Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 26, 2021
Date Accepted: Apr 3, 2021
CANreduce 2.0 – the effects of adherence-focused guidance for Internet self-help among cannabis misusers: results of a three-arm randomized controlled trial
ABSTRACT
Background:
Despite increasing demand for treatment among cannabis misusers in many countries, most misusers are not in treatment. Internet-based self-help offers an alternative for those hesitant to seek face-to-face therapy, though low-effectiveness and adherence issues often arise. Through adherence-focused guidance enhancement (AFGE), we aimed to increase adherence to, and the effectiveness of Internet-based self-help among cannabis misusers.
Objective:
A three-arm randomized controlled trial was conducted comparing the effectiveness of (1) an AFGE Internet-based self-help intervention with social presence (AFGE-SP), (2) a similar intervention with an impersonal service team (AFGE-ST), and (3) Internet access as usual (IAU, controls).
Methods:
From July 2016—May 2019, 575 cannabis misusers (70.6% males, mean age=28.3) not otherwise in treatment were recruited from the general population. The primary outcome was cannabis-use days over the preceding 30 days. Secondary outcomes included cannabis-dependence severity, changes in cannabis misuse disorder (CMD) symptoms, and intervention adherence.
Results:
All groups exhibited reduced cannabis-use days after 3 months (AFGE-SP: -8.2; AFGE-ST: -9.8; IAU: -4.2). AFGE-ST participants reported significantly fewer cannabis-use days than IAU controls (P = .01, d = .60); a similar reduction in the AFGE-SP (d=.40) group failed to achieve significance (P =.07). There was no significant difference between the two intervention groups. AFGE-ST patients also exhibited superior improvements in cannabis-use disorder, cannabis-dependence severity, and general anxiety symptoms after three months.
Conclusions:
Adding an impersonal service team to the AFGE Internet-based self-help intervention significantly reduced cannabis use, cannabis use disorder, dependence severity, and general anxiety symptoms. Clinical Trial: http://www.isrctn.com/ISRCTN11086185
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