Randomized Trial of Computerized Cognitive Behavioral Therapy for Alcohol Use Disorders: Efficacy as a Virtual Stand-Alone and Treatment Add-On Compared with Standard Outpatient Treatment

Abstract

Background: Cognitive behavioral therapy (CBT) is an evidence-based treatment for alcohol use disorders (AUDs), yet is rarely implemented with high fidelity in clinical practice. Computer-based delivery of CBT offers the potential to address dissemination challenges, but to date there have been no evaluations of a web-based CBT program for alcohol use within a clinical sample.

Methods: This study randomized treatment-seeking individuals with a current AUD to 1 of 3 treatments at a community outpatient facility: (i) standard treatment as usual (TAU); (ii) TAU plus on-site access to a computerized CBT targeting alcohol use (TAU + CBT4CBT); or (iii) CBT4CBT plus brief weekly clinical monitoring (CBT4CBT + monitoring). Participant alcohol use was assessed weekly during an 8-week treatment period, as well as 1, 3, and 6 months after treatment.

Results: Sixty-eight individuals (65% male; 54% African American) were randomized (TAU = 22; TAU + CBT4CBT = 22; CBT4CBT + monitoring = 24). There were significantly higher rates of treatment completion among participants assigned to 1 of the CBT4CBT conditions compared to TAU (Wald = 6.86, p < 0.01). Significant reductions in alcohol use were found across all conditions within treatment, with participants assigned to TAU + CBT4CBT demonstrating greater increases in percentage of days abstinent (PDA) compared to TAU, t(536.4) = 2.68, p < 0.01, d = 0.71, 95% CI (0.60, 3.91), for the full sample. Preliminary findings suggest the estimated costs of all self-reported AUD-related services utilized by participants were considerably lower for those assigned to CBT4CBT conditions compared to TAU, both within treatment and during follow-up.

Conclusions: This trial demonstrated the safety, feasibility, and preliminary efficacy of web-based CBT4CBT targeting alcohol use. CBT4CBT was superior to TAU at increasing PDA when delivered as an add-on, and it was not significantly different from TAU or TAU + CBT4CBT when delivered with clinical monitoring only.

Trial registration: ClinicalTrials.gov NCT01615497.

Keywords: Alcohol Use Disorders; CBT4CBT; Computer-Delivered Treatment.

Copyright © 2016 by the Research Society on Alcoholism.

Figures

Figure 1

CONSORT diagram of participant flow

Figure 2

Figure 2a. Percentage of Days Abstinent (PDA) by treatment week Figure 2b. Percentage of Heavy Drinking Days (PHDD) by treatment week

Figure 2

Figure 2a. Percentage of Days Abstinent (PDA) by treatment week Figure 2b. Percentage of Heavy Drinking Days (PHDD) by treatment week

Figure 3

Marginal costs of treatment per participant by condition Note: Intention to treat = expected attendance at all sessions offered in protocol As treated = actual session attendance All services included = all services utilized both within and outside of protocol treatments