Web Based Interventions Produce Good Results in Treating Substance Abuse

A new study in the American Journal Of Psychiatry (Volume 171, Issue 6, June 2014) shows that incorporating a web-based educational intervention in the treatment of drug abuse can not only help people stop using drugs, but can also keep them in treatment longer.

TES is a web-based version of the Community Reinforcement Approach plus Contingency Management, a packaged approach with demonstrated efficacy.  The National Institute on Drug Abuse (NIDA), part of the NIH, funded this study.

TES consists of 62 interactive modules that teach patients how to achieve and maintain abstinence from drug use and includes prize-based motivational incentives to encourage adherence to treatment.  Patients given TES were less likely to drop out of treatment than those in the control group.  Also, the web-based intervention helped patients stay abstinent from drug use, even those who were not abstinent at the beginning of the study.  With such findings, web-based interventions like TES are promising additions to drug abuse treatment.

This approach, which combines skills-oriented counseling and contingency management in an Internet-delivered behavioral intervention, produced high rates of abstinence from drugs and heavy drinking among patients with a good prognosis (those who entered the study with positive urine drug or breath alcohol screen) but doubled the likelihood of abstinence among patients with an otherwise poor prognosis.

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).

Internet-delivered interventions such as TES have the potential to expand access and improve addiction treatment outcomes. Additional research is needed to assess effectiveness in non-specialty clinical settings and to differentiate the effects of the community reinforcement approach and contingency management components of TES.

Tom Wilson Counseling Online Alcohol Classes currently uses similar evidenced based practices inclusing cognitive behavioral techniques, motivational enhancement therapy and stages of change theory.