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.

ABSTRACT. Objective: This study evaluated the psychometric properties of the 15-item alcohol Short Index of Problems (SIP) instrument and those of a newly constructed 15-item drug Short Index of Problems (SIP-D) instrument in 277 newly entered substance-abuse patients. Method: The SIP is derived from the longer, 50-item Drinker Inventory of Consequences (DrInC), which was designed to assess adverse consequences of alcohol use. The SIP-D was constructed by substituting the term "drug use" for the term "drinking" in each SIP item. A 3-month recall interval was employed. Results: Factor analyses of each of the instruments revealed similar solutions, with only one main factor accounting for the majority of variance. Nonparametric item response theory methods produced the same fi nding. Internal consistency reliability estimates for the SIP and SIP-D total scores were .98 and .97, respectively. Concurrent validity was demonstrated by examining the correlations of the total scores for each of the instruments with the recent summary indexes of the newly revised Addiction Severity Index (ASI-Version 6): alcohol, drug, medical, economic, legal, family/social, and psychiatric problems. (Blanchard et al., 2003). Indeed, research suggests that consumption levels alone are not necessarily good predictors of substance use-related impairment (Bender et al., 2007). Within this context, Miller and colleagues (1995) developed the Drinking Inventory of Consequences (DrInC) for alcohol-dependent patients to serve as a relatively brief, self-report measure of the severity of the consequences of alcohol use. Constructed by a panel of experts, the DrInC consists of 45 primary items in fi ve domains: Physical, Intrapersonal, Social Responsibility, Interpersonal, and Impulse Control consequences. The instrument can be administered using either a lifetime or a 3-month recall timeframe. The DrInC also includes an additional fi ve "control" items designed to detect careless responding or dishonesty. These items are not included in psychometric evaluations of the instrument. Although factor analysis has not supported fi ve independent domains (Anderson et al., 2001;Miller et al. 1995), these domains have been used in research in addition to the total score. The generally excellent internal consistency reliability and test-retest reliability of each of the subscales appear to have been accepted as indications of their independent integrity. Miller et al. (1995) also developed a short version of the DrInC labeled the Short Index of Problems (SIP). The SIP was derived by including the three items in each DrInC subscale that were most highly correlated with the total subscale score. Internal consistency of this new instrument was lower than for the full DrInC subscales, ranging from .57 to .66; that for the entire instrument was .81. Six-month test reliability was good for both the subscales and the total score. In another study that used the full DrInC (Feinn et al., 2003), the internal consistency of the embedded 3-month SIP subscales rang...

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.

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.

The goal was to identify factors that predicted sustained cocaine abstinence and transitions from cocaine use to abstinence over 24 months. Data from baseline assessments and multiple followups were obtained from three studies of continuing care for patients in intensive outpatient programs (IOPs). In the combined sample, remaining cocaine abstinent and transitioning into abstinence at the next follow-up were predicted by older age, less education, and less cocaine and alcohol use at baseline, and by higher self-efficacy, commitment to abstinence, better social support, lower depression, and lower scores on other problem severity measures assessed during the follow-up. In addition, higher self-help participation, self-help beliefs, readiness to change, and coping assessed during the follow-up predicted transitions from cocaine use to abstinence. These results were stable over 24 months. Commitment to abstinence, self-help behaviors and beliefs, and self-efficacy contributing independently to the prediction of cocaine use transitions. Implications for treatment are discussed.