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  • 1.
    Ekström, Veronica
    et al.
    Ersta Sköndal Bräcke University College, Department of Social Sciences, Institute for Research on Conditions, Organisation and Outcomes of Social Work.
    Johansson, Magnus
    Karolinska Institutet; Beroendecentrum, Stockholms läns landsting.
    Choosing internet-based treatment for problematic alcohol use - why, when and how?: Users’ experiences of treatment online2020In: Addiction science & clinical practice, ISSN 1940-0632, E-ISSN 1940-0640, Vol. 15, p. 1-11, article id 22Article in journal (Refereed)
    Abstract [en]

    Background: Internet-based treatment has emerged as a cost-effective option for reaching people who for different reasons are not reached by traditional treatment. Internet-based treatment for problematic alcohol use, specifically, has been found to show results on par with other forms of treatment. However, in-depth knowledge of users’ experiences is required to understand what works, and what needs further development. The aim of this study is to investigate the help-seeking motives among users of an internet-based service for problematic alcohol use, as well as the users’ experiences of the support available through the service.

    Method: The study consists of a thematic analysis of interviews with 38 former users of the internet-based intervention Alkoholhjälpen.

    Results: The analysis shows that health and relationship factors, as well as feelings of shame, were important motives for the users’ decisions to reduce their drinking. Availability and anonymity seem to have been important reasons for choosing internet-based support. The different treatment components, i.e. ICBT program, therapist support and discussion forum, were each perceived as helpful by some users but not by others. Treatment components were described as more useful when users were able to personally identify with the content, and when it helped them reflect on their own alcohol consumption.

    Conclusions: There are several aspects that are relevant, beyond the comparison between components, if we want to understand what works and for whom in internet-based treatment. Internet-based treatment services should be generous in terms of options for the users.

  • 2.
    Ekström, Veronica
    et al.
    Ersta Sköndal Bräcke University College, Department of Social Sciences.
    Johansson, Magnus
    Karolinska institutet; Stockholms läns landsting.
    Sort of a nice distance: a qualitative study of the experiences of therapists working with internet-based treatment of problematic substance use2019In: Addiction science & clinical practice, ISSN 1940-0632, E-ISSN 1940-0640, Vol. 14, p. 1-11, article id 44Article in journal (Refereed)
    Abstract [en]

    Background: Internet interventions have been developed and tested for several psychiatric and somatic conditions. Few people with substance use disorders receive treatment and many drug users say that they would prefer getting help from online tools. Internet interventions are effective for reducing alcohol and cannabis use. The aim of the current study is to understand differences between internet-based and face-to-face treatment of problematic substance use. The concept of alliance will be used as a theoretical frame for understanding differences between internet-based treatment and face-to-face treatment, as perceived by therapists.

    Method: The study has a qualitative design and is based on 3 focus group interviews with 12 therapists working with internet-based treatment for alcohol or cannabis use problems within five different programs.

    Results: The analysis revealed five themes in the differences between internet-based and face-to-face treatment: communication, anonymity, time, presence and focus. Treatment online in written and asynchronous form creates something qualitatively different from regular face-to-face meetings between patients and therapists. The written form changes the concept of time in treatment, that is, how time can be used and how it affects the therapist’s presence. The asynchronous (i.e. time delayed) form of communication and the lack of facial expressions and body language require special skills.

    Conclusions: There are important differences between internet-based treatment and face-to-face treatment. Different aspects of the alliance seem to be important in internet-based treatment compared to face-to-face.

  • 3.
    Siljeholm, Ola
    et al.
    Karolinska institutet; Stockholms läns sjukvårdsområde, Region Stockholm.
    Ekström, Veronica
    Marie Cederschiöld University, Department of Social Sciences.
    A shift in focus: Mothers’ descriptions of sharing a child with a co-parent with unhealthy alcohol use after participating in a support program2023In: Addiction science & clinical practice, ISSN 1940-0632, E-ISSN 1940-0640, Vol. 18, no 12Article in journal (Refereed)
    Abstract [en]

    Background

    Unhealthy alcohol use (UAU) affects not only the drinking individual, but also significant others (SOs), such as partners and children. Most of the harm to others caused by alcohol can be attributed to common, moderate drinking patterns, but existing studies have mainly included SOs of individuals with severe UAU. There is a need for increased knowledge regarding SOs of individuals in an earlier stage of UAU and efficacious support programs for this group. The aims of this study were to investigate reasons for seeking support as described by SOs sharing a child with a co-parent with UAU and to investigate how SOs perceived effects of a web-based self-delivered support program.

    Methods

    A qualitative design conducting semi-structured interviews with 13 female SOs sharing a child with a co-parent with UAU. The SOs were recruited from a randomized controlled trial of the web-based program and had completed at least two of four modules in the program. Transcribed interviews were analyzed using conventional qualitative content analysis.

    Results

    Regarding reasons for seeking support, we created four categories and two subcategories. Main reasons were wanting validation/emotional support and coping strategies for handling the co-parent, and negative perceptions of available support options for SOs. Regarding perceived effects of the program, we created three categories and three subcategories. Main effects were an improved relationship to their children, increased own positive activities, and less adaptation to the co-parent, though SOs also mentioned what was perceived as missing in the program. We argue that the interviewees represent a population of SOs living with co-parents with slightly less severe UAU than previous studies and therefore provide new insights for future interventions.

    Conclusions

    The web-based approach with potential anonymity was important for facilitating support-seeking. Support for the SOs themselves and coping strategies for co-parent alcohol consumption were more common reasons for seeking help than worry about the children. For many SOs, the program was a first step in seeking further support. Spending more dedicated time with their children and being validated as living under stressful conditions were described by the SOs as particularly helpful.

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