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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. l 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. Keywords: comparative effectiveness study, alcohol dependence, continuing care, telephone counseling, monitoring and feedback DOI: 10.1037/a0020700

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2010.07.002 Byline: Arthur I. Alterman, John S. Cacciola, Karen L. Dugosh, Megan A. Ivey, Donna M. Coviello Keywords: Mental health measurement; Patients with SUD; Psychometric properties Abstract: Few studies have examined mental health (MH) attributes of patients with substance use disorder (SUD). This study examines the internal consistency, concurrent validity, and comparative level of MH attributes (i.e., optimism, life attitudes, spirituality/religiousness, social support, positive mood, hope, and vitality) in patients with SUD compared with the instrument development group. The internal consistency of optimism, spirituality/religiousness, positive mood, hope, and vitality were similar in both groups. Some subscales of the social support and life attitude measures had lower internal consistency than was found for the original samples, although internal consistency of more global constructs were comparable. Patients with SUD had higher positive mood, spirituality/religiousness, and hope scores, whereas social support, life attitudes, and optimism scores were lower than in the original sample. Correlations between MH attributes and recent life problems of patients with SUD generally supported the concurrent validity of the MH measures. Article History: Received 24 March 2010; Revised 6 July 2010; Accepted 7 July 2010

Objective: This study evaluated the psychometric properties of the 15-item alcohol Short Index of Problems (SIP) instrument and those of a newly constructed 15-item drug Short Index of Problems (SIPD) instrument in 277 newly entered substance-abuse patients. Method: The SIP is derived from the longer, 50-item Drinker Inventory of Consequences (DrInC), which was designed to assess adverse consequences of alcohol use. The SIP-D was constructed by substituting the term 'drug use' for the term 'drinking' in each SIP item. A 3-month recall interval was employed. Results: Factor analyses of each of the instruments revealed similar solutions, with only one main factor accounting for the majority of variance. Nonparametric item response theory methods produced the same finding. Internal consistency reliability estimates for the SIP and SIP-D total scores were .98 and .97, respectively. Concurrent validity was demonstrated by examining the correlations of the total scores for each of the instruments with the recent summary indexes of the newly revised Addiction Severity Index (ASI-Version 6): alcohol, drug, medical, economic, legal, family/social, and psychiatric problems. Conclusions: This study is the first to confirm the psychometric validity of the SIP when used as an independent instrument unembedded within the DrInC. The study also supports the use of the SIP-D as a brief measure of adverse consequences of drug use. The findings strongly support the unidimensional structure of both measures., EFFORTS TO ASSESS ADVERSE CONSEQUENCES of alcohol and drug use often have been confounded with symptoms of dependence and quantity and frequency of substance use (Blanchard et al., 2003). Indeed, [...]

Background and Aims: Management of alcohol use disorder (AUD) could be enhanced by effective remote treatments. This study tested whether supplementing intensive outpatient programs (IOPs) with continuing care delivered via (1) telephone, (2) smartphone or (3) their combination improves outcomes relative to (4) IOP only. Continuing care conditions were also compared. Design Randomized controlled trial of four groups with 3‐, 6‐, 9‐, 12‐ and 18‐month follow‐ups. Setting: University research center in Philadelphia, PA, USA. Participants: Participants (n = 262) met DSM‐V criteria for AUD, were largely male (71%) and African American (82%). Interventions and Comparator: Telephone monitoring and counseling (TMC; n = 59), addiction comprehensive health enhancement support system (ACHESS; n = 68) and TMC + ACHESS (n = 70) provided for 12 months. The control condition received IOP only (TAU; n = 65). Measurement The primary outcome was percentage of days heavy drinking (PDHD) in months 1–12. Secondary outcomes were any drinking, any drug use, drinking consequences and quality of life. Findings Mean PDHD in months 1–12 was 10.29 in TAU, 5.41 in TMC, 6.80 in ACHESS and 5.99 in TMC + ACHESS. PDHD was lower in TMC [Cohen's d = 0.35, P = 0.018, 95% confidence interval (CI) = (−1.42, −0.20)], ACHESS [d = 0.31, P = 0.031, 95% CI = (−1.27, −0.06)] and TMC + ACHESS [d = 0.36, P = 0.009, 95% CI = (−1.40, −0.20)] than in TAU. Differences between TMC + ACHESS, TMC and ACHESS were small (d ≤ 0.06) and non‐significant. Findings were inconclusive as to whether or not the treatment conditions differed on PDHD at 18 months. A significant effect was obtained on any drinking, which was higher in months 1–12 in TAU than in TMC [odds ratio (OR) = 3.02, standard error (SE) = 0.43, 95% CI = (1.30, 6.99), P = 0.01] and TMC + ACHESS [OR = 2.43, SE = 0.39, 95% CI = (1.12, 5.27), P = 0.025). No other significant effects were obtained on other secondary outcomes during or after treatment. Conclusions: A telephone‐delivered intervention and a smartphone‐delivered intervention, alone and in combination, provided effective remote continuing care for alcohol use disorder. The combination of both interventions was not superior to either alone and effects did not persist post‐treatment. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate potential moderators of the effect of adding extended telephone monitoring (TM) and telephone monitoring and counseling (TMC) continuing care to treatment as usual (TAU) for alcoholism. Continuing care was predicted to be more effective for patients with severe substanceuse histories, poor initial response to treatment, and other risk factors for relapse. Methods: Randomized study with 18-month follow-up. Outcomes were frequency of drinking and any drinking. Results: Main effects favored TMC over TAU on alcohol outcomes. However, none of the 11 variables examined moderated these effects. Conversely, main effect and moderator analyses indicated TM was more beneficial than TAU only for women and for participants with lower readiness to change. Conclusions: TMC improves drinking outcomes when added to standard care, regardless of alcohol use history, early response to treatment, or other risk factors for relapse. TM is recommended for women and less motivated patients. [ABSTRACT FROM AUTHOR]