Investigating Alexithymia as a Moderator of Outcomes in a Randomized Controlled Trial of an Online Intervention for Co-Occurring Depression and Hazardous Alcohol Use: Enquête sur l'alexithymie en tant que modérateur des résultats dans un essai randomisé contrôlé d'une intervention en ligne pour la dépression concomitante et la consommation dangereuse d'alcool.

OBJECTIVE: Alexithymia is characterized by difficulty identifying and/or describing emotions, reduced imaginal processes, and externally oriented thinking. High levels of alexithymia may increase the challenge of supporting individuals with co-occurring depression and hazardous alcohol use. This secondary analysis sought to investigate whether or not alexithymia moderated the outcomes of an online intervention for depression and alcohol use. METHOD: As part of a randomized controlled trial, 988 participants were randomly assigned to receive an intervention dually focused on depression and alcohol use, or an intervention only focused on depression. The pre-specified mediation hypothesis was that changes in drinking at 3 months follow-up would effect the association between the intervention and change in depression at 6 months. This secondary analysis extends the investigation by adding alexithymia as a moderator. RESULTS: The current analysis demonstrated that including alexithymia as a moderator resulted in a conditional direct effect. Specifically, there was an intervention effect where participants who received the combined depression and alcohol intervention had larger improvements in their depression scores at 6 months, but this was only when their alexithymia score at baseline was also high (60.5 or higher). CONCLUSION: These results suggest that treatment planning and intervention effectiveness could be informed and optimized by taking alexithymia severity into consideration. This is especially merited as alexithymia can contribute to the weaker therapeutic alliance, more distress and dysphoria, shorter periods of abstinence, and more severe depression, compounding the complexity of supporting individuals with comorbid conditions. More research is needed to systematically investigate these possible modifying effects. PLAIN LANGUAGE TITLE: Does difficulty identifying/describing emotions or externally-oriented thinking influence the effectiveness of an intervention among people with both depression and hazardous alcohol use?

In a recent study we recruited participants who were concerned with both their alcohol use and low mood. We provided two different online interventions. Half of the participants received an intervention designed for both concerns and half received an intervention that addressed only depression. We hypothesized that receiving the combined intervention for both concerns would result in greater benefits, however, our results indicated no apparent difference. This analysis uses the same data, but investigated the influences of alexithymia on the effectiveness of the interventions. Alexithymia is defined as having difficulty identifying/describing emotions and/or thinking more about external events than internal feelings. It commonly co-occurs with depression and with hazardous alcohol use and can increase the challenge of supporting individuals with these co-occurring concerns. The results of this analysis showed support for our original hypothesis that participants who received the intervention that addressed both their mood and alcohol concerns had lower depression scores 6-months later, but only among individuals who also had alexithymia scores above 60.5. Taking alexithymia severity into consideration during treatment planning may help optimize the effectiveness of interventions. These results show merit for future research to consider alexithymia as a variable that could potentially impact outcomes among individuals with co-occurring depression and hazardous alcohol use.

Computer-Based Training for Cognitive Behavioural Therapy for Substance Use Disorder: A Randomized Controlled Trial Including Quantitative and Qualitative Health and Economic Outcomes: Formation informatisée pour la thérapie cognitivo-comportementale pour les troubles liés à l'usage de substances : un essai randomisé contrôlé y compris les résultats quantitatifs et qualitatifs en matière de santé et d'économie.

