Evaluation of Web-based Recovery Monitoring with Clinical Alerts; Adam Brooks, Ph.D. A web-based concurrent recovery monitoring system (RecoveryTrack™) has been implemented in all publicly funded outpatient substance abuse treatment programs in the state of Delaware. Although monitoring and feedback approaches have been recommended, and many lines of evidence support their potential value, none has been formally evaluated in community based substance abuse treatment. The specific aims of this project are to conduct a three-phased study to modify RecoveryTrack™ so that counselors and their supervisors are provided with an automated Clinical Alert when a patient’s regularly administered monitoring assessment indicates a high risk of drop out from treatment, and to adapt a cognitive-behavioral intervention (CBI) to equip counselors in responding to “High Risk” patients. The feasibility of Clinical Alerts + CBI at a small treatment program will be assessed in advance of conducting a pilot randomized clinical trial at one large treatment program. It is hypothesized that patients who evidence a high risk for attrition will have longer lengths of stay, attend more treatment sessions, have more drug-free urine results, and receive more supplemental services in the Clinical Alerts + CBI condition. RecoveryTrack™, including Clinical Alerts + CBI, will be a monitoring and intervention system by which minimally trained clinical staff can easily incorporate an evidence-based psychosocial intervention into their usual practice.

Monitoring and Feedback in Substance Abuse Treatment; John Cacciola, Ph.D.
In substance abuse treatment, although monitoring and feedback approaches have been recommended and many lines of evidence support their potential value, none has been formally evaluated in standard outpatient treatment. The specific aims of this three-year NIDA grant are to conduct a three-staged study to develop and evaluate a monitoring instrument and associated intervention, as follows: Stage 1 - Develop and determine the reliability, validity, and sensitivity to change of a brief Multidimensional Monitoring Instrument (MMI) for clients in substance abuse treatment; Stage 2 - Develop a Monitoring and Feedback Intervention (MFI) and treatment manual/training materials that use the MMI, and conduct a feasibility study to refine the intervention; Stage 3 - Conduct a randomized clinical trial to determine the preliminary efficacy of the MFI compared to treatment as usual (TAU). The intervention (MFI) is an approach that counselors can easily incorporate into their usual practice with minimal training. The MFI has the potential to be portable, practical and sustainable. Future work could establish benchmarks and data could be fed back to supervisory personnel as well as to the treating clinician, and quality improvement efforts could be initiated and evaluated. Finally, the monitoring instrument (MMI) could aid evaluators and researchers in evaluating the course of clients' change during treatment and their discharge status across treatment organizations or experimental conditions.

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.

New Findings: Continuous Recovery Management: More evidence that chronic disease model is clinically feasible in substance abuse treatment.

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.