Peter Tossmann

Multidimensional family therapy lowers the rate of cannabis dependence in adolescents: A randomised controlled trial in Western European outpatient settings

BACKGROUND Noticing a lack of evidence-based programmes for treating adolescents heavily using cannabis in Europe, government representatives from Belgium, France, Germany, The Netherlands, and Switzerland decided to have U.S.-developed multidimensional family therapy (MDFT) tested in their countries in a trans-national trial, called the International Need for Cannabis Treatment (INCANT) study. METHODS INCANT was a 2 (treatment condition)×5 (time) repeated measures intent-to-treat randomised effectiveness trial comparing MDFT to Individual Psychotherapy (IP). Data were gathered at baseline and 3, 6, 9 and 12 months thereafter. Study participants were recruited at outpatient secondary level addiction, youth, and forensic care clinics in Brussels, Berlin, Paris, The Hague, and Geneva. Participants were adolescents from 13 through 18 years of age with a recent cannabis use disorder. 85% were boys; 40% were of foreign descent. One-third had been arrested for a criminal offence in the past 3 months. Three primary outcomes were assessed: (1) treatment retention, (2) prevalence of cannabis use disorder and (3) 90-day frequency of cannabis consumption. RESULTS Positive outcomes were found in both the MDFT and IP conditions. MDFT outperformed IP on the measures of treatment retention (p<0.001) and prevalence of cannabis dependence (p=0.015). MDFT reduced the number of cannabis consumption days more than IP in a subgroup of adolescents reporting more frequent cannabis use (p=0.002). CONCLUSIONS Cannabis use disorder was responsive to treatment. MDFT exceeded IP in decreasing the prevalence of cannabis dependence. MDFT is applicable in Western European outpatient settings, and may show moderately greater benefits than IP in youth with more severe substance use.

INCANT: A transnational randomized trial of Multidimensional Family Therapy versus treatment as usual for adolescents with cannabis use disorder

BackgroundIn 2003, the governments of Belgium, France, Germany, the Netherlands and Switzerland agreed that there was a need in Europe for a treatment programme for adolescents with cannabis use disorders and other behavioural problems. Based on an exhaustive literature review of evidence-based treatments and an international experts meeting, Multidimensional Family Therapy (MDFT) was selected for a pilot study first, which was successful, and then for a joint, transnational randomized controlled trial named INCANT (INternational CAnnabis Need for Treatment).Methods/designINCANT is a randomized controlled trial (RCT) with an open-label, parallel group design. This study compares MDFT with treatment as usual (TAU) at and across sites in Brussels, Berlin, Paris, The Hague and Geneva. Assessments are at baseline and at 3, 6, 9 and 12 months after randomization. A minimum of 450 cases in total is required; sites will recruit 60 cases each in Belgium and Switzerland, and a maximum of 120 each in France, Germany and the Netherlands.Eligible for INCANT are adolescents from 13 through 18 years of age with a cannabis use disorder (dependence or abuse), with at least one parent willing to take part in the treatment. Randomization is concealed to, and therefore beyond control by, the researcher/site requesting it. Randomization is stratified as to gender, age and level of cannabis consumption.Assessments focus on substance use; mental function; behavioural problems; and functioning regarding family, school, peers and leisure time.For outcome analyses, the study will use state of the art latent growth curve modelling techniques, including all randomized participants according to the intention-to-treat principle.INCANT has been approved by the appropriate ethical boards in Belgium, France, Germany, the Netherlands, Switzerland, and the University of Miami Miller School of Medicine. INCANT is funded by the (federal) Ministries of Health of Belgium, Germany, the Netherlands, Switzerland, and by MILDT: the Mission Interministerielle de Lutte Contra la Drogue et de Toximanie, France.DiscussionUntil recently, cannabis use disorders in adolescents were not viewed in Europe as requiring treatment, and the co-occurrence of such disorders with other mental and behavioural problems was underestimated. This has changed now.Initially, there was doubt that a RCT would be feasible in treatment sectors and countries with no experience in this type of study. INCANT has proven that such doubts are unjustified. Governments and treatment sites from the five participating countries agreed on a sound study protocol, and the INCANT trial is now underway as planned.Trial registrationISRCTN51014277

Bestimmung der konkurrenten Validität des CRAFFT-d Ein Screeninginstrument für problematischen Alkoholkonsum bei Jugendlichen

Fragestellung: Uberpruft wurde, wie gut der CRAFFT-d problematischen Alkoholkonsum bei Jugendlichen identifizieren kann. Methodik: Die Kriteriumsvaliditat des CRAFFT-d wurde anhand eines zweiten Tests erfasst. Parallel zum CRAFFT-d wurde der Alcohol Use Disorders Identification Test (AUDIT) verwendet. Es wurde uberpruft, in wie weit die erzielten Urteile ubereinstimmen. Die Instrumente wurden im Rahmen der Webseite www.drugcom.de («check your drinking») eingesetzt. Ergebnisse: Von den 12250 befragten Jugendlichen wiesen 54.2 % nach dem AUDIT und 63.6 % nach dem CRAFFT-d einen problematischen Alkoholkonsum auf. Die Testergebnisse zeigen eine hohe Ubereinstimmung (Phi φ = .57; χ² 3978.671**, df = 1, p > .001). Bei einem Cut-off-Wert von 2 Punkten erzielte der CRAFFT-d eine Sensitivitat von 88.8 % und eine Spezifitat von 66.2 %. Schlussfolgerung: Die Ergebnisse der Untersuchung legen nahe, dass der CRAFFT-d ein geeignetes Instrument zur Fruherkennung von problematischem Alkoholkonsum bei Jugendlichen sein ka...AIM The aim of this study was to determine the concurrent validity of the CRAFFT-d alcohol abuse screening test for adolescents. METHOD This criterion-related validity study compared the decisions of the CRAFFT-d with the decisions of the concurrently administered Alcohol Use Disorders Identification Test (AUDIT). Data was obtained from an online questionnaire including CRAFFT-d and AUDIT. RESULTS Of the 12250 participants, 54.2 % were found to have an alcohol use disorder due to the AUDIT. CRAFFT-d identifies 63.6 % with problematic alcohol consumption. The Phi-coefficient showed high agreement between AUDIT and CRAFFT-d classifications (Phi Phi = .57; chi(2) 3978.671**; df = 1, p > .001). At a score of 2 or higher, CRAFFT showed sensitivity of 88.8 % and specificity of 66.2 %. CONCLUSION The CRAFFT-d is a valid instrument for screening adolescents for problematic alcohol consumption. However, further comparison of CRAFFT items with diagnostic criteria for adolescents is needed.

