The majority of adolescents entering residential treatment programs already have chronic and relapsing problems with alcohol abuse and dependence as well as multiple comorbid problems that complicate treatment. Two thirds relapse to alcohol use within 90 days after discharge from residential programs, a fifth returning to weekly use. While all are referred to an outpatient program at discharge, in some counties as many as 60% never get any treatment and only a fraction of these stay in aftercare treatment for even four sessions. The primary goal of this research is to evaluate the effectiveness of an Assertive Aftercare Protocol (AAP) in increasing successful transfer and decreasing relapse and other problems relative to the current system's Status Quo (SQ) level of aftercare. AAP is designed to ensure a specified quantity and quality of aftercare services are provided including assessment, aftercare planning, frequent community-based contacts, linkages between systems, relapse prevention, problem solving, social skill building; family/social support and other forms of case management.
The specific aims are to evaluate two core hypotheses: Hl. Following discharge from residential treatment, clients randomly assigned to the experimental assertive aftercare protocol will have improved intermediate outcomes (treatment participation, self-efficacy We will test these hypotheses for both immediate and long-term effects in a blocked randomized field experiment. Over a 3-year period approximately 250 clients will be interviewed at intake to residential care, discharge from residential care, and then quarterly post-discharge for a year. At the point of discharge from residential services, half the clients will be randomly assigned to the experimental Assertive Aftercare Protocol (AAP) and the other half to receive the current Status Quo aftercare. Data will include self-reports, collateral reports, service records, and urine tests for alcohol, marijuana and cocaine. Additional comparisons will be possible with a pre-experimental baseline group of another 80 clients and a separate state-wide study we are currently conducting with 38 treatment units serving approximately 7200 clients per year.
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