Chronic Care Management for Dependence on Alcohol and Other Drugs

Abstract

IMPORTANCE People with substance dependence have health consequences, high health care utilization, and frequent comorbidity but often receive poor-quality care. Chronic care management (CCM) has been proposed as an approach to improve care and outcomes.OBJECTIVE To determine whether CCM for alcohol and other drug dependence improves substance use outcomes compared with usual primary care. DESIGN, SETTING, AND PARTICIPANTSThe AHEAD study, a randomized trial conducted among 563 people with alcohol and other drug dependence at a Boston, Massachusetts, hospital-based primary care practice. Participants were recruited from September 2006 to September 2008 from a freestanding residential detoxification unit and referrals from an urban teaching hospital and advertisements; 95% completed 12-month follow-up.INTERVENTIONS Participants were randomized to receive CCM (n=282) or no CCM (n=281). Chronic care management included longitudinal care coordinated with a primary care clinician; motivational enhancement therapy; relapse prevention counseling; and on-site medical, addiction, and psychiatric treatment, social work assistance, and referrals (including mutual help). The no CCM (control) group received a primary care appointment and a list of treatment resources including a telephone number to arrange counseling. MAIN OUTCOMES AND MEASURESThe primary outcome was self-reported abstinence from opioids, stimulants, or heavy drinking. Biomarkers were secondary outcomes. RESULTSThere was no significant difference in abstinence from opioids, stimulants, or heavy drinking between the CCM (44%) and control (42%) groups (adjusted odds ratio, 0.84; 95% CI, 0.65-1.10; P=.21). No significant differences were found for secondary outcomes of addiction severity, health-related quality of life, or drug problems. No subgroup effects were found except among those with alcohol dependence, in whom CCM was associated with fewer alcohol problems (mean score, 10 vs 13; incidence rate ratio, 0.85; 95% CI, 0.72-1.00; P=.048).CONCLUSIONS AND RELEVANCE Among persons with alcohol and other drug dependence, CCM compared with a primary care appointment but no CCM did not increase self-reported abstinence over 12 months. Whether more intensive or longer-duration CCM is effective requires further investigation.

Alcohol Screening and Intervention Among United States Adults who Attend Ambulatory Healthcare

“…[32][33][34] Alcohol pharmacotherapy is efficacious 35 and alcohol care management in primary care settings may be helpful, 36,37 but current evidence for chronic care management for alcohol dependence in primary care settings appears mixed. 36,38 Future national surveys should track whether and where pharmacotherapy was offered and received by patients with alcohol use disorder.…”

Engagement and Substance Dependence in a Primary Care-Based Addiction Treatment Program for People Infected with HIV and People at High-Risk for HIV Infection

“…and a study of HIVinfected patients with opioid dependence, primary care-based buprenorphine treatment versus referral to off-site buprenorphine treatment was associated with greater receipt of buprenorphine treatment, reduced heroin and cocaine use, and more HIV primary care visits (Lucas et al, 2010). The AHEAD trial was a randomized controlled trial among patients mostly recruited from inpatient detoxification programs of chronic care management for addictions integrated within primary care versus referral to standard primary care with usual addiction treatment referral that showed no improvements in abstinence or addiction severity (Saitz et al, 2013).…”

Addiction, Chronic Illness, and Responsibility

“…After a year, the researchers found no significant differences in drug or alcohol consumption between the care management group and the control group, nor were there significant differences in secondary outcomes, like the severity of the addiction or the health-related quality of life (cf. Saitz et al 2013).…”