This application addresses broad Challenge Area (05): Comparative Effectiveness Research and specific Challenge Topic 05-DA-102: Treatment of Substance Abuse and Related Health Consequences Using Web-Based Technologies Web-based videoconferencing platform technologies hold far-reaching potential to increase and even improve the delivery of evidence-based substance abuse interventions because they permit substance users to access """"""""real time"""""""" professional therapy from the convenience of their homes. The present study will be the first to evaluate the efficacy of using one of these accredited (by Joint Commission and Commission on Accreditation of Rehabilitation Facilities) web-based platforms (eGetgoingTM, CRC Health Group, Inc.) to deliver routine counseling on a schedule commonplace in opioid-agonist treatment programs (OTPs). It will substantially extend our previous work that demonstrated the efficacy of administering intensified levels of eGetgoing group counseling, and has outstanding potential to advance the rationale for more routine use of this technology. Unfortunately, the overall effectiveness of OTPs is often seriously hindered by long-term treatment demands that may include weekly attendance to scheduled counseling and psychosocial services that often continues for many years. While research shows that counseling augments the benefits of OTPs, patients often cite counseling as one of the major burdens of care. These demands reduce utilization of therapy services with resulting negative impacts on treatment outcome. Web-based videoconferencing provides a remarkable opportunity to reduce some of the inconvenience of counseling and to facilitate the pursuit of other responsibilities (e.g., child care) or treatment goals (e.g., employment) essential to rehabilitation. Our research team substantially added to this literature by publishing the first randomized and controlled clinical trial evaluating the efficacy of eGetgoing in delivering intensified counseling services to OTP patients (King et al., 2009). Poorly performing study participants (n = 37) with 2 or more weeks of drug- positive urine samples were scheduled to attend two manual-guided relapse-prevention groups weekly, in addition to their weekly routine individual counseling, and were randomly assigned to either: 1) standard on-site group therapy, or 2) eGetgoing delivery of group therapy. eGetgoing was associated with greater attendance to intensified sessions (92 percent vs. 76 percent, n = .07), and patients exposed to eGetgoing markedly preferred it to on-site delivery, citing convenience as one of several reasons for their preference. These findings clearly supported eGetgoing treatment delivery in an OTP setting and only failed to reach statistical significance because of low sample size (insufficient power). The proposed work will remedy the statistical limitations of that study and substantially extend the relevance of this intervention. Participants in the proposed 3-month study will be randomly assigned to receive delivery of routine counseling services either: 1) on-site, or 2) via eGetgoing. Rates of service utilization constitute the primary outcome measures, while a novel Multiple Choice Procedure will evaluate the relative reinforcement value of eGetgoing compared to other clinic-based incentives. Secondary analyses will evaluate the collateral effects of the intervention on program satisfaction, time and transportation costs, rates of unscheduled appointments, and pre/post changes in the therapeutic relationship. The proposed study logically extends our work using the currently available eGetgoing delivery platform. Unlike our first study, this study 1) specifically targets both patients and counseling schedules that reflect standard care in most OTPs;2) uses standard measures of satisfaction, therapeutic alliance, and a measure of reinforcement value that have not been used prior to this study;3) will help determine transportability of this technology to other treatment programs by demonstrating the benefits of integration of eGetgoing with on-site services to expand the continuum of care. The entire study, including dissemination of the major findings at a national meeting and submission of the first manuscript, is designed to be completed within 2-years. Every year Johns Hopkins Institutions directly generate about $10 billion in economic activity in the State of Maryland, a 43 percent increase from the $7 billion generated in 2002 and the equivalent of one of every twenty-four dollars in the states economy today. In 2008, Johns Hopkins Institutions provided 45,000 jobs and created 700 new jobs each year since 2002. Directly and indirectly Johns Hopkins Institutions support more than 100,000 jobs in Maryland, one of every 29 in the state. In Baltimore City alone Johns Hopkins directly and indirectly supports 60,000 jobs, or 16.7 percent of all City employment. This application will create or retain 4 jobs in addition to partial salary support for 3 Johns Hopkins faculty members.
This study will be the first to evaluate the efficacy of an accredited and currently available, Internet web-based videoconferencing platform to deliver routine schedules of counseling in an opioid agonist treatment program. It has outstanding potential to help determine transportability of this technology to other treatment programs by demonstrating the benefits of integration of web-based therapy with on-site services to expand the continuum of care.
|King, Van L; Brooner, Robert K; Peirce, Jessica M et al. (2014) A randomized trial of Web-based videoconferencing for substance abuse counseling. J Subst Abuse Treat 46:36-42|