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

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

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

Allgemeine Informationen

Development › “quit the shit” was developed on behalf of the Federal Centre of Health Education (FCHE / BZgA) › Start: August 2004 › Embedded in “ Usage of “quit the shit” › Until 15 June 2012, 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 Bundeszentrale für gesundheitliche Aufklärung

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” 1.1. Basic facts

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 -Address › Appointment for the Admission-Chat Admission- Chat 2 Programme- Participation 3 Concluding Chat 4 Registration Structure & content of the programme Registration 1

2. 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 1.2. Structure & content of the programme Programme- Participation 3 Concluding Chat 4 Registration 1 Admission- Chat 2

3. 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 Structure & content of the programme Admission- Chat 2 Concluding Chat 4 Registration 1 Programme- Participation 3

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

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? 1.2. Structure & content of the programme Admission- Chat 2 Programme- Participation 3 Registration 1 Concluding Chat 4

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

Structure of the survey Registration- questionnaire Socio-demographics Cannabis consumption (quantity, freq.) Psychological well-being etc. Delay-conditionParticipation at QTS 3 Months Follow-up Cannabis consumption (quantity, freq.) Psychological well-being etc Study design: Randomised Control Trial (RCT)

Inclusion criteria fulfilled (n=1.292) Participation at QTS (Intervention Group) (n=863) Waiting Condition (Control Group) (n=429) Follow-up-data (n=150) Analysed Data (n=100) Analysed Data (n=106) Follow-up-data (n=144) Inclusion Programm (n=360) Randomisation exclusion: n=44 professional help: n=44 response: 35% response: 39% 2.2. Results: Participants

Study population: N=206 participants 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) 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) 2.2. Results: Participants

T(187,02)=6,593; p<.001; d = Results: Days of consumption / past 30 days Abstinence (Follow-up) IG: 32,6% CG:5,4%  Odds Ratio: 8,5 (p<.001)

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

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

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

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

“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 4. Summary

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