Alexander H Harris’s research while affiliated with Stanford University and other places

Many patients treated for substance use disorder (SUD) do not achieve lasting recovery from a single episode of treatment and require continuing care. The current randomized clinical trial investigated whether in-person continuing care as usual (CCAU) following intensive outpatient SUD treatment leads to better SUD outcomes when compared with telephone case monitoring (TCM). This study randomized 667 intensive SUD outpatients to telephone case monitoring versus face-to-face continuing care as usual at two sites. Patients completed data at baseline, 3 and 12months with telephone interviews. Data of interest include self-report of substance use, psychiatric symptoms, quality of life, and treatment satisfaction. We also evaluated potential interaction effects for distance to VA provider, SUD severity, and presence of co-morbid psychiatric disorder. Participants randomized to the telephone case monitoring condition substantially engaged with face-to-face continuing care resulting in cross-over contamination. We addressed this issue by using randomization as an instrumental variable to evaluate the impact of telephone case monitoring (contamination adjusted, intent to treat analysis). Instrumental variable analyses indicated significant benefit of telephone case monitoring for drug and alcohol percent days abstinent and psychiatric symptom outcomes at 3-months follow-up, but not at 12-month follow-up. No interaction analyses were significant. Participants receiving telephone case monitoring achieved better short term outcomes in terms of substance use and psychiatric symptoms. The "on treatment" effects suggests the need for future studies to investigate consumer (patient) perspectives on the optimal duration of telephone case monitoring and use of alternative monitoring methods such as text messaging.

Studies measuring the effectiveness of 12-step self-help group attendance have yielded mixed results but none of the prior studies have accounted for the potential impact of interim abstinence status. Participants were 1683 patients with substance use disorders (SUD) from 88 community residential facilities. Self-report data were collected at baseline and 1- and 4-year follow-ups, and included measures of SUD severity, social resources, coping, and 12-step self-help group attendance. We tested the hypothesis that 12-step self-help group attendance is more effective for non-abstinent patients than for abstinent patients. We also controlled for self-selection effects by using propensity score analyses and we cross-validated our results in a second sample of patients (N=2173). Sample 1. Patients abstinent at 1-year post-treatment who attended 12-step self-help group meetings were no more likely to be abstinent at 4 years than abstinent patients who did not attend. However, for patients not abstinent at 1 year, a significant improvement in abstinence rates at 4 years emerged for those who attended 12-step self-help groups compared to those who did not (42% vs. 28.9%). A similar pattern emerged for SUD problems. There were no benefits from 12-step self-help group attendance for patients abstinent at 1 year, but non-abstinent patients who attended 12-step self-help groups had significantly fewer problems at 4 years. Sample 2. The cross-validation yielded consistent results as 12-step self-help group attendance led to higher abstinence rates and fewer SUD problems only among patients non-abstinent at interim assessment. Individual's abstinence status should be considered when evaluating the potential influence of 12-step self-help group attendance on SUD outcomes. In addition, increased clinical resources should focus on assessing patients after discharge and on improving linkage of non-abstinent patients to self-help groups.

Few studies focus on the outcome of patients after they drop out of substance-use disorder (SUD) treatment, and there appear to be no prior studies of the long-term outcomes of these patients. The aim of this study is to determine how well such patients do after dropping out of treatment and to identify predictors of differential outcomes. Patients in 15 residential SUD treatment programs were assessed at treatment entry and at 5-year follow-up on their frequency and severity of substance use, expectancies and beliefs about substance use, and social resources and stressors. Patients who dropped out and stayed out of treatment (n = 193) were compared with those who completed treatment (n = 3,204). Predictors of 5-year SUD problems among dropouts were identified. In general, dropouts and treatment completers did not differ significantly on their levels of SUD problems at 5 years. At baseline, patients who dropped out reported more involvement in 12-step organizations and greater cognitive impairment and more closely identified with the label "drug addict" than "alcoholic." Lower severity of SUD, lower self-efficacy, fewer positive substance- use expectancies, and less stress from social networks predicted fewer SUD problems at 5 years among dropouts. In addition to focusing on substance use, providers should address the adequacy of patients' social support and counter positive substance-use expectancies at the earliest stages of treatment before patients drop out.