Our initial evaluation of the CBT4CBT program as an adjunct to outpatient treatment indicated statistically significant effects on percent of urine toxicology screens that were positive for illicit drugs as well as significant durability of effects over 6 months. However, despite the enormous promise of computer- based treatments as well as very encouraging initial data from our work and others, well-controlled randomized clinical trials of computer-assisted therapies are still rare. The proposed project will be the first evaluation of CBT4CBT delivered with minimal clinician support, rather than as an adjunct to treatment, and will allow preliminary evaluation of CBT4CBT as a potential 'stand-alone'intervention. It will also be the first trial of CBT4CBT to include a clinician-delivered CBT condition, and thus will permit some exploration of the types of individuals for whom this approach might be most appropriate versus those who respond to clinician-delivered CBT.
Specific aims are: "To conduct a 12 week randomized trial with 180 treatment-seeking individuals meeting current criteria for illicit drug abuse or dependence. Participants will be randomized to one of three conditions: (1) standard outpatient counseling at a community treatment program, (2) individual clinician delivered CBT, or (3) web-based CBT4CBT with minimal counseling. "To evaluate the long-term durability and/or delayed emergence of treatment effects through a six month follow-up after termination of the study treatments. For these analyses, we hypothesize that either version of CBT (clinician and web-based) will be more effective than standard treatment. The primary outcome measures will be reduction in substance use, operationalized as the frequency of substance use by week confirmed by urine toxicology screens. Measures of treatment utilization and relative costs of the interventions will be used to evaluate cost effectiveness of the protocol interventions. As an exploratory aim, we hypothesize that incremental cost-effectiveness ratios (ICERS) will favor computer- delivered over clinician delivered CBT. Other secondary outcomes will be used to evaluate whether web- based CBT4CBT retains key characteristics of traditional clinician-administered CBT (e.g., acquisition of coping skills, use of change strategies) and to evaluate these as potential mediators of outcome as well as several participant variables that may moderate response to clinician-delivered versus computer-delivered CBT.

Public Health Relevance

Despite the enormous promise of computer-based treatments well-controlled randomized clinical trials of computer-assisted therapies are still rare. The proposed project will be the first evaluation of CBT4CBT, a promising computer-based treatment, delivered with minimal clinician support, rather than as an adjunct to treatment, and will allow preliminary evaluation of CBT4CBT as a potential 'stand-alone'intervention.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA015969-10
Application #
8206686
Study Section
Risk, Prevention and Intervention for Addictions Study Section (RPIA)
Program Officer
Grossman, Debra
Project Start
2002-09-30
Project End
2015-11-30
Budget Start
2011-12-01
Budget End
2012-11-30
Support Year
10
Fiscal Year
2012
Total Cost
$485,588
Indirect Cost
$112,211
Name
Yale University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Carroll, Kathleen M (2014) Lost in translation? Moving contingency management and cognitive behavioral therapy into clinical practice. Ann N Y Acad Sci 1327:94-111
Carroll, Kathleen M; Kiluk, Brian D; Nich, Charla et al. (2014) Toward empirical identification of a clinically meaningful indicator of treatment outcome: features of candidate indicators and evaluation of sensitivity to treatment effects and relationship to one year follow up cocaine use outcomes. Drug Alcohol Depend 137:3-19
Kiluk, Brian D; Serafini, Kelly; Frankforter, Tami et al. (2014) Only connect: The working alliance in computer-based cognitive behavioral therapy. Behav Res Ther 63C:139-146
Kiluk, Brian D; Nich, Charla; Witkiewitz, Katie et al. (2014) What happens in treatment doesn't stay in treatment: cocaine abstinence during treatment is associated with fewer problems at follow-up. J Consult Clin Psychol 82:619-27
Carroll, Kathleen M; Kiluk, Brian D; Nich, Charla et al. (2014) Computer-assisted delivery of cognitive-behavioral therapy: efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone. Am J Psychiatry 171:436-44
Decker, Suzanne E; Frankforter, Tami; Babuscio, Theresa et al. (2014) Assessment concordance and predictive validity of self-report and biological assay of cocaine use in treatment trials. Am J Addict 23:466-74
DeVito, Elise E; Babuscio, Theresa A; Nich, Charla et al. (2014) Gender differences in clinical outcomes for cocaine dependence: randomized clinical trials of behavioral therapy and disulfiram. Drug Alcohol Depend 145:156-67
Marsch, Lisa A; Carroll, Kathleen M; Kiluk, Brian D (2014) Technology-based interventions for the treatment and recovery management of substance use disorders: a JSAT special issue. J Subst Abuse Treat 46:1-4
Kiluk, Brian D; Carroll, Kathleen M (2013) New developments in behavioral treatments for substance use disorders. Curr Psychiatry Rep 15:420
Carroll, Kathleen M (2012) Dissemination of evidence-based practices: how far we've come, and how much further we've got to go. Addiction 107:1031-3

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