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IIR 03-267
Reinforcement of Abstinence and Attendance in Substance Abuse Treatment
Steven J Lash, PhD Salem VA Medical Center, Salem, VA Salem, VA Funding Period: August 2006 - March 2010 |
BACKGROUND/RATIONALE:
Although substance use disorder (SUD) treatment continuing care participation is strongly related to positive outcomes, participation rates are low and few effective adherence interventions have been developed. OBJECTIVE(S): This multi-site randomized clinical trial hypothesized that an enhanced version of Contracts, Prompts and Reinforcement (CPR+) compared to standard treatment (STX) would: 1) increase continuing care adherence, 2) increase 1-year abstinence rates, 3) demonstrate cost-effectiveness, 4) generalize across VA sites and 5) be particularly effective with participants with co-occurring psychiatric disorders. METHODS: Participants (n = 183) from the Salem and Jackson VAMCs were blocked on SUD diagnosis, presence of a co-occurring psychiatric disorder, and selected aftercare therapy group time prior to randomization to STX or CPR+ at each site. Participants were primarily African-American (54%) and Caucasian (44%) male (96%) veterans. Co-occurring psychiatric disorders were present in 62% of the sample, and 33% were alcohol dependent only while 67% were drug dependent. Treatment outcome was measured 3-, 6-, and 12-months after participants entered treatment. Abstinence rates were analyzed using a longitudinal logistic GEE (Generalized Estimating Equations) regression model. Secondary outcomes were analyzed using both logistic and linear mixed-effects models as appropriate. FINDINGS/RESULTS: We enrolled 102% of the projected number of participants and the follow-up rates were high. Among CPR+ participants,70% received at least 4 months of treatment compared to 58% of the STX group (p = .06). There was no significant change in the aftercare participation rate between groups over time during the 12 months of follow-up (p = .36). The average monthly rate (two or more sessions) was 51% for CPR+ and 44% for STX. Furthermore, the increase in the frequency of support group participation over 1 year was not significant (54.6 vs. 45.7; p = .17). Additionally, the CPR+ participants were not more likely than the STX group to be abstinent at the 3-month (67% vs. 71%; p =.52), 6-month (52% vs. 51%; p = .87), or 12-month interviews (48% vs. 49%; p = .68). The capital and labor cost of conducting CPR+ for one year was $266.54 per participant. The incremental cost compared to STX was $98.25 per participant. Data suggests that CPR+ was effective for individuals not required to attend continuing care. The effects of CPR+ were not moderated by site, co-occurring psychiatric disorder, or substance of abuse. IMPACT: The current trial demonstrated that CPR+ could be implemented at new VAMC sites, but it did not replicate the positive effects observed in previous trials. CPR+ did not significantly improve continuing care attendance, substance use outcomes, or quality of life compared to the STX group. A much higher percentage of participants in this trial compared to previous trials were required to attend aftercare. Results suggest that CPR+ was ineffective for those require to attend aftercare, but effective for those without this source of motivation. Additionally, findings suggest that changes to improve and adapt CPR+ to sites may have lessened its effectiveness in this trial. External Links for this ProjectDimensions for VA![]() If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/ VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address. Search Dimensions for this project PUBLICATIONS:Journal Articles
DRA:
Substance Use Disorders
DRE: none Keywords: Addictive Disorders MeSH Terms: none |