OBJECTIVES: Heavy alcohol and drug use is reported by a substantial number of Canadians; yet, only a minority of those experiencing substance use difficulties access specialized services. Computer-Based Training for Cognitive Behavioural Therapy (CBT4CBT) offers a low-cost method to deliver accessible and high-quality CBT for substance use difficulties. To date, CBT4CBT has primarily been evaluated in terms of quantitative outcomes within substance use disorder (SUD) samples in the United States. A comparison between CBT4CBT versus standard care for SUDs in a Canadian sample is critical to evaluate its potential for health services in Canada. We conducted a randomized controlled trial of CBT4CBT versus standard care for SUD. METHODS: Adults seeking outpatient treatment for SUD (N = 50) were randomly assigned to receive either CBT4CBT or treatment-as-usual (TAU) for 8 weeks. Measures of substance use and associated harms and quality of life were completed before and after treatment and at 6-month follow-up. Qualitative interviews were administered after treatment and at follow-up, and healthcare utilization and costs were extracted for the entire study period. RESULTS: Participants exhibited improvements on the primary outcome as well as several secondary outcomes; however, there were no differences between groups. A cost-effectiveness analysis found lower healthcare costs in CBT4CBT versus TAU in a subsample analysis, but more days of substance use in CBT4CBT. Qualitative analyses highlighted the benefits and challenges of CBT4CBT. DISCUSSION: Findings supported an overall improvement in clinical outcomes. Further investigation is warranted to identify opportunities for implementation of CBT4CBT in tertiary care settings.Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03767907.

Evaluating a digital intervention targeting substance use difficultiesPlain Language SummaryWhy was the study done?Heavy alcohol and drug use is frequent in the Canadian population, although very few people have access to treatment. The digital intervention, Computer-Based Training for Cognitive Behavioural Therapy (CBT4CBT), may provide a low-cost, high-quality, and easily accessible method of treatment for substance use difficulties. Limited research on this digital intervention has been conducted in Canadian populations, and few studies thus far have evaluated participants' subjective experience using the intervention, along with the cost on the Canadian healthcare system.What did the researchers do?The research team recruited participants and provided access to either CBT4CBT or to standard care at a mental health hospital for 8 weeks. Participants were asked questions about their substance use and related consequences, quality of life, and thoughts on the treatment they received. Information regarding healthcare use and the cost to the healthcare system was also gathered.What did the researchers find?Participants in both groups improved with regards to their substance use, some related consequences, and psychological quality of life. Participants provided insight on the benefits and challenges of both types of treatment. It was also found that the CBT4CBT intervention was less costly.What do these findings mean?These findings support that adults receiving CBT4CBT and standard care both improved to a similar degree in this sample. Participant feedback may inform future studies of how best to implement this intervention in clinical studies. Future studies with larger samples are needed to further examine whether CBT4CBT can increase access to supports and be beneficial in the Canadian healthcare system.

Assessing the Prevalence of Cannabis Use Through a Survey About Criminal Activity Versus One About Alcohol, Tobacco, and Other Drugs.

Background: The prevalence of cannabis use in the United Kingdom might be underestimated using the Crime Survey of England and Wales. The current study examined whether responding to questions about their cannabis use as part of a crime survey would be less likely to report that they use cannabis compared to those responding to the same questions that are part of a survey about health. Methods: Participants were randomized to be told that the items about cannabis use came from a crime survey versus from a health survey. In addition, the sample was recruited using a representative online sampling method and compared to published rates of self-reported cannabis use collected as part of the Crime Survey for England and Wales. Results: There was no significant difference (p > 0.05) in the proportion endorsing cannabis use between those told the items came from a crime survey versus a health survey. However, self-reported rates of cannabis use collected as part of the online panel (51.3% ever use; 11.9% past year; age range 18-64 years) appeared higher than those reported based on results from the Crime Survey for England and Wales (37.2% ever and 5.8% past year; age range 18-59 years). Conclusion: The current study did not find evidence that manipulating whether participants were told that the items asking about cannabis use came from a survey asking about criminal activity versus one about health had an impact on self-reported cannabis use. However, as prevalence estimates generated by the Crime Survey of England and Wales do appear to be an underestimate of actual levels of cannabis use in the United Kingdom, further research is merited on this topic.

Perceptions of the Seriousness of Different Addictive Behaviors in the United Kingdom.

