Search

Introduction: Polydrug use patterns among young adults using ecstasy vary, as well as their willingness to change them. Polydrug use patterns are likely associated with different adverse health outcomes. It is unknown whether polydrug use patterns of young adults who use ecstasy are similar in different countries. This study aims to identify and compare polydrug use patterns and willingness to change them of young adults that use ecstasy in the United Kingdom (UK) and the Netherlands (NL), two countries with a high prevalence of ecstasy use and a large electronic dance music (EDM) scene. Methods: The data from the online cross-sectional Electronic Music Scene Survey were used in a latent class analysis. The binary indicators used in the estimation were past-year substance use of 21 different substances. The sample consisted of young adult ecstasy users that regularly visit EDM events (age 18–34). Results: A total of 1,077 respondents from the UK (age M = 23.1) and 1,178 from the NL (age M = 23.7) that regularly visit EDM events were included in the analyses. In both countries, three polydrug use patterns of ecstasy users were identified based on Bayesian Information Criterion fit indices: a traditional polydrug use class (UK: 28%; NL: 40%), a stimulant and ketamine polydrug use class (UK: 48%; NL: 52%), and an extensive polydrug use class (UK: 24%; NL: 8%) characterized by substantial use of stimulants, depressant, and psychedelic substances. Overall, young adults that used ecstasy in the UK consumed 3,4-methylenedioxymeth-amphetamine (MDMA) more often as powder/crystalline and at higher dosages compared to young adults in the NL who preferred MDMA tablets. Regardless of polydrug class or country, most respondents indicated that they had the intention to reduce but not quit their use. Conclusion: In both countries, structurally similar polydrug use patterns among young adults that use ecstasy were found, while the use frequencies of individual substances and preferred MDMA form varied between the countries. [ABSTRACT FROM AUTHOR]

Background: Intensive home treatment (IHT) aims to prevent psychiatric hospitalisation. Although this intervention is well tested, it is still unknown for whom this intervention works best. Therefore, this study aims to explore prescriptive factors that moderate the effect of IHT compared to care as usual (CAU) on symptom severity. Methods: Using data from a randomised controlled trial, 198 participants that experience an exacerbation of acute psychiatric symptoms were included in this secondary analysis. In order to maximise clinical relevance, generally available environmental and clinical baseline factors were included as tentative moderators: age, gender, employment status, domestic situation, psychiatric disorders, psychological symptoms, psychosocial functioning, alcohol and other substance use. The outcome variable symptom severity was measured using the Brief Psychiatric Rating Scale (BPRS) and collected at 26 and 52 weeks post-randomisation. Multiple regression analysis was used to examine which participants' characteristics moderate the effect of IHT on the total BPRS score. Results: Our results suggest that being employed (B = 0.28, SE = 0.13, 95% CI = 0.03–0.53, p = 0.03) at baseline seems to have a moderation effect, which result in lower symptom severity scores at 26 weeks follow-up for patients who received IHT. This effect was not found at 52 weeks. Conclusions: On the basis of the number of factors tested, there is no evidence for robust outcome moderators of the effect of IHT versus CAU. Our conclusion is therefore that IHT can be offered to a diverse target population with comparable clinical results. Trial registration: This trial is registered (date of registration: 2016-11-23) at the international clinical trials registry platform (NTR6151). [ABSTRACT FROM AUTHOR]

Introduction: The aim is to perform an economic evaluation alongside a randomized controlled trial comparing guided self‐help cognitive behavioral therapy‐enhanced (CBT‐E) for binge‐eating disorder (BED) to a waiting list control condition. Methods: BED patients (N = 212) were randomly assigned to guided self‐help CBT‐E or the 3‐month waiting list. Measurements took place at baseline and the end‐of‐treatment. The cost‐effectiveness analysis was performed using the number of binge‐eating episodes during the last 28 days as an outcome indicator according to the eating disorder examination. A cost‐utility analysis was performed using the EuroQol‐5D. Results: The difference in societal costs over the 3 months of the intervention between both conditions was €679 (confidence interval [CI] 50–1330). The incremental costs associated with one incremental binge eating episode prevented in the guided self‐help condition was approximately €18 (CI 1–41). From a societal perspective there was a 96% likelihood that guided self‐help CBT‐E led to a greater number of binge‐eating episodes prevented, but at higher costs. Each additional quality‐adjusted life year (QALY) gained was associated with incremental costs of €34,000 (CI 2494–154,530). With a 95% likelihood guided self‐help CBT‐E led to greater QALY gain at higher costs compared to waiting for treatment. Based on the National Institute for Health and Clinical Excellence willingness‐to‐pay threshold of €35,000 per QALY, guided self‐help CBT‐E can be considered cost‐effective with a likelihood of 95% from a societal perspective. Discussion: Guided self‐help CBT‐E is likely a cost‐effective treatment for BED in the short‐term (3‐month course of treatment). Comparison to treatment‐as‐usual is recommended for future research, as it enables an economic evaluation with a longer time horizon. Public Significance: Offering treatment remotely has several benefits for patients suffering from binge‐eating disorders. Guided self‐help CBT‐E is an efficacious and likely cost‐effective treatment, reducing binge eating and improving quality‐of‐life, albeit at higher societal costs. [ABSTRACT FROM AUTHOR]

Background: The majority of people with cannabis use disorder do not seek treatment. If we were able to gain more insight into different subgroups of cannabis users based on help-seeking preferences, we could use this information to inform the development and promotion of interventions targeted at specific subgroups of cannabis users, to ultimately narrow the treatment gap. Methods: An online survey was conducted among 1,015 Dutch frequent cannabis users (18–72 years) to assess their cannabis use, help-seeking preferences, psychopathology, and psychological distress. Latent class analysis was used to identify classes of cannabis users based on their help-seeking preferences. Differences between the identified classes in terms of sociodemographics, cannabis use, and psychopathology were examined. Results: We identified four classes with distinct preferences for support. Class 1 ("no support/only social," n = 548) had a low probability of finding any form of support appealing other than social support. Class 2 ("online help," n = 170) had relatively high probabilities of finding online help appealing. Class 3 ("GP/outpatient," n = 208) had a relatively high probability of finding support from the general practitioner and outpatient substance use disorder treatment appealing. Class 4 ("all sources," n = 89) had moderate to high probabilities for all sources of support. In terms of sociodemographics, differences between the classes were found with regard to gender and level of education. The classes were fairly similar with regard to cannabis use, only the "online help" class scored significantly lower on both cannabis use frequency and quantity compared to most of the other classes. In terms of psychopathology, the "GP/outpatient" class and the "all sources" class experienced more cannabis use-related problems and were more likely to report multiple past quit attempts than the "online help" class and the "no support/only social" class. Conclusions: Our study shows that there is a lot of inter-individual variation in how appealing various forms of help are to cannabis users. Our findings emphasize the importance of promoting a variety of treatment modalities for cannabis users, including real-life and digital options, and indicate what might appeal to whom. [ABSTRACT FROM AUTHOR]

Objective: The uptake of digital interventions in mental health care (MHC) has been slow, as many therapists and patients believe that in‐person contact is essential for establishing a good working relationship and good outcomes in treatment. The public health policies regarding social distancing during the coronavirus disease‐2019 (COVID‐19) pandemic forced an abrupt transformation of MHC provisions for outpatients: Since mid‐March 2020, nearly all in‐person contact was replaced with videoconferencing. The COVID‐19 crisis offered a unique opportunity to investigate whether MHC with videoconferencing yields inferior results as compared to in‐person interventions. Method: In a large urban MHC facility in the Netherlands, measurement‐based care is routine practice. Outcome data are regularly collected to support shared decision making and monitor patient progress. For this study, pretest and post‐test data were used to compare outcomes for three cohorts: treatments performed prior to, partially during and entirely during the COVID‐19 lockdown. Outcomes were compared in two large data sets: Basic MHC (N = 1392) and Specialized MHC (N = 1040). Results: Therapeutic outcomes appeared robust for COVID‐19 conditions across the three cohorts: No differences in outcomes were found between treatments that were conducted during lockdown compared to in‐person treatments prior to COVID‐19, or treatments which started in‐person, but needed to be continued by means of videoconferencing. Discussion Videoconferencing care during the COVID‐19 pandemic had similar outcomes compared to traditional in‐person care. These real‐world results corroborate findings of previous randomized controlled studies and meta‐analyses in which videoconferencing and in‐person care has been directly compared in terms of clinical effectiveness. [ABSTRACT FROM AUTHOR]

