Yale researchers have developed a computer-based cognitive behavioral therapy (CBT) program to treat substance abuse and dependence, and report that it results in better outcomes both in the near term and over time. The program is known as Computer Based Training in Cognitive Behavioral Therapy, or CBT4CBT. Their findings, which confirm those of an earlier pilot study, appear online in the American Journal of Psychiatry.
The researchers studied 101 cocaine-dependent patients who were being treated with methadone, splitting them into two groups — those receiving standard methadone care, and those receiving weekly CBT4CBT in addition. Patients who had access to the program were more likely to attain abstinence, and used less cocaine during the next six months
The authors write that only a minority of those who could benefit from evidence-based substance abuse treatment actually receives it. Further, cognitive CBT remains rarely implemented in the treatment of substance use disorders, because of the limited availability of training programs, high rates of clinician turnover, and the cost of training clinicians in CBT.
Responding to this need, the Yale researchers developed an interactive Web-based program, CBT4CBT, that uses movies and interactive tools to teach users practical strategies to cope with craving, to manage their thoughts about drug use, and to change behavior patterns that can lead to relapse — all essential, they write, to achieving durable results.
With the Affordable Care Act having established parity for mental health and substance use treatment, the number of people seeking treatment for substance use disorders is expected to rise.
Greater availability of evidence-based approaches like CBT, utilizing new strategies such as Web-based programs, may help make this form of treatment more available to those who might benefit from it, say the researchers.
“CBT4CBT is now one of the only computer-based interventions demonstrated to be effective in multiple studies,” said lead author Kathleen Carroll, the Albert E. Kent Professor of Psychiatry at Yale School of Medicine. “These findings now allow us to make CBT4CBT available for use through professionally monitored treatment programs.”
Other authors are Brian Kiluk, Charla Nich, Melissa Gordon, Galina Portnoy, Daniel Marino, and Samuel Ball of Yale School of Medicine.
The study was supported by grants from the National Institute on Drug Abuse (R37-DA 015969 and P50-DA09241).
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