CBT4CBT WEB-BASED-ADD-ON TREATMENT FOR COCAINE USE DISORDER: RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Background

Cocaine use disorder (CUD) is characterized by high relapse rates and elevated percentages of treatment dropouts. According to clinical practice guidelines there is not an effective pharmacological treatment for cocaine. Consequently, psychosocial approaches, particularly cognitive-behavioral therapy (CBT), have emerged as the first-line treatments, demonstrating notable efficacy. Web-based interventions have proven to optimize face-to-face treatments in different mental health conditions, however web-based interventions in CUD are still limited. 

Objective

This study aims to evaluate whether adding a web-based CBT (i.e.: CBT4CBT) to standard CUD treatment, improves treatment outcomes in a Spanish sample of 68 patients with severe CUD.

Methods

Participants (42.8 years, SD=8.26; 38.2% women) of this open-label RCT were allocated to treatment as usual (TAU; n=34) or to TAU+CBT4CBT (n=34) after inpatient detoxification treatment. During the 14-day hospitalization, they all received an individualized psychological intervention. There were six time point assessments: at beginning of inpatient treatment, at the end of inpatient treatment and before starting day care and outpatient treatment, at the end of the 8-week CBT4CBT/TAU treatment and at 1-, 3- and 6-months posttreatment. Measures of addiction severity (SDS), severity of cocaine withdrawal symptoms (CSSA), craving (WCS), psychopathology (SCL-90-R global severity index [GSI]) and impulsivity (UPPS-P) were registered. At the end of the 8-week treatment dropout rate was recorded.

Results

Analyses show significant pre-post treatment differences in SDS (t=6.58; p<.001), CSSA (t=2.43; p=.022), WCS (t=2.66; p=.013), SCL-90-R GSI (t=5.23; p<.001), UPPS-P negative urgency (t=3.11; p=.005), UPPS-P positive urgency (t=2.64; p=.014) and UPPS-P lack of perseverance (t=-3.58; p=.001) within CBT4CBT group. Within TAU group pre-post differences are in addiction severity (t=3.73; p=.001), SCL-90-R GSI (t=4.26; p=.001) and UPPS-P sensation seeking (t=2.74; p=.013). There are no differences between groups in the described variables at post-treatment, yet there are more dropouts in TAU (50%) than TAU+ CBT4CBT group (45,16%).   

Conclusions

Results point towards a reduction in addiction severity and global psychopathology severity in both groups. However, noteworthy reductions in UPPS-P negative urgency and positive urgency, craving and severity of withdrawal symptoms were observed exclusively in the TAU+CBT4CBT group. These findings suggest that CBT4CBT web-based treatment holds potential as an effective add-on intervention for cocaine dependence, though further study is warranted.