Digital cognitive therapy program may be effective for alcohol use disorder

1. In this randomized clinical trial, adults with an alcohol use disorder (AUD) receiving either treatment as usual (TAU), clinician-delivered CBT or digital cognitive behavioural therapy (CBT), had an increase in percentage of days abstinent (PDA) through the 8-month study period. 

2. Although the 8-week study period did not show significant changes, the 8-month study period showed significant change between the treatment groups, providing evidence for the efficacy of the digital CBT program. 

Evidence Rating Level: 1 (Excellent)

Study Rundown: Alcohol use disorder (AUD) is one of the most prevalent mental health disorders globally often associated with high mortality rates. AUD is categorized as an inability to stop or control alcohol use even with knowledge of possible consequences. One underutilized evidence-based treatment for AUD is cognitive behavioural therapy (CBT), which can be accessed digitally to promote use. Digital therapies are a way to maximize evidence-based treatment for individuals with AUD, keeping the same high quality while also lowering the cost. Hence, the goal of this study was to determine the efficacy of a digital CBT program as a mechanism compared to the efficacy of standard treatment for AUD. To best assess AUD treatment, a randomized clinical trial assigned eligible participants to either receive treatment as usual (TAU), clinician-delivered CBT, or digital CBT with clinical monitoring. The TAU group received their standard outpatient treatment, while the clinician-delivered CBT group had weekly individual CBT sessions, the digital CBT group had 1 online module per week along with brief monitoring appointments with a clinician. Alcohol use was measured during the treatment period, as well as 1-, 3-, and 6 months after with follow-up interviews. At these times, the change in percentage of days abstinent (PDA) was measured. The rates of PDA increased in all groups from baseline to the 6-month follow-up period. Specifically, the random-effect regression showed digital CBT increased PDA at a faster rate than TAU and clinician-led CBT. Overall, there was no significant difference among the groups during the 8-week study period, however, there were changes during the 8-month period, supporting the use of the digital CBT program. 

Click here to read the study in JAMA Network Open 

Relevant Reading: Cognitive-behavioural therapy for substance use disorders  

In-Depth [randomized clinical trial]: This 3-arm randomized clinical study recruited participants from substance use treatment centers in Connecticut who meet the eligibility criteria. Those deemed eligible were 18 years or older, met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for AUD, had either 14 or 7 drinks weekly for men and women respectively, were stable for outpatient treatment, and fluent in English. A total of 99 patients (mean [SD] age, 45.5 [12.7]) were randomly assigned to one of the three treatment groups, of whom 90 started treatment, and 59 (65.6%) finished treatment. Among the participants, 66.7% were male, 39.8% were Black, 8.2% were Hispanic, 48.0% were White, and 3.1% were multiracial. The values for mean (SD) rates of PDA from baseline to week 8 were 49.3% (27.8%) to 69.3% (26.2%), 53.7% (29.8%) to 68.1% (29.9%), and 47.6% (31.8%) to 75.1% (25.1%) for TAU, CBT, and digital CBT respectively. The participants in the digital CBT group had an increased PDA over time quicker than participants in the TAU (b = 1.66, t733=2.55; P=.01) and CBT groups (b=2.14; t733=3.36; P<.001). Between the baseline and end of treatment, there was a significant chance in mean Coping Strategies Scale scores (F1, 68=13.10; P<.001). A total of 16 adverse events occurred in the treatment groups mainly due to alcohol-related withdrawal (n=7) or medical detoxification (=7). These results provide evidence that digital CBT with clinical monitoring was effective at increasing abstinence from alcohol in a group of individuals with AUD. However, there was no significant difference between the treatment groups during the 8-week study period. 

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