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Reinforcement of Abstinence and Continuing Care in Substance Abuse Treatment

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.
 
ClinicalTrials.gov Identifier: NCT00288886
Recruitment Status : Completed
First Posted : February 8, 2006
Results First Posted : October 29, 2014
Last Update Posted : April 24, 2015
Sponsor:
Information provided by (Responsible Party):
VA Office of Research and Development ( US Department of Veterans Affairs )

Study Type Interventional
Study Design Allocation: Randomized;   Intervention Model: Parallel Assignment;   Masking: Single (Outcomes Assessor);   Primary Purpose: Treatment
Conditions Substance Use Disorders
Alcohol Abuse
Alcoholism
Substance Dependence
Substance Abuse
Interventions Behavioral: Contracting, Prompting and Reinforcement arm
Behavioral: Control arm
Enrollment 183
Recruitment Details 426 Consecutive Graduates Screened for Eligibility, 243 (57%) of those were excluded. [203 (48%) not within a 60-minute drive of aftercare; 15 (4%) no transportation, or aftercare not available due to work schedule; 24 (6%) did not consent; 1 excluded for unknown reason(s)]
Pre-assignment Details  
Arm/Group Title Standard Treatment (STX) Contracts, Prompts and Reinforcement (CPR)
Hide Arm/Group Description

Control condition: Routine residential treatment and orientation to continuing care.

An addiction therapist from the participants' treatment program met with each participant for an individual aftercare orientation session during the final 4 days of the initial treatment program and again during the ninth week of aftercare. Individuals were also encouraged to get an AA or NA sponsor during this session.

Contracting, Prompting & Reinforcing Abstinence & Attendance: Contingent reinforcement of abstinence and prompting of AA/NA attendance

CPR participants received the STX aftercare orientation except they were also provided with the contracting intervention during the orientation sessions, as well as the prompting and reinforcement components of the intervention.

  • Contracting. Participant's completed a behavioral contract for continuing care participation that took approximately 20 minutes to complete during their final 4 days in initial treatment and after 9 weeks of participation in continuing care.
  • Prompting. CPR participants received prompts (mailed appointment cards, telephone reminders) to attend all of their aftercare appointments and AA/NA meetings, and following missed aftercare sessions for 1 year (or until discharged from treatment).
  • Reinforcement. CPR participants received social reinforcement (certificates, honor roll) for attending group therapy.
Period Title: Overall Study
Started 91 92
3-month Follow Up 82 85
6-month Follow Up 85 84
12-month Follow Up 80 81
Completed 80 81
Not Completed 11 11
Arm/Group Title Standard Treatment (STX) Contracts, Prompts and Reinforcement (CPR) Total
Hide Arm/Group Description

Control condition: Routine residential treatment and orientation to continuing care.

An addiction therapist from the participants' treatment program met with each participant for an individual aftercare orientation session during the final 4 days of the initial treatment program and again during the ninth week of aftercare. Individuals were also encouraged to get an AA or NA sponsor during this session.

Contracting, Prompting & Reinforcing Abstinence & Attendance: Contingent reinforcement of abstinence and prompting of AA/NA attendance

CPR participants received the STX aftercare orientation except they were also provided with the contracting intervention during the orientation sessions, as well as the prompting and reinforcement components of the intervention.

