Nicotine and tobacco products are widely used by adolescents and young adults in Switzerland. At the same time, WhatsApp is one of the most frequently used digital communication platforms by this age group. Delivering individually tailored, evidence-based coaching messages via WhatsApp is a promising way to support young people in quitting nicotine use. This study protocol outlines a randomized controlled trial to test the efficacy of a semi-automated, WhatsApp-based intervention program to support nicotine cessation and reduction in adolescents and young adults. A two-arm, parallel-group, randomized controlled trial will be conducted to test the efficacy of NicotineFreeCoach compared to a waitlist control group. Participants for the study will be recruited both online and offline and will be assessed at the beginning of the study and at follow-ups after three and six months. During 12 weeks, participants in the intervention group will receive individually tailored WhatsApp messages designed to motivate them to stop or reduce their nicotine use. These messages will provide advice on dealing with cravings and stressful situations, as well as tips on quitting or reducing nicotine use. They will also have the opportunity to ask a counsellor individual questions via a separate WhatsApp channel. Participants in the control group will not initially have the opportunity to take part in the program, but will be invited to do so after completing the six-month survey. The study will involve 870 regular nicotine users aged 16–30, including those who use tobacco cigarettes, vapes, snus or multiple nicotine products. The primary outcome will be the seven-day point prevalence of nicotine abstinence in the follow-up survey after six months. Secondary outcomes will include the quantity and frequency of nicotine use, intention to quit and self-efficacy to do so, quality of life and alcohol use. This is the first randomized controlled study to test the efficacy of an instant messaging-based coaching program in supporting young people to quit tobacco and nicotine use. It provides a scientifically sound evaluation of the effectiveness of NicotineFreeCoach in Switzerland, and of WhatsApp-based coaching programs in promoting healthy behavior more broadly. If this approach proves effective, it could easily be implemented in various settings to reach large numbers of young people in a cost-effective way. ISRCTN16197153 (registration date 20251209).

Abstract Background People who seek treatment often disengage between completing screening and starting treatment. Among those who begin treatment, many have low completion of program content and are lost to follow up. Currently, little is known about predictive factors of treatment initiation and engagement. The aims of this secondary analysis of the Canadian CANreduce program were to discuss the practicality of a randomized controlled trial for online heavy cannabis use treatment and to examine predictors of treatment initiation and engagement in the Canadian CANreduce program. Method The CANreduce intervention was pre-registered on clinicaltrials.gov for traceability (ID: NCT04965012). Statistical models were organized into three conceptual predictor groupings using baseline data: individual cannabis-specific factors, mental health and other substance use factors, and treatment belief factors. Binary logistic regressions examined which factors predicted treatment initiation in the CANreduce treatment program and multiple regression analyses examined which factors predicted percentage of the CANreduce program modules completed among participants who initiated treatment. Results Despite following the core elements of published treatment retention protocols, challenges in recruitment were evident. Of 928 people who created a profile on the website and began screeners, 86.3% (n = 801) completed screeners. Of the 801 who completed screeners, 31.3% (n = 251) were eligible for the program. Of those eligible and assigned to active treatment, 54.3% (n = 51) assigned to the therapist condition and 45.7% (n = 43) assigned to the research assistant condition initiated treatment. Treatment initiation predictors included higher cannabis use problems score, lower family history density, increased alcohol use frequency, and more positive attitudes towards treatment. Treatment engagement (percentage of program completed) predictors included increased social motives for cannabis use and more positive attitudes towards treatment. Discussion This secondary analysis shifts the focus from treatment efficacy to pre-treatment attrition and early engagement in an online cannabis intervention. Substantial recruitment and initiation challenges were observed, highlighting vulnerabilities in the treatment-seeking pathway before content is accessed. By identifying predictors of treatment initiation and module completion, this study offers practical “lessons learned” to inform recruitment and engagement strategies in future online cannabis trials.

