Substance Use Disorders Clinical Trial
Official title:
Early Re-Intervention (ERI) Experiment 2
The objective of this study was to evaluate the relative effectiveness of quarterly Recovery Management Checkups (RMC) on long-term outcomes of adult chronic substance users over 4 years.
CONTEXT: While drug abuse is the 10th leading cause of mortality in the US, the disorder
remains an orphan of the public health care system. Unlike cancer, diabetes, and other
chronic diseases, the detection, re-emergence, and progression of which we have learned to
respond with aggressively timed monitoring and interventions, drug abuse remains isolated
from adoption into the "chronic condition" model of care.
OBJECTIVES AND HYPOTHESES: The objective of this study was to evaluate the relative
effectiveness of quarterly checkups on long-term outcomes of adult chronic substance users
over 4 years. Relative to participants randomly assigned to the control group, we predicted
that RMC participants would: H1) return to treatment sooner, H2) receive more treatment, H3)
decrease substance use, and H4) increase days of abstinence.
METHOD: Participants were recruited from sequential intakes at the largest addiction
treatment agency in Illinois between February and April of 2004. Inclusion criteria were:
any substance use in the past 90 days and any past-year symptoms of substance use disorders.
For logistical reasons, participants were excluded if they were: under 18, lived or planned
to move outside Chicago within 12 months, sentenced to a confined environment most of the
next 12 months, mandated to treatment because of a driving under the influence offense, were
not fluent in English or Spanish, or were cognitively unable to provide informed consent. To
evaluate efficacy of quarterly Recovery Management Checkups (RMC) on treatment reentry and
substance use, 446 adults (88% with dependence criteria) were randomly assigned quarterly
RMCs, or, an outcome monitoring only control group and followed quarterly for 4 years (94%
completion).
INTERVENTION. After interviewers completed the quarterly research interview and determined
participants' eligibility and need for early re-intervention, they transferred RMC
participants who were eligible and in need to a Linkage Manager. Using motivational
interviewing, the Linkage Manager: a) provided feedback to participants regarding their
current substance use and related problems, b) discussed implications of managing addiction
as a chronic condition, c) discussed treatment barriers and solutions, d) assessed and
discussed level of motivation for treatment, e) scheduled treatment appointments, f)
accompanied participants to treatment intake and stayed through the process, and g)
implemented Engagement and Retention Protocol during the 14 days of treatment. Detailed
procedures and forms are available in the RMC manual(Scott & Dennis, 2003;
http://www.chestnut.org/LI/downloads/Scott_&_Dennis_2003_RMC_Manual-2_25_03.pdf ).
OUTCOME MEASURES: Days to first treatment, days of treatment, successive quarters of needing
treatment, number of substance problem months, days of abstinence.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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