Substance use dependence with multiple co-occurring psychiatric problems is increasingly recognized as a chronic relapsing condition that may last for decades and require multiple episodes of care over many years before reaching a sustained state of remission. Observational studies that examined treatment effects across episodes of care found that the sooner after a relapse people return to treatment and the more subsequent treatment and aftercare they receive (particularly over 90 days total), the better their long term outcomes. Yet, there are less than a dozen long-term studies that look across episodes of care. The Early Re-Intervention experiment 1 (ERI-1) was the first study to experimentally evaluate the ability of a public health model of monitoring and early re-intervention to shorten the relapse, treatment re-entry, and recovery cycle. RMC participants were significantly more likely than those in the control group to return to treatment (64 percent vs. 51 percent), to return to treatment sooner (376 vs. 600 days), and to spend more subsequent days in treatment (mean of 62 vs. 40 days). RMC participants also experienced significantly fewer total quarters in need of treatment and were less likely to need treatment 2 years after intake (43 percent vs. 56 percent). In spite of the successful linkage rates, only 60 percent of the linked participants remained in treatment 14 or more days (which is associated with better odds of going into recovery). There were also interactions between the linkage rates and co-occurring psychiatric problems. Under ERI-2, we propose a 5-year extension in order to continue expanding our knowledge in this area. Specifically, we propose recruiting 300 adults with substance use dependence from sequential admissions at Haymarket Center and randomly assigning participants either quarterly assessments with no RMC intervention (control group) for 4 years or quarterly assessments plus an enhanced revised version of our RMC manual-guided protocol (in Appendix; Scott & Dennis, 2003). While the line of inquiry for ERI-2 parallels ERI-1, we propose several evidence-based modifications to the RMC protocol, including a more theoretically based model, adding biomarkers to the assessment of need, shifting to a longer time frame for observing RMC effects, and adding an Engagement Specialist at the treatment program to help engage and retain participants in treatment.
The specific aims of the new experiment are: (1) To examine the impact of recovery management checkups on the cycle of relapse, treatment re-entry, and recovery over the course of 4 years; (2) To assess the impact of recovery management checkups (direct effect) and subsequent treatment (indirect effect) on outcomes; and (3) To explore the (moderating) effects of co-occurring psychiatric problems on the relationship between RMC, patterns of treatment participation, and long-term outcomes.
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