Background: In this article, we present an evaluation of online psychoactive substance trade via Telegram, a free encrypted social media messenger service. The evaluation took place during the COVID-19 pandemic, which allowed us to monitor the effects of the spring 2020 lockdown in the Netherlands on substance trade via Telegram. Objective: The objective of this study was to evaluate whether changes in psychoactive substance trade on Telegram markets in the Netherlands can be observed during the COVID-19 pandemic. Results: Between December 2, 2019, and June 29, 2020, a total of 70,226 posts appeared in two analyzed Telegram groups. A total of 5,643 posts were psychoactive substance related. Based on the analyzed posts, Telegram is mostly a '"sellers" market as only a minority of the posts (6.3%) could be identified as a request for a substance. The proportion of posts related to specific substances varied between the periods before, during, and after the lockdown. The proportion of posts on the stimulants ecstasy, cocaine, and amphetamine was lower during the lockdown than before and after. For psychedelics – ketamine, lysergic acid diethylamide (LSD), and 2,5-dimethoxy-4-bromophenethylamine (2C-B) – and other substances, there was a relative increase in the number of posts during the lockdown, which was maintained after the lockdown. Conclusions: Telegram analysis shows that in the Netherlands, online psychoactive substance trade may have been affected during the COVID-19 pandemic. The direction of this effect was different for different classes of substances. [ABSTRACT FROM AUTHOR]

Economic evaluations of interventions for dual diagnosis patients are scarce. A recent randomized controlled trial has supported the effectiveness of the Self-wise, Otherwise, Streetwise (SOS) training to reduce victimization in dual diagnosis patients. The purpose of the current study was to analyze the cost-effectiveness and cost-utility of the SOS training as an add-on to care as usual (CAU). We performed an economic evaluation from a societal perspective alongside the SOS trial. Participants were 250 dual diagnosis patients recruited at three locations from a large urban psychiatric service in the Netherlands. The main outcomes were treatment response for victimization and quality-adjusted life years (QALYs). Both costs and effects were measured across a 14-month follow-up. There was no significant difference between CAU + SOS and CAU in total costs (mean difference €4,859; 95% CI [−€4,795 to €14,513]) and QALY gains (mean difference 0.0012; 95% CI [−0.05 to 0.05]). Significantly more participants in CAU + SOS achieved treatment response for victimization compared to CAU (68% vs. 54%; mean difference 0.14; 95% CI [0.02 to 0.26]). The cost-effectiveness analysis indicated an 83% likelihood that CAU + SOS resulted in a higher treatment response rate for victimization at higher costs compared to CAU. The cost-utility analysis indicated that adding SOS-training to CAU is probably not cost-effective at conventional willingness-to-pay levels for QALYs. At a societal willingness-to-pay of €38,000 or more per extra treatment responder, adding SOS-training to usual care is probably more attractive than usual care alone with regard to cost-effectiveness. This is a considerable willingness to pay. However, the direct costs of offering the SOS training are expected to be minor. Our findings should be interpreted with caution due to the short follow-up period and absence of data on potential reductions in police and judicial costs other than prison costs. [ABSTRACT FROM AUTHOR]

Background: Digital interventions may provide low-threshold support for smoking cessation (SC) and alcohol moderation (AM) to the growing population of cancer survivors. The objective was to explore preconditions of successful AM and SC digital interventions for cancer survivors.Methods: Using a multi-method approach we conducted a survey (n = 240), a qualitative study consisting of four focus groups (n = 15) and semi-structured interviews with Dutch cancer survivors (n = 8). To help interpretation of our results we interviewed experts in the field of eHealth and cancer survivors (n = 6) and we organized an expert meeting (n = 7). Qualitative data were analysed using the Framework approach and were double-coded by two coders.Results: Survey results show the majority of drinkers had not previously considered AM (n = 158, 84.9%), often because they deemed their alcohol use to be non-problematic. All current smokers in the survey had considered SC before. In focus groups and interviews it became clear that SC efforts did not always stem from their own willingness to quit smoking, but originated from a wish to please their social environment. Main themes to be addressed in digital SC and AM that emerged from the interviews and focus groups, centred on the different ways of identification as cancer survivors, need for autonomy, differential beliefs about SC and AM, and the importance of a positive, non-patronizing tone-of-voice. Several specific preferences for digital interventions were formulated, although some cancer survivors prefer no support or face-to-face contact.Conclusions: Cancer survivors are a diverse group with diverse preferences for AM and SC support. Digital AM and SC interventions for cancer survivors are perceived to be of value by some, especially when they incorporate a positive, non-judgemental and non-patronizing tone-of-voice, address concerns specifically relevant to cancer survivors, offer possibilities for personalization, and emphasize autonomy throughout. To encourage AM specifically, problem recognition and awareness of the health benefits of AM should be improved. [ABSTRACT FROM AUTHOR]

The authors present an economic evaluation performed alongside a randomized controlled trial of mentalization-based treatment in a day hospital setting (MBT-DH) versus specialist treatment as usual (S-TAU) for borderline personality disorder (BPD) with a 36-month follow-up period. Ninety-five patients from two Dutch treatment institutes were randomly assigned. Societal costs were compared with the proportion of BPD remissions and quality-adjusted life years (QALYs) measured using the five-dimensional EuroQol instrument. The incremental societal costs for one additional QALY could not be calculated. The costs for one additional BPD remission with MBT-DH are approximately €29,000. There was a 58% likelihood that MBT-DH leads to more remitted patients at additional costs compared with S-TAU, and a 35% likelihood that MBT-DH leads to more remissions at lower costs. MBT-DH is not cost-effective compared with S-TAU with QALYs as the outcome, and slightly more cost-effective than S-TAU at 36 months with BPD symptoms as the outcome. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorders (AUD) have the worst impact in low-middle-income countries (LMICs), where the disease burden per liter of alcohol consumed is higher than in wealthy populations. Furthermore, the median treatment gap for AUDs in LMICs is 78.1%. The highest prevalence of AUDs worldwide in 2004 was found in the western Pacific region, Southeast Asia, and the Americas. The main aim of this study was to estimate and compare the prevalence of risky alcohol use and the extent of the treatment gap in a rural (Nickerie) and in an urban (Paramaribo) area in Suriname, a LMICs country with a wide variety of ethnic groups. Methods: The respondents were randomly recruited using a specific sampling method of the National Census Bureau. The final samples were 1837 households for Paramaribo and 1026 for Nickerie, reflecting the populations in both regions. The Alcohol Use Disorder Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were used to assess the likelihood of the presence of alcohol use disorder. A score of > 7 for the AUDIT implies risky alcohol use. Results: The results indicated that 2% of the women and 15% of the men in the rural area scored 8 or higher on the AUDIT. In the urban area, these numbers were 3% and 17%, respectively. In both samples, the men had the highest addiction risk at about 16% compared with 2% for females. Married persons are significantly less likely to become alcoholic than singles and other groups in Paramaribo. In both areas, higher education was associated with a lower probability of alcohol abuse and dependence, while handymen showed a higher odd. A treatment gap of 50% was found for alcohol use disorders in the rural area. The corresponding gap in the urban area was 64%. Conclusions: Surinamese men show a high prevalence of the likelihood of AUD. In addition, the treatment gap for these possible patients is large. It is therefore of paramount importance to develop therapeutic strategies with the aim of tackling this physically and mentally disabling disorder. Tailored E-health programs may be of benefit. [ABSTRACT FROM AUTHOR]

Background: This study evaluated whether providing intensive home treatment (IHT) to patients experiencing a psychiatric crisis has more effect on self-efficacy when compared to care as usual (CAU). Self-efficacy is a psychological concept closely related to one of the aims of IHT. Additionally, differential effects on self-efficacy among patients with different mental disorders and associations between self-efficacy and symptomatic recovery or quality of life were examined. Methods: Data stem from a Zelen double consent randomised controlled trial (RCT), which assesses the effects of IHT compared to CAU on patients who experienced a psychiatric crisis. Data were collected at baseline, 6 and 26 weeks follow-up. Self-efficacy was measured using the Mental Health Confidence Scale. The 5-dimensional EuroQol instrument and the Brief Psychiatric Rating Scale (BPRS) were used to measure quality of life and symptomatic recovery, respectively. We used linear mixed modelling to estimate the associations with self-efficacy. Results: Data of 142 participants were used. Overall, no difference between IHT and CAU was found with respect to self-efficacy (B = − 0.08, SE = 0.15, p = 0.57), and self-efficacy did not change over the period of 26 weeks (B = − 0.01, SE = 0.12, t (103.95) = − 0.06, p = 0.95). However, differential effects on self-efficacy over time were found for patients with different mental disorders (F(8, 219.33) = 3.75, p < 0.001). Additionally, self-efficacy was strongly associated with symptomatic recovery (total BPRS B = − 0.10, SE = 0.02, p < 0.00) and quality of life (B = 0.14, SE = 0.01, p < 0.001). Conclusions: Although self-efficacy was associated with symptomatic recovery and quality of life, IHT does not have a supplementary effect on self-efficacy when compared to CAU. This result raises the question whether, and how, crisis care could be adapted to enhance self-efficacy, keeping in mind the development of self-efficacy in depressive, bipolar, personality, and schizophrenia spectrum and other psychotic disorders. The findings should be considered with some caution. This study lacked sufficient power to test small changes in self-efficacy and some mental disorders had a small sample size. Trial registration This trial is registered at Trialregister.nl, number NL6020. [ABSTRACT FROM AUTHOR]

