Culturally Adapted, Web-Based Cognitive Behavioral Therapy for Spanish-Speaking Individuals With Substance Use Disorders: A Randomized Clinical Trial

Abstract

Objectives. To evaluate whether adding Web-based cognitive behavioral treatment (CBT) to standard outpatient psychiatric or addiction treatment improved substance use outcomes. Methods. We conducted a randomized clinical trial in New Haven, Connecticut, between 2014 and 2017 comparing 8 weeks of standard outpatient treatment to the same treatment with access to a culturally adapted version of Web-based CBT with a 6-month follow-up. Participants were 92 treatment-seeking individuals with Spanish as their primary language and current substance use disorder, with few other restrictions. Results. Treatment completion and data availability were high (98% of the randomized sample). For the primary outcome (change in frequency of primary substance used), there was a significant effect of treatment condition by time (t 1, 718 = −2.64; 95% confidence interval = −0.61, 0.09; P = .01), indicating significantly greater reductions for those assigned to Web CBT, which were durable through the 6-month follow-up. The knowledge test indicated significantly greater increases for those assigned to Web CBT. Conclusions. Adding a culturally adapted version of Web-based CBT to standard treatment improved substance use outcomes. Public Health Implications. This approach has high potential to address health disparities by providing an easily accessible, inexpensive form of evidence-based treatment to a range of Latinos with substance use disorders.

Lessons from the Transition to Relational Teletherapy During COVID‐19

“…Outcome studies indicate that teletherapy is a viable treatment option. It has good user satisfaction (Campos et al, 2018; Holmqvist, Vincent, & Walsh, 2014), has been used with diverse populations (Alavi, Hirii, Sutton, & Naeem, 2016; Paris et al, 2018; Slone, Reese, & McClellan, 2012) and presenting problems (Carlbring, Andersson, Cuijpers, Riper, & Hedman‐Lagerlöf, 2018; Pasarelu, Andersson, Nordgren, & Dobrean, 2017; Turgoose, Ashwick, & Murphy, 2018) and has been found to have outcomes similar to traditional face‐to‐face psychotherapy (Hilty, Ferrer, Parish, Johnston, Callahan, & Yellowlees, 2013).…”

Digital Mental Health for Alcohol and Substance Use Disorders

“…Paris et al [57] recruited 92 treatment-seeking individuals at an outpatient mental health center. They randomized the patients to either TAU consisting of weekly supportive counseling or TAU in combination with unguided internetbased CBT.…”

Computerized Cognitive Behavioral Therapy for Substance Use Disorders: A Summary of the Evidence and Potential Mechanisms of Behavior Change

“…Results from multiple well-controlled RCTs indicate CBT4CBT is efficacious at reducing rates of substance use when provided as an add-on to standard outpatient addiction treatment (Carroll et al, 2008;Carroll et al, 2014;Kiluk et al, 2016;Paris et al, 2018), as well as when provided as a virtual "stand-alone" with minimal clinical monitoring (Kiluk et al, 2016;Kiluk et al, 2018). Furthermore, evaluation of its mechanisms has revealed that individuals appear to increase the quality of their coping skills acquired during treatment, and this in part contributes to their abstinence from drugs and alcohol.…”

“…This is a population that experiences significant health disparities, with elevated rates of substance use and related problems, yet limited access to behavioral health treatments (Alegria, Alvarez, & Falgas-Bague, 2017;Guerrero, Marsh, Khachikian, Amaro, & Vega, 2013). Results from a randomized trial with 92 primary Spanish-speaking adults with current substance-use disorder conducted at outpatient facilities providing substance-use and mental-health services to Spanish-speaking clients, indicated those assigned to CBT4CBT-Spanish plus TAU demonstrated a greater reduction in the frequency of substance use during the 8-week trial compared to TAU only, with effects maintained through a 6-month follow-up (Paris et al, 2018).…”