GPs’ use of computer based drug and alcohol treatment remains low, despite patient acceptability and positive results

November 2014
Kay-Lambkin, F. J., Simpson, A. L., Bowman, J., & Childs, S. (2014). Dissemination of a computer-based psychological treatment in a drug and alcohol clinical service: an observational study. Addiction Science & Clinical Practice, 9, 15. DOI: 10.1186/1940-0640-9-15.

The issue: There is emerging evidence for the potential of computer-based psychological treatments (CBPT) as an add-on to usual clinical practice in the management of health problems. Uptake of the programs remain patchy and it is not clear whether this is due to clinician or patient reluctance.

What we did: Researchers recruited 13 clinicians in a publicly funded drug and alcohol service to observe their use SHADE (Self-Help for Alcohol and other drug use and DEpression), a CBPT program for comorbid depression and alcohol or cannabis use, in their clinical practice. All 13 clinicians were assessed for their computer anxiety and openness to innovation. Clinicians referred current clients to the study, with 35 consenting and eligible clients completing a baseline and 15-week follow-up clinical assessment.

Results: Only 12 of the 35 clients were exposed to the SHADE modules despite 28 of 35 clients indicating that they would be willing to use CBPT during their current treatment program.

Reduction in drug and alcohol use was significantly higher for the group who were exposed to SHADE:

  • Participants who did not receive the SHADE modules reported a 3-standard-drink per day reduction in alcohol use between baseline and at 15-week follow-up assessment, while those who were exposed to SHADE reported an 8-standard-drink per day reduction over the same time period.
  • Clients exposed to the SHADE resource during treatment reported a 9-standard-use per day reduction in cannabis use over time, relative to a 3-standard-use per day reduction in those daily users not exposed to SHADE. 

Implications: Improving access to evidence-based treatments for mental health disorders, including alcohol and other drug problems, is a significant health care priority. CBPT offers potential to address this. However despite the superior results for clients using SHADE; the fact that clinicians were open to innovation and were not anxious about using computers; and clients themselves were open to using computer based treatments, only a third of the clients in the study were referred for computer based treatments. Clinicians need ongoing support and encouragement, in addition to an initial training session, to encourage their adoption of innovative technologies into clinical practice.