Transcript CL-06_Ubaka - Advocate Health Care

Evaluation of Internet as Treatment Support for
Methamphetamine Users: A Prospective Case-Study
Gopika Chandra, MD, PhD, MPH, Edward Mensah, PhD, Thomas M. Lyons, PhD,
and Jacek L. Ubaka, MD, MPH
Abstract:
Study Objective: The primary objective is to determine the demographic characteristics of
individuals visiting www.kci.org, their MA use pattern, current stage of recovery, Internet
use pattern and their mode of social support seeking preference.
Method: Two online surveys were implemented on an anti-methamphetamine website,
www.kci.org: MA user and MA nonuser surveys, respectively. MA users were defined as
persons currently using the drug, in recovery or experiencing relapse. A MA nonuser
questionnaire was completed by any individual visiting www.kci.org and meeting inclusion
criteria, who self-identified as a family member and/or a friend of MA user. Survey
administration commenced in November 2008 and concluded in March 2009. The
descriptive statistics, all calculations, and statistical testing for significant association were
performed with SPSS version 16.0. A qualitative analysis of comments section of the survey,
discussion board and the chat room was conducted to explore issues commonly discussed on
www.kci.org
Conceptual Model
The Transtheoretical Model of Behavioral Change is an integrative theoretical model of
behavioral change highlighting that positive behavior change occurs over time. This model
suggests five stages of change when modifying behavior: precontemplation, contemplation,
preparation, action, and maintenance.
Each SOCRATES construct approximately corresponds to different stages of change as
described by TTM. Every individual is measured in terms 3 SOCRATES constructs:
recognition, ambivalence, and taking steps.
Each SOCRATES construct is rated from very high, high, medium to very low and low scores.
The Recognition construct approximately corresponds to the precontemplation stage of TTM.
The Ambivalence construct approximately corresponds to the contemplation stage of TTM. The
Taking steps construct approximately correspond to the action, preparation, and maintenance
stages.
Results: A total of 449 individuals completed the study consisting of 245 MA users and 204 MA
nonusers. Overall, mean age of MA user was 37.4 years, 66.5% were females, and 85.1% were
Caucasian. White MA users were predominant globally. The male to female ratio is 1:2 indicating
a higher predominance of female MA users compared with male MA users in this study
population. Almost 60% of MA users were full-time or part-time employed. MA users reported
varied MA use ranging from 1 day to 1 year ago. Smoking was reported to be the most common
route of MA administration (92%) followed by snorting (85%).
Study participants existed in different stages of recovery. A total of 85% MA users agreed that
Internet provides help during recovery from MA use. Message board was reported to be the most
helpful online tool for social support during recovery (MA users, 55% versus MA nonusers, 63%,
respectively). For attaining social support to resolve any life problems including 79% MA users
reported to be very comfortable on www.kci.org followed by 68% reporting preference for
spouse, partner or significant other, 63% for friend and lastly, 37% for a relative.
Conclusion: Our qualitative and quantitative findings suggest that social support meetings are
effective for sustained recovery and online support is an effective treatment support
technology for MA users. It is plausible that online social support will fill the gap when
professional help is inaccessible and a social support meeting is unavailable.
Results:
Internet use
characteristics,
n(valid %)
Results:
MA
abusers
MA
nonusers
Mean age of study population, 39 years. Male to female ratio is 1:2. A total of 50%
reported 1st time MA abuse >10 years ago and 55% considered themselves in recovery.
Smoking (92%) reported as most common route of MA followed by snorting (85%). 53%
MA abusers attended support group meetings for MA abuse.
P-Value
Website most time spent
www.kci.org
127 (69.8%)
www.kci.org
109 (85.8%)
P < 0.05
Visiting www.kci.org <5
times/week to seek help
155(75%)
32 (20%)
P < 0.05
Visiting other recovery
websites
80 (38%)
66 (43%)
P >0.05
Time spent (< 1 hour) on other
drug recovery website/day
133 (66%)
91 (64%)
P >0.05
MA abusers received social support from family and friends for different life situations.
72.5% of MA abusers felt that family and friends assisted recovery, 54% found Internet, 41%
felt support group meetings, and 30% found inpatient and outpatient treatment. Most MA
nonusers received social support from www.kci.org for different life situations.
MA abusers that received medical treatment and currently attend social support
meetings tend to have undergone successful behavioral change towards recovery ( i.e.
have higher taking steps scores) compared with MA abusers who did not receive medical
treatment and did not attend meetings.
