Short- and long-term changes in substance-related coping as mediators of in-person and computerized CBT for alcohol and drug use disorders. (1st July 2020)

• Record Type: Journal Article
• Authors: Roos, Corey R.; Carroll, Kathleen M.; Nich, Charla; Frankforter, Tami; Kiluk, Brian D.
• Is Part Of: Drug and alcohol dependence. Volume 212(2020)
• Publication Date: 2020-07-01
• Subjects: Cognitive-behavioral therapy -- Substance use disorders -- Coping skills -- Mechanisms of change -- Mediator; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2020.108044
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Tested short- and long-term changes in coping as mediators of CBT for SUD. Analysis of two trials with different formats of CBT (in-person and computerized). Short-term changes in coping did not mediate effect of in-person or computerized CBT. In both trials, long-term increases in coping mediated effects of computerized CBT. Computerized CBT may work by mobilizing long-term improvements in coping skills. Abstract: Background: No studies have examined long-term changes in substance-related coping skills as a statistical mediator of cognitive-behavioral therapy (CBT) for substance use disorders (SUD). Methods: We tested both short- and long-term changes in coping as mediators of treatment effects in two trials of in-person and/or computerized CBT for SUD. The first trial included 137 individuals (75 % male; 65.7 % non-White; mean age = 35.9) with drug and/or alcohol use disorders randomized to one of the following: in-person CBT, computer-delivered CBT (CBT4CBT) plus brief monitoring, or treatment-as-usual (TAU). The second trial included 68 individuals (65 % male; 66.2 % non-white; mean age = 42.7) with an alcohol use disorder randomized to one of the following: CBT4CBT plus brief monitoring, CBT4CBT plus TAU, or TAU only. Coping was assessed with the Coping Strategies Scale. Latent growth curve mediational models were conducted, with both short-term (baseline through end-of-treatment) and long-term (baseline through 3-month post-treatment follow-up) changes in coping. Results: There were no mediation effects for short-term changes in coping. However, in both trials, there were significant mediation effects for long-term changes in coping: In trial 1, the effect of CBT4CBT vs. TAU on substance use at the 6-month follow-up was mediated by long-term increases in coping. This same mediation effect was not found for in-person CBT vs. TAU. In trial 2, the effect of CBT4CBT vs. not receiving CBT4CBT on heavy drinking at the 6-month follow-up was mediated by long-term increases in coping. Conclusions: Long-term increases in coping may be a mechanism of change in computerized CBT for SUD.