title: Adding an Internet-delivered treatment to an efficacious treatment package for opioid dependence.
abstract: OBJECTIVE
  To examine the benefit of adding an Internet-delivered behavior therapy to a buprenorphine medication program and voucher-based motivational incentives.
  
  
  METHODS
  A block-randomized, unblinded, parallel, 12-week treatment trial was conducted with 170 opioid-dependent adult patients (mean age = 34.3 years; 54.1% male; 95.3% White). Participants received an Internet-based community reinforcement approach intervention plus contingency management (CRA+) and buprenorphine or contingency management alone (CM-alone) plus buprenorphine. The primary outcomes, measured over the course of treatment, were longest continuous abstinence, total abstinence, and days retained in treatment.
  
  
  RESULTS
  Compared to those receiving CM-alone, CRA+ recipients exhibited, on average, 9.7 total days more of abstinence (95% confidence interval [CI = 2.3, 17.2]) and had a reduced hazard of dropping out of treatment (hazard ratio = 0.47; 95% CI [0.26, 0.85]). Prior treatment for opioid dependence significantly moderated the additional improvement of CRA+ for longest continuous days of abstinence.
  
  
  CONCLUSIONS
  These results provide further evidence that an Internet-based CRA+ treatment is efficacious and adds clinical benefits to a contingency management/medication based program for opioid dependence.
authors.affiliation: Faculty of Health Sciences, University of Lethbridge.
authors.forename: Darren R
authors.initials: DR
authors.lastname: Christensen
authors.affiliation: Department of Biostatistics.
authors.forename: Reid D
authors.initials: RD
authors.lastname: Landes
authors.affiliation: Department of Biostatistics.
authors.forename: Lisa
authors.initials: L
authors.lastname: Jackson
authors.affiliation: Department of Psychiatry, Dartmouth Psychiatric Research Center.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Marsch
authors.affiliation: Department of Psychiatry, University of Arkansas for Medical Sciences.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mancino
authors.affiliation: Department of Psychiatry, Boston University School of Medicine.
authors.forename: Mohit P
authors.initials: MP
authors.lastname: Chopra
authors.affiliation: Addiction Recovery Research Center.
authors.forename: Warren K
authors.initials: WK
authors.lastname: Bickel
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002047:Buprenorphine / Q000008:administration & dosage; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009292:Narcotic Antagonists / Q000008:administration & dosage; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000628:therapy*; D012054:Reinforcement, Psychology; D012111:Residence Characteristics; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D002047:Buprenorphine
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