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Randomized Controlled Trial
. 2014 Jun;171(6):683-90.
doi: 10.1176/appi.ajp.2014.13081055.

Internet-delivered treatment for substance abuse: a multisite randomized controlled trial

Aimee N C Campbell, Edward V Nunes, Abigail G Matthews, Maxine Stitzer, Gloria M Miele, Daniel Polsky, Eva Turrigiano, Scott Walters, Erin A McClure, Tiffany L Kyle, Aimee Wahle, Paul Van Veldhuisen, Bruce Goldman, Dean Babcock, Patricia Quinn Stabile, Theresa Winhusen, Udi E Ghitza
Randomized Controlled Trial

Internet-delivered treatment for substance abuse: a multisite randomized controlled trial

Aimee N C Campbell et al. Am J Psychiatry. 2014 Jun.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Am J Psychiatry. 2014 Dec 1;171(12):1338. doi: 10.1176/appi.ajp.2014.17112correction. Am J Psychiatry. 2014. PMID: 25756773 No abstract available.

Abstract

Objective: 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.

Method: 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.

Results: Compared with patients in the treatment-as-usual group, those in the TES group had a lower dropout rate (hazard ratio=0.72, 95% CI=0.57, 0.92) and a greater abstinence rate (odds ratio=1.62, 95% CI=1.12, 2.35). This effect was more pronounced among patients who had a positive urine drug or breath alcohol screen at study entry (N=228) (odds ratio=2.18, 95% CI=1.30, 3.68).

Conclusions: 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.

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Figures

Figure 1
Figure 1
Study Enrollment and Patient Flow.
Figure 2
Figure 2
Proportion of patients abstinent by treatment half-week and at 3 month post treatment follow-up and 6 month post treatment follow-up as a function of treatment assignment (Therapeutic Education System vs. Treatment-as-Usual) and abstinence at baseline/study entry.
Figure 3
Figure 3
Kaplan-Meier Plot of time to treatment program drop-out by treatment assignment (Therapeutic Education System vs. Treatment-as-Usual).
See this image and copyright information in PMC

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