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Health Services Research & Development

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2005 HSR&D National Meeting Abstract


1013 — Improving Substance Abuse Treatment Aftercare Adherence and Outcome

Author List:
Lash SJ (Salem VAMC & Univesity of Virginia)
Stephens RS (Virginia Polytechnic Institute and State University)
Burden JL (Salem VAMC & University of Virginia)
Grambow SC (Durham VAMC & Duke University)
Fearer SA (Salem VAMC)
Jeffreys AS (Durham VAMC)
Horner RD (University of Cincinnati)

Objectives:
Although continuing care participation in substance use disorder (SUD) treatment is strongly related to positive treatment outcomes, participation rates are low and few effective interventions are available. Our goal was to compare the effectiveness of an aftercare intervention consisting of a participation contract, attendance prompts, and attendance reinforcers (CPR) to standard treatment (STX) in increasing adherence to aftercare and improving treatment outcome.

Methods:
We recruited 150 veterans from the Salem VAMC’s SARRTP who could participate in aftercare. Our population was similar to those in other VA’s (97% male, 54% Caucasian, 46% minority, 49-years mean age, 44% alcohol dependent only, 56% drug dependent (with or without alcohol dependnce), and 44% comorbid psychiatric diagnosis). In this randomized clinical trial, individuals who completed the initial program were assigned to either the CPR or the STX condition. Treatment adherence and outcome, our primary outcome variables, were measured at baseline and 3-, 6- and 12-months after participants entered treatment. Data analysis involved logistic regression in which the parameters of interest were estimated using Generalized Estimating Equations (GEE).

Results:
Initial analyses indicated that the intervention resulted in greater treatment adherence with 55% of the CPR group receiving at least four months of treatment (the SUD continuity of care performance measure), compared to 36% of the STX group (p=.02). Similarly, the total amount of time in treatment was longer in the CPR than the STX group (5.2 vs. 3.9 months; p=.03). Treatment outcome was also improved for the CPR group. Compared to the STX group, the CPR group was more likely to be abstinent at the 12-month follow-up interview (55% vs. 36%; p. = .04). Final results will be presented at the conference.

Implications:
The CPR intervention produced meaningful improvements in adherence to continuing care therapy and this translated into improved 1-year abstinence rates. The CPR approach may yield greater improvements in treatment adherence and outcomes with further enhancement of its components.

Impacts:
The CPR intervention offers a practical means to improve participation among veterans seeking SUD treatment within the VAMC system. Strategies for incorporating the CPR intervention into VA programs will be discussed.


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