Substance dependence is increasingly conceptualized as a chronic disease. As currently treated, it has a high relapse rate and is characterized by periods of problematic use and/or functional impairment alternating with periods of remission or less problematic use. Outpatient (OP) substance abuse treatment (SAT) programs purport to provide extended care via a continuum. Nonetheless, most of the care that is delivered and that clients receive is actually acute care. Regular treatment attendance and extended treatment durations are exceptions rather than the rule. One way to promote a continuous care effort is to systematically monitor client progress following admission. That means to monitor and provide feedback to clients while they are regularly attending in order to help guide treatment, as well as to reach out and monitor clients when they are not attending treatment (e.g., missing sessions, dropped out) in order to support reengagement, or recovery in other ways. As research indicates SAT is effective as an HIV prevention strategy, as such a monitoring intervention that also specifically addresses HIV risk and related behaviors is warranted. In this context, TRI has developed """"""""RecoveryTrack"""""""" (RT), a clinically oriented, web-based, during treatment, outcomes monitoring system (OMS). The proposed Stage 1a/1b study will: 1) Develop """"""""RecoveryTrack""""""""- ExtendedCare (RT-E), a modified version of """"""""RecoveryTrack"""""""". The investigators will adapt and finalize the original web-based RT system, manual, and training to accommodate use by counselors for clients who are and are not attending OP treatment. RT-E will thus have expanded use beyond clients """"""""in"""""""" or attending treatment. 2) Include a pilot study to determine the preliminary efficacy of RT-E compared to treatment as usual (TAU) for clients entering intensive outpatient (IOP) SAT. In this randomized clinical trial, it is hypothesized that RT-E will positively impact treatment attendance and substance use outcomes. Exploratory analyses will also evaluate the impact of RT-E on HIV related client behaviors versus TAU. 3) Evaluate feasibility and acceptability of RT-E;and 4) Determine preliminary costs and cost effectiveness of RT-E compared to TAU.
Evidence is strong that longer treatment stays are associated with better outcomes. A clinically oriented, outcomes monitoring system is essential to improving attendance including extended care so that counselors can systematically monitor client progress and provide feedback for an extended period of time following admission in order to guide treatment, reduce HIV risk, and support recovery. Indeed, the Institute of Medicine has explicitly recommended the development and use of client monitoring systems in substance abuse treatment.
