Web-based treatments for substance use disorder (SUD) are gaining support in the addiction field due to their ability to reach people beyond traditional service settings.
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One such treatment, the Therapeutic Education System (TES), was shown to improve abstinence rates when substituted for two hours per week of regular in-person counseling.
This study explores if the use of this web-based treatment has differential effects for individuals who primarily use different substance (stimulants, alcohol, marijuana, and opioids).
This study used data from a prior study testing the effectiveness of the Theraputic Education randomized controlled trial testing the effectiveness of Theraputic Education System (TES combined with treatment as usual (TAU; i.e., in-person counseling) to TAU without TES.
Participants (N = 507) were recruited from ten outpatient treatment centers and received treatment for 12 weeks. Those randomly assigned to the TES group received 62 self-guided cognitive behavioral therapy modules instead of 2 hours of in-person counseling each week. TES also had a contingency management (CM) component where participants could earn over $100 dollars for completing modules and over $450 for remaining abstinent throughout the study.
Participants reported their primary substance as follows:
“Other substances” was not included due to small sample size, resulting in a final sample of 497 for the present analysis.
Outcomes included:
a) abstinence (self-report and negative urine sample) during the last 4 weeks of the 12-week study, which was measured twice per week (measured 8 times during the last 4 weeks)
b) treatment retention, defined as the proportion of participants remaining in the program at week 12
The majority of participants were male (62%), White (53%), single (61%), under or unemployed (59%), and had a high school diploma or equivalent (61%). The figure below shows the abstinence rates during the last 4 weeks of the treatment period measured dichotomously for those abstinent across the entire 4 week period versus those who were not.
In an analysis that adjusted for baseline levels of abstinence and time, there was a significant effect favoring TES for the stimulant group only. For this group, the odds of abstinence were almost 4 times higher for TES than TAU. It is interesting that participants who primarily used opioids in the TAU group experienced higher rates of abstinence than TES, though this difference was not statistically significant. Treatment condition and primary substance were not associated with treatment retention.
This study showed that a web-based intervention combined with in-person counseling produces significantly better results for individuals who primarily use stimulants than TAU. Results appeared also to be potentially promising among individuals who reported alcohol or cannabis as their primary substance. However, the advantage of TES for these participants did not reach statistical significance perhaps because of small sample sizes.
This study is important for determining if TES is more or less effective for certain groups of individuals. If effects are different by primary substance used, it may inform tailored clinical recommendations based on one’s substance of choice.
As the authors point out, these individuals may require more treatment such as medication in addition to psychosocial counseling. A different study of opioid-dependent patients in methadone treatment found that TES in place of a portion of standard treatment resulted in greater rates of opioid abstinence, and another study of opioid-dependent patients receiving buprenorphine found comparable abstinence rates for TES versus in-person CRA plus CM, suggesting that TES may be effective for patients with opioid use disorder if used in conjunction with medication-assisted treatment.
Individuals reporting stimulants as their primary substance were the only group where TES performed significantly better than TAU. This is consistent with prior research showing that CM can enhance the effect of CBT for individuals using cocaine (see here for a summary from a previous RRI Recovery Research Review). However, effects tend to wear off after the treatment phase when the possibility of reward is removed. Given the lack of follow-up data, it is unknown if this is the case with current study as well.
Individuals reporting stimulants as their primary substance were the only group where TES performed significantly better than TAU. This is consistent with prior research.
Future research should focus on determining for which specific populations TES and other web-based interventions are effective. Potential subgroups include young adults or people with co-occurring disorders. Also, cost-effectiveness studies could be conducted to investigate the increased value of providing TES and similar interventions.
Cochran, G., Stitzer, M., Campbell, A. N., Hu, M. C., Vandrey, R., & Nunes, E. V. (2015). Web-based treatment for substance use disorders: differential effects by primary substance. Addict Behav, 45, 191-194. doi:10.1016/j.addbeh.2015.02.002
l
One such treatment, the Therapeutic Education System (TES), was shown to improve abstinence rates when substituted for two hours per week of regular in-person counseling.
This study explores if the use of this web-based treatment has differential effects for individuals who primarily use different substance (stimulants, alcohol, marijuana, and opioids).
This study used data from a prior study testing the effectiveness of the Theraputic Education randomized controlled trial testing the effectiveness of Theraputic Education System (TES combined with treatment as usual (TAU; i.e., in-person counseling) to TAU without TES.
Participants (N = 507) were recruited from ten outpatient treatment centers and received treatment for 12 weeks. Those randomly assigned to the TES group received 62 self-guided cognitive behavioral therapy modules instead of 2 hours of in-person counseling each week. TES also had a contingency management (CM) component where participants could earn over $100 dollars for completing modules and over $450 for remaining abstinent throughout the study.
Participants reported their primary substance as follows:
“Other substances” was not included due to small sample size, resulting in a final sample of 497 for the present analysis.
Outcomes included:
a) abstinence (self-report and negative urine sample) during the last 4 weeks of the 12-week study, which was measured twice per week (measured 8 times during the last 4 weeks)
b) treatment retention, defined as the proportion of participants remaining in the program at week 12
The majority of participants were male (62%), White (53%), single (61%), under or unemployed (59%), and had a high school diploma or equivalent (61%). The figure below shows the abstinence rates during the last 4 weeks of the treatment period measured dichotomously for those abstinent across the entire 4 week period versus those who were not.
In an analysis that adjusted for baseline levels of abstinence and time, there was a significant effect favoring TES for the stimulant group only. For this group, the odds of abstinence were almost 4 times higher for TES than TAU. It is interesting that participants who primarily used opioids in the TAU group experienced higher rates of abstinence than TES, though this difference was not statistically significant. Treatment condition and primary substance were not associated with treatment retention.
This study showed that a web-based intervention combined with in-person counseling produces significantly better results for individuals who primarily use stimulants than TAU. Results appeared also to be potentially promising among individuals who reported alcohol or cannabis as their primary substance. However, the advantage of TES for these participants did not reach statistical significance perhaps because of small sample sizes.
This study is important for determining if TES is more or less effective for certain groups of individuals. If effects are different by primary substance used, it may inform tailored clinical recommendations based on one’s substance of choice.
As the authors point out, these individuals may require more treatment such as medication in addition to psychosocial counseling. A different study of opioid-dependent patients in methadone treatment found that TES in place of a portion of standard treatment resulted in greater rates of opioid abstinence, and another study of opioid-dependent patients receiving buprenorphine found comparable abstinence rates for TES versus in-person CRA plus CM, suggesting that TES may be effective for patients with opioid use disorder if used in conjunction with medication-assisted treatment.
Individuals reporting stimulants as their primary substance were the only group where TES performed significantly better than TAU. This is consistent with prior research showing that CM can enhance the effect of CBT for individuals using cocaine (see here for a summary from a previous RRI Recovery Research Review). However, effects tend to wear off after the treatment phase when the possibility of reward is removed. Given the lack of follow-up data, it is unknown if this is the case with current study as well.
Individuals reporting stimulants as their primary substance were the only group where TES performed significantly better than TAU. This is consistent with prior research.
Future research should focus on determining for which specific populations TES and other web-based interventions are effective. Potential subgroups include young adults or people with co-occurring disorders. Also, cost-effectiveness studies could be conducted to investigate the increased value of providing TES and similar interventions.
Cochran, G., Stitzer, M., Campbell, A. N., Hu, M. C., Vandrey, R., & Nunes, E. V. (2015). Web-based treatment for substance use disorders: differential effects by primary substance. Addict Behav, 45, 191-194. doi:10.1016/j.addbeh.2015.02.002
l
One such treatment, the Therapeutic Education System (TES), was shown to improve abstinence rates when substituted for two hours per week of regular in-person counseling.
This study explores if the use of this web-based treatment has differential effects for individuals who primarily use different substance (stimulants, alcohol, marijuana, and opioids).
This study used data from a prior study testing the effectiveness of the Theraputic Education randomized controlled trial testing the effectiveness of Theraputic Education System (TES combined with treatment as usual (TAU; i.e., in-person counseling) to TAU without TES.
Participants (N = 507) were recruited from ten outpatient treatment centers and received treatment for 12 weeks. Those randomly assigned to the TES group received 62 self-guided cognitive behavioral therapy modules instead of 2 hours of in-person counseling each week. TES also had a contingency management (CM) component where participants could earn over $100 dollars for completing modules and over $450 for remaining abstinent throughout the study.
Participants reported their primary substance as follows:
“Other substances” was not included due to small sample size, resulting in a final sample of 497 for the present analysis.
Outcomes included:
a) abstinence (self-report and negative urine sample) during the last 4 weeks of the 12-week study, which was measured twice per week (measured 8 times during the last 4 weeks)
b) treatment retention, defined as the proportion of participants remaining in the program at week 12
The majority of participants were male (62%), White (53%), single (61%), under or unemployed (59%), and had a high school diploma or equivalent (61%). The figure below shows the abstinence rates during the last 4 weeks of the treatment period measured dichotomously for those abstinent across the entire 4 week period versus those who were not.
In an analysis that adjusted for baseline levels of abstinence and time, there was a significant effect favoring TES for the stimulant group only. For this group, the odds of abstinence were almost 4 times higher for TES than TAU. It is interesting that participants who primarily used opioids in the TAU group experienced higher rates of abstinence than TES, though this difference was not statistically significant. Treatment condition and primary substance were not associated with treatment retention.
This study showed that a web-based intervention combined with in-person counseling produces significantly better results for individuals who primarily use stimulants than TAU. Results appeared also to be potentially promising among individuals who reported alcohol or cannabis as their primary substance. However, the advantage of TES for these participants did not reach statistical significance perhaps because of small sample sizes.
This study is important for determining if TES is more or less effective for certain groups of individuals. If effects are different by primary substance used, it may inform tailored clinical recommendations based on one’s substance of choice.
As the authors point out, these individuals may require more treatment such as medication in addition to psychosocial counseling. A different study of opioid-dependent patients in methadone treatment found that TES in place of a portion of standard treatment resulted in greater rates of opioid abstinence, and another study of opioid-dependent patients receiving buprenorphine found comparable abstinence rates for TES versus in-person CRA plus CM, suggesting that TES may be effective for patients with opioid use disorder if used in conjunction with medication-assisted treatment.
Individuals reporting stimulants as their primary substance were the only group where TES performed significantly better than TAU. This is consistent with prior research showing that CM can enhance the effect of CBT for individuals using cocaine (see here for a summary from a previous RRI Recovery Research Review). However, effects tend to wear off after the treatment phase when the possibility of reward is removed. Given the lack of follow-up data, it is unknown if this is the case with current study as well.
Individuals reporting stimulants as their primary substance were the only group where TES performed significantly better than TAU. This is consistent with prior research.
Future research should focus on determining for which specific populations TES and other web-based interventions are effective. Potential subgroups include young adults or people with co-occurring disorders. Also, cost-effectiveness studies could be conducted to investigate the increased value of providing TES and similar interventions.
Cochran, G., Stitzer, M., Campbell, A. N., Hu, M. C., Vandrey, R., & Nunes, E. V. (2015). Web-based treatment for substance use disorders: differential effects by primary substance. Addict Behav, 45, 191-194. doi:10.1016/j.addbeh.2015.02.002
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