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Intensive Referral Intervention to Improve Substance Use Disorder Treatment Outcomes Among Rural and Highly Rural Veterans (IRI)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02382042
Recruitment Status : Unknown
Verified March 2015 by Kathleen M. Grant, VA Nebraska Western Iowa Health Care System.
Recruitment status was:  Active, not recruiting
First Posted : March 6, 2015
Last Update Posted : March 6, 2015
Information provided by (Responsible Party):
Kathleen M. Grant, VA Nebraska Western Iowa Health Care System

Brief Summary:

Background Participation in continuing care is one of the two most significant factors in preventing relapse after intensive Substance Use Disorder (SUD) treatment.1 A primary component of continuing care, social support, is a protective factor for SUD treatment relapse.2 Social support provided by community self-help groups (e.g. 12-step programs such as Alcoholics Anonymous) improves Substance Use Disorder (SUD) treatment outcomes.1,4 Post-treatment referral to self-help groups was recently described as "an effective, low-cost option,"3 but counselors vary in their referral methods, often simply telling patients to find and attend meetings in their community.

In a study of urban veterans leaving treatment, researchers increased 1-year SUD abstinence rates by more than 24% through a three-step intensive referral intervention.5 First, counselors discussed the importance of social support and meeting attendance. Second, counselors identified accessible self-help meetings near the SUD treatment site and arranged for a meeting liaison to accompany the patient to a meeting. Third, counselors followed up on attendance and addressed obstacles. A follow-up study found patients with co-morbid SUD and psychiatric problems significantly benefitted from the intervention.6

The investigators have adapted this intervention so that it can be utilized in a rural as well as urban setting. The investigators have trained clinical staff, measured their fidelity to the intervention and successfully implemented it across three Veteran's Affairs (VA) Substance Use Disorder (SUD) treatment programs (Omaha, Lincoln and Grand Island). In 2012 an intriguing study showed that peer referral to 12-step support groups was significantly more effective than clinician referral.7 This is of particular interest given the scarcity of addiction counselors in rural communities and enhances the intervention's applicability to rural settings and other disciplines.

Specific Aim The investigators propose implementing this intervention in a correction population (Intervention Group) and comparing outcomes between the Intervention Group and a group who are receiving standard correction services (Standard Group).

Methods Phase I: Adapt Intensive Referral Intervention for correction population Phase II: Train correction staff in Intervention Research staff will train and continue to monitor trained correction staff to ensure fidelity to intervention and provide feedback to staff and leadership regularly.

Phase III: Comparison between Intervention Group and Standard Group The two groups will be compared on measures of interest to the Nebraska Department of Correctional Services and on measures of substance use, support group attendance and involvement at standard time points.

Condition or disease Intervention/treatment Phase
Substance Use Disorders Behavioral: Intensive Referral Intervention Not Applicable

  Show Detailed Description

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 450 participants
Intervention Model: Parallel Assignment
Primary Purpose: Treatment
Official Title: Intensive Referral Intervention to Improve Substance Use Disorder Treatment Outcomes Among Rural and Highly Rural Veterans
Study Start Date : September 2013
Estimated Primary Completion Date : July 2015
Estimated Study Completion Date : July 2015

Arm Intervention/treatment
Active Comparator: Intensive Referral Intervention Behavioral: Intensive Referral Intervention
No Intervention: Standard Care

Primary Outcome Measures :
  1. Sobriety [ Time Frame: 6 months ]
    Levels of sobriety will be measured by utilizing a time line fall back calendar.This measure outlines when the amount and timeline that a participant has used a particular substance.

Information from the National Library of Medicine

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Ages Eligible for Study:   19 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All

Inclusion Criteria:

  • All Veterans in SUD residential and outpatient treatment facilities in Grand Island, Lincoln and Omaha VA sites who are able to provide informed consent will be eligible for this research study.
  • Eligibility to provide informed consent will be determined by completing the MINI-COG, a brief 3-minute instrument to screen for cognitive impairment.

Exclusion Criteria:

-If the patient is cognitively impaired, as determined by the MINI-COG, he/she will not be eligible for study participation.

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Responsible Party: Kathleen M. Grant, Principal Investigator, VA Nebraska Western Iowa Health Care System Identifier: NCT02382042     History of Changes
Other Study ID Numbers: N32-FY13Q1-S1-P00642
First Posted: March 6, 2015    Key Record Dates
Last Update Posted: March 6, 2015
Last Verified: March 2015
Keywords provided by Kathleen M. Grant, VA Nebraska Western Iowa Health Care System:
Rural Health
Substance Abuse
Additional relevant MeSH terms:
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Substance-Related Disorders
Pathologic Processes
Chemically-Induced Disorders
Mental Disorders