Patrick L. Dulin

Results of a Pilot Test of a Self-Administered Smartphone-Based Treatment System for Alcohol Use Disorders: Usability and Early Outcomes

BACKGROUND This paper provides results from a pilot study focused on assessing early-stage effectiveness and usability of a smartphone-based intervention system that provides a stand-alone, self-administered intervention option, the Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A). The LBMI-A provided numerous features for intervening with ongoing drinking, craving, connection with supportive others, managing life problems, high-risk location alerting, and activity scheduling. METHODS Twenty-eight participants, ranging in age from 22 to 45, who met criteria for an alcohol use disorder used an LBMI-A-enabled smartphone for 6 weeks. RESULTS Participants indicated the LBMI-A intervention modules were helpful in highlighting alcohol use patterns. Tools related to managing alcohol craving, monitoring consumption, and identifying triggers to drink were rated by participants as particularly helpful. Participants also demonstrated significant reductions in hazardous alcohol use while using the system (56% of days spent hazardously drinking at baseline vs. 25% while using the LBMI-A) and drinks per day diminished by 52%. CONCLUSIONS Implications for system improvement as well as suggestions for designing ecological momentary assessment and intervention systems for substance use disorders are discussed.

Avoidance of potentially traumatic stimuli mediates the relationship between accumulated lifetime trauma and late‐life depression and anxiety

This study examined the influence of lifetime accumulated trauma on late-life mental health in a sample of 1,216 older adults, 65-94 years old, residing in New Zealand. Multiple regression analyses indicated that accumulated trauma predicted both depression and anxiety in this sample. The hypothesis that avoidance of memories and situations surrounding prior trauma mediates relationships between cumulative trauma and depression and anxiety was supported. Avoidance of prior traumatic memories and situations explained 49% of the variance between accumulated trauma and depression and 46% of the variance between accumulated trauma and anxiety. Results also suggest that traumatic experiences during young adulthood and middle age are stronger predictors of anxiety and depression among older adults than trauma experienced in childhood and adolescence.

Comparison of a smartphone app for alcohol use disorders with an Internet-based intervention plus bibliotherapy: A pilot study.

OBJECTIVE To date, no research has evaluated the efficacy of a stand-alone, smartphone-based intervention for individuals with an alcohol use disorder. The current pilot study evaluated the short-term outcomes of a smartphone-based intervention for alcohol use disorders compared with an Internet-based brief motivational intervention plus bibliotherapy. METHOD Adults (18 to 45 years old) with an alcohol use disorder received either the Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A; n = 28), a smartphone-based intervention, or the online Drinkers Check-up plus bibliotherapy (DCU + bib; n = 26). These groups were compared using the Timeline Followback interview for percent days abstinent (PDA), percent heavy drinking days (PHDD), and drinks per week (DPW) from baseline to 6 weeks after the introduction of the interventions. RESULTS Multilevel models revealed that the LBMI-A resulted in a significant increase in PDA over the course of the study, whereas the DCU + bib did not. Effect sizes for change from baseline for PDA suggest that the DCU + bib resulted in moderate a decrease, whereas the LBMI-A resulted in a large increase in PDA. Both interventions resulted in significant decreases in PHDD and DPW. The LBMI-A produced larger reductions in the first 3 to 4 weeks after the intervention was introduced than the DCU + bib. On weeks with greater LBMI-A usage, participants reported less DPW and PHDD. CONCLUSIONS Both interventions resulted in significant decreases in alcohol use over the 6-week trial, which is promising for stand-alone technology-based intervention systems aimed at individuals with an alcohol use disorder. (PsycINFO Database Record

Volunteering predicts happiness among older Māori and non-Māori in the New Zealand health, work, and retirement longitudinal study

