title: Randomized Trial of Computerized Cognitive Behavioral Therapy for Alcohol Use Disorders: Efficacy as a Virtual Stand-Alone and Treatment Add-On Compared with Standard Outpatient Treatment.
abstract: Cognitive behavioral therapy (CBT) is an evidence-based treatment for alcohol use disorders (AUDs), yet is rarely implemented with high fidelity in clinical practice. Computer-based delivery of CBT offers the potential to address dissemination challenges, but to date there have been no evaluations of a web-based CBT program for alcohol use within a clinical sample.
  
  
  
  This study randomized treatment-seeking individuals with a current AUD to 1 of 3 treatments at a community outpatient facility: (i) standard treatment as usual (TAU); (ii) TAU plus on-site access to a computerized CBT targeting alcohol use (TAU + CBT4CBT); or (iii) CBT4CBT plus brief weekly clinical monitoring (CBT4CBT + monitoring). Participant alcohol use was assessed weekly during an 8-week treatment period, as well as 1, 3, and 6 months after treatment.
  
  
  
  Sixty-eight individuals (65% male; 54% African American) were randomized (TAU = 22; TAU + CBT4CBT = 22; CBT4CBT + monitoring = 24). There were significantly higher rates of treatment completion among participants assigned to 1 of the CBT4CBT conditions compared to TAU (Wald = 6.86, p < 0.01). Significant reductions in alcohol use were found across all conditions within treatment, with participants assigned to TAU + CBT4CBT demonstrating greater increases in percentage of days abstinent (PDA) compared to TAU, t(536.4) = 2.68, p < 0.01, d = 0.71, 95% CI (0.60, 3.91), for the full sample. Preliminary findings suggest the estimated costs of all self-reported AUD-related services utilized by participants were considerably lower for those assigned to CBT4CBT conditions compared to TAU, both within treatment and during follow-up.
  
  
  
  This trial demonstrated the safety, feasibility, and preliminary efficacy of web-based CBT4CBT targeting alcohol use. CBT4CBT was superior to TAU at increasing PDA when delivered as an add-on, and it was not significantly different from TAU or TAU + CBT4CBT when delivered with clinical monitoring only.
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kiluk
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Devore
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Buck
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Charla
authors.initials: C
authors.lastname: Nich
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Tami L
authors.initials: TL
authors.lastname: Frankforter
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Donna M
authors.initials: DM
authors.lastname: LaPaglia
authors.affiliation: Department of Psychology, American University, Washington, District of Columbia.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Yates
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Gordon
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Carroll
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D000553:Ambulatory Care / Q000379:methods* / Q000592:standards; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016320:Substance Abuse Treatment Centers / Q000379:methods* / Q000592:standards; D013813:Therapy, Computer-Assisted / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome; D063367:Virtual Reality Exposure Therapy / Q000379:methods* / Q000592:standards
keywords: Alcohol Use Disorders; CBT4CBT; Computer-Delivered Treatment