Tofighi B, Campbell A N C, Pavlicova M, Hu M C, Lee J D, Nunes E V
Department of Population Health Medicine, New York University School of Medicine, 227 E.30th St. 718, 10016, New York, NY, USA.
New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
J Urban Health. 2016 Oct;93(5):871-883. doi: 10.1007/s11524-016-0077-2.
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 (χ (1) = 3.8089, p = .051). TES was associated with better retention among participants not abstinent at baseline who had internet access (X (1) = 6.69, p = .01). These findings demonstrate high acceptability of this web-based intervention among participants that lacked recent internet access.
对于那些近期无法上网且正在接受成瘾治疗的患者而言，基于网络的干预措施的可接受性及其临床影响尚不清楚。这项针对一项全国多地点治疗研究（美国国立药物滥用研究所临床试验网络-0044）的二次分析，评估了基于网络的心理社会干预措施在参加社区门诊成瘾治疗项目的参与者中的可接受性和临床影响。参与者被随机分配接受为期12周的基于社区强化方法加应急管理的网络治疗教育系统（TES），或接受常规治疗（TAU）。对入组前90天内有近期上网经历的参与者（N = 374）和没有上网经历的参与者（N = 133）的人口统计学和临床特征以及治疗结果进行了比较。主要结局变量包括：（1）TES的可接受性（即模块完成情况；基于网络的干预措施的可接受性），以及（2）临床影响（即通过尿液药物/呼气酒精测试确认的自我报告戒断情况；以退出时间衡量的留存率）。上网很常见（74%），在较年轻（18至49岁）的参与者以及完成高中学业的参与者中更有可能出现（p <.001）。随机分配到TES组（n = 255）且无基线上网经历的参与者对TES模块可接受性的评分显著高于有上网经历的参与者（t = 2.49，自由度 = 218，p = 0.01）。在退出时间方面，治疗、基线戒断情况和上网经历之间存在接近显著的交互作用（χ(1) = 3.8089，p = 0.051）。对于基线时未戒断且有上网经历的参与者，TES与更好的留存率相关（X(1) = 6.69，p = 0.01）。这些发现表明，这种基于网络的干预措施在近期无法上网的参与者中具有很高的可接受性。
