A Randomized Trial of Extended Telephone-Based Continuing Care for Alcohol Dependence: Within-Treatment Substance Use Outcomes
A Randomized Trial of Extended Telephone-Based Continuing Care for Alcohol Dependence: Within-Treatment Substance Use Outcomes
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DOI：
10.1037/a0020700
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发表时间：
2010-12-01
影响因子：
5.9
通讯作者：
Coviello, Donna M.
中科院分区：
文献类型：
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作者：
McKay, James R.;Van Horn, Deborah H. A.;Coviello, Donna M.
目的：该研究测试了在强化门诊计划（IOP）中增加长达18个月的电话持续护理（无论是作为监测和反馈（TM）还是包括咨询（TMC）在内的更长时间的接触）是否会改善酒精依赖患者的结局。方法：完成3周IOP的参与者（N = 252）被随机分配至TM（M = 11.5次）、TMC（M = 9.1次）或仅IOP（常规治疗[TAU]），最多36次。酒精使用的季度评估（18个月时评估的79.9%）与可用的附带报告（12个月时N = 63）相证实。可卡因依赖的参与者（N = 199）也提供了尿液样本。结果如下：在任何酒精使用（比值比[OR] = 1.88，CI [1.13，3.14]）和任何重度酒精使用（OR = 1.74，CI [1.03，2.94]）方面，主效应均有利于TMC而非TAU。与TAU相比，TMC在第10-18个月期间使用酒精的天数较少，在第13-18个月期间使用重度酒精的天数较少（ds = 0.46-0.65）。在第4-6个月期间，TMC的任何酒精使用和重度酒精使用天数也少于TM（ds = 0.39和0.43）。在第10-12个月和第13-15个月，TM产生的酒精使用天数百分比低于TAU（ds = 0.41和0.39）。对可卡因阳性尿液的发生率无治疗效应。结论：与单独使用IOP相比，将电话持续护理添加到IOP中可改善酒精使用结局。相反，提供监测和反馈但不提供咨询的较短电话通常不会改善IOP的结局。
Objective: The study tested whether adding up to 18 months of telephone continuing care, either as monitoring and feedback (TM) or longer contacts that included counseling (TMC), to intensive outpatient programs (IOPs) improved outcomes for alcohol-dependent patients. Method: Participants (N = 252) who completed 3 weeks of IOP were randomized to up to 36 sessions of TM (M = 11.5 sessions), TMC (M = 9.1 sessions), or IOP only (treatment as usual [TAU]). Quarterly assessment of alcohol use (79.9% assessed at 18 months) was corroborated with available collateral reports (N = 63 at 12 months). Participants with cocaine dependence (N = 199) also provided urine samples. Results: Main effects favored TMC over TAU on any alcohol use (odds ratio [OR] = 1.88, CI [1.13, 3.14]) and any heavy alcohol use (OR = 1.74, CI [1.03, 2.94]). TMC produced fewer days of alcohol use during Months 10-18 and heavy alcohol use during Months 13-18 than TAU (ds = 0.46-0.65). TMC also produced fewer days of any alcohol use and heavy alcohol use than TM during Months 4-6 (ds = 0.39 and 0.43). TM produced lower percent days alcohol use than TAU during Months 10-12 and 13-15 (ds = 0.41 and 0.39). There were no treatment effects on rates of cocaine-positive urines. Conclusions: Adding telephone continuing care to IOP improved alcohol use outcomes relative to IOP alone. Conversely, shorter calls that provided monitoring and feedback but no counseling generally did not improve outcomes over IOP.