Technology-assisted care (TAC), including computerized applications delivering evidence-based practices for substance use disorders (SUD), is likely to be a major player in the integration of SUD services with primary care, thanks to its transferability between an array of clinical settings, its standardization, and its promising efficacy.
A NIDA National Drug Abuse Treatment Clinical Trials Network study (CTN-0044) examined the effectiveness of the Therapeutic Education System, an interactive, web-based behavioral intervention that uses the Community Reinforcement Approach and motivational incentives.
In the study, TES was used as a “clinical extender,” with men and women in outpatient treatment receiving either 12 weeks of treatment as usual (TAU), or 12 weeks of TAU with TES replacing 2 hours of standard care per week.
Compared with patients in the treatment-as-usual group, those in the TES group had a lower dropout rate and a greater abstinence rate. Though this effect was not sustained at longer-term follow-up, researchers note this could be due to diminishing effects of contingency management after the contingencies end, or simply because of the need for ongoing monitoring and treatment due to the chronic nature of addiction (1).
Counselors involved in one of the participating community treatment programs in the trial reported that, compared to their clients in the TAU-only group, clients in the TES group appeared to be more motivated in other forms of treatment, shared new insights, and asked more advanced questions. This effect helped reduce those counselors’ initial skepticism of the utility of a computer program as an adjunct to usual care (2).
Two secondary studies based on the data collected in CTN-0044 have added more information to the science supporting its usefulness. The first looked specifically at whether TES was more accepted by or effective for men versus women, and found gender had no impact on either element, suggesting that men and women derive similar benefits from participating in a computer-assisted intervention (3).
The second study examined whether a participant’s self-identified primary drug of abuse had any impact on the effectiveness of TES: does it work better for some substances than others? Analysis found that TES was most effective for primary stimulant users. Alcohol and cannabis users in the TES group also exhibited higher rates of abstinence compared to those in the TAU-only group, though the difference was not as significant as it was for stimulant users. Abstinence among primary opioid users, however, was not improved by TES (4). This information may help providers when making decisions about whether or not to include TES in their care plan for individual clients.
Outside of the CTN, additional research on TES has continued to support its utility in SUD treatment, and additional technology-assisted care models have also been developed and appear promising, such as the Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT) intervention.
In 2014, a NIDA/SAMSHA Blending Team developed “Technology-Assisted Care for Substance Use Disorders (SUDTECH),” a Blending Product that consists of an online resource hub providing access to the public for information, trainings, and tools related to technology-assisted care for substance use disorders.
The website features information on a number of interventions, including TES and CBT4CBT, along with videos, training curricula, and resources for implementation. Read more about the SUDTECH product and find links to its website, as well as to other Blending Products, in the CTN Dissemination Library: http://ctndisseminationlibrary.org/display/1074.htm
Technology-assisted care has the potential to expand access to SUD treatment services in a variety of settings, and help bridge the gap between the enormous need for evidence-based treatments for addiction and the capacity of the treatment system to deliver. As integration of SUD services into other clinical settings (mental health, primary care, e.g.) expands, the ability to offer standardized, effective treatment despite limited resources or training, will be particularly beneficial.
Articles were written based on the following published research:
1. Campbell ANC, et al. Internet-delivered treatment for substance abuse: A multisite randomized controlled trial. Am J Psychiatry 2014;171:683-690. http://ctndisseminationlibrary.org/display/1056.htm 2. Abraham S, et al. The Therapeutic Education System: Client and staff experiences of participating in a randomized trial of an online drug education system. Counselor 2013;14(4):44-47. http://ctndisseminationlibrary.org/display/1015.htm 3. Campbell ANC, et al. Gender-based outcomes and acceptability of a computer-assisted psychosocial intervention for substance use disorders. J Subst Abust Treat 2015;53:9-15. http://ctndisseminationlibrary.org/display/1115.htm 4. Cochran G, et al. Web-based treatment for substance use disorders: Differential effects by primary substance. Addict Behav 2015;45:191-194. http://ctndisseminationlibrary.org/display/1123.htm