overcoming addictions & smart recovery: outcomes of a randomized clinical trial & our new...

Overcoming Addictions & SMART Recovery: Outcomes of a randomized clinical trial & our new web app

Reid K. Hester, Ph.D. Dir., Res. Div., Behavior Therapy Associates, LLC www.behaviortherapy.com reidhester@behaviortherapy.comwww.overcomingaddictions.net

Overcoming Addictions An interactive web app based on

the 4-point program of SMART Recovery Additional exercises added:

Increasing change talk (desire, importance, self-confidence exercises)

Values exercise Urge tracking & feedback Mindfulness exercises (Bowen et al.) Happiness Scale & goal setting Sobriety sampling

RCT The First RCT of a self-help group

Other than 2 AA studies w/mandated people (1967 & 1980)

189 participants new to SMART Recovery

Compared OA only, OA + SR, SR only Dropped OA only gp in intent to treat,

examined in actual use analyses

Variable Overall Group    SR SR + OA OA    (n = 86) (n = 83) (n = 19)Female n (%) 114 (60.6%) 52 (61%) 50 (60%) 12 (63%)Age M (SD) 44.3 (10.9) 43.4 (10.6) 44.6 (11.1) 48.3 (8.4)Ethnicity n (%)         White 170 (90.4%) 76 (88.4%) 77 (92.8%) 17 (89.5%) Hispanic 5 (2.7%) 3 (3.5%) 1 (1.2%) 1 (5.3%) Other 7 (6.9%) 7 (8.1%) 5 (6.0%) 1 (5.3%)         Education M (SD) 16.1 (2.4) 15.93 (2.5) 16.0 (2.3) 17.3 (2.1)

AUDIT M (SD)a 24.7 (8.1) 24.8 (8.1) 23.95 (8.2) 27.4 (7.2)BSI M (SD)b 17.4 (12.9) 19.35 (12.5) 15.95 (13.6) 14.8 (11.0)InDUC M (SD)c 41.4 (17.9) 42.2 (19.0) 40.6 (17.5) 40.8 (15.6)

Pretreatment characteristics of participants by group

Percent Days Abstinent

Baseline 3 months 6 months35

45

55

65

75

85

OA onlyOA + SRSR only

Drinks per Drinking Day

Baseline 3 months 6 months0123456789

10

OA onlyOA + SRSR only

Alcohol Problems

Baseline 3 months 6 months0

10

20

30

40

OA onlyOA + SRSR only

Do attending SR Meetings & other support predict outcomes at 3 mo? SR only: Yes on all outcome

measures at 3 mo. OA + SR: only #days any support

predictive of improvement in PDA & alcohol problems at 3 mo.

Conclusions Both the Overcoming Addictions

Web application and the use of the meetings and other resources of SMART Recovery are effective in helping people recover from heavy problem drinking.

People now have a choice in how they access help in changing.

OA: Cost? There is no free lunch. Much less than treatment or

seeing a counselor. $89 3 mo., $149 12 mo. (w/$30

maintenance fee thereafter in 12 mo.).

Profits from OA are shared with SMART Recovery.

What next? 6 mo. Qualitative data analyses,

part 2 of JMIR paper underway Apply to SAMHSA’s NREPP for

listing 1/1/14 http://www.nrepp.samhsa.gov

Reference Hester, RK, Lenberg, KL, Campbell, W, & Delaney,

HD. (2013). Overcoming Addictions, a web-based application & SMART Recovery, an online and in-person mutual help group for problem drinkers: Part 1, three month outcomes of a randomized clinical trial. Journal of Medical Internet Research. http://www.jmir.org/2013/7/e134