title: Can persons with a history of multiple addiction treatment episodes benefit from technology delivered behavior therapy? A moderating role of treatment history at baseline.
abstract: A growing line of research has shown positive treatment outcomes from technology-based therapy for substance use disorders (SUDs). However, little is known about the effectiveness of technology-based SUD interventions for persons who already had numerous prior SUD treatments. We conducted a secondary analysis on a 12-month trial with patients (N=160) entering methadone maintenance treatment (MMT). Patients were randomly assigned to either standard MMT treatment or a model in which half of standard counseling sessions were replaced with a computer-based intervention, called Therapeutic Education System (standard+TES). Four treatment history factors at baseline, the number of lifetime SUD treatment episodes, detoxification episodes, and inpatient/outpatient treatment episodes were categorized into three levels based on their tertile points, and analyzed as moderators. Dependent variables were urine toxicology results for opioid and cocaine abstinence for 52-weeks. The standard+TES condition produced significantly better opioid abstinence than standard treatment for participants with 1) a moderate or high frequency of lifetime SUD treatment episodes, and 2) those with all three levels (low, moderate and high) of detoxification and inpatient/outpatient treatment episodes, ps<.01. The standard+TES condition enhanced cocaine abstinence compared to standard treatment among people with 1) a moderate or high frequency of lifetime SUD treatment episodes, 2) a high level of detoxification episodes, and 3) a moderate or high level of inpatient treatment history, ps<.01. We found that including technology-based behavioral therapy as part of treatment can be more effective than MMT alone, even among patients with a history of multiple addiction treatment episodes.
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, 85 Mechanic Street, Lebanon, NH 03766, USA. Electronic address: Sunny.J.Kim@dartmouth.edu.
authors.forename: Sunny Jung
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, 85 Mechanic Street, Lebanon, NH 03766, USA. Electronic address: Lisa.A.Marsch@dartmouth.edu.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Marsch
authors.affiliation: National Development and Research Institutes, Inc., 71 W. 23rd St., New York, NY 10010, USA. Electronic address: acosta@ndri.org.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Acosta
authors.affiliation: National Development and Research Institutes, Inc., 71 W. 23rd St., New York, NY 10010, USA. Electronic address: guarino@ndri.org.
authors.forename: Honoria
authors.initials: H
authors.lastname: Guarino
authors.affiliation: National Development and Research Institutes, Inc., 71 W. 23rd St., New York, NY 10010, USA. Electronic address: aponte-melendez@ndri.org.
authors.forename: Yesenia
authors.initials: Y
authors.lastname: Aponte-Melendez
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001521:Behavior Therapy / Q000379:methods*; D020811:Biomedical Technology / Q000379:methods*; D019970:Cocaine-Related Disorders / Q000534:rehabilitation*; D003376:Counseling; D018765:Dopamine Uptake Inhibitors / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D018765:Dopamine Uptake Inhibitors; D008691:Methadone
keywords: Behavioral therapy; Cocaine dependence; Computer-based health intervention; Opioid dependence; Treatment history