Effect of Case Management Interventions for Patients with Substance Use Disorders: A Systematic Review

Abstract

BackgroundSubstance use disorder (SUD) is an important health problem that requires a complex range of care because of the chronic nature of the disorder and the multiple psychosocial problems involved. Current outpatient programs often have difficulties in delivering and coordinating ongoing care and access to different health-care providers. Various case management (CM) models have been developed, first for patients in other psychiatric domains and then for patients with SUD, in order to improve treatment outcomes.AimThis paper aims to assess the effectiveness of CM for patients with SUD.MethodsWe performed a systematic review of CM interventions for patients with SUD by analyzing randomized controlled studies published on the subject between 1996 and 2016 found on the electronic database PubMed.Results and conclusionFourteen studies were included in the analysis. Differences between studies in outcome measures, populations included, and intervention characteristics made it difficult to compare results. Most of these studies reported improvement in some of the chosen outcomes. Treatment adherence mostly improved, but substance use was reported to decrease in only a third of the studies. Overall functioning improved in about half of the studies. The heterogeneity of the results might be linked to these differences between studies. Further research is needed in the field.

A Meta-Analysis of the Efficacy of Case Management for Substance Use Disorders: A Recovery Perspective

“…The current study examined the effects of case management regarding various indicators of recovery and service utilization, updating results from two previous meta-analyses (2, 25) and adding effect sizes for various types of outcomes to available systematic reviews (14, 27–29). Outcomes were clustered around 5 personal functioning and 5 treatment-related outcomes as described elsewhere (25).…”

“…Following deinstitutionalization and the emerging recovery movement, case management was successfully adapted to the treatment and community-based support of various mental health populations in the United States, Canada, Australia and Europe (19–23). Its potential effectiveness for persons with SUDs was suggested in various narrative reviews (14, 18). Multiple randomized clinical trials of substance abuse case management have examined the intervention's impact on varied substance abusing populations: dually diagnosed persons, HIV infected drug users, opiate dependent individuals, female substance abusers, crack cocaine users, and homeless persons.…”

“…Case management is likely to support the recovery process, but few studies have looked beyond substance use outcomes or included substantial follow-up periods. Also, findings from available systematic reviews are limited to narrative and global appreciations of study findings, repeatedly stressing its importance for improving individuals' overall functioning and—to a certain extent—substance use outcomes, and for enhancing linkage and retention (14, 18, 26–29). Meta-analyses offer additional opportunities to statistically synthesize data from various studies and to calculate effect sizes per study and outcome category, controlling for sample size, and various follow-up moments (30).…”

Systematic review and meta‐analyses of randomized control trials of the effectiveness of psychosocial interventions for homeless adults

“…Most of the participants in the current review were homeless adults with substance use disorders. They tend to have multiple psychosocial problems and require a complex range of interventions (Penzenstadler, Machado, Thorens, Zullino, & Khazaal, ). Given these findings, psychosocial interventions that target a limited spectrum may be limited with regard to benefits for vulnerable populations such as homeless persons; therefore, future studies applying psychosocial interventions that can address the wide range of psychosocial issues are needed.…”

Night beds in psychosocial attention care centers for alcohol and drugs: analysis and characterization

“…Internationally, it is also being invested on community models for alcohol and drug use assistance, based on evidences showing that, in relation to traditional models (hospitalization), the user achieves a long-termed change in the usage level, reducing related social issues, being more satisfied with the treatment and also finding, in this kind of service, the attention to the demands not met by others (7) . Therefore, it is highlighted the necessity for investing on the CAPS as III, which, since they are the most recent health service in the network, have scarce publication related to their functioning, specially regarding the night beds and their role as a substitute for psychiatric hospitalization of alcohol and drug users.…”