Computer Training in CBT for Spanish-speaking Alcohol Users

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Alcohol use disorders are a significant problem among Latinos, who represent the largest ethnic minority group in the United States. Latinos tend to be less likely to receive mental health and substance abuse treatment services than non-Latinos and African Americans, and 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 treatment. We now propose to adapt the CBT4CBT program for use with a broad range of Latino individuals with alcohol use disorders whose principal/preferred language is Spanish and to evaluate its efficacy in this population. If 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 individuals with alcohol use disorders. Second, we propose to conduct an initial Stage 1 randomized trial evaluating the feasibility and efficacy of adding CBT4CBT-Spanish-Alcohol to treatment as usual in a community based treatment program in a population of 90 Spanish-speaking individuals who meet current DSM-5 criteria for alcohol use disorder. 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-Alcohol program. The long-term durability and/or delayed emergence of treatment effects will be evaluated through a six month follow-up.