Evaluations

• A pilot outcomes evaluation for computer assisted therapy for substance misuse — an evaluation of Breaking Free Online

  Elison S, Humphreys L, Ward J, Davies G. Journal of Substance Use. 2014. 19(4): 313-318. doi: 10.3109/14659891.2013.804605

  Summary: Breaking Free Online (BFO) was evaluated in a pilot cohort study. Adults were recruited through internet advertisements and screened for substance use disorders. Those with a current substance use disorder (N=34) were enrolled and had access to BFO. Substance use, cravings, and life satisfaction were assessed quantitatively at baseline and at 90-day follow-up. Participants also completed qualitative interviews focused on satisfaction with the BFO program. Participants reported significant decreases in cravings and increases in life satisfaction from baseline to 90 days. The majority of participants also reported reduced rates of substance use.

  Take Away: Breaking Free Online (BFO) is an acceptable and feasible intervention for use by people with self-reported substance use disorders.

• An outcomes study of eTherapy for dual diagnosis using Breaking Free Online.

  Elison S, Ward J, Davies G. Advances in Dual Diagnosis. 2014. 7(2): 52-62.

  Summary: This cohort study investigated the impact of Breaking Free Online (BFO) for individuals with co-occurring substance use disorders and mental health problems. Adults with co-occurring substance use and mild-to-moderate mental health problems were recruited from a mental health program in the United Kingdom. All 74 participants had access to BFO. Substance use and mental health outcomes were assessed at baseline and 12-weeks post-baseline. Results showed that social impairment, depression, anxiety, drug use, and social anxiety symptoms all decreased significantly from baseline to 12 weeks. The percent of participants with moderate to severe depression decreased from 72% at baseline to 49% at 12 weeks. No significant changes in panic disorder or specific phobias were found.

  Take Away: Breaking Free Online may reduce depressive and anxiety symptoms, in addition to substance use, in adults with co-occurring substance use and mental health problems. Further research is needed to evaluate the program in a controlled trial to demonstrate efficacy.

• Positive and negative features of a computer-assisted drug treatment program delivered by mentors to homeless drug users living in hostels.

  Neale J, Stevenson C. Journal of Substance Abuse Treatment. 2014. 47(4): 258-264. PMID: 25037480.

  Summary: In this study, 30 drug users living in homeless hostels were given access to Breaking Free Online (BFO). To assist participants with the BFO program, each participant was assigned a mentor. Mentors were recruited from staff employed at the hostels and met with participants weekly to provide assistance and encouragement with the program. Both participants and mentors completed semi-structured qualitative interviews before starting BFO and again 12-weeks post-baseline. The interviews revealed several positive and negative features of using a computer-assisted therapy program to treat homeless drug users. Participants liked the accessibility and flexibility of BFO, felt the program was less judgmental than a therapist, and thought it was good to have the support of a mentor. Participants felt that more mentor support was needed. Privacy was also an issue because participants often had to use computers in communal places. Both participants and mentors noticed that the program sometimes brought up topics participants were not ready to confront, which sometimes interfered with program engagement. Finally, mentors worried that the program did not engage or change behaviors in participants uninterested in stopping their substance use.

  Take Away: The study highlights facilitators and barriers to use of the online BFO program. Computer-delivered treatement for homeless drug users has potential benefits and may be most effective when used in combination with ongoing person-delivered support.

• An outcomes evaluation of computerized treatment for problem drinking using Breaking Free Online.

  Elison S, Davies G, Ward J. Alcoholism Treatment Quarterly. 2015. 33(2): 185-196.

  Summary: This pre-post study assessed the effect of Breaking Free Online (BFO) on alcohol use. Individuals with alcohol use disorders were referred to BFO after presenting for treatment at public substance abuse programs. Study participants (N=300) completed assessments on alcohol use and mental health before and after completing BFO. For users not completing BFO, assessments were given after users ended their engagement with the program. Compared to those who did not use BFO, users showed significant decreases in weekly alcohol consumption, alcohol dependence severity, depression, and anxiety, and significant increases in quality of life. Results of regression analyses revealed that those who spent more time using BFO displayed larger reductions in alcohol dependence severity.

