“Marsch & Borodovsky (2016). Technology-based interventions for preventing and treating substance use among youth.” – Article summary

Technology-based interventions are effective for preventing and treating substance use disorders. It is particularly suited for youth. They are relevant at any stage in the development of a substance-use disorder and they provide solutions to existing problems of traditional interventions.

Youth who use substances are at risk for sexually transmitted diseases (1), impaired cognitive functioning (2), major depressive episodes (3), poor educational attainment (4), involvement in the criminal justice system (5) and having a substance use disorder later in life (6).

Intervention strategies to prevent the development of a substance use disorder include universal prevention (1), selective prevention (2) and treatment (3). The goal of universal prevention is to prevent substance use initiation. Selective prevention involves identifying high-risk youth and intervening to stop problematic substance using behaviours that may escalate into a disorder. The goal of treatment is to intervene with individuals who meet the criteria for a disorder.

Problems with current treatments are that they are expensive (1), rarely tailored to adolescents (2) and are difficult to consistently access for patients (3). Technology-based treatment helps with these problems.

Technology-based universal intervention targets youth between 10 and 18 years old and consist of interactive, digital activities designed to increase drug-related knowledge and alter attitudes and normative beliefs around substance use. This is typically provided in three settings:

1. Primary care setting
   In a primary care setting, the computer-delivered brief intervention appeared to result in a lower cumulative proportion of cannabis use initiation compared to people who only read an educational brochure.
2. School setting
   
   1. CLIMATE
      This intervention provides six lessons based on social influence research. This provides the adolescents with information about the prevalence and consequences of substance use and ways to avoid substance use. After this, roleplaying, group discussion and other activities take place. It is more effective than standard health class curricula.
   2. HeadOn
      This intervention is designed for youth between grades 6 and 8. It consists of interactive, simulated scenarios that require youth to engage in substance-related decision making. They can master 10 topics and receive a skill card for each topic, which they can use in a card game. This makes it very interactive. The treatment appears to be effective and is reported to be fun and interesting.
3. Home setting
   In a home setting, youth can engage with the intervention and their parents at the same time. These interventions offer parents the opportunity to reinforce new behaviours and beliefs to foster healthy relationships. It helps youth develop better self-efficacy and less substance use.

Technology-based selective prevention identify at-risk adolescents across a range of treatment settings and patient populations. It makes use of screening, brief intervention and referral to treatment. This is typically provided in two settings:

1. Medical setting
   1. Primary care
      In a primary care setting, patients typically fill in a questionnaire about their substance use. This is done to calculate a risk score and provide the physician with tailored points to talk about. This typically results in better outcomes.
   2. Emergency room
      In an emergency room setting, people typically receive a screening which then opens the possibility for counselling. It improves perceptions concerning the importance of cutting down on substance use and the likelihood that they will actually do that.
2. University setting
   This consists of providing counselling after a substance-use related incident and preventative interventions to a large group of students. These interventions make use of a mix of skill development, education, motivational techniques and personalized normative feedback.

Personalized normative feedback changes student perceptions of norms and their alcohol use by providing corrective information about normative drinking among peers. It allows people to compare their drinking behaviour with peers.

Treatment tends to reduce substance use, although these effects disappear after three to six months. The adolescents who complete treatment struggle to maintain sobriety on their own. This means that post-treatment therapeutic support is crucial. Technology-based treatment is cost-effective. This can provide effective post-treatment support. There are several technology-based treatments:

1. Therapeutic Education System (TES)
   This is a web-based intervention designed to help individuals with substance use disorder develop skills emphasized in cognitive-behavioural therapy and relapse prevention training.
2. Step Up
   This is a web-based intervention of 21 modules completed over 12 sessions. It is designed to help participants develop assertiveness and communication skills. The participants complete the modules at their own pace and receive content tailored to their responses.
3. Identifying Therapeutic Opportunities: Ecological Momentary Assessment
   This involves repeated sampling of current behaviours and experiences in real time in the participants’ natural environment. The data leads to an accurate profile of the temporal relationship between behaviours and outcomes. This method allows to identify where, when and why youth are most vulnerable. It can inform functional analysis (i.e. identifying triggers) and it can address post-treatment relapse rates.
4. Educating and Supporting Inquisitive Youth in Recovery
   This helps youth maintain sobriety after treatment. The intervention consists of sending text messages, based on focus group data from youth in substance use treatment programmes. People receive two daily text messages and social resource information on weekends. The text message is tailored to the severity of the problems experienced by the individual at that time.
5. Momentary Self-Monitoring and Feedback Motivational Enhancement
   This intervention consists of first meeting with a counsellor to discuss triggers and then the youth report their triggers, cravings and actual substance use using their mobile phone. The participants then receive text messages to help them cope with the identified triggers.

Technology allows interventions to be tailored to different sub-groups (1), adapt content in real time (2), facilitate rapid dissemination to large groups (3), anytime/anywhere access to evidence-based therapeutic support (4) and respond quickly and effectively to provide a scalable response (5).