Randomized Trial of Computerized Cognitive Behavioral Therapy for Alcohol Use Disorders: Efficacy as a Virtual Stand‐Alone and Treatment Add‐On Compared with Standard Outpatient Treatment

Kiluk, Brian D.; Devore, Kathleen A.; Buck, Matthew; Nich, Charla; Frankforter, Tami L.; LaPaglia, Donna; Yates, Brian T.; Gordon, Melissa A; Carroll, Kathleen M.

doi:10.1111/acer.13162

Cited by 77 publications

(83 citation statements)

References 46 publications

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“…Moreover, treatment adherence and exposure to these programs varied. For instance, among those assigned to the specific CBT Tech intervention being evaluated, Riper and colleagues () reported only 45% actually accessed it, whereas Cunningham () reported 71%, and Kiluk and colleagues () reported 100% accessed the program at least once, respectively. It should be noted that because many CBT Tech programs are available 24 h/7 d/wk and individuals are encouraged to access the material as frequently as desired, there is often no a priori intended length of exposure reported.…”

Section: Discussionmentioning

confidence: 99%

Technology‐Delivered Cognitive‐Behavioral Interventions for Alcohol Use: A Meta‐Analysis

Kiluk

Ray

Walthers

et al. 2019

Alcoholism Clin & Exp Res

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Background: Cognitive-behavioral therapy (CBT) has long-standing evidence for efficacy in the treatment of alcohol use, yet implementation in clinical practice has been challenging. Delivery of CBT through technology-based platforms, such as web-based programs and mobile applications, has the potential to provide widespread access to this evidence-based intervention. While there have been reviews indicating the efficacy of technology-based delivery of CBT for various psychiatric conditions, none have focused on efficacy for alcohol use. The current meta-analysis was conducted to fill this research gap.Methods: Descriptive data were used to characterize the nature of the literature on technology-delivered, CBT-based interventions for alcohol use ("CBT Tech"). Inverse-variance-weighted effect sizes were calculated, and random effects, effect sizes were pooled in 4 subgroups.Results: Fifteen published trials conducted primarily with at-risk or heavy drinkers were identified. Of these studies, 60% explicitly targeted alcohol use moderation. The content of CBT Tech programs varied, ranging from 4 to 62 sessions/exercises, with many programs combining elements of motivational interviewing (47%). With respect to efficacy, CBT Tech as a stand-alone treatment in contrast to a minimal treatment control showed a positive and statistically significant, albeit small effect (g = 0.20: 95% CI = 0.22, 0.38, k es = 5). When CBT Tech was compared to treatment as usual (TAU), effects were nonsignificant. However, when CBT Tech was tested as an addition to TAU, in contrast to TAU only, the effect size was positive, significant (g = 0.30: 95% CI = 0.10, 0.50, k es = 7), and stable over 12-month follow-up. Only 2 studies compared CBT Tech to in-person CBT, and this pooled effect size did not suggest superior efficacy.Conclusions: These results show a benefit for technology-delivered, CBT-based interventions as a stand-alone therapy for heavy drinking or as an addition to usual care in specialty substance use settings.

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Section: Discussionmentioning

confidence: 99%

Technology‐Delivered Cognitive‐Behavioral Interventions for Alcohol Use: A Meta‐Analysis

Kiluk

Ray

Walthers

et al. 2019

Alcoholism Clin & Exp Res

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“…Among the 18 integrated blended interventions with face-to-face focus, seven aimed at delegating some elements of face-to-face therapy to Internet-based cognitive behavioral therapy (iCBT) and thereby, saving clinician time and reducing overall costs [ 15 , 51 , 54 , 58 , 62 , 69 , 75 ]. Nine of them aimed at supporting face-to-face therapy by delivering additional Internet elements and thereby increasing effectiveness of face-to-face psychotherapy [ 23 - 25 , 37 , 40 , 55 , 60 , 61 , 77 , 78 ]. Two studies stated as their aim integrating Internet elements with face-to-face psychotherapy to establish a proactive and long-term approach to the management of chronic conditions, thus providing long-term support for patients with chronic or recurrent mental diseases beyond the acute phase of face-to-face treatment [ 59 , 68 ].…”

Section: Resultsmentioning

confidence: 99%

Blending Face-to-Face and Internet-Based Interventions for the Treatment of Mental Disorders in Adults: Systematic Review

