Cognitive behavioral approaches have strong empirical support from randomized clinical trials in a variety of substance-using populations, but implementation of cognitive-behavioral therapy (CBT) remains rare in clinical practice. Although manuals that provide explicit guidelines for implementation of CBT have been developed and widely distributed, mere availability of these manuals has not been associated with dramatic changes in clinicians' use of CBT and other empirically evaluated therapies. Thus, alternative approaches of making CBT more widely available should be evaluated. CBT's highly structured, didactic, practice-oriented nature may make it extremely well suited to direct access by patients through an interactive, multimedia, and highly individualized computer-assisted training program. The computer-based training program (CBT for CBT) would focus on teaching basic coping skills, presenting examples of effective use of coping skills in a number of realistic situations, and providing opportunities for patients to practice and review new skills. Such a program, if found to be an effective adjunct to drug abuse treatment in community-based programs, would be comparatively inexpensive and straightforward to disseminate and implement in a wide range of programs. Thus, in this Stage 1 behavioral therapies development project, submitted in response to NIDA RFA DA-02-006, we propose to: a. Develop and pilot an individualized, interactive, computer based training program for cognitive behavioral therapy (CBT for CBT) for drug abusers. b. Conduct an initial randomized trial evaluating the feasibility and effectiveness of adding 'CBT for CBT' to treatment as usual in a community based treatment program. In the trial, 80 treatment-seeking, drug-dependent individuals will be randomly assigned to treatment as usual in a community-based clinic OR treatment as usual plus 12 hours of access to the 'CBT for CBT' program over a period of 12 weeks. Primary outcomes will be retention in treatment and reduction in drug use (percent days abstinent, confirmed by urine toxicology screens). The patients' ability to demonstrate coping skills through a role-play evaluation will be a secondary outcome. A six-month follow-up will assess durability and/or delayed emergence of effects.
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