Technology-assisted Care for Substance Use Disorders
Wendy Hausotter, MPH
“Science and technology multiply around us. To an increasing extent they dictate the languages in which we speak and think. Either we use those languages, or we remain mute.” ― J.G. Ballard
The innovative collaboration between NIDA and SAMHSA, known as the “Blending Initiative,” has once again produced cutting-edge information and tools for behavioral health practitioners—the latest focusing on technology-assisted care for substance use disorders. This article highlights some of the information and tools available on the new blending “product,” a resource hub called SUDTECH.ORG.
What does technology-assisted care mean? Basically, it is adding technology-based elements to a practitioners “toolkit” as a supplement and complement to their treatment repertoire. Technology-based care is a rapidly evolving field and can take many different forms and formats, including audio, video, animations and/or other forms of multimedia; may use information from medical records or physiological data capture devices, etc.; and may be interactively customized, or tailored, to an individual user’s needs (Aronson, Marsch, & Acosta, 2013). How often is technology used to deliver psychotherapy or behavioral treatment to patients? To date, more than 100 different computer-assisted therapy programs have been developed for a range of mental disorders and behavioral health problems (Klein et al., 2012; Moore et al., 2011). Treatment practices administered via technology-based interventions include: Cognitive Behavioral Therapy, Community Reinforcement Approach (CRA), Contingency Management, Motivational Enhancement, Motivational Interviewing, Screening, Brief Intervention and Relapse Prevention.
Technology-assisted care has applications in many settings and can be viewed in many ways; for example, as part of brief intervention—particularly in settings where SUD treatment services are limited (e.g., primary care settings)—and as a “clinician extender,” i.e., when used as an adjunct to treatment whereby clinicians “prescribe” it to enhance therapeutic intervention. The good news is that, in general, technology-based behavioral health interventions have been shown to be well accepted, efficacious, and cost effective, especially when compared to standard care (Aronson, Marsch, and Acosta, 2013).
What are the potential benefits of technology-assisted care?
Aside from the obvious benefit of helping to close the treatment gap (19.3 million people needed but did not receive treatment for illicit drug or alcohol use—SAMHSA, 2011), current research on this topic suggests that technology-assisted care has specific benefits for clients and treatment providers. Technology-assisted care:
The benefits for treatment providers, based on current research, include:
(Moyer & Finney, 2004/2005; Fotheringham et al., 2000)
Two examples of technology-assisted care models and outcomes
Therapeutic Education System (TES) is an interactive, web-based psychosocial intervention for SUDs grounded in: Community Reinforcement Approach (CRA), Cognitive Behavioral Therapy (CBT), and Contingency Management (CM). The specific features of TES include:
A NIDA Clinical Trials Network’s multi-site trial evaluated the effectiveness of TES. The trial involved 10 sites and 507 participants and showed the following (Campbell et al 2014):
Findings from other studies include:
Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT) is a web-based program that teaches a variety of skills to help people reduce substance abuse. Training lessons include understanding patterns of substance use, learning to recognize and deal with craving, addressing thoughts about substance use that can set a person up to use, how to effectively say ‘No’ to offers of alcohol or drugs, and how to be more aware of patterns of thinking and decision making that can lead to drug use. The seven training modules use a range of formats and techniques including graphic illustrations, games, videotaped examples, questions to consider, verbal instructions, audio voiceovers, interactive assessments, and practice exercises. The overall approach is to make the experience engaging and interactive. Each module or content area takes about one hour to complete and users typically complete one module per week. Users can choose the order of topics they wish, and work at their own pace for completion.
Outcomes for CBT4CBT include (Carroll et al., 2008; 2009; 2011; 2014; Olmstead, Ostrow, & Carroll, 2010) a randomized controlled trial of 77 individuals seeking outpatient treatment:
In a randomized controlled trial of 101 cocaine-dependent individuals maintained on methadone, participants:
Promising technology-assisted treatments exist for alcohol, tobacco, gambling, and illicit substance use. Moving forward, it behooves clinicians and administrators to think through how they can use these new technologies in clinical treatment. Now and in the future, behavioral health professionals have the opportunity to “view technology as a powerful partner in improving quality and productivity of behavioral healthcare” (Marsch & Gustafson, 2013). The resources below can help you move along that path.
Technology-Assisted Care for Substance Use Disorders website http://sudtech.org/ This site is a collaborative “Blending” product from the NIDA/SAMHSA Blending Initiative that provides information, videos, training, and other resource information for implementing technology assisted treatments/care to improve the quality and reach of treatment services for persons with substance use disorders. The site includes curricula, research studies and links, video interviews with practitioners who use technology-assisted care, information on administrative and other considerations for implementing this type of approach, program models, and much more.
The 2014 Addiction Treatment Technology Summit will be held in Chicago, Illinois on August 26-27, 2014. Hosted by the National Frontier and Rural ATTC, the goal of the summit is to increase knowledge and awareness regarding technology-based substance use disorder interventions to promote the utilization of telehealth technologies in delivering addiction treatment and recovery services. Leading addiction treatment researchers will present their findings on technology-based interventions to addiction treatment providers, followed by breakout discussion groups regarding implementation strategies. Registration is free.
The National Frontier and Rurall ATTC sponsors Telehealth Tuesdays
There will also be a Treatment Improvement Protocol (TIP) on this topic (Using Technology-Based Therapeutic Tools in Behavioral Health Services) coming in the near future.