Evaluating the efficacy of a web-based self-help intervention with and without chat counseling in reducing the cocaine use of problematic cocaine users: the study protocol of a pragmatic three-arm randomized controlled trial.

Michael P Schaub,Larissa J Maier,Lars Stark,Andreas Wenger,Oliver Berg,Boris B Quednow,Thilo Beck,Severin Haug

doi:10.1186/s12888-015-0518-6

Michael P Schaub, Larissa J Maier + Show 6 more

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https://doi.org/10.1186/s12888-015-0518-6

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Abstract

BackgroundWeb-based self-help interventions that aim to reduce problematic substance use are able to reach “hidden” consumer groups in the general population who often fear stigmatization and thus avoid institutional addiction treatment. In Western European countries, including Switzerland, cocaine is the most widely used psychoactive substance after alcohol, tobacco, and cannabis. Although approximately one in six users develop serious problems of dependency, only a minority seeks help from psychiatrists or in outpatient counseling centers or psychiatric hospitals. Offering web-based therapy treatment may potentially reach users who hesitate to approach institutional treatment services and help them reduce their cocaine use before they get into more serious trouble.Methods/designThe study will use a three-arm randomized controlled trial (RCT) design to test the efficacy of a web-based self-help intervention with or without guided chat counseling compared with that of a waiting list control condition in reducing or stopping cocaine use. The primary outcome measure will be the weekly quantity of cocaine used. Secondary outcome measures will include the number of cocaine use days in the past 30 days, the severity of cocaine dependence, the use of alcohol, tobacco, and/or other illicit drugs, changes in mental health symptoms, and treatment retention. The self-help intervention will consist of eight modules that are designed to reduce cocaine use and depression symptoms. These modules are based on the principles of Motivational Enhancement Therapy and Cognitive Behavioral Therapy, such as Behavioral Self-Management. The three individual chat therapy sessions will be based on the same therapy approaches and will be tailored to participants’ self-help data and aim to assist the reinstatement of social rewards and the improvement of social support and relationships.DiscussionThis study will be the first RCT to test the effectiveness of a web-based self-help intervention in combination with or without chat counseling in reducing cocaine use. The expected findings will contribute substantial knowledge that may help design effective guided and unguided web-based treatment for cocaine users. Moreover, the study will elucidate to what extent a therapeutic alliance with cocaine users can be established in a guided Internet-delivered setting. Additionally, the present study will investigate changes in social support with specific guided therapy interventions that aim to ameliorate social support and social perceptions and compare these changes with those in an unguided self-help interventionTrial RegistrationCurrent Controlled Trials ISRCTN12205466. Registered 24 February 2015.

Highlights

Web-based self-help interventions that aim to reduce problematic substance use are able to reach “hidden” consumer groups in the general population who often fear stigmatization and avoid institutional addiction treatment
This study will be the first randomized controlled trial (RCT) to test the effectiveness of a web-based self-help intervention in combination with or without chat counseling in reducing cocaine use
The present study aims to investigate and compare the effectiveness of the revised web-based self-help intervention, Snow Control 2.0, with tailored chat counseling that is based on Cognitive Behavioral Therapy (CBT), Motivational Enhancement Therapy (MET), Behavioral SelfManagement (BSM), and social problem solving in reducing problematic cocaine use

Summary

Introduction

Web-based self-help interventions that aim to reduce problematic substance use are able to reach “hidden” consumer groups in the general population who often fear stigmatization and avoid institutional addiction treatment. Offering web-based therapy treatment may potentially reach users who hesitate to approach institutional treatment services and help them reduce their cocaine use before they get into more serious trouble. The prevalence rates of problematic cocaine use and cocaine dependence are unclear, the lifetime prevalence of cocaine use has almost doubled in the Swiss general population (aged 15–24 and 25–34 years) over the past ten years [1], which is in line with findings in many other countries in Southern and Western Europe [2]. It is assumed that quasi-controlled, occasional use of cocaine is much more prevalent than addicted use and that only a few users are currently in treatment [6]. For problematic users and those with dependence symptoms, appropriate interventions follow the Concurrent Cover principle (i.e., minimally invasive, low-cost interventions that enhance therapeutic intensity according to need)

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