Understanding eHealth Cognitive Behavioral Therapy Targeting Substance Use: Realist Review.

Farhud Shams,Reinhard Michael Krausz,Ehsan Moazen-Zadeh,Ava Outadi,Mostafa M Kamel,James S H Wong,Kerry L Jang,Mohammadali Nikoo,Michael Jae Song

doi:10.2196/20557

Abstract

BackgroundThere is a growing body of evidence regarding eHealth interventions that target substance use disorders. Development and funding decisions in this area have been challenging, due to a lack of understanding of what parts of an intervention work in which context.ObjectiveWe conducted a realist review of the literature on electronic cognitive behavioral therapy (eCBT) programs for substance use with the goal of answering the following realist question: “How do different eCBT interventions for substance use interact with different contexts to produce certain outcomes?”MethodsA literature search of published and gray literature on eHealth programs targeting substance use was conducted. After data extraction, in order to conduct a feasible realist review in a timely manner, the scope had to be refined further and, ultimately, only included literature focusing on eCBT programs targeting substance use. We synthesized the available evidence from the literature into Context-Mechanism-Outcome configurations (CMOcs) in order to better understand when and how programs work.ResultsA total of 54 papers reporting on 24 programs were reviewed. Our final results identified eight CMOcs from five unique programs that met criteria for relevance and rigor.ConclusionsFive strategies that may be applied to future eCBT programs for substance use are discussed; these strategies may contribute to a better understanding of mechanisms and, ultimately, may help design more effective solutions in the future. Future research on eCBT programs should try to understand the mechanisms of program strategies and how they lead to outcomes in different contexts.

Highlights

An estimated 269 million individuals worldwide used drugs in 2018, which represents a 30% increase from 2009 [1]
Five strategies that may be applied to future electronic cognitive behavioral therapy (eCBT) programs for substance use are discussed; these strategies may contribute to a better understanding of mechanisms and, may help design more effective solutions in the future
The Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT) studies were delivered as a blended model combining Computer-Based Training for Cognitive Behavioral Therapy CBT for insomnia (CBT-I) (CBT4CBT) with treatment as usual, such as methadone maintenance treatment for opioid use disorder, as well as having a research associate available at all times to answer questions related to the program

Summary

Introduction

An estimated 269 million individuals worldwide used drugs in 2018, which represents a 30% increase from 2009 [1]. Around 36 million individuals have a drug use disorder; only 1 out of 8 individuals who need substance use treatment receive it [1]. The current system of addiction care has to deal with several challenges in providing care, especially for the most vulnerable populations. One such major challenge of the system of care is the availability of resources, which is limited in respect to incidence, prevalence, and distribution of substance use conditions [3]. There are only 2 full-time general psychiatrists in the territory (ie, 1.6 per 100,000 population). Development and funding decisions in this area have been challenging, due to a lack of understanding of what parts of an intervention work in which context

Methods

Results

Discussion

Conclusion