E-Mental Health Interventions for Harmful Alcohol Use Research Methods and Outcomes Matthijs ...

216 Pages·2011·7.67 MB·English

RE E-Mental Health Interventions
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ae for Harmful Alcohol Use
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2.5 million yearly deaths and 4.6% of the global burden of disease are at-
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tributable to the harmful use of alcohol, according to the World Health H
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Organization in 2011. tha
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Brief interventions have become increasingly valuable in the manage- s I
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ment of individuals with alcohol-related problems. The availability and
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uptake of these brief interventions is however limited. dr
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This so-called treatment gap may be narrowed through accessible, effec- t
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tive, and inexpensive treatment programmes. E-mental health interven- oio
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tions would be one promising approach for developing such treatment
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options, if they are shown to be effective. s f
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In this dissertation, the (cost-)effectiveness of two interventions based
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on cognitive behavioural therapy is subjected to research in three con-
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secutive studies. The two interventions are a non-therapist involved In-
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ternet-based self-help programme, and a therapist led Internet therapy,
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based on textual-chat interaction.
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The aim of this dissertation is twofold. First, there is a clinical aim: to h
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identify effective and cost-effective e-mental health interventions for l

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harmful alcohol use. Second, there is a methodological aim: to address
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methodological challenges in the design, execution, and analysis of e-
mental health randomized controlled trials.
In the coming years, it is expected that the development and dissemi-
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nation of e-mental health interventions will advance. This dissertation
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hopes to contribute valuably to the current knowledge base, upon which t
t
future research and interventions will build. h
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ISBN 978-90-6464-510-5
l
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n
k
e Matthijs Blankers
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s
9 789064645105
E-Mental Health Interventions
for Harmful Alcohol Use
Research Methods and Outcomes
STELLINGEN BIJ HET PROEFSCHRIFT
1. E-mental health bij schadelijk alcoholgebruik is effectief. (dit proefschrift)
De inzet van een therapeut geeft meerwaarde aan e-mental health interventies
2.
bij schadelijk alcoholgebruik. (dit proefschrift)
Met e-mental health in een stepped care framework kan een optimaal
3. gezondheidsresultaat worden behaald en worden zorgkosten gereduceerd ten
opzichte van alleen conventionele behandeling. (dit proefschrift)
E-mental health biedt perspectief op behandeling aan schadelijke drinkers die
4.
door de reguliere hulpverlening niet worden bereikt. (dit proefschrift)
Het ontbreken van meetgegevens in longitudinaal epidemiologisch onderzoek is
5. op zichzelf geen probleem; het wordt pas een probleem wanneer hier in analyses
onvoldoende rekening mee wordt gehouden. (dit proefschrift)
Mensen met een hoge inter-persoonlijke sensitiviteit die met anderen
6. samenwonen hebben het meest baat bij e-mental health bij schadelijk
alcoholgebruik. (dit proefschrift)
Het onder 6. genoemde effect is echter niet zodanig groot dat op voorhand
7. de meest kansrijke cliënten met een grote betrouwbaarheid kunnen worden
geselecteerd. (dit proefschrift)
Om de efficiëntiewinst die e-mental health biedt optimaal te benutten, zijn nu
8. de zorgverzekeraars aan zet: zij moeten dit type zorg stimuleren en op afdoende
wijze vergoeden.
Wetenschappelijk onderzoek dat wordt gefinancierd uit publieke middelen zou
9.
uitsluitend nog in “open access” vorm moeten worden gepubliceerd.
10. Een proefschrift zonder stellingen, dat is geen proefschrift! (R. A. Blankers)
E-Mental Health Interventions
for Harmful Alcohol Use
Research Methods and Outcomes
Matthijs Blankers
111001MBlankers-PhD-Thesis.pdf 1 1-10-2011 21:25:46
Matthijs Blankers, 2011. This work is licensed under a Creative
Commons Attribution Non-Commercial Share Alike 3.0 License.
Cover: Wassily Kandinsky Gelb-Rot-Blau (1925)
Copy-editing: W. Miles Cox (Chapter 1, 5, 8)
Michelle L. Miller (Chapter 3, 4)
Lay out: Matthijs Blankers
Printed by: GVO drukkers & vormgevers B.V. | Ponsen & Looijen
ISBN: 978-90-6464-510-5
Please cite as: Blankers, M. (2011). E-Mental Health Interventions for
Harmful Alcohol Use: Research Methods and Outcomes (Doctoral Dissertation).
Amsterdam: University of Amsterdam.
