title: An adaptive approach for identifying cocaine dependent patients who benefit from extended continuing care.
abstract: OBJECTIVE
  Study tested whether cocaine dependent patients using cocaine or alcohol at intake or in the first few weeks of intensive outpatient treatment would benefit more from extended continuing care than patients abstinent during this period. The effect of incentives for continuing care attendance was also examined.
  
  
  METHODS
  Participants (N = 321) were randomized to treatment as usual (TAU), TAU and telephone monitoring and counseling (TMC), or TAU and TMC plus incentives (TMC+). The primary outcomes were (a) abstinence from all drugs and heavy alcohol use and (b) cocaine urine toxicology. Follow-ups were at 3, 6, 9, 12, 18, and 24 months.
  
  
  RESULTS
  Cocaine and alcohol use at intake or early in treatment predicted worse outcomes on both measures (ps ≤ .0002). Significant effects favoring TMC over TAU on the abstinence composite were obtained in participants who used cocaine (odds ratio [OR] = 1.95 [1.02, 3.73]) or alcohol (OR = 2.47 [1.28, 4.78]) at intake or early in treatment. A significant effect favoring TMC+ over TAU on cocaine urine toxicology was obtained in those using cocaine during that period (OR = 0.55 [0.31, 0.95]). Conversely, there were no treatment effects in participants abstinent at baseline and no overall treatment main effects. Incentives almost doubled the number of continuing care sessions received but did not further improve outcomes.
  
  
  CONCLUSIONS
  An adaptive approach for cocaine dependence in which extended continuing care is provided only to patients who are using cocaine or alcohol at intake or early in treatment improves outcomes in this group while reducing burden and costs in lower risk patients.
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania.
authors.forename: James R
authors.initials: JR
authors.lastname: McKay
authors.forename: Deborah H A
authors.initials: DH
authors.lastname: Van Horn
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Lynch
authors.forename: Megan
authors.initials: M
authors.lastname: Ivey
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cary
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Drapkin
authors.forename: Donna M
authors.initials: DM
authors.lastname: Coviello
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Plebani
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation; D019970:Cocaine-Related Disorders / Q000191:economics / Q000523:psychology* / Q000534:rehabilitation*; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D015813:Substance Abuse Detection / Q000191:economics; D013689:Telephone
references.citation: J Subst Abuse Treat. 2009 Oct;37(3):313-7
references.pmid: 19339141
references.citation: J Consult Clin Psychol. 2006 Jun;74(3):592-601
references.pmid: 16822115
references.citation: J Subst Abuse Treat. 2009 Mar;36(2):131-45
references.pmid: 19161894
references.citation: J Stud Alcohol. 1993 Mar;54(2):199-208
references.pmid: 8459714
references.citation: Drug Alcohol Depend. 2011 Apr 1;114(2-3):225-8
references.pmid: 21041041
references.citation: Drug Alcohol Depend. 1997 Jun 6;46(1-2):79-85
references.pmid: 9246555
references.citation: Drug Alcohol Depend. 2007 May;88 Suppl 2:S24-30
references.pmid: 17056207
references.citation: Addiction. 2009 Jun;104(6):959-71
references.pmid: 19344441
references.citation: Addiction. 2002 Feb;97(2):126-32
references.pmid: 11860378
references.citation: J Consult Clin Psychol. 1999 Jun;67(3):420-7
references.pmid: 10369063
references.citation: JAMA. 2000 Oct 4;284(13):1689-95
references.pmid: 11015800
references.citation: J Consult Clin Psychol. 2010 Dec;78(6):912-23
references.pmid: 20873894
references.citation: Am J Addict. 2009 Mar-Apr;18(2):122-9
references.pmid: 19283563
references.citation: J Consult Clin Psychol. 1979 Feb;47(1):106-12
references.pmid: 429642
references.citation: J Consult Clin Psychol. 2004 Dec;72(6):967-79
references.pmid: 15612844
references.citation: Drug Alcohol Depend. 2000 Jan 1;57(3):225-38
references.pmid: 10661673
references.citation: J Nerv Ment Dis. 1980 Jan;168(1):26-33
references.pmid: 7351540
references.citation: J Consult Clin Psychol. 1998 Aug;66(4):691-6
references.pmid: 9735588
references.citation: Addiction. 2006 Feb;101(2):192-203
references.pmid: 16445548
references.citation: J Consult Clin Psychol. 2000 Feb;68(1):134-44
references.pmid: 10710848
references.citation: Perspect Psychol Sci. 2012 Jul;7(4):325-40
references.pmid: 26168470
references.citation: J Consult Clin Psychol. 2012 Apr;80(2):276-85
references.pmid: 22229758
references.citation: Eval Rev. 2007 Dec;31(6):515-47
references.pmid: 17986706
references.citation: Exp Clin Psychopharmacol. 2000 Aug;8(3):377-86
references.pmid: 10975629
references.citation: J Stud Alcohol. 1999 Mar;60(2):176-80
references.pmid: 10091955
references.citation: Behav Res Ther. 1979;17(2):157-60
references.pmid: 426744
references.citation: Addict Sci Clin Pract. 2007 Dec;4(1):45-55
references.pmid: 18292710
references.citation: Arch Gen Psychiatry. 1992 Aug;49(8):630-6
references.pmid: 1637253
references.citation: J Consult Clin Psychol. 2009 Apr;77(2):229-42
references.pmid: 19309183
references.citation: J Consult Clin Psychol. 1994 Aug;62(4):843-50
references.pmid: 7962889
references.citation: J Nerv Ment Dis. 1985 Jul;173(7):412-23
references.pmid: 4009158
references.citation: Subst Use Misuse. 2008 Jul;43(8-9):1016-26
references.pmid: 18649227
references.citation: Am J Addict. 2009 Jan-Feb;18(1):81-6
references.pmid: 19219669
references.citation: J Addict Med. 2007 Jun;1(2):79-87
references.pmid: 21768939
references.citation: Arch Gen Psychiatry. 2005 Feb;62(2):199-207
references.pmid: 15699297