MA abusers attending social support meetings at least 1-2 times per month or once
every week tend to have undergone successful behavioral change towards recovery ( i.e.
have higher taking steps scores) compared with MA abusers attending meetings every several
months.
MA abusers frequently visiting www.kci.org (>5 times a week ) tend to have undergone
successful behavioral change towards recovery ( i.e. have higher taking steps scores). MA
abusers were more comfortable discussing personal problems during online discussions
compared with face to face communication.
HOME as place of Internet
174 (86%)
127 (89%)
P >0.05
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Individuals agreeing that
Internet provides help
during recovery from MA
abuse
Online tools that help for drug
abuse recovery or social
support: Message boards
Chat rooms/E-support
rooms
Online-blogs
Email
Introduction:
The Internet has begun to provide community for persons suffering from many conditions.
167 (85%)
Place of Internet access at most times did not affect individual’s recovery status.
The optimal time spent on drug recovery websites for successful behavioral change
towards recovery was 1-2 hours/day.
Predictors for recognition construct: Longer duration of clean time from MA abuse ≥ 6
months (OR, 0.16; P=0.001); Attendance of social support meetings (OR, 0.28; P=0.002);
Educational level higher than high school degree (OR, 0.43; P=0.05); use of Internet for online
purchases of items other than drugs or sex partners (OR, 2.71; P=0.03). Predictors for
Ambivalence construct: Longer duration of clean time from MA abuse ≥ 6 months (OR,
0.45; P=0.05). Predictors for taking steps construct: Length of recovery ≥ 6 months (OR,
0.01; P<0.05).
A geo-mapping conducted by Survey Gizmo that mapped MA users on the world map using
geo-tracking by Internet Protocol (IP) addresses showed predominance of MA use in North
America
NA
85 (63%)
P < 0.05
33 (25%)
P >0.05
13 (10%)
P >0.05
47 (35%)
P >0.05
100 (55%)
56 (23%)
39 (22%)
21 (12%)
Role of free online community for social support on an anti-methamphetamine (MA)
website, analogous in some ways to, but in other ways very different from, live mutual
support groups.
The purpose of this study is:
To determine demographic characteristics of individuals visiting www.kci.org, their current
stage of recovery, Internet use pattern, and social support preference.
Identify specific features (discussion board, chat room, informational links and web pages)
of the website that participants found were useful for support.
Provide guidelines to improve web design of existing anti-MA websites so as to improve
online support.
Research Methodology:
Inclusion criteria: Age ≥ 18 years; any past or current MA use; identified as friend/family of
MA abuser or seeking information regarding MA.
A total of 449 participants (245 MA abusers and 204 MA nonusers ) voluntarily completed
anonymous online survey on an anti-MA website, www.kci.org.
Information about www.kci.org is passed on by word of mouth amongst MA abusers as a source
of support during attendance at 12-step meetings and healthcare settings.
This website can be accessed by using search engines by entering search term
‘methamphetamine’. Web-links were created on the home page, message board page, and chatroom page on www.kci.org.
Figure 1: Transition from General Transtheoretical Model of Change (TTM) to Stages of Change
Readiness and Treatment Eagerness Scale Index (SOCRATES)
Most important online tool
during drug abuse recovery
Discussion Forum (message
board)
Chat-room
Stories and letter section
Individuals agreeing that
Internet facilitates drug use
NA
44(24%)
28(15%)
28(15%)
85 (43%)
31 (23%)
P < 0.05
Conclusions:
Social support meetings are effective for sustained recovery and online support is an effective
treatment support for MA abusers. It is plausible that online social support will fill the gap when
professional help is inaccessible and a social support meeting is unavailable.
Discussion boards are most effective online tools during recovery and must be offered via antiMA websites in addition to the traditional treatment for MA abuse and social support meetings.
Restructuring of current anti-MA websites to facilitate better access to treatment facilities,
including social support meetings and development of standardized online support for MA abuse
is needed.
Study Limitations: Potential problems associated with online data collection: confidentiality,
privacy issues, questions asked may be stressful; difficulty measuring stages of change among
MA abusers with poly-drug use; unknown predictive utility of SOCRATES index in different
settings and diverse populations; no biochemical verification of being drug free; varied literacy
level and limited accessibility to the Internet amongst MA abusers; lack of generalizability; loss
of non-verbal cues leading to miscommunication during online communication.
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