Computer-assisted treatments have tremendous potential for making evidence based therapies more widely available to those who may benefit from them, standardizing treatment delivery, extending and freeing up the time of busy clinicians, and reducing the costs of treatment. Despite their enormous promise, however, well- controlled randomized clinical trials of computer-assisted therapies remain rare, and there are fewer still that would meet established methodological standards for the evaluation of clinician-delivered behavioral therapies. We have developed a computer-assisted version of CBT (CBT4CBT) and have demonstrated its efficacy, durability, and specificity as an adjunct to outpatient treatment for illicit drug dependence. In 2009, we were approached by NIAAA to develop a web-based version of CBT4CBT specifically for individuals with alcohol use disorders, as there are no existing full-scale computer-assisted CBT programs for alcohol use disorders with demonstrated efficacy. Funded through ARRA, development of the web based CBT4CBT alcohol program was completed in 2011, within our specified timeline. We now propose an exploratory, Stage I study to evaluate the program's feasibility and preliminary efficacy with treatment-seeking alcohol dependent individuals. We propose to conduct an 8-week randomized clinical trial with 90 treatment-seeking individuals meeting current criteria for alcoho dependence. Participants will be randomized to one of three conditions: (1) standard outpatient counseling, (2) counseling plus CBT4CBT (the website delivered as an add-on to standard counseling, or (3) web-based CBT4CBT as a virtual standalone (CBT4CBT plus minimal clinical monitoring). This design is novel for a Stage 1 study in that it will allow evaluation of the program in two of the forms in which it is most likely to be implemented clinically (add-on and stand alone). The primary outcome measures will be reduction in alcohol use (percent days abstinent, heavy drinking days by week). Measures of treatment utilization and other secondary outcomes will be used to evaluate whether web-based CBT4CBT retains key characteristics of traditional clinician-delivered CBT (e.g., acquisition of coping skills, use of change strategies).

Public Health Relevance

This project proposes to conduct an exploratory, Stage 1 study to evaluate the feasibility and preliminary efficacy of a web-based version of Cognitive Behavioral Therapy (CBT4CBT) adapted for use by individuals with alcohol use disorders. The availability of an effective computer-assisted treatment for alcohol dependence could greatly broaden the availability of treatment and hence have a major impact on public health through making treatment more available to underserved populations.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Exploratory/Developmental Grants (R21)
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Health Services Research Review Subcommittee (AA)
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Lowman, Cherry
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Yale University
Schools of Medicine
New Haven
United States
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Carroll, Kathleen M; Kiluk, Brian D (2017) Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again. Psychol Addict Behav 31:847-861
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