Background: Heavy cannabis use is associated with adverse physical and mental health effects. Despite available effective treatments, the majority of heavy cannabis users does not seek professional help. Web-based interventions can provide an alternative for cannabis users who are reluctant to seek professional help. Several web-based cannabis interventions are effective in reducing cannabis use; however, the effect sizes are typically small and attrition rates are typically high. This suggests that web-based programs can be an effective cannabis use intervention for some, while others may need additional substance use treatment after completing a web-based intervention. Therefore, it is important that web-based interventions do not solely focus on reducing cannabis use, but also on improving attitudes towards substance use treatment. The Screening Brief Intervention and Referral to Treatment (SBIRT) approach appears to be well suited for the purpose of reducing cannabis use and improving substance use treatment utilization. Based on the SBIRT approach-and based on cognitive behavioral therapy (CBT) and motivational interviewing (MI)-we developed the Internet-based cannabis reduction intervention ICan.Methods/design: This protocol paper presents the design of a randomized controlled trial (RCT) in which we evaluate the effectiveness of the ICan intervention compared to four online modules of educational information on cannabis in a sample of Dutch frequent cannabis users. The primary outcome measure is frequency of cannabis use. Secondary outcome measures include the quantity of cannabis used (grams), the attitudes towards seeking help and the number of participants who enter specialized treatment services for cannabis use-related problems.Discussion: To the best of our knowledge, ICan is the first Internet-based intervention for cannabis users that combines screening, a brief intervention-based on CBT and MI-and referral to treatment options.Trial Registration: The study is registered in the Netherlands Trial Register; identifier NL7668 . Registered on 17 April 2019. [ABSTRACT FROM AUTHOR]

Background: Accurate prediction models for whether patients on the verge of a psychiatric criseis need hospitalization are lacking and machine learning methods may help improve the accuracy of psychiatric hospitalization prediction models. In this paper we evaluate the accuracy of ten machine learning algorithms, including the generalized linear model (GLM/logistic regression) to predict psychiatric hospitalization in the first 12 months after a psychiatric crisis care contact. We also evaluate an ensemble model to optimize the accuracy and we explore individual predictors of hospitalization.Methods: Data from 2084 patients included in the longitudinal Amsterdam Study of Acute Psychiatry with at least one reported psychiatric crisis care contact were included. Target variable for the prediction models was whether the patient was hospitalized in the 12 months following inclusion. The predictive power of 39 variables related to patients' socio-demographics, clinical characteristics and previous mental health care contacts was evaluated. The accuracy and area under the receiver operating characteristic curve (AUC) of the machine learning algorithms were compared and we also estimated the relative importance of each predictor variable. The best and least performing algorithms were compared with GLM/logistic regression using net reclassification improvement analysis and the five best performing algorithms were combined in an ensemble model using stacking.Results: All models performed above chance level. We found Gradient Boosting to be the best performing algorithm (AUC = 0.774) and K-Nearest Neighbors to be the least performing (AUC = 0.702). The performance of GLM/logistic regression (AUC = 0.76) was slightly above average among the tested algorithms. In a Net Reclassification Improvement analysis Gradient Boosting outperformed GLM/logistic regression by 2.9% and K-Nearest Neighbors by 11.3%. GLM/logistic regression outperformed K-Nearest Neighbors by 8.7%. Nine of the top-10 most important predictor variables were related to previous mental health care use.Conclusions: Gradient Boosting led to the highest predictive accuracy and AUC while GLM/logistic regression performed average among the tested algorithms. Although statistically significant, the magnitude of the differences between the machine learning algorithms was in most cases modest. The results show that a predictive accuracy similar to the best performing model can be achieved when combining multiple algorithms in an ensemble model. [ABSTRACT FROM AUTHOR]

Background: Although substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) show significant symptomatic overlap, ADHD is often overlooked in SUD patients.Objective: The aim of the present study was to characterize aspects of attention and inhibition (as assessed by a continuous performance test [CPT]) in SUD patients with and without a comorbid diagnosis of ADHD and in healthy controls, expecting the most severe deficits in patients with a combined diagnosis.Methods: The MOXO-CPT version, which incorporates visual and auditory environmental distractors, was administered to 486 adults, including healthy controls (n = 172), ADHD (n = 56), SUD (n = 150), and combined SUD and ADHD (n = 108).Results: CPT performance of healthy controls was better than that of individuals in each of the 3 clinical groups. The only exception was that the healthy control group did not differ from the ADHD group on the Timing index. The 3 clinical groups differed from each other in 2 indices: (a) patients with ADHD (with or without SUD) showed increased hyperactivity compared to patients with SUD only and (b) patients with ADHD showed more responses on correct timing as compared with the SUD groups (with or without ADHD).Conclusion: The CPT is sensitive to ADHD-related deficits, such as disinhibition, poor timing, and inattention, and is able to consistently differentiate healthy controls from patients with ADHD, SUD, or both. Our results are in line with previous research associating both ADHD and SUD with multiple disruptions across a broad set of cognitive domains such as planning, working memory, decision-making, inhibition control, and attention. The lack of consistent differences in cognitive performance between the 3 diagnostic groups might be attributed to various methodological aspects (e.g., heterogeneity in severity, type, and duration of substances use). Our results support the view that motor activity should be considered a significant marker of ADHD. [ABSTRACT FROM AUTHOR]

Objective The objective of this study is to evaluate current evidence for the effectiveness of distance‐based interventions to support smoking cessation (SC) or alcohol moderation (AM) among cancer survivors. Secondary, differences in effectiveness are explored regarding multibehaviour interventions versus single‐behaviour interventions targeting SC or AM only. Methods: A systematic search of PubMed, PsycINFO, Web of Science, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials was conducted. Intervention studies with and without control groups and randomized controlled trials were included. Random effects meta‐analyses were conducted for the main outcomes: SC and AM rates at the follow‐up closest to 6 months. Using subgroup analyses and meta‐regression, effectiveness of single‐behaviour versus multibehaviour interventions was evaluated. Results: A total of 17 studies with 3796 participants; nine studies on SC only, eight studies on multibehaviour interventions including an SC or AM module, and no studies on AM only were included. All studies had at least some concerns regarding bias. Distance‐based SC interventions led to higher cessation rates than control conditions (10 studies, odds ratio [OR] = 1.56; 95% CI, 1.13‐2.15, P =.007). Single‐behaviour SC interventions reduced smoking rates compared with baseline (risk difference [RD] = 0.29; 95% CI, 0.19‐0.39, P <.0001), but multibehaviour interventions did not (RD = 0.13; 95% CI, −0.05 to 0.31, P = 0.15). There was insufficient evidence that distance‐based multibehaviour interventions reduced alcohol use compared with controls (three studies, standardized mean difference [SMD] = 0.12; 95% CI, −0.08 to 0.31, P =.24). Conclusions: Distance‐based SC interventions are effective in supporting SC among cancer survivors. Single‐behaviour SC interventions appear more effective than multibehaviour interventions. No evidence was found for the effectiveness of distance‐based AM interventions for cancer survivors. [ABSTRACT FROM AUTHOR]

Many offenders with a substance use disorder (SUD) do not enter addiction treatment. The aim of this study was to examine predictors of addiction treatment entry and to get more insight in the predictive value of treatment motivation. A total of 83 male offenders with a SUD under probation supervision in the Netherlands were assessed at the start of probation supervision and at 12-month follow-up. A total of 38 offenders (45.5%) entered addiction treatment in the follow-up period. Offenders with any mandated treatment (p =.028) and higher treatment motivation (p =.005) were more likely to enter treatment. Multiple logistic regression analysis showed that treatment motivation predicts addiction treatment entry in the first year of probation (OR = 2.215, p <.01). This emphasizes the relevance of treatment motivation for addiction treatment entry among offenders with a SUD. Pretreatment motivational interventions are therefore recommended for offenders with low motivation for treatment in probation settings. [ABSTRACT FROM AUTHOR]

Many offenders with a substance use disorder (SUD) do not enter addiction treatment. The aim of this study was to examine predictors of addiction treatment entry and to get more insight in the predictive value of treatment motivation. A total of 83 male offenders with a SUD under probation supervision in the Netherlands were assessed at the start of probation supervision and at 12-month follow-up. A total of 38 offenders (45.5%) entered addiction treatment in the follow-up period. Offenders with any mandated treatment (p = .028) and higher treatment motivation (p = .005) were more likely to enter treatment. Multiple logistic regression analysis showed that treatment motivation predicts addiction treatment entry in the first year of probation (OR = 2.215, p < .01). This emphasizes the relevance of treatment motivation for addiction treatment entry among offenders with a SUD. Pretreatment motivational interventions are therefore recommended for offenders with low motivation for treatment in probation settings. [ABSTRACT FROM AUTHOR]

