Effectiveness of Extended Treatments for Drug Dependence
Condition: Cocaine Dependence
MeSH terms: Cocaine-Related Disorders; Substance-Related Disorders
Study type: Interventional

Summary: 
      This study tests the effectiveness of two 24 month, telephone-based adaptive continuing care
      interventions for patients with cocaine dependence. The two interventions are predicted to
      produce better drug use outcomes than standard care. Furthermore, the intervention that also
      includes monetary incentives for continued participation is hypothesized to produce better
      retention and drug use outcomes than the intervention without incentives. Economic analyses
      will determine the cost-effectiveness and benefit-cost of the interventions relative to
      standard care, and to each other.
    

Detailed description: 
      There is considerable evidence that treatment for drug use disorders can lead to substantial
      improvements in substance use and psychosocial problem severity. However, a significant
      percentage of patients relapse to problematic levels of substance use after primary
      treatment, and require additional treatment episodes. Patients are therefore frequently
      referred to continuing care programs to prevent relapse and decrease the probability of
      additional rehabilitation treatments. However, current models of continuing care may not be
      adequate for the long-term management of a chronic, relapsing disorder such as substance
      dependence. One possible approach for improving the management of drug dependence is adaptive
      treatment regimes, which combine low intensity monitoring and counseling when patients are
      doing well with stepped care protocols to increase the intensity of treatment when warranted
      by deteriorations in status and functioning. However, addiction management protocols may
      require incentives and other features to make long-term participation more appealing.

      Cocaine dependent patients who have completed 2 weeks of intensive outpatient treatment (IOP)
      will be randomly assigned to one of the following interventions: (1) continued participation
      in IOP without additional intervention (TAU); (2) TAU plus an adaptive protocol that includes
      monitoring, feedback, and brief counseling via telephone on a tapered schedule out to 24
      months, and more intensive face-to-face treatment when warranted (TMAC); or (3) TAU and the
      adaptive protocol, plus incentives for sustained participation (TMAC-Plus). Patients will be
      followed up at 3, 6, 9, 12, 18, and 24 months post intake into the study. Follow-up
      assessments will include measures of drug use, treatment process and potential mediating
      factors, psychosocial problem severity, utilization of health and social services, and costs.

      The two adaptive extended interventions (TMAC and TMAC-Plus) are predicted to produce better
      drug use outcomes than TAU. TMAC-Plus is hypothesized to produce better retention and drug
      use outcomes than TMAC. Economic analyses will determine the cost-effectiveness and
      benefit-cost of TMAC and TMF-Plus relative to TAU, and to each other. Other analyses will
      test mediation hypotheses, examine potential moderator effects, and test the impact of
      disease management on HIV risk behaviors.
    

Intervention name(s): Intensive Outpatient Treatment; Adaptive telephone-based counseling; Adaptive telephone-based counseling plus incentives
Intervention type(s): Other; Other; Other
Intervention description(s): 9 hours of group counseling per week for 2-3 months; In addition to IOP, patients receive telephone counseling calls, in which risk level is assessed and coping skills intervention delivered to address risk areas. Adaptive stepped care algorithm is included; In addition to IOP, patients receive telephone counseling calls, in which risk level is assessed and coping skills intervention delivered to address risk areas. Adaptive stepped care algorithm and monetary incentives for participation are included
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: cocaine dependence; treatment; continuing care; outcomes; incentives; adaptive