Computer-Based Behavioral Therapy Shows Promise for Addiction Treatment
The Problems With Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is one of the most common approaches to psychological treatment around the world. However, earlier research on its use in substance abuse cases from the lead author of the new study, Kathleen Carroll, PhD, showed that only 3 percent of those claiming to use CBT actually incorporated its strategies into treatment. Further investigation revealed that intensive training and continued supervision were required for substance abuse treatment providers to attain a modest level of proficiency in the approach. The research suggesting the benefits of CBT was conducted in favorable conditions, with expert practitioners that didn’t represent real-world treatment. There was a clear problem with the practical application of CBT.
A Computer-Based Solution?
With this problem in mind, Carroll learned about computer-based treatment approaches (previously tested on individuals struggling with depression), and decided to attempt to apply them to substance abuse settings. She reasoned that the approach would be cost-effective and may also help to break down the barriers to finding treatment among substance-dependent individuals. Her team worked to develop a computer-based software program dedicated to helping drug users, with modules focusing on issues such as dealing with cravings and recognizing potentially risky situations. The program is primarily composed of video content, but also features games, interactive graphics and exercises dedicated to helping people learn to overcome cravings and stay substance-free. In addition, the program was made very user-friendly, so no computer experience is needed to go through the course.
The team of researchers previously found positive results from a pilot study into the effectiveness of this new approach, and aimed to test its efficacy in a more robust fashion through a randomized clinical trial. This study involved 101 cocaine-dependent participants who were being maintained on methadone treatment, and the participants were randomized to either receive methadone treatment as usual or standard treatment in addition to the CBT4CBT program. The trial ran for eight weeks, with a follow-up period of six months.
CBT4CBT Improves Outcomes
The results showed that those receiving the computer-based program were significantly more likely to attain three or more weeks of consecutive abstinence from cocaine, with 36 percent of patients assigned to the computer course achieving this milestone in comparison to 17 percent of those receiving treatment as usual. Abstinence was confirmed with urine specimens, but based on this more objective measure, the treatment had a significant effect only when the entire eight weeks of treatment were completed. Follow-ups also showed that there was a continued improvement in those who completed the CBT4CBT program, indicating that the skills learned during the initial eight weeks were continually applied in the absence of the program.
What Does This Mean for Treatment?
The initial research into the effectiveness of CBT4CBT seems very promising, but it’s important to remember that this couldn’t form the main bulk of treatment. While it may help to convey some important messages to substance abusers who would otherwise not attend treatment, it doesn’t “stand alone” as an approach to treatment. In both pieces of research conducted so far, it was used in addition to standard treatment. In this role, it does appear to work remarkably well, but it’s hard to imagine a computer program being able to achieve the same headway as a real, human expert guiding substance dependent individuals to sobriety. As Carroll comments: “The program is a skills-building machine. It doesn't build a relationship, ask you how you're doing or really care.”
In addition, the approach doesn’t offer the peer support, understanding or camaraderie provided by 12-step treatment methods. While it may be a useful additional tool, it seems like too much to ask from an uncaring computer program to lead individuals through the emotional and challenging process of getting clean without support provided by an understanding, caring and adapting human being.