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