Research evidence for the effectiveness of technology delivered psychological treatment for addiction
Evidence for the effectiveness of technology delivered psychological treatment for addiction
A study evaluating the efficacy of a computer-based version of cognitive behavioural therapy (CBT) for substance dependence found not only that participants assigned to the technology program condition submitted significantly more urine specimens that were negative for any type of drugs, but also that participants tended to have longer continuous periods of abstinence during treatment. The participants positively evaluated the program, and the use of the program was strongly correlated with treatment engagement, as opposed to treatment as usual (TAU). Overall, this evidence shows how use of technology may improve one’s treatment or recovery journey.
While this study concludes that CBT4CBT has both a short term and long term effect on drug use, the participants only accessed computerized treatment biweekly. This is unlike Addicaid’s approach in that contact with the app can be daily, and the use of smartphones as an interface also allows more practicality. Furthermore, the main measures were frequency of use, and urine toxicology screens. The latter mostly matched the self-reports given by the participants, but these are not comprehensive measures. Addicaid aims to not only assess patient satisfaction, but the implication of recovery (including abstinence if relevant to the individual) on other important life skills. For instance, we may choose to address how impairment in behavioural control has changed, how individuals are dealing with cravings, or recognizing problems in one’s behaviours and interpersonal relationships, and dealing more effectively with emotional responses.
What this study does include is a 6-month follow up. It is highly important to consider the efficacy of treatment aided by technological programs in the long-term. This study showed that while TAU patients increased their dug use across time, CBT4CBT participants tended to maintain or increase the gains they had achieved during treatment. The latter supports Addicaid’s philosophy in being an important assistance tool after treatment, ensuring a steady upward slope to full recovery.
IN HIGH SCHOOLS
Since adolescence is highly important in the development of certain unhealthy behaviours, and the latter may affect academic development, we must consider the implementation of early intervention treatments, using technology, in high school and college settings. Screening, brief motivational counselling intervention and referral to treatment (SBIRT) were translated into two New
York public school settings effectively, in part as a result of the use of computerized programs. 248 students were screened during non-academic classes: 42% of them reported substance use, and all but one of the positively screened students voluntarily accepted one or more brief intervention sessions. Two students were referred to treatment. This school-based SBIRT model did not interfere with academic activities, was feasible to implement, and was attractive to students, teachers and administration. This provides evidence not only for the need for these systems in a school environment, but also the ease with which the implementation of these can take place. The most important things to take away about using technology-based treatment in a school setting are:
a) If in-person screening is provided, it is more effective to use non-school personnel, for added security in terms of anonymity
b) Indeed, the procedures must all be confidential
c) Services should be provided during non-academic periods (PE class, study hall)
Technology-based interventions for tobacco and other drug usage (excluding alcohol) in college students were analysed, using abstinence outcome measures mainly. The 20 interventions from the 12 included studies utilized a range of technology types, including stand-alone computer programs, the Internet, telephone, and mobile SMS. For the tobacco studies, the interventions increased the rate of abstinence by 1.5 times that of controls. The intervention with the strongest effect size was the most intensive, including a 30-week program with access to a website plus personalized follow-up emails from peer coaches. The majority of interventions for tobacco use in the meta-analysis were compared with usual care control conditions, indicating that additional, tailored content may increase abstinence in groups. Indeed, what proved to be most effective in treatment was:
a) Age-tailored content
b) An intensive approach
c) The distal method - internet interventions may hold greater appeal for students who may be concerned with stigma associated with seeking services on campus
Emerging adults (age 18-25) with substance use problems were used in a study that aimed to evaluate a peer-enhanced version of the Community Reinforcement Approach. Similar to the Addicaid components, this adapted Community Reinforcement Approach (CRA; Meyers et al., 2002) adds peer sessions and Motivational Interviewing. The main measures were:
· Global Appraisal of Individual Needs (GAIN), a semi-structured assessment tool that covers eight main areas, including background, substance use, mental health, physical health, risk behaviors, legal problems, environment, and vocational.
· Adjusted Days Abstinent (ADA), that assesses past 90 day abstinence for many substances (e.g. alcohol, marijuana).
· Days of Binge Drinking (DBD), asking participants on how many days in the past 90 they got drunk or drank four (females) or five (males) or more drinks.
· Quarterly Cost to Society (QCS), estimating the economic cost each participant incurs through utilization of various health, substance use treatment, and criminal justice services.
These are important to consider, because they assess the effectiveness of the treatment on a much wider scale, and can provide useful data for Addicaid. Outcomes were promising, as evidenced by significant linear effects for increased ADA and decreased DBD, at 3 months and then 6 months. Peers experienced similar reductions in DBD and increases in ADA. Quarterly cost to society for peers and clients were non-significant overall. This study provides clear evidence that Concerned Supportive Others (CSOs) can help experience treatment benefits for alcohol and substance abuse. This is a low-cost way of increasing the generally poor reach of treatment to individuals, and is in line with Addicaid’s belief in the importance of close family and friends in the recovery process. In particular, this study highlighted the importance of a session focused on eliciting change talk, or pro-change language, about helping one’s friend, as this was the most frequently attended session by peers.
Of course, the largest component missing in this evidence is the used of online platforms to aid treatment. But by including peers in treatment follow-up, we know we can multiply the app’s effect on individuals’ recoveries.
A 2014 study  was the first experimental trial to evaluate the effectiveness of a Web-based behavioral intervention when deployed in a model where it partially substituted for standard counseling in a community-based specialty addiction treatment program. Opioid-dependent intakes in methadone maintenance treatment were randomly assigned for 12 months to either standard treatment or reduced standard treatment plus a Web-based psychosocial intervention (the Therapeutic Education System, TES, based on the Community Reinforcement Approach). Of course, Addicaid aims to work alongside standard treatment, rather than act as a partial substitution or replacement, but this study provides useful data nonetheless.
Participants in the reduced standard + TES condition had a significantly greater percentage of overall study weeks of abstinence from opioids compared to those in standard treatment, as well as a greater percentage of continued abstinence over consecutive weeks. Reasons for this could be the highly interactive nature of the program, similar to Addicaid, and the requirement for active and ongoing participation in individuals’ own recoveries. Another important element to consider is the program’s individually paced testing on the therapy materials. This allows all users to obtain a high level skill and knowledge set, regardless of their baseline experience or previous knowledge. This fluency-based technology could be extremely useful for Addicaid to project a similar mastery level to all it’s users. Overall, although participants received shorter treatment sessions with counsellors, what pushed them to obtain and maintain high abstinence levels as a test group was the combination of ‘real-life’ treatment and the use of the TES intervention together. This serves to strengthen Addicaid’s ideas and approach as a personalized treatment enhancement program.
OCCUPATION BASED INTERVENTION
 Carroll KM, Ball SA, Martino S, et al. Computer-Assisted Delivery of Cognitive-Behavioral Therapy for Addiction: A Randomized Trial of CBT4CBT. The American journal of psychiatry. 2008;165(7):881-888. doi:10.1176/appi.ajp.2008.07111835.
 Translating SBIRT to public school settings: An initial test of feasibility
Journal of Substance Abuse Treatment, Volume 46, Issue 1, Pages 15-21
Brenda L. Curtis, A. Thomas McLellan, Beth N. Gabellini
 Technology-based interventions for tobacco and other drug use in university and college students: a systematic review and meta-analysis,, by Amelia Gulliver, Louise Farrer, Jade KY Chan, Robert J Tait, Kylie Bennett, Alison L Calear, and Kathleen M Griffiths
 Smith DC, Davis JP, Ureche DJ, Dumas TM. Six month outcomes of a peer-enhanced community reinforcement approach for emerging adults with substance misuse: A Preliminary Study. Journal of substance abuse treatment. 2016;61:66-73. doi:10.1016/j.jsat.2015.09.002.
 Marsch LA, Guarino H, Acosta M, et al. Web-based Behavioral Treatment for Substance Use Disorders as a Partial Replacement of Standard Methadone Maintenance Treatment. Journal of substance abuse treatment. 2014;46(1):10.1016/j.jsat.2013.08.012. doi:10.1016/j.jsat.2013.08.012.
 Occupation-Based Intervention for Addictive Disorders: A Systematic Review, by Wasmuth, Pritchard, and Kaneshiro.