Extended telephone-based continuing care for alcohol dependence: 24-month outcomes and subgroup analyses

Abstract

Aims: To determine whether 18 months of telephone continuing care improves 24-month outcomes for patients with alcohol dependence. Subgroup analyses were performed to identify patients who would benefit most from continuing care.

Design: Comparative effectiveness trial of continuing care that consisted of monitoring and feedback only (TM) or monitoring and feedback plus counseling (TMC). Patients were randomized to treatment as usual (TAU), TAU plus TM or TAU plus TMC, and followed quarterly for 24 months.

Setting: Publicly funded intensive out-patient programs (IOP).

Participants: A total of 252 alcohol-dependent patients (49% with current cocaine dependence) who completed 3 weeks of IOP.

Measurements: Percentage of days drinking, any heavy drinking and a composite good clinical outcome.

Findings: In the intent-to-treat sample, group differences in alcohol outcomes out to 18 months favoring TMC over TAU were no longer present in months 19-24. There was also a non-significant trend for TMC to perform better than usual care on the good clinical outcome measure (60% vs. 46% good clinical outcome in months 19-24). Overall significant effects favoring TMC and TM over TAU were seen for women; and TMC was also superior to TAU for participants with social support for drinking, low readiness to change and prior alcohol treatments. Most of these effects were obtained on at least two of three outcomes. However, no effects remained significant at 24 months.

Conclusions: The benefits of an extended telephone-based continuing care programme to treat alcohol dependence did not persist after the end of the intervention. A post-hoc analysis suggested that women and individuals with social support for drinking, low readiness to change or prior alcohol treatments may benefit from the intervention.

Conflict of interest statement

Megan Ivey, Donna Coviello, Qin Yu, and Kevin G. Lynch report no conflicts of interest and no financial disclosures. Drs. McKay and Drapkin have provided consultation in telephonic continuing care to Altarum, which has provided technical assistance to SAMHSA state grantees. Drs. McKay and Van Horn are authors of a manual for delivering telephone based continuing care, which has been published by Hazelden. Dr. McKay has also provided consultation to investigators at Wright State University, Columbia University, and the University of Wisconsin who have received NIH grants to study other approaches to disease management in the addictions, and was a consultant to the National Quality Forum on the development of a White Paper on the measurement of continuing care management in the addictions. Dr. McKay also consults to Caron Treatment Centers on ways to improve continuing care. Dr. Van Horn has provided training in, or has received a fee or honorarium to speak about, treatment for substance use disorders at 23 organizations from the start of the present study up through publication. She is owner of Deborah H.A. Van Horn, PhD, LLC, which has provided continuing education courses to health care professionals treating substance use disorders. None of the training, speaking engagements, or courses focused on the intervention models are tested in the present study. Dr. Oslin’s research is supported by grants from Hazelden, the Commonwealth of Pennsylvania, the Department of Veterans Affairs, and the NIH.

© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Figures

Figure 1

Consort Diagram

Figure 2

Main effect of percent days drinking (top panel), any heavy drinking (middle panel) and good clinical outcome (bottom panel) in groups receiving aftercare treatment as usual (TAU), Telephone Monitoring (TM) or Telephone Monitoring plus Counseling (TMC) during an 18 week intervention with follow-up to 24 months.

Figure 2

Main effect of percent days drinking (top panel), any heavy drinking (middle panel) and good clinical outcome (bottom panel) in groups receiving aftercare treatment as usual (TAU), Telephone Monitoring (TM) or Telephone Monitoring plus Counseling (TMC) during an 18 week intervention with follow-up to 24 months.

Figure 2

Main effect of percent days drinking (top panel), any heavy drinking (middle panel) and good clinical outcome (bottom panel) in groups receiving aftercare treatment as usual (TAU), Telephone Monitoring (TM) or Telephone Monitoring plus Counseling (TMC) during an 18 week intervention with follow-up to 24 months.

Figure 3

Rates of good clinical outcomes among women (left panel) and men (right panel) receiving aftercare treatment with TAU, TM, and TMC

Figure 4

Rates of good clinical outcome among participants with social support for continued alcohol use (top panel), low readiness for change (middle panel) and prior treatments for alcohol (bottom panel) who received TAU and TMC during the 18 week continuing care intervention.

Figure 4

Rates of good clinical outcome among participants with social support for continued alcohol use (top panel), low readiness for change (middle panel) and prior treatments for alcohol (bottom panel) who received TAU and TMC during the 18 week continuing care intervention.

Figure 4

Rates of good clinical outcome among participants with social support for continued alcohol use (top panel), low readiness for change (middle panel) and prior treatments for alcohol (bottom panel) who received TAU and TMC during the 18 week continuing care intervention.