RESUMO
Telehealth interventions have the potential to deter repeated detoxification episodes and improve outcomes. Using a sample of 298 detoxification inpatients, this randomized controlled trial compared Enhanced Telephone Monitoring (ETM) to usual care (UC) on the primary outcome of reducing subsequent detoxification, and secondary outcomes of linking patients to addiction treatment and mutual-help, and patients' experience of improved substance use and mental health outcomes. At the 3-month follow-up (i.e., at the end of the ETM intervention), compared to UC patients, ETM patients were significantly less likely to have received additional inpatient detoxification, but no more likely to have participated in 12-step groups or received outpatient addiction treatment. Even so, ETM patients had better alcohol, drug, and mental health outcomes. In contrast, at the 6-month follow-up, patients in ETM and UC generally did not differ on primary or secondary outcomes. Findings suggest that ETM deters additional detoxification episodes while the intervention is ongoing, but not after the intervention ends. Because telephone monitoring is low-intensity and low-cost, its extension over time may help reduce repeated detoxifications.
Assuntos
Transtornos Relacionados ao Uso de Álcool/terapia , Pacientes Internados/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Síndrome de Abstinência a Substâncias/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Telemedicina , Telefone , Continuidade da Assistência ao Paciente , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Atenção Primária à SaúdeRESUMO
The Contracts, Prompts, and Reinforcement (CPR) intervention has demonstrated an ability to increase the duration of continuing care participation following substance use disorder (SUD) treatment, resulting in improved treatment outcome. The current project was a qualitative pre-implementation study aimed at identifying barriers and facilitators to implementation of CPR using an evidence-based quality improvement (EBQI) approach. Formative evaluations were conducted with staff from residential SUD treatment programs across three VA sites, and key informant interviews were completed with opinion and program leaders. Data were analyzed using a grounded theory approach, which identified barriers and facilitators to implementation. Fidelity measures were developed for each of the core CPR components, and the research-focused treatment manual was rewritten to facilitate future implementation efforts with the design and content of the documents shaped by the findings of the qualitative analyses. Overall, data suggested that clinicians and administrators are receptive to the core components of CPR.
Assuntos
Cooperação do Paciente , Transtornos Relacionados ao Uso de Substâncias/terapia , Contratos , Grupos Focais , Humanos , Entrevistas como Assunto , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Melhoria de Qualidade , Resultado do TratamentoRESUMO
Differential rates of schizophrenia and paranoia symptoms have been found for Black and White individuals. Paranoid personality disorder shares symptoms with schizophrenia, yet has received minimal attention with regard to potential racial differences. In a sample consisting of 180 substance use disorder treatment-seeking individuals, the association between the diagnosis of paranoid personality disorder and the variables of race, cannabis use disorder, and income were examined. Results extended previous findings to paranoid personality disorder, supporting the hypothesis that Black individuals would be diagnosed with higher rates of paranoid personality disorder. Cannabis use disorder status and income did not predict paranoid personality disorder diagnoses.
Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Abuso de Maconha/epidemiologia , Transtorno da Personalidade Paranoide/epidemiologia , População Branca/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Abuso de Maconha/etnologia , Abuso de Maconha/reabilitação , Pessoa de Meia-Idade , Transtorno da Personalidade Paranoide/etnologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Estados Unidos/epidemiologia , Adulto JovemRESUMO
The contracting, prompting and reinforcing (CPR) aftercare intervention has improved treatment adherence and outcomes in a number of clinical trials. In multisite randomized clinical trial 92 graduates of two intensive substance use disorder programs who received CPR were compared to 91 who received standard treatment (STX). The CPR group evidenced increased frequency of aftercare group therapy attendance and near significant findings suggested that more CPR than STX participants completed 3 months (76 vs. 64%), 6 months (48 vs. 35%), and 9 months (35 vs. 22%) of aftercare. However, the groups did not differ on the majority of attendance measures and had similar abstinence rates at the 3-month (67% CPR vs. 71% STX), 6-month (52% CPR vs. 51% STX), and 12-month (the primary outcome measure; 48% CPR vs. 49% STX) follow-up points. Exploratory analyses suggest that CPR might be more effective among participants not required to attend aftercare. The incremental capital and labor cost of CPR compared to STX was $98.25 per participant.
Assuntos
Motivação , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Assistência ao Convalescente , Alcoólicos Anônimos , Análise Custo-Benefício , Diagnóstico Duplo (Psiquiatria) , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Pessoa de Meia-Idade , Cooperação do Paciente , Recidiva , Reforço Psicológico , Tratamento Domiciliar , Detecção do Abuso de Substâncias , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do Tratamento , Estados Unidos , United States Department of Veterans AffairsRESUMO
Continuing care following initial substance use disorder treatment often is associated with improved treatment outcomes and evidence-based interventions (EBIs) have been developed in this area. However, rates of patient participation in continuing care treatment and mutual help groups (MHGs) are low and a large gap exists between the existing EBIs and actual clinical care. This paper uses the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) to review the literature on continuing care treatment and monitoring, and mutual help-group promotion. Although existing research provides implications for implementing EBIs in continuing care, few direct implementation trials have been conducted. This literature indicates that EBIs in continuing care have been successfully modified for different settings, that they can be delivered using different modalities (e.g., individual, group, and telephone-based care), and that low cost options are available. Additionally, much is known about the differential effectiveness of continuing care with different populations that may guide treatment programs and providers in selecting the most effective interventions for their clients. One significant barrier to successful implementation of EBIs for continuing care is the lack of information about incentives for providing continuing care across what in the CFIR terminology is a program's outer setting (i.e., external economic, political, and social setting), and its inner setting (i.e., internal political, structural, and cultural contexts). Implications for implementation of EBIs in substance use disorder continuing care are discussed.
