2008 HSR&D National Meeting Abstract
3050 — Contracting, Prompting and Reinforcing Substance Use Disorder Continuing Care
Lash SJ (Salem VAMC & University of Virginia), Burden JL
(Salem VAMC & University of Virginia)
Adherence to substance use disorder (SUD) treatment for at least 3 months is typically the minimum amount of time associated with improved outcomes. However, only a small percentage of clients remain in treatment this long and few interventions have been developed to improve treatment adherence. The Contracting, Prompting and Reinforcing (CPR) intervention for increasing continuing care attendance has been shown to be an effective means of increasing SUD treatment adherence and improving treatment outcome. This intervention seeks to motivate clients to remain in treatment for at least 3-months and is currently being examined in a multi-site HSR&D funded clinical trial.
In a series of 5 simple experiments (N = 229), the CPR aftercare adherence intervention was built in a stepwise manner. Adherence interventions were compared to standard care and once an intervention was shown effective, this became the new standard care. New components were then added to the intervention, but only retained if they increased aftercare adherence compared to the existing standard care.
Aftercare exposure and peer attendance contracting were found to be ineffective in increasing aftercare attendance compared to standard care. However, therapist contracting was effective in increasing the frequency of weekly aftercare group therapy sessions attended over 8 weeks (37% vs. 17%) compared to standard care. Contracting plus attendance prompting further increased group therapy attendance compared to contracting alone (55% vs. 29%) and resulted in a 62% decrease in re-hospitalizations. Finally, contracting, prompting and social reinforcement (CPR) of aftercare attendance improved attendance (69% vs. 49%) and 6-month abstinence rates (76% vs. 40%), compared to contracting and prompting.
Results of these clinical trials demonstrate that all three components of CPR additively improve adherence to SUD aftercare treatment. These trials also indicate that CPR improves treatment outcome. The impact on the SUD Continuity of Care performance measure will be discussed.
CPR was developed with clinical settings in mind: 1) it takes little additional therapist time to implement, 2) it is inexpensive, and 3) it is compatible with a variety of theoretical approaches to treatment. It offers much promise for improvement in continuity of care in VA SUD treatment programs.