Reinforcement of Abstinence and Continuing Care in Substance Abuse Treatment
Condition: Substance Use Disorders; Alcohol Abuse; Alcoholism; Substance Dependence; Substance Abuse
MeSH terms: Substance-Related Disorders; Alcoholism
Intervention: Contracting, Prompting and Reinforcement arm; Control arm
Intervention description: Contracting, prompting and reinforcement of continuing care and abstinence.; Routine residential treatment and orientation to continuing care.
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Enrollment: 183.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Compliance; Aftercare; Reinforcement, social; Alcoholics Anonymous; Support Groups; Treatment Outcome

Summary:

      The Contracts, Prompts, and Social Reinforcement (CPR) intervention was designed to address
      the continuing care adherence needs of veterans presenting for substance use disorder (SUD)
      treatment. Final results of our recently completed HSR&D clinical trial suggest CPR
      meaningfully impacts aftercare adherence and abstinence rates. However, CPR did not impact
      abstinence rates at earlier follow-up points, other important measures of treatment outcome,
      or AA/NA support group attendance. Furthermore, the generalizability of CPR to other sites
      has not been established. Thus, the intervention has been modified and pilot testing of this
      improved version of CPR, which includes contingent reinforcement of abstinence and improved
      prompting of AA/NA attendance (CPR+), shows promising results. We are conducting a multi-site
      randomized clinical trial to examine the effectiveness of CPR+. We recruited 183 veterans
      seeking residential treatment at the Salem and Jackson VAMCs. Our primary hypothesis is that
      the CPR group will have higher 1-year abstinence rates compared to the STX group. Our
      secondary hypotheses are that the CPR will be particularly effective for individuals with
      co-morbid psychiatric disorders, and that the CPR+ group will remain in AA/NA and in
      aftercare for a longer duration, have fewer days of substance use, fewer hospitalizations,
      and lower costs of care. Treatment outcome will be measured 3-, 6-, and 12-months after
      participants enter treatment and compared to baseline levels. The current study will seek to
      extend past findings to show longer-term effectiveness of the CPR+ intervention on continuing
      care adherence and greater impact on treatment outcome. Dissemination and implementation
      efforts will be ongoing for this brief, inexpensive intervention, which offers an important
      means to improve participation and outcome for individuals seeking SUD treatment within the
      VAMC. Data collection and analysis has been completed.
    

Eligibility criteria:

        Inclusion Criteria:

        Participants were recruited from consecutive veterans who successful complete the 28-day
        SARRTP at the Salem VAMC and the 21-day SARRTP at the Jackson VAMC. Participants who are
        uninterested in aftercare, who have unstable housing or other factors that made aftercare
        participation difficult, will be included to maximize the generalizability of our results.

        Exclusion Criteria:

        Individuals who did not live within a 60-minute drive, and those who did not have
        transportation and a work schedule allowing attendance of aftercare were ineligible.