Randomized Clinical Trial of Computerized and Clinician-Delivered CBT in Comparison With Standard Outpatient Treatment for Substance Use Disorders: Primary Within-Treatment and Follow-Up Outcomes
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OBJECTIVE: Previous trials have demonstrated the efficacy and durability of computer-based cognitive-behavioral therapy (CBT4CBT) as an add-on to standard outpatient care in a range of treatment-seeking populations. In this study, the authors evaluated the efficacy and safety of CBT4CBT as a virtual stand-alone treatment, delivered with minimal clinical monitoring, and clinician-delivered cognitive-behavioral therapy (CBT) compared with treatment as usual in a heterogeneous sample of treatment-seeking outpatients with substance use disorders. METHOD: This was a randomized clinical trial in which 137 individuals who met DSM-IV-TR criteria for current substance abuse or dependence were randomly assigned to receive treatment as usual, weekly individual CBT, or CBT4CBT with brief weekly monitoring. RESULTS: Rates of treatment exposure differed by group, with the best retention in the CBT4CBT group and the poorest in the individual CBT group. Participants who received CBT or CBT4CBT reduced their frequency of substance use significantly more than those who received treatment as usual. Six-month follow-up outcomes indicated continuing benefit of CBT4CBT (plus monitoring) over treatment as usual, but not for clinician-delivered CBT over treatment as usual. Analysis of secondary outcomes indicated that participants in the CBT4CBT group demonstrated the best learning of cognitive and behavioral concepts, as well as the highest satisfaction with treatment. CONCLUSIONS: This first trial of computerized CBT as a virtual stand-alone intervention delivered in a clinical setting to a diverse sample of patients with current substance use disorders indicated that it was safe, effective, and durable relative to standard treatment approaches and was well-liked by participants. Clinician-delivered individual CBT, while efficacious within the treatment period, was unexpectedly associated with a higher dropout rate and lower effects at follow-up.
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References 40 · Cited by 138
Research works printed but not linked: 5
- [1]U.S. Department of Health and Human Services (HHS) Office of the Surgeon General: Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health Washington, DC HHS 2016 28252892
- [20]First MB Spitzer RL Gibbon M Williams JBW Structured Clinical Interview for DSM-IV, Patient Edition Washington, DC American Psychiatric Press 1995
- [26]Carroll KM Kiluk BD Nich C Gordon MA Portnoy GA Marino DR Ball SA Computer-assisted delivery of cognitive-behavioral therapy: efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone Am J Psychiatry 2014 171 436 444 24577287 PMC4042674
- [27]Carroll KM Ball SA Martino S Nich C Babuscio TA Nuro KF Gordon MA Portnoy GA Rounsaville BJ Computer-assisted delivery of cognitive-behavioral therapy for addiction: a randomized trial of CBT4CBT Am J Psychiatry 2008 165 881 888 18450927 PMC2562873
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- Authors
- Kiluk, B. D., Nich, C., Buck, M. B., Devore, K. A., Frankforter, T. L., LaPaglia, D. M., Muvvala, S. B., & Carroll, K. M.
- Affiliations
- Yale University (US)
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2018-09-01
- Volume
- 175
- Issue
- 9
- Pages
- 853-863
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC6120780
- OpenAlex
- W2804010510
- Cited by
- 138
- References
- 40
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 17 · 2023: 13 · 2022: 10 · 2021: 11 · 2020: 60 · 2019: 8 · 2018: 3
- FWCI
- 25.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (R01AA024122)
- National Institute on Drug Abuse (R37DA015969, P50DA009241, R01DA015969)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- computerized cognitive behavioral therapy, substance use disorders, outpatient care, treatment retention, treatment discontinuation, treatment satisfaction, relapse prevention, usual care
- MeSH terms
- Adult, Ambulatory Care, Female, Follow-Up Studies, Humans, Male, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Substance-Related Disorders
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