Implementation of evidence-based substance use disorder continuing care interventions.

Abstract

Continuing care following initial substance use disorder treatment often is associated with improved treatment outcomes and evidence-based interventions (EBIs) have been developed in this area. However, rates of patient participation in continuing care treatment and mutual help groups (MHGs) are low and a large gap exists between the existing EBIs and actual clinical care. This paper uses the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) to review the literature on continuing care treatment and monitoring, and mutual help-group promotion. Although existing research provides implications for implementing EBIs in continuing care, few direct implementation trials have been conducted. This literature indicates that EBIs in continuing care have been successfully modified for different settings, that they can be delivered using different modalities (e.g., individual, group, and telephone-based care), and that low cost options are available. Additionally, much is known about the differential effectiveness of continuing care with different populations that may guide treatment programs and providers in selecting the most effective interventions for their clients. One significant barrier to successful implementation of EBIs for continuing care is the lack of information about incentives for providing continuing care across what in the CFIR terminology is a program's outer setting (i.e., external economic, political, and social setting), and its inner setting (i.e., internal political, structural, and cultural contexts). Implications for implementation of EBIs in substance use disorder continuing care are discussed.

Profile of Addicted Patients who Reenter Treatment Programs

“…For example, some of the proposals that have been developed in recent years focus on treatment programs that include reaching out to patients and inquiring about their situations (16,17) or extending the care of a patient over time. (18) The problems with treatment compliance that were observed in the present study are not unique to patients with addictions. It is estimated that 20% to 40% of chronic patients fail to follow the medical recommendations that have been made to them and that dysfunctional social support is detrimental for treatment adherence and may result in withdrawal from treatment.…”

“…(11,13,(15)(16)(17) In other cases, systematic contact is intended to offer ongoing support beyond that provided in the actual treatment. (18) The results that have been found to date are promising. Among other benefits, fewer episodes of use and shorter durations of these episodes were found among the subjects who were included in these studies.…”

Contingency management treatment for substance use disorders: How far has it come, and where does it need to go?

“…Implementation efforts should consider common concerns about CM, as well as important understudied aspects related to this intervention. In addition, implementation science should be consulted because adoption of even non-controversial evidence-based practices can be slow (e.g., Lash, Timko, Curran, McKay, & Burden 2011; Sorensen & Kosten, 2011). …”

Efficacy of automated telephone continuing care following outpatient therapy for alcohol dependence

“…There is considerable evidence that continuing care can prolong the therapeutic effects of the initial treatment (see Lash et al, 2011, and McKay, 2009 for reviews). The umbrella of continuing care encompasses a range of activities including self-help groups, home visits, and outpatient counseling reflecting various therapeutic orientations (e.g., Twelve-step, Cognitive-Behavioral Therapy (CBT), Motivational Enhancement), and delivered in group or individual contexts or by telephone.…”