Comparing Acute and Continuous Drug Abuse Treatment: A Randomized Clinical Trial

Wright State University

Status and phase

Completed

Phase 3

Conditions

Drug Addiction

Treatments

Behavioral: Treatment as Usual (TAU)

Behavioral: TAU + Long-Term Recovery Management

Study type

Interventional

Funder types

Other

NIH

Identifiers

NCT01003496

NIDA/NIH 1RC1DA028467-01

1RC1DA028467-01 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The purpose of this 2 year study is to conduct a fully powered effectiveness trial comparing recovery trajectories of 200 drug dependent adults (the subjects) who will be randomly assigned to Treatment as Usual (TAU) or TAU + Long-Term Recovery Management (LTRM).

Full description

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 needs an addiction management model for drug-dependent patients, which, like disease management for other chronic conditions, provides: 1) initial stabilization; 2) ongoing treatment to maintain clinical gains; 3) monitoring of patient symptoms; and 4) 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 substance abuse 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 combines 3 established treatment techniques (Community Reinforcement Approach, Contingency Management, and Facilitated Therapeutic Alliance), each with demonstrated efficacy, into a chronic disease model. In addition, patient cases are kept open, thereby removing potential obstacles to re-engagement with stepped-up care, when indicated. 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.

Enrollment

204 patients

Sex

All

Ages

18 to 80 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

To be eligible for the study, a subject must:

At least 18 years of age
Meet current dependence criteria for stimulants (cocaine/other), opioids (heroin/other), and/or alcohol (if also dependent on cocaine or opioids). Persons who are opioid dependent are eligible if they are not in methadone maintenance therapy; they will be eligible if they are in short-term buprenorphine detoxification
Self-report use of a primary drug of dependence in the past 60 days; 4) be admitted to outpatient care at Maryhaven
Willing to participate in the protocol (i.e., to be randomized to treatment condition and agree to attend regular treatment sessions).

Exclusion criteria

Potential subjects will be excluded if they: 1) present with current suicide risk
Have a current, untreated psychotic disorder
Plan to relocate outside of the area within 12 months
Have been sentenced to incarceration of more than 30 days over the next 6 months
Are alcohol dependent without current dependence on cocaine or opioids.