Turning to drug use disorders, Bickel, Marsch and colleagues developed the Therapeutic Education System (TES), a computerized version of the well-validated Community Reinforcement Approach (CRA)(Azrin, 1976; Budney & Higgins, 1998). TES combines over 60 online modules, many consistent with CBT, with voucher based contingency management where users receive vouchers upon submission of drug-free urine specimens. In their first study, TES was compared with therapist-delivered CRA (maximum value of vouchers was $1316 if all urines were negative for cocaine and opioid metabolites) with standard counseling for 135 opioid dependent adults maintained on buprenorphine. Those assigned to either form of CRA (therapist delivered or via TES) had significantly longer periods of continuous abstinence (8.0 weeks for therapist-delivered CRA and 7.8 for TES) compared with standard buprenorphine treatment (4.7 weeks) in this 23-week trial (Bickel et al., 2008). Subsequent trials of TES have indicated benefit of adding TES to standard methadone treatment (Marsch, Guarino, et al., 2014) as well as the benefits of the TES system itself in addition to contingency management in the context of buprenorphine maintenance treatment (Christensen et al., 2014).
