Virtual relapse prevention group tele-therapy with peer involvement for substance use disorder: a multicentre randomised controlled trial in Indonesia

Background: In Indonesia, standardised psychotherapy for substance use disorder (SUD) is nonexistent and current services do not meet the needs of the diverse SUD population. This study aimed to develop and evaluate a psychotherapy for SUD with potential for widespread implementation throughout the archipelago.

Methods: We developed Indonesia Drug Addiction Relapse Prevention Programme (Indo-DARPP), a cognitive behavioural therapy-based module delivered by three-month weekly group sessions, co-facilitated by healthcare workers and peer counsellors. A video-conferencing platform was chosen due to COVID-19 pandemic. To investigate the effectiveness, a multicentre randomised controlled trial (RCT) was started, aiming to recruit 220 adults with SUD nationwide. Intervention is Indo-DARPP added to treatment as usual (TAU) while control is TAU only. Primary outcome is the increase in days of abstinence from the primary substance in the past 28 days. Secondary outcomes include Addiction Severity Index (ASI), EuroQol-5D, University of Rhode Island Change Assessment (URICA), Symptom Checklist-90 Revised (SCL-90-R), and Internalised Stigma of Mental Illness (ISMI). Assessments are performed at baseline, post-treatment, 3-, and 12-month after treatment completion.

Results: As of January 2022, 61 participants (31 Indo-DARPP vs 30 control) completed post-treatment assessment (90% male; median age 39; 92% residence in Java; 57% high-school graduates). Primary substances included heroin (44%), methamphetamine (26%), and benzodiazepine (18%). 80% of the Indo-DARPP arm attended more than half of all sessions. The Indo-DARPP arm showed a significantly larger increase in days of abstinence from the primary substance [mean=6.7, SD=6.5 vs mean=2.8, SD=6.7] with a medium effect size (Cohen’s d=0.60, p=0.029), and better changes in ASI composite scores, EuroQol-5D, URICA action stage subscale, SCL-90-R Global Severity Index, and ISMI (p >0.05 at this point).

Conclusion: Our interim results showed that Indo-DARPP was effective in reducing substance use among people with SUD. We hope to present the final report of the RCT at the conference.