Recent internet use and associations with clinical outcomes among patients entering addiction treatment involved in a web-delivered psychosocial intervention study.
The acceptability and clinical impact of a web-based intervention among patients entering addiction treatment who lack recent internet access are unclear. This secondary analysis of a national multisite treatment study (CTN-0044) assessed for acceptability and clinical impact of a web-based psychosocial intervention among participants enrolling in community-based, outpatient addiction treatment programs. Participants were randomly assigned to 12 weeks of a web-based therapeutic education system (TES) based on the community reinforcement approach plus contingency management versus treatment as usual (TAU).
Demographic and clinical characteristics and treatment outcomes were compared among participants with recent internet access in the 90 days preceding enrollment (N=374) and without internet access (N=133). Primary outcome variables included (1) acceptability of TES (i.e., module completion, acceptability of web-based intervention) and (2) clinical impact (i.e., self-reported abstinence confirmed by urine drug/breath alcohol tests, retention measured as time to dropout).
Internet use was common (74%) and was more likely among younger (18-49 year old) participants and those who completed high school (p<.001). Participants randomized to TES (n=255) without baseline internet access rated the acceptability of TES modules significantly higher than those with internet access (t=2.49, df=218, p=.01). There was a near significant interaction between treatment, baseline abstinence, and internet access on time to dropout. TES was associated with better retention among participants not abstinent at baseline who had internet access.
Conclusions: This study explores the association between internet access and demographic and clinical outcomes among a national multi-site sample of patients entering community-based, outpatient addiction treatment. Overall, the data are encouraging for the potential to use technology-based interventions among diverse outpatient addiction treatment populations. Rates of internet access (in the 90 days prior to enrollment) (74%) were similar to the general population (79%). Further, there was high acceptability of the web-based intervention, especially among participants reporting no recent internet access. Findings also suggest that a lack of recent internet access was not associated with abstinence or retention outcomes. Expanding the capacity of publicly funded community-based addiction treatment programs with acceptable evidence-based health information technologies is imperative. The suitability of providing access and training to web-based interventions within clinics may mitigate barriers to access among vulnerable populations lacking remote internet access.
Related protocols: CTN-0044