Background: Users of new psychoactive substances including 4-fluoroamphetamine (4-FA/4-FMP) frequently share their experiences or opinions in online drug forums. We have tested the potential of computerised analysis of drug users' forum posts for monitoring and early detection of trends. Specifically, we tested whether changes in the volume of 4-FA related posts and sentiments expressed in those posts can be observed around the time 4-FA was increasingly reported by Dutch drug monitoring sources (2012-2017).Methods: Opening posts from two popular Dutch internet-based drug discussion forums, written between January 1 st, 2012 and January 1 st, 2018 were scraped: Portions of the forum posts about 4-FA were collected. To contrast 4-FA findings against other categories of forum posts, we also collected posts on two other substances (ecstasy and cocaine) and posts not related to a specific substance. Sentiments expressed in these posts were inferred using text recognition software, and analysed for trends using linear mixed modelling.Results: The number of 4-FA posts increased between 2012 and 2015: 76 posts in 2012, 138 in 2013, 322 in 2014, 323 in 2015, and decreased thereafter: 264 in 2016 and 135 in 2017; X2(5) = 271.8, p < .001. Over time, a decrease in positive sentiment towards 4-FA can be observed starting in 2015, compared to the period before 2015, coinciding with more news searches and reports on adverse events related to 4-FA use. Linear mixed modelling analysis confirmed a significantly higher sentiment score in 2015 compared to 2017 for 4-FA, B = 0.062; SE = 0.023; t(1252) = 2.70; p = 0.007, but not for posts on other substances.Conclusion: Changes in the volume and sentiments of forum posts coincided with news media exposure related to 4-FA and with trends observed by established drug monitoring sources. Hence, internet forum monitoring facilitates early discovery of trends in the popularity, prevalence and adverse events related to new psychoactive substances. [ABSTRACT FROM AUTHOR]

Background: Social distancing measures during the COVID‐19 pandemic forced an abrupt transformation of treatment delivery for mental health care. In mid‐March 2020, nearly all in‐person contact was replaced with video conferencing. The pandemic thus offered a natural experiment and a unique opportunity to conduct an observational study of whether alcohol use disorder treatment through video conferencing is non‐inferior to in‐person treatment. Methods: In a large urban substance use disorder treatment center in the Netherlands, treatment evaluation is routine practice. Outcome data are regularly collected to support shared decision making and monitor patient progress. For this study, pre‐test and post‐test data on alcohol use (Measurements in the Addictions for Triage and Evaluation), psychopathology (Depression Anxiety Stress Scales), and quality of life (Manchester Short Assessment of Quality of Life) were used to compare outcomes of cognitive behavioral therapy treatment for three cohorts: patients who received treatment for a primary alcohol use disorder performed prior to (n = 628), partially during (n = 557), and entirely during (n = 653) the COVID‐19 lockdown. Results: Outcome was similar across the three cohorts: No inferior outcomes were found for treatments that were conducted predominantly through video conferencing during lockdown or treatments that started in‐person, but were continued through video conferencing, compared to in‐person treatments that were conducted prior to COVID‐19. The number of drop‐outs were also similar between cohorts. However, there was a difference in average treatment intensity between cohorts, with treatment partially or fully conducted during the COVID‐19 pandemic lasting longer. Conclusions: Treatment for a primary alcohol use disorder, provided partially or predominantly through video conferencing during the COVID‐19 pandemic resulted in abstinence rates and secondary outcomes similar to traditional in‐person care, in spite of the potentially negative effects of the COVID‐related lockdown measures themselves. These results from everyday clinical practice corroborate findings of randomized controlled studies and meta‐analyses in which video conferencing appeared non‐inferior to in‐person care in clinical effectiveness. [ABSTRACT FROM AUTHOR]

Background The present study investigates the suitability of various treatment outcome indicators to evaluate performance of mental health institutions that provide care to patients with severe mental illness. Several categorical approaches are compared to a reference indicator (continuous outcome) using pretest-posttest data of the Health of Nation Outcome Scales (HoNOS). Methods Data from 10 institutions and 3189 patients were used, comprising outcomes of the first year of treatment by teams providing long-term care. Results Findings revealed differences between continuous indicators (standardized pre-post difference score ES and ΔT) and categorical indicators (SEM, JTRCI, JTCS, JTRCI&CS, JTrevised) on their ranking of institutions, as well as substantial differences among categorical indicators; the outcome according to the traditional JT approach was most concordant with the continuous outcome indicators. Conclusions For research comparing group averages, a continuous outcome indicator such as ES or ΔT is preferred, as this best preserves information from the original variable. Categorical outcomes can be used to illustrate what is accomplished in clinical terms. For categorical outcome, the classical Jacobson-Truax approach is preferred over the more complex method of Parabiaghi et al. with eight outcome categories. The latter may be valuable in clinical practice as it allows for a more detailed characterization of individual patients. [ABSTRACT FROM AUTHOR]

Background: Brief interventions for smoking cessation and alcohol moderation may contribute considerably to the prevention of cancer among populations at risk, such as cancer survivors, in addition to improving their general wellbeing. There is accumulating evidence for the effectiveness of internet-based brief health behaviour interventions. The objective of this study is to assess the effectiveness, patient-level cost-effectiveness and cost-utility of two new online theory-based self-help interventions among adult cancer survivors in the Netherlands. One of the interventions focuses on alcohol moderation, the other on smoking cessation. Both interventions are tailored to cancer survivors.Methods: Effectiveness will be assessed in two separate, nearly identical 2-armed RCTs: alcohol moderation (AM RCT) and smoking cessation (SC RCT). Participants are randomly allocated to either the intervention groups or the control groups. In the intervention groups, participants have access to one of the newly developed interventions. In the control groups, participants receive an online static information brochure on alcohol (AM RCT) or smoking (SC RCT). Main study outcome parameters are the number of drinks post-randomisation (AM RCT) and tobacco abstinence (SC RCT). In addition, cost-data and possible effect moderators and mediators will be assessed. Both treatments are internet-based minimally guided self-help interventions: MyCourse - Moderate Drinking (in Dutch: MijnKoers - Minderen met Drinken) and MyCourse - Quit Smoking (MijnKoers - Stoppen met Roken). They are based on cognitive behaviour therapy (CBT), motivational interviewing (MI) and acceptance and commitment therapy (ACT). Both interventions are optimized in collaboration with the target population of cancer survivors in focus groups and interviews, and in collaboration with several experts on eHealth, smoking cessation, alcohol misuse and cancer survivorship.Discussion: The present study will add to scientific knowledge on the (cost-)effectiveness of internet-based self-help interventions to aid in smoking cessation or alcohol moderation, working mechanisms and impact on quality of life of cancer survivors. If found effective, these interventions can contribute to providing evidence-based psychosocial oncology care to a growing population of cancer survivors.Trial Registration: Trials are prospectively registered in The Netherlands Trial Register (NTR): NTR6011 (SC RCT), NTR6010 (AM RCT) on 1 September 2016. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this review is to provide an overview of knowledge and knowledge gaps in the field of computer-based alcohol interventions by (1) collating evidence on the effectiveness of computer-based alcohol interventions in different populations and (2) exploring the impact of four specified moderators of effectiveness: therapeutic orientation, length of intervention, guidance and trial engagement. Methods: A review of systematic reviews of randomized trials reporting on effectiveness of computer-based alcohol interventions published between 2005 and 2015. Results: Fourteen reviews met the inclusion criteria. Across the included reviews, it was generally reported that computer-based alcohol interventions were effective in reducing alcohol consumption, with mostly small effect sizes. There were indications that longer, multisession interventions are more effective than shorter or single session interventions. Evidence on the association between therapeutic orientation of an intervention, guidance or trial engagement and reductions in alcohol consumption is limited, as the number of reviews addressing these themes is low. None of the included reviews addressed the association between therapeutic orientation, length of intervention or guidance and trial engagement. Conclusions: This review of systematic reviews highlights the mostly positive evidence supporting computer-based alcohol interventions as well as reveals a number of knowledge gaps that could guide future research in this field. [ABSTRACT FROM AUTHOR]

Background: Tobacco use prevalence is elevated among people with mental illnesses, leading to elevated rates of premature smoking-related mortality. Opportunities to encourage smoking cessation among them are currently underused by mental health professionals. In this paper, we aim to explore mechanisms to invigorate professionals' intentions to help patients stop smoking. Methods: Data stem from a recent staff survey on the provision of smoking cessation support to patients with mental illnesses in the Netherlands. Items and underlying constructs were based on the theory of planned behaviour and literature on habitual behaviour. Data were weighted and only data from staff members with regular patient contact (n = 506) were included. Descriptive statistics of the survey items are presented and in a second step using structural equation modelling (SEM), we regressed the latent variables attitudes, subjective norms (SN), perceived behavioural control (PBC), past cessation support behaviour (PB) and current smoking behaviour on intentions to provide support. In optimisation steps, models comprising a subset of this initial model were evaluated. Results: A sample of 506 mental health workers who had direct contact with patients completed the survey. The majority of them were females (70.0 %), respondents had an average age of 42.5 years (SD= 12.0). Seventy-five percent had at least a BSc educational background. Of the respondents, 76 % indicated that patients should be encouraged more to quit smoking. Respondents were supportive to train their direct colleagues to provide cessation support more often (71 %) and also supported the involvement of mental health care facilities in providing cessation support to patients (69 %). The majority of the respondents feels capable to provide cessation support (66 %). Two thirds of the respondents wants to provide support, however only a minority (35 %) intends to actually do so during the coming year. Next, using SEM an acceptable fit was found of the constructs derived from the theory of planned behaviour and literature on habitual behaviour to the weighted data (χ²(322) = 1188, p < .001; RMSEA = 0.067; CFI = 0.983), after removal of insignificant latent variables (SN and current smoking) and inclusion of covariates. Attitudes, PBC and PB of staff are the strongest identified correlates of intention toward providing cessation support to patients. SN and staff smoking behaviour were found to be weaker, non-significant correlates. Conclusions: To nudge staff towards providing cessation support to people with mental illnesses one should aim at influencing attitudes and perceived behavioural control. [ABSTRACT FROM AUTHOR]

