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Can Computer Delivered Treatment Bring Help to More People with Substance Use Disorders?

     

Nearly 20 million people in the U.S. had a substance use disorder in the past year, according to a recent national survey from the Substance Abuse and Mental Health Services Administration. By age group, this includes about 4 percent of adolescents (12 to 17 years old), 15 percent of young adults (18 to 25) and 6 percent of adults (26 and older). Substance use disorders involve recurrent use of alcohol or other drugs (or both) causing significant impairment and potentially leading to health problems, disability, and problems at work, school or home.

Among people 12 and older with a substance use disorder:

  • 74 percent had alcohol use disorder
  • 38 percent had illicit drug use disorder
  • 12 percent had both

While effective treatments are available, most people with substance use disorder are not getting treatment. Only about one in five people with a substance use disorder in the past year received any type of treatment. By age group, about 19 percent of adolescents, 13 percent of young adults, and 24 percent of adults received any treatment.

computer use.jpgComputer or internet delivered treatments are increasingly being used to treat a variety of mental health conditions. A new study looked at use of computerized cognitive behavioral therapy (CBT) in comparison with clinician-delivered CBT and standard outpatient treatment for substance use disorders.

The study found that the web-based CBT along with brief clinical monitoring was safe and effective compared to other approaches and was well-liked by participants.

The randomized clinical trial involved 137 individuals with substance use disorder separated into three groups receiving different treatment:

  • Web-based CBT with brief weekly monitoring
  • Weekly individual CBT with an experienced clinician
  • Treatment as usual (group or individual weekly therapy)

The web-based program, called CBT4CBT, has seven core skill modules each with on-screen narration, graphic animation, quizzes and other interactive exercises. Each module has a video demonstrating use of a specific skill and provides printable take-home practice exercises. Those participating in web-based CBT4CBT completed one module each week and had a brief (about 10 min) in-person meeting with a clinician each week.

Participants who received therapy through the web-based program reduced their substance use significantly more than those who received treatment as usual. Those benefits continued through the six-month follow-up. In addition, those receiving the web-based treatment learned the cognitive and behavioral concepts better and were more satisfied with treatment than those in either of the other groups.

The study authors conclude this web-based approach “not only may broaden access to an evidence-based treatment, but it also may be a more appealing option for many individuals.” In an accompanying editorial in the American Journal of Psychiatry, Steven Ondersma, Ph.D., notes that these findings provide “what may be the strongest evidence yet that technology-delivered treatment should be embraced” and the findings “challenge the assumption that intensive individual therapist contact should always be seen as the best possible nonpharmacological option.”

While the authors and Ondersma note that more research is needed, this study shows great promise for making substance use treatment more available and acceptable, potentially helping address a very important need.

References

  • Substance Abuse and Mental Health Services Administration, Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.
  • Kiluk, BD, et al. Randomized Clinical Trial of Computerized and Clinician-Delivered CBT in Comparison with Standard Outpatient Treatment for Substance Use Disorders: Primary Within-Treatment and Follow-up Outcomes. Am J Psychiatry, 2018, 175:9.
  • Ondersma, SJ. Editorial: Computer-Delivered, Evidence-Supported Treatment for Drug Addition. Am J Psychiatry. Published online Sept. 1, 2018.

     

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