title: Web-based treatment for substance use disorders: differential effects by primary substance.
abstract: BACKGROUND
  This secondary analysis of data from a large, multi-site effectiveness trial (NCT01104805) sought to determine whether effects of a web-based behavioral treatment (Therapeutic Education System [TES]) differed by participants' self-identified primary drug of abuse.
  
  
  METHODS
  The all-comers sample of individuals entering outpatient psychosocial counseling treatment for substance abuse (N=497) cited cannabis (22.9%; n=114), stimulants (34.4%, n=171), opioids (21.7%, n=108), or alcohol (20.9%, n=104) as their primary substance of abuse. Participants were randomly assigned to receive treatment-as-usual (TAU) with or without TES substituted for approximately 2h of usual counseling. Multivariate analyses of abstinence outcomes examined interactions of treatment effects with primary substance.
  
  
  RESULTS
  Adjusted odds ratios (AORs) demonstrated that primary stimulant users receiving TES were more likely to be abstinent in the final four weeks of treatment compared to stimulant users receiving TAU (AOR=3.59, 95% CI=1.25-10.27). Adjusted odds ratios for alcohol (AOR=3.15, 95% CI=0.85-11.65) and cannabis (AOR=2.64, 95% CI=0.73-9.52) also were of similar magnitude to stimulants but did not reach significance. Abstinence among primary opioid users was not improved by the TES intervention (AOR=0.35, 95% CI=0.09-1.47).
  
  
  CONCLUSIONS
  This study supports the TES web-delivered treatment as a viable intervention for the majority of substance users entering outpatient counseling treatment, with demonstrated effectiveness among stimulant users and promising effects in alcohol and cannabis users but little or no effect in primary opioid users. Web-delivered treatments hold promise for expanding the availability of effective behavioral interventions for the majority of substance use disorders.
authors.affiliation: University of Pittsburgh, School of Social Work, 4200 Forbes Ave., 2117 CL, Pittsburgh, PA 15260, United States. Electronic address: gcochran@pitt.edu.
authors.forename: Gerald
authors.initials: G
authors.lastname: Cochran
authors.affiliation: Johns Hopkins University, School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224-6823, United States.
authors.forename: Maxine
authors.initials: M
authors.lastname: Stitzer
authors.affiliation: Columbia University, College of Physicians and Surgeons, 630W 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States.
authors.forename: Aimee N C
authors.initials: AN
authors.lastname: Campbell
authors.affiliation: Columbia University, College of Physicians and Surgeons, 630W 168th St, New York, NY 10032, United States.
authors.forename: Mei-Chen
authors.initials: MC
authors.lastname: Hu
authors.affiliation: Johns Hopkins University, School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224-6823, United States.
authors.forename: Ryan
authors.initials: R
authors.lastname: Vandrey
authors.affiliation: Columbia University, College of Physicians and Surgeons, 630W 168th St, New York, NY 10032, United States; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States.
authors.forename: Edward V
authors.initials: EV
authors.lastname: Nunes
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000534:rehabilitation*; D000697:Central Nervous System Stimulants; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003376:Counseling / Q000379:methods; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D002189:Marijuana Abuse / Q000534:rehabilitation*; D016017:Odds Ratio; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D019966:Substance-Related Disorders / Q000534:rehabilitation; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants
keywords: Multi-site clinical trial; Primary substance of abuse; Web-based drug treatment