Budney Alan J, Stanger Catherine, Tilford J Mick, Scherer Emily B, Brown Pamela C, Li Zhongze, Li Zhigang, Walker Denise D
Department of Psychiatry, Geisel School of Medicine at Dartmouth.
Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences.
Psychol Addict Behav. 2015 Sep;29(3):501-11. doi: 10.1037/adb0000078. Epub 2015 May 4.
Computer-assisted behavioral treatments hold promise for enhancing access to and reducing costs of treatments for substance use disorders. This study assessed the efficacy of a computer-assisted version of an efficacious, multicomponent treatment for cannabis use disorders (CUD), that is, motivational enhancement therapy, cognitive-behavioral therapy, and abstinence-based contingency-management (MET/CBT/CM). An initial cost comparison was also performed. Seventy-five adult participants, 59% Black, seeking treatment for CUD received either, MET only (BRIEF), therapist-delivered MET/CBT/CM (THERAPIST), or computer-delivered MET/CBT/CM (COMPUTER). During treatment, the THERAPIST and COMPUTER conditions engendered longer durations of continuous cannabis abstinence than BRIEF (p < .05), but did not differ from each other. Abstinence rates and reduction in days of use over time were maintained in COMPUTER at least as well as in THERAPIST. COMPUTER averaged approximately $130 (p < .05) less per case than THERAPIST in therapist costs, which offset most of the costs of CM. Results add to promising findings that illustrate potential for computer-assisted delivery methods to enhance access to evidence-based care, reduce costs, and possibly improve outcomes. The observed maintenance effects and the cost findings require replication in larger clinical trials.
计算机辅助行为疗法有望增加物质使用障碍治疗的可及性并降低治疗成本。本研究评估了一种计算机辅助版的、对大麻使用障碍(CUD)有效的多成分治疗方法的疗效,即动机增强疗法、认知行为疗法和基于禁欲的应急管理(MET/CBT/CM)。还进行了初步成本比较。75名寻求治疗CUD的成年参与者(59%为黑人)接受了仅MET(简短版)、治疗师提供的MET/CBT/CM(治疗师版)或计算机提供的MET/CBT/CM(计算机版)。在治疗期间,治疗师版和计算机版导致连续大麻戒断的持续时间比简短版更长(p < .05),但两者之间没有差异。计算机版的戒断率和随着时间推移使用天数的减少至少与治疗师版一样好。计算机版在治疗师成本方面平均每个案例比治疗师版少约130美元(p < .05),这抵消了大部分应急管理的成本。结果进一步证明了有前景的发现,即计算机辅助交付方法有潜力增加循证护理的可及性、降低成本并可能改善治疗效果。观察到的维持效果和成本结果需要在更大规模的临床试验中进行重复验证。