Background: Societal beliefs about the seriousness of different addictions were assessed in the United Kingdom (UK). Methods: An online panel, conducted in 2021 and sampled to be representative of the UK general population 18 years and over (N = 1499), was conducted and asked participants their views regarding the seriousness of different societal problems, including various addictive behaviors. Results: Cannabis was ranked as the least serious of the addictive behaviors. Other illicit drug use (cocaine, amphetamine, heroin) was rated as the most serious of addictive behaviors. None of the addictive behaviors were rated as being as serious a problem to society as environmental damage, violent crime, poverty, and the COVID-19 pandemic. Conclusions: Ratings of cannabis use were not as expected and stand in contrast to the current UK policy on cannabis use. In addition, the UK policy on alcohol consumption contrasts with societal concerns about alcohol use.

Examining Changes in Quality of Life as an Outcome Measure in Three Randomized Controlled Trials of Online Interventions That Included an Intervention for Hazardous Alcohol Use.

BACKGROUND: Quality of life (QOL) summarizes an individual's perceived satisfaction across multiple life domains. Many factors can impact this measure, but research has demonstrated that individuals with addictions, physical, and mental health concerns tend to score lower than general population samples. While QOL is often important to individuals, it is rarely used by researchers as an outcome measure when evaluating treatment efficacy. METHODS: This secondary analysis used data collected during three separate randomized controlled trials testing the efficacy of different online interventions to explore change in QOL over time between treatment conditions. The first project was concerned with only alcohol interventions. The other two combined either a gambling or mental health intervention with a brief alcohol intervention. Males and females were analyzed separately. RESULTS: This analysis found treatment effects among female participants in two projects. In the project only concerning alcohol, female quality of life improved more among those who received an extensive intervention for hazardous alcohol use compared to a brief intervention (p = .029). QOL among females who received only the mental health intervention improved more than those who also received a brief alcohol intervention (p = .049). CONCLUSION: Poor QOL is often cited as a reason individuals decide to make behavior changes, yet treatment evaluations do not typically consider this patient-important outcome. This analysis found some support for different treatment effects on QOL scores in studies involving at least one intervention for hazardous alcohol use.

Applying the Canadian Low-Risk Gambling Guidelines to Gambling Harm Reduction in England.

There is a need for evidence-based guidelines for gamblers who wish to reduce their risk of harm by setting self-directed limits on their gambling. Recognizing this, the Canadian Low-Risk Gambling Guidelines were developed using data from 8 countries to establish the relationship between gambling behaviour and harm. The guidelines include recommended limits on gambling spending as a percentage of income, gambling frequency, and number of types of games played. However, the developers of the LRGG's did not include UK data in their analysis. This study analyzes data from Health Survey England to assess the applicability of the Canadian Low-Risk Gambling Guidelines to gamblers in England. Using HSE data from 2016 to 2018, we generated risk curves for the relationship between 2 dimensions of gambling behaviour-frequency of gambling sessions and number of types of games played-and gambling harm. We defined harm as a score of 1 or above on the Problem Gambling Severity Index. HSE does not include questions on gambling spending, therefore this was not assessed. The relationship observed between frequency and types of gambling and harm among HSE respondents was similar to the risk curves generated for the development of the Canadian LRGG's. Gamblers in England who gambled twice weekly or more, or who played 3 or more types of games, were significantly more likely to experience harm from gambling than those who gambled below these limits. The Canadian LRGG's may potentially be applied to gambling harm reduction efforts in England. More research is needed to determine the acceptability of these guidelines to people who gamble in England.

Disentangling Medicinal and Recreational cannabis Use Among People Living with HIV: An Ecological Momentary Assessment Study.