Introduction: In this study, penalized imputation (PI), a common approach to handle missing smoking status data and sometimes referred to as "missing=smoking," is compared with other missing data approaches using data from internet-based smoking cessation trials. Two hypotheses were tested: (1) PI leads to more conservative effect estimates than complete observations analysis; and (2) PI and multiple imputation (MI) lead to similar effect estimates under balanced (equal missingness proportions among the trial arms) and unbalanced missingness.Methods: First, the outcomes of 22 trials included in a recent Cochrane review on internet-based smoking cessation interventions were reanalyzed using only the complete observations, and after applying PI. Second, in a simulation study outcomes under PI, complete observations analysis, and two types of MI were compared. For this purpose, individual patient data from one of the Cochrane review trials were used. Results of the missing data approaches were compared with reference data without missing observations, upon which balanced and unbalanced missingness scenarios were imposed.Results: In the reanalysis of 22 trials, relative risks (RR = 1.15 [1.00; 1.33]) after PI were nearly identical to those under complete observations analysis (RR = 1.14 [0.98; 1.32]). In the simulation study, PI was the only approach that led to deviations from the reference data beyond its 95% confidence interval.Conclusions: Analyses after PI led to pooled results equivalent to complete observations analyses. PI also led to significant deviations from the reference in the simulation studies. PI biases the reported effects of interventions, favoring the condition with the lowest proportion of missingness. Therefore, more sophisticated missing data approaches than PI should be applied. [ABSTRACT FROM AUTHOR]

Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of basing policy on empirical evidence, international conventions exist for policy on alcohol, tobacco, and illegal substances. This paper examines the evidence of best practice policies to provide recommendations for international guidelines for harm-minimisation policy for gambling, including specific consideration of the specific requirements for policies on Internet gambling. Evidence indicates that many of the public health policies implemented for addictive substances can be adapted to address gambling-related harms. Specifically, a minimum legal age of at least 18 for gambling participation, licensing of gambling venues and activities with responsible gambling and consumer protection strategies mandated, and brief interventions should be available for those at-risk for and experiencing gambling-related problems. However, there is mixed evidence on the effectiveness of limits on opening hours and gambling venue density and increased taxation to minimise harms. Given increases in trade globalisation and particularly the global nature of Internet gambling, it is recommended that jurisdictions take actions to harmonise gambling public health policies. [ABSTRACT FROM AUTHOR]

Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of basing policy on empirical evidence, international conventions exist for policy on alcohol, tobacco, and illegal substances. This paper examines the evidence of best practice policies to provide recommendations for international guidelines for harm-minimisation policy for gambling, including specific consideration of the specific requirements for policies on Internet gambling. Evidence indicates that many of the public health policies implemented for addictive substances can be adapted to address gambling-related harms. Specifically, a minimum legal age of at least 18 for gambling participation, licensing of gambling venues and activities with responsible gambling and consumer protection strategies mandated, and brief interventions should be available for those at-risk for and experiencing gambling-related problems. However, there is mixed evidence on the effectiveness of limits on opening hours and gambling venue density and increased taxation to minimise harms. Given increases in trade globalisation and particularly the global nature of Internet gambling, it is recommended that jurisdictions take actions to harmonise gambling public health policies. [ABSTRACT FROM AUTHOR]

Introduction: Cannabis is Europe's most commonly used illicit drug. Some users do not develop dependence or other problems, whereas others do. Many factors are associated with the occurrence of cannabis-related disorders. This makes it difficult to identify key risk factors and markers to profile at-risk cannabis users using traditional hypothesis-driven approaches. Therefore, the use of a data-mining technique called binary recursive partitioning is demonstrated in this study by creating a classification tree to profile at-risk users. Methods: 59 variables on cannabis use and drug market experiences were extracted from an internet-based survey dataset collected in four European countries (Czech Republic, Italy, Netherlands and Sweden), n = 2617. These 59 potential predictors of problematic cannabis use were used to partition individual respondents into subgroups with low and high risk of having a cannabis use disorder, based on their responses on the Cannabis Abuse Screening Test. Both a generic model for the four countries combined and four country-specific models were constructed. Results: Of the 59 variables included in the first analysis step, only three variables were required to construct a generic partitioning model to classify high risk cannabis users with 65–73% accuracy. Based on the generic model for the four countries combined, the highest risk for cannabis use disorder is seen in participants reporting a cannabis use on more than 200 days in the last 12 months. In comparison to the generic model, the country-specific models led to modest, non-significant improvements in classification accuracy, with an exception for Italy (p = 0.01). Conclusion: Using recursive partitioning, it is feasible to construct classification trees based on only a few variables with acceptable performance to classify cannabis users into groups with low or high risk of meeting criteria for cannabis use disorder. The number of cannabis use days in the last 12 months is the most relevant variable. The identified variables may be considered for use in future screeners for cannabis use disorders. [ABSTRACT FROM AUTHOR]

Background: Children of parents with post-traumatic stress disorder (PTSD) are at increased risk of adverse psychological outcomes. An important risk mechanism is impaired parental functioning, including negative parenting behavior, perceived incompetence, and lack of social support. Several parenting interventions for trauma-exposed parents and parents with psychiatric disorders exist, but none have specifically targeted parents with PTSD. Our objective is to evaluate the effectiveness of a blended care preventive parenting intervention for parents with PTSD. Methods: The intervention was adapted from an existing online intervention, KopOpOuders Self-Help. In co-creation with parents with PTSD and partners, the intervention was adapted into KopOpOuders-PTSD, by adding PTSD-specific content and three in-person-sessions with a mental health prevention professional. Effectiveness will be tested in a randomized controlled trial among N = 142 parents being treated for PTSD at Arkin Mental Health Care (control condition: treatment as usual, n = 71; intervention condition: treatment as usual + intervention, n = 71). Online questionnaires at pretest, posttest, and three-month follow-up and ecological momentary assessment at pretest and posttest will be used. Intervention effects on primary (parenting behavior) and secondary outcomes (perceived parenting competence, parental social support, parenting stress, child overall psychological problems and PTSD symptoms) will be analyzed using generalized linear mixed modeling. We will also analyze possible moderation effects of parental PTSD symptoms at pretest on primary and secondary outcomes. Discussion: This study protocol describes the randomized controlled trial of KopOpOuders-PTSD, a blended care preventive parenting intervention for parents with PTSD. Findings can contribute to understanding of the effectiveness of parenting support in clinical practice for PTSD. Trial registration: This protocol (Version 1) was registered on 11-02-2022 at ClinicalTrials.gov under identification number NCT05237999. [ABSTRACT FROM AUTHOR]

Background: Alcohol misuse ranks within the top ten health conditions with the highest global burden of disease. Low-intensity, Internet interventions for curbing adult alcohol misuse have been shown effective. Few meta-analyses have been carried out, however, and they have involved small numbers of studies, lacked indicators of drinking within low risk guidelines, and examined the effectiveness of unguided self-help only. We therefore conducted a more thorough meta-analysis that included both guided and unguided interventions. Methods: Systematic literature searches were performed up to September 2013. Primary outcome was the mean level of alcohol consumption and drinking within low risk guidelines for alcohol consumption at post-treatment. Findings: We selected 16 randomised controlled trials (with 23 comparisons and 5,612 participants) for inclusion. Results, showed a small but significant overall effect size in favour of Internet interventions (g = 0.20, 95% CI: 0.13–0.27, p<.001). Participants in Internet interventions drunk on average 22 grams of ethanol less than controls and were significantly more likely to be adhering to low-risk drinking guidelines at post-treatment (RD 0.13, 95% CI: 0.09–0.17, p<.001). Subgroup analyses revealed no significant differences in potential moderators for the outcome of alcohol consumption, although there was a near-significant difference between comparisons with waitlist control and those with assessment-only or alcohol information control conditions (p = .056). Conclusions: Internet interventions are effective in reducing adult alcohol consumption and inducing alcohol users to adhere to guidelines for low-risk drinking. This effect is small but from a public health point of view this may warrant large scale implementation at low cost of Internet interventions for adult alcohol misuse. Moderator analyses with sufficient power are, however, needed in order to assess the robustness of these overall results and to assess whether these interventions may impact on subgroups with different levels of success. [ABSTRACT FROM AUTHOR]