  • Contracting. Participant's completed a behavioral contract for continuing care participation that took approximately 20 minutes to complete during their final 4 days in initial treatment and after 9 weeks of participation in continuing care.
  • Prompting. CPR participants received prompts (mailed appointment cards, telephone reminders) to attend all of their aftercare appointments and AA/NA meetings, and following missed aftercare sessions for 1 year (or until discharged from treatment).
  • Reinforcement. CPR participants received social reinforcement (certificates, honor roll) for attending group therapy.
Total of all reporting groups
Overall Number of Baseline Participants 91 92 183
Hide Baseline Analysis Population Description
[Not Specified]
Age, Continuous  
Mean (Standard Deviation)
Unit of measure:  Years
Number Analyzed 91 participants 92 participants 183 participants
50.63  (7.88) 49.55  (8.63) 50.09  (8.26)
Sex: Female, Male  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 91 participants 92 participants 183 participants
Female
3
   3.3%
5
   5.4%
8
   4.4%
Male
88
  96.7%
87
  94.6%
175
  95.6%
Region of Enrollment  
Measure Type: Number
Unit of measure:  Participants
United States Number Analyzed 91 participants 92 participants 183 participants
91 92 183
1.Primary Outcome
Title Abstinence Rate (During the Preceding 90 Days) at 12 Months Follow-up Point as Assessed by the Form-90
Hide Description Participants who were abstinent was assessed via Form-90 Interview (Form 90I) is a structured interview that assesses substance use and related behaviors over the previous 90 days employing a calendar-based follow-back method that provides continuous measures of substance use, and has good reliability. Measures include days abstinent, days using alcohol, days using drugs, total number of standard drinks, and days of self help meeting attendance. Briefer versions were constructed to collect data via telephone in instances when participants did not return for in-person interviews. As a reliability check on participants' self-report, a collateral interview was employed when contacting informants. Participants who denied use on the Form-90, but had a positive substance use screen were considered to be not abstinent for that follow-up point.
Time Frame Assessed at 12 months
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Standard Treatment (STX) Contracts, Prompts and Reinforcement (CPR)
Hide Arm/Group Description:

Control condition: Routine residential treatment and orientation to continuing care.

An addiction therapist from the participants' treatment program met with each participant for an individual aftercare orientation session during the final 4 days of the initial treatment program and again during the ninth week of aftercare. Individuals were also encouraged to get an AA or NA sponsor during this session.

Contracting, Prompting & Reinforcing Abstinence & Attendance: Contingent reinforcement of abstinence and prompting of AA/NA attendance

CPR participants received the STX aftercare orientation except they were also provided with the contracting intervention during the orientation sessions, as well as the prompting and reinforcement components of the intervention.

  • Contracting. Participant's completed a behavioral contract for continuing care participation that took approximately 20 minutes to complete during their final 4 days in initial treatment and after 9 weeks of participation in continuing care.
  • Prompting. CPR participants received prompts (mailed appointment cards, telephone reminders) to attend all of their aftercare appointments and AA/NA meetings, and following missed aftercare sessions for 1 year (or until discharged from treatment).
  • Reinforcement. CPR participants received social reinforcement (certificates, honor roll) for attending group therapy.
Overall Number of Participants Analyzed 83 81
Measure Type: Number
Unit of Measure: participants
Abstinence from alcohol and drugs 40 38
Abstinence from alcohol 47 51
Abstinence from drugs 55 49
2.Secondary Outcome
Title Abstinence Rate (During the Preceding 90 Days) at 3- and 6-months Follow-up Point as Assessed by the Form-90
Hide Description Participants who were abstinent was assessed via Form-90 Interview (Form 90I) is a structured interview that assesses substance use and related behaviors over the previous 90 days employing a calendar-based follow-back method that provides continuous measures of substance use, and has good reliability. Measures include days abstinent, days using alcohol, days using drugs, total number of standard drinks, and days of self help meeting attendance. Briefer versions were constructed to collect data via telephone in instances when participants did not return for in-person interviews. As a reliability check on participants' self-report, a collateral interview was employed when contacting informants. Participants who denied use on the Form-90, but had a positive substance use screen were considered to be not abstinent for that follow-up point.
Time Frame Assessed at 3 and 6 months
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Standard Treatment (STX) Contracts, Prompts and Reinforcement (CPR)
Hide Arm/Group Description:

Control condition: Routine residential treatment and orientation to continuing care.

An addiction therapist from the participants' treatment program met with each participant for an individual aftercare orientation session during the final 4 days of the initial treatment program and again during the ninth week of aftercare. Individuals were also encouraged to get an AA or NA sponsor during this session.

Contracting, Prompting & Reinforcing Abstinence & Attendance: Contingent reinforcement of abstinence and prompting of AA/NA attendance

CPR participants received the STX aftercare orientation except they were also provided with the contracting intervention during the orientation sessions, as well as the prompting and reinforcement components of the intervention.

