducted via GoToMeeting sessions with a Research Assistant (RA) and the study participant. We interviewed significant others to corroborate the participant's self-report. Primary outcome measures included percent days abstinent (PDA), mean drinks per drinking day (DDD), and alcohol/drug-related consequences.

Results: The intent-to-treat analysis of the 3-month outcomes supported the first hypothesis but not the others. Participants in all groups significantly increased their percent days abstinent from 44% to 72% (P<.001), decreased their mean drinks per drinking day from 8.0 to 4.6 (P<.001), and decreased their alcohol/drug-related problems (P<.001). Actual use relationships were found for the OA groups, between SR online meetings and improvement in PDA (r=.261, P=.033). In addition in the OA groups, the number of total sessions of support (including SR & other meetings, counselor visits) was significantly related to PDA (r=.306, P=012) and amount of improvement in alcohol-related problems (r=.305, P=.012). In the SR only group, the number of face-to-face meetings was significantly related to all three dependent variables, and predicted increased PDA (r=.358, P=.003), fewer mean DDD (r=-.250, P=.039), and fewer alcohol-related problems (r=-.244, P=.045), as well as to the amount of improvement in all three of these variables. Six-month follow-ups have been completed, and the results are currently being analyzed.

Conclusions: These results support our first experimental hypothesis but not the second or third. All groups significantly increased their PDA and decreased both their mean DDD and their alcohol-related problems, which indicates that both interventions being investigated were equally effective in helping people recover from their problem drinking.

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Related in: MedlinePlus

Actual use groups: Percent days abstinent.
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figure3: Actual use groups: Percent days abstinent.

Mentions: Although we had to abandon our initial design, which included a group that would have used only OA without having the option of participating in any SR meetings, there were 29 of the 83 participants in the OA conditions who did not take part in SR meetings. This allowed post hoc comparisons to be made among three groups: those using only the OA app (n=29), those who both used the OA app and attended SR meetings (n=54), and those randomly assigned to SR only. These three groups did not differ significantly in composition by gender, ethnicity, age, or education. Although there were no significant differences in mean baseline values on our three primary dependent variables, the trend in each case was for those in the OA only group to be more impaired initially than those who attended SR meetings. Repeated measures ANOVAs again indicated highly significant changes over time on all three dependent variables (P<.001), but, more importantly, tests of the group x time interaction were nonsignificant. As suggested by the plots of means in Figures 3-5, the test for differential change across the three groups did not approach significance for DDD, F1,141=0.09, P=.919, or for InDUC, F1,141=0.34, P=.713. For PDA, while the omnibus test of the group x time interaction was nonsignificant, F1,141=2.04, P=.134, the plot of means revealed more separation of the groups. In fact, the main effect of groups on PDA was significant, F2,141=3.10, P=.048, because the overall mean PDA in the OA+SR group (63.4) was greater than the average of the other two groups (53.5), F1,141=4.65, P=.033. However, this resulted in part from the higher mean PDA at baseline in the OA+SR group, because there was not significant evidence of differential improvement across groups. That is, tests of interaction contrasts indicated that not only was the improvement in the SR only group (27.6) not different from that in the OA only group (23.2), F1,141=0.51, P=.475, but the improvement in the OA+SR group (32.9) was also not significantly larger than the average improvement of the other two groups (25.4), F1,141=2.41, P=.122.


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 controlled trial.

Hester RK, Lenberg KL, Campbell W, Delaney HD - J. Med. Internet Res. (2013)

Actual use groups: Percent days abstinent.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3713880&req=5

