Drug and alcohol abusers are more likely to complete treatment and use less drugs and alcohol, both within treatment and through a six-month follow-up if they use an online program teaching skills and strategies to control behavior rather than undergoing standard therapy, a new study by Yale University researchers show.
The web-based program uses a range of multimedia strategies, including brief movies that feature actors who employ cognitive behavioral therapy strategies to cope with real-life problems facing substance abusers. The program proved more effective in reducing substance use than standard group counseling, as well as one-on-one sessions with therapists teaching the same cognitive behavioral therapy lessons, according to findings reported May 24 in the American Journal of Psychiatry.
“We spend billions of dollars on stuff that doesn’t work in terms of treating addiction, so it is exciting that a cost-effective website in and of itself outperforms standard treatment and produces durable benefits,” said Kathleen Carroll, PhD, Yale’s Albert E. Kent Professor of Psychiatry and senior author of the study. “Why can’t treatment be fun and engaging and teach skills that really help?”
The study split 137 users of alcohol, cocaine, opioids, or marijuana with diagnosed abuse or dependence problems into three treatment groups. One group received weekly group counseling, typical of many outpatient treatment programs. Another group received individual sessions with a therapist providing cognitive behavioral therapy, which consists of practical exercises designed to help them cope with stress and other triggers of substance abuse. The third group used the web-based program called CBT4CBT, which featured videos with actors using cognitive behavioral skills as well as interactive exercises, quizzes, and practice exercises. Those assigned to the web-based program also met with a therapist weekly for 10-minutes to monitor symptoms and functioning.
About half of the subjects dropped out of standard counseling and one-on-one sessions with therapists; however only about a quarter of subjects failed to complete the web-based program. At the end of treatment, 67% of those using the web-based program no longer met official diagnostic criteria for substance abuse, compared with 43% for standard counseling and just 52% for one-on-one therapy.
“The CBT4CBT program is engaging, with movies that reflect real world problems — a woman trying to stop drinking has a horrible day a work, and has a fight with her husband who opens up a bottle of wine,” Carroll said. “The viewers can see how to use cognitive and behavioral self-control skills to deal with the problem. There is something powerful about seeing the problem rather than hearing about it in the abstract.”
CBT4CBT provides a reliable and cost-effective strategy for delivering an evidence-based treatment to individuals who are in need of help for problems with substance abuse, added Brian D. Kiluk, PhD, of Yale, first author of the study, which was primarily funded by the National Institute on Drug Abuse.
Carroll is a member of CBT4CBT, which makes validated versions of CBT4CBT for qualified clinical providers.
Other Yale authors are Charla Nich, MS; Matthew B. Buck; Kathleen A. Devore; Tami L. Frankforter; Donna M. LaPaglia, PsyD; and Srinivas B. Muvvala, MD.