Assertive Community Treatment for Patients Suffering From Substance Use Disorders

Study Overview
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Brief Summary
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According to the World Health Organization the population suffering from addiction problems is increasing. This population is characterized by multiple needs at the medico-psychosocial level. However, some of these patients, a particular subgroup that we are going to be interested in the so-called high need user group, find it difficult to access and stay in outpatient treatment programs. Persons with substance use disorder often present a chaotic use of the health system, including a high number of hospitalizations in times of crisis. These individuals also show very low utilization of health care services, accompanied by social marginalization. This can be related to relapses and poor social functioning. A high number of relapses occur particularly at the end of hospitalization. Community Interventions, such as Assertive Community Treatment (ACT) should increase the adherence of these patients to treatment by accompanying them in the community and helping them during sensitive and crisis periods. One of the objectives of the study is to evaluate the impact of ACT on the time until service disengagement, measuring treatment adherence. The secondary objectives of this study will be to see the effect of ACT on duration and type of hospitalizations, as well as the number of emergency room visits. The investigators will focus on the impact of ACT on the participant's medico-psycho-social network, substance use and other psychological variables. The investigators will also evaluate his or her psychiatric symptoms and global and social functioning. Life satisfaction and satisfaction with the care received will also be measured. The investigators will compare the population treated with ACT with sex, age and substance-matched controls which do not respond to ACT inclusion criteria chosen from new admissions of our addictology consultation. The study will investigate this through questionnaires at the beginning of care, at three months, six months and 12 months after the start of the ACT intervention.

Official Title
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Assertive Community Treatment for Patients Suffering From Substance Use

Conditions
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Substance Use Disorders

Intervention / Treatment
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* Other: Assertive Community Treatment
* Other: Treatment As Usual


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Substance use disorder Competent subjects, able to give informed consent French speaking Exclusion Criteria: Evidence of organic brain disease or learning disability based on the chart review.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Assertive Community Treatment<br>patients with DSM-5 Diagnosis of SUD and one of the following criteria (1) present important functional difficulties, in at least one of the following areas: everyday life activities and maintaining a supportive social network, for minimum two years. or (2) difficulties to attend their health care appointments, during the last 3 months. | Other: Assertive Community Treatment<br>* The intervention program is a type of very flexible community treatment. This is facilitated by a small case load ratio per health care professional (1:10). The healthcare workers are specialized in SUD treatment. The time of the intervention differs, there is no prefixed limitation but the duration of the intervention depends on the goals agreed on with the patient. The main objective of this intervention is to ensure an adherence to an addiction treatment program and establish or consolidate a stable healthcare and social network for the patient. The intervention aims to prevent service disengagement. The healthcare workers will explore specific patient needs and ensure that health and social services are better coordinated to fit their needs.<br>|
| Treatment As Usual<br>patients with DSM-5 Diagnosis of SUD which do not respond to ACT inclusion criteria | Other: Treatment As Usual<br>* The treatment as usual is the intervention given in our outpatient addictology unit. It consists of an individual treatment program at our outpatient unit with regular appointments with psychiatrists and nurses. The patient can also take part in therapeutic groups and receive help from a psychologist for a targeted program or psychotherapy. The multidisciplinary team also comprises a social worker and an occupational therapist.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Treatment adherence | Number of days until service disengagement | at 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Service use | Number of hospital admissions and number of days in hospital | at 12 months | 
| Patient network | Number of persons in network | 0, 3, 6, 12 months | 
| Number of ER visits | Number of ER visits reviewed on patient file | 0, 3, 6, 12 months | 
| Addictive behaviour | Alcohol, Smoking and Substance Involvement Screening Test (ASSIST. V.3 French) | 0, 3, 6, 12 months | 
| General psychiatric symptoms | Health of Nation Outcome Scale - French version (HoNOS-F): scores 0 - 52 (higher score = more psychiatric symptoms) | 0, 3, 6, 12 months | 
| Global Functioning | World Health Organization Disability Assessment Schedule (WHODAS) | 0, 3, 6, 12 months | 
| General life satisfaction: Satisfaction With Life Scale | Satisfaction With Life Scale: scores 5 - 35 (higher score = higher life satisfaction) | 0, 3, 6, 12 months | 
| Advance directives written by the participant | Advance directives written by the participant (yes - no) | at Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Substance Use Disorders, Assertive Community Treatment, Community Treatment, Treatment engagement, Service Use