The Continuing Care Model of Substance Use Treatment: What Works, and When Is “Enough,” “Enough?”

Abstract

There is little disagreement in the substance use treatment literature regarding the conceptualization of substance dependence as a cyclic, chronic condition consisting of alternating episodes of treatment and subsequent relapse. Likewise, substance use treatment efforts are increasingly being contextualized within a similar disease management framework, much like that of other chronic medical conditions (diabetes, hypertension, etc.). As such, substance use treatment has generally been viewed as a process comprised of two phases. Theoretically, the incorporation of some form of lower intensity continuing care services delivered in the context of outpatient treatment after the primary treatment phase (e.g., residential) appears to be a likely requisite if all stakeholders aspire to successful long-term clinical outcomes. Thus, the overarching objective of any continuing care model should be to sustain treatment gains attained in the primary phase in an effort to ultimately prevent relapse. Given the extant treatment literature clearly supports the contention that treatment is superior to no treatment, and longer lengths of stay is associated with a variety of positive outcomes, the more prudent question appears to be not whether treatment works, but rather what are the specific programmatic elements (e.g., duration, intensity) that comprise an adequate continuing care model. Generally speaking, it appears that the duration of continuing care should extend for a minimum of 3 to 6 months. However, continuing care over a protracted period of up to 12 months appears to be essential if a reasonable expectation of robust recovery is desired. Limitations of prior work and implications for routine clinical practice are also discussed.

Influencing quality of outpatient SUD care: Implementation of alerts and incentives in Washington State

“…Moreover, the optimal length of stay may vary by the phase of treatment (Proctor & Herschman, 2014), level of treatment, type of substance and patient characteristics. For years, Washington State’s contracts with agencies had included a different performance measure, retention in outpatient treatment and many agencies may have viewed this retention measure as easier to achieve, since it required only one visit per month for three consecutive months and may have focused on the retention measure because it was in their contracts throughout the study period.…”

Pathways to rearrest among court mandated female substance use treatment patients

“…This study utilized data from the Comprehensive Assessment and Treatment Outcome Research (CATOR) program . CATOR was designed as an assessment of program outcomes based on the collection of information related to patients' correlates of recovery and abstinence from all substances.…”

Risk Factors for Early Discharge from a Residential Addiction Treatment Program

“…At the same time, clients are taught skills that promote a healthy lifestyle and specific coping skills that can be used after treatment to prevent relapse. Studies have shown that residential programs are effective as part of an overall theme of the length of time in treatment being associated with a better long-term outcome [4][5][6][7]. Unfortunately, most who do receive treatment suffer a high relapse rate which suggests there is still much to learn about the most effective treatment of SUDs.…”