title: Recent Internet Use and Associations with Clinical Outcomes among Patients Entering Addiction Treatment Involved in a Web-Delivered Psychosocial Intervention Study.
abstract: The acceptability and clinical impact of a web-based intervention among patients entering addiction treatment who lack recent internet access are unclear. This secondary analysis of a national multisite treatment study (NIDA Clinical Trials Network-0044) assessed for acceptability and clinical impact of a web-based psychosocial intervention among participants enrolling in community-based, outpatient addiction treatment programs. Participants were randomly assigned to 12 weeks of a web-based therapeutic education system (TES) based on the community reinforcement approach plus contingency management versus treatment as usual (TAU). Demographic and clinical characteristics, and treatment outcomes were compared among participants with recent internet access in the 90 days preceding enrollment (N = 374) and without internet access (N = 133). Primary outcome variables included (1) acceptability of TES (i.e., module completion; acceptability of web-based intervention) and (2) clinical impact (i.e., self-reported abstinence confirmed by urine drug/breath alcohol tests; retention measured as time to dropout). Internet use was common (74 %) and was more likely among younger (18-49 years old) participants and those who completed high school (p < .001). Participants randomized to TES (n = 255) without baseline internet access rated the acceptability of TES modules significantly higher than those with internet access (t = 2.49, df = 218, p = .01). There was a near significant interaction between treatment, baseline abstinence, and internet access on time to dropout (χ2(1) = 3.8089, p = .051). TES was associated with better retention among participants not abstinent at baseline who had internet access (X2(1) = 6.69, p = .01). These findings demonstrate high acceptability of this web-based intervention among participants that lacked recent internet access.
authors.affiliation: Department of Population Health Medicine, New York University School of Medicine, 227 E.30th St. 718, 10016, New York, NY, USA. Babak.tofighi@nyumc.org.
authors.forename: B
authors.initials: B
authors.lastname: Tofighi
authors.affiliation: New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
authors.forename: A N C
authors.initials: AN
authors.lastname: Campbell
authors.affiliation: Mailman School of Public Health, Department of Biostatistics, Columbia University, New York, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Pavlicova
authors.affiliation: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Hu
authors.affiliation: Department of Population Health Medicine, New York University School of Medicine, 227 E.30th St. 718, 10016, New York, NY, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Lee
authors.affiliation: New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
authors.forename: E V
authors.initials: EV
authors.lastname: Nunes
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D057566:Self Report; D019966:Substance-Related Disorders / Q000628:therapy*; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome; D055815:Young Adult
keywords: Addiction; Computer-assisted treatment; Disparities; Health information technologies; Substance use disorders; Web-based treatment