A digital cognitive behavioral therapy program culturally adapted for Spanish-speaking individuals with alcohol use disorder: a stage 1 randomized clinical trial

BackgroundDigital formats are an important tool for making evidence-based therapies for alcohol use, such as cognitive behavioral therapy (CBT), more broadly available, yet only a small percentage are available in Spanish and none with evidence from effectiveness studies with Spanish-speaking individuals. This study evaluated the feasibility and efficacy of adding a culturally-adapted, web-based CBT program for Spanish-speakers, known as CBT4CBT-SA, to community-based outpatient care for alcohol use disorder.MethodsWe conducted a 2-arm, unblinded, parallel-group randomized clinical trial among 51 primary Spanish-speaking adults seeking outpatient treatment for alcohol use. Participants were randomly assigned to either standard treatment (ST), or ST plus access to the CBT4CBT-SA program. Frequency of alcohol use was measured during an 8-week treatment period, and at monthly intervals at 1-, 3-, and 6-month follow-up. The primary outcome was the percentage of days abstinent (PDA) from alcohol by week during the 8-week period. Other outcomes included change in consequences from alcohol, coping strategies, and knowledge of CBT concepts.ResultsRates of treatment completion (63%) and data availability (84% of randomized sample at 6-month follow-up) were high. Results of random effects regression analyses did not indicate a significant change in PDA in the full sample. Among the subsample of treatment completers, those assigned to ST + CBT4CBT-SA had a greater increase in PDA compared to ST during the 8-week treatment (treatment by week, t258 = 2.56, p = .01), as well as across the full 8-month study period (treatment by month, t239.85 = 2.50, p = .01). While there was a subsequent reduction in negative consequences from alcohol during the treatment period, it did not differ by treatment condition.ConclusionThis culturally adapted, web-based version of CBT targeting alcohol use for Spanish speakers appeared acceptable with preliminary efficacy at improving alcohol use outcomes when added to standard outpatient treatment. Future studies are warranted to evaluate efficacy in a larger sample and with differing levels of clinical support.