  • Contracting. Participant's completed a behavioral contract for continuing care participation that took approximately 20 minutes to complete during their final 4 days in initial treatment and after 9 weeks of participation in continuing care.
  • Prompting. CPR participants received prompts (mailed appointment cards, telephone reminders) to attend all of their aftercare appointments and AA/NA meetings, and following missed aftercare sessions for 1 year (or until discharged from treatment).
  • Reinforcement. CPR participants received social reinforcement (certificates, honor roll) for attending group therapy.
Overall Number of Participants Analyzed 91 92
Measure Type: Number
Unit of Measure: participants
Abstinence from alcohol and drugs (3 month) 57 57
Abstinence from alcohol (3 month) 65 69
Abstinence from drugs (3 month) 64 62
Abstinence from alcohol and drugs (6 months) 43 43
Abstinence from alcohol (6 month) 50 61
Abstinence from drugs (6 month) 51 55
3.Secondary Outcome
Title Days Until First Use of Alcohol or Drugs
Hide Description [Not Specified]
Time Frame Baseline to 12 months
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Standard Treatment (STX) Contracts, Prompts and Reinforcement (CPR)
Hide Arm/Group Description:

Control condition: Routine residential treatment and orientation to continuing care.

An addiction therapist from the participants' treatment program met with each participant for an individual aftercare orientation session during the final 4 days of the initial treatment program and again during the ninth week of aftercare. Individuals were also encouraged to get an AA or NA sponsor during this session.

Contracting, Prompting & Reinforcing Abstinence & Attendance: Contingent reinforcement of abstinence and prompting of AA/NA attendance

CPR participants received the STX aftercare orientation except they were also provided with the contracting intervention during the orientation sessions, as well as the prompting and reinforcement components of the intervention.

  • Contracting. Participant's completed a behavioral contract for continuing care participation that took approximately 20 minutes to complete during their final 4 days in initial treatment and after 9 weeks of participation in continuing care.
  • Prompting. CPR participants received prompts (mailed appointment cards, telephone reminders) to attend all of their aftercare appointments and AA/NA meetings, and following missed aftercare sessions for 1 year (or until discharged from treatment).
  • Reinforcement. CPR participants received social reinforcement (certificates, honor roll) for attending group therapy.
Overall Number of Participants Analyzed 91 92
Mean (Standard Deviation)
Unit of Measure: days
200.74  (136.31) 202.43  (140.46)
4.Secondary Outcome
Title Aftercare Attendance
Hide Description Measures of aftercare attendance include: Percentage of participants who attended at least 1 aftercare session; percentage of participants who attended at least 2 aftercare sessions/month for at least 3, 6, 9 and 12 months; and percentage of participants who passed the VAMC's SUD continuity of care performance measure (a benchmark for retention of clients in aftercare for at least two visits each month for 3 months following initial treatment)
Time Frame Assessed at 3-, 6-, 9-, and 12-months
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Standard Treatment (STX) Contracts, Prompts and Reinforcement (CPR)
Hide Arm/Group Description:

Control condition: Routine residential treatment and orientation to continuing care.

An addiction therapist from the participants' treatment program met with each participant for an individual aftercare orientation session during the final 4 days of the initial treatment program and again during the ninth week of aftercare. Individuals were also encouraged to get an AA or NA sponsor during this session.

Contracting, Prompting & Reinforcing Abstinence & Attendance: Contingent reinforcement of abstinence and prompting of AA/NA attendance

CPR participants received the STX aftercare orientation except they were also provided with the contracting intervention during the orientation sessions, as well as the prompting and reinforcement components of the intervention.

  • Contracting. Participant's completed a behavioral contract for continuing care participation that took approximately 20 minutes to complete during their final 4 days in initial treatment and after 9 weeks of participation in continuing care.
  • Prompting. CPR participants received prompts (mailed appointment cards, telephone reminders) to attend all of their aftercare appointments and AA/NA meetings, and following missed aftercare sessions for 1 year (or until discharged from treatment).
  • Reinforcement. CPR participants received social reinforcement (certificates, honor roll) for attending group therapy.
Overall Number of Participants Analyzed 91 92
Measure Type: Number
Unit of Measure: percentage of participants
Attended at least 1 aftercare session 97 97
Passed the SUD continuity of care measure 58 70
Attended at least 3 months of treatment 64 76
Attended at least 6 months of treatment 35 48
Attended at least 9 months of treatment 22 35
Attended at least 12 months of treatment 10 16
5.Secondary Outcome
Title Self-help Support Group Attendance
Hide Description [Not Specified]
Time Frame Assessed over the past 90 days at 3, 6 and 12 months, and cumulative over 1 year
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Standard Treatment (STX) Contracts, Prompts and Reinforcement (CPR)
Hide Arm/Group Description:

Control condition: Routine residential treatment and orientation to continuing care.

