title: Transitioning opioid-dependent patients from detoxification to long-term treatment: efficacy of intensive role induction.
abstract: Despite findings that opioid detoxification serves little more than a palliative function, few patients who enter detoxification subsequently transition to long-term treatment. The current study evaluated intensive role induction (IRI), a strategy adapted from a single-session intervention previously shown to facilitate engagement of substance-dependent patients in drug-free treatment. IRI was delivered either alone or combined with case management (IRI+CM) to determine the capacity of each condition to enhance transition and engagement in long-term treatment of detoxification patients. Study participants were 240 individuals admitted to a 30-day buprenorphine detoxification delivered at a publicly funded outpatient drug treatment clinic. Following clinic intake, participants were randomly assigned to IRI, IRI+CM, or standard clinic treatment (ST). Outcomes were assessed in terms of adherence and satisfaction with the detoxification program, detoxification completion, and transition and retention in treatment following detoxification. Participants who received IRI and IRI+CM attended more counseling sessions during detoxification than those who received ST (both ps<.001). IRI, but not IRI+CM participants, were more likely to complete detoxification (p=.017), rated their counselors more favorably (p=.01), and were retained in long-term treatment for more days following detoxification (p=.005), than ST participants. The current study demonstrated that an easily administered psychosocial intervention can be effective for enhancing patient involvement in detoxification and for enabling their engagement in long-term treatment following detoxification.
authors.affiliation: Department of Psychology, Towson University, 8000 York Road, Towson, MD 21252, USA. ekatz@towson.edu
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Katz
authors.forename: Barry S
authors.initials: BS
authors.lastname: Brown
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schwartz
authors.forename: Kevin E
authors.initials: KE
authors.lastname: O'Grady
authors.forename: Stuart D
authors.initials: SD
authors.lastname: King
authors.forename: Devang
authors.initials: D
authors.lastname: Gandhi
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D002047:Buprenorphine / Q000627:therapeutic use*; D019090:Case Management; D002568:Certification; D003376:Counseling / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000534:rehabilitation*; D017060:Patient Satisfaction; D011594:Psychometrics; D011613:Psychotherapy / Q000379:methods; D059039:Standard of Care; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000534:rehabilitation; D013637:Tape Recording; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine