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

NCT ID: NCT01104805

Last Updated: 2017-07-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

507 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-04-30

Study Completion Date

2012-09-30

Brief Summary

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The main objective of this study 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.

Detailed Description

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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.

Conditions

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Substance Abuse

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Therapeutic Education System (TES)

Participants randomized to this arm will replace approximately 2 hours of Standard Treatment with the Therapeutic Education System (TES) (comprised of a web-based version of the Community Reinforcement Approach and contingency management).

Group Type EXPERIMENTAL

Therapeutic Education System (TES)

Intervention Type BEHAVIORAL

Participants will received modified treatment-as-usual plus the computerized psychosocial intervention (Therapeutic Education System), including contingency management. Participants will be asked to use the self-directed TES intervention twice weekly and will be asked to complete 2 modules during each session (for a total of 4 modules per week) during the 12-week intervention. Participants will receive incentives contingent primarily upon abstinence from drugs of abuse and, secondarily, upon completion of TES modules.

Treatment-as-Usual (TAU)

Participants randomized to TAU will receive standard treatment offered and prescribed, as usual, in the outpatient substance abuse treatment program.

Group Type OTHER

Treatment-as-Usual (TAU)

Intervention Type BEHAVIORAL

Participants in this condition will receive TAU, consisting of standard treatment offered at each collaborating CTP and will reflect the model of treatment typically provided to most individuals in outpatient, community-based substance abuse treatment settings in the U.S. These sessions will consist of a combination of group and individual counseling.

Interventions

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Therapeutic Education System (TES)

Participants will received modified treatment-as-usual plus the computerized psychosocial intervention (Therapeutic Education System), including contingency management. Participants will be asked to use the self-directed TES intervention twice weekly and will be asked to complete 2 modules during each session (for a total of 4 modules per week) during the 12-week intervention. Participants will receive incentives contingent primarily upon abstinence from drugs of abuse and, secondarily, upon completion of TES modules.

Intervention Type BEHAVIORAL

Treatment-as-Usual (TAU)

Participants in this condition will receive TAU, consisting of standard treatment offered at each collaborating CTP and will reflect the model of treatment typically provided to most individuals in outpatient, community-based substance abuse treatment settings in the U.S. These sessions will consist of a combination of group and individual counseling.

Intervention Type BEHAVIORAL

Other Intervention Names

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Therapeutic Education System TES Treatment as Usual TAU Standard Treatment

Eligibility Criteria

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Inclusion Criteria

* Male and female patients, 18 years or older, accepted for outpatient, substance abuse treatment at a participating study site.
* Self-report any substance use problem (including alcohol, as long as they also report other drug use in addition to alcohol).
* Self-report recent drug use.
* Within 30 days of initiating treatment at a collaborating study site.
* Self-report a planned substance abuse treatment episode of at least 3 months.

Exclusion Criteria

* Receiving opioid replacement medication.
* Plan to move out of the area within the next 3 months.
* Insufficient ability to provide informed consent.
* Insufficient ability to use English to participate meaningfully in the consent process, the interventions or research assessments.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National Institute on Drug Abuse (NIDA)

NIH

Sponsor Role collaborator

New York State Psychiatric Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Edward V Nunes, MD

Role: PRINCIPAL_INVESTIGATOR

NIDA Clinical Trials Network - Long Island Regional Node

Locations

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MCCA: Midwestern CT Council on Alcoholism

Danbury, Connecticut, United States

Site Status

The Center for Drug Free Living

Orlando, Florida, United States

Site Status

Hina Mauka

Waipahu, Hawaii, United States

Site Status

Midtown Community Mental Health Center

Indianapolis, Indiana, United States

Site Status

HARBEL Prevention and Recovery Center

Baltimore, Maryland, United States

Site Status

Stanley Street Treatment and Resources (SSTAR)

Fall River, Massachusetts, United States

Site Status

Project Outreach

West Hempstead, New York, United States

Site Status

Willamette Family, Inc.

Eugene, Oregon, United States

Site Status

Homeward Bound

Dallas, Texas, United States

Site Status

Evergreen Manor

Everett, Washington, United States

Site Status

Countries

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United States

References

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Luderer HF, Campbell ANC, Nunes EV, Enman NM, Xiong X, Gerwien R, Maricich YA. Engagement patterns with a digital therapeutic for substance use disorders: Correlations with abstinence outcomes. J Subst Abuse Treat. 2022 Jan;132:108585. doi: 10.1016/j.jsat.2021.108585. Epub 2021 Jul 30.

Reference Type DERIVED
PMID: 34366201 (View on PubMed)

Murphy SM, Campbell AN, Ghitza UE, Kyle TL, Bailey GL, Nunes EV, Polsky D. Cost-effectiveness of an internet-delivered treatment for substance abuse: Data from a multisite randomized controlled trial. Drug Alcohol Depend. 2016 Apr 1;161:119-26. doi: 10.1016/j.drugalcdep.2016.01.021. Epub 2016 Jan 30.

Reference Type DERIVED
PMID: 26880594 (View on PubMed)

Cochran G, Stitzer M, Campbell AN, Hu MC, Vandrey R, Nunes EV. Web-based treatment for substance use disorders: differential effects by primary substance. Addict Behav. 2015 Jun;45:191-4. doi: 10.1016/j.addbeh.2015.02.002. Epub 2015 Feb 8.

Reference Type DERIVED
PMID: 25697725 (View on PubMed)

Mitchell SG, Schwartz RP, Alvanzo AA, Weisman MS, Kyle TL, Turrigiano EM, Gibson ML, Perez L, McClure EA, Clingerman S, Froias A, Shandera DR, Walker R, Babcock DL, Bailey GL, Miele GM, Kunkel LE, Norton M, Stitzer ML. The Use of Technology in Participant Tracking and Study Retention: Lessons Learned From a Clinical Trials Network Study. Subst Abus. 2015;36(4):420-6. doi: 10.1080/08897077.2014.992565. Epub 2015 Feb 11.

Reference Type DERIVED
PMID: 25671593 (View on PubMed)

Cochran G, Stitzer M, Nunes EV, Hu MC, Campbell A. Clinically relevant characteristics associated with early treatment drug use versus abstinence. Addict Sci Clin Pract. 2014 Apr 4;9(1):6. doi: 10.1186/1940-0640-9-6.

Reference Type DERIVED
PMID: 24708748 (View on PubMed)

Related Links

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http://www.drugabuse.gov/CTN/

National Institute on Drug Abuse, Clinical Trials Network

Other Identifiers

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U10DA013035

Identifier Type: NIH

Identifier Source: secondary_id

View Link

NIDA-CTN-0044

Identifier Type: OTHER

Identifier Source: secondary_id

NYSPI #6051

Identifier Type: -

Identifier Source: org_study_id

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