Computerized behavior therapy for opioid-dependent outpatients: a randomized controlled trial

Abstract

The authors evaluated the efficacy of an interactive, computer-based behavioral therapy intervention, grounded in the community reinforcement approach (CRA) plus voucher-based contingency management model of behavior therapy. Our randomized, controlled trial was conducted at a university-based research clinic. Participants comprised 135 volunteer adult outpatients who met DSM-IV criteria for opioid dependence. All participants received maintenance treatment with buprenorphine and were randomly assigned to one of three treatments: (a) therapist-delivered CRA treatment with vouchers, (b) computer-assisted CRA treatment with vouchers, or (c) standard treatment. The therapist-delivered and computer-assisted CRA plus vouchers interventions produced comparable weeks of continuous opioid and cocaine abstinence (M = 7.98 and 7.78, respectively) and significantly greater weeks of abstinence than the standard intervention (M = 4.69; p < .05), yet participants in the computer-assisted CRA condition had over 80% of their intervention delivered by an interactive computer program. The comparable efficacy obtained with computer-assisted and therapist-delivered therapy may enable more widespread dissemination of the evidence-based CRA plus vouchers intervention in a manner that is cost-effective and ensures treatment fidelity.

Figures

Figure 1

Flow of user activity with computer-based community reinforcement approach (CRA) plus vouchers program.

Figure 2

Mean weeks continuous abstinence from opiates and cocaine by treatment condition. Means sharing a common letter are not significantly different from one another.

Figure 3

Retention by treatment condition during 23-week treatment maintenance phase.

Figure 4

Mean weeks of continuous opioid and cocaine abstinence plotted by mean contact time with therapist during treatment by treatment condition.