TY - JOUR
KW - Aftercare/methods
KW - Alcoholism/rehabilitation/therapy
KW - Ambulatory Care
KW - Clinical Protocols/standards
KW - Cocaine-Related Disorders/rehabilitation/therapy
KW - Cognitive Therapy
KW - Continuity of Patient Care
KW - Counseling/methods
KW - Follow-Up Studies
KW - Humans
KW - Psychotherapy, Group/methods
KW - Substance Abuse Detection
KW - Telephone/standards/utilization
KW - Temperance
KW - Treatment Outcome
AU - J. R. McKay
AU - K. G. Lynch
AU - D. S. Shepard
AU - H. M. Pettinati
A1 - 
AB - CONTEXT: Telephone-based disease management protocols have shown promise in improving outcomes in a number of medical and psychiatric disorders, but this approach to continuing care has received little study in alcohol- and drug-dependent individuals. OBJECTIVE: To compare telephone-based continuing care with 2 more intensive face-to-face continuing care interventions. DESIGN: A randomized 3-group clinical trial with a 2-year follow-up. SETTING: Two outpatient substance abuse treatment programs, one community-based and the other at a Veterans Affairs medical center facility. PATIENTS: Alcohol- and/or cocaine-dependent patients (N = 359) who had completed 4-week intensive outpatient programs. INTERVENTIONS: Three 12-week continuing care treatments: weekly telephone-based monitoring and brief counseling contacts combined with weekly supportive group sessions in the first 4 weeks (TEL), twice-weekly cognitive-behavioral relapse prevention (RP), and twice-weekly standard group counseling (STND). MAIN OUTCOME MEASURES: Percentage of days abstinent from alcohol and cocaine, total abstinence from alcohol and cocaine, negative consequences of substance use, cocaine urine toxicological results, and gamma-glutamyltransferase. RESULTS: Participants in TEL had higher rates of total abstinence over the follow-up than those in STND (P<.05). In alcohol-dependent participants, 24-month gamma-glutamyltransferase levels were lower in TEL than in RP (P = .005). In cocaine-dependent participants, there was a significant group x time interaction (P = .03) in which the rate of cocaine-positive urine samples increased more rapidly in RP as compared with TEL. On percentage of days abstinent or negative consequences of substance use, TEL did not differ from RP or STND. Participants with high scores on a composite risk indicator, based on co-occurring alcohol and cocaine dependence and poor progress toward achieving intensive outpatient program goals, had better total abstinence outcomes up to 21 months if they received STND rather than TEL, whereas those with lower scores had higher abstinence rates in TEL than in STND (P = .04). CONCLUSIONS: Telephone-based continuing care appears to be an effective form of step-down treatment for most patients with alcohol and cocaine dependence who complete an initial stabilization treatment, compared with more intensive face-to-face interventions. However, high-risk patients may have better outcomes if they first receive group counseling continuing care after completing intensive outpatient programs.
BT - Archives of General Psychiatry
C5 - HIT & Telehealth
CP - 2
CY - United States
DO - 10.1001/archpsyc.62.2.199
IS - 2
JF - Archives of General Psychiatry
N2 - CONTEXT: Telephone-based disease management protocols have shown promise in improving outcomes in a number of medical and psychiatric disorders, but this approach to continuing care has received little study in alcohol- and drug-dependent individuals. OBJECTIVE: To compare telephone-based continuing care with 2 more intensive face-to-face continuing care interventions. DESIGN: A randomized 3-group clinical trial with a 2-year follow-up. SETTING: Two outpatient substance abuse treatment programs, one community-based and the other at a Veterans Affairs medical center facility. PATIENTS: Alcohol- and/or cocaine-dependent patients (N = 359) who had completed 4-week intensive outpatient programs. INTERVENTIONS: Three 12-week continuing care treatments: weekly telephone-based monitoring and brief counseling contacts combined with weekly supportive group sessions in the first 4 weeks (TEL), twice-weekly cognitive-behavioral relapse prevention (RP), and twice-weekly standard group counseling (STND). MAIN OUTCOME MEASURES: Percentage of days abstinent from alcohol and cocaine, total abstinence from alcohol and cocaine, negative consequences of substance use, cocaine urine toxicological results, and gamma-glutamyltransferase. RESULTS: Participants in TEL had higher rates of total abstinence over the follow-up than those in STND (P<.05). In alcohol-dependent participants, 24-month gamma-glutamyltransferase levels were lower in TEL than in RP (P = .005). In cocaine-dependent participants, there was a significant group x time interaction (P = .03) in which the rate of cocaine-positive urine samples increased more rapidly in RP as compared with TEL. On percentage of days abstinent or negative consequences of substance use, TEL did not differ from RP or STND. Participants with high scores on a composite risk indicator, based on co-occurring alcohol and cocaine dependence and poor progress toward achieving intensive outpatient program goals, had better total abstinence outcomes up to 21 months if they received STND rather than TEL, whereas those with lower scores had higher abstinence rates in TEL than in STND (P = .04). CONCLUSIONS: Telephone-based continuing care appears to be an effective form of step-down treatment for most patients with alcohol and cocaine dependence who complete an initial stabilization treatment, compared with more intensive face-to-face interventions. However, high-risk patients may have better outcomes if they first receive group counseling continuing care after completing intensive outpatient programs.
PP - United States
PY - 2005
SN - 0003-990X; 0003-990X
SP - 199
EP - 207
EP - 
T1 - The effectiveness of telephone-based continuing care for alcohol and cocaine dependence: 24-month outcomes
T2 - Archives of General Psychiatry
TI - The effectiveness of telephone-based continuing care for alcohol and cocaine dependence: 24-month outcomes
U1 - HIT & Telehealth
U3 - 10.1001/archpsyc.62.2.199
VL - 62
VO - 0003-990X; 0003-990X
Y1 - 2005
ER -