Outreach by Clinicians Improves Outcomes in Addicted Young Adults

December 09, 2009

By Karla Gale

NEW YORK (Reuters Health) Dec 08 - An "assertive" outreach program, with clinicians repeatedly encouraging young adult substance abusers to come in for treatment, can improve their engagement in therapy and improve outcomes, a pilot study indicates.

"Typically, young people are less motivated than older folks to receive treatment for their addictions," Dr. John F. Kelly told Reuters Health in an interview. "The principle of a Community Reinforcement Approach is that we (the professionals) take responsibility for getting young people to come in for treatment and getting them engaged with treatment, as opposed to just waiting for them to come in on their own."

Dr. Kelly, from Massachusetts General Hospital, Boston, presented his group's findings at the American Academy of Addiction Psychiatry annual meeting being held this week in Los Angeles.

He explained that patients were referred by parents or someone in their community, such as their school or their primary care physician. Clinicians at their Addiction Recovery Management Service would then follow-up, calling patients on the telephone until they came in for an evaluation and then regularly during the trial period until the patients started attending in person.

"Counselors shouldn't be afraid to use innovative approaches," he added. "For example, we would use texting to make contact; they like that and will respond."

Once they had patients engaged, the treatment was based on cognitive behavioral therapy, but with greater emphasis on contingency management - catching someone doing something good and rewarding that.

"Our program uses a lot of community support; that could be the family, peers, or other people in mutual help programs who try to alter contingencies in the patient's environment to make it more likely that the patient would want to remain abstinent," the researcher added.

At this week's meeting, he and his colleagues reported on 16 patients, ages 18 to 25, who entered treatment and completed a 3-month follow-up. Compared with the 90 days prior to baseline, the mean number of days spent abstinent increased from 28 to 55 days. Days in which patients were high or intoxicated all day fell from 31 days to 19 days, and the longest period of continuous abstinence rose from 17 to 33 days.

In addition, patients' reports of being bothered by mental health problems declined from 31 to 23 days, while the number of days that mental health had an impact on their functioning fell from 14 to 7.

Dr. Kelly pointed out that two indices of engagement showed positive results. After being in the program for about 6 weeks, patients themselves tended to initiate contacts rather than the counselor. Also, during the second and third months, the patients came to significantly more in-person visits.

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