Assertive Community Treatment for Patients Suffering From Substance Use Disorders

Assertive Community Treatment for Patients Suffering From Substance Use

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 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.

Study Overview

• Status: Completed
• Conditions: Substance Use Disorders
• Intervention / Treatment: Other: Assertive Community Treatment

• Study Type: Observational
• Enrollment (Actual): 29

Contacts and Locations

Study Locations

• Switzerland
  • Geneva, Switzerland, 1202
    • Service d'addictologie, HUG

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Subgroup of high need users with difficulties in engaging in substance use disorder treatment.

Description

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.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Assertive Community Treatment; 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; 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.

What is the study measuring?

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
Patient network	Number of persons in network	0, 3, 6, 12 months
Service use	Number of hospital admissions and number of days in hospital	at 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

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient satisfaction with Assertive Community Treatment	Patient satisfaction with Assertive Community Treatment (very satisfied, satisfied, more or less satisfied, not satisfied	at 3, 6, 12 months

Collaborators and Investigators

• Sponsor: University Hospital, Geneva
• Investigators: Principal Investigator: Louise Penzenstadler, MD, University Hospital, Geneva

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2017
• Primary Completion (Actual): January 1, 2023
• Study Completion (Actual): December 1, 2023

Study Registration Dates

• First Submitted: August 1, 2018
• First Submitted That Met QC Criteria: August 7, 2018
• First Posted (Actual): August 9, 2018

Study Record Updates

• Last Update Posted (Actual): May 21, 2025
• Last Update Submitted That Met QC Criteria: May 18, 2025
• Last Verified: August 1, 2018

More Information

Terms related to this study

• Keywords: Substance Use Disorders; Assertive Community Treatment; Community Treatment; Treatment engagement; Service Use
• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders
• Other Study ID Numbers: ID 2017-01087

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No