title: The effect of assertive continuing care on continuing care linkage, adherence and abstinence following residential treatment for adolescents with substance use disorders.
abstract: OBJECTIVE
  This study compared assertive continuing care (ACC) to usual continuing care (UCC) on linkage, retention and a measure of continuing care adherence. Outcome analyses tested the direct and indirect effects of both conditions and level of adherence on early (months 1-3) and longer-term (months 4-9) abstinence.
  
  
  METHODS
  Two-group randomized design.
  
  
  METHODS
  Eleven counties surrounding a community-based residential treatment program in the Midwestern section of the United States.
  
  
  METHODS
  A total of 183 adolescents, ages 12-17 years, with one or more Diagnostic and Statistical Manual version IV (DSM-IV) substance use dependence disorder and met American Society for Addiction Medicine (ASAM) placement criteria for non-medical residential treatment.
  
  
  METHODS
  Prior to discharge from residential treatment, participants were assigned randomly to receive either UCC, available at outpatient clinics in the 11-county study area, or ACC via home visits.
  
  
  METHODS
  Self-reported interview data were collected at intake, 3, 6 and 9 months post-residential discharge. Urine test data and interviews with a caregiver were conducted at baseline and 3 months.
  
  
  RESULTS
  ACC led to significantly greater continuing care linkage and retention and longer-term abstinence from marijuana. ACC resulted in significantly better adherence to continuing care criteria which, in turn, predicted superior early abstinence. Superior early abstinence outcomes for both conditions predicted longer-term abstinence.
  
  
  CONCLUSIONS
  ACC appears to be an effective alternative to UCC for linking, retaining and increasing adherence to continuing care. Replication with larger samples is needed to investigate further the direct and indirect effects of ACC found in this study
authors.affiliation: Chestnut Health Systems, Bloomington, IL 61701, USA. mgodley@chestnut.org
authors.forename: Mark D
authors.initials: MD
authors.lastname: Godley
authors.forename: Susan H
authors.initials: SH
authors.lastname: Godley
authors.forename: Michael L
authors.initials: ML
authors.lastname: Dennis
authors.forename: Rodney R
authors.initials: RR
authors.lastname: Funk
authors.forename: Lora L
authors.initials: LL
authors.lastname: Passetti
mesh_terms: D000293:Adolescent; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012114:Residential Treatment; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000628:therapy*; D014481:United States / Q000453:epidemiology