Internet-Delivered Treatment for Substance Abuse: A Multisite Randomized Controlled Trial

Abstract

Objective Drug and alcohol abuse constitutes a major public health problem. Computer-delivered interventions have potential to improve access to quality care. The objective of this study was to evaluate the effectiveness of the Therapeutic Education System, 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 12-weeks of treatment-as-usual (n=252) or treatment-as-usual + Therapeutic Education System, whereby the intervention substituted for 2 hours of standard care per week (n=255). Therapeutic Education System consists of 62 computer-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. Primary outcomes were (1) abstinence from drugs and heavy drinking measured by twice weekly urine drug screens and self-report, and (2) time to drop-out from treatment. Results Compared to treatment-as-usual, those receiving Therapeutic Education System reduced dropout from treatment (Hazard Ratio=0.72 [95% CI, 0.57-0.92], P=.010), and increased abstinence (Odds Ratio=1.62 [95% CI: 1.12-2.35], P=.010), an effect that was more pronounced among patients with a positive urine drug and/or breath alcohol screen at the point of study entry (n=228) (Odds Ratio=2.18 [95% CI: 1.30-3.68], P=.003). Conclusion Internet-delivered interventions, such as Therapeutic Education System, have the potential to expand access and improve addiction treatment outcomes; additional research is needed to assess effectiveness in non-specialty clinical systems and to differentiate the effect of Community Reinforcement Approach and Contingency Management.

Recent Internet Use and Associations with Clinical Outcomes among Patients Entering Addiction Treatment Involved in a Web-Delivered Psychosocial Intervention Study

“…7,19 The study enrolled participants seeking treatment for illicit substance or alcohol use disorders at 10 community-based, outpatient addiction treatment programs in the USA between June 2010 and August 2011. Programs offered a minimum of two therapeutic group or individual sessions per week that lasted for at least 2 h.…”

“…5 Computer-and mobile-assisted web-based interventions are uniquely positioned to deliver complex, evidence-based behavioral interventions for the treatment of substance use disorders with high fidelity and minimal disruption to clinical work flow. [6][7][8][9] Webbased platforms streamline exposure to standardized behavior change and educational content within and beyond traditional clinical settings at the convenience and privacy of users. 6,7,10 Web-based psychosocial interventions have demonstrated efficacy, 11,12 and most recently in a national multi-site trial, effectiveness of the Therapeutic Education System (TES), grounded in the community reinforcement approach and including prizebased motivational incentives.…”

“…[6][7][8][9] Webbased platforms streamline exposure to standardized behavior change and educational content within and beyond traditional clinical settings at the convenience and privacy of users. 6,7,10 Web-based psychosocial interventions have demonstrated efficacy, 11,12 and most recently in a national multi-site trial, effectiveness of the Therapeutic Education System (TES), grounded in the community reinforcement approach and including prizebased motivational incentives. 7 As barriers to internet use are strongly patterned by demographic (e.g., older age, less education) and clinical (e.g., mental illness) characteristics, clarifying the representativeness of individuals willing to participate in an intervention (i.e., reach) is necessary.…”

“…6,7,10 Web-based psychosocial interventions have demonstrated efficacy, 11,12 and most recently in a national multi-site trial, effectiveness of the Therapeutic Education System (TES), grounded in the community reinforcement approach and including prizebased motivational incentives. 7 As barriers to internet use are strongly patterned by demographic (e.g., older age, less education) and clinical (e.g., mental illness) characteristics, clarifying the representativeness of individuals willing to participate in an intervention (i.e., reach) is necessary. [13][14][15][16] To date, evidence is lacking of actual reach for web-based interventions due to limited real-world trials.…”

Coping strategies as a mediator of internet-delivered psychosocial treatment: Secondary analysis from a NIDA CTN multisite effectiveness trial

“…Internet-delivered treatment represents an interesting alternative in CRA implementation as it effectively addresses traditional barriers to implementing standardized evidence-based behavioral treatments. Indeed, there is an emerging literature regarding the effectiveness of internet-delivered versions of evidence-based behavioral treatment (Bickel et al, 2008;Campbell et al, 2014;Carroll et al, 2008;Sugarman et al, 2010). However, less is known about the mechanism of effectiveness of computer-delivered interventions, or the extent to which such interventions engender coping skills.…”