Take Care of Me: Findings from a randomized controlled trial testing a novel online integrated intervention for young adults with alcohol misuse-emotion comorbidities
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It is currently estimated that nearly 40% of young adults who struggle with alcohol misuse also experience emotional difficulties, such as depression or anxiety. Despite calls for integrated treatment, there is a paucity of accessible interventions for this population. As such, the primary aim of this dissertation was to develop a novel, online, integrated treatment for young adults struggling with comorbid alcohol misuse and emotional problems. Study 1 (N = 222) was a two-arm RCT examining the efficacy of Take Care of Me, an 8-week, minimally guided program using principles of cognitive behaviour therapy and motivational interviewing. Participants were randomized to either the integrated treatment or a psychoeducational control condition. Assessment data was collected at baseline, at the end of treatment (8 weeks), and at follow-up (24 weeks). Results supported larger reductions in depression, hazardous drinking, as well as increases in psychological quality of life and confidence in the treatment group relative to the control group at the end of treatment. Effects on hazardous drinking and psychological quality of life were maintained at follow-up. However, effects were not observed for the primary outcome, total weekly alcohol use. Therefore, the goal of Study 2 was to explore heterogeneity in treatment outcomes based on pre-treatment factors. First, latent-class analyses were used to identify subgroups within the sample based on pre-treatment factors that have been shown to be relevant for substance use treatment, namely background factors (i.e., gender, previous mental health diagnosis and treatment, family history of alcohol use), symptom severity (i.e., depression, anxiety, alcohol-related problems, cannabis use), executive function, and motivation. Results revealed evidence for three distinct classes: a low severity group (n = 123), a moderate severity group (n = 57), who were highly likely to endorse a previous mental health diagnosis and treatment and higher symptom severity than the low group, and a high severity group (n = 42), who endorsed a family history of alcoholism, the highest baseline symptom severity, and the lowest executive functioning skills. Furthermore, individuals showed differential responses to the treatment based on their class membership. Results of moderated regression analyses revealed that high severity individuals in the treatment condition had higher levels of alcohol consumption and hazardous drinking, and lower quality of life at follow-up relative to the low severity group. Moderate severity individuals in the treatment condition had lower levels of alcohol consumption at follow-up and lower hazardous drinking at the end of treatment relative to the low severity group. Overall, this dissertation provided auspicious initial evidence for the Take Care of Me program, as well as provided insight into key pre-treatment factors (e.g., symptom severity, cognitive capacity) that may improve treatment outcomes for future iterations of the intervention.