Most of the studies presented in this dissertation were supported by
grant #31160006 from the ZonMw Addiction II Program (Risk Behaviour and
Dependency). The randomized trial presented in this dissertation is registered in
the Netherlands Trial Register and is traceable as NTR-TC1155. Arkin supported
and facilitated the presented research studies. None of the funders had any
role in the design of the studies, selection of the measurement instruments, or
preparation of the publications or the chapters of the dissertation.
Financial support for the printing of this dissertation was kindly provided by
AMC Graduate School, Arkin, and ZonMw.
111001MBlankers-PhD-Thesis.pdf 2 1-10-2011 21:25:47
E-Mental Health Interventions
for Harmful Alcohol Use
Research Methods and Outcomes
ACADEMISCH PROEFSCHRIFT
ter verkrijging van de graad van doctor
aan de Universiteit van Amsterdam
op gezag van de Rector Magnificus
prof. dr. D. C. van den Boom
ten overstaan van een door het college voor promoties
ingestelde commissie,
in het openbaar te verdedigen in de Agnietenkapel
op woensdag 23 november 2011, te 10:00 uur
door
Matthijs Blankers
geboren te Amsterdam
111001MBlankers-PhD-Thesis.pdf 3 1-10-2011 21:25:47
Promotiecommissie:
Promotor: prof. dr. G. M. Schippers
Copromotores: dr. M. W. J. Koeter
dr. U. W. Nabitz
Overige leden: prof. dr. W. van den Brink
prof. dr. J. Dekker
prof. dr. R. J. de Haan
prof. dr. A. H. Schene
prof. dr. M. J. Sorbi
dr. M. M. Riper
Faculteit der Geneeskunde
111001MBlankers-PhD-Thesis.pdf 4 1-10-2011 21:25:47
Contents
Chapter 1 7
General Introduction
Internet-Based Self-Help for Harmful Alcohol Use: First
Chapter 2 27
Experiences
Evaluating Internet Therapy and Internet Self-Help
Chapter 3 for Harmful Alcohol Use: Protocol of a Randomized 41
Controlled Trial
Missing Data Approaches in E-Health Research:
Chapter 4 Simulation Study for Non-Mathematically Inclined 63
Researchers
Internet Therapy versus Internet Self-Help versus No
Chapter 5 Treatment for Harmful Alcohol Use: A Randomized 87
Controlled Trial
Economic Evaluation of Internet-Based Interventions
Chapter 6 for Harmful Alcohol Use alongside a Pragmatic 117
Randomized Trial
Baseline Predictors of Treatment Outcome in
Chapter 7 Internet-Based Alcohol Interventions: A Recursive 139
Partitioning Classification Tree Analysis
Chapter 8 Summary and General Discussion 159
Appendix Summary in Dutch 185
203
Acknowledgements
207
List of Publications
211
About the Author
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Chapter 1
General Introduction
111001MBlankers-PhD-Thesis.pdf 7 1-10-2011 21:25:47
8
Background
Alcohol
Ethanol, commonly called alcohol, is the main psychoactive ingredient in
(cid:374)
(cid:381)
(cid:415) alcoholic beverages (beers, wines, and spirits). It is a depressant of the central
(cid:272)
(cid:437) nervous system. Initially at lower doses, alcohol generally produces feelings
(cid:282)
(cid:381)
(cid:396) of relaxation and cheerfulness; consumption of higher doses can lead to
(cid:410)
(cid:374)
(cid:258)(cid:367)(cid:3)(cid:47) blurred vision and coordination problems (Pohorecky & Brick, 1988). Alcohol is
(cid:396)
(cid:286) consumed and produced in most countries of the world, and its consumption
(cid:374)
(cid:286)
(cid:39) often reflects both cultural and religious peculiarities and geographical and
sociological conditions (Hanson, 1995).
The discovery that beer jugs existed in late Stone Age confirms that
fermented beverages existed at least as early as 10,000 B.C. (Patrick, 1952). It
has been suggested that beer may have preceded bread as a staple in people’s
diet (Braidwood, Sauer, Helbaek, et al., 1953; Katz & Voigt, 1987). Wine appeared
as a manufactured product in Egyptian pictographs around 4,000 B.C. (Lucia,
1963). Surviving records of ancient Greek and Roman culture reveal the copious
use of wine by the gods, as well as by people of all social classes. The worship
of Dionysus, or Bacchus, the wine god, and his festival, the Bacchanalia, was
most popular. The Greco-Roman classics often provide descriptions of drinking
and drunkenness. On the other hand, the literature of the Greeks is replete
with warnings against the possible negative effects of excessive drinking
(Encyclopaedia Britannica, 2011). With the collapse of the Roman Empire and
decline of urban life, religious institutions became the repositories of brewing
and winemaking that had been earlier developed (Babor, 1986). The Black Death
and subsequent plagues, which began in the mid-fourteenth century, changed
people’s perception of autonomy over their lives. Some dramatically increased
their consumption of alcohol in the belief that this might protect them from
illnesses, whereas others thought that they would stay healthy through
moderate consumption (Hanson, 1995). All in all, alcohol consumption has been
part of European culture and other civilizations since ancient times.
Until the beginning of the nineteenth century, attitudes towards drinking
were characterized by a continued recognition of the positive effects of
moderate consumption, without much public concern about the negative
effects. The nineteenth century, however, brought a change in attitudes as a
result of industrialization and the need for a reliable and punctual workforce
(Porter, 1990). Problems commonly associated with industrialization and rapid
urbanization were now also attributed to alcohol. Abolitionist groups arose and
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