Abstract:

1
Evaluation of Internet as Treatment Support for
Methamphetamine Users A Prospective
Case-Study Gopika Chandra, MD, PhD, MPH, Edward
Mensah, PhD, Thomas M. Lyons, PhD, and Jacek L.
Ubaka, MD, MPH
Results
Abstract
Results
Conceptual Model

• The Transtheoretical Model of Behavioral Change
  is an integrative theoretical model of behavioral
  change highlighting that positive behavior change
  occurs over time. This model suggests five stages
  of change when modifying behavior
  precontemplation, contemplation, preparation,
  action, and maintenance.
• Each SOCRATES construct approximately corresponds
  to different stages of change as described by
  TTM. Every individual is measured in terms 3
  SOCRATES constructs recognition, ambivalence,
  and taking steps.
• Each SOCRATES construct is rated from very high,
  high, medium to very low and low scores.
• The Recognition construct approximately
  corresponds to the precontemplation stage of TTM.
  The Ambivalence construct approximately
  corresponds to the contemplation stage of TTM.
  The Taking steps construct approximately
  correspond to the action, preparation, and
  maintenance stages.

Study Objective The primary objective is to
determine the demographic characteristics of
individuals visiting www.kci.org, their MA use
pattern, current stage of recovery, Internet use
pattern and their mode of social support seeking
preference. Method Two online surveys were
implemented on an anti-methamphetamine website,
www.kci.org MA user and MA nonuser surveys,
respectively. MA users were defined as persons
currently using the drug, in recovery or
experiencing relapse. A MA nonuser questionnaire
was completed by any individual visiting
www.kci.org and meeting inclusion criteria, who
self-identified as a family member and/or a
friend of MA user. Survey administration
commenced in November 2008 and concluded in March
2009. The descriptive statistics, all
calculations, and statistical testing for
significant association were performed with SPSS
version 16.0. A qualitative analysis of comments
section of the survey, discussion board and the
chat room was conducted to explore issues
commonly discussed on www.kci.org Results A
total of 449 individuals completed the study
consisting of 245 MA users and 204 MA nonusers.
Overall, mean age of MA user was 37.4 years,
66.5 were females, and 85.1 were Caucasian.
White MA users were predominant globally. The
male to female ratio is 12 indicating a higher
predominance of female MA users compared with
male MA users in this study population. Almost
60 of MA users were full-time or part-time
employed. MA users reported varied MA use ranging
from 1 day to 1 year ago. Smoking was reported to
be the most common route of MA administration
(92) followed by snorting (85). Study
participants existed in different stages of
recovery. A total of 85 MA users agreed that
Internet provides help during recovery from MA
use. Message board was reported to be the most
helpful online tool for social support during
recovery (MA users, 55 versus MA nonusers, 63,
respectively). For attaining social support to
resolve any life problems including 79 MA users
reported to be very comfortable on www.kci.org
followed by 68 reporting preference for spouse,
partner or significant other, 63 for friend and
lastly, 37 for a relative. Conclusion Our
qualitative and quantitative findings suggest
that social support meetings are effective for
sustained recovery and online support is an
effective treatment support technology for MA
users. It is plausible that online social support
will fill the gap when professional help is
inaccessible and a social support meeting is
unavailable.
Internet use characteristics, n(valid ) MA abusers MA nonusers P-Value
Website most time spent www.kci.org 127 (69.8) www.kci.org 109 (85.8) P lt 0.05
Visiting www.kci.org lt5 times/week to seek help 155(75) 32 (20) P lt 0.05
Visiting other recovery websites 80 (38) 66 (43) P gt0.05
Time spent (lt 1 hour) on other drug recovery website/day 133 (66) 91 (64) P gt0.05
HOME as place of Internet access at most times 174 (86) 127 (89) P gt0.05
Medical information as most frequent type of information obtained on the Internet 126 (66) 100 (73) P gt0.05
Individuals agreeing that Internet provides help during recovery from MA abuse 167 (85) NA
Online tools that help for drug abuse recovery or social support Message boards Chat rooms/E-support rooms Online-blogs Email 100 (55) 56 (23) 39 (22) 21 (12) 85 (63) 33 (25) 13 (10) 47 (35) P lt 0.05 P gt0.05 P gt0.05 P gt0.05
Most important online tool during drug abuse recovery Discussion Forum (message board) Chat-room Stories and letter section 44(24) 28(15) 28(15) NA
Individuals agreeing that Internet facilitates drug use 85 (43) 31 (23) P lt 0.05