This study examined the feasibility of using ecological momentary assessment (EMA) to disentangle medicinal cannabis use (MCU) from recreational cannabis use (RCU) among people living HIV (PLWH). Over a 14-day period, PLWH (N = 29) who engaged in both MCU and RCU completed a smartphone-based survey before and after every cannabis use event assessing general motivation for cannabis use (MCU-only, RCU-only, or mixed MCU/RCU), cannabis use behavior, and several antecedents and outcomes of cannabis use. A total of 739 pre-cannabis surveys were completed; 590 (80%) of the prompted post-cannabis surveys were completed. Motives for cannabis use were reported as MCU-only on 24%, RCU-only on 30%, and mixed MCU/RCU on 46% of pre-cannabis surveys. Mixed effects models examined within-person differences across MCU-only, RCU-only, and mixed MCU/RCU events. Results showed that relative to RCU-only events, MCU-only events were more likely to involve symptom management and drug substitution motives, physical and sleep-related symptoms, solitary cannabis use, and use of cannabis oils and sprays; MCU-only events were less likely to involve relaxation, happiness, and wellness motives, cannabis flower use, and positive cannabis consequences. Differences between mixed MCU/RCU and RCU-only events were similar, except that mixed MCU/RCU events were additionally associated with stress reduction motives and symptoms of anxiety and depression. Findings support the feasibility of partially disentangling MCU and RCU behavior among PLWH who engage in concurrent MCU and RCU. This study highlights the need for more EMA studies isolating MCU from RCU to inform ongoing changes to cannabis policies.

Knowledge of Cannabinoid Content Among People Living with HIV Who Use Cannabis: a Daily Diary Study.

BACKGROUND: Many people living with HIV (PLWH) use cannabis for medicinal reasons. Patients' knowledge of the tetrahydrocannabinol (THC) and cannabidiol (CBD) concentrations of the cannabis products they use may be important in helping patients achieve symptom relief while guarding against potential risks of cannabis use. However, no studies have examined cannabinoid concentration knowledge among PLWH. METHOD: PLWH (N = 29; 76% men, mean age 47 years) reporting cannabis use for both medicinal and nonmedicinal reasons completed daily surveys over 14 days assessing cannabis products used, knowledge of cannabinoid concentrations of cannabis products used, cannabis use motives (medicinal, nonmedicinal, both), and positive and negative cannabis-related consequences. Across the 361 cannabis use days captured on the daily surveys, at least some knowledge of cannabinoid concentrations was reported on an average of 43.1% (for THC) and 26.6% (for CBD) of the days. RESULTS: Generalized linear mixed models revealed that participants were more likely to report knowing THC and CBD concentrations on days when they used non-flower forms of cannabis relative to days when they used cannabis flower only. Participants who used cannabis for medicinal reasons on a greater proportion of days had greater knowledge of cannabinoid concentration overall across days. Further, greater overall knowledge of cannabinoid concentrations was associated with fewer reported negative cannabis-related consequences. CONCLUSIONS: Findings suggest that among PLWH, knowledge of cannabinoid concentrations may be higher when using non-flower cannabis products and among those reporting primarily medicinal cannabis use. Moreover, knowledge of cannabinoid concentration may protect against negative cannabis-related consequences in this population.

Using a consistency check during data collection to identify invalid responding in an online cannabis screening survey.

BACKGROUND: Inconsistent responding is a type of invalid responding, which occurs on self-report surveys and threatens the reliability and validity of study results. This secondary analysis evaluated the utility of identifying inconsistent responses as a real-time, direct method to improve quality during data collection for an Internet-based RCT. METHODS: The cannabis subscale of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was administered as part of eligibility screening for the RCT. Following the consent procedure, the cannabis subscale was repeated during the baseline interview. Responses were automatically compared and individuals with inconsistent responses were screened out. RESULTS: Nearly half of those initially eligible for the RCT were subsequently screened out for data quality issues (n = 626, 45.3%). Between-group bivariate analysis found that those screened out (OUT) were significantly older (OUT = 39.5 years (SD = 13.9), IN = 35.7 years (SD = 12.9), p < .001), more had annual incomes less than $20,000CND (OUT = 58.3%, IN = 53.0%, p = .047), used cannabis less often in the past 30 days (OUT = 23.3 days (SD = 9.7), IN = 24.8 days (SD = 11.3), p < .006), and had lower total ASSIST scores at screener (OUT = 19.3 (SD = 8.0), IN = 23.8 (SD = 10.4), p < .001) and baseline (OUT = 17.5 (SD = 7.9), IN = 23.3 (SD = 10.3), p < .001) compared to participants who were screened in to the RCT. CONCLUSION: Inconsistent responding may occur at high rates in Internet research and direct methods to identify invalid responses are needed. Comparing responses for consistency can be programmed in Internet surveys to automatically screen participants during recruitment and reduce the need for post-hoc data cleaning.

