title: Effectiveness of Computer-Assisted Therapy for Substance Dependence Using Breaking Free Online: Subgroup Analyses of a Heterogeneous Sample of Service Users.
abstract: BACKGROUND
  Substance misuse services within the United Kingdom have traditionally been oriented to opiate and crack users, and attended predominantly by male service users. Groups who do not fit this demographic, such as women or those whose primary drug of choice is neither heroin nor crack, have tended to be underrepresented in services. In addition, there can be stigma associated with traditional opiate and crack-centric services. Therefore, the computerized treatment and recovery program, Breaking Free Online (BFO), was developed to enable service users to access confidential support for dependence on a wide range of substances. BFO is delivered as computer-assisted therapy (CAT), or, where appropriate, used as self-help.
  
  
  OBJECTIVE
  The aim of this study was to report psychometric outcomes data from 393 service users accessing online support for substance misuse via BFO.
  
  
  METHODS
  Following initial referral to substance misuse services, all participants were supported in setting up a BFO login by a practitioner or peer mentor, and, where required, assisted as they completed an online baseline assessment battery contained within the BFO program. Following a period of engagement with BFO, all participants completed the same battery of assessments, and changes in the scores on these assessments were examined.
  
  
  RESULTS
  Significant improvements were found across the 393 service users in several areas of psychosocial functioning, including quality of life, severity of alcohol and drug dependence, depression, and anxiety (P=<.001 across all aspects of functioning). Additionally, significant improvements were found within specific subgroups of participants, including females (P=.001-<.001), males (P=.004-<.001), service users reporting alcohol dependence (P=.002-<.001), opiate and crack dependence (P=.014-<.001), and those seeking support for other substances that may be less well represented in the substance misuse sector (P=.001-<.001).
  
  
  CONCLUSIONS
  Data from this study indicates that BFO is an effective clinical treatment for a wide range of individuals requiring support for substance misuse. Further work is currently underway to examine more closely the clinical effectiveness of the program.
authors.affiliation: Breaking Free Online Manchester United Kingdom.
authors.forename: Sarah
authors.identifier: 0000-0002-5649-640X
authors.initials: S
authors.lastname: Elison
authors.affiliation: Breaking Free Online Manchester United Kingdom.
authors.forename: Glyn
authors.identifier: 0000-0002-0839-8450
authors.initials: G
authors.lastname: Davies
authors.affiliation: Breaking Free Online Manchester United Kingdom.
authors.forename: Jonathan
authors.identifier: 0000-0001-8911-6007
authors.initials: J
authors.lastname: Ward
keywords: computer-assisted therapy; psychosocial interventions; substance misuse; treatment