Computer-based CBT for substance abuse may reduce barriers to treatment

Results of the first randomised clinical trial to evaluate computer-assisted treatment for substance use disorders suggest that this approach is an effective adjunct to standard outpatient treatment for substance dependence, and may help make CBT accessible to a broader range of patients. Cognitive behavioural therapy (CBT) has been shown to be an effective treatment option — on its own or as adjunctive therapy — across a broad range of psychiatric disorders. Yet, despite its good track record, it is seldom implemented for substance use disorders. Possible reasons include the limited availability and the cost of appropriately trained professionals in the delivery of CBT. Computer-assisted CBT is a cost-effective alternative method that has been shown to be effective in the treatment of depression and anxiety disorders; however, it has not been tested in the treatment of any addictions. Researchers Carroll et al. sought to evaluate the effectiveness of this approach among patients with substance dependence. A total of 77 individuals seeking outpatient treatment for substance dependence were included in the randomised clinical trial. They were assigned to 8 weeks of either standard therapy — consisting of weekly individual and group sessions of general drug counselling ¬— or standard treatment with biweekly access to computer-based training in CBT (CBT4CBT). The CBT4CBT program was designed so that it required no previous experience with computers and minimal use of text-based materials. Participants were assessed before treatment, twice weekly during treatment, and at the 8-week treatment end point. Participants’ self-reports of illegal drug use were verified with urine toxicology screens obtained at each assessment point. The primary outcome measures were the results of urine toxicology screens and the frequency of substance use. Twenty-two subjects in the CBT4CBT group and 26 in the treatment-as-usual group completed the study. Their results demonstrated that subjects in the CBT4CBT group submitted significantly more urine specimens that were negative for any type of drugs (34% versus 53%; p=0.05). They also demonstrated longer continuous periods of abstinence during treatment than their treatment-as-usual counterparts; however, the difference between groups for self-reported percentage days of abstinence for all illicit drugs and alcohol was not statistically significant. The researchers found that treatment involvement was found to be more closely tied to outcome in the CBT4CBT group than the treatment-as-usual group. “In the treatment-as-usual group, the indicators of baseline substance use severity tended to have higher correlations with outcome than the treatment-retention indicators, whereas the reverse held for the CBT4CBT condition, in which treatment involvement and completion of homework assignments had higher correlations,” the authors clarified. Importantly, the authors noted that CBT4CBT was well received by patients, stating that the CBT4CBT program was viewed as “highly engaging”. They concluded that the results of their trial provide strong biologically verified evidence that CBT4CBT can effectively reduce the number of drug-positive urine samples and provide longer periods of abstinence during treatment compared with the treatment-as-usual approach, among a sample of community-based, help-seeking substance abuse outpatients. Reference...