It is very common for individuals to have both mental health and substance abuse problems. This is particularly the case for individuals accessing substance abuse treatment, where up to 80% of participants have a co-occurring mental health diagnosis (Ross, Glaser, & Germanson, 1988). When compared to people with a single diagnosis, individuals diagnosed with both mental health and substance abuse problems have significantly poorer treatment outcomes across a broad range of outcome domains (see Brunette, Mueser & Drake, 2004). It is extremely important that Australian residential substance abuse services provide comprehensive treatment for individuals diagnosed with co-occurring mental health and substance abuse problems. However, the majority of Australian residential substance abuse services still primarily target only the person’s substance abuse problems (Mathews, Kelly & Deane, in press) and cognitive-behaviour therapy (CBT) is infrequently employed in these settings, despite its strong evidence base for substance use problems (Kay-Lambkin, Baker & Lewin, 2004).
Professor Amanda Baker (University of Newcastle)
Dr Peter Kelly (University of Wollongong)
Professor Frank Deane (University of Wollongong)
The aim of the present study is to examine the effectiveness of using a computer delivered comorbidity treatment program for individuals attending long-term residential substance abuse programs. The study will be conducted as a real-world randomized trial, where the Treatment Condition will complete the computer-delivered intervention in addition to treatment as usual (TAU). The computer intervention consists of cognitive-behaviour therapy for co-existing mental health and substance use problems, and has proven efficacy in two previous randomized controlled trials conducted in a lab-based setting. The Control Condition will complete TAU only (i.e. The Salvation Army residential treatment program).
The specific aims of the project are:
- To examine the acceptability of using a computer-based intervention within a residential substance abuse setting
- To examine differences in substance use and mental health outcomes between participants in the Treatment Condition and participants in the Control Condition
The proposed study will evaluate the effectiveness of ‘adding’ a computer delivered comorbidity CBT intervention (SHADE) to an already established substance abuse program. The study will be conducted as a randomized trial, where the Treatment Condition will complete the SHADE program in addition to treatment as usual (i.e. The Salvation Army residential program, TAU). The Control Condition will complete TAU only (i.e. The Salvation Army program, based on the 12-step approach). As mental illness is not specifically targeted as part of The Salvation Army program, and CBT not systematically available for substance use problems, it is hypothesized that individuals in the Treatment Condition will report greater improvements in their mental health and reductions in their substance use at follow-up than individuals in the Control Condition
Recruitment to the project has been completed, and 12-month follow-ups are also now complete. Participants have enjoyed the opportunity to use the computer to manage their own health and wellbeing, indicating the feasibility of these approaches in residential settings. Data analysis is currently underway.
Kelly, P., Kay-Lambkin, F.J., Baker, A.L., Deane, F.P., Brooks, A.C., Mitchell, A., Marshall, S., Whittington, N. & Dingle, G.A. (2012). Study protocol: A randomized controlled trial of a computer-based depression and substance abuse intervention for people attending residential substance abuse treatment. BMC Public Health, 12(1): Article Number 13. DOI: 10.1186/1471-2458-12-11322325594.
The primary aim of the current project is to examine the effectiveness of using a computer-delivered CBT comorbidity intervention within a residential substance abuse setting. If the program proves to be effective it will continue to be offered to all participants who enter William Booth House in Sydney each year. Additionally, the intervention would be expanded across each of the Salvation Army residential substance abuse services across New South Wales, Queensland and the Australian Capital Territory (500 beds in total, 1800 individuals treated annually). An advantage of using a computer-delivered intervention is that high quality, evidenced-based clinical interventions are readily available for uptake by clinical services, with expansion of the program not placing any additional burden on the staff or organisation. Rather, implementation will only require the Salvation Army to utilise already existing computer terminals and ensure that the intervention is timetabled into the participants’ weekly activities. It is hoped that these activities will help to promote the use of computer-based interventions within residential substance abuse settings across Australia.