Reducing Service and Substance Use Among Frequent Service Users: A Brief Report From the Toronto Community Addictions Team

Abstract

The Toronto Community Addictions Team (TCAT) is an intensive case management intervention designed to serve people with addictions who are frequent service users, thus addressing a health system priority. Questionnaires given to 65 participants at baseline, 3 months, and 6 months and semi-structured interviews of 10 program participants explored participants' outcomes and experiences with the program. Qualitative findings, analyzed using thematic content analysis, suggest that participants value the program's commitment to harm reduction, financial trusteeship, and recovery orientation. Quantitative findings from paired t-tests reveal that participants improved in community functioning and decreased days of problematic substance use and money spent on alcohol and drugs as early as 3 months after program participation. Future research should used a controlled design and explore predictors of positive outcomes in this vulnerable population.

Efficacy of extensive intervention models for substance use disorders: A systematic review

“…Overall, short‐term outcomes (immediately after the end of the treatment) tend to be positive: Of the 12 studies measuring substance use, 6 show positive effects , and 2 show mixed effects . All six studies measuring treatment utilisation show positive effects , and of the five measuring other outcomes, three show positive results , and two show mixed results .…”

“…Finally, three studies evaluated other outcomes. The intensive case management model improved employment status [29]; the case management model improved community functioning [20], and the assertive community treatment improved employment status, role functioning, quality of life and self-esteem of the participants [42].…”

“…Overall, short-term outcomes (immediately after the end of the treatment) tend to be positive: Of the 12 studies measuring substance use, 6 show positive effects [11,[28][29][30]33,34,42,44], and 2 show mixed effects [20,43]. All six studies measuring treatment utilisation show positive effects [9,20,28,29,33,34,46], and of the five measuring other outcomes, three show positive results [20,28,29,43], and two show mixed results [42,44]. However, the lasting effects are less convincing: Of the five studies measuring substance use, three show no effect [11,30,43,44] and two mixed results [32,36]; of the three studies measuring treatment utilisation, one shows no effect [32] and two positive results [36,45], and the two studies measuring other outcomes show no effect [43,44].…”

Reprise: Case Management in Substance Use Services in the Age of the Affordable Care Act

“…In a recent meta-analysis, R. Rapp and associates (2014) noted the impact of case management on treatment tasks, in particular activities that link clients to a range of needed services, as well as treatment retention. This finding is vitally important in the current health care environment, as continued involvement with services through the use of targeted case management has been shown to ultimately reduce costs by curbing the use of expensive services, notably emergency room visits and hospitalization (Kirk et al, 2013;Kumar & Klein, 2013;McLellan et al, 2005;Draanen et al, 2013).…”

Intensive Case Management for Addiction to promote engagement with care of people with severe mental and substance use disorders: an observational study

“…On a structural level, the service location and organisation or the unavailability of addiction specialists have been recognised as care access limitations [4, 5]. Absence of care can lead to health and social complications and contributes to higher costs of public services as emergency department visits arise [6]. Different models of case management have proved to be effective in promoting engagement with care of people with substance use disorders in a variety of settings [7–9].…”