The role of continuing care in outpatient alcohol treatment programs.

Substance-abusing patients are frequently urged to participate in continuing care, or "after-care," following an initial phase of treatment. However, there has been relatively little research on the effectiveness of continuing care, particularly in the context of outpatient service delivery systems. Since 1988, 12 controlled studies of continuing care for alcohol use disorders have been published. Only three of these studies were conducted exclusively within outpatient service delivery systems; in the other studies, all patients (six studies) or at least half of the patients (three studies) were first treated in inpatient or residential facilities. Four of the 12 studies yielded positive findings (two of six studies with minimal/no continuing care control conditions and two of six studies with active control conditions). It is suggested that continuing care treatment might be improved by placing greater emphasis on addressing co-occurring problems and facilitating the identification and strengthening of patients' skills, interests, and talents, although additional research would be needed to evaluate the impact of these modifications. Further research is also needed to establish guidelines for when patients are ready to enter continuing care and to develop performance indicators to monitor progress.