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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
Author(s) -
Kiluk Brian D.,
Devore Kathleen A.,
Buck Matthew B.,
Nich Charla,
Frankforter Tami L.,
LaPaglia Donna M.,
Yates Brian T.,
Gordon Melissa A.,
Carroll Kathleen M.
Publication year - 2016
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/acer.13162
Subject(s) - randomized controlled trial , alcohol use disorder , medicine , cognitive behavioral therapy , alcohol dependence , cognitive therapy , psychiatry , alcohol , physical therapy , biochemistry , chemistry
Background Cognitive behavioral therapy ( CBT ) is an evidence‐based treatment for alcohol use disorders ( AUD s), 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 + CBT 4 CBT ); or (iii) CBT 4 CBT plus brief weekly clinical monitoring ( CBT 4 CBT + 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 + CBT 4 CBT = 22; CBT 4 CBT + monitoring = 24). There were significantly higher rates of treatment completion among participants assigned to 1 of the CBT 4 CBT 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 + CBT 4 CBT 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 CBT 4 CBT conditions compared to TAU , both within treatment and during follow‐up. Conclusions This trial demonstrated the safety, feasibility, and preliminary efficacy of web‐based CBT 4 CBT targeting alcohol use. CBT 4 CBT was superior to TAU at increasing PDA when delivered as an add‐on, and it was not significantly different from TAU or TAU + CBT 4 CBT when delivered with clinical monitoring only.