Improving Substance Abuse Treatment Aftercare Adherence and Outcome

Although substance abuse treatment continuing care participation is strongly related to positive treatment outcomes, participation rates are low and few interventions have been developed that improve continuing care adherence and outcome.

Background: Although substance abuse treatment continuing care participation is strongly related to positive treatment outcomes, participation rates are low and few interventions have been developed that improve continuing care adherence and outcome. Objectives: The objectives of the study were: 1) to compare the effectiveness of an aftercare intervention consisting of a participation contract, attendance prompts, and attendance reinforcers (CPR) to a standard treatment (STX) on adherence to therapy; and 2) to assess the effects of this intervention on treatment outcome Methods: We recruited 150 veterans from the Salem VAMC�s SARRTP who could participate in aftercare. Our population is similar to those in other VA�s (97% male, 54% Caucasian, 46% minority, 49 years mean age, 44% alcohol dependent only, 56% drug dependent, and 44% with a dual diagnosis). In this randomized clinical trial, treatment adherence and outcome were measured at baseline and 3-, 6- and 12-months after participants entered treatment using interviews, questionnaires, alcohol and drug screens, VA medical records, and therapist ratings. The study design is a repeated measures nested cohort design, with an intervention and a standard care group. The primary outcome, abstinence rate, will be analyzed using a logistic regression model in which the parameters of interest are estimated using Generalized Estimating Equations (GEE). Status: Participant recruitment and follow-up interviews were completed in June 2003 and August 2004, respectively. The HSR&D final report was submitted in April 2005. The main results paper and additional papers will be submitted for publication in 2005.

Inclusion Criteria: All graduates of the Salem VA's SARRTP who: live within a 60 minute drive of the Salem VAMC, or 1 of our 5 SARRTP outreach clinics; have transportation and a job schedule that allows them to attend outpatient aftercare therapy. Exclusion Criteria:

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Lash SJ, Stephens RS, Burden JL, Grambow SC, DeMarce JM, Jones ME, Lozano BE, Jeffreys AS, Fearer SA, Horner RD. Contracting, prompting, and reinforcing substance use disorder continuing care: a randomized clinical trial. Psychol Addict Behav. 2007 Sep;21(3):387-97. doi: 10.1037/0893-164X.21.3.387.