Web-delivery of Evidence-based, Psychosocial Treatment for Substance Use Disorders

The principal objective of the planned trial is to evaluate the effectiveness of including
an interactive, web-based version of the Community Reinforcement Approach (CRA), called the
Therapeutic Education System (TES), as part of community-based, outpatient substance abuse
treatment. CRA is a cognitive-behavioral intervention which seeks to give patients skills to
achieve and maintain abstinence and improve social functioning and is often paired with
contingency management, where patients earn rewards contingent upon drug negative urines.
CRA is an intensive treatment, generally delivered in individual sessions 2 to 3 times per
week. Thus, it is expensive and time-consuming to deliver, to train clinical staff, and to
provide supervision to maintain clinical staff skill. However, because CRA is oriented
toward knowledge and skills, it lends itself to being delivered by computer, using
computer-interactive learning technologies.

Individuals accepted into community-based outpatient treatment for substance use disorders
(excluding those receiving opioid pharmacotherapy for opioid dependence) will be eligible to
participate. This is a multi-site, controlled trial, using NIDA's Clinical Trials Network
platform, at approximately 10 Community Treatment Programs, in which participants (N =
approximately 500) will be randomized to receive 12 weeks of either: (1) Treatment-as-Usual
(TAU), reflecting standard treatment at the collaborating treatment programs in which
participants are enrolled, or (2) a modification of TAU which includes access to the TES. It
is hypothesized that access to TES will improve substance use outcome and retention in
outpatient treatment.

Computer interactive interventions like TES have the potential to deliver science-based
psychosocial treatments with high fidelity and cost-effectiveness while conserving clinician
time to focus on monitoring and addressing patients' needs. If found to be effective, TES
could substantially advance the substance abuse treatment system by improving quality of
care delivered, increasing availability of treatment slots by extending and leveraging the
efforts of clinical staff, and projecting treatment to rural and other underserved areas.