Comparing Acute and
Continuous Drug Abuse Treatment: A Randomized Clinical Trial (1RC1DA028467-01)
Drug addiction is a chronic illness
characterized by problematic drug use, followed by periods of abstinence,
reductions in use, or return to problematic drug use. Despite this, substance abuse treatment has traditionally
been based on an acute care model. The field of substance abuse treatment is developing
and testing approaches to treat addiction as a chronic illness. Aftercare and continuing care models
have been developed to extend the benefits of the initial treatment episode,
and recovery monitoring has been developed to assess patients’ status and
return them to treatment as needed. The continuing care literature suggests
that interventions work best when they are offered for extended periods.
Limitations of continuing care models include:
- their narrow focus on
treatment completers;
- their general inability to adjust to changes in
patient status;
- patients tiring of participation and dropping out; and
- the treatment is of limited duration.
Recommendations for improving continuing
care interventions include:
- engaging patients earlier in the treatment
process;
- reducing the burden of treatment for participants;
- developing
algorithms that adjust the treatment to the patient’s response; and
- utilizing active outreach to engage and retain patients.
The field needs an addiction management
model for drug-dependent patients, which, like disease management for other
chronic conditions, provides:
- initial stabilization;
- ongoing treatment to
maintain clinical gains;
- monitoring of patient symptoms; and
- adjustments
to the treatment based on the patient’s response.
In response to these needs,
we have developed the Long Term Recovery Management (LTRM) model. LTRM is predicated on initiating
long-term addiction management at the onset of treatment, extending the length
of treatment, expediting the transitions between intensive treatment and
maintenance of behavioral change, adapting treatment intensity to patient’s
response to treatment, and actively facilitating the therapeutic alliance. LTRM
modifies the service delivery model and incorporates therapeutic techniques
from several behavioral therapies, with established efficacy, to address the specific challenges to
establishing and maintaining adequate adherence to long-term treatment
engagement. The LTRM model emphasizes: engagement in continuous long-term
treatment and recovery support, therapeutic alliance, and early re-intervention
as the main mechanisms for maintenance of behavioral change.
The purpose of this two-year National Institutes of
Heath/National Institute on Drug Abuse-funded study is to conduct a fully
powered effectiveness trial
comparing recovery trajectories of 200 drug dependent adults who are randomly
assigned to Treatment as Usual (TAU) or Long-Term Recovery Management (LTRM).
The study is being conducted in Maryhaven’s outpatient treatment program in
Columbus, Ohio. Patients will be engaged in LTRM during the first two weeks of
outpatient treatment and continue in LTRM for 12 months. Research assessments
will be conducted at 6 and 12 months after baseline. The main outcome is weeks of abstinence from the primary
drug of dependence. Secondary outcomes include drug-free days and reduction in
HIV risk behaviors. The aims of the study are:
- Specific Aim 1: To compare the effectiveness of an episodic care model (TAU) and a
continuous care model (LTRM) of substance abuse treatment among drug-dependent
adults.
- Secondary Aim 1: To compare HIV risk behaviors among
participants in LTRM versus TAU.
- Exploratory Aim 1: To identify key moderating factors,
such as primary drug of dependence, gender, ethnicity, and psychiatric
comorbidity, that may influence treatment outcome.
Funded through the American Recovery and
Reinvestment Act, this study is a collaborative research effort involving
investigators from CITAR at Wright State University Boonshoft School of Medicine, Maryhaven, and the University of Arkansas
for Medical Sciences.
Staff contact Information
CITAR
Robert
Carlson, Ph.D., Principal Investigator (robert.carlson@wright.edu)
Russel Falck, M.A., Co-Investigator (russel.falck@wright.edu)
Maryhaven
Greg
Brigham, Ph.D., Co-Investigator (gbrigham@maryhaven.com)
University
of Arkansas for Medical Sciences
Brenda
Booth, Ph.D., Co-Investigator (boothbrendam@uams.edu)
For
more information, contact:
Center for Interventions, Treatment and Addictions Research
Wright State University School of Medicine
3640 Colonel Glenn Highway
Dayton, OH 45435
Phone: (866) 217-1205 (toll free) or (937) 775-2066
Fax: (937) 775-2214 |
