Adolescent Outpatient and Continuing Care Study (AOCCS)

Chestnut Health Systems

Status and phase: Completed; Phase 3

Conditions: Substance Dependence; Substance Abuse

Treatments: Behavioral: Assertive Continuing Care (ACC); Behavioral: Motivational Enhancement Therapy/Cognitive Behavior Treatment (MET/CBT 7); Behavioral: Chestnut Bloomington Outpatient (CBOP)

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT01381133

1022-0602

R01DA018183 (U.S. NIH Grant/Contract)

U79TI13356 (Other Grant/Funding Number)

Details and patient eligibility

About

The purpose of this study was to evaluate the effectiveness and cost-effectiveness of two types of outpatient treatment with and without Assertive Continuing Care (ACC) for 320 adolescents with substance use disorders. Study participants were randomly assigned to one of four conditions: (a) Chestnut's Bloomington Outpatient Treatment (CBOP) without ACC; (b) CBOP with ACC; (c) Motivational Enhancement Therapy/Cognitive Behavior Therapy-7 session model (MET/CBT7) without ACC; and (d) MET/CBT7 with ACC. Based on prior quasi and experimental studies, the investigators hypothesized that MET/CBT would be more effective and cost-effective than CBOP in terms of increasing days abstinent and decreasing substance abuse problems. Additionally, the investigators hypothesized that the groups receiving ACC would have significantly better outcomes than the groups without ACC. Lastly, the investigators hypothesized that adding ACC to MET/CBT would be the most cost-effective option in terms of days abstinent.

Full description

This study evaluated the effectiveness and cost-effectiveness of two types of outpatient treatment with and without Assertive Continuing Care (ACC) for 320 adolescents with substance use disorders. Study participants were randomly assigned to one of four conditions: (a) Chestnut's Bloomington Outpatient Treatment (CBOP) without ACC; (b) CBOP with ACC; (c) Motivational Enhancement Therapy/Cognitive Behavior Therapy-7 session model (MET/CBT7) without ACC; and (d) MET/CBT7 with ACC. All study conditions attained high rates of participant engagement and retention. Follow-up interviews were completed with over 90% of the adolescents at three, six, nine, and 12 months after treatment admission. There was a significant time by condition effect over 12 months, with CBOP having a slight advantage for average percentage of days abstinent. Unlike previous findings that ACC provided incremental effectiveness following residential treatment, there were no statistically significant findings with regard to the incremental effectiveness of ACC following outpatient treatment. Analysis of the costs of each intervention combined with its outcomes revealed that the most cost-effective condition was MET/CBT7 without ACC.

Enrollment: 320 patients

Sex: All

Ages: 12 to 18 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 12-18 years old
• met ASAM's (2001) Patient Placement Criteria for Level I outpatient treatment based on a substance abuse or dependence diagnosis and six dimensional admission criteria (i.e., severity of intoxication/withdrawal, physical health, emotional/behavioral health, treatment readiness, relapse potential, and recovery environment)
• attended an admission appointment

Exclusion criteria

• "stepped-down" from residential treatment and were therefore more severe than adolescents who entered outpatient treatment from the community
• were recommended only for individual counseling, as both outpatient treatment conditions had group components
• were a ward of the state
• did not have a parent/guardian present during admission to outpatient treatment
• appeared to have insufficient mental capacity to provide informed consent
• did not speak English with sufficient ability to understand study procedures and instruments

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: None (Open label)

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320 participants in 4 patient groups

CBOP without ACC

Experimental group

Treatment:

Behavioral: Chestnut Bloomington Outpatient (CBOP)

CBOP with ACC

Experimental group

Treatment:

Behavioral: Assertive Continuing Care (ACC)

Behavioral: Chestnut Bloomington Outpatient (CBOP)

MET/CBT 7 without ACC

Experimental group

Treatment:

Behavioral: Motivational Enhancement Therapy/Cognitive Behavior Treatment (MET/CBT 7)

MET/CBT 7 with ACC

Experimental group

Treatment:

Behavioral: Motivational Enhancement Therapy/Cognitive Behavior Treatment (MET/CBT 7)

Behavioral: Assertive Continuing Care (ACC)