Grant: Project Grant

Heavy alcohol and drug use is reported by a substantial number of Canadians, and incurs billions of dollars in costs to Canadian society each year. Yet, only a minority of those struggling with addiction receives specialized services. Numerous barriers to care exist, highlighting the need for scalable and engaging treatment alternatives. Online cognitive behavioural therapy (CBT) for addiction has exhibited promise in the reduction of substance use, although studies to date highlight the key importance of patient engagement to optimize clinical outcomes. Peer support may provide a way to engage patients using online interventions. The goal of this proposal is to evaluate the efficacy and cost-effectiveness of online CBT with and without peer support. The proposed research will specifically evaluate Breaking Free Online (BFO), which has demonstrated effectiveness in adults with substance use difficulties. BFO has developed peer support programming; however, the impact of peer support on patient engagement during the implementation has yet to be evaluated. We propose to randomize 225 outpatients receiving standard care to clinical monitoring (CM), BFO only, or BFO with peer support, in an eight-week trial with a three- and six-month follow-up. The primary outcome is substance use frequency; secondary outcomes include substance use problems, depression, anxiety, quality of life, treatment engagement, and cost-effectiveness. We hypothesize that BFO will be associated with greater reductions in substance use and other clinical outcomes, as well as more durable improvements and greater cost-effectiveness, compared to clinical monitoring alone. We further hypothesize that BFO with peer support will be associated with greater engagement in treatment, and that engagement will mediate improvements over treatment. Results will support the implementation of this innovative approach within adults with addiction, who face numerous risks for harm and barriers to services.