Assuntos
Prática Clínica Baseada em Evidências , Transtornos Relacionados ao Uso de Substâncias/terapia , Acessibilidade aos Serviços de Saúde , Humanos , Resultado do TratamentoRESUMO
Epidemiological data from treatment and community samples of individuals with substance use disorders indicate that the rates of co-occurring psychiatric disorders are high and that these disorders are associated with poor treatment adherence and outcomes. A growing body of research indicates that continuing care adherence interventions positively impact treatment outcome. However, it is unclear whether these interventions are effective for individuals with co-occurring psychiatric disorders. This paper explores this question with data from 150 participants who were randomized to receive a behavioral continuing care adherence intervention involving contracting, prompting and reinforcing attendance (CPR), or standard treatment. Fifty-one percent of the participants had one or more co-occurring Axis I or Axis II psychiatric disorders in addition to a SUD diagnosis. Among individuals with co-occurring disorders, those who received the CPR intervention show increased duration of treatment and improved 1-year abstinence rates compared to those who received STX. Additionally, effects of the CPR intervention were generally more pronounced among persons with co-occurring Axis I and/or Axis II disorders than those without these disorders. Treatment implications are discussed.
Assuntos
Continuidade da Assistência ao Paciente/normas , Transtornos Mentais/terapia , Cooperação do Paciente/psicologia , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Diagnóstico Duplo (Psiquiatria) , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Cooperação do Paciente/estatística & dados numéricos , Tratamento Domiciliar , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
Although continuing care is strongly related to positive treatment outcomes for substance use disorder (SUD), participation rates are low and few effective interventions are available. In a randomized clinical trial with 150 participants (97% men), 75 graduates of a residential Veterans Affairs Medical Center SUD program who received an aftercare contract, attendance prompts, and reinforcers (CPR) were compared to 75 graduates who received standard treatment (STX). Among CPR participants, 55% completed at least 3 months of aftercare, compared to 36% in STX. Similarly, CPR participants remained in treatment longer than those in STX (5.5 vs. 4.4 months). Additionally, CPR participants were more likely to be abstinent compared to STX (57% vs. 37%) after 1 year. The CPR intervention offers a practical means to improve adherence among individuals in SUD treatment.
Assuntos
Assistência ao Convalescente , Alcoolismo/reabilitação , Terapia Comportamental , Motivação , Reforço Social , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Veteranos/psicologia , Adulto , Alcoólicos Anônimos , Alcoolismo/psicologia , Comorbidade , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Tratamento Domiciliar , Transtornos Relacionados ao Uso de Substâncias/psicologia , Temperança/psicologiaRESUMO
This study examined the convergent validity of the Timeline Followback (TLFB) for individuals with comorbid (Axis I and/or Axis II) psychiatric disorders in a sample of persons (N=150) engaged in residential treatment for substance use disorders (SUDs). Approximately one-half of the sample was diagnosed with at least one comorbid psychiatric disorder. Validity was assessed comparing data from the TLFB with data from the Addiction Severity Index (ASI) and collateral reports. For the entire sample, data from the TLFB was significantly correlated with data from the ASI and collateral reports of substance use. No significant differences were found between those with and those without a comorbid psychiatric disorder, suggesting that the TLFB was equally valid for both groups.
Assuntos
Ansiedade/epidemiologia , Transtorno Bipolar/epidemiologia , Depressão/epidemiologia , Tratamento Domiciliar , Esquizofrenia/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Ansiedade/diagnóstico , Transtorno Bipolar/diagnóstico , Comorbidade , Depressão/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esquizofrenia/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Inquéritos e QuestionáriosRESUMO
Contracting and prompting clients to attend substance abuse treatment aftercare substantially improves treatment adherence and outcome. However, this approach has not been evaluated for improving entry into initial treatment. We recruited 102 individuals scheduled to begin a 28-day substance use disorder (SUD) residential treatment program and randomly assigned them to receive either our standard treatment (STX) or STX plus attendance contracting and prompting (CP). CP participants showed fewer subsequent hospitalization days, lower hospitalization costs, greater improvement in alcohol problem scores, and lower legal problem scores at a 3-month follow-up than the STX group. The two groups did not differ on treatment entry rate, time in treatment, or drug use problem scores. The clinical utility of CP procedures and areas for future research are discussed.
Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Alcoolismo/economia , Alcoolismo/psicologia , Alcoolismo/reabilitação , Custos e Análise de Custo/economia , Feminino , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Projetos Piloto , Tratamento Domiciliar/métodos , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Fatores de Tempo , Resultado do TratamentoRESUMO
Although adherence to aftercare therapy in substance abuse treatment is associated with improved outcome, little research has explored the effects of adherence interventions on outcome. We compared 20 graduates of our 28-day intensive treatment program who received a standard aftercare orientation with 20 graduates who received this intervention plus social reinforcement of aftercare group therapy attendance. The social reinforcement group showed less alcohol use than the standard care group at a 6-month follow-up assessment as measured by the Addiction Severity Index (ASI), but not less drug use. Additionally, compared to standard care, the social reinforcement participants were more likely to be abstinent at the 6-month follow up (76% vs. 40%). The groups did not differ on hospital readmission rates over a 12-month follow-up period. Additionally, the social reinforcement group showed better long-term aftercare attendance compared to the standard care group.