Extended telephone‐based continuing care for alcohol dependence: 24‐month outcomes and subgroup analyses

McKay, James R.; Horn, Deborah Van; Oslin, David W.; Ivey, Megan; Drapkin, Michelle; Coviello, Donna M.; Yu, Qin; Lynch, Kevin G.

doi:10.1111/j.1360-0443.2011.03483.x

Cited by 50 publications

(82 citation statements)

References 37 publications

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“…According to the Institute of Medicine (2001), a treatment is patient centered when it is responsive to a patient's individual preferences, needs, and values. The third way in which the approach is consistent with general trends in healthcare is that treatment decisions are guided by data through the use of empirically developed algorithms (also called "adaptive treatment" designs; e.g., McKay et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Is the Construct of Relapse Heuristic, and Does It Advance Alcohol Use Disorder Clinical Practice?

Maisto

Witkiewitz

Moskal

et al. 2016

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: Alcohol use disorder (AUD) relapse is a construct that has been of major clinical and research interest but has been inconsistently defined. The purpose of this study was to review the definitions of AUD relapse that have been used in clinical research as a basis for drawing conclusions about its heuristic value. Method: A systematic review of the literature was conducted on empirical studies that (a) were published in peer-reviewed journals, (b) were published between 2010 and 2015, (c) were written in English, and (d) provided a definition of alcohol relapse (or lapse) that was used in the study. Results: The review yielded 139 individual studies that met inclusion criteria. The studies showed wide variability in how relapse was defined and interpreted in the literature, and there was little direct empirical or theoretical rationale provided for the definitions of relapse that were chosen. Furthermore, the concept of AUD relapse as a discrete state is not consistent with the empirical literature on the clinical course of alcohol consumption. Conclusions: We conclude that the heuristic value of AUD relapse as currently studied is low. An alternative approach that embeds the construct in theory and data on the clinical course of alcohol consumption and aligns with current trends in healthcare would seem to have a better chance of improving AUD clinical decision-making and knowledge about AUD in general. (J. Stud. Alcohol Drugs, 77, 849-858, 2016 T HE TERM RELAPSE is part of the common discourse with respect to addictive behaviors. For example, a simple Google search for either "relapse and addiction" or "relapse and alcohol" yields millions of results. The purpose of this article is to examine the use of the term relapse in the area of alcohol use/alcohol use disorder (AUD) change, whether by self-initiation, the use of mutual-help groups, formal treatment services, or some combination of the three. The ultimate goal of this line of inquiry is to appraise the heuristic value of the term relapse in advancing clinical research and treatment. Heuristic value in this article means value in aiding the discovery of knowledge about AUD clinical course through the generation of research. The article begins with an overview of conceptual definitions of AUD relapse followed by reporting the findings of a systematic review of recently published (2010)(2011)(2012)(2013)(2014)(2015) empirical studies that have included relapse as an independent or dependent variable. Definition of relapseAccording to the online edition of the Merriam-Webster Dictionary (n.d.), "relapse" is derived from the Latin word relabi, which means "to slide back." Relapse as a verb means "to become ill again after a period of improvement in health," or "to return to a bad condition, form of behavior, etc." The noun form of relapse simply means a return of illness or a return to a former and undesirable condition.The construct of relapse is often applied in reference to what typically are considered physical illnesses. In this conte...

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Section: Discussionmentioning

confidence: 99%

Is the Construct of Relapse Heuristic, and Does It Advance Alcohol Use Disorder Clinical Practice?

Maisto

Witkiewitz

Moskal

et al. 2016

J. Stud. Alcohol Drugs

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“…In the current paper [5], the authors look at whether the improvements in alcohol use were sustained during the 6 months after continuing care was withdrawn and the results indicate that none of the observed effects remained significant. While this provides evidence of the effectiveness of continuing care, it also reaffirms the observation noted by McLellan and colleagues [8] that clinical effects dissipate quickly when care is discontinued.…”

Section: Commentary On Mckay Et Al (2011)mentioning

confidence: 99%

“…It is clear that cost-effective strategies are needed to increase initiation and longer-term participation in post-treatment continuing care. One logical strategy for increasing access would be to provide a low patient burden method of delivery, such as telephone monitoring, instead of requiring clinic attendance over an extended time-period.To that end, McKay and colleagues [5,6] randomized individuals with alcohol dependence and high rates of co-occurring cocaine dependence to one of three conditions: (i) continuing care treatment as usual (TAU); (ii) telephone monitoring (TM) that included a brief assessment and feedback (5-10 minutes); or (iii) telephone monitoring and counseling (TMC) that included a brief assessment, feedback plus telephone counseling over 18 months. During the 18-month continuing care phase, TMC produced significantly better alcohol outcomes than treatment as usual (TAU).…”