Erbe¹,

Eichert²,

Riper³

et al. 2017

J Med Internet Res

429

377

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BackgroundMany studies have provided evidence for the effectiveness of Internet-based stand-alone interventions for mental disorders. A newer form of intervention combines the strengths of face-to-face (f2f) and Internet approaches (blended interventions).ObjectiveThe aim of this review was to provide an overview of (1) the different formats of blended treatments for adults, (2) the stage of treatment in which these are applied, (3) their objective in combining face-to-face and Internet-based approaches, and (4) their effectiveness.MethodsStudies on blended concepts were identified through systematic searches in the MEDLINE, PsycINFO, Cochrane, and PubMed databases. Keywords included terms indicating face-to-face interventions (“inpatient,” “outpatient,” “face-to-face,” or “residential treatment”), which were combined with terms indicating Internet treatment (“internet,” “online,” or “web”) and terms indicating mental disorders (“mental health,” “depression,” “anxiety,” or “substance abuse”). We focused on three of the most common mental disorders (depression, anxiety, and substance abuse).ResultsWe identified 64 publications describing 44 studies, 27 of which were randomized controlled trials (RCTs). Results suggest that, compared with stand-alone face-to-face therapy, blended therapy may save clinician time, lead to lower dropout rates and greater abstinence rates of patients with substance abuse, or help maintain initially achieved changes within psychotherapy in the long-term effects of inpatient therapy. However, there is a lack of comparative outcome studies investigating the superiority of the outcomes of blended treatments in comparison with classic face-to-face or Internet-based treatments, as well as of studies identifying the optimal ratio of face-to-face and Internet sessions.ConclusionsSeveral studies have shown that, for common mental health disorders, blended interventions are feasible and can be more effective compared with no treatment controls. However, more RCTs on effectiveness and cost-effectiveness of blended treatments, especially compared with nonblended treatments are necessary.

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“…The included studies from the last three years seem to more often investigate digital interventions as add-on compared to an active control group, but they still are mostly unguided. Seven studies investigated guided interventions, of which four focused on alcohol [33,[35][36][37], two on polysubstance interventions [51,55], and one on psychostimulants [59]. Furthermore, the literature on psychostimulants and opioid interventions is still scarce, with only one study focusing on psychostimulant use, a guided add-on intervention compared to an active control group, and none focusing on opioids.…”

Section: Discussionmentioning

confidence: 99%

“…Digital CBT interventions have not been previously evaluated in a clinical population with alcohol use disorder (AUD). Kiluk et al [35] recruited 68 treatment-seeking individuals with an AUD (according to DSM-IV criteria for alcohol abuse or dependence) from an outpatient addiction facility. Patients were randomized to (a) TAU-only or individual psychotherapy, (b) a computer-based intervention combined with TAU delivered in the outpatient facility, or (c) a computer-based intervention delivered in the outpatient facility in combination with brief weekly clinical monitoring.…”

Section: Cognitive Behavioral Therapymentioning

confidence: 99%

Digital Mental Health for Alcohol and Substance Use Disorders

Boumparis

Schulte

Riper

2019

Curr Treat Options Psych

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Purpose Only about 20% of people suffering from substance use disorders access available treatments due to various obstacles; digital interventions could potentially overcome some of these. Meta-analyses suggest the strongest evidence for interventions targeting alcohol use reduction, followed by cannabis and illicit substances. However, most randomized controlled trials (RCTs) used unguided standalone interventions compared to non-active controls, with limited follow-up periods and disregarded comorbidity. This review examines the literature published over the last three years (2016-2019), with a focus on recent RCTs and whether they addressed some of these gaps. Recent findings Except for digital interventions targeting alcohol use, the number of RCTs in the last three years is limited. Although there is considerable heterogeneity between the studies, most of them applied unguided add-on interventions compared to active control groups, and a limited number investigated guided interventions. In addition, there is a need for longer follow-up periods, active rather than non-active control groups, outcome standardization, and increased focus on comorbidity. Summary Although the number of studies using guided add-on or blended interventions compared to active controls has increased, future studies should consider our identified gaps and suggestions to further strengthen the evidence of digital interventions for reducing the use of alcohol and other substances.

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Randomized Trial of Computerized Cognitive Behavioral Therapy for Alcohol Use Disorders: Efficacy as a Virtual Stand‐Alone and Treatment Add‐On Compared with Standard Outpatient Treatment

Cited by 77 publications

References 46 publications

Technology‐Delivered Cognitive‐Behavioral Interventions for Alcohol Use: A Meta‐Analysis

Technology‐Delivered Cognitive‐Behavioral Interventions for Alcohol Use: A Meta‐Analysis

Blending Face-to-Face and Internet-Based Interventions for the Treatment of Mental Disorders in Adults: Systematic Review

Digital Mental Health for Alcohol and Substance Use Disorders

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