It's Worth a Try: The Treatment Experiences of Rural and Urban Participants in a Randomized Controlled Trial of Computerized Psychological Treatment for Comorbid Depression and Alcohol/Other Drug Use

Abstract

Objective: To examine clinician-assisted computerized psychological treatment for depression and alcohol/other drug use comorbidity in rural and urban communities. Methods: Participants in an Australian randomized controlled clinical trial who completed the 3-month post-baseline assessment were examined (n = 163), including those from remote/outer regional (n = 16, 10%) and inner regional (n = 37, 23%) areas and major cities (n = 110, 67%). Participants were using alcohol and/or cannabis at hazardous levels in the month prior to baseline and concurrently reported at least moderate levels of depression. Following provision of the first treatment session (conducted face-to-face for all conditions), participants were randomized to: (1) nine further face-to-face sessions of combination cognitive behavioral therapy and motivational interviewing; (2) nine sessions of combination cognitive behavioral therapy and motivational interviewing delivered via computer, with brief clinician assistance; or (3) nine sessions of supportive counseling. Blind, independent follow-up occurred at 3 months post-baseline. Changes in depression, alcohol, and cannabis use at 3 months post-baseline were the outcomes of interest, with rurality, treatment allocation, and treatment preference fulfilment as independent variables. Self-reported helpfulness and experience of treatment was also explored. Results: Participants completing the 3-month post-baseline assessment (n = 163) were significantly older than those who did not (n = 111) and attended significantly more treatment sessions. The outcomes of interest, including helpfulness of treatment, were not significantly associated with rurality. Of the 92 participants indicating a treatment preference prior to randomization, 13 (14%) nominated a preference for computer-delivered treatment. However, treatment preference did not affect retention, therapeutic alliance, or the benefits reported by urban and rural participants in the trial receiving computerized treatment. Computerized treatment was associated with significantly greater reductions in alcohol use relative to face-to-face cognitive behavioral therapy/motivational interviewing (d = 0.621) and supportive counseling (d = 0.904). Conclusions: Computer-delivered cognitive behavioral therapy and motivational interviewing (with clinical assistance) is an efficacious treatment for depressive and addictive disorders, with similar levels of acceptability and benefit in rural and urban participants. Computerized psychological treatment might be an acceptable treatment for underserviced populations, with real potential to bridge service gaps and to overcome isolation and perceived stigma among isolated communities. This clinical trial is registered with the Australian New Zealand Clinical Trials Registry as trial #ACTRN12610000274077 (http://www.anzctr.org.au/trial_view.aspx?id=335314).

Keywords:

• computerized treatment
• comorbidity
• depression
• alcohol
• cannabis

ACKNOWLEDGMENTS

Our research was supported in full by a grant from the Alcohol Education and Rehabilitation Foundation (AERFDOCS\2002\G0353). The conduct and analysis of the study were independent of the funding body. Our study was carried out in accordance with the National Health and Medical Research Council's National Statement on Ethical Conduct in Human Research.