Possible Contribution of Multiple Sclerosis Pathology to Treatment-Resistant Schizophrenia: A Case Study.

Nationally, less than one in 10 people with alcohol use disorder (AUD) receive treatment (NIAAA ). While AUD is the most common substance use disorder (SUD) in the United States, fewer people in need of AUD treatment receive it compared to treatment for other use disorders (Martin et al. ). Among people with a past year SUD, less than 3% perceived a treatment need and made efforts to seek treatment (Liu et al. ). Reasons for not seeking or receiving treatment vary, including not being ready to stop substance use, stigma, and lack of access, health care coverage, or knowledge of treatment programs (Liu et al. ; SAMHSA ). While some people who develop AUD can reduce or resolve their problem on their own, evidence‐based treatment for AUD is recommended to improve health and functioning (Lewer et al. ). Given the numerous reasons for not receiving AUD treatment, it is important to investigate strategies that expand reach of evidence‐based interventions and study who utilizes and benefits from access to these interventions among the large group of people with untreated AUD. The United States Preventative Services Task Force recommends universal screening (S), evidence‐based brief intervention (BI), and referral to specialized treatment (RT)—SBIRT—in medical settings for alcohol use to help reduce alcohol‐related morbidity and mortality (Tucker et al. ). SBI has demonstrated success for many individuals, particularly those with heavy/problem drinking and mild AUD. However, efforts to refer those with moderate to severe AUD who need specialized treatment to community residential or outpatient programs have been largely unsuccessful (Vendetti et al. ). Additionally, although cognitive behavioral therapy (CBT) is considered the standard of care for AUD behavioral treatment (Carroll and Kiluk ; Magill et al. ; Boness et al. ) and has been widely implemented in many different treatment settings, it is often under‐used or implemented with limited fidelity (Carroll ; Magill et al. ). Computer‐Based Training for Cognitive Behavioral Therapy (CBT4CBT) is a web‐delivered program for AUD based on the principles of CBT (Carroll et al. ). Research to date has demonstrated CBT4CBT's effectiveness as an adjunct to SUD treatment (Carroll et al. , ; Kiluk et al. ) and as an alternative care option within specialized outpatient SUD treatment settings (Kiluk et al. ). Individuals randomized to CBT4CBT demonstrate more negative urine specimens, longer periods of abstinence, a faster rate of change, and better durability of intervention effects (Carroll et al. , , , ; Kiluk et al. , ; Kelpin et al. ).