A randomized trial of extended telephone-based continuing care for alcohol dependence: within-treatment substance use outcomes.
OBJECTIVE
The study tested whether adding up to 18 months of telephone continuing care, either as monitoring and feedback (TM) or longer contacts that included counseling (TMC), to intensive outpatient programs (IOPs) improved outcomes for alcohol-dependent patients.


METHODS
Participants (N = 252) who completed 3 weeks of IOP were randomized to up to 36 sessions of TM (M = 11.5 sessions), TMC (M = 9.1 sessions), or IOP only (treatment as usual [TAU]). Quarterly assessment of alcohol use (79.9% assessed at 18 months) was corroborated with available collateral reports (N = 63 at 12 months). Participants with cocaine dependence (N = 199) also provided urine samples.


RESULTS
Main effects favored TMC over TAU on any alcohol use (odds ratio [OR] = 1.88, CI [1.13, 3.14]) and any heavy alcohol use (OR = 1.74, CI [1.03, 2.94]). TMC produced fewer days of alcohol use during Months 10-18 and heavy alcohol use during Months 13-18 than TAU (ds = 0.46-0.65). TMC also produced fewer days of any alcohol use and heavy alcohol use than TM during Months 4-6 (ds = 0.39 and 0.43). TM produced lower percent days alcohol use than TAU during Months 10-12 and 13-15 (ds = 0.41 and 0.39). There were no treatment effects on rates of cocaine-positive urines.


CONCLUSIONS
Adding telephone continuing care to IOP improved alcohol use outcomes relative to IOP alone. Conversely, shorter calls that provided monitoring and feedback but no counseling generally did not improve outcomes over IOP.
McKay
James R
JR
Department of Psychiatry, University of Pennsylvania and Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania 19104, USA. mckay_j@mail.trc.upenn.edu
Van Horn
Deborah H A
DH
Oslin
David W
DW
Lynch
Kevin G
KG
Ivey
Megan
M
Ward
Kathleen
K
Drapkin
Michelle L
ML
Becher
Julie R
JR
Coviello
Donna M
DM
D000328:Adult; D000437:Alcoholism / Q000628:therapy*; D019970:Cocaine-Related Disorders / Q000628:therapy*; D003266:Continuity of Patient Care; D003376:Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012720:Severity of Illness Index; D013689:Telephone; D016896:Treatment Outcome