Objectives: This study sought to understand the relationship between volunteer activity and happiness among a sample of older adult New Zealanders. It specifically sought to determine if ethnicity (Māori vs. non-Māori) and economic living standards (ELS) functioned as moderators of the relationship between volunteering and happiness. Method: Data were garnered from the 2008 administration of the New Zealand Health, Work, and Retirement Longitudinal Study. Correlational and multiple regression procedures were employed to examine study hypotheses. Results: Results from multiple regression analyses showed that the amount of volunteering per week was a unique predictor of the overall level of happiness. Moderation analyses indicated that ethnicity did not function as a moderator of the relationship between volunteering and happiness, but ELS did. Those with low ELS evidenced a stronger relationship between volunteering and happiness than those with high ELS. Results also indicated that Māori and those with low ELS volunteered more frequently than non-Māori and those with high ELS. Conclusion: This study provides evidence that volunteering is related to increased happiness, irrespective of ethnicity. It also provides further evidence that the relationship between volunteering and happiness is moderated by economic resources. Older individuals at the low end of the economic spectrum are likely to benefit more from volunteering than those at the high end.

Development of a Smartphone-Based, Self-Administered Intervention System for Alcohol Use Disorders

Advances in mobile technology provide an opportunity to deliver in-the-moment interventions to individuals with alcohol use disorders, yet availability of effective “apps” that deliver evidence-based interventions is scarce. The authors developed an immediately available, portable, smartphone-based intervention system whose purpose is to provide stand-alone, self-administered assessment and intervention. In this article, the authors describe how theory and empirical evidence, combined with smartphone functionality, contributed to the construction of a user-friendly, engaging alcohol intervention. With translation in mind, the authors discuss how they selected appropriate intervention components including assessments, feedback and tools, that work together to produce the hypothesized outcomes.

Estimating older hazardous and binge drinking prevalence using AUDIT-C and AUDIT-3 thresholds specific to older adults

BACKGROUND This study aimed to provide hazardous and binge drinking prevalence, odds and risk attributable to specific demographic correlates in community dwelling older adults using both the standard and new older-specific AUDIT-C thresholds. METHODS Hazardous drinking was assessed using the AUDIT-C in a cross-sectional postal survey of 6662 New Zealanders aged 55-70 years old (m=60.94, SD=4.70) randomly selected from the New Zealand Electoral Roll. Prevalence data is presented for whole sample and stratified by key demographic correlates using standard and older-specific threshold scores on the AUDIT-C. Hazardous drinking prevalence using the standard AUDIT-C threshold was 56.01%, as compared to 42.28% and 50.20% under two older-specific thresholds. RESULTS Being younger, male, and wealthy were consistent drinking predictors across thresholds but the older-specific thresholds substantially altered the prevalence and risk for females, Asians, and poorer people. Past-month binge prevalence of 18.18% was considerably lower than the past-year prevalence of 33.51%, but change from past-month to past-year binge threshold had no significant effect on the demographic composition of binge drinkers. The standard AUDIT-C threshold over-estimates hazardous drinking prevalence in older adults by up to 33%, but even the most conservative rates in this study are cause for concern regarding the level of drinking by older people in New Zealand. CONCLUSION Older hazardous drinkers are predominantly younger, wealthier, white, partnered males, whichever threshold is used, but binge drinkers are more likely to be rural, Māori, and lack tertiary education. Further efforts are needed to determine factors underpinning hazardous drinking, especially in older Māori.

The impact of socio-contextual, physical and lifestyle variables on measures of physical and psychological wellbeing among Māori and non-Māori: the New Zealand Health, Work and Retirement Study

ABSTRACT This article provides an overview of the New Zealand Health, Work and Retirement Study (HWR), the focus of which is on determinants of cultural-contextual factors on physical and mental health among 6,662 New Zealand citizens, a nationally representative sample of adults between 55 and 70 years of age. The HWR was initiated in 2006 with two-year re-assessment intervals. The health and wellbeing of older Māori was a study priority as previous research has shown large health disparities between Māori and non-Māori in New Zealand. Persons of Māori origin were over-sampled to ensure adequate information for subsequent analyses. First-wave results indicated that socioeconomic status, social support and retirement status were associated with optimal ageing among older adults in New Zealand. Māori scored lower on markers of physical and mental health, which was partially explained by restrictive factors including reduced economic living standards and a propensity towards less physical activity. After controlling for multiple socio-contextual and biological variables, ethnicity continued to predict health, suggesting that there are other markers of health and wellbeing in ageing among Māori. Structural variables which restrict access to health care and predispose Māori to engage in maladaptive lifestyle behaviours combined with the distal effects of colonisation may contribute to the health disparities found between Māori and the majority population in New Zealand.

