While therapists may stray from the scripted material, the computer always delivers the same content faithfully.
rewards ranging from $1 to $100 for completing modules and submitting negative urine screens. At the end of the 12-week treatment period, the patients who used TES had a 60 percent higher rate of biologically confirmed abstinence from 10 different substances. Among participants who were still using substances when they entered the study, the TES-based intervention nearly doubled the likelihood of achieving abstinence compared with the controls. “The impact of the TES treatment was greatest among those participants who had a more severe problem,” says Dr. Edward Nunes, who led the study at the New York State Psychiatric Institute, based at Columbia University Medical Center. TES also improved treatment adherence. At the end of the treatment period, almost 50 percent of the participants assigned to receive TES were still participating, whereas that proportion had dropped to about 40 percent among the participants assigned to receive only the treatment-as-usual program. Researchers see the TES intervention as a tool clinicians can prescribe to patients to augment the face-to-face therapy provided by most treatment programs for drug abuse, says Dr. Nunes.
Community reinforcement approach works
The TES program is based on the community reinforcement approach for treating drug addiction, covering a wider range of topics than CBT4CBT. For example, some of its 65 interactive modules, which include short films and self-assessment quizzes, are designed to teach patients relationship and employment skills to enable them to elicit and enjoy social support and reintegrate into their communities. A patient’s homework might simply involve taking their family to a movie and reporting back on the experience. In a multisite trial with 10 outpatient treatment program partners, all of the participants received their particular clinic’s standard outpatient therapy, which was usually group therapy. Half spent all of their therapy time in clinician- led sessions, and half substituted working independently with TES for approximately two hours per week of clinician-led sessions. To enhance patients’ motivation, TES provided
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