Treatment for addiction is one of the most labor-intensive medical activities. It involves hours and hours of human face-to-face contact and support. Not only does the therapist spend huge amounts of time with the patient, others – including support staff and the close family and friends of the patient – are also actively involved.
Enter the world of technology. Much of the well-established therapies are amenable to technology-based assistance. Cognitive behavioral therapy, motivational enhancement therapy, and contingency management with prize-based incentives lend themselves to help from technology.
A number of studies have already been done on the efficacy of computer-based online programs that augment therapies overseen by therapists and clinicians. In a world of scarce resources dedicated to mental health, such technological enhancements are a welcome addition.
Even though the potential for saving dollars by cutting face time in individual therapies is attractive, the initial investment can be a problem. The drug treatment center not only needs new equipment and software to make these therapies work, they need trained personnel to run them. There are also rules that govern how therapists and patients can interact. But the overriding issue is that drug abuse and the problems it brings with it is likely to increase in the foreseeable future.
Computer games are easy to implement and patients usually like them. A collection of learning games with five or six modules based on cognitive behavioral therapy strategies has already demonstrated its efficacy. One recent study at Yale showed that twice the number of computer-assisted therapy patients were able to achieve abstinence from cocaine over those undergoing conventional face-to-face therapy.
The program consists of an introduction to the theory of cognitive behavioral therapy in a simple way the layman can grasp. It goes on to present the varied patterns of drug abuse, how to deal with craving, techniques for refusing offers of drugs or booze from friends, problem-solving techniques, decision-making, and how to gain insight into one’s own situation.
A group at Columbia recently tested an internet-based therapy package called Therapeutic Education System. It consisted of a set of 62 interactive modules in a multimedia form that focused on positive reinforcement for activities that exclude drug use. Included were some prize-based incentives. The lessons also contained instruction in relapse prevention skills and information on how to prevent HIV and sexually transmitted diseases. There were motivational incentives for both abstinence and for completing the modules. (The patients get to draw tickets from a virtual fishbowl which contains a prize (between $1 and $100) or a congratulatory message.)
The therapeutic education system, which uses a community reinforcement approach, improved abstinence in all patients, but especially in the ones who needed it the most – the patients who were actively using narcotics at the beginning of the study.
By the end of the study, about 40 percent of the people who tested positive for drugs achieved abstinence. In the group receiving standard therapy, only 26 percent did.
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