Effectiveness of Extended Treatments for Drug Dependence

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DESCRIPTION (provided by applicant): This application is in response to the following notice: NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications (NOT-OD-09-058). There is considerable evidence that treatment for drug use disorders can lead to substantial improvements in substance use and psychosocial problem severity. However, a significant percentage of patients drop out relatively quickly, rates of relapse are high, and continuing care is often inadequate or unavailable. In our NIDA parent grant, we are testing two extended continuing care models designed to manage patients for up to two years. These models combine low-level telephone-based monitoring and counseling, with an adaptive component to step up level of care when needed. One of these models also includes small incentives for completed continuing care contacts. Data from the first 250 participants indicates these incentives produce very high rates of continuing care contact, compared to the same intervention without incentives (74% vs. 52% of all possible continuing care contacts completed). Preliminary analyses of cocaine urine toxicology samples at 3, 6, 9, and 12 months indicated that both extended care interventions are producing better outcomes than outpatient treatment as usual. In the parent study, we are recruiting insured patients out of publicly funded community programs. The extended continuing care interventions are provided by a group of highly trained and closely supervised counselors. For the supplement, we propose to extend this continuing care model into a new population of high risk individuals, inner city residents without any kind of insurance who seek treatment for cocaine dependence through a special program run by the City of Philadelphia's Behavioral Health Department. We will train city telephone care managers to deliver our telephone continuing care intervention to patients who enter this program, to provide 12 months of regular monitoring, brief counseling, case management and linkage to community supports, and further referral to treatment services as needed. We will randomize 200 participants to receive this intervention or usual care, and follow them up for 12 months. This supplement will provide a more direct test of whether our continuing care model can be implemented successfully by "real world" publicly funded programs and their staff of paraprofessionals and counselors, and will facilitate the City's transformation into a recovery-oriented, continuing care model of addiction treatment. The University of Pennsylvania School of Medicine contributes substantially to the local economy. In 2008, the School created 37,000 jobs and $5.4 billion in regional economic activity, with the area's highly trained workforce producing more than 24,600 applications for just 840 open Penn staff research positions. The current proposal will create or retain 16 jobs. PUBLIC HEALTH RELEVANCE: Treatment for substance use disorders generally consists of relatively brief episodes of care that do not properly address the chronic, relapsing nature of these disorders. In the parent grant and other prior work, we have developed a telephone-based continuing care model that provides extended care and has proved efficacious in several carefully controlled studies. The proposed supplement will determine whether a 12 month version of this continuing care protocol can be used effectively in disadvantaged cocaine dependent individuals seeking treatment in publicly funded, inner-city programs.