Brent A Moore1, Frank D Buono2, Daniel P Lloyd3, Destiny M B Printz2, David A Fiellin4, Declan T Barry3. 1. Department of Psychiatry, Yale School of Medicine, New Haven, 06511, CT, USA; VA Connecticut Healthcare System, West Haven, 06516, CT, USA; APT Foundation, New Haven, 06511, CT, USA. Electronic address: brent.moore@yale.edu. 2. Department of Psychiatry, Yale School of Medicine, New Haven, 06511, CT, USA; VA Connecticut Healthcare System, West Haven, 06516, CT, USA; APT Foundation, New Haven, 06511, CT, USA. 3. Department of Psychiatry, Yale School of Medicine, New Haven, 06511, CT, USA; APT Foundation, New Haven, 06511, CT, USA. 4. Department of Internal Medicine, Yale University School of Medicine, New Haven, 06510, CT, USA.
Abstract
BACKGROUND: Relapse, drug use, and treatment dropout are common challenges facing patients receiving methadone. Though effective, multiple barriers to face-to-face counseling exist. The Recovery Line (RL), an automated, self-management system based on Cognitive Behavioral Therapy, is a phone-based adjunctive treatment that provides low cost, consistent delivery and immediate therapeutic availability 24 h a day. METHODS: The current study was a 12-week randomized clinical efficacy trial of treatment-as-usual (TAU) only or RL + TAU for methadonetreatment patients with continued illicit drug use (N = 82). Previous small trial phases evaluated methods to increase participant engagement and use of the RL and were incorporated into the current RL version. Primary outcomes were days of self-reported illicit drug abstinence and urine screens negative for illicit drugs. RESULTS: Days of self-reported illicit drug abstinence improved for patients in RL + TAU but not in TAU. Percent of urine screens negative for illicit drugs, coping skills efficacy, and retention in methadone treatment did not differ by condition. Patients in RL + TAU attended more substance use disorder treatment and self-help group sessions during treatment than those in TAU. RL system use was generally low and more system use was correlated with abstinence outcomes. CONCLUSIONS: Although the RL did not impact urine screen outcomes, it increases self-reported abstinence. Additional methods to increase patient engagement with automated, self-management systems for substance use disorder are needed.
RCT Entities:
BACKGROUND: Relapse, drug use, and treatment dropout are common challenges facing patients receiving methadone. Though effective, multiple barriers to face-to-face counseling exist. The Recovery Line (RL), an automated, self-management system based on Cognitive Behavioral Therapy, is a phone-based adjunctive treatment that provides low cost, consistent delivery and immediate therapeutic availability 24 h a day. METHODS: The current study was a 12-week randomized clinical efficacy trial of treatment-as-usual (TAU) only or RL + TAU for methadone treatment patients with continued illicit drug use (N = 82). Previous small trial phases evaluated methods to increase participant engagement and use of the RL and were incorporated into the current RL version. Primary outcomes were days of self-reported illicit drug abstinence and urine screens negative for illicit drugs. RESULTS: Days of self-reported illicit drug abstinence improved for patients in RL + TAU but not in TAU. Percent of urine screens negative for illicit drugs, coping skills efficacy, and retention in methadone treatment did not differ by condition. Patients in RL + TAU attended more substance use disorder treatment and self-help group sessions during treatment than those in TAU. RL system use was generally low and more system use was correlated with abstinence outcomes. CONCLUSIONS: Although the RL did not impact urine screen outcomes, it increases self-reported abstinence. Additional methods to increase patient engagement with automated, self-management systems for substance use disorder are needed.
Authors: Lisa A Marsch; Honoria Guarino; Michelle Acosta; Yesenia Aponte-Melendez; Charles Cleland; Michael Grabinski; Ronald Brady; Joyce Edwards Journal: J Subst Abuse Treat Date: 2013-09-21