Computerized Cognitive–Behavioral Therapy

With an estimated 90 percent or more of alcohol use disorders going untreated (Substance Abuse and Mental Health Services Administration 2012), the search for interventions that easily, effectively, and economi­ cally reach more people has become a priority. The landmark 1990 report, Broadening the Base of Treatment for Alcohol Problems (Institute of Medicine 1990), refocused alcohol treatment research toward an emphasis on developing, standardizing, and disseminating new behavioral thera­ pies to expand the reach of alcohol treatment. A particularly exciting development on this front has been the creation of computerized versions of interventions shown to be effective in clinical settings. Computerized treatments have multiple potential advantages for expanding the base of treatment for alcohol use disorders, including broad availability 24 hours a day, lower cost, standardization, greater ability to reach rural and underserved pop­ ulations, and greater confidentiality, leading to fewer concerns about stigma (Carroll and Rounsaville 2010; Cunningham and Van Mierlo 2009). In effect, computer-based interventions can serve as “clinician extenders,” offering a means of delivering high-quality, standardized versions of screening, evaluation, and brief treatments, at relatively low cost. That said, these interventions are relatively new, and, therefore, both their quality and the level of rigor of the studies supporting them varies widely (Carey et al. 2009; Kiluk et al. 2011; Rooke et al. 2010). Here, we will highlight only approaches with at least preliminary validation in clinical trials. Electronic Screenings and Brief Interventions (eSBIs)