title: Chronic care management for dependence on alcohol and other drugs: the AHEAD randomized trial.
abstract: OBJECTIVE
  People with substance dependence have health consequences, high health care utilization, and frequent comorbidity but often receive poor-quality care. Chronic care management (CCM) has been proposed as an approach to improve care and outcomes.
  
  
  OBJECTIVE
  To determine whether CCM for alcohol and other drug dependence improves substance use outcomes compared with usual primary care.
  
  
  METHODS
  The AHEAD study, a randomized trial conducted among 563 people with alcohol and other drug dependence at a Boston, Massachusetts, hospital-based primary care practice. Participants were recruited from September 2006 to September 2008 from a freestanding residential detoxification unit and referrals from an urban teaching hospital and advertisements; 95% completed 12-month follow-up.
  
  
  METHODS
  Participants were randomized to receive CCM (n=282) or no CCM (n=281). Chronic care management included longitudinal care coordinated with a primary care clinician; motivational enhancement therapy; relapse prevention counseling; and on-site medical, addiction, and psychiatric treatment, social work assistance, and referrals (including mutual help). The no CCM (control) group received a primary care appointment and a list of treatment resources including a telephone number to arrange counseling.
  
  
  METHODS
  The primary outcome was self-reported abstinence from opioids, stimulants, or heavy drinking. Biomarkers were secondary outcomes.
  
  
  RESULTS
  There was no significant difference in abstinence from opioids, stimulants, or heavy drinking between the CCM (44%) and control (42%) groups (adjusted odds ratio, 0.84; 95% CI, 0.65-1.10; P=.21). No significant differences were found for secondary outcomes of addiction severity, health-related quality of life, or drug problems. No subgroup effects were found except among those with alcohol dependence, in whom CCM was associated with fewer alcohol problems (mean score, 10 vs 13; incidence rate ratio, 0.85; 95% CI, 0.72-1.00; P=.048).
  
  
  CONCLUSIONS
  Among persons with alcohol and other drug dependence, CCM compared with a primary care appointment but no CCM did not increase self-reported abstinence over 12 months. Whether more intensive or longer-duration CCM is effective requires further investigation.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00278447.
authors.affiliation: Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, Massachusetts 02118-2335, USA. rsaitz@bu.edu
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: Michael
authors.initials: M
authors.lastname: Winter
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Kim
authors.forename: Seville M
authors.initials: SM
authors.lastname: Meli
authors.forename: Don
authors.initials: D
authors.lastname: Allensworth-Davies
authors.forename: Christine A
authors.initials: CA
authors.lastname: Lloyd-Travaglini
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000628:therapy*; D015415:Biomarkers / Q000032:analysis; D002908:Chronic Disease / Q000628:therapy; D003376:Counseling; D019468:Disease Management; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011320:Primary Health Care; D012008:Recurrence; D012017:Referral and Consultation; D057566:Self Report; D012947:Social Work; D019966:Substance-Related Disorders / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
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