Objective The study tested whether adding up to 18 months of telephone continuing care, either as monitoring and feedback (TM) or longer contacts that included counseling (TMC), to intensive outpatient programs (IOP) improved outcomes for alcohol dependent patients. Methods Participants (N=252) who completed 3 weeks of IOP continued to receive IOP (M=36 sessions over 6 months) and were randomized to up to 36 sessions of TM (M=11.5 sessions of M=8.2 minutes), TMC (M=9.1 sessions of M=16.8 minutes), or IOP only (TAU). Quarterly assessment of alcohol use with the Time-Line Follow-Back (79.9% assessed at 18 months) was corroborated with available collateral reports (N=63 at 12 months). Participants with lifetime cocaine dependence (N=199) also provided urine samples. Results Main effects favored TMC over TAU on any alcohol use (OR=1.88, CI=1.13,3.14) and any heavy alcohol use (OR=1.74, CI=1.03,2.94). TMC produced significantly fewer days of alcohol use during months 10–18 and heavy alcohol use during months 13–18 than TAU (ds of .46 to .65). TM produced significantly better alcohol use outcomes than TAU only on percent days alcohol use, only during months 10–12 and 13–15 (ds of .41 and .39). TMC produced significantly fewer days of any alcohol use and heavy alcohol use than TM only during months 4–6 (ds= .39 and .43). Among participants with cocaine dependence, there were no treatment main effects on rates of cocaine positive urines. Conclusion Adding telephone continuing care to IOP significantly improved alcohol use outcomes relative to IOP alone. Conversely, shorter telephone calls that provided monitoring and feedback but no counseling generally did not improve outcomes over IOP.

Aims Determine whether 18 months of telephone continuing care improves 24 month outcomes for patients with alcohol dependence. Subgroup analyses were done to identify patients who would most benefit 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 outpatient programs (IOP) Participants 252 alcohol dependent patients (49% with current cocaine dependence) who completed 3 weeks of IOP. Measurements Percent 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. Approximately 50% of participants met criteria for Good Clinical Outcomes throughout treatment and follow-up with a non-significant trend for TMC to perform better than usual care. 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 2 of 3 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.

Smoking and sexual risk behaviors in urban adolescent females are prevalent and problematic. Family planning clinics reach those who are at most risk. This randomized effectiveness trial evaluated a transtheoretical model (TTM)-tailored intervention to increase condom use and decrease smoking. At baseline, a total of 828 14- to 17-year-old females were recruited and randomized within four urban family planning clinics. Participants received TTM or standard care (SC) computerized feedback and stage-targeted or SC counseling at baseline, 3, 6 and 9 months. Blinded follow-up telephone surveys were conducted at 12 and 18 months. Analyses revealed significantly more consistent condom use in the TTM compared with the SC group at 6 and 12, but not at 18 months. In baseline consistent condom users (40%), significantly less relapse was found in the TTM compared with the SC group at 6 and 12, but not at 18 months. No significant effects for smoking prevention or cessation were found, although cessation rates matched those found previously. This TTM-tailored intervention demonstrated effectiveness for increasing consistent condom use at 6 and 12 months, but not at 18 months, in urban adolescent females. This intervention, if replicated, could be disseminated to promote consistent condom use and additional health behaviors in youth at risk.

Objective Study tested whether cocaine dependent patients using cocaine or alcohol at intake or in the first few weeks of intensive outpatient treatment would benefit more from extended continuing care than patients abstinent during this period. The effect of incentives for continuing care attendance was also examined. Methods Participants (N=321) were randomized to: treatment as usual (TAU), TAU and Telephone Monitoring and Counseling (TMC), or TAU and TMC plus incentives (TMC+). The primary outcomes were: (1) abstinence from all drugs and heavy alcohol use, and (2) cocaine urine toxicology. Follow-ups were at 3, 6, 9, 12, 18, and 24 months. Results Cocaine and alcohol use at intake or early in treatment predicted worse outcomes on both measures (ps≤ .0002). Significant effects favoring TMC over TAU on the abstinence composite were obtained in participants who used cocaine (OR=1.95 [1.02, 3.73]) or alcohol (OR=2.47 [1.28, 4.78]) at intake or early in treatment. A significant effect favoring TMC+ over TAU on cocaine urine toxicology was obtained in those using cocaine during that period (OR= 0.55 [0.31, 0.95]). Conversely, there were no treatment effects in participants abstinent at baseline, and no overall treatment main effects. Incentives almost doubled the number of continuing care sessions received, but did not further improve outcomes. Conclusion An adaptive approach for cocaine dependence in which extended continuing care is provided only to patients who are using cocaine or alcohol at intake or early in treatment improves outcomes in this group while reducing burden and costs in lower risk patients.