Many people who engage in heavy cannabis use do not seek treatment, and those who do are often met with long treatment wait times or high cost of services. Online treatment programs reduce barriers to accessing treatment in a timely manner. Online cannabis use treatment programs are effective, showing moderate effect sizes, particularly with text-based therapist support. Literature suggests brief therapist-guided introductions (i.e., self-completed interventions offered with the support of a therapist) informed by Motivational Enhancement Therapy (MET) may help to bolster and maintain program gains. The current evaluation of MET-informed therapist-guided introduction was conducted with a sample of Canadians who report heavy cannabis use, using a new Canadian version of CANreduce, an online treatment program for heavy cannabis use. The intervention was pre-registered on clinicaltrials.gov for traceability (ID: NCT04965012). Participants (N = 152) were randomized into one of three conditions: MET-therapist guided introduction plus 6-week, online, self-guided treatment program; non-MET research assistant introduction plus 6-week, online, self-guided treatment program; or a psychoeducational control condition. Module content to reduce cannabis use was informed by cognitive behavioural therapy and motivational interviewing approaches. Participants completed assessments at baseline, end of treatment (i.e., 6 weeks), and at follow up (i.e., 10 weeks). Data were analyzed using Generalized Estimating Equations. All participants reduced their cannabis consumption frequency (use days in the past week), as well as cannabis-related problems, at end of treatment and follow up. Participants in the MET-therapist condition showed significantly greater reductions in quantity of cannabis used over time compared to the waitlist control. Participants in the non-MET research assistant condition showed significantly greater reductions in cannabis problems compared to waitlist control. There were no significant differences between MET-therapist guided conditions and non-MET research assistant conditions. There was no significant effect of condition on cannabis consumption days in the past week, anxiety, depression or quality of life. The present study provides preliminary support for the CANreduce program in addition to the MET-therapist guided introduction.

Internet-based psychological interventions can effectively reduce depressive symptoms in adults, but adherence remains challenging. In this preregistered individual participant data meta-analysis, we examined predictors of treatment adherence. We searched PubMed, Embase and PsycINFO on 6 February 2024 for randomized trials of internet-based interventions among adults with elevated depressive symptoms. We conducted a one-stage logit-link multilevel beta regression, with adherence defined as the proportion of completed modules post-intervention. This study included 71 trials (85 treatment arms, 8,082 participants). Lower adherence was associated with younger age (β = 0.005, standard error (SE) 0.002, P = 0.028), male gender (β = −0.163, SE 0.053, P = 0.002), lower education (β = −0.133, SE 0.05, P = 0.008) and employment (β = −0.113, SE 0.054, P = 0.037). No significant interactions were found between individual predictors and intervention format (guided versus self-guided). Higher adherence was associated with lower post-intervention depression severity, adjusting for baseline severity (β = −0.30, SE 0.04, P < 0.001). Identifying subgroups at risk of low adherence may inform targeted strategies to improve engagement and clinical effectiveness. Using data from 71 randomized controlled trials that involve 8,082 participants, the authors of this individual participant data meta-analysis examine individual- and study-level predictors of adherence to internet-based interventions for depression.

Background:Previous studies demonstrated the effectiveness of SmartCoach, a mobile phone-based life-skills training program for addiction prevention among adolescents. However, socially stratifying factors, such as educational level or migration background, were associated with lower program engagement and participation. To address these disparities, we optimized and tailored program elements, particularly for subgroups with low engagement, using qualitative interview data. Objective:This study aimed to test whether the optimized program version was superior to the original one in terms of efficacy and program use. We hypothesized that optimization and advanced tailoring would result in increased program efficacy and engagement. Methods:A 2-arm, parallel-group, double-blind, cluster-randomized controlled trial was conducted with assessments at baseline and follow-up after 6 months. Secondary and upper secondary school classes were randomized into two groups: (1) an intervention group receiving the optimized program version and (2) a control group receiving the original version. Participants in both groups received up to 4 weekly SMS text messages over 4 months to stimulate (1) self-management skills to cope with stress, (2) self-efficacy to resist social pressure, (3) observational learning, and (4) self-regulation. The optimized program version included additional reminders, extended time for challenges, simplified language, different days for weekly messages, and additional tailoring for participants with personal or parental backgrounds from non-German-speaking countries. This subgroup received shorter video clips and information on additional stressors, including acculturation and family conflicts. The primary outcomes of this trial were the quantity of alcohol use, the number of days per month that nicotine-containing products were smoked, and cannabis use days. Results:A total of 1175 students from 67 Swiss secondary and upper secondary school classes were invited to participate in the study between September 2023 and September 2024. Of these 1175 students, 890 (75.7%; mean age 14.9, SD 1.3 y; women: n=511, 57.4%; men: n=379, 42.6%; nonbinary: n=0, 0.0%) participated in the study. Six-month follow-up assessments were completed by 552 (62.0%) of the 890 study participants. On average, program use did not differ between the study groups, with 12.6 (SD 12.8) of 38 possible activities completed in the intervention group and 12.5 (SD 12.7) activities in the control group (P=.18). The results concerning efficacy showed no significant differences between the study groups regarding the main outcomes of alcohol use quantity (P=.91), nicotine use days (P=.45), and cannabis use days (P=.67). Similarly, no significant group differences were observed for changes in perceived stress (P=.77) and social skills (P=.45). Conclusions:The results did not show improved program use or efficacy in the optimized version of the program. Possible explanations include the relatively minor differences between the 2 program versions and the generally low prevalence rates of substance use in this age group, which limited the statistical power of the study.

Purpose of reviewLarge language models (LLMs) are increasingly integrated into digital mental health tools, yet their role in substance use disorder (SUD) interventions remains poorly understood. This review synthesizes emerging evidence on the opportunities and risks of applying LLMs across the digital SUD care continuum.Recent findingsStudies report promising applications in early detection, personalized support, continuous monitoring, and relapse prevention. LLMs demonstrate capacity to extract substance-use signals from natural language, generate supportive and motivational responses, and interpret narrative data for patient-reported outcomes. However, risks are substantial. LLMs can produce inaccurate or hallucinated content, may reinforce stigma or demographic bias, and can generate misleading or potentially unsafe advice. Privacy concerns are amplified in SUD contexts, where sensitive data are often managed outside regulated healthcare systems. Existing regulatory frameworks such as the EU AI Act or U.S. device regulations, do not yet provide clear governance for anonymous, AI-supported SUD interventions.SummaryLLMs have potential to expand scalable, low-threshold support for SUDs, but their safe deployment requires validation, bias mitigation, transparent data governance, and robust human oversight. Evidence remains preliminary, and clinical integration should proceed cautiously.

BACKGROUND: One of the most significant risk factors for cancer and several other adverse health outcomes is nicotine and tobacco use. Life-skills training programs conducted within the school curriculum are effective in preventing substance use, including nicotine and tobacco use, however, large-scale implementation is hindered by time, organizational and financial constraints. Providing life-skills training programs via smartphones may be a more economical and scalable approach. SUNRISE SmartCoach is the first life skills training program to use instant messaging and storytelling to present life-skills training in an emotional and engaging way. This study protocol outlines a cluster-randomized controlled trial testing the efficacy of SUNRISE SmartCoach among adolescents in eight European countries. METHODS: A two-arm, parallel-group, cluster-randomized, controlled trial will be conducted to test the efficacy of SUNRISE SmartCoach in comparison to an assessment only control group. The study participants will be assessed at baseline and at follow-ups after 6 and 18 months. The fully automated program is based on social cognitive theory and aims to improve self-management skills, social skills, and resistance to addictive behavior. Participants in the intervention group will receive online feedback on their life skills via Smartphone, as well as individually tailored coaching dialogues via WhatsApp or Viber over four months, to improve life skills. Active program engagement will be stimulated by interactive features such as quiz questions, message- and picture-contests, and integration of a friendly competition in which program users collect credits with each interaction. Study participants will be 3,500 secondary and upper secondary school students between the ages of 14 and 17 years from eight European countries: Switzerland, Greece, Slovenia, Spain, Cyprus, Italy, Belgium, and Romania. The primary outcome criterion will be nicotine or tobacco use within 30 days preceding the follow-up assessment at month 18. Secondary outcomes include the use of other substances, such as alcohol and cannabis, social skills, perceived stress, healthy eating habits, and quality of life. DISCUSSION: This is the first randomized controlled study testing the efficacy of an instant messenger- and storytelling-based life-skills training program to prevent nicotine and tobacco use as well as other behavioral risk factors among adolescents. If this intervention approach proves to be effective, it could be easily implemented in various settings and could reach large numbers of young people in a cost-effective way. TRIAL REGISTRATION: NCT06922201 (registration date: 2025-04-09).

Purpose:Inclusion in sports fosters social integration and well-being for individuals with disabilities. However, sports environments also present risks related to alcohol consumption, particularly through social interactions and established drinking norms. While general prevention programs exist in Swiss sports, limited research exists and no specific strategies are tailored to the needs of disability sports settings. This study explores alcohol consumption and prevention measures in Swiss disability sports, focusing on the perspectives of sports coaches. Methods:A qualitative research design was employed using semi-structured interviews with 27 coaches from disability sports programs in Switzerland. The thematic analysis by means of NVivo examined four key dimensions: perceptions of alcohol consumption, knowledge of alcohol-related risks, intervention approaches, and prevention strategies. The sample included coaches from diverse sports, disability groups, linguistic regions, and educational backgrounds. Results:Coaches exhibited varying perspectives on alcohol consumption, with some considering it irrelevant in disability sports and others recognizing its role in social settings surrounding sports activities. While alcohol use was largely rejected during training, it was often normalized in post-sports socialization. Knowledge of alcohol-related risks, particularly concerning its interaction with medication, was inconsistent among coaches, and few had received formal guidance on managing alcohol-related issues. Additionally, prevention measures were seldom implemented, and coaches' awareness of the (national) prevention programs was unexpectedly low. Conclusion:The findings highlight a need for targeted prevention strategies in disability sports, particularly concerning alcohol consumption and its health implications for athletes with disabilities. Strengthening educational initiatives for coaches, integrating substance use prevention into training curricula, and fostering structured intervention strategies could improve awareness and promote safer sports environments. Future research should explore the perspectives of athletes with disabilities and examine broader policy implications to enhance prevention efforts in inclusive sports.

The college stage is marked by high prevalence of mental disorders, particularly anxiety, low mood, and substance abuse. Despite this, many affected students do not receive treatment, underscoring the need for preventive strategies. In respose, the CORE program, an internet-based intervention, was developed to enhance resilience and coping skills among college students. The present study, part of the ICare project (EU-634757), aims to assess the effectiveness of the CORE intervention in improving resilience and reducing symptoms of anxiety and depression in comparison to a Waiting List (WL) condition. The study was registered at ISRCTN (ISRCTN13856522). In the study the unguided internet-based intervention (CORE) was compared to a WL control group in a multicenter two-arm, single-blind, randomized controlled trial (RCT) conducted in Spain, Germany, and Switzerland. Questionnaire based evaluations occurred at baseline (BL), 8 weeks (post-intervention), 6 and 12 months after randomization. A total of 493 students with low levels of resilience participated in the study. Participants in the intervention group gained access to an internet-based program aiming to enhance resilience by learning to cope with stressors in daily life, promote self-empowerment, and improve well-being. Participants were instructed to engage in six interactive modules delivered weekly in a sequential order. The program's therapeutic content was developed following the Ryff model of well-being. The primary outcome measure used was the Connor-Davidson Resilience Scale (CD-RISC-25). Additionally, anxiety and depressive symptomatology, coping strategies, and well-being were measured. Participants in the CORE condition reported a significant increase in resilience compared to WL condition (Differences post-BL: d = 0.34, p = .0005; 6 M-BL: d = 0.24, p = .0171; 12 M-BL: d = 0.33, p = .0031). Although, a general time trend towards improvement in the resilience was observed in both groups. Participants in the CORE condition, compared to those in the WL condition, showed a significant reduction in anxiety symptoms in the short and long term (differences post-BL: d = 0.30, p = .0015; 6 M-BL: d = 0.18, p = .0857; 12 M-BL: d = 0.23, p = .0312) and depression in the short term. Furthermore, participants in CORE condition showed a significant improvement in positive functioning measurements, such as well-being and self-compassion compared to WL condition. (Differences post-BL: d = 0.25, p = .0123; 6 M-BL: d = 0.16, p = .1505; 12 M-BL: d = 0.13, p = .1835). Adherence to fully complete the intervention was approximately 59 %. In conclusion, our study revealed promising outcomes for the CORE program, indicating its efficacy. These results position the CORE program as a valuable and validated tool in fostering resilience, offering promising ways for addressing mental health challenges in academic settings.

Preventing mental disorders is important to avoiding clinical conditions. This study evaluated the efficacy of internet-based indicated prevention for anxiety and depressive disorders. In a three-arm randomized controlled trial, 566 adults with subthreshold anxiety (GAD-7 ≥ 5) and/or depressive symptoms (CES-D ≥ 16), but no clinical diagnosis in the past six months (MINI 6.0), were assigned to either an individually (IG-IMI, n = 186) or automatically (AG-IMI, n = 189) guided digital intervention, or waitlist control (WLC, n = 191). The digital intervention comprised 8 transdiagnostic, self-tailored, CBT-based sessions. The primary outcome was time to onset of any anxiety or depressive disorder over 12 months, assessed via blinded diagnostic interviews (MINI). AD/DD onset was 19.4% in IG-IMI, 14.8% in AG-IMI, and 30.9% in WLC. Cumulative incidence was 23.1% (IG-IMI), 20.7% (AG-IMI), and 36.0% (WLC; p < 0.001). Hazard ratios were 0.59 and 0.47; NNTs were 7.76 and 5.79. Both individually guided and automated interventions effectively reduced AD/DD incidence. Trial Registration: The study was preregistered in the German Clinical Trial Registration (DRKS00011099; https://drks.de/search/de/trial/DRKS00011099 ).

Abstract: Introduction: Research on (recreational) psychoactive substance use among individuals with disabilities (IWDs) is still very rare. This study investigates alcohol consumption behaviors, perceptions, and associated risks among IWD engaged in Swiss sports programs of the Swiss disabled sports system. Methods: Employing a participatory research approach, we conducted free-listing interviews with 117 athletes (N = 117) from various disability sports groups (physical, psychiatric, and intelligence disabilities each ca. 1/3) to uncover the social, legal, and personal factors that influence drinking behavior in this population. Interviews were analyzed using Thematic Analysis and Nvivo. Results: Our findings reveal a dual role of alcohol: while it contributes to social inclusion, it also presents significant risks, especially when combined with medications commonly used by IWDs, a factor very often overlooked by both participants and club leaders. Notably, we observed substantial knowledge gaps concerning alcohol’s health impacts and the dangers of mixed substance use (“Mischkonsum”), a growing concern in Switzerland’s National Addiction Strategy. Additionally, limited awareness among sports club leaders regarding alcohol-related risks complicates prevention efforts, underscoring the need for tailored educational programs. Discussion: This research emphasizes the importance of creating accessible, targeted prevention strategies to foster responsible alcohol consumption and reduce harm within sports clubs, enhancing social well-being and health outcomes for IWDs.

Background: The use of tobacco cigarettes and electronic nicotine products is widespread among young people in Switzerland. At the same time, the instant messaging platform WhatsApp (Meta Platforms, Inc) is the most frequently used smartphone app in this population group. The provision of individually tailored, evidence-based coaching messages via WhatsApp seems promising to support smoking cessation in adolescents and young adults. Objective: This study aims to test the feasibility, acceptance, and preliminary efficacy of a newly developed, semiautomated WhatsApp-based intervention program to support smoking and vaping cessation and reduction in adolescents and young adults. Methods: Recruitment took place in Switzerland in 2023 and 2024 via various channels, both online and offline. For a period of 11 weeks, regular users of cigarettes or electronic cigarettes, aged between 16 and 30 years, received individually tailored messages on how to deal with cravings or stressful situations and how to stop or reduce smoking. A separate WhatsApp channel provided the opportunity to ask individual questions to a counselor. A one-group pre-post design was used to obtain preliminary information on the acceptability and potential efficacy of the program. Results: A total of 167 young people (mean age 23.2, SD 4.0 years; n=95, 56.9% women and n=72, 43.1% men) who regularly smoked tobacco cigarettes (n=81, 48.5%), vaped electronic nicotine products (n=17, 10.2%), or used both (n=69, 41.3%) were recruited for participation in the program. Of these, 100 (59.9%) intended to stop smoking or vaping while 67 (40.1%) aimed at reducing their use. The participants actively engaged in an average of 5.5 (SD 3.5) of the 11 program weeks, the average number of interactions with the program was 26.8 (SD 26.1), and the average duration from the start of the program to the last interaction was 45.0 (SD 31.1) days. The follow-up survey at the end of the 11-week coaching program was completed by 108 (64.7%) participants. The generalized estimating equation (GEE) analyses revealed significant reductions in the mean number of days in the last 30 days on which tobacco cigarettes were used from 20.6 (SD 11.8) at baseline to 14.0 (SD 12.0) at post assessment (incidence rate ratio [IRR] 0.68, P<.001) and for electronic nicotine products from 11.1 1 (SD 13.1) days at baseline to 7.7 (SD 11.3) days at follow-up (IRR 0.71, P=.005). Overall, 6/108 (5.6%) participants in the follow-up survey stated that they neither consumed tobacco cigarettes nor electronic nicotine products in the last 30 days. Conclusions: The WhatsApp-based program appears to be a feasible, moderately accepted, and promising intervention for reducing the consumption of tobacco cigarettes and electronic nicotine products among young people. A larger-scale randomized controlled trial would be reasonable in order to make more substantiated statements about the program's efficacy.

This qualitative study investigated non-doping-related substance use among Swiss elite para-athletes, an area with limited existing research. Through in-depth semi-structured interviews conducted at the beginning of 2023 with 15 elite para-athletes (N=15) from diverse sports and language regions, the study explores athletes' perceptions and experiences of substance use, including both legal (alcohol, nicotine, supplements, medications) and illegal non-doping-related substances (illicit drugs). Overall, interviewed para-athletes reported low levels of non-doping-related substance use, but with differences related to on/off-season, sports, or time of the entrance in professional sports. The findings indicate a complex relationship between non-doping-related substance use and para-sports, highlighting both negative impacts on athletic performance and health, and the role of non-doping-related substances in coping with physical pain and stress. Professionalization and doping controls are seen to reduce non-doping-related substance use, promoting healthier lifestyles and heightened awareness of performance and health. The study underscored the need for comprehensive mental and physical health support systems and enhanced educational resources to address substance use within this vulnerable population. The insights gained aim to inform targeted interventions to support the health and well-being of para-athletes, contributing positively to their sporting careers and overall quality of life.

Delayed reward discounting (DRD) refers to the phenomenon where future rewards are perceived as less valuable compared to immediate rewards. The extent of this devaluation has been repeatedly linked to addictive behaviors. DRD could play an important role in the development and maintenance of problem gambling. We aim to better understand the relationship between DRD and problem gambling, examine temporal changes in DRD, and evaluate its predictive value for adherence. We conducted a secondary analysis of data from participants in the Win Back Control study (n = 345), a two-arm RCT that demonstrated effectiveness in reducing problematic gambling behavior. DRD was assessed using the Monetary Choice Questionnaire (MCQ), the severity of problem gambling was measured with the Problem Gambling Severity Index (PGSI), and gambling symptom severity was evaluated using the Gambling Symptom Assessment Scale (G-SAS). DRD is significantly positively associated with gambling symptom severity (G-SAS: b = 13.90, p = 0.002) and problem gambling severity (PGSI: b = 9.39, p < 0.001). DRD decreased significantly on a weekly basis over the three measurement time points (b = -0.001, p < 0.001). DRD could not be identified as a mediator, which should be further investigated in future studies. DRD is significantly positively associated with problem gambling severity and gambling symptom severity. DRD does not serve as a predictor of adherence. DRD decreases over the three time points along with severities of gambling behavior and gambling symptoms. However, the findings are correlational and may be affected by attrition bias.

Objective The scientific studies on the mental health and substance use among elite para-athletes are rare (Lardi et al., in preparation; Lüdi et al., 2023). However, the shows similarities as well as differences to the regular elite athletes’ populations (Rice et al., 2016; Swartz et al., 2019). The aim of this study was to investigate the mental health and substance use of para-athletes (PAs) from their perspective, in order to gain an overview of the situation in elite para-sport and to potentially create a basis for prevention campaigns and, if necessary, interventions. Methodology An online survey (SoSciSurvey) was used to create a questionnaire, which was translated into eight languages to reach PAs internationally. In addition to socio-demographic and sports-specific (Para-Sport, PS) variables, psychological and physical factors, as well as substance use, were assessed using standardized instruments. Results (CAVE: at the time at submission preliminary since the survey ends by the end of November/The final results will be presented at the congress): The PAs (N = 82) showed different prevalences regarding mental disorders compared to data from the general population and regular elite athletes, with disorder-specific deviations. There were significant gender differences in psychological distress (K-10, p < .001), depression severity (PHQ-9, p < .001), and anxiety severity (GAD-7, p < .001). The majority of PAs reported good or very good mental (69.51%) and physical (64.63%) health, and these results significantly correlated (p < .001) with a strong effect size. PAs were more likely to disclose and seek support in professional than in private settings. 51.22% of the PAs felt disadvantaged in everyday life, and in PS, it was 29.27%. The BA and K-10 did not correlate significantly (p > .05), but there was a significant correlation (p < .001) between discrimination in PS and the K-10. The results of discrimination in everyday life and in PS both significantly correlated with the WHODAS-12 (p < .01, and p < .001), with a weak and moderate effect size, respectively. Regarding substance use, 41.46% of PAs reported alcohol, 7.32% nicotine, and 8.54% cannabis use. The AUDIT-C did not significantly correlate with the K-10 or the WHODAS-12 (p > .05), and there was no significant gender difference (AUDIT-C, p > .05). Conclusions Based on the results, prevention should occur in the disorder-specific area and refer to the professional services, social support, focusing more on discrimination, and include substance use (alcohol and cannabis). It is important to consider that PAs are a vulnerable population and research gaps still exist. References Lardi, M., Kiselev, N., Imboden, C., Stoffel, O., Heiniger, A., & Schaub, M. (in preparation). Unveiling the shadows - Substance use among para-athletes: A qualitative study with Swiss elite para-athletes. Lüdi, L., Pfarrwaller, G., Imboden, C., Stoffel, O., Schlüssel, M., Heiniger, A., Kleim, B., & Kiselev, N. (2023). Perspectives on mental health and well-being: Voices of Swiss paralympic athletes. Sports Psychiatry: Journal of Sports and Exercise Psychiatry. Advance online publication. https://doi.org/10.1024/2674-0052/a000057 Rice, S. M., Purcell, R., De Silva, S., Mawren, D., McGorry, P. D., & Parker, A. G. (2016). The mental health of elite athletes: A narrative systematic review. Sports Medicine, 46, 1333-1353. https://doi.org/10.1007/s40279-016-0492-2 Swartz, L., Hunt, X., Bantjes, J., Hainline, B., & Reardon, C. L. (2019). Mental health symptoms and disorders in Paralympic athletes: A narrative review. British Journal of Sports Medicine, 53(12), 737-740. https://doi.org/10.1136/bjsports-2019-100731

BACKGROUND:Problematic drinking frequently co-occurs with depression among young adults, but often remains unaddressed in depression treatment. Evidence is insufficient on whether digital alcohol interventions can be effective in this young comorbid population. In a randomized controlled trial, we examined the effectiveness of Beating the Booze (BtB), an add-on digital alcohol intervention to complement depression treatment for young adults. METHODS:Participants were randomized to BtB + depression treatment as usual (BTB + TAU, n = 81) or TAU (n = 82). The primary outcome was treatment response, a combined measure for alcohol and depression after 6-month follow-up. Secondary outcomes were number of weekly drinks (Timeline Follow-back) and depressive symptoms (Center for Epidemiologic Studies Depression scale). Treatment response was analyzed using generalized linear modeling and secondary outcomes using robust linear mixed modeling. RESULTS:Low treatment response was found due to lower than expected depression remission rates. No statistically significant between-group effect was found for treatment response after 6-month follow-up (odds ratio 2.86, p = 0.089, 95% confidence interval [CI] 0.85-9.63). For our secondary outcomes, statistically significant larger reductions in weekly drinks were found in the intervention group after 3-month (B = -4.00, p = 0.009, 95% CI -6.97 to -1.02, d = 0.27) and 6-month follow-up (B = -3.20, p = 0.032, 95% CI -6.13 to -0.27, d = 0.23). We found no statistically significant between-group differences on depressive symptoms after 3-month (B = -0.57, p = 0.732, 95% CI -3.83 to 2.69) nor after 6-month follow-up (B = -0.44, p = 0.793, 95% CI -3.69 to 2.82). CONCLUSIONS:The add-on digital alcohol intervention was effective in reducing alcohol use, but not in reducing depressive symptoms and treatment response among young adults with co-occurring depressive disorders and problematic alcohol use. TRIAL REGISTRATION:Pre-registered on October 29, 2019 in the Overview of Medical Research in the Netherlands (OMON), formerly the Dutch Trial Register(https://onderzoekmetmensen.nl/en/trial/49219).

