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Frances Kay Lambkin. DrugInfo seminar: Information and communication technology. 22 August 2011
Citation preview
Stepping out of the SHADE
The use of e-health approaches to the treatment of comorbid depression and alcohol/other drug
misuse
Frances Kay-Lambkin, Amanda Baker, Brian Kelly, Terry Lewin, Vaughan Carr
The SHADE Project
National Drug & Alcohol Research CentreUniversity of New South Wales, Australia
Centre for Brain and Mental Health Research
Self Help for Alcohol/other drug use & DEpression
Depression and substance use comorbidity...
•Comorbidity is important because…▫Increases burden of illness and disability▫Negative mood cited most often as cause of relapse
across a range of substances mild depression elevates the risk of relapse to drinking
three-fold in comparison to people without depressive symptomatology
▫Consistent association between suicidality, depression and alcohol use problems
▫No clear treatment model▫Difficulties accessing treatment
Self Help for Alcohol/other drug use & DEpression
Treating depression and substance use comorbidity
•Reducing the burden of disease involves developing and disseminating efficacious treatments▫Australia: 62% of people with mental illness do not
seek any professional help. Stigma, economic, geographic disadvantage
▫Even more the case with comorbid depression and problematic alcohol/other drug use
•Research sparse
Self Help for Alcohol/other drug use & DEpression
Health System Challenges...
• “Increased health care service demands, costs and complexities are already testing the limits of the financial, physical and human resources of the Australian Health System...These challenges will not be solved by doing more of the same, particularly given the limits of available human and financial resources...”
AIHW (2008)AHMAC (2008)
Self Help for Alcohol/other drug use & DEpression
The potential of e-health to respond to these challenges...•E-health = rapidly expanding field of health
information and communication technology•Widespread recognition within health sector that
better use of e-health initiatives should play a critical role in improving the Australian healthcare system
• Increasing acceptance for individuals to take a more active role in protecting their health and participating in their own health care
Self Help for Alcohol/other drug use & DEpression
The potential of e-health approaches
•Treatment can be accessible at times and in locations that suit clients
•May reduce stigma associated with treatment•Clients can work at their own pace, tailoring the
provision of information and strategies•May be able to circumvent some of the challenges of
treatment access▫Particularly for comorbidity
Self Help for Alcohol/other drug use & DEpression
The potential of e-health approaches
• In Australia...▫72% of households in 2009 reported home access to
the internet• In Canada...
▫Current drinkers significantly more likely than abstainers to have at home internet access (73% vs 50%)
▫Illicit drug users (cannabis and cocaine) report equivalent rates of home internet access to non-users
Self Help for Alcohol/other drug use & DEpression
RCTs of E-health interventions for…
•Depression•Panic disorder•Chronic tension/migraine•Trauma• Insomnia•Obesity•Complicated grief•Eating Disorders•Alcohol Problems
Self Help for Alcohol/other drug use & DEpression
The SHADE ProjectComputerized, clinician assisted, combination CBT/MI for depression
and alcohol/other drug use problems
Self Help for Alcohol/other drug use & DEpression
The SHADE Project•Developed in the Hunter (NSW)•Project run in collaboration with Centre for Rural
and Remote Mental Health (rural and urban)•Target depression (and co-occurring alcohol use,
cannabis use problems)▫Use CBT
•Compare face-to-face treatment with computer treatment (SHADE) with supportive treatment (PCT)
•Follow-up people up for 3 years
Self Help for Alcohol/other drug use & DEpression
Depression
-70.0
-60.0
-50.0
-40.0
-30.0
-20.0
-10.0
0.0
10.0
20.0
Baseline Baseline - 3 months Baseline - 6 months Baseline - 12 months Baseline - 24 months Baseline - 36 months
Perc
enta
ge re
ducti
on in
dep
ress
ive
sym
ptom
s rel
ative
to b
asel
ine
Therapist-delivered CBT/MI
Clinician-assisted SHADE
PCT (control)
No change
50% reduction
Self Help for Alcohol/other drug use & DEpression
Alcohol use
-100
-80
-60
-40
-20
0
20
40
Baseline Baseline - 3 months Baseline - 6 months Baseline - 12 months Baseline - 24 months Baseline - 36 months
Perc
enta
ge re
ducti
on in
alco
hol c
onsu
mpti
on re
lative
to ba
selin
e
Therapist-delivered CBT/MIClinician-assisted SHADEPCT (control)
No change
50% reduction
Self Help for Alcohol/other drug use & DEpression
Binge Drinking
-40.0
-35.0
-30.0
-25.0
-20.0
-15.0
-10.0
-5.0
0.0
5.0
10.0
Baseline Baseline - 6 months Baseline - 12 months Baseline - 24 months Baseline - 36 months
Perc
enta
ge re
ducti
on in
bing
e drin
king
freq
uenc
y
Therapist-delivered CBT/MI
Clinician-assisted SHADE
PCT (control)
No change
Self Help for Alcohol/other drug use & DEpression
Cannabis use
-100
-80
-60
-40
-20
0
20
40
60
Baseline Baseline - 3 months Baseline - 6 months Baseline - 12 months Baseline - 24 months Baseline - 36 months
Perc
enta
ge re
ducti
on in
mar
ijuan
a con
sum
ption
rela
tive
to b
asel
ine
Therapist-delivered CBT/MI
Clinician-assisted SHADE
PCT (control)
No change
50% reduction
Self Help for Alcohol/other drug use & DEpression
SHADE...• Andersson & Carlbring (2009)
▫ “[SHADE] has the potential to fit in well with existing health-care services...”• Key challenges in the uptake of e-health in clinical practice:
▫ Access to technology▫ Reluctance of healthcare providers to adopt technology or change their practice
without compelling reasons to do so Research trials attest to efficacy Lack of evidence from service-based dissemination trials
▫ Lack of understanding about the potential for e-health systems to augment health care DoHA-funded consultation Most common response by community was confusion (“online AA?”, “like MMN or
something?”, “what, talking to someone online...?”)
Self Help for Alcohol/other drug use & DEpression
So, what’s the upshot for e-health?•? Enhanced adherence to best (or evidence-based)
practice•? Empowering clients to better manage their own
health•Can be applied to the complexities of comorbid
depression and alcohol/other drug use▫? Reduced time and cost addressing comorbidity
•Use of e-health initiatives may be a question of costs, client preference and provider preference
Self Help for Alcohol/other drug use & DEpression
AcknowledgementsChief Investigators• Frances Kay-Lambkin• Amanda Baker• Brian Kelly• Terry Lewin• Vaughan CarrStatistician• Terry LewinFunding• AERF
Institutions
Address for correspondence: [email protected]
Centre for Brain & Mental Health
Research
Therapists• Ali Beck• Katrina Bell• Richa Gupta• Juanita Todd• Leigh Underwood• Anna Britton• Victoria Clack• Jenny Geddes• Alyna Turner• Melanie Haile• Sue Startup• Holly Devir• Frances Kay-Lambkin
Follow-up Interviewers• Madeleine DeVille• Lisa Phillips• Veronica Clipsham