Web-based treatment outperforms in-person therapy in Yale study

A study released Thursday in the American Journal of Psychiatry suggests an online addiction treatment program might not be just a viable alternative to in-person treatment, but a more effective option.

Individuals participating in a Yale University study who misuse drugs and alcohol were found to be more likely to complete treatment and use illicit substances less, both during treatment and in the six months following, if they completed an online treatment program that teaches behavior control strategies and skills versus those who engaged in traditional therapy.

The study tracked 137 users of alcohol, opioids, cocaine and/or marijuana who were diagnosed with abuse or dependence problems and sought treatment at an outpatient facility. Kathleen Carroll, Albert E. Kent professor of psychiatry at Yale and the study’s senior author told Addiction Professional in an email that the study was “all comers,” meaning it did not exclude potential participants for psychiatric or other reasons. Most participants were unemployed, 27% had major depressive disorder, 24% met the criteria for antisocial personality disorder, and 82% were using both drugs and alcohol.

Participants were divided into three groups: a group that received weekly group counseling typical of outpatient programs, a group that received individual cognitive behavioral therapy (CBT) sessions, and a third group that used a web-based program. The online program, called CBT4CBT (Computer-Based Training for Cognitive Behavioral Therapy), incorporated multimedia content that included brief movies with actors who employ CBT coping strategies, as well as interactive exercises and quizzes. The third group also met with a therapist for 10 minutes a week to track symptoms and functioning.

The results

The web-based CBT4CBT program was completed by roughly three-quarters of its participants; about half of the participants in standard counseling and one-on-one sessions completed their treatment. At the end of their respective treatment programs, 67% of web-based program participants no longer met the diagnostic criteria for substance abuse versus 43% of standard counseling participants and 52% of those in one-on-one therapy.

“I think it provided something of value, as it concentrated on teaching new skills in an engaging way,” Carroll said of CBT4CBT in her email. (Note: Carroll is also the founder of the CBT4CBT program.) “One of the aims of the study was to sort out what type of people need/do better with a skilled clinician, and who does fine with just a computer—we’re still working on those analyses, but one of the things I’ve realized over the years is that not everyone coming into treatment wants ‘therapy’, especially group therapy.”

Carroll said the web-based program did not demonstrate any variance in effectiveness based on the substance being misused by the patient, and that many were misusing multiple substances upon entering treatment.

The researchers who conducted the study are currently testing different versions of the CBT4CBT program among various underserved populations, as well as primary care settings.