Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States.
Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States.
Drug Alcohol Depend. 2023 Feb 1;243:109758. doi: 10.1016/j.drugalcdep.2022.109758. Epub 2022 Dec 28.
Reward deficits negatively impact recovery from substance use disorder (SUD). LETS ACT, a behavioral activation treatment targeting substance-free reward, has demonstrated effectiveness in reducing post treatment substance use. There remains room for modifications to extend recovery gains, and LETS ACT remains largely untested in outpatient treatment. We tested the effect of LETS ACT when delivered alongside intensive outpatient SUD treatment, with and without a smartphone app designed to extend access to treatment content outside of clinician-administered sessions.
In this three-arm randomized controlled trial (N = 206; 54 % White, 67 % male), all participants received intensive outpatient SUD treatment as usual (TAU) and either LETS ACT (n = 56), smartphone-enhanced LETS ACT (n = 65), or assessments only (n = 61). Substance use days and substance related problems were assessed through 12 months posttreatment.
Generalized estimating equations indicated a significant condition*time interaction for substance use days; Days of substance use significantly declined from pretreatment until 1-month for TAU, 3-months for LETS ACT-SE, and 6-months for LETS ACT. Decreases in substance-related problems were maintained across all conditions through 12 months.
Adding LETS ACT to intensive outpatient treatment resulted in significant decreases in substance use through 6 months posttreatment, yet these gains were not sustained through 12 months posttreatment. A smartphone app did not facilitate superior treatment outcomes. Future studies should consider factors impacting treatment efficacy in outpatient settings and the utility of providing more than six sessions of behavioral activation.
奖励不足会对物质使用障碍（SUD）的康复产生负面影响。LETS ACT 是一种针对无物质奖励的行为激活治疗方法，已被证明可有效减少治疗后的物质使用。仍有改进的空间以扩大康复收益，并且 LETS ACT 在门诊治疗中基本上未经测试。我们测试了在提供强化门诊 SUD 治疗的同时，使用和不使用旨在扩大治疗内容获取渠道的智能手机应用程序来提供 LETS ACT 的效果，以治疗物质使用障碍。
在这项三臂随机对照试验（N=206；54%为白人，67%为男性）中，所有参与者均接受强化门诊 SUD 治疗（TAU），并接受 LETS ACT（n=56）、智能手机增强型 LETS ACT（n=65）或仅接受评估（n=61）。通过治疗后 12 个月评估物质使用天数和物质相关问题。
广义估计方程表明物质使用天数的条件*时间交互作用具有统计学意义；与 TAU 相比，在治疗前至 1 个月，LETS ACT-SE 组在 3 个月，LETS ACT 组在 6 个月，物质使用天数显著下降。在所有条件下，物质相关问题的减少在治疗后 12 个月内均得到维持。
在强化门诊治疗中加入 LETS ACT 可显著减少治疗后 6 个月内的物质使用，但这些收益在治疗后 12 个月内无法维持。智能手机应用程序并没有促进更好的治疗效果。未来的研究应考虑影响门诊环境中治疗效果的因素以及提供超过六次行为激活治疗的效用。
