Effectiveness of Different Models of Case Management for Substance-Abusing Populations

Ghent University, Department of Orthopedagogics, Gent, Belgium.
Journal of psychoactive drugs (Impact Factor: 1.1). 04/2007; 39(1):81-95. DOI: 10.1080/02791072.2007.10399867
Source: PubMed


Case management has been implemented in substance abuse treatment to improve (cost-) effectiveness, but controversy exists about its potential to realize this objective. A systematic and comprehensive review of peer-reviewed articles (n = 48) published between 1993 and 2003 is presented, focusing on the effects of different models of case management among various substance-abusing populations. Results show that several studies have reported positive effects, but only some randomized and controlled trials have demonstrated the effectiveness of case management compared with other interventions. Longitudinal effects of this intervention remain unclear. Although no compelling evidence was found for the effectiveness of case management, some evidence is available about the (differential) effectiveness of intensive case management and assertive community treatment for homeless and dually-diagnosed substance abusers. Strengths-based and generalist case management have proven to be relatively effective for substance abusers in general. Most positive effects concern reduced use of inpatient services and increased utilization of community-based services, prolonged treatment retention, improved quality of life, and high client satisfaction. Outcomes concerning drug use and psychosocial functioning are less consistent, but seem to be mediated by retention in treatment and case management. Further research is required to learn more about the extent of the effects of this intervention, how long these are sustained and what specific elements cause particular outcomes.

25 Reads
  • Source
    • "Collaborative, holistic, patient-centred, individualised services and health promotion are recommended to address the diverse needs of PLWHA [7e9]. An individualised case-management approach, defined as " a coordinated and integrated approach to service delivery, intended to provide on-going supportive care and to help people access the resources they need for living and functioning in the community " [10] and mandated in the USA for HIV [3], can help to meet these needs and also improve adherence to HIV medications [11,12]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To present a case study of complementary therapy (CT) provision within a community HIV multi-agency service in a Northwest London deprived area. Anonymised routine service data were provided for all clients (n = 1030) August 2010 to October 2012. Face-to-face meetings provided feedback from volunteers (9 CT-using clients and 9 staff). CT-users were demographically similar to other clients. Support for coping with HIV was commonly cited as a service benefit. Over 26 months 1416 CT sessions were provided; 875 aromatherapy and 471 shiatsu. CT-users' most common concerns were pain (48%), stress (15%) and insomnia (13%), few had heard of or used CT before. Perceived mental and emotional benefits included relaxation,stress relief, relieving musculoskeletal aches and pains. Service challenges included time and funding, though staff felt CT may be cost-effective. CT may provide important support and treatment options for HIV disease, but cost effectiveness requires further evaluation.
    Complementary therapies in clinical practice 02/2014; 20(1):65-9. DOI:10.1016/j.ctcp.2013.10.003
  • Source
    • "Case management is an effective strategy for HIV infected IDU patients to improve substance abuse and HIV treatment outcomes [20,21]. HIV-infected individuals with case managers are more likely to receive benefits advocacy, psychological services, and emotional and practical support. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The majority of HIV-infected individuals requiring antiretroviral therapy (ART) in Russia are Injection Drug Users (IDU). Substitution therapy used as part of a comprehensive harm reduction program is unavailable in Russia. Past data shows that only 16 % of IDU receiving substance abuse treatment completed the course without relapse, and only 40 % of IDU on ART remained on treatment at 6 months. Our goal was to determine if it was feasible to improve these historic outcomes by adding intensive case management (ICM) to the substance abuse and ART treatment programs for IDU. IDU starting ART and able to involve a "supporter" who would assist in their treatment plan were enrolled. ICM included opiate detoxification, bi-monthly contact and counseling with the case, weekly group sessions, monthly contact with the "supporter" and home visits as needed. Full follow- up (FFU) was 8 months. Stata v10 (College Station, TX) was used for all analysis. Descriptive statistics were calculated for all baseline demographic variables, baseline and follow-up CD4 count, and viral load. Median baseline and follow-up CD4 counts and RNA levels were compared using the Kruskal-Wallis test. The proportion of participants with RNA < 1000 copies mL at baseline and follow-up was compared using Fisher's Exact test. McNemar's test for paired proportions was used to compare the change in proportion of participants with RNA < 1000 copies mL from baseline to follow-up. Between November 2007 and December 2008, 60 IDU were enrolled. 34 (56.7 %) were male. 54/60 (90.0 %) remained in FFU. Overall, 31/60 (52 %) were active IDU at enrollment and 27 (45 %) were active at their last follow-up visit. 40/60 (66.7 %) attended all of their ART clinic visits, 13/60 (21.7 %) missed one or more visit but remained on ART, and 7/60 (11.7 %) stopped ART before the end of FFU. Overall, 39/53 (74 %) had a final 6--8 month HIV RNA viral load (VL) < 1000 copies/mL. Despite no substitution therapy to assist IDU in substance abuse and ART treatment programs, ICM was feasible, and the retention and adherence of IDU on ART in St. Petersburg could be greatly enhanced by adding ICM to the existing treatment programs.
    Harm Reduction Journal 09/2013; 10(1):15. DOI:10.1186/1477-7517-10-15 · 1.26 Impact Factor
  • Source
    • "Search terms used were Assertive Community Treatment and substance use. A meta-analysis (Coldwell & Bender, 2007) and critical reviews of ACT (Burns & Santos, 1995; Dixon et al., 2010; Lehman, 1999; O&apos;campo et al., 2009; Vanderplasschen et al., 2007) were also read to identify pertinent articles. Eight studies were initially identified; four were excluded as they did not measure substance use (Jerrell, 1999; Lehman et al., 1997) or adequately report substance use outcomes (e.g., relied solely on self-reported measures; Bond & McDonel, 1991; Clarke et al., 2000). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Assertive Community Treatment (ACT) has been studied extensively in people with severe mental illness, but there have only been a few clinical trials in which substance use was one of the measured outcomes. The goal of this article was to describe the efficacy of ACT in treating co-occurring substance use disorders and suggest approaches to make it more efficacious. A literature review was conducted and randomized clinical trials describing ACT's impact on substance use were reviewed. Four randomized clinical trials of ACT that measured substance abuse adequately were identified, all of which showed small to no effect on substance abuse compared with control conditions. Methodological issues might account for the small effects. ACT might further reduce substance use by being paired with evidenced-based substance abuse treatment, helping clients become housed or helping them manage their money better. Integrated ACT, in which the ACT team provides substance abuse counseling, has the potential to reduce substance use by several mechanisms, but this has been difficult to demonstrate in clinical trials when participants in control groups receive similar interventions.
    Journal of the American Psychiatric Nurses Association 03/2011; 17(1):45-50. DOI:10.1177/1078390310393509 · 0.98 Impact Factor
Show more