Continuing care research: What we have learned and where we are going

Abstract

In the field of addiction treatment, the term “continuing care” has been used to indicate the stage of treatment that follows an initial episode of more intensive care. This article reviews controlled studies of continuing care conducted over the prior 20 years. The results indicate that continuing care interventions were more likely to produce positive treatment effects when they had a longer planned duration, made more active efforts to deliver treatment to patients, and were studied more recently. However, there was considerable variability in patient response and room for improvements in participation rates and effectiveness. It is possible that the effectiveness of continuing care interventions could be further improved by the use of adaptive algorithms, which adjust treatment over time on the basis of changes in patients' symptoms and status. The use of alternative service delivery methods and care settings may also lead to greater engagement and retention in continuing care, particularly among the large numbers of individuals who do not want traditional, clinic-based specialty care.

Driving While Intoxicated Among Individuals Initially Untreated for Alcohol Use Disorders: One- and Sixteen-Year Follow-Ups

“…By specifi cally including the outcome of a lower likelihood of relapse to DWI, our fi ndings extend those of other studies in which more alcohol-related specialty care (McKay, 2009;Moos et al, 1999;Ritsher et al, 2002) and AA participation (Kaskutas et al, 2008;Timko and DeBenedetti, 2007) were associated with better drinking outcomes (e.g., abstinence) in general. They concur with conceptual models hypothesizing that a longer duration of help may reduce the risk of impaired driving among individuals prone to drive while intoxicated (Mann et al, 1983;Wells-Parker and Williams, 2002).…”

“…For example, the frequency with which individuals engage in DWI may moderate the effects of the amount and intensity of treatment or AA on subsequent drinking and driving behaviors. Generally, individuals with highly chronic and severe substance use problems have better outcomes when they receive more (and more intensive) treatment, whereas individuals with milder problems tend to improve whether they receive lower or higher amounts and intensities of help (Blonigen et al, 2009;Chen et al, 2006;McKay, 2009). Accordingly, future research should recognize that treatment and AA participation, whether mandated or voluntary, may not be suffi cient for some people who repeatedly engage in DWI to desist such behavior (DeYoung, 1997).…”

Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment

“…[37][38][39] Substance use disorders are typically chronic disorders treated with acute care, yet they warrant flexible, patient-centered, longitudinal care. 40 There is an unmet need for treatment of substance use disorders; one study indicated that less than 10% of PSUDs were receiving treatment. 41 Among persons living with HIV who also have substance use disorders, access to substance use disorder treatment may also be limited or nonexistent.…”

Continuing Care and Long-Term Substance Use Outcomes in Managed Care: Early Evidence for a Primary Care-Based Model

“…However, the addiction field has focused mainly on aftercare services involving 12-step participation or modalities conducted through specialty substance abuse treatment programs. Many of these increase the benefit of treatment (3–9), but in most cases the aftercare period is limited. At some point it ends, and patients become disconnected from the clinic, specialty care providers, and other resources and services (10).…”