Enhanced Continuing Care Provided in Parallel to Intensive Outpatient Treatment Does Not Improve Outcomes for Patients With Cocaine Dependence
Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania. Journal of studies on alcohol and drugs
(Impact Factor: 2.76).
07/2013; 74(4):642-51. DOI: 10.15288/jsad.2013.74.642
This study tested whether the addition of an enhanced continuing care (ECC) intervention that combined in-person and telephone sessions and began in the first week of treatment improved outcomes for cocaine-dependent patients entering an intensive outpatient program (IOP).
Participants (N = 152) were randomized to IOP treatment as usual (TAU) or IOP plus 12 months of ECC. ECC included cognitive-behavioral therapy elements to increase coping skills, as well as monetary incentives for attendance. It was provided by counselors situated at a separate clinical research facility who did not provide IOP. The primary outcomes measured were (a) cocaine urine toxicology and (b) good clinical outcome, as indicated by abstinence from all drugs and from heavy alcohol use. Secondary outcomes were frequency of abstinent days, cocaine use days, and heavy drinking days. Follow-ups were conducted at 3, 6, 9, and 12 months after baseline.
Patients in ECC completed a mean of 18 sessions. Contrary to the hypotheses, patients in TAU had better scores on both the cocaine urine toxicology and the good clinical outcome measures than those in ECC, as indicated by significant Group × Time interactions (cocaine urine toxicology, p = .0025; abstinence composite, p = .017). These results were not moderated by substance use before or early in treatment or by IOP attendance. Results with the secondary outcomes also did not favor ECC over TAU.
Continuing care that is not well integrated with the primary treatment program may interfere in some way with the therapeutic process, particularly when it is implemented shortly after intake.
Available from: Brandon G Bergman
- "1.2. Emerging adulthood: a clinically unique stage of the life course Taken together, with some exceptions (e.g., Godley et al., 2010; McKay et al., 2013), evidence suggests well-articulated, active continuing care interventions can improve post-treatment outcomes among adolescents and adults. Little is known, however, regarding professional continuing care among treatment-seeking emerging adults (e.g., 18–25 years old; Arnett, 2000), who comprise approximately one-fifth of all SUD treatment admissions (SAMHSA, 2014), and are developmentally unique in their combination of life stressors (e.g., transition to independent living) and recovery barriers (e.g., social networks with substantial proportions of substance using individuals; Kelly et al., 2013; Mason and Luckey, 2003). "
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ABSTRACT: Professional continuing care services enhance recovery rates among adults and adolescents, though less is known about emerging adults (18-25 years old). Despite benefit shown from emerging adults' participation in 12-step mutual-help organizations (MHOs), it is unclear whether participation offers benefit independent of professional continuing care services. Greater knowledge in this area would inform clinical referral and linkage efforts.
Emerging adults (N=284; 74% male; 95% Caucasian) were assessed during the year after residential treatment on outpatient sessions per week, percent days in residential treatment and residing in a sober living environment, substance use disorder (SUD) medication use, active 12-step MHO involvement (e.g., having a sponsor, completing step work, contact with members outside meetings), and continuous abstinence (dichotomized yes/no). One generalized estimating equation (GEE) model tested the unique effect of each professional service on abstinence, and, in a separate GEE model, the unique effect of 12-step MHO involvement on abstinence over and above professional services, independent of individual covariates.
Apart from SUD medication, all professional continuing care services were significantly associated with abstinence over and above individual factors. In the more comprehensive model, relative to zero 12-step MHO activities, odds of abstinence were 1.3 times greater if patients were involved in one activity, and 3.2 times greater if involved in five activities (lowest mean number of activities in the sample across all follow-ups).
Both active involvement in 12-step MHOs and recovery-supportive, professional services that link patients with these community-based resources may enhance outcomes for emerging adults after residential treatment.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Available from: link.springer.com
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ABSTRACT: The widespread availability of high-speed, mobile cellular telephones and other advances in communication technology have the potential to change the way in which interventions for substance use disorders (SUD) are delivered and how progress is monitored. This article reviews recent research on the use of new technology to monitor progress and deliver interventions for SUD. Several studies of telephone-based interventions have shown positive effects, but sometimes only in certain subgroups. However, other studies have produced negative results. Studies have supported the use of interactive voice response (IVR) and personal digital assistants (PDAs) to conduct assessments, but there are few data on whether IVR- or PDA-based interventions improve outcomes. Text messaging has received comparatively little research, but appears promising as a means to conduct assessments and deliver automated interventions. Finally, smartphone technology provides the widest range of features and interventions and the greatest flexibility, but few intervention studies using smartphones have been conducted.
Available from: Michael L Dennis
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ABSTRACT: Scientific advances in the past 15 years have clearly highlighted the need for recovery management approaches to help individuals sustain recovery from chronic substance use disorders. This article reviews some of the recent findings related to recovery management: (1) continuing care, (2) recovery management checkups, (3) 12-step or mutual aid, and (4) technology-based interventions. The core assumption underlying these approaches is that earlier detection and re-intervention will improve long-term outcomes by minimizing the harmful consequences of the condition and maximizing or promoting opportunities for maintaining healthy levels of functioning in related life domains. Economic analysis is important because it can take a year or longer for such interventions to offset their costs. The article also examines the potential of smartphones and other recent technological developments to facilitate more cost-effective recovery management options.
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