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The Recovery Management paradigm provides a conceptual framework for the examination of joint impact of a focal treatment and post-treatment service utilization on substance abuse treatment outcomes. This study tested this framework by examining the interactive effects of a treatment for comorbid PTSD and substance use, Seeking Safety, and post-treatment Twelve-Step Affiliation (TSA) on alcohol and cocaine use. Data from 363 women in a six-site, randomized controlled effectiveness trial within the National Drug Abuse Treatment Clinical Trials Network (CTN-0015, “Women’s Treatment for Trauma and Substance Use Disorders”) were analyzed under latent class pattern mixture modeling. LCPMM was used to model variation in Seeking Safety by TSA interaction effects on alcohol and cocaine use. Significant reductions in alcohol use among women in Seeking Safety (compared to health education) were observed; women in the Seeking Safety condition who followed up with TSA had the greatest reductions over time in alcohol use. Reductions in cocaine use over time were also observed but did not differ between treatment conditions nor were there interactions with post-treatment TSA.
Conclusions: This study extends current knowledge on treating conditions with a high risk for relapse, such as PTSD and comorbid SUDs, and the adjunctive benefits of TSA for extending treatment effects. Findings underscore the importance of maintaining an ongoing connection to some form of recovery services and the need for continued social support, particularly among a population of women who are most vulnerable, and, more specifically, suggest that providers may consider the use of TSA in combination with Seeking Safety to promote potential synergistic effects.
Related protocols: CTN-0015
Detoxification often serves as an initial contact for treatment and represents an opportunity for engaging patients in aftercare to prevent relapse. However, there is limited information concerning clinical profiles of individuals seeking detoxification, and the opportunity to engage patients in detoxification for aftercare often is missed. This study used data from protocols CTN-0001 and CTN-0002 to examine clinical profiles of a geographically diverse sample of opioid-dependent adults in detoxification to discern the treatment needs of a growing number of women and whites with opioid addiction and to inform interventions aimed at improving use of aftercare or rehabilitation. Gender and racial/ethnic differences in addiction severity, HIV risk, and quality of life were examined. Results found that women and whites were more likely than men and African Americans to have greater psychiatric and family/social relationship problems, and to report poorer health-related quality of life and functioning. White and Hispanics exhibited higher levels of total HIV risk scores and risky injection drug use scores than African Americans, and Hispanics showed a higher level of unprotected sexual behaviors than whites. African Americans were more likely than whites to use heroin and cocaine, and to have more severe alcohol and employment problems. These results highlight the need to monitor an increased trend of opioid addiction among women and whites and to develop effective combined psychosocial and pharmacologic treatments to meet the diverse needs of the expanding opioid-abusing population. Elevated levels of HIV risk behaviors among Hispanics and whites also warrant more research to delineate mechanism and reduce their risky behaviors.
Supported by the Duke Clinical Research Institute (CTN DSC 1).
Related protocols: CTN-0001, CTN-0002
Substance use relapse rates are often high in the first months after discharge from inpatient substance abuse treatment, and patient adherence to aftercare plans is often low. Four residential addiction treatment centers participated in a feasibility study designed to estimate the efficacy of a post-discharge telephone intervention intended to encourage compliance with aftercare (CTN-0011, “A Feasibility Study of a Telephone Enhancement Procedure (TELE) to Improve Participation in Continuing Care Activities “). A total of 282 participants (100 women, 182 men) with substance use disorders were included in this secondary analysis.
The findings revealed that women were more likely than men to attend aftercare. This “gender effect” persisted after adjustment for a number of potential mediators.
Related protocols: CTN-0011
The TELE study (protocol CTN-0011) examined the feasibility and potential efficacy of phone calls to patients after discharge from short-term inpatient and residential substance abuse treatment programs to encourage compliance with continuing care plans. After review of their continuing care plans, 339 patients from four programs were randomized either to receive calls or have no planned contact. Ninety-two percent of patients randomized to receive calls received at least one call. No difference was found between groups in self-reported attendance at one or more outpatient counseling sessions after discharge (p = .89). When program records of all participants were examined, those receiving calls had a greater likelihood of documented attendance (48%) than those not called (37%).
Results were not statistically significant (p < .003) because of the Hochberg correction for multiple tests. While the phone calls were feasible, the lack of clear evidence of efficacy of the calls suggests the need for further investigation of the role of telephone intervention to encourage compliance and improve outcomes.
Related protocols: CTN-0011
This secondary analysis of data from protocol CTN-0011, “Feasibility Study of a Telephone Enhancement Procedure (TELE) to Improve Participation in Continuing Care Activities,” examines the relationship of participant gender on aftercare attendance, and the moderating effects of a history of physical abuse. Four residential addiction treatment centers participated in CTN-0011, a feasibility study designed to estimate the efficacy of a post-discharge telephone intervention intended to encourage compliance with aftercare.
Participants were 282 outpatients (100 women, 182 men) with substance use disorders. The findings revealed that the odds of attending aftercare were 1.91 times higher in women than men. Women were also more likely to report higher rates of physical abuse (PA) and sexual abuse (SA). To determine whether prior PA or SA confounded the gender effect observed, separate logistic regression models were used to test each interaction. A significant gender-by-PA interaction was found, but there was no interaction between SA and gender. However, while the interaction between SA and gender was not significant, the gender effect persisted after adjustment for history of SA. For the PA-by-gender interaction, women without PA were more likely to return for aftercare when compared to men with PA or men without PA; however, the odds of aftercare for women with PA were one-tenth times that of females without PA. Women with PA were no more likely to attend aftercare than either males with or without PA. The findings suggest that women may be more influenced by the post-discharge telephone intervention than men, although it is not clear from the data whether this is a result of the women benefiting more from this particular intervention or the result of other unmeasured variables. Further studies are needed to better understand the observed gender effect.
Related protocols: CTN-0011