Treatment history: relationship to treatment outcomes.

It is important to understand whether the number of prior treatment episodes relate to treatment completion, discharge status, and 6-month outcomes. The data set contains information on 2,429 clients in treatment. A modified Addiction Severity Index was administered at the time of admission and at 6-months postdischarge. Additionally, length of stay and discharge status data were obtained. ANOVAs, MANOVAs, and chi(2) tests were used. Clients with the most prior treatment episodes had greater baseline substance use and psychosocial severity, and were more likely to be treated in residential settings. Nonetheless, treatment acceptance was greatest for these clients. Clients with no prior treatment reported the least acceptance. Treatment completion rates did not vary as a function of treatment experience. Clients achieved positive changes in multiple life domains regardless of treatment history. Nevertheless, at admission, discharge and follow-up, clients with >or= 2 treatments generally had greater problems than clients with fewer treatments.

Extending residential care through telephone counseling: initial results from the Betty Ford Center Focused Continuing Care protocol.

There is increasing evidence that a chronic care model may be effective when treating substance use disorders. In 1996, the Betty Ford Center (BFC) began implementing a telephone-based continuing care intervention now called Focused Continuing Care (FCC) to assist and support patients in their transition from residential treatment to longer-term recovery in the "real world". This article reports on patient utilization and outcomes of FCC. FCC staff placed clinically directed telephone calls to patients (N=4094) throughout the first year after discharge. During each call, a short survey was administered to gauge patient recovery and guide the session. Patients completed an average of 5.5 (40%) of 14 scheduled calls, 58% completed 5 or more calls, and 85% were participating in FCC two months post-discharge or later. There was preliminary evidence that greater participation in FCC yielded more positive outcomes and that early post-discharge behaviors predict subsequent outcomes. FCC appears to be a feasible therapeutic option. Efforts to revise FCC to enhance its clinical and administrative value are described.

Comparison of two ASI-based standardized patient placement approaches.

This study evaluated the predictive validity of two automated approaches based on the Addiction Severity Index (ASI) to patient placement criteria. Patients (N = 2,429) in 78 substance abuse treatment programs completed an ASI at intake and were assigned a treatment modality based on availability and clinical considerations. Treatment completion and self-reported abstinence 6 months post-discharge were collected. Two placement approaches were developed using ASI summary score cut points or problem-specific algorithms from ASI items. Both approaches showed evidence of predictive validity. Given the ASI's widespread use in community programs, evidence is provided in support of its ability to inform clinical judgment and implementation of standardized placement.