Addiction Science Made Easy
May 2022
CTN Dissemination Library
Key points:
Despite rising substance use and substance-related harms, only about 6.5% of Americans with substance use disorders ever receive treatment, partly because of a lack of access to specialty facilities and/or trained healthcare providers.
Digital therapeutics (DTs) are software-based treatments that help expand access to evidence-based behavioral treatments for SUDs and improve outcomes. DTs may also enhance the therapeutic relationship by providing clinicians with real-time information about their clients' progress in care.
The Therapeutic Education System (TES) is a DT for SUD that provides computerized cognitive behavioral therapy and contingency management via a browser on an internet-connected device. A commercial version of TES accessible by mobile phone, reSET®, is the first and only FDA-authorized prescription therapeutic for patients with cocaine, cannabis, or stimulant use disorder.
A NIDA Clinical Trials Network study of TES, CTN-0044, separated patients into two groups: one group received 12 weeks of outpatient treatment-as-usual (TAU) and the other received TAU with reduced counseling plus TES. The study included patients with a range of SUDs, however those with OUD did not receive medications like buprenorphine or methadone and had poor outcomes as a result.
In order to get a better look at the potential effectiveness of reSET®, approved only for patients with cocaine, cannabis, or stimulant use disorder, researchers in this study excluded OUD patients from the original data set and just looked at those with SUDs related to other substances.
They found that abstinence was significantly higher for folks in the TES group compared to the TAU group (40.3% vs. 17.6%), as was retention in therapy (76.2% vs. 63.2%). Adverse event rates were not significantly different in the two groups.
Conclusions: Use of a digital therapeutic increased abstinence and retention in treatment among patients with substance use disorders related to alcohol, cannabis, cocaine, or other stimulants. The DT also appeared to encourage participation in in-person treatment: the number of in-person counseling session hours were similar between the two groups, even though the TES group was only required to attend 2 hours per week. This suggests that DTs could also play a role as a "clinician-extender" to expand and improve treatment. The reSET® app could be particularly helpful in the COVID and post-COVID era, when more and more patients are seeking effective remote options for care.