Peter Tossmann Benjamin Jonas Marc Tensil Peter Lang Evelin Strüber Berlin / Cologne, June 2012...

Peter TossmannBenjamin Jonas

Marc TensilPeter Lang

Evelin StrüberBerlin / Cologne, June 2012

Quit the shit – An internet-based intervention program for cannabis users

Bundeszentrale fürgesundheitliche Aufklärung

Structure of the presentation

1. The programme “quit the shit“1.1. Basic facts1.2. Structure & content

2. Evaluation of the programme (RCT)2.1. Study design 2.2. Results

3. Conclusion

Development

› “quit the shit” was developed on behalf of the

Federal Centre of Health Education (FCHE / BZgA)

› Start: August 2004

› Embedded in “www.drugcom.de”

1.1. Basic facts

Bundeszentrale fürgesundheitliche Aufklärung

Allgemeine Informationen

Development

› “quit the shit” was developed on behalf of the

Federal Centre of Health Education (FCHE / BZgA)

› Start: August 2004

› Embedded in “www.drugcom.de”

Usage of “quit the shit”

› Until 15 June 2012, 3.900 users (approx. 40 – 50 per month)

Target group

› Cannabis-addicted adolescents and young adults

Aim of the programme

› To reduce cannabis consumption or to quit within 50 days

1.1. Basic facts

Bundeszentrale fürgesundheitliche Aufklärung

Brief intervention

› Clear timeframe (50 days)

› Target oriented approach

Counselling concept

› Social learning theory (Kanfer, 1986): Self-monitoring & self-regulation

› Solution-focussed strategy (Berg & Miller, 2000)

› Motivational Interviewing (Miller & Rollnik, 1999)

Additional Information for the users

› Section title: “How to control cannabis use”

1.1. Basic facts

1. Registration

› Registration questionnaire

› Current use of cannabis & other substances (quantity, frequency,

dependence etc.)

› Mental well-being (life satisfaction, psych. problems, social support etc.)

› Socio-demographics (age, gender, educational & employment status etc.)

› Registration with E-Mail-Address

› Appointment for the Admission-Chat

Admission-Chat

2Programme-Participation

3Concluding

Chat

4Registration

1

1.2. Structure & content of the programme

Registration1

2. Admission-Chat with trained psychologist

› Where? In the chat-room of “quit the shit”

› Duration: 50 minutes

› Aims:

› Establish a trustful relationship

› Elicit the personal situation of the client

› Define individual goals & coping strategies

1.2. Structure & content of the programme

Programme-Participation

3Concluding

Chat

4Registration

1Admission-

Chat

2

3. Programme Participation (I)

› Online diary for 50 days

› Cannabis-use for each day (yes / no):

› If “yes”: When? How much? Situational context? Reasons?

› If “no”: Reasons for abstinence? Which coping strategies?

› Daily resume

› Exercises

› Coping strategies, pleasurable activities & healthy lifestyle, self-efficacy &

problem solving etc.

1.2. Structure & content of the programme

Admission-Chat

2Concluding

Chat

4Registration

1Programme-Participation

3

3. Programme Participation (II)

› Weekly feedback from the counsellor

› Topics: Substance use, psychosocial situation, progress within the

programme

› Ideas & suggestions, exercises

› Answering questions etc.

1.2. Structure & content of the programme

Admission-Chat

2Concluding

Chat

4Registration

1Programme-Participation

3

4. Concluding Chat (30 min)

› Where? In the chat-room of “quit the shit”

› Topics:

› Which goals could be obtained? Which ones not?

› Which coping strategies worked? Which ones have to be improved?

› Future perspectives: Is there a need for additional support?

1.2. Structure & content of the programme

Admission-Chat

2Programme-Participation

3Registration

1Concluding

Chat

4

Is “quit the shit” helpful ....› to reduce cannabis use ?

› to improve psychological well-being ?

2. Evaluation of the programme

Structure of the survey

Registration-questionnaire

• Socio-demographics• Cannabis consumption (quantity, freq.)• Psychological well-being• etc.

Delay-conditionParticipation at QTS

3 M

onth

s

Follow-up• Cannabis consumption (quantity, freq.)• Psychological well-being• etc.

2.1. Study design: Randomised Control Trial (RCT)

Inclusion criteria fulfilled (n=1.292)

Participation at QTS(Intervention Group)

(n=863)

Waiting Condition (Control Group) (n=429)

Follow-up-data

(n=150)

Analysed Data (n=100)

Analysed Data (n=106)

Follow-up-data

(n=144)

Inclusion Programm (n=360)

Randomisation

exclusion: n=44professional help: n=44

response: 35% response: 39%

2.2. Results: Participants

Study population: N=206 participants

Cannabis: Consumption & dependence• On average on 25,5 days (SD=6,1) during the last 30 days• On average 20,4 grams (SD=18,1) during the last 30 days• 95% are addicted to cannabis (DSM IV)

Socio-demographic data• Significantly more male participants (74%)• Average age: 25 yrs. (MD) (youngest: 14 yrs.; oldest: 59 yrs.)• Relatively high education: 55% attend Gymnasium (grammar

school) or have reached Abitur (a-levels)

2.2. Results: Participants

Registration Follow up0

5

10

15

20

25

30

24.9

21.0

26.1

12.4

CG (n=106)

IG (n=100)

Day

s of

con

sum

ption

T(187,02)=6,593; p<.001; d = 0.98

3.2. Results: Days of consumption / past 30 days

Abstinence (Follow-up)

IG: 32,6%

CG: 5,4%

Odds Ratio: 8,5 (p<.001)

T(166,969)=5,174; p<.001; d = 0.74

3.2. Results: Amount (grams) / past 30 days

* State-Trait-Anxiety-Inventory, Trait-Subscale (Laux et al., 1981)

T(183)=3,747; p<.001; d = 0.45

3.2. Results: Anxiety (STAI-T)*

50,947,3

51,4

42,6

20

30

40

50

60

70

80

Registration Follow Up

STA

I-T sc

ore

80 = scale max.20 = scale min.

CG (n=99)

IG (n=86)

* Allgemeine Depressions-Skala, Kurzversion (Hautzinger & Bailer, 1993)

T(180)=1,907; p=.029; d = 0.26

3.2. Results: Depressiveness (ADS-K)*

* Satisfaction with Life Scale (Schumacher, 2003)

T(195)=-2,683; p=.004; d = 0.29

3.2. Results: Life satisfaction (SWLS)*

“Quit the shit” is one of the first internet-based treatment programmes for cannabis-related disorders in Europe

It was successfully established in Germany (3.900 users so far)

Extended and optimized continuously

Highly elaborated system (programme, user management)

It has been proven to be effective in reducing cannabis use and improving psychological well-being

4. Summary

Thank you!