Terapia cognitivo-comportamental por internet para dependentes de álcool: viabilidade e estudo piloto de um ensaio clínico randomizado

Abstract

Household surveys conducted in the country have pointed to the increase in the number of individuals who use alcohol dependent, however, the search for treatments is still small in relation to demand, which can be understood by the low supply of specialized treatments directed to this population. The interest of many countries in the assessment of the efficacy and effectiveness of internet interventions for different disorders, including substance use disorders, is increasing. In this context, the Conselho Federal de Psicologia regulated, through resolutions from 2000 to 2018, the psychotherapeutic care mediated by the computer. This study had the first objective of reviewing the literature on studies that included the participation of a mediator in cognitive-behavioral interventions on the internet for alcohol users. We searched the Medline, PsycARTICLES, Lilacs and Scielo databases resulting in 9887 abstracts, of which 7287 were withdrawn because they were duplicated and 2595 because they did not meet the inclusion criteria, leaving a total of five articles. An article was included later, although it was not found in the review, remaining six studies for content analysis. The studies indicated that there was a reduction in the weekly consumption of alcohol from the intervention carried out via the Internet and that this type of intervention can be assimilated to other modalities of treatment, such as face-to-face interventions. However, few studies found, suggesting the need for further studies to evaluate the effectiveness of this type of intervention. Despite the interest in the area, in Brazil no study of effectiveness of Internet interventions based on Cognitive-Behavioral Therapy (CBT) for alcohol dependents with the presence of a therapist was found. In this sense, the second objective of the present study was to conduct a pilot study of a randomized clinical trial to assess viability and obtain initial data on the effectiveness of Internet psychotherapy for alcohol dependents based on CBT, Relapse Prevention (RP) and principles of the Motivational Interview (MI). The rate of loss at each stage of the study was about 50% of participants. After the inclusion / exclusion criteria, 22 subjects were randomized to CBT-Presence (n = 12) or CBT-Internet (n = 10). Adherence to treatment was 70% (Internet-CBT) and 50% (CBT-Presence). As for the number of days in which he drank, the groups reduced significantly between pre- and posttest evaluations, but increased intake at follow-up assessment compared to post-test. In comparison to the pre-test, both maintained a significant reduction at the end. The groups did not differ in the final follow-up evaluation. As for the number of doses consumed, the CBTPresence group started consuming more, but both significantly reduced consumption. There was an increase in consumption between the post-test and the follow-up evaluation, but, compared to the pre-test, the reduction obtained still remained significant in both groups. The results of this study showed that it is feasible to perform an effectiveness study with a larger sample, but that more investment in the recruitment of patients is required.