Learning to quit: can reinforcement theories predict the success of smoking cessation attempts using nicotine replacement therapy patches in a general population sample of smokers at 8-weeks and 6-months follow-up?

Primary, secondary, and tertiary reinforcement contribute to the maintenance of smoking behaviour and may influence the efficacy of different cessation treatments. This analysis examined these relationships in a large general population sample and investigated how previous experiences of the different reinforcement mechanisms impacted future quit attempts. Random digit telephone dialing was used to recruit a sample of Canadian adults who smoked and were interested in being part of a hypothetical program that would provide nicotine replacement therapy (NRT) patches free by mail and half of the eligible participants were randomized to actually receive a five-week supply of NRT patches. During the interviews, reasons for relapse to smoking during previous quit attempts were collected and coded by two reviewers (disagreements were settled by a third reviewer). Binary logistic regression was used to determine if type of reinforcer moderated the intervention effect of the patches. Participants who made cessation attempts in the past year were more likely to report negative (p = .039), secondary (p = .041), and tertiary (p = .010) reinforcers and less likely to report positive reinforcers (p = .016) compared to those who did not attempt to quit. Logistic regressions revealed no significant conditional effects of the intervention on the relationship between reinforcer type and quit attempts or 30-day smoking abstinence. Analysis including all three reinforcers showed negative reinforcers decreased but tertiary reinforcers increased the odds participants reported a cessation attempt before the baseline interview and between baseline and 8-weeks. Understanding the different ways nicotine reinforces smoking behaviour could help guide individuals to more effective treatment options.

To thine own self, be true: Examining change in self-reported alcohol measures over time as related to socially desirable responding bias among people with unhealthy alcohol use.

BACKGROUND: Due to a conscious or unconscious desire to be perceived favorably by others, some participants may under or overexaggerate when reporting sensitive behaviors or attitudes, including those related to addictions. This socially desirable responding bias should be considered when using self-reports in predictive models since it introduces error. Methods: A total of 1711 participants were recruited using Amazon's Mechanical Turk crowdsourcing platform for two randomized controlled trials investigating the effectiveness of brief online interventions for hazardous alcohol use. At baseline, participants completed the Balanced Inventory of Desirable Responding (BIDR). Four measures of alcohol use were collected at baseline and follow-up: number of drinks consumed in a typical week, on one occasion, consequences experienced, and amount of perceived risk of injury or illness from alcohol use. Results: As expected, individuals scoring high on the BIDR subscales reported less alcohol use and related behaviors (p < 0.05); however, repeating the analyses for each gender showed no difference for females asked direct questions about the frequency of their alcohol use. Mixed-effects models investigating the interaction of socially desirable responding bias over time on alcohol-related measures showed some significant differences in the amount of change reported depending on BIDR scores. Participants with higher self-deceptive enhancement scores reported less change over time in their ratings of risk of illness or injury (p = 0.001) compared to lower-scoring participants. Likewise, high-scoring participants reported less change in the number of consequences experienced due to alcohol use over time on both BIDR subscales. Neither direct measure of alcohol use seemed affected by BIDR scores over time. A different pattern was found in males and females analyzed separately. Conclusions: These findings suggest that researchers should consider including measures of socially desirable responding bias in longitudinal studies involving self-reported alcohol use, particularly when modeling alcohol-related measures using rating scales across time. In addition, separate gender analyses may be appropriate. Trial registration: ClinicalTrials.gov NCT03008928. Registered 30 December 2016; ClinicalTrials.gov NCT03060135. Registered 17 February 2017.

