Adolescent Outpatient and Continuing Care Study

Phase 3

Completed

• Conditions: Substance Abuse; Substance Dependence
• Interventions: Behavioral: Chestnut Bloomington Outpatient (CBOP); Behavioral: Motivational Enhancement Therapy/Cognitive Behavior Treatment (MET/CBT 7); Behavioral: Assertive Continuing Care (ACC)

• Registration Number: NCT01381133
• Lead Sponsor: Chestnut Health Systems

Brief Summary

The purpose of this study was to evaluate the effectiveness and cost-effectiveness of two types of outpatient treatment with and without Assertive Continuing Care (ACC) for 320 adolescents with substance use disorders. Study participants were randomly assigned to one of four conditions: (a) Chestnut's Bloomington Outpatient Treatment (CBOP) without ACC; (b) CBOP with ACC; (c) Motivational Enhancement Therapy/Cognitive Behavior Therapy-7 session model (MET/CBT7) without ACC; and (d) MET/CBT7 with ACC. Based on prior quasi and experimental studies, the investigators hypothesized that MET/CBT would be more effective and cost-effective than CBOP in terms of increasing days abstinent and decreasing substance abuse problems. Additionally, the investigators hypothesized that the groups receiving ACC would have significantly better outcomes than the groups without ACC. Lastly, the investigators hypothesized that adding ACC to MET/CBT would be the most cost-effective option in terms of days abstinent.

Detailed Description

This study evaluated the effectiveness and cost-effectiveness of two types of outpatient treatment with and without Assertive Continuing Care (ACC) for 320 adolescents with substance use disorders. Study participants were randomly assigned to one of four conditions: (a) Chestnut's Bloomington Outpatient Treatment (CBOP) without ACC; (b) CBOP with ACC; (c) Motivational Enhancement Therapy/Cognitive Behavior Therapy-7 session model (MET/CBT7) without ACC; and (d) MET/CBT7 with ACC. All study conditions attained high rates of participant engagement and retention. Follow-up interviews were completed with over 90% of the adolescents at three, six, nine, and 12 months after treatment admission. There was a significant time by condition effect over 12 months, with CBOP having a slight advantage for average percentage of days abstinent. Unlike previous findings that ACC provided incremental effectiveness following residential treatment, there were no statistically significant findings with regard to the incremental effectiveness of ACC following outpatient treatment. Analysis of the costs of each intervention combined with its outcomes revealed that the most cost-effective condition was MET/CBT7 without ACC.

Study Timeline

• Study Start: 2002-09
• Primary Completion: 2008-12
• Study Completion: 2008-12
• Study First Submitted: 2011-06-23
• Study First Submitted QC: 2011-06-23
• Study First Posted: 2011-06-27
• Status Verified: 2013-08
• Last Update Submitted: 2013-08-13
• Last Update Posted: 2013-08-14

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 320

Inclusion Criteria

• 12-18 years old
• met ASAM's (2001) Patient Placement Criteria for Level I outpatient treatment based on a substance abuse or dependence diagnosis and six dimensional admission criteria (i.e., severity of intoxication/withdrawal, physical health, emotional/behavioral health, treatment readiness, relapse potential, and recovery environment)
• attended an admission appointment

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Exclusion Criteria

• "stepped-down" from residential treatment and were therefore more severe than adolescents who entered outpatient treatment from the community
• were recommended only for individual counseling, as both outpatient treatment conditions had group components
• were a ward of the state
• did not have a parent/guardian present during admission to outpatient treatment
• appeared to have insufficient mental capacity to provide informed consent
• did not speak English with sufficient ability to understand study procedures and instruments

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
CBOP without ACC	Chestnut Bloomington Outpatient (CBOP)	-
CBOP with ACC	Chestnut Bloomington Outpatient (CBOP)	-
CBOP with ACC	Assertive Continuing Care (ACC)	-
MET/CBT 7 without ACC	Motivational Enhancement Therapy/Cognitive Behavior Treatment (MET/CBT 7)	-
MET/CBT 7 with ACC	Motivational Enhancement Therapy/Cognitive Behavior Treatment (MET/CBT 7)	-
MET/CBT 7 with ACC	Assertive Continuing Care (ACC)	-

Primary Outcome Measures

Name	Time	Method
Change in Percentage of days abstinent from any alcohol and drugs	Baseline and 3, 6, 9, and 12 months post-baseline
Change in Days abstinent from alcohol alone	Baseline and 3, 6, 9, and 12 months post-baseline
Change in Substance use problems	Baseline and 3, 6, 9, and 12 months post-baseline	Measured using the Substance Problem Scale of the Global Appraisal of Individual Needs
Change in Recovery status	12 months post-baseline	Being in recovery at the end of the study was defined as living in the community (vs. being incarcerated, or residing in inpatient treatment or other controlled environment) and reporting no past month substance use, abuse, or dependence problems at the 12 month interview. Urine samples were collected as described above in Section 2.4.2, and when an adolescent reported being in recovery but the urine test result suggested a false-negative self-report, data were re-coded to show the adolescent as not being in recovery.

Trial Locations

Locations (1)

Chestnut Health Systems; 🇺🇸 Bloomington, Illinois, United States