Abstract Background Alcohol misuse is common and causes substantial harm. Internet-delivered cognitive behaviour therapy (ICBT) is effective in reducing alcohol misuse; however, the literature investigating how treatment outcomes are impacted by patients’ preferences for therapist- versus self-guided ICBT for alcohol misuse is sparse. Methods In this preference trial, 74 eligible patients (who reported ≥ 14 drinks in the previous week and obtained scores suggesting hazardous or harmful drinking) chose between enrolling in either therapist- or self-guided ICBT for alcohol misuse. We investigated whether those who chose therapist- versus self-guided ICBT differed in their (a) drinking outcomes—as measured by Timeline Follow-Back (TLFB) and heavy drinking days (HDD) at post-treatment and 3-month follow-up—and (b) post-treatment ICBT engagement and satisfaction. Results The majority (81.1%) of eligible patients chose therapist-guided ICBT. These patients reported higher psychotropic medication use, drinking difficulties, and anxiety symptoms. For both the therapist- and self-guided patients, a modified intention-to-treat analysis revealed large within-group treatment effects for TLFB (β = − 2.64, SE 0.66; p < 0.001) and HDD (β = − 0.34, SE 0.07; p < 0.001), with large pre-to-post-treatment Cohen’s effect sizes of d = 0.97 (95% CI [0.49, 1.45]) for TLFB and d = 1.19 (95% CI [0.69, 1.68]) for HDD. The interaction comparing the effects of therapist- to self-guided ICBT over time was not significant for TLFB (p = 0.34) or HDD (p = 0.06). With treatment, for both therapist- and self-guided patients, there was a significant improvement in drinking difficulties, cravings, and confidence with controlling cravings, as well as in anxiety, depression, and functional impairment. Further, the majority (75.7%) of patients completed five or more lessons, as well as reported overall satisfaction with the treatment (88.9%) and increased confidence in managing their symptoms (86.7%); these outcomes also did not differ between therapist- and self-guided patients. Conclusions The current study shows that ICBT for alcohol misuse is associated with reduced drinking and comorbid mental health difficulties over time, irrespective of whether patients chose to complete the course on their own or with therapist guidance. Trial registration number: NCT04611854 ( https://clinicaltrials.gov/ct2/show/NCT04611854 ).

[Background] Research on cultural adaptation of psychological interventions indicates that a higher level of adaptation is associated with a higher effect size of the intervention. However, direct comparisons of different levels of adaptations are scarce. [Aims] This study used a smartphone-based self-help programme called Step-by-Step (Albanian: Hap-pas-Hapi) for the treatment of psychological distress among Albanian-speaking immigrants in Switzerland and Germany. Two levels of cultural adaptation (i.e., surface vs. deep structure adaptation) were compared. We hypothesised that the deep structure adaptation would enhance the acceptance and efficacy of the intervention. [Method] We conducted a two-arm, single-blind randomised controlled trial. Inclusion criteria were good command of the Albanian language, age above 18, and elevated psychological distress (Kessler Psychological Distress Scale score above 15). Primary outcome measures were the total score of the Hopkins Symptom Checklist and the number of participants who completed at least three (out of five) sessions. Secondary outcomes were global functioning, well-being, post-traumatic stress, and self-defined problems. [Results] Two-hundred-twenty-two participants were included, of which 18 (8%) completed the post-assessments. The number of participants who completed the third session was equal in both conditions, with N = 5 (5%) and N = 6 (6%) respectively. [Discussion] Drop-out rates were high in both conditions, and no group difference was found regarding the acceptance of the intervention. The high drop-out rate stands in contrast with other trials testing Step-by-Step. Future research should examine cultural factors impacting recruitment strategies, as insights could help to reduce participant drop-out rates in clinical trials.