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The National Drug Abuse Treatment Clinical Trials Network (CTN) began in 2000 with the goal of “improv[ing] the quality of drug abuse treatment throughout the country using science as the vehicle.” Since then, 24 discrete clinical trials were launched, 20 are completed, and 15 have published main outcome papers. Of the latter, 4 tested pharmacological treatment, 8 psychosocial/behavioral treatment, 1 a combination of medication and counseling, and 2 targeted HIV/hepatitis C virus risk behavior.
In this paper, the authors review main study findings for each of the 15 completed trials, including information about the dates of data collection, design, population, treatments, and results (primary, secondary, and treatment retention when analyzed). The purpose of this review is to identify the incremental progress toward improving drug treatment made by these trials and to propose next steps for the CTN and for the field arising from these studies. The CTN provides a unique opportunity to systematically design trials that incorporate treatment improvements from previous trials and to direct efforts toward innovations most likely to be incorporated into practice. Although the NIDA CTN has accomplished a considerable amount in its first 10 years of operation, it is clear that there is considerably more to accomplish to improve the quality of the research, as well as its dissemination, to fully realize the original goal of improving the quality of drug abuse treatment with science as the vehicle.
Related protocols: CTN-0001, CTN-0002, CTN-0003, CTN-0004, CTN-0005, CTN-0006, CTN-0007, CTN-0009, CTN-0010, CTN-0013, CTN-0015, CTN-0018, CTN-0019, CTN-0021
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
This brochure, intended for participants thinking about joining the CTN-0011 (A Feasibility Study of a Telephone Enhancement Procedure (TELE) to Improve Participation in Continuing Care Activities) study, provides an overview of telephone enhancement and answers questions participants might have.
Related protocols: CTN-0011
This brochure, intended for participants in the CTN-0011 (A Feasibility Study of a Telephone Enhancement Procedure (TELE) to Improve Participation in Continuing Care Activities) protocol, provides an overview of the project and answers any questions participants might have about being involved.
Related protocols: CTN-0011