Examining Change in Self-Reported Gambling Measures Over Time as Related to Socially Desirable Responding Bias.

Socially desirable responding is a response bias that can affect the accuracy of self-reports. It is especially likely when questions address sensitive topics, such as gambling attitudes, problems and behaviours. A sample of 321 participants were recruited from Amazon's mTurk crowdsourcing platform for a randomized controlled trial investigating an online gambling intervention. Data from this study was used to examine the influence of socially desirable responding on gambling self-report measures over time. At baseline, self-deception (SD), a factor of socially desirable responding, was significantly higher among males than females and among those with household incomes greater than $20,000 per year. Controlling for demographic variability, mixed effects models examining the relationship between socially desirable responding factors [SD and impression management (IM)] and time were conducted. Among males, there were significant interactions between IM with the NORC DSM-IV screen for gambling problems (NODS) and the gambling symptom assessment scale (G-SAS) scores respectively, over time. In other words, males with higher IM scores, demonstrated less change in NODS and G-SAS scores from baseline to 6-month follow-up compared to males with lower IM scores. There were no significant interactions in any models among females or among the full sample. Controlling the well-documented effect of socially desirable responding on self-reported measures in addictions research should be considered as a method to help reduce error and improve validity. Future research should continue to examine the effect of this bias on gambling measures over time and in each gender.Trial registration: https://ClinicalTrials.gov/NCT03124589 , registered 19 January 2017.

Targeting mailed nicotine patch distribution interventions to rural regions of Canada: protocol for a randomized controlled trial.

BACKGROUND: Quitting smoking is the most effective way of reducing the risk of cancer among smokers. One way of helping people stop smoking is to provide them with free Nicotine Replacement Therapy (NRT), such as when NRT is sent to people by postal mail as part of a mass distribution initiative. Our previous research indicated that there may be a substantial impact on increasing quit rates of a mailed NRT intervention in rural areas. The current research seeks to confirm this finding and to understand the social determinants of health driving these anticipated large effects. METHODS/DESIGN: Telephone numbers will be randomly selected from across rural regions of Canada in order to recruit adult smokers interested in completing a smoking survey and willing to be interviewed again in 6 months. The survey will ask participants about their smoking history, demographic characteristics, and a hypothetical question: would they be interested in receiving nicotine patches if they were provided to them free of charge? Half of the smokers interested in receiving nicotine patches will be selected by chance and offered the NRT package. The other half of smokers will not be offered the nicotine patches. In addition, the municipality where each participant lives will be identified and, once the relevant general population data becomes available, attempts will be made to link participant data to relevant municipal characteristics (e.g., smoking rates, availability of health services). Characteristics of the participants and the municipalities in which they live will be used to explain why the nicotine patch intervention may have a larger impact in some rural regions compared to others. DISCUSSION: The findings from the proposed RCT are timely and of high relevance as the distribution of nicotine patches has substantial potential to combat the public health problem of cigarette related cancer, other diseases, and premature death from tobacco use. Targeting such tobacco cessation initiatives to rural regions may substantially increase the impact of this intervention, helping to optimize the use of limited prevention resources while aiming to save the maximum number of lives. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov NCT04606797 , October, 27, 2020.

Beliefs about cannabis at the time of legalization in Canada: results from a general population survey.

