Internet-delivered Treatment for Substance Abuse: a Multisite Randomized Controlled Trial

Overview

Journal Am J Psychiatry

Specialty Psychiatry

Date 2014 Apr 5

PMID 24700332

Citations 139

Authors

Aimee N C Campbell

Edward V Nunes

Abigail G Matthews

Maxine Stitzer

Gloria M Miele

Daniel Polsky

Eva Turrigiano

Scott Walters

Erin A McClure

Tiffany L Kyle

Aimee Wahle

Paul Van Veldhuisen

Bruce Goldman

Dean Babcock

Patricia Quinn Stabile

Theresa Winhusen

Udi E Ghitza

Affiliations

Soon will be listed here.

Abstract

Objective: Computer-delivered interventions have the potential to improve access to quality addiction treatment care. The objective of this study was to evaluate the effectiveness of the Therapeutic Education System (TES), an Internet-delivered behavioral intervention that includes motivational incentives, as a clinician-extender in the treatment of substance use disorders.

Method: Adult men and women (N=507) entering 10 outpatient addiction treatment programs were randomly assigned to receive 12 weeks of either treatment as usual (N=252) or treatment as usual plus TES, with the intervention substituting for about 2 hours of standard care per week (N=255). TES consists of 62 computerized interactive modules covering skills for achieving and maintaining abstinence, plus prize-based motivational incentives contingent on abstinence and treatment adherence. Treatment as usual consisted of individual and group counseling at the participating programs. The primary outcome measures were abstinence from drugs and heavy drinking (measured by twice-weekly urine drug screens and self-report) and time to dropout from treatment.

Results: Compared with patients in the treatment-as-usual group, those in the TES group had a lower dropout rate (hazard ratio=0.72, 95% CI=0.57, 0.92) and a greater abstinence rate (odds ratio=1.62, 95% CI=1.12, 2.35). This effect was more pronounced among patients who had a positive urine drug or breath alcohol screen at study entry (N=228) (odds ratio=2.18, 95% CI=1.30, 3.68).

Conclusions: Internet-delivered interventions such as TES have the potential to expand access and improve addiction treatment outcomes. Additional research is needed to assess effectiveness in non-specialty clinical settings and to differentiate the effects of the community reinforcement approach and contingency management components of TES.

Citing Articles

What smartphone apps exist to support recovery from opioid use disorder? A content analysis of publicly available opioid-related smartphone apps.

Williamson A, Heydarshahi B, Finley-Abboud D, Massac L, Jacobson L, Christophe N Addict Sci Clin Pract. 2025; 20(1):26.

PMID: 40075426 PMC: 11905484. DOI: 10.1186/s13722-025-00549-y.

Application of Causal Forest Model to Examine Treatment Effect Heterogeneity in Substance Use Disorder Psychosocial Treatments.

Susukida R, Amin-Esmaeili M, Badillo-Goicoechea E, Nguyen T, Stuart E, Rosenblum M Int J Methods Psychiatr Res. 2024; 34(1):e70011.

PMID: 39729473 PMC: 11675088. DOI: 10.1002/mpr.70011.

Use of Digital Health and Digital Therapeutics to Treat SUD in Criminal Justice Settings: a Review.

Sawyer-Morris G, Wilde J, Molfenter T, Taxman F Curr Addict Rep. 2024; 11(1):149-162.

PMID: 39676893 PMC: 11643629. DOI: 10.1007/s40429-023-00523-1.

Formative evaluation of the implementation of digital therapeutics for opioids and other substance use disorders in primary care (DIGITS trial).

Palazzo L, Dorsey C, Mogk J, Beatty T, King D, Stefanik-Guizlo K Implement Res Pract. 2024; 5:26334895241301670.

PMID: 39676816 PMC: 11639013. DOI: 10.1177/26334895241301670.

Drug Overdose Death among Residents of Urban Census Tracts: How Granular Geographical Analyses Uncover Socioenvironmental Correlates in Cuyahoga County, Ohio.

McMaster R, Masarweh-Zawahri L, Flynn K, Deo V, Flannery D J Urban Health. 2024; .

PMID: 39627444 DOI: 10.1007/s11524-024-00939-8.

