Effectiveness of Continuing Care for Drug Dependence; James McKay, Ph.D.
Five-year NIDA grant evaluates the effectiveness and costs of two extended telephone continuing care protocols relative to treatment as usual in cocaine dependent patients participating in intensive outpatient treatment. One continuing care protocol involves regular assessment of relapse risk status, provision of feedback, counseling, and an adaptive treatment component that can be used to adjust level of care in response to changes in patient status over time. The other continuing care protocol also includes incentives to increase sustained participation.

Caron Foundation: Telephone Based Continuing Care; James McKay, Ph.D.
Center experts developed and are evaluating a telephone-based continuing care protocol to provide extended therapeutic support after patients have been discharged from residential treatment. The standardized protocol and training includes a measure to assess risk and protective factors, and a series of clinical responses to patients who report substance use or various risk factors for relapse, including failure to attend AA meetings, symptoms of active psychiatric disorders, reduced confidence in ability to cope without resorting to substance use, and family or marital problems, as well as other problems and issues that indicate a need to adjust the continuing care plan.

Betty Ford: Focused Continuing Care; Deni Carise, Ph.D.
An existing extended care model, “Focused Continuing Care” or “FCC” was revised to become more standardized and focused, thereby easier to train others to perform and maximally engaging to patients. The frequency of post-discharge telephone contact has been increased and more emphasis placed on follow-up contact rates. Other changes are designed to engage clients and their families in the recovery process by providing graphic reports illustrating clinical progress and “next steps” toward recovery. An important task is to develop a data collection/reporting infrastructure allowing Betty Ford counselors to assess results of future FCC changes.

Effectiveness of Extended Telephone Monitoring; James McKay, Ph.D.
In this NIAAA-funded study, McKay and other Center colleagues are evaluating the effectiveness and economic viability of two 18-month, telephone-based continuing care interventions, against treatment as usual in publicly funded addiction specialty care programs. One intervention provides regularl monitoring of status and symptoms via the telephone over 18 months, along with feedback concerning risk level. The second intervention includes these components, but also features a stepped care algorithm that provides additional treatment when risk for relapse increases. Results from this study should be available in 2008.

Adaptive Naltrexone Treatment for Alcoholism; David Oslin, M.D.
This study is designed to develop an optimal adaptive treatment algorithm for the use of naltrexone to treat alcohol dependence. Patients are placed on open-label naltrexone and followed for up to eight weeks. Those who continue to experience days with heavy alcohol use go into the “nonresponder” arm of the study, whereas those who maintain good drinking outcomes over the eight weeks go into the “responder” arm of the study. Patients in the nonresponder arm receive stepped care, in the form of a more intensive behavioral intervention, and are randomized to continue or stop naltrexone. Those in the responder arm are randomized to no further care or to telephone disease management check ups.

Effectiveness and Costs of Enhanced Treatments for Cocaine; James McKay, Ph.D.
This NIDA-funded study seeks to determine the impact of providing enhanced services to cocaine dependent patients participating in IOP. The enhanced services consist of a contingency management protocol that provides reinforcement for cocaine-free urine samples, individualized relapse prevention, or the combination of both. These services are provided either from the point of entry into treatment or after initial engagement has been achieved. The results of the study will provide information on the relative effectiveness and cost-benefit of these enhancements to standard IOP, and whether these results vary as a function of when the services are provided.

Selected Collaborations

Adaptive Treatment Network; Susan Murphy, Ph.D.
Drs. McKay, Lynch, and Oslin are members of a small, interdisciplinary group of researchers with interest in the development and evaluation of adaptive treatment protocols for the addictions, other psychiatric disorders, and various medical disorders including HIV and cancer. The PI of this network is Susan Murphy, a statistician from the University of Michigan. It is funded through an NIH Roadmap grant.

Health Maintenance Consortium (HMC)
This group, funded by the Office of Behavioral and Social Science Research (OBSSR) and other NIH institutes, brings together a group of 20 investigators with R01s that address the issue of the maintenance of behavior change. These projects include maintenance studies of interventions in the areas of diet, exercise, cancer screening, smoking, alcohol use, and drug addiction. Dr. McKay is leading a cross site project within the HMC to identify components of interventions that account for positive outcomes.