Background: Internet-based interventions are seen as attractive for harmful users of alcohol and lead to desirable clinical outcomes. Some participants will however not achieve the desired results. In this study, harmful users of alcohol have been partitioned in subgroups with low, intermediate or high probability of positive treatment outcome, using recursive partitioning classification tree analysis. Methods: Data were obtained from a randomized controlled trial assessing the effectiveness of two Internet-based alcohol interventions. The main outcome variable was treatment response, a dichotomous outcome measure for treatment success. Candidate predictors for the classification analysis were first selected using univariate regression. Next, a tree decision model to classify participants in categories with a low, medium and high probability of treatment response was constructed using recursive partitioning software. Results: Based on literature review, 46 potentially relevant baseline predictors were identified. Five variables were selected using univariate regression as candidate predictors for the classification analysis. Two variables were found most relevant for classification and selected for the decision tree model: 'living alone', and 'interpersonal sensitivity'. Using sensitivity analysis, the robustness of the decision tree model was supported. Conclusions: Harmful alcohol users in a shared living situation, with high interpersonal sensitivity, have a significantly higher probability of positive treatment outcome. The resulting decision tree model may be used as part of a decision support system but is on its own insufficient as a screening algorithm with satisfactory clinical utility. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe a 12-year (1997-2008) observation of substance-related incidents occurring at rave parties in the Netherlands, including length of visits to first-aid stations, substances used, and severity of the incidents. During rave parties, specifically trained medical and paramedical personnel staffed first aid stations. Visitors were diagnosed and treated, and their data were recorded using standardized methods. During the 12-year period with 249 rave parties involving about 3,800,000 visitors, 27,897 people visited a first aid station, of whom 10,100 reported having a substancerelated problem. The mean age of these people was 22.3+/25.4 years; 52.4% of them were male. Most (66.7%) substancerelated problems were associated with ecstasy or alcohol use or both. Among 10,100 substance-related cases, 515 required professional medical care, and 16 of these cases were life threatening. People with a substance-related problem stayed 20 min at the first aid station, which was significantly longer than the 5 min that those without a substance-related health problem stayed. These unique data from the Netherlands identify a variety of acute health problems related to the use of alcohol, amphetamines, cannabis, cocaine, ecstasy, and GHB. Although most problems were minor, people using GHB more often required professional medical care those using the other substances. We recommended adherence to harm and risk reduction policy, and the use of first aid stations with specially trained staff for both minor and serious incidents. [ABSTRACT FROM AUTHOR]

Objective: Problematic alcohol use is the third leading contributor to the global burden of disease, partly because the majority of problem drinkers are not receiving treatment. Internet-based alcohol interventions attract an otherwise untreated population, but their effectiveness has not yet been established. The current study examined the effectiveness of Internet-based therapy (therapy alcohol online; TAO) and Internet-based self-help (self-help alcohol online; SAO) for problematic alcohol users. Method: Adult problem drinkers (n = 205; 51% female; mean age = 42 years; mean Alcohol Use Disorders Identification Test score = 20) were randomly assigned to TAO, SAO, or an untreated waiting-list control group (WL). Participants in the TAO arm received 7 individual text-based chat-therapy sessions. The TAO and SAO interventions were based on cognitive-behavioral therapy and motivational interviewing techniques. Assessments were given at baseline and 3 and 6 months after randomization. Primary outcome measures were alcohol consumption and treatment response. Secondary outcome measures included measures of quality-of-life. Results: Using generalized estimating equation regression models, intention-to-treat analyses demonstrated significant effects for TAO versus WL (p = .002) and for SAO versus WL (p = .03) on alcohol consumption at 3 months postrandomization. Differences between TAO and SAO were not significant at 3 months postrandomization (p = . 11 ) but were significant at 6 months postrandomization (p = .03), with larger effects obtained for TAO. There was a similar pattern of results for treatment response and quality-of-life outcome measures. Conclusions: Results support the effectiveness of cognitive-behavioral therapy/motivational interviewing Internet-based therapy and Internet-based self-help for problematic alcohol users. At 6 months postrandomization, Internet-based therapy led to better results than Internet-based self-help. [ABSTRACT FROM AUTHOR]

Background: Only a minority of all alcohol- and drug abusers is receiving professional care. In an attempt to narrow this treatment gap, treatment facilities experiment with online healthcare. Therefore, it is important to test the (cost-)effectiveness of online health interventions in a randomized clinical trial. Methods: This paper presents the protocol of a three-arm randomized clinical trial to test the (cost-) effectiveness of online treatment for problem drinkers. Self-help online, therapy online and a waiting list are tested against each other. Primary outcome is change in alcohol consumption. Secondary outcome measures include quality of life and working ability. Incremental cost-effectiveness ratios for self-help online alcohol and therapy online alcohol will be calculated. The predictive validity of participant characteristics on treatment adherence and outcome will be explored. Discussion: To our best knowledge, this randomized clinical trial will be the first to test the effectiveness of therapy online against both self-help online and a waiting-list. It will provide evidence on (cost-) effectiveness of online treatment for problem drinkers and investigate outcome predictors. Trial registration: This trial is registered in the Dutch Trialregister (Cochrane Collaboration) and traceable as NTR-TC1155. [ABSTRACT FROM AUTHOR]

Sundström and colleagues found no difference in effects between a low- and high-intensity digital alcohol intervention among alcohol use disorder patients. These results differ from findings of previous studies in this field,and suggest a need for further exploration of how to optimize guidance and treatment intensity.

Background: Patients with substance use disorder (SUD) or Attention Deficit Hyperactivity Disorder (ADHD) have a high risk of drop out from treatment. Few studies have investigated predictors of therapy drop out and outcome in SUD patients with comorbid ADHD. Recently, integrated cognitive behavioral therapy (CBT/Integrated) was shown to be more effective than standard CBT (CBT/SUD) in the treatment of SUD + ADHD.Objective: To investigate the association of demographic, clinical and neurocognitive variables with drop-out and treatment outcome, and to examine which of these variables are suitable for patient-treatment matching.Methods: We performed an RCT in which 119 patients were allocated to CBT/Integrated (n = 60) or CBT/SUD (n = 59). In addition, 55 patients had dropped out before randomization. Demographic variables, clinical characteristics and measures of cognitive functioning (Stroop, Tower of London (ToL) and Balloon Analogue Risk Task (BART)) were included as predictors. Outcome measures were: early treatment drop-out, ADHD symptom severity, and substance use severity at end of treatment and follow up.Results: Primary substance of abuse (drugs as opposed to alcohol only) and lower accuracy scores on the ToL were significant predictors of early treatment drop-out. Having more depression and anxiety symptoms and using ADHD medication at baseline significantly predicted more ADHD symptoms at end of treatment, and higher accuracy scores on the ToL significantly predicted higher substance use at end of treatment. No significant predictor-by-treatment interactions were found.Conclusion: The results add to the existing realization that also relatively mild cognitive deficits are a risk factor for treatment drop-out in these patients. [ABSTRACT FROM AUTHOR]

Aims: This study addressed the age of onset of conduct disorder (CD) and oppositional defiant disorder (ODD) in treatment-seeking substance use disorder (SUD) patients with and without adult attention-deficit/hyperactivity disorder (ADHD) and its association with early onset of SUD.Methods: We examined data from the 2nd International ADHD in Substance Use Disorders Prevalence Study, including 400 adults in SUD treatment from Puerto Rico, Hungary, and Australia. ADHD, SUD, and CD/ODD were assessed with the Conners Adult ADHD Diagnostic Interview for DSM-IV, the MINI International Neuropsychiatric Interview, and the K-SADS, respectively. Cox regression analyses modeled time to emergence of CD/ODD separately for SUD patients with and without adult ADHD. Linear regression models examined associations between age of onset of SUD and presence of ADHD and adjusted for sex, age, and country. To assess the mediating role of CD/ODD on the association of ADHD with onset of SUD, adjusted regression models were estimated.Results: Treatment-seeking SUD patients with ADHD presented an earlier onset of CD/ODD compared with those without ADHD. CD/ODD symptom loads were higher among the SUD and ADHD group. Age of first substance use and SUD were significantly earlier in SUD patients with ADHD, and these findings remained significant after adjustment for demographics and coexisting CD/ODD.Conclusions: ADHD is associated with earlier onset of SUD as well as with an earlier onset of more frequent and more severe disruptive behavioral disorders. These findings may inform preventive interventions to mitigate adverse consequences of ADHD. [ABSTRACT FROM AUTHOR]

The aim of this study was to test the effectiveness of a brief motivational enhancing intervention (MEI) as an add-on to supervision-as-usual (SAU) in reducing time to treatment initiation in offenders with substance use disorders (SUDs) under probation supervision. We also tested the effectiveness in enhancing treatment retention and abstinence of primary substance rates. The study was designed as a multi-site, cluster randomized trial (CRT) in six addiction probation offices. We randomized 73 probation officers (37 to intervention, 36 to control) and followed 220 substance-abusing repeat offenders during their supervision (111 intervention, 109 control). Individualized SAU was compared with supervision with MEI. We report time to treatment initiation, treatment retention rate during the 12 months follow-up, and primary substance abstinence rate in the 30 days before follow-up. Results show that time to treatment initiation (χ2(1) = 1.817, p = .178), and the proportion of treatment retention (OR = 1.980, p = .213) and primary substance abstinence (OR = 0.945, p = .886) did not significantly differ between offenders that received SAU plus MEI and those that received SAU at 12 months follow-up. Our findings provide no evidence that supervision plus a brief manual-base MEI is more effective than SAU. [ABSTRACT FROM AUTHOR]

