Abstract
Background: Numerous trials have demonstrated the efficacy of internet interventions targeting alcohol or cannabis use, yet a substantial proportion of users do not benefit from the format, warranting further research to identify moderators of treatment effects. Users' initial attitudes toward treatment is a potential moderator, yet no previous study has investigated users' attitudes in the context of internet interventions for addictive disorders.Method: In this secondary analysis on two internet-based trials targeting harmful alcohol use (n = 1,169) and regular cannabis use (n = 303), respectively, we compared user groups' attitudes at the item level; explored within-group heterogeneity by submitting attitude scores to a k-means cluster analysis; and investigated whether latent subgroups in each user group moderated the treatment effects. Outcome models were run using generalized linear models with 10,000 bias-corrected bootstraps accounting for subject-level clustering.Results: While substance groups and latent subgroups converged in enjoying the anonymity provided by the format, their interest toward treatment differed. Outcome analyses revealed a significant and negative time by subgroup effect on grams of cannabis consumed and screening test score (CAST), favoring the subgroup with positive treatment attitudes. There were not any significant effects of subgroup on alcohol consumption. Despite initial treatment reluctance, participants in the neutral subgroup decreased their cannabis use (gram) significantly when receiving the intervention vs. control.Conclusions: This first, exploratory study revealed key differences between substance groups' attitudes, but more importantly that within-group heterogeneity appear to affect cannabis outcomes. Assessing attitudes could be key in patient-treatment matching, yet more research is needed.
Highlights
Alcohol and cannabis are among the most used psychoactive substances globally [1]
The aim of the current study was three-fold: (a) to examine difference in specific attitudes toward internet interventions among users of programs for alcohol vs. cannabis use; (b) to explore latent subgroups based on attitudes in each of the two groups of users; and (c), to explore whether such subgroups moderated the respective treatment effect
On items covering possible reasons for seeking internet-based treatment, both substance groups saw great value in anonymity, but the aspect of not having to disclose treatment-seeking to other people was on average higher valued in subjects with cannabis use disorder (CUD), as was the autonomy-emphasizing aspect that the program allow the user to set his or her own goal, whereas the alcohol-use group had a higher preference for being able to access treatment at any time
Summary
Alcohol and cannabis are among the most used psychoactive substances globally [1]. Every third user is likely to experience a transition from recreational use to addiction at some point in their life [2], entailing substantial psychosocial and monetary costs for the affected individual, significant others and society at large [3]. Perceived and institutional barriers to seeking and entering treatment for alcohol use include treatment unavailability [6, 7], and attitudinal factors such as fear of stigma and shame [8,9,10,11] and finding traditional treatment services unattractive [10]. In addition to these hinders, treatment-seeking for cannabis use is associated with particular challenges: many users view cannabis as an important part of their identity that demonstrates independence and free-thinking [12, 13]. Users’ initial attitudes toward treatment is a potential moderator, yet no previous study has investigated users’ attitudes in the context of internet interventions for addictive disorders
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