title: Who benefits from extended continuing care for cocaine dependence?
abstract: The goal of this study was to determine which cocaine dependent patients engaged in an intensive outpatient program (IOP) were most likely to benefit from extended continuing care (24 months). Participants (N=321) were randomized to: IOP treatment as usual (TAU), TAU plus Telephone Monitoring and Counseling (TMC), or TAU plus TMC plus incentives for session attendance (TMC+). Potential moderators examined were gender, stay in a controlled environment prior to IOP, number of prior drug treatments, and seven measures of progress toward IOP goals. Outcomes were: (1) abstinence from all drugs and heavy alcohol use, and (2) cocaine urine toxicology. Follow-ups were conducted at 3, 6, 9, 12, 18, and 24 months post-baseline. Results indicated that there were significant effects favoring TMC+ over TAU on the cocaine urine toxicology outcome for participants in a controlled environment prior to IOP and for those with no days of depression early in IOP. Trends were obtained favoring TMC over TAU for those in a controlled environment (cocaine urine toxicology outcome) or with high family/social problem severity (abstinence composite outcome), and TMC+ over TAU for those with high family/social problem severity or high self-efficacy (cocaine urine toxicology outcome). None of the other potential moderator effects examined reached the level of a trend. These results generally do not suggest that patients with greater problem severity or poorer performance early in treatment on the measures considered in this report will benefit to a greater degree from extended continuing care.
authors.affiliation: University of Pennsylvania, 3440 Market Street, Suite 370, Philadelphia, PA 19104, USA; Philadelphia VAMC, University and Baltimore Avenues, Philadelphia, PA 19104, USA. Electronic address: jimrache@mail.med.upenn.edu.
authors.forename: James R
authors.initials: JR
authors.lastname: McKay
authors.affiliation: University of Pennsylvania, 3440 Market Street, Suite 370, Philadelphia, PA 19104, USA.
authors.forename: Deborah H A
authors.initials: DH
authors.lastname: Van Horn
authors.affiliation: University of Pennsylvania, 3440 Market Street, Suite 370, Philadelphia, PA 19104, USA.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Lynch
authors.affiliation: University of Pennsylvania, 3440 Market Street, Suite 370, Philadelphia, PA 19104, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Ivey
authors.affiliation: University of Pennsylvania, 3440 Market Street, Suite 370, Philadelphia, PA 19104, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cary
authors.affiliation: Philadelphia VAMC, University and Baltimore Avenues, Philadelphia, PA 19104, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Drapkin
authors.affiliation: University of Pennsylvania, 3440 Market Street, Suite 370, Philadelphia, PA 19104, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Coviello
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D003042:Cocaine / Q000652:urine*; D019970:Cocaine-Related Disorders / Q000628:therapy*; D003376:Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance; D011615:Psychotherapy, Group / Q000379:methods*; D012008:Recurrence; D015813:Substance Abuse Detection; D013689:Telephone; D016896:Treatment Outcome
chemical_list: D003042:Cocaine
keywords: Adaptive treatment; Cocaine dependence; Continuing care; Incentives; Moderators