The Evidence Is Still Unclear on Digital Cognitive Behavioral Therapy
For many clients, barriers to accessing alcohol and other drug treatment stem from the availability or practical accessibility of services as well as considerations of anonymity and autonomy and stigma.
Digital cognitive behavioral therapy treatments (also known as computer delivered interventions, and computer assisted interventions) offer a means for mitigating the impact of some or all of these barriers to care. Digital treatments offer several potential advantages over traditional delivery modalities, not least being their ability to help a greater number of people access treatment
Several early reviews of computer-delivered interventions for a range of high-prevalence mental health disorders (e.g. depression and anxiety) were promising, suggesting that this modality offered similar efficacy to traditional face to face delivery.
However, this early enthusiasm has been tempered by methodological issues with much of the available literature, not least the large variation in how digital treatment interventions are operationalised, delivered and evaluated.
The overwhelming majority of substance disorder focused digital treatments have been based on Cognitive Behaviour Therapy foundations, albeit with considerable variation in how Cognitive Behaviour Therapy has been implemented, and how faithfully the treatment has been represented.
These include variations in frequency, intensity and involvement of the clinician.
Programs can be provided as completely self-guided activities (similar to traditional self-help approaches) or as combined self-guided/clinician supported modalities. Clinician support is provided as structured or ad-hoc contact via face to face, telephone or video-based sessions, or text-based interactions. Digital treatment resources can also play a role as adjunctive elements supporting traditional face-to-face interventions (for example, assisting with treatment adherence and homework compliance).
Effectiveness of digital cognitive behavioral therapy treatment
There have been a number of systematic reviews of the effectiveness of digital treatment approaches for alcohol and other drug use disorders, indicating broad preliminary support for these interventions as effective means for reducing rates of alcohol and other drug use compared to treatment as usual approaches (See Bickel et al., 2011; Moore et al., 2011; Marsch and Dallery, 2012).
However, it is difficult to estimate the overall effectiveness of Cognitive Behaviour Therapy based online treatments for alcohol and other drug use disorders given the wide variety of digital intervention types, structures, populations and alcohol and other drug use types targeted.
There may be differential effectiveness for these programs based on substance type. A 2017 meta-analysis of the effectiveness of digital treatments for illicit substances found that when viewed across all substance types internet-based interventions demonstrated small but significant effect sizes in terms of decreasing use compared to control conditions, and these effects appeared to be retained at follow-up, but there was too few high quality studies to be confident that their effectiveness was uniform across specific drug types.
Conclusion on digital cognitive behavioral therapy
The evidence base for digital interventions for alcohol and other drug use disorders exhibits some methodological weaknesses, including comparatively weak or inconsistent (wait list / information / treatment as usual) control conditions, and comparatively infrequent reporting of follow-up outcomes.
Despite enthusiasm for the potential of digital modalities to reach larger numbers of individuals requiring treatment, and indications that these modalities are somewhat effective in modifying alcohol and other drug use behaviour, the current state of the evidence supports a prudent approach be taken to their widespread adoption as stand-alone methods of treatment.
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