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Lack of Recent Internet Access Does Not Impact Outcomes for Online SUD Treatment Interventions

January 11, 2016
Tofighi, B.
Tofighi B, et al. Recent Internet Use and Associations with Clinical Outcomes Among Patients Entering Addiction Treatment Involved in a Web-Delivered Psychosocial Intervention Study.  Journal of Urban Health 2016;93(5):871-883.
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  • People with substance use disorders experience pervasive health disparities, creating increased vulnerability.
  • Barriers to the initiation of and retention in addiction treatment for these populations often include the shortage of specialty treatment programs and perceived stigma by persons accessing them.

Computer- and mobile-assisted, web-based interventions can deliver complex, evidence-based treatments for substance use disorders (SUD), while also helping to address those very types of barriers. However, there is limited data characterizing recent internet access among vulnerable populations seeking community-based outpatient treatment for SUD. That means we also don’t know how a patient entering treatment who has not had recent online access might react to an online intervention, both in terms of their acceptability of such a format, and in terms of their clinical outcomes.

This secondary analysis of data from the CTN multisite treatment study “Web-Delivery of Evidence-Based, Psychosocial Treatment for Substance Use Disorders” (CTN-0044) explored these questions. Participants in the original study were randomly assigned to 12 weeks of the web-based Therapeutic Education System (TES), based on the Community Reinforcement Approach plus contingency management, versus treatment as usual (TAU). Primary substances of use were opioids, alcohol, cocaine, other stimulants, and marijuana.

The authors hypothesized that lack of recent internet access (over the previous 90 days) would be more prevalent among vulnerable patient subgroups (people of color, unemployed persons, e.g.), as well as associated with lower acceptability of the online intervention and less abstinence at follow-up.

Contrary to the hypothesis, however, results of the analysis found the highest acceptability of the web-based intervention among those reporting no recent internet access. Findings also suggest a lack of recent internet access was not significantly associated with either abstinence or retention outcomes. Additionally, rates of internet access in the 90 days prior to enrollment were similar between the study population (74%) and the general population (79%).

Conclusions: Overall, these data are encouraging for the potential implementation of technology-based interventions among diverse outpatient addiction treatment populations. Expanding the capacity of publicly funded community-based addiction treatment programs with acceptable evidence-based health information technologies is imperative, as these programs have the potential to significantly mitigate barriers to access among vulnerable populations.

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