A web-based addiction treatment worked well for stimulant and cannabis users but not for opioid users | Research

The takeaway

The Therapeutic Education System (TES) web-based treatment significantly improved abstinence for stimulant users and showed promising trends for cannabis and alcohol users, but had no effect for opioid users.

Read this if you're considering online or app-based programs to help reduce cannabis use.

Cannabis users 2.64x more likely to be abstinent with web treatment

What the researchers found

This secondary analysis of a large multi-site trial (497 participants) examined whether a web-based behavioral treatment worked differently depending on the primary substance of abuse. Participants entering outpatient counseling were randomly assigned to receive treatment-as-usual with or without TES substituted for about 2 hours of usual counseling.

Primary stimulant users receiving TES were 3.59 times more likely to be abstinent in the final four weeks compared to those without TES. Cannabis users showed a similar magnitude of benefit (2.64 times more likely) and alcohol users as well (3.15 times), but neither reached statistical significance due to smaller subgroup sizes.

Primary opioid users showed no benefit from TES and trended toward worse outcomes (odds ratio 0.35). The findings suggest web-based behavioral treatments are most effective for stimulant, cannabis, and alcohol use disorders but may need different approaches for opioid dependence.

Why it matters

Web-based treatments can dramatically expand access to addiction care, particularly in underserved areas. Knowing which substance use disorders respond best helps clinicians match treatments to patients and avoid offering ineffective interventions.

The numbers in context

497 participants across 4 substance groups. Stimulant users: AOR 3.59 (significant). Alcohol: AOR 3.15 (trending). Cannabis: AOR 2.64 (trending). Opioid: AOR 0.35 (no benefit). Cannabis users were 22.9% of the sample.

How the study worked

Secondary analysis of a randomized multi-site effectiveness trial (NCT01104805). 497 participants entering outpatient counseling were categorized by primary substance: cannabis (22.9%), stimulants (34.4%), opioids (21.7%), alcohol (20.9%). TES replaced approximately 2 hours of usual counseling. Abstinence in final 4 weeks was the primary outcome.

What this study cannot tell us

Secondary analysis with subgroup sizes that limited statistical power for cannabis and alcohol groups. Cannabis users were 22.9% of the sample (n=114). The study could not determine why opioid users did not benefit. Treatment-as-usual varied across sites.

How to read the evidence

Secondary analysis of a randomized multi-site trial. Cannabis subgroup showed promising but non-significant trends due to sample size.

When this study was published

Published in 2015. Digital treatment platforms have expanded significantly since.

The bigger picture

Digital and web-based treatments are increasingly important for substance use disorders. This study suggests they work well for some substances but not universally, highlighting the need to tailor digital interventions to specific substance use patterns.

Questions still open

Why did opioid users not benefit from web-based behavioral treatment? Would a cannabis-specific web program show stronger effects? Can digital treatments be combined with pharmacotherapy for better outcomes?

Common questions

Do online treatment programs work for cannabis?

In this study, cannabis users who received a web-based treatment program were 2.64 times more likely to be abstinent, though the result did not reach statistical significance due to the subgroup size. The trend was promising.

Why might web treatments work better for some drugs than others?

The researchers did not fully explain this, but opioid dependence involves strong physical withdrawal and often requires medication-assisted treatment, which may limit the effectiveness of behavioral-only approaches delivered online.

Read the original research

Web-based treatment for substance use disorders: differential effects by primary substance.

Addictive behaviors, 45, 191-4

View on PubMed ↗Publisher’s paper ↗

Citation

Cochran, Gerald; Stitzer, Maxine; Campbell, Aimee N C; Hu, Mei-Chen; Vandrey, Ryan; Nunes, Edward V. (2015). Web-based treatment for substance use disorders: differential effects by primary substance.. Addictive behaviors, 45, 191-4. https://doi.org/10.1016/j.addbeh.2015.02.002