Aims: To test the effectiveness of a digital intervention to reduce cannabis use (ICan) with adherence‐focused guidance compared with educational cannabis information. Design: This was a single‐blind randomized controlled trial. Follow‐up clinical outcome measurements took place 3 and 6 months after randomization. Setting: The trial was conducted in the Netherlands. The intervention and guidance took place on‐line, with recruitment via Facebook/Instagram advertisement campaigns. Participants: Inclusion criteria were ≥ 18 years, cannabis use on ≥ 3 days/week, the desire to reduce/quit cannabis and using a smartphone. Participants were allocated to either ICan (n = 188) or control (n = 190) (69% male, mean age = 27.5 years). Intervention and comparator: ICan is a mobile (web‐)application based on motivational interviewing and cognitive behavioural therapy and includes three main components: screening, brief intervention (six modules) and referral to treatment. The control condition consisted of non‐interactive educational cannabis information. Measurements Primary outcome was the number of cannabis use days in the 7 days prior to the 6‐month follow‐up measurement. Secondary outcome measures at 3‐ and 6‐month follow‐up were the number of grams of cannabis used and attitudes towards seeking professional help for cannabis use related problems. Findings Intention‐to‐treat analysis showed that 6 months after randomization the mean number of cannabis use days in the past 7 days was reduced in both conditions (time P < 0.001), with no significant group × time interaction effect [ICan = 4.17 days, control = 4.31 days, Cohen's dbetween = 0.06, 95% confidence interval (CI) = −0.15, 0.26, P = 0.93]. Three months after randomization the mean number of grams used in the past 7 days was reduced in both conditions, with a significantly larger reduction in the ICan condition (P = 0.009, Cohen's dbetween = 0.15). At 6‐month follow‐up the significant group × time interaction effect was no longer present (P = 0.30). In both conditions, attitudes towards seeking professional help remained virtually unchanged over time. Conclusions: A digital intervention to reduce cannabis use (ICan) was more effective than non‐interactive educational cannabis information in reducing grams of cannabis used over 3 months, but not more effective at reducing cannabis use days at 6‐month follow‐up. Cannabis use reductions were maintained in both conditions between 3 and 6 months' follow‐up. [ABSTRACT FROM AUTHOR]

Background: Frequent Cannabis use has been linked to a variety of negative mental, physical, and social consequences. We assessed the effects of digital prevention and treatment interventions on Cannabis use reduction in comparison with control conditions.Methods: Systematic review with two separate meta-analyses. Thirty randomized controlled trials met the inclusion criteria for the review, and 21 were included in the meta-analyses. Primary outcome was self-reported Cannabis use at post-treatment and follow-up. Hedges's g was calculated for all comparisons with non-active control. Risk of bias was examined with the Cochrane risk-of-bias tool.Results: The systematic review included 10 prevention interventions targeting 8138 participants (aged 12 to 20) and 20 treatment interventions targeting 5195 Cannabis users (aged 16 to 40). The meta-analyses showed significantly reduced Cannabis use at post-treatment in the prevention interventions (6 studies, N = 2564, g = 0.33; 95% CI 0.13 to 0.54, p =  0.001) and in the treatment interventions (17 comparisons, N = 3813, g = 0.12; 95% CI 0.02 to 0.22, p =  0.02) as compared with controls. The effects of prevention interventions were maintained at follow-ups of up to 12 months (5 comparisons, N = 2445, g = 0.22; 95% CI 0.12 to 0.33, p <  0.001) but were no longer statistically significant for treatment interventions.Conclusions: Digital prevention and treatment interventions showed small, significant reduction effects on Cannabis use in diverse target populations at post-treatment compared to controls. For prevention interventions, the post-treatment effects were maintained at follow-up up to 12 months later. [ABSTRACT FROM AUTHOR]

Objective: The high prevalence of smoking and cognitive deficits in schizophrenia patients is well known, but findings regarding the association between the two are contradictory, and longitudinal studies are lacking. The authors sought to examine the multi-cross-sectional association between smoking behavior and performance in specific cognitive domains and the longitudinal association between change in smoking behavior and change in cognitive functioning in a large prospective study.Method: The authors conducted a cohort study of patients with nonaffective psychosis (N=1,094), their siblings (N=1,047), and healthy control subjects (N=579). At baseline and at 3- and 6-year follow-ups, smoking behavior was assessed with the Composite International Diagnostic Interview and cognitive functioning with a test battery. Multivariate linear mixed-effects regression analyses were conducted to assess associations between smoking and cognitive domains while adjusting for variation in demographic factors, psychopathology, medication, and substance use. Bonferroni correction for multiple testing was applied.Results: At baseline, 66.6% of the patients smoked, compared with 38.3% of the siblings and 25.2% of the control subjects. Significant multi-cross-sectional associations were found between smoking and lower processing speed in the patient and control groups compared with the nonsmoking patient group (estimate=-2.38, SE=0.84) and the nonsmoking control group (estimate=-3.13, SE=1.06). In siblings, smoking was significantly associated with lower performance in working memory and reasoning and problem solving compared with nonsmoking. Also, the number of cigarettes smoked per day was negatively associated with these domains. Patients, but not siblings and control subjects, who quit smoking showed a significant improvement in processing speed (estimate=4.90, SE=1.73).Conclusions: The study findings indicate that smoking is associated with poorer cognitive performance in patients, their siblings, and healthy control subjects compared with nonsmoking. Smoking cessation may improve processing speed in patients. [ABSTRACT FROM AUTHOR]

Introduction We present an online decision aid to involve patients with a psychotic disorder in shared decision-making concerning the selection of antipsychotic medication. Method Patients selected effectiveness and adverse effects criteria from the Subject's Response to Antipsychotics-34 questionnaire. Numerical data from meta-analyses, clinical trial data, receptor affinities and expert opinions were used to rank antipsychotics on each criterion. When using the the tool, patients indicate on a 5-point Likert scale how they value each (adverse) effect. The Likert scale values are combined in an algorithm with the rank orders of antipsychotics to create a personalized ranking. Results Criteria used were: effectiveness concerning psychotic, depressive and cognitive symptoms, weight gain, sexual dysfunction, drowsiness, hypersomnia, extrapyramidal symptoms, anticholinergic adverse effects, hypersalivation, nausea, dizziness, energy loss, blunted affect/less need for companionship. High-level evidence was available for ranking weight gain, sexual dysfunction, menstrual disorders, extrapyramidal symptoms and effectiveness on psychotic symptoms. We used lower level evidence ranking the remaining criteria. Discussion A transparent procedure has resulted in an updateable tool to produce individual ranking of antipsychotics based on the patients' input. [ABSTRACT FROM AUTHOR]

Background: Clinicians in the field of drug addiction have started to exploit the growth of Technology-Based Interventions (TBIs). However, there is little information on how health personnel evaluate them.Methods: Semi-structured interviews were conducted among 20 European experts.Results: All of the interviewees recognised TBIs as a valuable tool to improve the management of substance-use disorders (SUDs). Most interviewees indicated that combining both traditional face-to-face therapist-patient clinic appointment with TBIs is probably the most effective method. Most interviewees agree that TBIs are valuable tools to overcome both physical and social barriers, and hence significantly facilitate the access to treatment. Poor infrastructure and lack of digital literacy are recognised as major barriers to the diffusion of these tools.Conclusions: The application of various forms of technology in SUD treatment is an interesting development for the European Union. Technical and non-technical barriers exist and impede their full exploitation. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented that focuses on the development of specific app-based interventions in e-health for addictive behaviors using guided frameworks for complex interventions and the methodological challenges of general concern to researchers and developers within the field of m-healh.

Background: Internet-based interventions are seen as attractive for harmful users of alcohol and lead to desirable clinical outcomes. Some participants will however not achieve the desired results. In this study, harmful users of alcohol have been partitioned in subgroups with low, intermediate or high probability of positive treatment outcome, using recursive partitioning classification tree analysis.Methods: Data were obtained from a randomized controlled trial assessing the effectiveness of two Internet-based alcohol interventions. The main outcome variable was treatment response, a dichotomous outcome measure for treatment success. Candidate predictors for the classification analysis were first selected using univariate regression. Next, a tree decision model to classify participants in categories with a low, medium and high probability of treatment response was constructed using recursive partitioning software.Results: Based on literature review, 46 potentially relevant baseline predictors were identified. Five variables were selected using univariate regression as candidate predictors for the classification analysis. Two variables were found most relevant for classification and selected for the decision tree model: 'living alone', and 'interpersonal sensitivity'. Using sensitivity analysis, the robustness of the decision tree model was supported.Conclusions: Harmful alcohol users in a shared living situation, with high interpersonal sensitivity, have a significantly higher probability of positive treatment outcome. The resulting decision tree model may be used as part of a decision support system but is on its own insufficient as a screening algorithm with satisfactory clinical utility.Trial Registration: Netherlands Trial Register (Cochrane Collaboration): NTR-TC1155. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Day hospital versus intensive outpatient mentalization-based treatment: 3-year follow-up of patients treated for borderline personality disorder in a multicentre randomized clinical trial" published in December 7, 2020 issue.