Perceived control as a longitudinal moderator of late-life stressors on depressive symptoms.

Objectives: This study examined perceived control as a moderator of the relationship between late-life stressors and depressive symptoms among a sample of older New Zealanders. Method: Data were drawn from a longitudinal study with two data collection periods, one year apart. The Time 1 sample consisted of 1489 participants ranging in age from 65 to 94 years and 72% percent participated at Time 2. Correlational and multiple regression procedures were used to examine study hypotheses. Results: Results showed that Time 1 perceived control beliefs were a unique predictor of depressive symptoms at Time 2 after controlling for Time 1 depressives symptoms and other relevant variables. Further, perceived control beliefs at Time 1 moderated the relationship between late-life stressors and depressive symptoms at Time 2. Those with low perceived control demonstrated a stronger relationship between late-life stressors and depressive symptoms than those with high perceived control. Conclusion: This study provides evidence that perceived control influences levels of depressive symptoms over time among older adults. Results also support the hypothesis that control beliefs moderate the relationship between late-life stressors and depressive symptoms among older adults. Implications include attributional retraining to promote perceived control and subsequent well-being in older adults.

Comparisons of alcohol consumption by timeline follow back vs.smartphone-based daily interviews

Abstract This study compared alcohol consumption data collected through daily interviews on a smartphone with data collected via the timeline follow back (TLFB) during a 6-week pilot study of a smartphone-based alcohol intervention system. The focus of the study was to assess for discrepancies between the two measurement methodologies on commonly utilized alcohol outcome variables. Twenty-five participants, aged between 22 and 45 years and were drinking heavily at study incipience, completed a 6-week alcohol intervention delivered by a smartphone application that monitored drinking through a daily interview. Participants also completed a TLFB of their alcohol consumption during the intervention period. Difference scores were calculated by subtracting the average weekly outcome variables derived from the smartphone daily interview from the average weekly outcome variables derived from the TLFB which yielded six discrepancy scores for each of the 25 participants and resulted in 150 observations. Hierarchical linear modeling indicated that the TLFB and smartphone daily interview methods did not produce significant discrepancies over the 6-week interval when examining percent of heavy drinking days and percent of days abstinent. However, discrepancies on drinks per drinking day increased substantially over time, suggesting that it is susceptible to recall bias when assessed by the TLFB. Results also indicated that participants under-reported their drinking on the TLFB compared to the daily smartphone-based assessment. Results indicate that outside of assessing for extreme drinking (binge or no drinking), the TLFB should be used cautiously and that smartphone apps represent a promising method for accurately assessing alcohol consumption over time.

“Giving It Space”: A Case Study Examining Acceptance and Commitment Therapy for Health Anxiety in an Older Male Previously Exposed to Nuclear Testing

Most psychotherapeutic approaches have been developed for problems that have an “irrational” or “pathological” foundation. These approaches often fit poorly with psychological distress that stems from cognitions that are based in reality and may need to be accepted rather than changed. Acceptance and Commitment Therapy (ACT) is currently being applied to a number of conditions, but may be particularly useful in situations where cognitive change is not warranted. This study examined ACT with an older male of Māori descent experiencing high levels of health anxiety resulting from prior nuclear testing exposure while in the military. Results of self-report measures administered at baseline, during treatment, post-treatment, and at 6-week follow-up indicated clinically significant reductions in health anxiety, experiential avoidance, and overall distress. This case study has implications for the utility of ACT with individuals who are distressed about the real possibility that their health has been negatively affected by toxic exposure.