Efficacy of automated telephone continuing care following outpatient therapy for alcohol dependence

Abstract

Background Relapse rates following cognitive behavioral therapy (CBT) for alcohol dependence are high. Continuing care programs can prolong therapeutic effects but are underutilized. Thus there is need to explore options having greater accessibility. Methods This randomized controlled trial tested the efficacy of a novel, fully automated continuing care program, Alcohol Therapeutic Interactive Voice Response (ATIVR). ATIVR enables daily monitoring of alcohol consumption and associated variables, offers targeted feedback, and facilitates use of coping skills. Upon completing 12 weeks of group CBT for alcohol dependence, participants were randomly assigned to either four months of ATIVR (n=81) or usual care (n=77). Drinking behavior was assessed pre- and post-CBT, then at 2 weeks, 2 months, 4 months, and 12 months post-randomization. Results Drinking days per week increased over time for the control group but not the intervention group. There were no significant differences between groups on the other alcohol-related outcome measures. Comparisons on the subset of participants abstinent at the end of CBT (n=72) showed higher rates of continuous abstinence in the experimental group. Effect sizes for the other outcome variables were moderate but not significant in this subgroup. Conclusions For continuing care, ATIVR shows some promise as a tool that may help clients maintain gains achieved during outpatient treatment. However, ATIVR may not be adequate for clients who have not achieved treatment goals at the time of discharge.

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

“…On the basis of 10 RCTs, they found that, in comparison with strictly on-site interventions, psychological interventions were considerably more effective for a range of conditions when behavior changes between face-to-face sessions had been supported by a mobile component, such as short message service (SMS; d =0.27). There is also some evidence that telephone-based interventions may help maintain advances achieved during outpatient treatment or increase effectiveness of face-to-face interventions [ 86 , 87 ]. Nevertheless, more research is clearly needed to conclude whether the effectiveness of psychotherapy can potentially be increased by using blended treatments.…”

Customized recommendations and reminder text messages for automated, computer-based treatment during methadone.

“…ACBI interventions have advantages over standard clinic-based treatment and telehealth, including low cost, consistent intervention delivery, and widespread availability (Hall & Huber, 2000; Marsch & Dallery, 2012; Moore et al, 2013; Moore et al, 2011). Some of these automated systems can be used by patients for self-management in their own environment, potentially increasing use of coping skills at times of greater craving or high-risk situations and limiting reliance on patient memory and cognitive ability to implement these skills (Keoleian, Polcin, & Galloway, 2015; Lewis et al, 2012; Rose, Skelly, Badger, Ferraro, & Helzer, 2015). Despite these potential advantages, self-management systems often depend on a patient’s initiative and active engagement.…”

Interactive voice response interventions targeting behaviour change: a systematic literature review

“…The system was described as an IVR system in nine studies 25 31 33 35-38 41 43 and as an Alcohol Therapeutic IVR in one study. 39 Other names used were automated Telephone Linked Computer system, 40 Telephone-Linked Care 42 and automated telephone calls. 32 34 The IVR delivery mode was quite variable in structure and interaction with the participant.…”

“…An interesting feature of some of the IVR interventions was the use of culturally sensitive voices (eg, 25 42 ) or prerecorded messages of their therapist's voice to increase acceptability of the intervention. 39 Furthermore, another study provided participants with the opportunity to choose the gender and language of the voice delivering the IVR intervention. 34 These features of the delivery mode could have influenced engagement with the intervention and potentially impacted on its effectiveness.…”