Bestimmung der konkurrenten Validität des CRAFFT-d

Fragestellung: Uberpruft wurde, wie gut der CRAFFT-d problematischen Alkoholkonsum bei Jugendlichen identifizieren kann. Methodik: Die Kriteriumsvaliditat des CRAFFT-d wurde anhand eines zweiten Tests erfasst. Parallel zum CRAFFT-d wurde der Alcohol Use Disorders Identification Test (AUDIT) verwendet. Es wurde uberpruft, in wie weit die erzielten Urteile ubereinstimmen. Die Instrumente wurden im Rahmen der Webseite www.drugcom.de («check your drinking») eingesetzt. Ergebnisse: Von den 12250 befragten Jugendlichen wiesen 54.2 % nach dem AUDIT und 63.6 % nach dem CRAFFT-d einen problematischen Alkoholkonsum auf. Die Testergebnisse zeigen eine hohe Ubereinstimmung (Phi φ = .57; χ² 3978.671**, df = 1, p > .001). Bei einem Cut-off-Wert von 2 Punkten erzielte der CRAFFT-d eine Sensitivitat von 88.8 % und eine Spezifitat von 66.2 %. Schlussfolgerung: Die Ergebnisse der Untersuchung legen nahe, dass der CRAFFT-d ein geeignetes Instrument zur Fruherkennung von problematischem Alkoholkonsum bei Jugendlichen sein ka...AIM The aim of this study was to determine the concurrent validity of the CRAFFT-d alcohol abuse screening test for adolescents. METHOD This criterion-related validity study compared the decisions of the CRAFFT-d with the decisions of the concurrently administered Alcohol Use Disorders Identification Test (AUDIT). Data was obtained from an online questionnaire including CRAFFT-d and AUDIT. RESULTS Of the 12250 participants, 54.2 % were found to have an alcohol use disorder due to the AUDIT. CRAFFT-d identifies 63.6 % with problematic alcohol consumption. The Phi-coefficient showed high agreement between AUDIT and CRAFFT-d classifications (Phi Phi = .57; chi(2) 3978.671**; df = 1, p > .001). At a score of 2 or higher, CRAFFT showed sensitivity of 88.8 % and specificity of 66.2 %. CONCLUSION The CRAFFT-d is a valid instrument for screening adolescents for problematic alcohol consumption. However, further comparison of CRAFFT items with diagnostic criteria for adolescents is needed.

rauchfrei – Ein internetbasiertes Ausstiegsprogramm für junge Raucherinnen und Raucher

Background: Because of its increasing number of users, the internet gains more and more importance in prevention and health communications. In spring of 2005, the Federal Centre of Health Education in Germany (BZgA) has installed an internet-based smoking cessation programme for adolescents and young adults (www.rauchfrei.info/programm), which meanwhile has been used by more than 3.800 people. Aims: This contribution outlines the structure of the programme and briefly presents results of the evaluation of the programme. Therefore, its sections (1) information and motivation, (2) phase of preparation and (3) phase of action are described at first. Afterwards, its users are being described by demographic characteristics and by different variables relating to their nicotine-consumption before and after attending the programme. Furthermore, the extent of the utilization of the programme is presented. Finally, the possibilities of further development are discussed.

Efficacy of an internet-based intervention for burnout: a randomized controlled trial in the German working population

ABSTRACT Background and Objectives: Internet-based interventions are a viable treatment option for various mental problems. However, their effects on the burnout syndrome yielded mixed results. In this paper, we examine the efficacy of a structured and therapist-guided internet intervention, based on solution-focused and cognitive-behavioral therapy, for individuals with symptoms of burnout. Design: Two-arm, Internet-based, randomized, wait-list controlled trial (RCT). Methods: Participants were recruited through in-house events and online advertising. They were randomly assigned to the intervention or a wait-list. Group comparison was conducted three months after randomization. Outcomes were the burnout level according to the Maslach Burnout Inventory (MBI-GS) and the levels of depression, anxiety and stress according to the DASS-21. Results: Thirty-nine participants were included in the trial; 36 (92.3%) took part at the 3-months-follow-up. Intention-to-treat analyses revealed significant group differences in favor of the intervention group in depression (d = 0.66), cynicism (d = 0.87) and personal accomplishment (d = 0.75). Conclusions: The intervention helped ameliorate symptoms of work-related stress and burnout. Although limited by a small sample size, the study suggests that the program provides effective support for affected individuals. However, further studies with bigger sample sizes should be conducted to examine the effects of such programs more precisely.