References

McLellan A, Carise D, Kleber H . Can the national addiction treatment infrastructure support the public's demand for quality care?. J Subst Abuse Treat. 2003; 25(2):117-21. View

Kampman K, Volpicelli J, Mulvaney F, Rukstalis M, Alterman A, Pettinati H . Cocaine withdrawal severity and urine toxicology results from treatment entry predict outcome in medication trials for cocaine dependence. Addict Behav. 2002; 27(2):251-60. DOI: 10.1016/s0306-4603(01)00171-x. View

Kay-Lambkin F, Baker A, Lewin T, Carr V . Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacy. Addiction. 2009; 104(3):378-88. DOI: 10.1111/j.1360-0443.2008.02444.x. View

Kiluk B, Sugarman D, Nich C, Gibbons C, Martino S, Rounsaville B . A methodological analysis of randomized clinical trials of computer-assisted therapies for psychiatric disorders: toward improved standards for an emerging field. Am J Psychiatry. 2011; 168(8):790-9. PMC: 3607199. DOI: 10.1176/appi.ajp.2011.10101443. View

Magill M, Ray L . Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. J Stud Alcohol Drugs. 2009; 70(4):516-27. PMC: 2696292. DOI: 10.15288/jsad.2009.70.516. View

McLellan A . Have we evaluated addiction treatment correctly? Implications from a chronic care perspective. Addiction. 2002; 97(3):249-52. DOI: 10.1046/j.1360-0443.2002.00127.x. View

Bewick B, Trusler K, Barkham M, Hill A, Cahill J, Mulhern B . The effectiveness of web-based interventions designed to decrease alcohol consumption--a systematic review. Prev Med. 2008; 47(1):17-26. DOI: 10.1016/j.ypmed.2008.01.005. View

Carroll K, Ball S, Martino S, Nich C, Babuscio T, Rounsaville B . Enduring effects of a computer-assisted training program for cognitive behavioral therapy: a 6-month follow-up of CBT4CBT. Drug Alcohol Depend. 2008; 100(1-2):178-81. PMC: 2742309. DOI: 10.1016/j.drugalcdep.2008.09.015. View

Martino S, Ball S, Nich C, Frankforter T, Carroll K . Informal discussions in substance abuse treatment sessions. J Subst Abuse Treat. 2008; 36(4):366-75. PMC: 2705985. DOI: 10.1016/j.jsat.2008.08.003. View

10.

Carroll K, Rounsaville B . Computer-assisted therapy in psychiatry: be brave-it's a new world. Curr Psychiatry Rep. 2010; 12(5):426-32. PMC: 2967758. DOI: 10.1007/s11920-010-0146-2. View

11.

Nunes E, Ball S, Booth R, Brigham G, Calsyn D, Carroll K . Multisite effectiveness trials of treatments for substance abuse and co-occurring problems: have we chosen the best designs?. J Subst Abuse Treat. 2010; 38 Suppl 1:S97-112. PMC: 2909698. DOI: 10.1016/j.jsat.2010.01.012. View

12.

Nunes E, Pavlicova M, Hu M, Campbell A, Miele G, Hien D . Baseline matters: the importance of covariation for baseline severity in the analysis of clinical trials. Am J Drug Alcohol Abuse. 2011; 37(5):446-52. PMC: 3260520. DOI: 10.3109/00952990.2011.596980. View

13.

Higgins S, Sigmon S, Wong C, Heil S, Badger G, Donham R . Community reinforcement therapy for cocaine-dependent outpatients. Arch Gen Psychiatry. 2003; 60(10):1043-52. DOI: 10.1001/archpsyc.60.9.1043. View

14.

Chaple M, Sacks S, McKendrick K, Marsch L, Belenko S, Leukefeld C . Feasibility of a computerized intervention for offenders with substance use disorders: a research note. J Exp Criminol. 2014; 10:105-127. PMC: 3945711. DOI: 10.1007/s11292-013-9187-y. View

15.

Campbell A, Nunes E, McClure E, Hu M, Turrigiano E, Goldman B . Characteristics of an outpatient treatment sample by primary substance of abuse. J Addict Med. 2013; 7(5):363-71. PMC: 3790139. DOI: 10.1097/ADM.0b013e31829e3971. View

16.

Bickel W, Marsch L, Buchhalter A, Badger G . Computerized behavior therapy for opioid-dependent outpatients: a randomized controlled trial. Exp Clin Psychopharmacol. 2008; 16(2):132-43. PMC: 2746734. DOI: 10.1037/1064-1297.16.2.132. View

17.

Buck J . The looming expansion and transformation of public substance abuse treatment under the Affordable Care Act. Health Aff (Millwood). 2011; 30(8):1402-10. DOI: 10.1377/hlthaff.2011.0480. View

18.

Marsch L, Guarino H, Acosta M, Aponte-Melendez Y, Cleland C, Grabinski M . Web-based behavioral treatment for substance use disorders as a partial replacement of standard methadone maintenance treatment. J Subst Abuse Treat. 2013; 46(1):43-51. PMC: 3839618. DOI: 10.1016/j.jsat.2013.08.012. View

19.

Higgins S, Budney A, Bickel W, Foerg F, Donham R, Badger G . Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. Arch Gen Psychiatry. 1994; 51(7):568-76. DOI: 10.1001/archpsyc.1994.03950070060011. View

20.

Roozen H, Boulogne J, Van Tulder M, van den Brink W, de Jong C, Kerkhof A . A systematic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction. Drug Alcohol Depend. 2004; 74(1):1-13. DOI: 10.1016/j.drugalcdep.2003.12.006. View