AIMS: Cannabis became a legally available drug in Canada in October of 2018. The objective of this study was to examine beliefs about cannabis use at the time of legalization among past year cannabis users, those who had used cannabis but not in the last year, and people who had never used cannabis. DESIGN AND METHODS: A survey of 813 participants, 18 years and over, and identified using random digit dialing methods, was made of the Canadian general population. Among other items, participants were asked a series of questions about their beliefs regarding cannabis use and recovery. RESULTS: Compared to never and ever users, participants who used cannabis in the last year regarded cannabis as less of a societal problem (mean [SD] past year use = 3.8 [2.4] versus 6.4 [2.6] and 6.0 [2.4] respectively, p = .001), than people were less likely to become addicted to cannabis if they tried it (past year use = 13.3% versus 48.3% and 25.1%, p = .001), and a larger proportion believed that recovery from cannabis without treatment was likely (past year use = 40.8% versus 14.2% and 19.3%, p = .001). All groups were equally positive of the chances of recovering from cannabis addiction with treatment (p = .72). DISCUSSION AND CONCLUSION: Beliefs about cannabis use vary substantially between those who have used the drug in the past year and those who have not. Replication of the survey at a later date is merited in order to assess the ways in which beliefs about cannabis evolve after an extended period of cannabis being available as a legal drug.

Out damn bot, out: Recruiting real people into substance use studies on the internet.

While the Internet has become a popular and effective strategy for recruiting substance users into research, there is a large risk of recruiting duplicate individuals and Internet bots that pose as humans. Strategies to mitigate these issues are outlined and categorized into two groups: (1) automatic techniques which are often embedded into surveys and (2) ongoing manual techniques implemented during recruitment. Potential limitations of these strategies are discussed, and an example of the prevalence of duplicate data within a substance using sample is provided. Overall, it is recommended that researchers consider the use of routine strategies to mitigate the risks associated with recruiting online samples such as: verifying participant contact information, IP address checks, and ongoing cross-checking of participant information for duplicates, similarities and inconsistencies.

Electronic screening and brief intervention for unhealthy alcohol use in primary care waiting rooms - A pilot project.

Background: In primary care, electronic self-administered screening and brief interventions for unhealthy alcohol may overcome some of the implementation barriers of face-to-face intervention. We developed an anonymous electronic self-administered screening brief intervention device for unhealthy alcohol use and assessed its feasibility and acceptability in primary care practice waiting rooms. Two modes of delivery were compared: with or without the presence of a research assistant (RA) to make patients aware of the device's presence and help users. Using the device was optional. Methods: The devices were placed in 10 participating primary care practices waiting rooms for 6 weeks, and were accessible on a voluntary basis. Number of appointments by each practice during the course of the study was recorded. Access to the electronic brief intervention was voluntary among those who screened positive. Screening and brief intervention rates and characteristics of users were compared across the modes of delivery. Results: During the study, there were 7270 appointments and 1511 individuals used the device (20.8%). Mean age of users was 45.3 (19.5), and 57.9% screened positive for unhealthy alcohol use. Of them, 53.8% accessed the brief intervention content. The presence of the RA had a major impact on the device's usage (59.6% vs 17.4% when absent). When the RA was present, participants were less likely to screen positive (49.4% vs 60.7%, P = 0.0003) but more likely to access the intervention (62.7% vs 51.4%, P = 0.009). Results from the satisfaction survey indicated that users found the device easy to use (93.5%), questions useful (89-95%) and 77.2% reported that their friends would be willing to use it. Conclusions: This pilot project indicates that the implementation of an electronic screening and brief intervention device for unhealthy alcohol is feasible and acceptable in primary care practices but that, without human support, its use is rather limited.

Correction to: Self-Directed Gambling Changes: Trajectory of Problem Gambling Severity in Absence of Treatment.

The original version of this article unfortunately contained errors in the Methods section. The citations blinded during the review process were inadvertently omitted during the production process and subsequent stages.

Outcomes of two randomized controlled trials, employing participants recruited through Mechanical Turk, of Internet interventions targeting unhealthy alcohol use.

