Adding an Internet-Delivered Treatment to an Efficacious Treatment Package for Opioid Dependence

Objective: To examine the benefit of adding an Internet-delivered behavior therapy to a buprenorphine medication program and voucher-based motivational incentives. Method: A block-randomized, unblinded, parallel, 12-week treatment trial was conducted with 170 opioid-dependent adult patients (mean ag...

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Bibliographic Details
Published in:Journal of consulting and clinical psychology 2014-12, Vol.82 (6), p.964-972
Main Authors: Christensen, Darren R., Landes, Reid D., Jackson, Lisa, Marsch, Lisa A., Mancino, Michael J., Chopra, Mohit P., Bickel, Warren K.
Format: Article
Language:English
Subjects:
Adjunctive Treatment
Adult
Aged
Analgesics, Opioid - administration & dosage
Behavior modification
Behavior Therapy
Buprenorphine
Buprenorphine - administration & dosage
Clinical trials
Cognitive Behavioral Therapy - methods
Cognitive therapy
Combined Modality Therapy
Computer Assisted Therapy
Drug abuse
Drug Dependency
Drug Therapy
Female
Human
Humans
Internet
Male
Middle Aged
Motivation
Narcotic Antagonists - administration & dosage
Narcotics
Opiate Substitution Treatment - methods
Opiates
Opioid-Related Disorders - drug therapy
Opioid-Related Disorders - therapy
Reinforcement, Psychology
Residence Characteristics
Treatment Outcome
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Summary:Objective: To examine the benefit of adding an Internet-delivered behavior therapy to a buprenorphine medication program and voucher-based motivational incentives. Method: A block-randomized, unblinded, parallel, 12-week treatment trial was conducted with 170 opioid-dependent adult patients (mean age = 34.3 years; 54.1% male; 95.3% White). Participants received an Internet-based community reinforcement approach intervention plus contingency management (CRA+) and buprenorphine or contingency management alone (CM-alone) plus buprenorphine. The primary outcomes, measured over the course of treatment, were longest continuous abstinence, total abstinence, and days retained in treatment. Results: Compared to those receiving CM-alone, CRA+ recipients exhibited, on average, 9.7 total days more of abstinence (95% confidence interval [CI = 2.3, 17.2]) and had a reduced hazard of dropping out of treatment (hazard ratio = 0.47; 95% CI [0.26, 0.85]). Prior treatment for opioid dependence significantly moderated the additional improvement of CRA+ for longest continuous days of abstinence. Conclusions: These results provide further evidence that an Internet-based CRA+ treatment is efficacious and adds clinical benefits to a contingency management/medication based program for opioid dependence.
ISSN:0022-006X
1939-2117
1939-2117
DOI:10.1037/a0037496