Drug addiction is a chronic illness characterized by problematic drug use, followed by periods of abstinence, reductions in use, or return to problematic drug use. Despite this, substance abuse treatment has traditionally been based on an acute care model. The field of substance abuse treatment is developing and testing approaches to treat addiction as a chronic illness. Aftercare and continuing care models have been developed to extend the benefits of the initial treatment episode, and recovery monitoring has been developed to assess patients' status and return them to treatment as needed. The continuing care literature suggests that interventions work best when they are offered for extended periods. Limitations of continuing care models include:
- their narrow focus on treatment completers;
- their general inability to adjust to changes in patient status;
- patients tiring of participation and dropping out; and
- the treatment is of limited duration.
Recommendations for improving continuing care interventions include:
- engaging patients earlier in the treatment process;
- reducing the burden of treatment for participants;
- developing algorithms that adjust the treatment to the patient's response; and
- utilizing active outreach to engage and retain patients.
The field needs an addiction management model for drug-dependent patients, which, like disease management for other chronic conditions, provides:
- initial stabilization;
- ongoing treatment to maintain clinical gains;
- monitoring of patient symptoms; and
- adjustments to the treatment based on the patient's response.
In response to these needs, we have developed the Long Term Recovery Management (LTRM) model. LTRM is predicated on initiating long-term addiction management at the onset of treatment, extending the length of treatment, expediting the transitions between intensive treatment and maintenance of behavioral change, adapting treatment intensity to patient's response to treatment, and actively facilitating the therapeutic alliance. LTRM modifies the service delivery model and incorporates therapeutic techniques from several behavioral therapies, with established efficacy, to address the specific challenges to establishing and maintaining adequate adherence to long-term treatment engagement. The LTRM model emphasizes: engagement in continuous long-term treatment and recovery support, therapeutic alliance, and early re-intervention as the main mechanisms for maintenance of behavioral change.
The purpose of this two-year National Institutes of Heath/National Institute on Drug Abuse-funded study is to conduct a fully powered effectiveness trial comparing recovery trajectories of 200 drug dependent adults who are randomly assigned to Treatment as Usual (TAU) or Long-Term Recovery Management (LTRM). The study is being conducted in Maryhaven's outpatient treatment program in Columbus, Ohio. Patients will be engaged in LTRM during the first two weeks of outpatient treatment and continue in LTRM for 12 months. Research assessments will be conducted at 6 and 12 months after baseline. The main outcome is weeks of abstinence from the primary drug of dependence. Secondary outcomes include drug-free days and reduction in HIV risk behaviors. The aims of the study are:
- Specific Aim 1: To compare the effectiveness of an episodic care model (TAU) and a continuous care model (LTRM) of substance abuse treatment among drug-dependent adults.
- Secondary Aim 1: To compare HIV risk behaviors among participants in LTRM versus TAU.
- Exploratory Aim 1: To identify key moderating factors, such as primary drug of dependence, gender, ethnicity, and psychiatric comorbidity, that may influence treatment outcome.
Funded through the American Recovery and Reinvestment Act, this study is a collaborative research effort involving investigators from CITAR at Wright State University Boonshoft School of Medicine, Maryhaven, and the University of Arkansas for Medical Sciences.