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 #
5R01DA015969-13
Application #
8775208
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
2014-12-01
Budget End
2015-11-30
Support Year
13
Fiscal Year
2015
Total Cost
$439,619
Indirect Cost
$101,601
Name
Yale University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06510
Decker, Suzanne E; Morie, Kristen P; Malin-Mayo, Bo et al. (2018) Positive and negative affect in cocaine use disorder treatment: Change across time and relevance to treatment outcome. Am J Addict :
Yip, Sarah W; Worhunsky, Patrick D; Xu, Jiansong et al. (2018) Gray-matter relationships to diagnostic and transdiagnostic features of drug and behavioral addictions. Addict Biol 23:394-402
Carroll, Kathleen M; Nich, Charla; DeVito, Elise E et al. (2018) Galantamine and Computerized Cognitive Behavioral Therapy for Cocaine Dependence: A Randomized Clinical Trial. J Clin Psychiatry 79:
Kiluk, Brian D; Nich, Charla; Buck, Matthew B et al. (2018) Randomized Clinical Trial of Computerized and Clinician-Delivered CBT in Comparison With Standard Outpatient Treatment for Substance Use Disorders: Primary Within-Treatment and Follow-Up Outcomes. Am J Psychiatry 175:853-863
Paris, Manuel; Silva, Michelle; AƱez-Nava, Luis et al. (2018) Culturally Adapted, Web-Based Cognitive Behavioral Therapy for Spanish-Speaking Individuals With Substance Use Disorders: A Randomized Clinical Trial. Am J Public Health 108:1535-1542
Kiluk, Brian D; DeVito, Elise E; Buck, Matthew B et al. (2017) Effect of computerized cognitive behavioral therapy on acquisition of coping skills among cocaine-dependent individuals enrolled in methadone maintenance. J Subst Abuse Treat 82:87-92
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
Yip, Sarah W; Morie, Kristen P; Xu, Jiansong et al. (2017) Shared microstructural features of behavioral and substance addictions revealed in areas of crossing fibers. Biol Psychiatry Cogn Neurosci Neuroimaging 2:188-195
Montgomery, LaTrice; Carroll, Kathleen M (2017) Comparable efficacy of behavioral and pharmacological treatments among African American and White cocaine users. J Ethn Subst Abuse 16:445-459
Decker, Suzanne E; Kiluk, Brian D; Frankforter, Tami et al. (2016) Just showing up is not enough: Homework adherence and outcome in cognitive-behavioral therapy for cocaine dependence. J Consult Clin Psychol 84:907-12

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