Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Drug Alcohol Depend. 2011 May 1;115(1-2):74-9. doi: 10.1016/j.drugalcdep.2010.10.014. Epub 2010 Dec 4.
The most potent outcomes for cannabis use disorders have been observed with a combination of three evidence-based interventions, motivational enhancement therapy (MET), cognitive-behavioral therapy (CBT), and abstinence-based contingency-management (CM). Access to this intervention remains limited because of cost and service availability issues. This report describes the initial stages of a project designed to develop and test a computer-assisted version of MET/CBT/CM that could address many of the current barriers to its dissemination. A nonrandomized, 12-week comparison study assigned 38 adults seeking treatment for a cannabis use disorder to either therapist-delivered (n=22) or computer-delivered (n=16) MET/CBT/CM. Attendance, retention, and cannabis use outcomes did not differ significantly between groups, and there were no indications of superior outcomes favoring therapist delivery. Participants provided positive ratings of the computer-delivered sessions. These preliminary findings suggest that computer-assisted delivery of MET/CBT/CM is acceptable to outpatients and does not adversely impact compliance or outcomes achieved during treatment with MET/CBT/CM for cannabis use disorders. Assessment of post-treatment outcomes and replication in randomized trials are needed to determine reliability and longer term effects. As observed in a growing number of studies, computerized therapies have the potential to increase access to, reduce costs, and enhance fidelity of providing evidence-based treatments without sacrificing and possibly enhancing effectiveness.
最有效的大麻使用障碍治疗结果是通过三种基于证据的干预措施的组合观察到的,即动机增强疗法(MET)、认知行为疗法(CBT)和基于戒除的 contingency-management(CM)。由于成本和服务可用性问题,这种干预措施的应用仍然有限。本报告描述了一个旨在开发和测试基于计算机的 MET/CBT/CM 版本的项目的初始阶段,该版本可以解决当前传播的许多障碍。一项非随机、12 周的比较研究将 38 名寻求大麻使用障碍治疗的成年人分配到治疗师提供的(n=22)或计算机提供的(n=16)MET/CBT/CM。两组之间的出勤率、保留率和大麻使用结果没有显著差异,也没有迹象表明治疗师提供的结果更好。参与者对计算机提供的课程给予了积极的评价。这些初步结果表明,MET/CBT/CM 的计算机辅助提供对门诊患者是可以接受的,并且不会对 MET/CBT/CM 治疗大麻使用障碍期间的依从性或结果产生不利影响。需要评估治疗后的结果并在随机试验中进行复制,以确定可靠性和长期效果。正如越来越多的研究所观察到的,计算机化疗法有可能增加获得机会,降低成本,并提高提供基于证据的治疗的保真度,而不会牺牲甚至可能增强有效性。