Comparing Acute and Continuous Drug Abuse Treatment: A Randomized Clinical Trial
Condition: Drug Addiction
MeSH terms: Substance-Related Disorders
Study type: Interventional
Phase: Phase 3

Summary: 
      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).
    

Detailed 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.
    

Intervention name(s): Treatment as Usual (TAU); TAU + Long-Term Recovery Management
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Outpatient substance abuse treatment; Long-Term Recovery Management (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. Patients randomly assigned to LTRM will be asked to participate in group sessions each month for 12 months.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cocaine; crack; heroin; non-prescribed opioids; contingency management; community reinforcement approach; facilitated therapeutic alliance; chronic disease treatment models