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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 ... – PowerPoint PPT presentation

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Title: Abstract:


1
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
Results
Abstract
Results
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.

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 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 12 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.
Internet use characteristics, n(valid ) MA abusers MA nonusers P-Value
Website most time spent www.kci.org 127 (69.8) www.kci.org 109 (85.8) P lt 0.05
Visiting www.kci.org lt5 times/week to seek help 155(75) 32 (20) P lt 0.05
Visiting other recovery websites 80 (38) 66 (43) P gt0.05
Time spent (lt 1 hour) on other drug recovery website/day 133 (66) 91 (64) P gt0.05
HOME as place of Internet access at most times 174 (86) 127 (89) P gt0.05
Medical information as most frequent type of information obtained on the Internet 126 (66) 100 (73) P gt0.05
Individuals agreeing that Internet provides help during recovery from MA abuse 167 (85) NA
Online tools that help for drug abuse recovery or social support Message boards Chat rooms/E-support rooms Online-blogs Email 100 (55) 56 (23) 39 (22) 21 (12) 85 (63) 33 (25) 13 (10) 47 (35) P lt 0.05 P gt0.05 P gt0.05 P gt0.05
Most important online tool during drug abuse recovery Discussion Forum (message board) Chat-room Stories and letter section 44(24) 28(15) 28(15) NA
Individuals agreeing that Internet facilitates drug use 85 (43) 31 (23) P lt 0.05
  • Mean age of study population, 39 years. Male to
    female ratio is 12. A total of 50 reported 1st
    time MA abuse gt10 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.
  • 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 (gt5
    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.
  • Place of Internet access at most times did not
    affect individuals 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 P0.001) Attendance of social support
    meetings (OR, 0.28 P0.002) Educational level
    higher than high school degree (OR, 0.43
    P0.05) use of Internet for online purchases of
    items other than drugs or sex partners (OR, 2.71
    P0.03). Predictors for Ambivalence construct
    Longer duration of clean time from MA abuse 6
    months (OR, 0.45 P0.05). Predictors for taking
    steps construct Length of recovery 6 months
    (OR, 0.01 Plt0.05).
  • 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

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Introduction
  • The Internet has begun to provide community for
    persons suffering from many conditions.
  • 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.

Figure 1 Transition from General
Transtheoretical Model of Change (TTM) to Stages
of Change Readiness and Treatment Eagerness Scale
Index (SOCRATES)
Research Methodology
Conclusions
  • 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 chat-room page
    on www.kci.org.
  • 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 anti- MA
    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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