JMIR Publications

ABSTRACT

Background:

People with alcohol and substance use disorders (SUDs) often have underlying difficulties in regulating emotions. While dialectical behavioral therapy (DBT) is effective for SUDs, it is often difficult to access. Self-guided, Internet-delivered DBT (iDBT) allows for expanded availability, but few studies have rigorously evaluated it within those seeking care for SUD.

Objective:

This aim of the study was to examine the feasibility, acceptability, and potential efficacy of an iDBT intervention in treatment-seeking adults with SUDs. We hypothesized that iDBT would be feasible, credible, and acceptable to people with SUDs and that they would engage with the resource. We also hypothesized that the immediate versus delayed iDBT group would show comparatively greater improvements and that both groups would show significant improvements over time.

Methods:

A 12-week, single-blinded, parallel arm, RCT was implemented, with assessments at baseline, 4 (acute), 8, and 12 weeks (follow-up). 72 community adults aged 18-64 were randomized. The immediate group (n=38) received access to iDBT at baseline and the delayed group (n=34) received access after 4 weeks. The iDBT intervention (Pocket Skills) was self-guided via a website, with immediate access to all content, text and email reminders, and additional support meetings as requested. Our primary outcome was substance dependence, with secondary outcomes pertaining to feasibility, clinical outcomes, functional disability, and emotion dysregulation, among other measures. All outcomes were assessed via questionnaires.

Results:

iDBT was perceived as a credible and acceptable treatment. In terms of feasibility 94% of participants started iDBT, 13% were early dropouts, and 35% used it for the recommended 8 days in the first month. On average, participants used iDBT for 2h and 24min across 10 separate days. At the acute period, no greater benefit was found for the immediate group on substance dependence, though we did find lower depression (b=-2.46, p=.02) and anxiety (b=-2.22, p=.02). At follow-up, there were greater benefits in the severity of alcohol (b=-2.00, p=.02) and non-alcoholic substance (b=-3.74, p=.01) consumption in the immediate access group. Both groups demonstrated improvements in substance dependence at the acute (b=-1.73, p<.0001) and follow-up period (b=-2.09, p<.0001). At follow-up, both groups reported reduced depression, anxiety, suicidal behaviors, emotion dysregulation, and functional disability (all ps<.03).

Conclusions:

iDBT was supported as a feasible and acceptable intervention for those with SUDs, though methods to improve engagement should be developed. Results did not support early efficacy for the primary outcome; however, findings for reductions in substance dependence and other commonly comorbid mental health concerns were found overall. Notwithstanding the limitations of this study, results suggest the potential value of iDBT in the treatment of SUDs and other mental health conditions. Clinical Trial: ClinicalTrials.gov NCT05094440; https://clinicaltrials.gov/show/NCT05094440