Computerized programs can improve treatment outcomes when they are used to supplement or partially replace in-person behavioral therapy for drug addiction. That was the finding of researchers from the Yale University School of Medicine’s department of psychiatry in recent trials sponsored by the National Institutes of Drug Abuse (NIDA). In one trial, adding Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT) to standard methadone-maintenance therapy increased abstinence from cocaine among patients who were addicted to both opioids and cocaine. In the other trial, outpatients who interacted with the Therapeutic Education System (TES) in place of attending some in-person therapy sessions had almost twice the odds of abstaining from all drugs and alcohol in the last four weeks of a 12-week trial period.
Digitized cognitive behavioral therapy shows promise CBT4CBT uses a variety of interactive techniques, games, quizzes and short films. The tools teach patients how to recognize triggers for substance use, cope with drug cravings and counter negative thoughts and challenging situations. For example, each of the CBT4CBT films depicts a character in a high-risk situation for substance use. Alternative endings contrast a negative outcome, such as a relapse to drug use, with a positive one resulting from a skill a patient has just learned. CBT4CBT “trains a person’s skills in cognitive control,” by focusing on decision-making skills, problem-solving, and other cognitive, affective, and behavioral self-control strategies, Dr. Kathleen Carroll, a lead researcher, explains. In the trial, 101 adult outpatients dually addicted to cocaine and opioids received daily methadone-maintenance treatment and weekly group therapy. All the patients also met twice a week with a research assistant who monitored their drug use and collected urine specimens to be tested for cocaine and other drugs. At these visits, roughly half also had access to CBT4CBT on a dedicated computer. The patients who used CBT4CBT were twice as likely as those who did not to achieve three consecutive weeks of abstinence from cocaine use (36 percent versus 17 percent). They also provided a higher percentage of completely drug-free urine samples. The difference in abstinence is an important indicator of how patients may fare in the future, Dr. Carroll says. Follow-up interviews and urine screens disclosed that the patients in the CBT4CBT group reduced their cocaine use more than those in the control group for six months after the end of treatment.
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