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Coping skills mediate the effectiveness of Internet treatment for substance use disorders

December 1, 2016
Levesque, et al.
Levesque A, et al. Coping Strategies as a Mediator of Internet-Delivered Psychosocial Treatment: Secondary Analysis from a NIDA CTN Multisite Effectiveness Trial. Addictive Behaviors 2017 (in press).
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  • Coping strategies are a predictor of abstinence among patients with substance use disorders (SUD).
  • However, not much is known about the role they play in the effectiveness of the Community Reinforcement Approach (CRA), a treatment for SUD that aims to decrease the reinforcement value associated with substance use by developing alternative positively reinforcing social experiences.

To test the role of coping strategies as a mediator of treatment effectiveness, data from a 12-week randomized controlled trial assessing the effectiveness of the Therapeutic Education System (TES), an Internet-delivered version of the CRA combined with contingency management, was analyzed (read more about the original TES study, CTN-0044, here).

507 participants entering 10 outpatient addiction treatment programs received either treatment-as-usual (TAU), a counselor-driven therapy, or reduced TAU plus TES, wherein 2 hours of in-person, counselor-driven TAU per week were replaced by the Internet-delivered TES instead.

The average baseline coping strategies were not significantly different between the two study groups. But after 12 weeks of treatment, there was an overall increase in coping strategies scores, with higher scores found among participants assigned to the TES group compared to those in the TAU group. Additionally, higher coping strategies scores at week 12 were associated with an increased likelihood of abstinence during the last 4 weeks of treatment. 

Conclusions:  Results of this analysis support the importance of coping skills as a partial mediator of the effectiveness of an Internet-based version of CRA combined with contingency management.  CRA is an effective behavioral approach, but implementation is limited, often due to the resources required for proper training and delivery, barriers a standardized and web-based version could help address.  This study supports the promising role of Internet-assisted therapeutic approaches for substance use disorders and, most importantly, it provides additional evidence of the role of coping strategies as a mechanism of effective SUD treatment.

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