LINK: Aftercare Monitoring Project

Background: The prevalence of substance use disorders (SUD) in the VA is rising, making
SUD(s) among the most commonly diagnosed disorders in the VA. A substantial body of data
attests to the effectiveness of substance use disorder treatment; further the predictor most
consistently associated with positive addiction treatment outcomes is duration. Despite the
body of evidence supporting length of treatment as one of the stronger predictors of
long-term SUD outcomes, only 36% of SUD treatment programs in the VA are meeting the
continuing care performance criterion specified by the Office of Quality Performance. The
proposed randomized clinical trial investigates whether substance use disorder patients
assigned to telephone case monitoring (TCM) for continuing care will do better than those
attending face-to-face continuing care as usual (CCAU)(standard outpatient care).

Objectives: The objective of this research is to test, in a randomized clinical trial,
whether in-person CCAU following intensive outpatient SUD treatment leads to better SUD
outcomes when compared with TCM. In addition, we will investigate whether continuing care
condition interacts with distance from providers such that telephone case monitoring (TCM)
produces increasingly stronger results relative to continuing care as usual (CCAU) as
distance from care increases. Should we find an interaction, we will test whether the
interaction is due to TCM producing better proximal outcomes such as level of participation
in continuing care and satisfaction with treatment. Finally, we will investigate the cost of
providing telephone care relative to continuing care as usual.

Methods: The design of this study is a randomized controlled trial of telephone case
monitoring versus face-to-face continuing care as usual with 2 sites and up to 500 patients
per site recruited over 1.5 years for a total of up to 1000 patients. Patients will be
involved in the intervention for up to 6 months and data collection will occur at baseline,
3, 6 and 12 months via mailed surveys. Data of interest include self-report of substance use,
psychiatric symptoms, and quality of life. Data analyses will be conducted using hierarchical
linear modeling.

Status: Patient recruitment has ended. Treatment and follow-up are on-going.

Inclusion Criteria:

Participants will be recruited from all patients who complete at least 14 days of intensive
outpatient (IOP) substance use disorder treatment over an 18-month period in 2 VA IOP SUD
programs.

Exclusion Criteria:

Completion of less than 14 days of IOP treatment.