Alcohol use and misuse are prevalent in the United States. Alcohol use disorder (AUD) is the most common substance use disorder. Evidence-based treatments are effective; however, most people with AUD do not receive treatment, and among those who do, responses to treatment modalities vary. Technology provides the opportunity to expand treatment and improve outcomes. Therefore, the overall goal of this project is to incorporate neurofunctional phenotyping into a preliminary investigation of the feasibility of providing mobile CBT4CBT for AUD among a non-treatment seeking population
Nationally, alcohol is the third leading preventable cause of death. In 2019, 14.1 million adults had an alcohol use disorder (AUD). However, most people with AUD do not receive treatment, and treatments are only moderately effective among those who do receive treatment largely due to the heterogeneity of people with AUD. Precision medicine is a method to guide tailoring individual treatment regimens and improve outcomes in evidence-based treatments. Recently, neurofunctional phenotyping approaches have emerged as a promising avenue to advance precision medicine in AUD. For example, studies of the Addictions Neuroclinical Assessment (ANA) framework-a neuroscience-based framework that uses three neurofunctional domains that are considered critical to the development and maintenance of AUD-suggest there are associations between ANA domains and drinking behavior. However, the utility of phenotyping approaches has not been investigated in behavioral treatment modalities for AUD. Additionally, although AUD is the most common substance use disorder (SUD), fewer people in need of AUD treatment receive it compared to treatment for other use disorders. Many of these individuals, particularly those with mild AUD, can reduce or cease alcohol use without specialized treatment. However, efforts to refer those with more severe AUD to community residential or outpatient programs have been largely unsuccessful, especially among women who often face practical barriers like lack of transportation and childcare. Technology offers innovative opportunities to make treatment more readily accessible to those in need. Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT) is a web-based intervention with demonstrated effectiveness as an adjunct to standard AUD and other drug use disorder treatment programming. To-date, however, it has not been tested with non-treatment seeking men and women with AUD. For the proposed study, a sample of non-treatment seeking people with AUD will be recruited using ResearchMatch.org and randomized (3:1) to complete the mobile CBT4CBT program or an assessment only control condition stratified by sex (N=248 total; females: n=93 CBT4CBT, n=31 Control; males: n=93 CBT4CBT, n=31 Control). Feasibility and acceptability of CBT4CBT will be assessed among participants in the CBT4CBT condition. Study assessments that include self-reported AUD outcomes and neurofunctional assessments will be administered to all participants at baseline, immediately post-intervention, and at one month following the intervention period. All outcomes will also be assessed for sex differences using sex-stratified analyses.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
248
CBT4CBT is a 7-module web-delivered program based on CBT, an evidence-based behavioral treatment for alcohol use disorder (AUD).
Virginia Commonwealth University
Richmond, Virginia, United States
Examine feasibility of CBT4CBT use as a mobile stand-alone intervention in a sample of non-treatment seeking people with AUD
Use of mobile CBT4CBT outside of specialized SUD treatment settings will be feasible for participants, as measured by participants completing a mean number of 70% of modules within the 8-week CBT4CBT intervention period. The outcome variable will be the mean number of modules completed (out of 7).
Time frame: 4 week check in and follow-up visit 1 (immediately after 8 week intervention period ends)
Examine the acceptability of CBT4CBT as a mobile stand-alone intervention in a sample of non-treatment seeking people with AUD
Use of mobile CBT4CBT outside of specialized SUD treatment settings will be acceptable for participants measured by 80% of participants reporting they are satisfied with CBT4CBT program. The outcome variable will be the mean satisfaction rating based on the following question: Overall, how satisfied are you with the intervention you received? (1, very dissatisfied to 5, very satisfied).
Time frame: 4 week check in and follow-up visit 1 (immediately after 8 week intervention period ends)
Assess AUD outcomes (absence of heavy drinking days) utilizing the Timeline Follow Back (TLFB) in a sample of non-treatment seeking people with AUD who have access to the CBT4CBT compared to those who do not
Participants in the CBT4CBT condition will be less likely to report any heavy drinking days during the last month of the intervention period and during the month following the end of the intervention than those in the control condition based on the TLFB. The TLFB measures the quantity and frequency of past month alcohol use. The outcome variable will be absence of heavy drinking days (yes/no).
Time frame: Follow-up study visit 1 (immediately after intervention period and follow-up study visit 2 (one month later)
Assess AUD outcomes (recovery total score) utilizing the Substance USe Recovery Evaluator (SURE) in a sample of non-treatment seeking people with AUD who have access to the CBT4CBT compared to those who do not
Participants in the CBT4CBT condition will report higher total scores on the SURE during the last month of the intervention period and during the month following the end of the intervention than those in the control condition based on the TLFB. The SURE is a 21-item measure of holistic recovery. Total scores range from 21 to 63 with higher scores indicating better recovery. The outcome variable will be the total score on the SURE.
Time frame: Follow-up study visit 1 (immediately after intervention period and follow-up study visit 2 (one month later)
Evaluate sex differences in feasibility of CBT4CBT use as a mobile stand-alone intervention in a sample of non-treatment seeking people with AUD
In the CBT4CBT condition, females will complete more CBT4CBT on average than males. The outcome variable will be the mean number of modules completed (out of 7).
Time frame: 4 week check in and follow-up visit 1 (immediately after 8 week intervention period ends)
Evaluate sex differences in the acceptability of CBT4CBT as a mobile stand-alone intervention in a sample of non-treatment seeking people with AUD
In the CBT4CBT condition, females will report higher mean satisfaction ratings for CBT4CBT than males. The outcome variable will be the mean satisfaction rating based on the following question: Overall, how satisfied are you with the intervention you received? (1, very dissatisfied to 5, very satisfied).
Time frame: Baseline, Follow-up study visit 1 (immediately after intervention period) and follow-up study visit 2 (one month later)
Evaluate sex differences in AUD outcomes (absence of heavy drinking days) utilizing the Timeline Follow Back (TLFB) in a sample of non-treatment seeking people with AUD who have access to the CBT4CBT compared to those who do not.
Participants in the CBT4CBT condition will be less likely to have any heavy drinking days than the control group during the last month of the intervention period and during the month following the end of the intervention for both males and females.
Time frame: Last month of the intervention and one month following the end of the intervention
Evaluate sex differences in AUD outcomes (recovery total score) utilizing the Substance USe Recovery Evaluator (SURE) in a sample of non-treatment seeking people with AUD who have access to the CBT4CBT compared to those who do not.
Participants in the CBT4CBT condition will have higher recovery scores based on the SURE than the control group during the last month of the intervention period and during the month following the end of the intervention for both males and females.
Time frame: Last month of the intervention and one month following the end of the intervention
Examine associations between ANA neurofunctional and social domains at baseline
Associations between domains and absence of heavy drinking days (yes/no) during the last month of the intervention period and during the month following the end of the intervention will vary by domain (i.e., negative emotionality, incentive salience, executive function, and social environment). Domains will be assessed using the ANA Domains Brief Scale (ANA Brief, 15-items, higher scores indicate greater impairment) and the Health Leads Social Needs Survey (HLSN, 8-items, higher scores indicate greater impairment).
Time frame: Last month of the intervention and one month following the end of the intervention
Examine absence of heavy drinking days after access to the CBT4CBT program in a sample of non-treatment seeking people with AUD.
Associations between domains and absence of heavy drinking days (yes/no) during the last month of the intervention period and during the month following the end of the intervention will vary by domain (i.e., negative emotionality, incentive salience, executive function, and social environment)
Time frame: Last month of the intervention and one month following the end of the intervention
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