CTN-0044: Web-Delivery of Evidence-Based, Psychosocial Treatment for Substance Use Disorders

Edward V. Nunes, MD
Lead Investigator
Columbia University and New York State Psychiatric Hospital
nunesed@pi.cpmc.columbia.edu

The purpose of this study is to evaluate the effectiveness of including an interactive, web-based version of the Community Reinforcement Approach (CRA) intervention plus incentives targeting drug abstinence and treatment participation as part of community-based, outpatient substance abuse treatment. The trial will randomize individuals entering outpatient treatment for substance use disorders to receive 12 weeks of either: (1) Treatment as Usual (TAU), reflecting standard treatment at the outpatient programs in which participants are enrolled, or (2) a modification of TAU which includes access to the Therapeutic Education System (TES), a computerized psychosocial intervention which combines skills building modules based on the Community Reinforcement Approach (CRA) with incentives contingent primarily upon abstinence from drugs of abuse and, secondarily, upon completion of TES modules. The primary outcome measure is drug abstinence during active treatment (as measured via urine testing and confirmed via self-report), and the study will also evaluate if improved outcomes are maintained at 3 and 6 months post-intervention. Additionally, the study will perform a comprehensive economic analysis of adding TES to TAU.

Primary Findings

Compared with patients in the treatment-as-usual group, those in the Therapeutic Education System (TES) group had a lower dropout rate and a greater abstinence rate. This effect was more pronounced among patients who had a positive urine drug or breath alcohol screen at study entry (N=228). These results demonstrate the potential internet-delivered interventions like TES have to help bridge the gap between the enormous need for high-quality evidence-based treatment for addiction and the capacity of the treatment system to deliver.

Primary Outcomes Article: Campbell ANC, et al. Internet-Delivered Treatment for Substance Abuse: A Multisite Randomized Controlled Trial. American Journal of Psychiatry 2014;171:683-690. [get article]