Contingency management (CM) is effective in enhancing retention in therapy. After an 8-week baseline, four community-based substance abuse treatment clinics were exposed in random order to 16 weeks of standard care with CM followed by 16 weeks of standard care without CM or vice versa. In total, 75 outpatients participated. Patients who were enrolled in the clinics when the CM treatment phase was in effect attended a significantly greater percentage of therapy sessions than patients who were enrolled in treatment when CM was not in effect. This study is one of the first to investigate CM in community settings implemented entirely by community clinicians, and results suggest that CM is effective in improving therapy attendance.
Background
For adolescents, substance use disorder (SUD) treatment outcomes (e.g., abstinence, problematic behaviors) often cannot be measured soon enough to influence treatment trajectory. Although process measures (e.g., treatment engagement) can play an important role, it is essential to demonstrate their association with outcomes. This study explored the extent to which engagement in outpatient treatment was associated with outcomes and whether demographic/clinical characteristics moderated these relationships.
Methods
This is a prospective study of adolescents (N=1,491) who received outpatient treatment for SUDs at one of 28 treatment sites taking part in a national evidence-based practice implementation initiative. Information from the Global Appraisal of Individual Needs interviews at intake and six-month follow-up, as well as encounter data, were used. Adjusted hierarchical logistic models were used to estimate effects of engagement on six-month outcomes.
Results
Sixty-one percent of adolescents engaged in outpatient treatment. Adolescents engaging in treatment had significantly lower likelihoods of reporting any substance use (OR 0.60, 95% CI 0.41, 0.87), alcohol use (OR 0.63, 95% CI 0.45, 0.87), heavy alcohol use (OR 0.53, 95% CI 0.33, 0.86), and marijuana use (OR 0.64, 95% CI 0.45, 0.93). This association of engagement with abstinence outcomes was not limited to any particular group. Treatment engagement, however, was not associated with adolescents' self-report of illegal activity or trouble controlling behavior at follow-up.
Conclusion
At the individual level, the Washington Circle engagement measure was a predictor of some positive outcomes for adolescents in outpatient treatment. Efforts to better engage adolescents in treatment could improve quality of care.
Summary
Research shows that many adolescents who enter treatment for substance
use do not complete the recommended program, and after discharge, do not connect
with continuing care services. Furthermore, the majority of adolescents will
return to some level of substance use either during or after participation in
treatment. Our review found 10 outcome studies of continuing care treatment for
adolescents. Five of six studies with randomized designs resulted in significant
clinical improvement for youth receiving the experimental continuing care
approaches. Key findings of these trials are that more assertive approaches can
increase continuing care initiation rates and that rapid initiation of
continuing care made a difference in reducing substance use. Findings suggest
that continuing care is not only appropriate for those who successfully complete
treatment but also for many individuals who do not. Although there are no
randomized controlled studies of adolescent participation in mutual aid groups,
evidence is accumulating suggesting that matching adolescents to age-appropriate
12-step and other mutual aid groups can support recovery. Research employing
adaptive treatment designs holds promise for establishing decision rules as to
which adolescents need low-intensity continuing care services and which need
more intensive care.
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