Computer-Based Training for Cognitive Behavioural Therapy for Substance Use Disorder: A Randomized Controlled Trial Including Quantitative and Qualitative Health and Economic Outcomes: Formation informatisée pour la thérapie cognitivo-comportementale pour les troubles liés à l'usage de substances : un essai randomisé contrôlé y compris les résultats quantitatifs et qualitatifs en matière de santé et d'économie

Objectives Heavy alcohol and drug use is reported by a substantial number of Canadians; yet, only a minority of those experiencing substance use difficulties access specialized services. Computer-Based Training for Cognitive Behavioural Therapy (CBT4CBT) offers a low-cost method to deliver accessible and high-quality CBT for substance use difficulties. To date, CBT4CBT has primarily been evaluated in terms of quantitative outcomes within substance use disorder (SUD) samples in the United States. A comparison between CBT4CBT versus standard care for SUDs in a Canadian sample is critical to evaluate its potential for health services in Canada. We conducted a randomized controlled trial of CBT4CBT versus standard care for SUD.Methods Adults seeking outpatient treatment for SUD (N = 50) were randomly assigned to receive either CBT4CBT or treatment-as-usual (TAU) for 8 weeks. Measures of substance use and associated harms and quality of life were completed before and after treatment and at 6-month follow-up. Qualitative interviews were administered after treatment and at follow-up, and healthcare utilization and costs were extracted for the entire study period.Results Participants exhibited improvements on the primary outcome as well as several secondary outcomes; however, there were no differences between groups. A cost-effectiveness analysis found lower healthcare costs in CBT4CBT versus TAU in a subsample analysis, but more days of substance use in CBT4CBT. Qualitative analyses highlighted the benefits and challenges of CBT4CBT.Discussion Findings supported an overall improvement in clinical outcomes. Further investigation is warranted to identify opportunities for implementation of CBT4CBT in tertiary care settings. Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03767907Discussion Findings supported an overall improvement in clinical outcomes. Further investigation is warranted to identify opportunities for implementation of CBT4CBT in tertiary care settings. Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03767907 Evaluating a digital intervention targeting substance use difficultiesPlain Language SummaryWhy was the study done? Heavy alcohol and drug use is frequent in the Canadian population, although very few people have access to treatment. The digital intervention, Computer-Based Training for Cognitive Behavioural Therapy (CBT4CBT), may provide a low-cost, high-quality, and easily accessible method of treatment for substance use difficulties. Limited research on this digital intervention has been conducted in Canadian populations, and few studies thus far have evaluated participants' subjective experience using the intervention, along with the cost on the Canadian healthcare system.What did the researchers do? The research team recruited participants and provided access to either CBT4CBT or to standard care at a mental health hospital for 8 weeks. Participants were asked questions about their substance use and related consequences, quality of life, and thoughts on the treatment they received. Information regarding healthcare use and the cost to the healthcare system was also gathered.What did the researchers find? Participants in both groups improved with regards to their substance use, some related consequences, and psychological quality of life. Participants provided insight on the benefits and challenges of both types of treatment. It was also found that the CBT4CBT intervention was less costly.What do these findings mean? These findings support that adults receiving CBT4CBT and standard care both improved to a similar degree in this sample. Participant feedback may inform future studies of how best to implement this intervention in clinical studies. Future studies with larger samples are needed to further examine whether CBT4CBT can increase access to supports and be beneficial in the Canadian healthcare system. Objectifs Une consommation excessive d'alcool et de drogues est d & eacute;clar & eacute;e par un nombre substantiel de Canadiens; et pourtant, seule une minorit & eacute; des personnes & eacute;prouvant des difficult & eacute;s li & eacute;es & agrave; l'usage de substances a acc & egrave;s aux services sp & eacute;cialis & eacute;s. La Formation informatis & eacute;e pour la th & eacute;rapie cognitivo-comportementale (FITCC) offre une m & eacute;thode peu co & ucirc;teuse pour prodiguer une TCC accessible et de grande qualit & eacute; dans le cas de difficult & eacute;s li & eacute;es & agrave; l'usage de substances. Jusqu'ici, la FITCC a principalement & eacute;t & eacute; & eacute;valu & eacute;e & agrave; l'& eacute;gard des r & eacute;sultats quantitatifs dans des & eacute;chantillons du trouble d'usage de substances (TUS) aux & Eacute;tats-Unis. Une comparaison entre la FITCC et les soins standards du TUS dans un & eacute;chantillon canadien est essentielle pour & eacute;valuer son potentiel dans les services de sant & eacute; du Canada. Nous avons men & eacute; un essai randomis & eacute; contr & ocirc;l & eacute; de la FITCC contre les soins du TUS standards.M & eacute;thodes Les adultes recherchant un traitement ambulatoire du TUS (N = 50) ont & eacute;t & eacute; assign & eacute;s au hasard & agrave; recevoir soit la FITCC ou le traitement comme d'habitude (TCH) pendant 8 semaines. Des mesures de la consommation de substances, des m & eacute;faits et de la qualit & eacute; de vie associ & eacute;s ont & eacute;t & eacute; r & eacute;alis & eacute;es avant et apr & egrave;s le traitement, et au suivi de 6 mois. Des entrevues qualitatives ont & eacute;t & eacute; administr & eacute;es apr & egrave;s le traitement et au suivi, et les co & ucirc;ts et l'utilisation des soins de sant & eacute; ont & eacute;t & eacute; extraits de toute la p & eacute;riode de l'& eacute;tude. R & eacute;sultats : Les participants ont d & eacute;montr & eacute; des am & eacute;liorations au r & eacute;sultat principal ainsi qu'& agrave; plusieurs r & eacute;sultats secondaires; cependant, il n'y avait pas de diff & eacute;rences entre les groupes. Une analyse co & ucirc;t-efficacit & eacute; a constat & eacute; des co & ucirc;ts de soins de sant & eacute; plus faibles dans la FITCC contre le TCH dans une analyse de sous-& eacute;chantillon, mais plus de jours d'usage de substances dans la FITCC. Les analyses qualitatives ont fait ressortir les avantages et les difficult & eacute;s de la FITCC. Discussion : Les r & eacute;sultats soutenaient une am & eacute;lioration g & eacute;n & eacute;rale des r & eacute;sultats cliniques. Une recherche plus approfondie est n & eacute;cessaire pour identifier les opportunit & eacute;s de mise en oe uvre dans les & eacute;tablissements de soins tertiaires.Enregistrement de l'essai https://clinicaltrials.gov/ct2/show/NCT03767907