Quit the shit An internetbased intervention program for

Quit the shit – An internetbased intervention program for cannabis users Bundeszentrale für gesundheitliche Aufklärung Peter Tossmann Benjamin Jonas Marc Tensil Peter Lang Evelin Strüber Berlin / Cologne, June 2012

Structure of the presentation 1. The programme “quit the shit“ 1. 1. Basic facts 1. 2. Structure & content 2. Evaluation of the programme (RCT) 2. 1. Study design 2. 2. Results 3. Conclusion

1. 1. Basic facts Development › “quit the shit” was developed on behalf of the Federal Centre of Health Education (FCHE / BZg. A) › Start: August 2004 › Embedded in “www. drugcom. de” Bundeszentrale für gesundheitliche Aufklärung

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1. 1. Basic facts Development › “quit the shit” was developed on behalf of the Federal Centre of Health Education (FCHE / BZg. A) Bundeszentrale für gesundheitliche Aufklärung › Start: August 2004 › Embedded in “www. drugcom. de” Usage of “quit the shit” › Until 15 June 2012, 3. 900 users (approx. 40 – 50 per month) Target group › Cannabis-addicted adolescents and young adults Aim of the programme › To reduce cannabis consumption or to quit within 50 days

1. 1. Basic facts Brief intervention › Clear timeframe (50 days) › Target oriented approach Counselling concept › Social learning theory (Kanfer, 1986): Self-monitoring & self-regulation › Solution-focussed strategy (Berg & Miller, 2000) › Motivational Interviewing (Miller & Rollnik, 1999) Additional Information for the users › Section title: “How to control cannabis use”

1. 2. Structure & content of the programme 1 1 2 Registration 3 Admission-Chat Programme. Participation 4 Concluding Chat 1. Registration › Registration questionnaire › Current use of cannabis & other substances (quantity, frequency, dependence etc. ) › Mental well-being (life satisfaction, psych. problems, social support etc. ) › Socio-demographics (age, gender, educational & employment status etc. ) › Registration with E-Mail-Address › Appointment for the Admission-Chat

1. 2. Structure & content of the programme 1 2 Registration 2. Admission-Chat 3 Programme. Participation Admission-Chat with trained psychologist › Where? In the chat-room of “quit the shit” › Duration: 50 minutes › Aims: › Establish a trustful relationship › Elicit the personal situation of the client › Define individual goals & coping strategies 4 Concluding Chat

1. 2. Structure & content of the programme 1 2 Registration 3. Admission-Chat 3 Programme. Participation 4 Concluding Chat Programme Participation (I) › Online diary for 50 days › Cannabis-use for each day (yes / no): › If “yes”: When? How much? Situational context? Reasons? › If “no”: Reasons for abstinence? Which coping strategies? › Daily resume › Exercises › Coping strategies, pleasurable activities & healthy lifestyle, self-efficacy & problem solving etc.

1. 2. Structure & content of the programme 1 2 Registration 3. 3 Admission-Chat Programme. Participation 4 Concluding Chat Programme Participation (II) › Weekly feedback from the counsellor › Topics: Substance use, psychosocial situation, progress within the programme › Ideas & suggestions, exercises › Answering questions etc.

1. 2. Structure & content of the programme 1 2 Registration 4. Admission-Chat 3 Programme. Participation 4 Concluding Chat (30 min) › Where? In the chat-room of “quit the shit” › Topics: › Which goals could be obtained? Which ones not? › Which coping strategies worked? Which ones have to be improved? › Future perspectives: Is there a need for additional support?

2. Evaluation of the programme Is “quit the shit” helpful. . › to reduce cannabis use ? › to improve psychological well-being ?

2. 1. Study design: Randomised Control Trial (RCT) Structure of the survey 3 Months Registrationquestionnaire Participation at QTS Follow-up • Socio-demographics • Cannabis consumption (quantity, freq. ) • Psychological well-being • etc. Delay-condition • Cannabis consumption (quantity, freq. ) • Psychological well-being • etc.

2. 2. Results: Participants Inclusion criteria fulfilled (n=1. 292) Randomisation Waiting Condition (Control Group) (n=429) Participation at QTS (Intervention Group) (n=863) Inclusion Programm (n=360) response: 35% response: 39% Follow-up-data (n=150) (n=144) professional help: n=44 Analysed Data (n=106) exclusion: n=44 Analysed Data (n=100)

2. 2. Results: Participants Study population: N=206 participants Socio-demographic data • • • Significantly more male participants (74%) Average age: 25 yrs. (MD) (youngest: 14 yrs. ; oldest: 59 yrs. ) Relatively high education: 55% attend Gymnasium (grammar school) or have reached Abitur (a-levels) Cannabis: Consumption & dependence • • • On average on 25, 5 days (SD=6, 1) during the last 30 days On average 20, 4 grams (SD=18, 1) during the last 30 days 95% are addicted to cannabis (DSM IV)

3. 2. Results: Days of consumption / past 30 days 30 Abstinence (Follow-up) 26. 1 Days of consumption 25 24. 9 21. 0 20 15 12. 4 10 5 0 Registration T(187, 02)=6, 593; p<. 001; d = 0. 98 Follow up IG: 32, 6% CG: 5, 4% Odds Ratio: 8, 5 (p<. 001)

3. 2. Results: Amount (grams) / past 30 days T(166, 969)=5, 174; p<. 001; d = 0. 74

3. 2. Results: Anxiety (STAI-T)* T(183)=3, 747; p<. 001; d = 0. 45 * State-Trait-Anxiety-Inventory, Trait-Subscale (Laux et al. , 1981)

3. 2. Results: Depressiveness (ADS-K)* T(180)=1, 907; p=. 029; d = 0. 26 * Allgemeine Depressions-Skala, Kurzversion (Hautzinger & Bailer, 1993)

3. 2. Results: Life satisfaction (SWLS)* T(195)=-2, 683; p=. 004; d = 0. 29 * Satisfaction with Life Scale (Schumacher, 2003)

4. Summary “Quit the shit” is one of the first internet-based treatment programmes for cannabis-related disorders in Europe It was successfully established in Germany (3. 900 users so far) Extended and optimized continuously Highly elaborated system (programme, user management) It has been proven to be effective in reducing cannabis use and improving psychological well-being

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