title: A Web-Based Self-Help Intervention With and Without Chat Counseling to Reduce Cannabis Use in Problematic Cannabis Users: Three-Arm Randomized Controlled Trial.
abstract: BACKGROUND
  After alcohol and tobacco, cannabis is the most widely used psychoactive substance in many countries worldwide. Although approximately one in ten users develops serious problems of dependency, only a minority attend outpatient addiction counseling centers. A Web-based intervention could potentially reach those users who hesitate to approach such treatment centers.
  
  
  OBJECTIVE
  To test the efficacy of a Web-based self-help intervention with and without chat counseling-Can Reduce-in reducing the cannabis use of problematic cannabis users as an alternative to outpatient treatment services.
  
  
  METHODS
  Altogether, 436 participants were recruited by various online and offline media for the Web-based trial. A total of 308 of these were eligible for study participation and were randomly allocated in an unblinded manner to either self-help with chat (n=114), self-help without chat (n=101), or a waiting list control group (n=93). The fully automated self-help intervention consisted of eight modules designed to reduce cannabis use, and was based on the principles of motivational interviewing, self-control practices, and methods of cognitive behavioral therapy. Additional individual chat counseling sessions were based on the same therapeutic principles. The sessions were conducted by trained counselors and addressed participants' personal problems. The main outcomes were the frequency (number of days) and quantity of cannabis use (number of standardized joints) per week, as entered into the consumption diary at baseline and at the 3-month follow-up. Secondary outcomes included self-reported symptoms of cannabis use disorder, severity of cannabis dependence, risky alcohol use, and mental health symptoms. Intervention participation and retention were extracted from the user progress data and the consumption diary, respectively.
  
  
  RESULTS
  Can Reduce participants were older (U=2.296, P=.02) and reported a greater number of cannabis use days at baseline than patients who entered outpatient treatment with cannabis as their main problem substance (data from the Swiss treatment demand monitoring statistics were used; chi-square [df 2]=4.0, P=.046). Participants in the self-help with chat study arm completed a mean of 3.2 modules and 27 out of 114 (23.7%) of the participants received at least one chat session. Participants in the self-help without chat study arm completed similar numbers of self-help modules. A total of 117 of 308 participants (38.0%) completed the 3-month follow-up assessment. The change in the mean number of cannabis use days per week at 3 months differed between self-help without chat (mean change 0.7, SD -0.2) and self-help with chat (mean change 1.4, SD -0.5; beta=-0.75, SE=0.32, t=-2.39, P=.02, d=0.34, 95% CI 0.07-0.61), as well as between self-help with chat and waiting list (mean change 1.0, SD -0.8; beta=0.70, SE=0.32, t=2.16, P=.03, d=0.20, 95% CI -0.07 to 0.47). However, there were no differences between self-help without chat and waiting list (beta=-0.05, SE=0.33, t=-0.16, P=.87, d=-0.14, 95% CI -0.43 to 0.14). Self-reported abstinence was significantly different in the self-help without chat study arm (2.0%) than in the self-help with chat study arm (8.8%; beta=-1.56, SE=0.79, P=.05, odds ratio [OR]=0.21, 95% CI 0.02-2.33). There were no significant differences between the study arms with respect to the secondary outcomes.
  
  
  CONCLUSIONS
  Web-based self-help interventions supplemented by brief chat counseling are an effective alternative to face-to-face treatment and can reach a group of cannabis users who differ in their use and sociodemographic characteristics from those who enter outpatient addiction treatment.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trial Number (ISRCTN): 59948178; http://www.isrctn.com/ISRCTN59948178 (Archived by WebCite at http://www.webcitation.org/6bt01gfIr).
authors.affiliation: Swiss Research Institute for Public Health and Addiction (ISGF), associated to the University of Zurich and World Health Organization Collaborating Center, Zurich, Switzerland. michael.schaub@isgf.uzh.ch.
authors.forename: Michael P
authors.identifier: http://orcid.org/0000-0002-8375-4005
authors.initials: MP
authors.lastname: Schaub
authors.forename: Andreas
authors.identifier: http://orcid.org/0000-0003-4818-4681
authors.initials: A
authors.lastname: Wenger
authors.forename: Oliver
authors.identifier: http://orcid.org/0000-0002-4511-0567
authors.initials: O
authors.lastname: Berg
authors.forename: Thilo
authors.identifier: http://orcid.org/0000-0001-8542-0554
authors.initials: T
authors.lastname: Beck
authors.forename: Lars
authors.identifier: http://orcid.org/0000-0002-4329-2993
authors.initials: L
authors.lastname: Stark
authors.forename: Eveline
authors.identifier: http://orcid.org/0000-0003-0178-7880
authors.initials: E
authors.lastname: Buehler
authors.forename: Severin
authors.identifier: http://orcid.org/0000-0002-6539-5045
authors.initials: S
authors.lastname: Haug
mesh_terms: D016739:Behavior, Addictive; D003376:Counseling; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D002189:Marijuana Abuse / Q000628:therapy*; D008385:Marijuana Smoking / Q000523:psychology*; D057566:Self Report; D016896:Treatment Outcome
keywords: Internet; Web based; behavioral self-management; cannabis; chat; cognitive behavioral therapy; counseling; motivational interviewing; self-control; self-help