TeleMonitoring to Improve Substance Use Disorder Treatment After Detoxification
Phase: NA
Conditions: Enhanced Telephone Monitoring, Usual Care
Sponsor: VA Office of Research and Development

TeleMonitoring to Improve Substance Use Disorder Treatment After Detoxification 
NCT02269787 
10/01/2014 

Protocol (10/1/2014) 
Sample and procedures 
 
Patients entering one of two psychiatry units within the same health care system were 
included on the basis of (1) undergoing detoxification for alcohol and/or opioid dependence; and 
having (2) sufficient cognitive functioning to understand study procedures (i.e., able to answer 
the Montreal Cognitive Assessment’s section on Orientation; Nasreddine et al., 2005), (3) 
access to a cell or land line telephone when not hospitalized, and (4) at least one person who 
would know of their whereabouts after discharge, for whom contact information was available. 
After receiving an introduction to the study, participants signed an informed consent form. All 
study procedures were approved by the VA Central Institutional Review Board. Patients who 
provided informed consent completed the baseline interview. After the baseline interview, 
participants were randomly assigned to condition (ETM or UC) using random numbers 
generated by a computer program. 
 
Regarding follow-ups, the research assistant, blinded to patients’ condition assignment, 
collected self-report data from patients by telephone at three months post-baseline (which was 
upon completion of the intervention for patients in the ETM condition) and at three months after 
the three-month follow-up (i.e., six months post-baseline). We used an intent-to-treat design and 
so followed all participants irrespective of participation in the intervention. Follow-up 
assessments were conducted by telephone because not all patients resided in close 
geographical proximity to the inpatient facility. 
Conditions 
 
Usual Care.  All patients, regardless of condition, received usual inpatient detoxification 
which consisted of medically supervised withdrawal. The health care system had available post-
detoxification addiction outpatient and residential specialty care and pharmacotherapy. Study 
participants, as part of usual care, were offered by detoxification staff a referral to or an 
appointment with addiction treatment services, if they chose to consider seeking treatment. 

 
ETM. Patients assigned to the ETM condition received usual care plus the ETM 
intervention.  ETM consisted of one 50-minute individual session during the inpatient stay and 
12 weekly 15-minute telephone sessions from the same TeleCoach who conducted the in-
person session.   
 
The in-person session enhanced procedures in McKay, Van Horn, & Morrison’s (2010a) 
manual for implementing telephone monitoring with addiction patients transitioning from more to 
less intensive treatment. It provided an orientation to the telephone monitoring protocol, which 
was enhanced by Motivational Interviewing and Contracting.  Motivational components included 
the TeleCoach’s empathy, conveying the patient’s responsibility for change, and supporting the 
patient’s self-efficacy to make changes, while addressing post-detoxification engagement in 
addiction treatment and mutual-help. Participants completed a contract containing two main 
elements:  information that attending treatment and mutual-help increases the chances of 
remaining abstinent; and an intention to attend addiction treatment and/or mutual-help, with as 
much specificity as the patient could provide regarding these plans. Participants were informed 
of ETM’s reinforcers for beginning and participating in treatment and mutual-help, and given The 
Next Step Toward a Better Life (SAMHSA, 2014), which tells people completing detoxification 
what to expect physically and psychologically post-discharge, encourages use of treatment and 
mutual-help, and provides tools for remaining clean and sober.   
 
Telephone sessions also enhanced procedures in the McKay et al. (2010a) protocol. 
Patients were expected to complete one 15-minute telephone call per week for 12 weeks. When 
the patient failed to answer a call, the TeleCoach made at least two more attempts at that 
scheduled contact, and when successful, the initial non-response was discussed. Patients 
received reinforcements for completing 6 and then 12 phone calls (e.g., tote bags, key chains). 
During each telephone session, patients completed the Risk Assessment Worksheet (McKellar 
et al., 2012) about substance use and compliance with treatment and mutual-help since the last 
call. Telephone sessions were enhanced with prompts and reinforcements. The TeleCoach 

checked whether participants had attended planned treatment sessions and mutual-help 
meetings, and reminded them to return even if they had missed a session or meeting. 
Participants received social reinforcements for attending treatment and mutual-help, i.e., a 
personal congratulations letter from the TeleCoach for entering treatment and attending the first 
post-detoxification mutual-help meeting, certificates for abstinence milestones (2, 4, and 8 
weeks), and a certificate plus medallion for abstinence through 12 weeks. 
2.3 Measures 
 
At baseline, patients were asked whether they had received previous inpatient 
detoxification (no or yes). At follow-ups, patients were asked whether they had received 
inpatient detoxification since the previous interview (in the past three months; no or yes).   
 
At baseline, patients were asked whether they had received previous outpatient 
treatment for alcohol and/or drugs in their lifetime and in the past 30 days.  At follow-ups, 
patients were asked whether they had received outpatient treatment for alcohol and/or drugs 
since the last interview (in the past three months; no or yes).  At baseline and follow-ups, 
patients were asked whether they had attended a 12-step meeting in the past three months and 
if so, how many meetings.   
 
At baseline and follow-ups, we used the Addiction Severity Index (ASI; McLellan, 
Cacciola, Alterman, Rikoon, & Carise, 2006) to assess alcohol use, drug use, and psychiatric 
severity. In each area, items measured the number, extent, and duration of symptoms in the 
past 30 days. ASI composite scores were produced from sets of items that were standardized 
and summed to provide internally consistent evaluations of patient status in the problem areas 
(McLellan et al., 2006). They range from 0 to 1, with higher scores indicating poorer outcomes. 
In addition, to ensure the clinical utility of findings, we report responses to the ASI items 
referring to the past 30 days that assessed number of days drank alcohol (0-30), number of 
days used opioids (0-30), experienced serious thoughts of suicide (that is, seriously considered 
a plan for taking own life) (no or yes), and attempted suicide (no or yes).  

 
We also used the Brief Addiction Monitor (which is required in VA for measurement 
based substance use disorder care) at baseline and follow-ups (Cacciola et al., 2013; CESATE, 
2010), which yields two composite scores referring to the past 30 days. (1) Substance use is the 
sum of three items, i.e., number of days drank alcohol; had at least 5 drinks (if a man) or at least 
4 drinks (if a woman); and used any illegal/street drugs or abused any prescription medications 
(for each, 0=0, to 4=16-30 days). (2) Risk factors for substance use is the sum of five items, 
e.g., physical health (0=excellent, 4=poor); number of nights having trouble falling or staying 
asleep (0=0, 4=16-30 days); in any situations or with any people that might increase risk for 
using alcohol or drugs (0=0, 4=16-30 days).  
 
At baseline and follow-ups self-efficacy was assessed with the Brief Situational 
Confidence Questionnaire (Breslin, Sobell, Sobell, & Agrawal, 2000).  Eight items asked 
patients to rate their level of confidence in resisting drinking and using drugs as a response to 
different types of situations (e.g., unpleasant emotions, social pressure to drink/use), and then 
responses were averaged such that higher scores indicate more self-efficacy (Cronbach’s alpha 
= .91, .92, and .91 at baseline and 3 and 6 months, respectively).  
2.4 Analysis Plan 
 
We first compared patients randomly assigned to ETM or UC on baseline demographic 
and outcome characteristics. We then used analysis of covariance (ANCOVAs) to compare the 
ETM and UC groups on outcomes at the 3- and 6-month follow-ups.  Covariates were the 
baseline value of the outcome and the inpatient detoxification unit.