Regular article Feasibility and effectiveness of computer-based therapy in community treatment Adam C. Brooks, (Ph.D.) a, ⁎ , Deanna Ryder, (M.A.) a , Deni Carise, (Ph.D.) a,b,c , Kimberly C. Kirby, (Ph.D.) a,c a Treatment Research Institute, Philadephia, PA 19106 b Phoenix House, New York, NY 10023 c Department of Psychiatry, University of Pennsylvania School of Medicine, Treatment Research Center, Philadelphia, PA 19104 Received 21 January 2010; received in revised form 14 May 2010; accepted 4 June 2010 Abstract Computerized therapy approaches may expand the reach of evidence-based treatment; however, it is unclear how to integrate these therapies into community-based treatment. We conducted a two-phase pilot study to explore (a) whether clients' use of the Therapeutic Education System (TES), a Web-based community reinforcement approach (CRA) learning program, would benefit them in the absence of counselor support and (b) whether counselors and clients would use the TES in the absence of tangible research-based reinforcement. In Phase 1, clients in the TES condition (n = 14) demonstrated large improvements in knowledge, F(1, 20) = 8.90, p = .007, d = 1.05, and were significantly more likely to select CRA style coping responses, F (1, 20) = 11.95, p = .002, d = 1.16, relative to the treatment-as-usual group (n = 14). We also detected small, nonsignificant, between-group effects indicating TES decreased cocaine use during treatment. In Phase 2, counselors referred only around 10% of their caseload to the TES, and the modal number of completed modules in the absence of tangible reinforcement was three. Computer-based therapy approaches are viable in community-based treatment but must be integrated with incentive systems to ensure engagement. © 2010 Elsevier Inc. All rights reserved. Keywords: Computer-assisted; Behavior therapy; Cocaine; Coping skills; Community reinforcement approach 1. Introduction Many psychotherapeutic approaches (particularly cogni- tive and behavioral approaches) have been computerized or augmented with computer-based didactics components to increase the reach of evidence-based mental health treatments (Spek et al., 2007; Taylor & Luce, 2003; Tumur, Kaltentha- ler, Ferriter, Beverley, & Parry, 2007), to improve the cost- effectiveness of treatment (McCrone et al., 2004), and to decrease therapist contact time (Wright et al., 2005). A number of computerized and Web-based approaches recently have been applied in substance abuse treatment settings and hold tremendous potential for expanding the reach of evidence-based treatment. Web-based approaches have been demonstrated to be efficacious in the delivery of empirically supported nicotine cessation strategies (Glenn & Dallery, 2007; Shiffman, Paty, Rohay, Di Marino, & Gitchell, 2001; Strecher, Shiffman, & West, 2005), motiva- tional enhancement strategies (Ondersma, Chase, Svikis, & Schuster, 2005; Ondersma, Svikis, & Schuster, 2007), moderation management (Hester, Squires, & Delaney, 2005; Squires & Hester, 2004), and HIV prevention strategies (Marsch & Bickel, 2004). In addition, three separate research groups have shown the benefit of using a computerized approach to behavioral therapies (Bickel, Marsch, Buchhal- ter, & Badger, 2008; Carroll et al., 2008; Kay-Lambkin, Baker, Lewin, & Carr, 2009). Computerization of behavioral psychosocial approaches offers many advantages to substance abuse treatment. Journal of Substance Abuse Treatment 39 (2010) 227 – 235 ⁎ Corresponding author. Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadephia, PA 19106. Tel.: +1 215 399 0980; fax: +1 215 399 0987. E-mail address: abrooks@tresearch.org (A.C. Brooks). 0740-5472/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jsat.2010.06.003