• Mean age of study population, 39 years. Male to
  female ratio is 12. A total of 50 reported 1st
  time MA abuse gt10 years ago and 55 considered
  themselves in recovery. Smoking (92) reported as
  most common route of MA followed by snorting
  (85). 53 MA abusers attended support group
  meetings for MA abuse.
• MA abusers received social support from family
  and friends for different life situations. 72.5
  of MA abusers felt that family and friends
  assisted recovery, 54 found Internet, 41 felt
  support group meetings, and 30 found inpatient
  and outpatient treatment. Most MA nonusers
  received social support from www.kci.org for
  different life situations.
• MA abusers that received medical treatment and
  currently attend social support meetings tend to
  have undergone successful behavioral change
  towards recovery ( i.e. have higher taking steps
  scores) compared with MA abusers who did not
  receive medical treatment and did not attend
  meetings.
• MA abusers attending social support meetings at
  least 1-2 times per month or once every week tend
  to have undergone successful behavioral change
  towards recovery ( i.e. have higher taking steps
  scores) compared with MA abusers attending
  meetings every several months.
• MA abusers frequently visiting www.kci.org (gt5
  times a week ) tend to have undergone successful
  behavioral change towards recovery ( i.e. have
  higher taking steps scores). MA abusers were more
  comfortable discussing personal problems during
  online discussions compared with face to face
  communication.
• Place of Internet access at most times did not
  affect individuals recovery status.
• The optimal time spent on drug recovery websites
  for successful behavioral change towards recovery
  was 1-2 hours/day.
• Predictors for recognition construct Longer
  duration of clean time from MA abuse 6 months
  (OR, 0.16 P0.001) Attendance of social support
  meetings (OR, 0.28 P0.002) Educational level
  higher than high school degree (OR, 0.43
  P0.05) use of Internet for online purchases of
  items other than drugs or sex partners (OR, 2.71
  P0.03). Predictors for Ambivalence construct
  Longer duration of clean time from MA abuse 6
  months (OR, 0.45 P0.05). Predictors for taking
  steps construct Length of recovery 6 months
  (OR, 0.01 Plt0.05).
• A geo-mapping conducted by Survey Gizmo that
  mapped MA users on the world map using
  geo-tracking by Internet Protocol (IP) addresses
  showed predominance of MA use in North America

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Introduction

• The Internet has begun to provide community for
  persons suffering from many conditions.
• Role of free online community for social support
  on an anti-methamphetamine (MA) website,
  analogous in some ways to, but in other ways very
  different from, live mutual support groups.
• The purpose of this study is
• To determine demographic characteristics of
  individuals visiting www.kci.org, their current
  stage of recovery, Internet use pattern, and
  social support preference.
• Identify specific features (discussion board,
  chat room, informational links and web pages) of
  the website that participants found were useful
  for support.
• Provide guidelines to improve web design of
  existing anti-MA websites so as to improve online
  support.

Figure 1 Transition from General
Transtheoretical Model of Change (TTM) to Stages
of Change Readiness and Treatment Eagerness Scale
Index (SOCRATES)
Research Methodology
Conclusions

• Inclusion criteria Age 18 years any past or
  current MA use identified as friend/family of MA
  abuser or seeking information regarding MA.
• A total of 449 participants (245 MA abusers and
  204 MA nonusers ) voluntarily completed anonymous
  online survey on an anti-MA website, www.kci.org.
  
• Information about www.kci.org is passed on by
  word of mouth amongst MA abusers as a source of
  support during attendance at 12-step meetings and
  healthcare settings.
• This website can be accessed by using search
  engines by entering search term
  methamphetamine. Web-links were created on the
  home page, message board page, and chat-room page
  on www.kci.org.

• Social support meetings are effective for
  sustained recovery and online support is an
  effective treatment support for MA abusers. It is
  plausible that online social support will fill
  the gap when professional help is inaccessible
  and a social support meeting is unavailable.
• Discussion boards are most effective online tools
  during recovery and must be offered via anti- MA
  websites in addition to the traditional treatment
  for MA abuse and social support meetings.
  Restructuring of current anti-MA websites to
  facilitate better access to treatment facilities,
  including social support meetings and development
  of standardized online support for MA abuse is
  needed.
• Study Limitations Potential problems associated
  with online data collection confidentiality,
  privacy issues, questions asked may be stressful
  difficulty measuring stages of change among MA
  abusers with poly-drug use unknown predictive
  utility of SOCRATES index in different settings
  and diverse populations no biochemical
  verification of being drug free varied literacy
  level and limited accessibility to the Internet
  amongst MA abusers lack of generalizability
  loss of non-verbal cues leading to
  miscommunication during online communication.