figure3: Actual use groups: Percent days abstinent.
Mentions: Although we had to abandon our initial design, which included a group that would have used only OA without having the option of participating in any SR meetings, there were 29 of the 83 participants in the OA conditions who did not take part in SR meetings. This allowed post hoc comparisons to be made among three groups: those using only the OA app (n=29), those who both used the OA app and attended SR meetings (n=54), and those randomly assigned to SR only. These three groups did not differ significantly in composition by gender, ethnicity, age, or education. Although there were no significant differences in mean baseline values on our three primary dependent variables, the trend in each case was for those in the OA only group to be more impaired initially than those who attended SR meetings. Repeated measures ANOVAs again indicated highly significant changes over time on all three dependent variables (P<.001), but, more importantly, tests of the group x time interaction were nonsignificant. As suggested by the plots of means in Figures 3-5, the test for differential change across the three groups did not approach significance for DDD, F1,141=0.09, P=.919, or for InDUC, F1,141=0.34, P=.713. For PDA, while the omnibus test of the group x time interaction was nonsignificant, F1,141=2.04, P=.134, the plot of means revealed more separation of the groups. In fact, the main effect of groups on PDA was significant, F2,141=3.10, P=.048, because the overall mean PDA in the OA+SR group (63.4) was greater than the average of the other two groups (53.5), F1,141=4.65, P=.033. However, this resulted in part from the higher mean PDA at baseline in the OA+SR group, because there was not significant evidence of differential improvement across groups. That is, tests of interaction contrasts indicated that not only was the improvement in the SR only group (27.6) not different from that in the OA only group (23.2), F1,141=0.51, P=.475, but the improvement in the OA+SR group (32.9) was also not significantly larger than the average improvement of the other two groups (25.4), F1,141=2.41, P=.122.

Bottom Line: Six-month follow-ups have been completed, and the results are currently being analyzed.These results support our first experimental hypothesis but not the second or third.All groups significantly increased their PDA and decreased both their mean DDD and their alcohol-related problems, which indicates that both interventions being investigated were equally effective in helping people recover from their problem drinking.

View Article: PubMed Central - HTML - PubMed

Affiliation: Behavior Therapy Associates, LLC, Research Division, Albuquerque, NM 87111, United States. reidkhester@gmail.com

ABSTRACT

Background: Overcoming Addictions (OA) is an abstinence-oriented, cognitive behavioral, Web application based on the program of SMART Recovery. SMART Recovery is an organization that has adapted empirically supported treatment strategies for use in a mutual help framework with in-person meetings, online meetings, a forum, and other resources.

Objective: To evaluate the effectiveness of OA and SMART Recovery (SR) with problem drinkers who were new to SMART Recovery. Our experimental hypotheses were: (1) all groups will reduce their drinking and alcohol/drug-related consequences at follow-up compared to their baseline levels, (2) the OA condition will reduce their drinking and alcohol/drug-related consequences more than the control group (SR), and (3) the OA+SR condition will reduce their drinking and alcohol/drug-related consequences more than the control group (SR only).

Methods: We recruited 189 heavy problem drinkers primarily through SMART Recovery's website and in-person meetings throughout the United States. We randomly assigned participants to (1) OA alone, (2) OA+attend SMART Recovery (SR) meetings (OA+SR), or (3) attend SR only. Baseline and follow-ups were conducted via GoToMeeting sessions with a Research Assistant (RA) and the study participant. We interviewed significant others to corroborate the participant's self-report. Primary outcome measures included percent days abstinent (PDA), mean drinks per drinking day (DDD), and alcohol/drug-related consequences.

Results: The intent-to-treat analysis of the 3-month outcomes supported the first hypothesis but not the others. Participants in all groups significantly increased their percent days abstinent from 44% to 72% (P<.001), decreased their mean drinks per drinking day from 8.0 to 4.6 (P<.001), and decreased their alcohol/drug-related problems (P<.001). Actual use relationships were found for the OA groups, between SR online meetings and improvement in PDA (r=.261, P=.033). In addition in the OA groups, the number of total sessions of support (including SR & other meetings, counselor visits) was significantly related to PDA (r=.306, P=012) and amount of improvement in alcohol-related problems (r=.305, P=.012). In the SR only group, the number of face-to-face meetings was significantly related to all three dependent variables, and predicted increased PDA (r=.358, P=.003), fewer mean DDD (r=-.250, P=.039), and fewer alcohol-related problems (r=-.244, P=.045), as well as to the amount of improvement in all three of these variables. Six-month follow-ups have been completed, and the results are currently being analyzed.

Conclusions: These results support our first experimental hypothesis but not the second or third. All groups significantly increased their PDA and decreased both their mean DDD and their alcohol-related problems, which indicates that both interventions being investigated were equally effective in helping people recover from their problem drinking.

Show MeSH
Related in: MedlinePlus