Computer Based Training in CBT for Spanish-Speaking Substance Users

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DESCRIPTION (provided by applicant): Substance abuse is a significant problem among Hispanic Americans, who represent the largest ethnic minority group in the United States. Latino/as tend to be less likely to receive mental health and substance abuse treatment services than European and African Americans, experience disproportionate levels of adverse consequences of drug use, and yet are highly underrepresented in clinical and research samples. To address the issue of improving access to empirically validated therapies, we have developed a computer-assisted version of cognitive behavioral therapy (Computer Based Training for Cognitive Behavioral Therapy, CBT4CBT) and have demonstrated its efficacy and durability as an adjunct to standard outpatient substance abuse treatment. We now propose to adapt the CBT4CBT program for use with a broad range of substance abusers whose principal/preferred language is Spanish and to evaluate its efficacy in this population. If this Spanish version of CBT4CBT is found to be an effective adjunct to treatment, it would be comparatively inexpensive and straightforward to disseminate and implement in a wide range of programs. It would thus also represent a significant step in making evidence-based therapies more broadly available to this important and underserved population and hence to address a critical health disparity in the US and an NIH priority. We propose to, first, adapt our individualized, interactive, web-based training program (CBT4CBT) for Spanish- speaking substance users. Second, we propose to conduct an initial randomized trial evaluating the feasibility and efficacy of adding CBT4CBT-Spanish to treatment as usual in a community based treatment program in a population of 100 Spanish-speaking individuals who meet current criteria for substance abuse dependence. Participants will be randomized to one of two conditions: (1) standard treatment (ST) at the Hispanic Clinic of the Connecticut Mental Health Center, or (2) ST with access to the CBT4CBT-Spanish program as an adjunct to treatment. The long-term durability and/or delayed emergence of treatment effects will be evaluated through a six month follow-up. The primary outcome measures will be reduction in substance use, operationalized as reduction in the frequency of substance use by week confirmed by urine toxicology screens. Secondary outcomes will include HIV risk reduction, psychosocial functioning, and the participants' ability to demonstrate the skills targeted in the CBT4CBT intervention as a mediator of outcome.