An addiction therapist from the participants' treatment program met with each participant for an individual aftercare orientation session during the final 4 days of the initial treatment program and again during the ninth week of aftercare. Individuals were also encouraged to get an AA or NA sponsor during this session.

Contracting, Prompting & Reinforcing Abstinence & Attendance: Contingent reinforcement of abstinence and prompting of AA/NA attendance

CPR participants received the STX aftercare orientation except they were also provided with the contracting intervention during the orientation sessions, as well as the prompting and reinforcement components of the intervention.

  • Contracting. Participant's completed a behavioral contract for continuing care participation that took approximately 20 minutes to complete during their final 4 days in initial treatment and after 9 weeks of participation in continuing care.
  • Prompting. CPR participants received prompts (mailed appointment cards, telephone reminders) to attend all of their aftercare appointments and AA/NA meetings, and following missed aftercare sessions for 1 year (or until discharged from treatment).
  • Reinforcement. CPR participants received social reinforcement (certificates, honor roll) for attending group therapy.
Overall Number of Participants Analyzed 91 92
Mean (Standard Deviation)
Unit of Measure: days
Days of AA or NA attendance (3 months) 20.18  (21.16) 23.44  (22.29)
Days of AA or NA attendance (6 months) 18.14  (25.90) 21.99  (26.50)
Days of AA or NA attendance (12 months) 12.41  (21.57) 14.18  (23.21)
Total Days of AA or NA attendance at 1 year 45.7  (57.3) 54.6  (58.2)
6.Secondary Outcome
Title Days of Substance Abuse (Across the Prior 90 Days)
Hide Description [Not Specified]
Time Frame Assessed at Baseline, 3-, 6-, and 12-month follow-up
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Standard Treatment (STX) Contracts, Prompts and Reinforcement (CPR)
Hide Arm/Group Description:

Control condition: Routine residential treatment and orientation to continuing care.

An addiction therapist from the participants' treatment program met with each participant for an individual aftercare orientation session during the final 4 days of the initial treatment program and again during the ninth week of aftercare. Individuals were also encouraged to get an AA or NA sponsor during this session.

Contracting, Prompting & Reinforcing Abstinence & Attendance: Contingent reinforcement of abstinence and prompting of AA/NA attendance

CPR participants received the STX aftercare orientation except they were also provided with the contracting intervention during the orientation sessions, as well as the prompting and reinforcement components of the intervention.

  • Contracting. Participant's completed a behavioral contract for continuing care participation that took approximately 20 minutes to complete during their final 4 days in initial treatment and after 9 weeks of participation in continuing care.
  • Prompting. CPR participants received prompts (mailed appointment cards, telephone reminders) to attend all of their aftercare appointments and AA/NA meetings, and following missed aftercare sessions for 1 year (or until discharged from treatment).
  • Reinforcement. CPR participants received social reinforcement (certificates, honor roll) for attending group therapy.
Overall Number of Participants Analyzed 91 92
Mean (Standard Deviation)
Unit of Measure: percentage of 90 days
% of days using alcohol or drugs (Baseline) 51  (33) 58  (29)
% of days using alcohol or drugs (3 month) 6  (17) 7  (19)
% of days using alcohol or drugs (6 month) 11  (23) 8  (19)
% of days using alcohol or drugs (12 month) 15  (28) 15  (31)
7.Secondary Outcome
Title Rates of Hospitalization (Across the Prior 90 Days)
Hide Description Number of days hospitalized for any reason per the previous 90 days
Time Frame Assessed at Baseline, 3-, 6-, and 12-months
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Standard Treatment (STX) Contracts, Prompts and Reinforcement (CPR)
Hide Arm/Group Description:

Control condition: Routine residential treatment and orientation to continuing care.

