American Journal of Psychiatry 2014;171:683-690. [doi: 10.1176/appi.ajp.2014.13081055]
Aimee N. C. Campbell, PhD, MSW (Columbia University, GNY Node), Edward V. Nunes, MD (New York State Psychiatric Institute, GNY Node), Abigail G. Matthews, PhD (EMMES Corporation, Data & Statistics Center (DSC)), Maxine L. Stitzer, PhD (Johns Hopkins University, MA Node), Gloria M. Miele, PhD (Columbia College of Physicians and Surgeons, GNY Node), Daniel Polsky, PhD (University of Pennsylvania, DV Node), Eva Turrigiano, MS (New York State Psychiatric Institute, GNY Node), Scott Walters, PhD (University of North Texas, TX Node), Tiffany L. Kyle, PhD (Center for Drug-Free Living, Inc., FNA Node), Aimee Wahle, MS (EMMES Corporation, DSC), Paul C. VanVeldhuisen, PhD (EMMES Corporation, DSC), Bruce Goldman, LCSW, CASAC (North Shore-Long Island Jewish Health System, GNY Node), Dean Babcock, MSW (Midtown Community Mental Health Center (OV Node)), Patricia Q. Stabile, MSW (HARBEL Prevention and Recovery Center, MA Node), Theresa M. Winhusen, PhD (University of Cincinnati, OV Node), Udi E. Ghitza, PhD (Center for the Clinical Trials Network, NIDA).
This is the Primary Outcomes Article for CTN-0044. Computer-delivered interventions have the potential to improve access to quality addiction treatment care. The objective of this study was to evaluate the effectiveness of the Therapeutic Education System (TES), an Internet-delivered behavioral intervention that includes motivational incentives, as a clinician-extender in the treatment of substance use disorders. Adult men and women (N=507) entering 10 outpatient addiction treatment programs were randomly assigned to receive 12 weeks of either treatment as usual (N=252) or treatment as usual plus TES, with the intervention substituting for about 2 hours of standard care per week (N=255). TES consists of 62 computerized interactive modules covering skills for achieving and maintaining abstinence, plus prize-based motivational incentives contingent on abstinence and treatment adherence. Treatment as usual consisted of individual and group counseling at the participating programs. The primary outcome measures were abstinence from drugs and heavy drinking (measured by twice-weekly urine drug screens and self-report) and time to dropout from treatment.
Compared with patients in the treatment-as-usual group, those in the TES group had a lower dropout rate and a greater abstinence rate. This effect was more pronounced among patients who had a positive urine drug or breath alcohol screen at study entry (N=228).
The superiority of TES over treatment as usual was not sustained at longer-term follow-up, however. This could be due to dimishing effects of contingency management after the contingencies end, or simply because of the chronic, relapsing nature of addiction and the need for ongoing monitoring and treatment. In the trial, TES was only made available to participants for the 12 weeks of the study; however, since it is Internet accessible, it could be made available to patients indefinitely, an option that should be studied.
Conclusions: Internet-delivered interventions such as TES have the potential to help bridge the gap between the enormous need for high-quality evidence-based treatment for addiction and the capacity of the treatment system to deliver. Additional research is needed to assess the effectiveness TES in non-specialty clinical settings, including primary care, and to differentiate the effects of the community reinforcement approach and contingency management components of TES. (Article (Peer-Reviewed), PDF, English, 2014)
Keywords: Alcohol | Behavior therapy | Cocaine | Community Reinforcement Approach (CRA) | CTN primary outcomes | Heroin | Internet counseling | Marijuana | Motivational incentives | Prescription-type opiates | Stimulant abuse | Therapeutic Education System (TES) | American Journal of Psychiatry (journal)
Document No: 1056, PMID: 24700332, PMCID: PMC4079279.
Submitted by Elizabeth Wells, PhD, PN Node, 4/7/2014.