title: Enhanced continuing care provided in parallel to intensive outpatient treatment does not improve outcomes for patients with cocaine dependence.
abstract: OBJECTIVE
  This study tested whether the addition of an enhanced continuing care (ECC) intervention that combined in-person and telephone sessions and began in the first week of treatment improved outcomes for cocaine-dependent patients entering an intensive outpatient program (IOP).
  
  
  METHODS
  Participants (N = 152) were randomized to IOP treatment as usual (TAU) or IOP plus 12 months of ECC. ECC included cognitive-behavioral therapy elements to increase coping skills, as well as monetary incentives for attendance. It was provided by counselors situated at a separate clinical research facility who did not provide IOP. The primary outcomes measured were (a) cocaine urine toxicology and (b) good clinical outcome, as indicated by abstinence from all drugs and from heavy alcohol use. Secondary outcomes were frequency of abstinent days, cocaine use days, and heavy drinking days. Follow-ups were conducted at 3, 6, 9, and 12 months after baseline.
  
  
  RESULTS
  Patients in ECC completed a mean of 18 sessions. Contrary to the hypotheses, patients in TAU had better scores on both the cocaine urine toxicology and the good clinical outcome measures than those in ECC, as indicated by significant Group × Time interactions (cocaine urine toxicology, p = .0025; abstinence composite, p = .017). These results were not moderated by substance use before or early in treatment or by IOP attendance. Results with the secondary outcomes also did not favor ECC over TAU.
  
  
  CONCLUSIONS
  Continuing care that is not well integrated with the primary treatment program may interfere in some way with the therapeutic process, particularly when it is implemented shortly after intake.
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. Mckay_j@mail.trc.upenn.edu
authors.forename: James R
authors.initials: JR
authors.lastname: McKay
authors.forename: Deborah
authors.initials: D
authors.lastname: van Horn
authors.forename: Megan
authors.initials: M
authors.lastname: Ivey
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Drapkin
authors.forename: Lior
authors.initials: L
authors.lastname: Rennert
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Lynch
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000553:Ambulatory Care / Q000379:methods* / Q000458:organization & administration; D019970:Cocaine-Related Disorders / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010045:Outpatients; D010349:Patient Compliance; D015813:Substance Abuse Detection; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome