Review of: Kelpin SS et al, J Subst Abuse Treat 2022;132:108622

Study Type: Randomized open-label controlled trial

Cognitive behavioral therapy (CBT) is helpful for substance use disorders, and studies have shown that computer-based CBT is effective in outpatient settings. But is computer-based CBT also effective in intensive residential treatment settings? Researchers sought to answer this question by investigating the efficacy of an adjunctive CBT program called Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT).

This pilot study took place in a residential treatment program for women with addiction that offered medication management, individual and group counseling, and case management services. Sixty-three women were randomized to one of two groups. One group (n=29) continued in the standard residential treatment program, which consisted of individual and group therapy, medications, and case management. The other group (n=34) participated in adjunctive CBT4CBT. Participants were predominantly Black (79.4%), with an average age of 41.2 years (range 18–65 years). Most identified opioids (61.9%) and cocaine (73.0%) as their primary substance use problem, and nearly half (47.6%) identified using both.

The CBT4CBT program consists of seven videos (30–45 minutes each), interactive exercises, and “homework” to be completed between sessions for extra skills practice. Women accessed the program on tablets in a private on-site area for a minimum of two sessions per week for 3.5 weeks. These sessions were in addition to the services offered in the residential treatment program.

Researchers assessed drug and alcohol use with urine toxicology and breathalyzer, as well as self-report. Participants were assessed at the study’s initiation, at the time of facility discharge, and at four and 12 weeks post-discharge. At 12 weeks post-discharge, women in the CBT4CBT group had lower relapse rates (30.4% vs 47.6%) and reported fewer substance use days (3.4 vs 9.2) of their primary problematic substance. Time to relapse was also about a week longer in the CBT4CBT group (57.4 days vs 51.8 days). Because the study did not enroll enough patients, it was not powered to detect statistical significance, but the trends were in favor of CBT.

Carlat Take

Computer-based CBT programs have already shown promise as an adjunctive treatment for outpatients, and this small pilot demonstrates that CBT4CBT seems to be helpful in residential settings as well. This study only evaluated efficacy as an adjunctive treatment, so more robustly controlled trials are needed before we can give this program a full recommendation. Nonetheless, its relatively low cost and ease of access make it something to consider adding to usual treatment.