BACKGROUND: Two randomized controlled trials (RCTs) were conducted to explore the utility of the Mechanical Turk (MTurk) crowdsourcing platform to conduct rapid trials evaluating online interventions for unhealthy alcohol use. METHODS: Both trials employed a staged recruitment procedure where participants who drank in an unhealthy fashion were identified using a baseline survey and then invited to take part in a 6-month follow-up. Participants in both trials were randomized to receive one of several different online interventions or to a no intervention control condition. In study 1, the online interventions were password protected and only those who accessed the study portal were randomized to condition. In study 2, participants were directed to free-of charge interventions and asked to send a screenshot of the intervention to demonstrate that they had complied. RESULTS: Participants reporting unhealthy alcohol use were recruited fairly rapidly. Large numbers of screeners were completed (Study 1: n = 4910; Study 2: n = 5812), found eligible (Study 1: n = 3741; Study 2: n = 4095), and randomized to condition (Study 1: n = 511; Study 2: n = 878). Fair follow-up rates were observed at 6 months for each study (Study 1: 82%; Study 2: 66%). Neither trial was able to clearly demonstrate that providing access to the online interventions lead to increased reductions in alcohol use as compared to the control group. CONCLUSIONS: While recruitment through a crowdsourcing platform is rapid and relatively low cost, it is possible that the lack of impact of the online websites employed in these trials could be due to the source of participants rather than the lack of efficacy of the interventions. TRIAL REGISTRATION: ClinicalTrials.gov # NCT02977026 and NCT03060135 .

The origin of animals: Can molecular clocks and the fossil record be reconciled?

The evolutionary emergence of animals is one of the most significant episodes in the history of life, but its timing remains poorly constrained. Molecular clocks estimate that animals originated and began diversifying over 100 million years before the first definitive metazoan fossil evidence in the Cambrian. However, closer inspection reveals that clock estimates and the fossil record are less divergent than is often claimed. Modern clock analyses do not predict the presence of the crown-representatives of most animal phyla in the Neoproterozoic. Furthermore, despite challenges provided by incomplete preservation, a paucity of phylogenetically informative characters, and uncertain expectations of the anatomy of early animals, a number of Neoproterozoic fossils can reasonably be interpreted as metazoans. A considerable discrepancy remains, but much of this can be explained by the limited preservation potential of early metazoans and the difficulties associated with their identification in the fossil record. Critical assessment of both records may permit better resolution of the tempo and mode of early animal evolution.

Online Self-Directed Interventions for Gambling Disorder: Randomized Controlled Trial.

Self-directed treatments for gambling disorder have been developed to attract individuals who are reluctant to seek formal treatment. Self-directed treatments provide individuals with information and support to initiate a recovery program without attending formal treatment. In this study, an online version of a previously evaluated telephone-based intervention package is compared to a brief online normative feedback intervention called Check Your Gambling. In a randomized controlled trial design, participants with gambling problems who were not interested in formal treatment (N = 181) were recruited through media announcements. After a baseline telephone assessment, participants were assigned to have access to either the brief Check Your Gambling, or the extended self-management tools intervention. Follow-up assessments were conducted at 3, 6, and 12 months post baseline by blinded interviewers. Participant nominated collaterals were contacted to validate self-reported gambling involvement. The follow-up rate at 12 months was 78%. Participants in both conditions showed significant reductions in days of gambling and problem severity but no differences between conditions were found, contrary to the primary hypothesis. Lack of previous treatment for gambling and higher baseline self-efficacy predicted fewer days of gambling in both conditions. Self-efficacy increased over time but did not appear to mediate changes in gambling. Participants who were most engaged in the extended online program showed better outcomes. Those with low engagement showed a slower trajectory of change but equivalent improvements by 12 months. The extended online intervention was not associated with better outcomes than the brief Check Your Gambling intervention. Future research needs to explore the attractiveness, uptake, and effectiveness of online interventions with and without therapist support to understand their potential role in gambling disorder treatment systems.Trial Registration ISRCTN06220098.