Computerized behavior therapy for opioid-dependent outpatients: A randomized controlled trial.

Abstract

The authors evaluated the efficacy of an interactive, computer-based behavioral therapy intervention, grounded in the community reinforcement approach (CRA) plus voucher-based contingency management model of behavior therapy. Our randomized, controlled trial was conducted at a university-based research clinic. Participants comprised 135 volunteer adult outpatients who met DSM-IV criteria for opioid dependence. All participants received maintenance treatment with buprenorphine and were randomly assigned to one of three treatments: (a) therapist-delivered CRA treatment with vouchers, (b) computer-assisted CRA treatment with vouchers, or (c) standard treatment. The therapist-delivered and computer-assisted CRA plus vouchers interventions produced comparable weeks of continuous opioid and cocaine abstinence (M = 7.98 and 7.78, respectively) and significantly greater weeks of abstinence than the standard intervention (M = 4.69; p < .05), yet participants in the computer-assisted CRA condition had over 80% of their intervention delivered by an interactive computer program. The comparable efficacy obtained with computer-assisted and therapist-delivered therapy may enable more widespread dissemination of the evidence-based CRA plus vouchers intervention in a manner that is cost-effective and ensures treatment fidelity.

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

“…[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.…”

Feasibility and effectiveness of computer-based therapy in community treatment

“…Web-based approaches have been demonstrated to be efficacious in the delivery of empirically supported nicotine cessation strategies (Glenn & Dallery, 2007;Shiffman, Paty, Rohay, Di Marino, & Gitchell, 2001;Strecher, Shiffman, & West, 2005), motivational enhancement strategies (Ondersma, Chase, Svikis, & Schuster, 2005;Ondersma, Svikis, & Schuster, 2007), moderation management (Hester, Squires, & Delaney, 2005;Squires & Hester, 2004), and HIV prevention strategies (Marsch & Bickel, 2004). In addition, three separate research groups have shown the benefit of using a computerized approach to behavioral therapies (Bickel, Marsch, Buchhalter, & Badger, 2008;Carroll et al, 2008;Kay-Lambkin, Baker, Lewin, & Carr, 2009).…”

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.…”

“…The Community Reinforcement Approach (CRA) is an efficacious treatment for alcohol and drug use disorders (Abbott, 2009;Bickel et al, 2008;Meyers et al, 2011;Roozen et al, 2004). This form of behavioral therapy aims to decrease the reinforcement value associated with substance use by developing alternative positively reinforcing social experiences (Budney et al, 1998).…”