The effectiveness of a case management model in improving treatment access, retention, and outcomes was examined within a cohort of 360 intravenous drug users (IDUs) pursuing substance-abuse treatment through a central intake facility. IDUs were randomly assigned either to the case management group or to the comparison group. In the case managed condition, IDUs received assistance from their case manager in identifying and accessing needed services, including substance abuse treatment. In the comparison condition, IDUs received limited referral information for substance abuse treatment. Clients in the case managed group accessed substance abuse treatment in significantly greater numbers and more rapidly than clients in the comparison group. Case-managed clients also remained in substance abuse treatment nearly twice as long as did comparison group clients. Finally, case-managed clients showed better treatment outcomes including reduced alcohol and drug use.
In a one year study, 130 methadone maintained subjects with a six month history of good treatment performance were assigned randomly to an experimental condition of one monthly non-random urine screen, one monthly counseling session, one monthly doctor visit, two times per month methadone pick up, a quarterly true random urine screen and participation in a diversion control program or to a control condition of staying under standard conditions for six months and then being transferred to the experimental condition for six months. Results of urine screens and scores on the Addiction Severity Index (ASI) at entrance and six month intervals showed no differences between groups. Three out of four subjects completed the year in good standing. Subject satisfaction was such that the IRB judged that return to standard conditions would be a hardship. Experimental conditions were cheaper such that resources freed up could be applied to the HIV epidemic.
This article describes a 300-bed substance abuse treatment program that is part of a continuum of care focused on preventing drug and criminal recidivism in substance abusing criminals incarcerated in Dallas County, Texas. It is the product of a joint effort of the judiciary, the Dallas County Supervision and Corrections Department, the State of Texas Criminal Justice Division, and Interventions Co., a not-for-profit treatment provider. The program is rooted in over 25 years of treatment experience and incorporates therapeutic community (TC) technology combined with 12-Step programming, behavior modification, job training (having a job is required for graduation), educational, and medical/psychiatric elements. Treatment is conceived as part of a continuum of care to provide substantial and sustained support for the inmate in the difficult process of adapting to the community post incarceration. Treatment plans are individualized and are based on an extended workup in which the individual's status in a number of domains is assessed. Specialized services, such as transportation and childcare, facilitate recovery. Once in the community, urine monitoring, groups, and counseling continue. The program is beginning its fourth year of operation and approximately 600 inmates have started the program. A formal evaluation is in process.
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