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confidence: 99%

“…TM did not perform significantly better than TAU overall, although there was some evidence that TM had an effect over TAU among women and those with low treatment readiness [7]. Neither of the telephone conditions produced significant reductions in cocaine use overall or in the 11 subgroups they evaluated.In the current paper [5], the authors look at whether the improvements in alcohol use were sustained during the 6 months after continuing care was withdrawn and the results indicate that none of the observed effects remained significant. While this provides evidence of the effectiveness of continuing care, it also reaffirms the observation noted by McLellan and colleagues [8] that clinical effects dissipate quickly when care is discontinued.…”

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Commentary on McKay et al. (2011): The many and varied pathways to recovery

Scott¹,

Dennis²

2011

Addiction

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Commentary on McKay et al. (2011):The many and varied pathways to recoverya dd_3585 1770..1771 In a recent book on continuing care, McKay [1] provided an excellent review and critique of the literature, which helped to focus the field and identify the primary challenges to providing continuing care. He and others have done much to demonstrate the effectiveness of various continuing care approaches, as well as to identify components of continuing care models that might increase the likelihood of their success. For example, continuing care approaches are more likely to produce positive treatment effects when they incorporate more assertive efforts to deliver the treatment (thereby improving initiation and retention) and when such efforts are provided over longer periods of time.Unfortunately, the existing financially overburdened treatment systems often limit the availability of formal continuing care. Moreover, even when continuing care is offered, participation rates remain low; a vexing, prevalent and long-term problem that health and behavioral health care industries have faced for decades [2][3][4]. This problem plagues surgeons, internists, psychiatrists and addiction counselors, and is observed most often in the context of treating chronic conditions. It is clear that cost-effective strategies are needed to increase initiation and longer-term participation in post-treatment continuing care. One logical strategy for increasing access would be to provide a low patient burden method of delivery, such as telephone monitoring, instead of requiring clinic attendance over an extended time-period.To that end, McKay and colleagues [5,6] randomized individuals with alcohol dependence and high rates of co-occurring cocaine dependence to one of three conditions: (i) continuing care treatment as usual (TAU); (ii) telephone monitoring (TM) that included a brief assessment and feedback (5-10 minutes); or (iii) telephone monitoring and counseling (TMC) that included a brief assessment, feedback plus telephone counseling over 18 months. During the 18-month continuing care phase, TMC produced significantly better alcohol outcomes than treatment as usual (TAU). TM did not perform significantly better than TAU overall, although there was some evidence that TM had an effect over TAU among women and those with low treatment readiness [7]. Neither of the telephone conditions produced significant reductions in cocaine use overall or in the 11 subgroups they evaluated.In the current paper [5], the authors look at whether the improvements in alcohol use were sustained during the 6 months after continuing care was withdrawn and the results indicate that none of the observed effects remained significant. While this provides evidence of the effectiveness of continuing care, it also reaffirms the observation noted by McLellan and colleagues [8] that clinical effects dissipate quickly when care is discontinued.Results from the current study also provide an excellent opportunity to observe participation rates when a low patient burden...

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“…This question was addressed in the context of an aftercare intervention delivered by telephone. Aftercare interventions have received mixed support (McKay, 2009;McKay et al, 2011). The present research came from a parent study that was a randomized clinical trial to examine the effectiveness of telephone-based aftercare for stimulant users.…”

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confidence: 99%

Patient Reactance Moderates the Effect of Directive Telephone Counseling for Methamphetamine Users

Karno

Farabee²,

Brecht³

et al. 2012

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: This study examined the impact of the interaction between patient reactance and treatment directiveness on the effectiveness of telephone aftercare for methamphetamine dependence. Method: Reactance was assessed at baseline, and participants were randomly assigned to directive or nondirective treatment conditions. Logistic regression tested for the signifi cance of the interaction as a predictor of 3-month and 12-month use of methamphetamine and stimulants. Results: A signifi cant interaction was observed at the 3-month follow-up, in which the directive condition was less effective for patients higher in reactance and was more effective for patients lower in reactance. Among patients at a high level of reactance, the nondirective condition increased the likelihood of abstinence. Conclusions: This study suggests that, in the context of telephone-based care, directive interventions offer shortterm clinical benefi t for methamphetamine users who readily accept infl uence from authority fi gures, whereas nondirective interventions offer benefi t for patients who do not readily accept infl uence. The short-term nature of these effects indicates that there is a need for brief but ongoing telephone support to maintain treatment gains. (J. Stud. Alcohol Drugs,

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Extended telephone‐based continuing care for alcohol dependence: 24‐month outcomes and subgroup analyses

Cited by 50 publications

References 37 publications

Is the Construct of Relapse Heuristic, and Does It Advance Alcohol Use Disorder Clinical Practice?

Is the Construct of Relapse Heuristic, and Does It Advance Alcohol Use Disorder Clinical Practice?

Commentary on McKay et al. (2011): The many and varied pathways to recovery

Patient Reactance Moderates the Effect of Directive Telephone Counseling for Methamphetamine Users

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