Background: Psychiatric patients are more likely to be victims of crime than others in the community. Dual diagnosis patients with comorbid psychiatric and substance use disorders are especially prone to victimization. Victimization is associated with substance abuse, more severe symptomatology and homelessness. There is a strong need for interventions to reduce victimization in this population. We developed the Self-wise, Other-wise, Streetwise (SOS) training to reduce victimization in patients with dual diagnosis. Methods/design: This study is a randomized controlled trial using a parallel group design to determine the effectiveness of adding the SOS training to care as usual. Patients with dual diagnosis (N = 250) will be allocated to either care as usual plus SOS training (N = 125) or care as usual only (N = 125) using computer-generated stratified block randomization. To compare effectiveness participants will be interviewed at baseline and 2, 8 and 14 months follow-up. The primary outcome measure is treatment response (yes/no), defined as either no victimization at 14 months follow-up or at least a 50% reduction in incidents of victimization at 14 months follow-up compared to baseline assessment. Victimization is measured with the Safety Monitor, an adequate self-report instrument used by Statistics Netherlands to measure victimization on a large scale in the Netherlands. Outcome assessors are blind to treatment allocation. An economic evaluation will be performed alongside the randomized controlled trial and will take the societal perspective. Discussion: This study is the first randomized controlled trial to examine the effectiveness of an intervention that aims to reduce victimization in patients with dual diagnosis. If the intervention is effective it can be implemented in mental health care and contribute to the safety and well-being of patients. [ABSTRACT FROM AUTHOR]

• Stress reduction did not explain reduction in smoking behavior in our sample of pregnant women. • Motivation to quit smoking moderated the intervention effect on the number of smoking days per week and number of cigarettes smoked on average on a weekly basis. • The dose–response effect of program use on smoking frequency, and smoking quantity suggests that the eHealth intervention consists of effective components. Prenatal smoking and stress are associated with adverse health effects for women themselves and are risk factors for adverse outcomes of the child. Effective interventions are needed to support women with smoking cessation and reducing stress. The aims were (1) to test the effectiveness of an 8-week eHealth intervention targeting stress reduction and smoking cessation; (2) to examine whether stress reduction mediated the intervention effect on smoking behavior; (3) to test motivation to quit as a moderator; and (4) to investigate a dose–response effect of program usage. Pregnant women were included if they were >18 years of age, < 28 weeks pregnant at recruitment, and currently smoking. In total, 156 consenting participants were randomly assigned to the intervention or active control condition. Study outcomes on smoking (yes/no, frequency, and quantity) were collected via online questionnaires at pre-intervention (baseline; t0), post-intervention (8 weeks after t0; t1), and follow up at two weeks (t2) and three months (t3) after birth. Smoking and stress reduced over the 8-week period in both conditions. The intervention effect on smoking was not mediated by stress reduction. Motivation to quit was found to moderate the intervention effect (smoking frequency and quantity) and a dose–response effect was found for program usage in the intervention for the reduction on smoking frequency and quantity. Program usage and motivation to quit are important for smoking reduction in pregnant women. Further research is needed to examine how the intervention could be improved to increase treatment effectiveness. [ABSTRACT FROM AUTHOR]

Background: Two types of mentalization-based treatment (MBT), day hospital MBT (MBT-DH) and intensive outpatient MBT (MBT-IOP), have been shown to be effective in treating patients with borderline personality disorder (BPD). This study evaluated trajectories of change in a multi-site trial of MBT-DH and MBT-IOP at 36 months after the start of treatment. Methods: All 114 patients (MBT-DH n = 70, MBT-IOP n = 44) from the original multicentre trial were assessed at 24, 30 and 36 months after the start of treatment. The primary outcome was symptom severity measured with the Brief Symptom Inventory. Secondary outcome measures included borderline symptomatology, personality and interpersonal functioning, quality of life and self-harm. Data were analysed using multilevel modelling and the intention-to-treat principle. Results: Patients in both MBT-DH and MBT-IOP maintained the substantial improvements made during the intensive treatment phase and showed further gains during follow-up. Across both conditions, 83% of patients improved in terms of symptom severity, and 97% improved on borderline symptomatology. No significant differences were found between MBT-DH and MBT-IOP at 36 months after the start of treatment. However, trajectories of change were different. Whereas patients in MBT-DH showed greater improvement during the intensive treatment phase, patients in MBT-IOP showed greater continuing improvement during follow-up. Conclusions: Patients in both conditions showed similar large improvements over the course of 36 months, despite large differences in treatment intensity. MBT-DH and MBT-IOP were associated with different trajectories of change. Cost-effectiveness considerations and predictors of differential treatment outcome may further inform optimal treatment selection. [ABSTRACT FROM AUTHOR]

Background: Suriname is a Low-middle income country consisting of diverse population groups. Epidemiological studies concerning mental disorders like depression and anxiety had not been conducted until 2015. The treatment gap for mental disorders in Low and middle-income countries (LMICs) may reach 76-80% as treatment is not always readily available. In this study, we estimate and compare the prevalence of potential cases of depression and anxiety, as well as the size of the treatment gap in a rural (Nickerie) and urban (Paramaribo) region of Suriname, a lower middle-income country.Methods: Subjects were selected by a specific sampling method of the national census bureau. The Center for Epidemiological Studies-Depression (CES-D) was used to assess depression. Generalized anxiety disorder was assessed with the Generalized Anxiety Disorder 7 (GAD-7) and The Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ) were used to assess Panic disorder. The treatment gap was calculated by estimating the percentage of subjects with depression or anxiety that did not seek out professional help.Results: About 18% of the respondents from Nickerie and 16% from Paramaribo were at risk of depression and the established cut-off values of the instruments used indicate that about 3-4% in both regions may suffer from Generalized Anxiety Disorder. Women in both samples were most at risk of high anxiety about body sensations and maladaptive thoughts about panic. The treatment gap varies between 78 and 100% for the two disorders.Conclusions: A high depression rate has been found in both areas, especially among young females. In addition, a high treatment gap is noted which insinuates that more therapeutic strategies are required to tackle depression and anxiety in Suriname. [ABSTRACT FROM AUTHOR]

Background: For anorexia nervosa, firm evidence of the superiority of specialized psychological treatments is limited and economic evaluations of such treatments in real world settings are scarce. This consecutive cohort study examined differential (cost-)effectiveness for adult inpatients and outpatients with anorexia nervosa, after implementing cognitive behavioral therapy-enhanced (CBT-E) throughout a routine setting. Methods: Differences in remission, weight regain and direct eating disorder treatment costs were examined between one cohort (N = 75) receiving treatment-as-usual (TAU) between 2012–2014, and the other (N = 88) CBT-E between 2015–2017. The economic evaluation was performed from a health care perspective with a one-year time horizon, using EDE global score < 2.77, the absence of eating disorder behaviors combined with a BMI ≥ 18.5, as effect measure. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that CBT-E is cost effective compared to TAU. Results: Using direct eating disorder treatment costs in the cost-effectiveness analysis, the cost-effectiveness plane of the base case scenario for all patients indicated a 84% likelihood of CBT-E generating better health gain at additional costs. The median ICER is €51,081, indicating a probable preference for CBT-E (> 50% probability of cost-effectiveness) assuming a WTP of €51,081 or more for each additional remission, On remission, no difference was found with 9.3% remission during TAU and 14.6% during CBT-E (p =.304). Weight regain was higher during CBT-E (EMD = 1.33 kg/m2, SE =.29, 95% CI [0.76–1.9], p <.001). Conclusions: In this mixed inpatient and outpatient cohort study, findings indicate a probability of CBT-Ebeing more effective at higher costs. These findings may contribute to the knowledge of effectiveness and cost-effectiveness of specialized psychological treatments. Plain English Summary: In this study, the effectiveness and treatment costs of a specialized psychological treatment for adult clients with anorexia nervosa were compared with a regular, non-specialist treatment. One group of inpatients and outpatients did receive non-specialist treatment, the next group of inpatients and outpatients received CBT-E, a specialized treatment, later on. CBT-E is recommended for clients with bulimia and with binge eating disorder, for clients with anorexia nervosa it is less clear which specialized psychological treatment should be recommended. Results indicate that at end-of-treatment, CBT-E was not superior on remission. When looking at weight regain, CBT-E seemed superior than the treatment offered earlier. Economic evaluation suggests that CBT-E generates better health gain, but at additional costs. This study contributes to the knowledge on the effectiveness and treatment costs of psychological treatments, as they are offered in routine practice, to adults with anorexia nervosa. [ABSTRACT FROM AUTHOR]