An addiction therapist from the participants' treatment program met with each participant for an individual aftercare orientation session during the final 4 days of the initial treatment program and again during the ninth week of aftercare. Individuals were also encouraged to get an AA or NA sponsor during this session.

Contracting, Prompting & Reinforcing Abstinence & Attendance: Contingent reinforcement of abstinence and prompting of AA/NA attendance

CPR participants received the STX aftercare orientation except they were also provided with the contracting intervention during the orientation sessions, as well as the prompting and reinforcement components of the intervention.

  • Contracting. Participant's completed a behavioral contract for continuing care participation that took approximately 20 minutes to complete during their final 4 days in initial treatment and after 9 weeks of participation in continuing care.
  • Prompting. CPR participants received prompts (mailed appointment cards, telephone reminders) to attend all of their aftercare appointments and AA/NA meetings, and following missed aftercare sessions for 1 year (or until discharged from treatment).
  • Reinforcement. CPR participants received social reinforcement (certificates, honor roll) for attending group therapy.
Overall Number of Participants Analyzed 91 92
Mean (Standard Deviation)
Unit of Measure: days
Days of hospitalization (Baseline) 9.23  (14.42) 6.87  (12.39)
Days of hospitalization (3 months) 1.18  (4.74) 1.93  (8.21)
Days of hospitalization (6 months) 2.14  (8.74) 4.23  (14.73)
Days of hospitalization (12 months) 1.47  (4.07) 2.08  (11.27)
Time Frame 1 year.
Adverse Event Reporting Description No Adverse Events were found in this behavioral intervention study.
 
Arm/Group Title Standard Treatment (STX) Contracts, Prompts and Reinforcement (CPR)
Hide Arm/Group Description

Control condition: Routine residential treatment and orientation to continuing care.

An addiction therapist from the participants' treatment program met with each participant for an individual aftercare orientation session during the final 4 days of the initial treatment program and again during the ninth week of aftercare. Individuals were also encouraged to get an AA or NA sponsor during this session.

Contracting, Prompting & Reinforcing Abstinence & Attendance: Contingent reinforcement of abstinence and prompting of AA/NA attendance

CPR participants received the STX aftercare orientation except they were also provided with the contracting intervention during the orientation sessions, as well as the prompting and reinforcement components of the intervention.

  • Contracting. Participant's completed a behavioral contract for continuing care participation that took approximately 20 minutes to complete during their final 4 days in initial treatment and after 9 weeks of participation in continuing care.
  • Prompting. CPR participants received prompts (mailed appointment cards, telephone reminders) to attend all of their aftercare appointments and AA/NA meetings, and following missed aftercare sessions for 1 year (or until discharged from treatment).
  • Reinforcement. CPR participants received social reinforcement (certificates, honor roll) for attending group therapy.
All-Cause Mortality
Standard Treatment (STX) Contracts, Prompts and Reinforcement (CPR)
Affected / at Risk (%) Affected / at Risk (%)
Total   --/--   --/-- 
Hide Serious Adverse Events
Standard Treatment (STX) Contracts, Prompts and Reinforcement (CPR)
Affected / at Risk (%) Affected / at Risk (%)
Total   0/91 (0.00%)   0/92 (0.00%) 
Hide Other (Not Including Serious) Adverse Events
Frequency Threshold for Reporting Other Adverse Events 0%
Standard Treatment (STX) Contracts, Prompts and Reinforcement (CPR)
Affected / at Risk (%) Affected / at Risk (%)
Total   0/91 (0.00%)   0/92 (0.00%) 
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
Results Point of Contact
Layout table for Results Point of Contact information
Name/Title: Steven Lash, Ph.D.
Organization: Salem Veterans Affairs Medical Center
Phone: (540)982-2463 ext 2593
EMail: Steven.Lash@va.gov
Layout table for additonal information
Responsible Party: VA Office of Research and Development ( US Department of Veterans Affairs )
ClinicalTrials.gov Identifier: NCT00288886    
Other Study ID Numbers: IIR 03-267
First Submitted: February 6, 2006
First Posted: February 8, 2006
Results First Submitted: October 17, 2014
Results First Posted: October 29, 2014
Last Update Posted: April 24, 2015