Advances

Treating addiction with technology

By Amos Esty

Lisa Marsch is investigating new ways to use technology to improve the treatment of substance use disorders.

Photo by Mark Washburn

A recent trial led by Lisa Marsch, an associate professor of psychiatry at Geisel, could help extend the reach of evidence-based behavioral health treatments. The study evaluated the effectiveness of a web-based treatment program used to supplement in-person counseling and methadone treatment for people with a history of drug abuse. Marsch found that the treatment regimen that included the web-based program was more effective than standard treatment.

"Patients get this very interactive and personalized behavior therapy experience through this technology," says Marsch, who is the director of Dartmouth's Center for Technology and Behavioral Health, which is part of Geisel's Psychiatric Research Center. "What you see is that that translates into better treatment outcomes."

The trial included 160 patients with a history of drug abuse. Half of the patients received standard treatment, which included methadone treatment and one-hour counseling sessions with clinicians trained in treating substance use disorders. The sessions were held once a week for the first four weeks and twice a month thereafter. The other half of the patients also received methadone treatment and met on the same schedule with a counselor. But instead of 60-minute sessions, the patients spent 30 minutes with a counselor and 30 minutes working with a web-based therapeutic education system developed by Marsch and other behavioral health researchers.

The web-based program includes dozens of modules intended to help patients develop healthier patterns of behavior and avoid situations that put them at risk for drug use. The modules were developed using evidence from years of research into what works in behavioral health, and Marsch notes that the program is a great way to ensure that evidence-based treatments make their way into clinical settings, something that has long been a challenge.

The study followed patients for up to a year and had scheduled drug tests each week, although many patients missed some of the drug-testing sessions.

Overall, the experimental treatment that included the web modules proved to be more effective in helping patients avoid drug use by the two measured criteria. The first measure was the percentage of weeks patients were tested that they tested negative. Patients in the standard treatment arm tested negative in 43 percent of weeks tested, compared to 59 percent for patients in the experimental arm. By a more conservative measure of success—the total percentage of weeks of the study in which a patient tested negative (with missing samples considered positive)—the experimental treatment also proved more effective, with 48 percent of weeks of negative tests compared to 37 percent for those in the standard arm.

Marsch says that the study validates the importance of finding ways to use technology to implement evidence-based treatments. "There are so many barriers to widespread adoption of evidence-based behavioral health care, and this is how we're trying to leverage technology to see if there are ways we can use these tools to promote greater access to things that work," she says. "The goal is not about replacing clinicians, it's about extending the reach of clinicians and providing more personalized care and support to patients at the same time."

There is still a lot to be learned, she adds, "but the data are increasingly, overwhelmingly showing the promise of this at many, many levels."