A randomized trial of extended telephone-based continuing care for alcohol dependence: Within-treatment substance use outcomes.

Abstract

Objective The study tested whether adding up to 18 months of telephone continuing care, either as monitoring and feedback (TM) or longer contacts that included counseling (TMC), to intensive outpatient programs (IOP) improved outcomes for alcohol dependent patients. Methods Participants (N=252) who completed 3 weeks of IOP continued to receive IOP (M=36 sessions over 6 months) and were randomized to up to 36 sessions of TM (M=11.5 sessions of M=8.2 minutes), TMC (M=9.1 sessions of M=16.8 minutes), or IOP only (TAU). Quarterly assessment of alcohol use with the Time-Line Follow-Back (79.9% assessed at 18 months) was corroborated with available collateral reports (N=63 at 12 months). Participants with lifetime cocaine dependence (N=199) also provided urine samples. Results Main effects favored TMC over TAU on any alcohol use (OR=1.88, CI=1.13,3.14) and any heavy alcohol use (OR=1.74, CI=1.03,2.94). TMC produced significantly fewer days of alcohol use during months 10–18 and heavy alcohol use during months 13–18 than TAU (ds of .46 to .65). TM produced significantly better alcohol use outcomes than TAU only on percent days alcohol use, only during months 10–12 and 13–15 (ds of .41 and .39). TMC produced significantly fewer days of any alcohol use and heavy alcohol use than TM only during months 4–6 (ds= .39 and .43). Among participants with cocaine dependence, there were no treatment main effects on rates of cocaine positive urines. Conclusion Adding telephone continuing care to IOP significantly improved alcohol use outcomes relative to IOP alone. Conversely, shorter telephone calls that provided monitoring and feedback but no counseling generally did not improve outcomes over IOP.

Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: A review of current practice

“…The distinction between treatment-emergent reactions linked to the treatment and unwanted events unrelated to the treatment is central. A few reports in the present review indicated that such judgments were made, in some cases by an Institutional Review Board [27] or an independent Data Monitoring Committee [25].…”

“…Five trials provided information about adverse events in the results section but had missing or incomplete information about how the data was collected [24][25][26][27], or how the adverse events were defined [28]. Four reports only briefly stated in the results section [29], methods section [30,31] or the discussion [32] that no adverse events occurred or were observed, without providing information about how these adverse events were defined or monitored.…”

A Pilot Trial of Telephone-Based Collaborative Care Management for PTSD Among Iraq/Afghanistan War Veterans

“…27 Within VA, telemental health has an increasingly prominent role. 28 Telephonebased care is poised to address veteran geographic access to care barriers in a cost-effective manner by reducing the need to travel for care.…”

Enhanced Continuing Care Provided in Parallel to Intensive Outpatient Treatment Does Not Improve Outcomes for Patients With Cocaine Dependence

“…The intervention includes elements found in cognitive-behavioral therapy (CBT), such as regular monitoring of current substance use and other risk and protective factors, identifi cation of upcoming high-risk situations, rehearsal of coping strategies, and linkage to community supports. Prior studies with TMC have found that the intervention produced better drug and alcohol use outcomes than standard care, particularly in patients who continued to use alcohol or other drugs or failed to achieve other goals of early treatment (McKay et al, 2005(McKay et al, , 2010b.…”

“…This has meant that substantial numbers of patients dropped out of IOP before becoming eligible to enter the studies (McKay et al, 2010b). The present study was an initial test of whether we could extend the reach of TMC by offering the intervention to patients immediately following intake to treatment and whether doing so would improve outcomes.…”