  Take Away: This quasi-experimental studydemonstrated that the BFO program may help reduce alcohol use and co-occurring mental health programs, and improve quality of life, for adults with alcohol use disorders. There is some indication that increased “dose” (translated here as use of the program) produces better outcomes. Randomized controlled studies could help elucidate strength of potential impact.

• Effectiveness of computer-assisted therapy for substance dependence using Breaking Free Online: Subgroup analyses of a heterogeneous sample of service users.

  Elison S, Davies G, Ward J. JMIR Mental Health. 2015. 2(2): e13. doi: 10.2196/mental.4355

  Summary: Participants (785) with substance use disorders referred from substance abuse treatment programs and the criminal justice system in the United Kingdom were provided with BFO program.  Each participant had access to a peer mentor or provider who helped set up the program and provided assistance with completing assessments. Participants were asked to complete pre- and post-treatment assessments. Those who did not complete BFO were asked to fill out the post-treatment assessment after their final session using BFO. Only the 393 users who completed the post-treatment assessment were included in the statistical analyses. Among these 393 users, there were significant improvements in substance dependence severity, depression, anxiety, and quality of life from pre-to post-assessment. Subgroup analyses showed that primary alcohol users and primary opioid users had improved substance use and mental health outcomes after accessing BFO.

  Take Away: Breaking Free Online (BFO) was associated with improvements in substance use and mental health issues overall and for some subgroups in particular.The BFO program has not yet been tested against a comparator to assess relative efficacy.

• Examining effectiveness of tailorable computer-assisted therapy programmes for substance misuse: Programme usage and clinical outcomes data from Breaking Free Online.

  Elison S, Jones A, Ward J, Davies G, Dugdale S. Addictive Behaviors. 2017. 74: 140-147. doi: 10.1016/j.addbeh.2017.05.028

   Summary: Researchers recruited 2,311 people being treated for substance use disorders (SUDs) using referrals from clinicians and peer mentors in treatment settings. Participants were given access to Breaking Free Online to use for approximately 8 weeks. Participants completed assessments of quality of life, depression, anxiety, drug and alcohol dependence, and biopsychosocial functioning based on the six domains in the Lifestyle Balance Model (negative thoughts, emotional impact, unhelpful behaviors, difficult situations, physical sensations, lifestyle) at baseline and post-intervention. Researchers completed analyses to determine how level of impairment affected intervention completion and whether there was a relationship between intervention completion and participant outcomes. Results indicated that level of impairment in a Lifestyle Balance Model domain was significantly related to completion of the corresponding intervention module (e.g., negative thoughts and cognitive restructuring, emotional impact and mindfulness). Participants were significantly more likely to complete modules associated to domains in which they reported significant impairment compared to modules associated with domains in which they reported moderate or minor impairment. Participants reported significant improvements in depression, anxiety, drug and alcohol dependence, and quality of life between baseline and post-intervention. Degree of improvement in participant outcomes was significantly related to the number of intervention modules completed (dose-response effect). Completion of the cognitive restructuring module was related to changes in all assessed outcomes with the exception of drug dependence.

  Take Away: Completion of Breaking Free Online modules was related to improvement in participant outcomes, in particular, completion of the cognitive restructuring was related to change in almost all outcomes.

• Related Articles

  Implementation of computer-assisted therapy for substance misuse: A qualitative study of Breaking Free Online using Roger’s diffusion of innovation theory. Elison S, Ward J, Davies G, Moody M. Drugs and Alcohol Today. 2014. 14(4): 207-218.

  The role of lifestyle in perpetuating substance use disorder: The Lifestyle Balance Model. Davies G, Elison S, Ward J, Laudet A. Substance Abuse Treatment, Prevention, and Policy. 2015. 10:2.