Web-delivery of Evidence-based, Psychosocial Treatment for Substance Use Disorders
Condition: Substance Abuse
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      The main objective of this study is to evaluate the effectiveness of including an
      interactive, web-based version of the Community Reinforcement Approach (CRA), called the
      Therapeutic Education System (TES), as part of community-based, outpatient substance abuse
      treatment.
    

Detailed description: 
      The principal objective of the planned trial is to evaluate the effectiveness of including an
      interactive, web-based version of the Community Reinforcement Approach (CRA), called the
      Therapeutic Education System (TES), as part of community-based, outpatient substance abuse
      treatment. CRA is a cognitive-behavioral intervention which seeks to give patients skills to
      achieve and maintain abstinence and improve social functioning and is often paired with
      contingency management, where patients earn rewards contingent upon drug negative urines. CRA
      is an intensive treatment, generally delivered in individual sessions 2 to 3 times per week.
      Thus, it is expensive and time-consuming to deliver, to train clinical staff, and to provide
      supervision to maintain clinical staff skill. However, because CRA is oriented toward
      knowledge and skills, it lends itself to being delivered by computer, using
      computer-interactive learning technologies.

      Individuals accepted into community-based outpatient treatment for substance use disorders
      (excluding those receiving opioid pharmacotherapy for opioid dependence) will be eligible to
      participate. This is a multi-site, controlled trial, using NIDA's Clinical Trials Network
      platform, at approximately 10 Community Treatment Programs, in which participants (N =
      approximately 500) will be randomized to receive 12 weeks of either: (1) Treatment-as-Usual
      (TAU), reflecting standard treatment at the collaborating treatment programs in which
      participants are enrolled, or (2) a modification of TAU which includes access to the TES. It
      is hypothesized that access to TES will improve substance use outcome and retention in
      outpatient treatment.

      Computer interactive interventions like TES have the potential to deliver science-based
      psychosocial treatments with high fidelity and cost-effectiveness while conserving clinician
      time to focus on monitoring and addressing patients' needs. If found to be effective, TES
      could substantially advance the substance abuse treatment system by improving quality of care
      delivered, increasing availability of treatment slots by extending and leveraging the efforts
      of clinical staff, and projecting treatment to rural and other underserved areas.
    

Intervention name(s): Therapeutic Education System (TES); Treatment-as-Usual (TAU)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants will received modified treatment-as-usual plus the computerized psychosocial intervention (Therapeutic Education System), including contingency management. Participants will be asked to use the self-directed TES intervention twice weekly and will be asked to complete 2 modules during each session (for a total of 4 modules per week) during the 12-week intervention. Participants will receive incentives contingent primarily upon abstinence from drugs of abuse and, secondarily, upon completion of TES modules.; Participants in this condition will receive TAU, consisting of standard treatment offered at each collaborating CTP and will reflect the model of treatment typically provided to most individuals in outpatient, community-based substance abuse treatment settings in the U.S. These sessions will consist of a combination of group and individual counseling.
Other intervention name(s): Therapeutic Education System; TES; Treatment as Usual; TAU; Standard Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Drug Abuse; Substance Abuse; Substance Use Disorder; Addiction; Behavioral Treatment