JMIR Publications

ABSTRACT

Background:

Substance use disorder (SUD) is a major health issue in Indonesia where several barriers to treatment exist, including inaccessibility to treatment services, stigma, and criminalization of drug issues. Peer involvement and the use of telemedicine to deliver psychotherapy are promising approaches to overcome these barriers.

Objective:

This study aimed (1) to describe the development of a new group psychotherapy co-provided by a health-care worker and a peer and (2) to evaluate the acceptability, practicality, and preliminary outcomes of the program delivered via video-conferencing in Indonesia.

Methods:

Building upon an established relapse prevention therapy in Japan, we developed a 3-month weekly group therapy module in the Indonesian language. Adjustments were made via focus group discussions with local stakeholders in terms of substance types, understandability, inclusive language, and cultural relevance. A pilot study was conducted to test the new module provided by a peer and a psychiatrist via video-conferencing, termed tele-Indo-DARPP, with a pre- and post-controlled design. We analyzed data from semi-structured feedback interviews and outcome measurements, including number of days using substances and quality of life, and compared the intervention (tele-Indo-DARPP added to treatment as usual [TAU]) and control (TAU only) arms.

Results:

In total, eight people diagnosed with SUD participated in the pilot study with a mean age of 37.8 years. All were men, and 88% used sedatives as the primary substance. Collectively, they attended 44 of the 48 tele-Indo-DARPP sessions. Three out of four (75%) preferred telemedicine rather than in-person therapy. Positive acceptability and practicality were shown from qualitative feedback, in which the participants who joined the tele-Indo-DARPP reported that they liked the convenience of joining from home, and that they were able to open up about personal matters, received helpful advice from peers, and received support from other participants. Providers reported that they feel the module is provider-friendly, the session is convenient to join without diminishing rapport-building. Meanwhile, troubles with the Internet connection and difficulty in comprehending some terminologies in the workbook were reported. The intervention arm showed better improvements in psychological health and anxiety symptoms.

Conclusions:

Group psychotherapy via video-conferencing, co-provided by health-care workers and peers, was acceptable and practical for participants with SUD and service providers in this study. A large-scale study is warranted to examine the effectiveness of the newly developed module in Indonesia.