title: Web-Based Cognitive Behavioral Relapse Prevention Program With Tailored Feedback for People With Methamphetamine and Other Drug Use Problems: Development and Usability Study.
abstract: BACKGROUND
  Although drug abuse has been a serious public health concern, there have been problems with implementation of treatment for drug users in Japan because of poor accessibility to treatment, concerns about stigma and confidentiality, and costs. Therapeutic interventions using the Internet and computer technologies could improve this situation and provide more feasible and acceptable approaches.
  
  
  OBJECTIVE
  The objective of the study was to show how we developed a pilot version of a new Web-based cognitive behavioral relapse prevention program with tailored feedback to assist people with drug problems and assessed its acceptance and usability.
  
  
  METHODS
  We developed the pilot program based on existing face-to-face relapse prevention approaches using an open source Web application to build an e-learning website, including relapse prevention sessions with videos, exercises, a diary function, and self-monitoring. When users submitted exercise answers and their diary, researchers provided them with personalized feedback comments using motivational interviewing skills. People diagnosed with drug dependence were recruited in this pilot study from a psychiatric outpatient ward and nonprofit rehabilitation facilities and usability was evaluated using Internet questionnaires. Overall, website usability was assessed by the Web Usability Scale. The adequacy of procedures in the program, ease of use, helpfulness of content, and adverse effects, for example, drug craving, mental distress, were assessed by original structured questionnaires and descriptive form questions.
  
  
  RESULTS
  In total, 10 people participated in the study and completed the baseline assessment, 60% completed all relapse prevention sessions within the expected period. The time needed to complete one session was about 60 minutes and most of the participants took 2 days to complete the session. Overall website usability was good, with reasonable scores on subscales of the Web Usability Scale. The participants felt that the relapse prevention sessions were easy to use and helpful, but that the length of the videos was too long. The participant who until recently used drugs was satisfied with the self-monitoring, but others that had already maintained abstinence for more than a year felt this activity was unhelpful and were bored tracking and recording information on daily drug use. Feedback comments from researchers enhanced participants' motivation and further insight into the disease. Serious adverse effects caused by the intervention were not observed. Some possible improvements to the program were suggested.
  
  
  CONCLUSIONS
  The Web-based relapse prevention program was easy to use and acceptable to drug users in this study. This program will be helpful for drug users who do not receive behavioral therapy. After the pilot program is revised, further large-scale research is needed to assess its efficacy among drug users who have recently used drugs.
authors.affiliation: Graduate School of Medicine, Department of Psychiatric Nursing, The University of Tokyo, Tokyo, Japan. ayumi-takano@umin.ac.jp.
authors.forename: Ayumi
authors.identifier: http://orcid.org/0000-0001-8363-1235
authors.initials: A
authors.lastname: Takano
authors.forename: Yuki
authors.identifier: http://orcid.org/0000-0002-2192-0469
authors.initials: Y
authors.lastname: Miyamoto
authors.forename: Norito
authors.identifier: http://orcid.org/0000-0003-1080-2720
authors.initials: N
authors.lastname: Kawakami
authors.forename: Toshihiko
authors.identifier: http://orcid.org/0000-0002-8195-605X
authors.initials: T
authors.lastname: Matsumoto
keywords: Internet; cognitive behavioral therapy; drug dependence; motivational interviewing; relapse prevention; self-monitoring; web-based