Effectiveness Bank Bulletin. [Transitioning from detox to long-term treatment]

Transitioning opioid-dependent patients from detoxification to long-term treatment: efficacy of intensive role induction. Katz E.C., Brown B.S., Schwartz R.P. et al. Drug and Alcohol Dependence: 2011, 117, p. 24–30. The drive in Britain to increase drug treatment exits will mean more patients detoxifying and in need of being linked to effective follow-on care to safeguard their lives and their recovery. Evidence from the USA that a simple counselling intervention can help make that vital link. Summary The featured study tested two ways of promoting follow-on treatment after patients have been withdrawn (or 'detoxified') from opiate-type drugs – attempts to stabilise their abstinence and avoid the relapse which commonly follows withdrawal. Such initiatives are needed because by itself detoxification usually fails to lead to follow-on treatment. The study builds on previous work showing that involvement in long-term treatment following detoxification can be enhanced by methods including case management to coordinate care from various sources, and role induction counselling, which aims to establish a collaborative relationship within which the dependent user sees themself as a patient in need of further treatment. Prior research from the same team had established that outpatient treatment entry and retention were promoted by a single role induction session with the counsellor who would also conduct the treatment, offered when the patient first attended to apply for treatment. Also in Baltimore, the featured study tested a similar but more extensive intervention as a means of promoting treatment engagement during and after a 30-day opiate detoxification involving stabilisation on buprenorphine/naloxone ('Suboxone') and then tapering doses. Also tested was whether adding case management would further improve engagement. At the outpatient centre, between 2005 and 2008, 240 patients who had opted for a buprenorphine-based detoxification qualified for and joined the study. Typically unemployed and unmarried black men and women in their early 40s, all the patients tested positive for opiates and used these drugs almost every day, and 55% were also positive for cocaine. On average they had two prior detoxifications. The day after medical assessment and their first dose of medication, patients were assigned at random to three types of counselling conducted over five weekly sessions by the counsellor who would care for them during and after detoxification: • the clinic's usual counselling beginning later in the first week of treatment, focused on the disease model of addiction and addressing issues and concerns raised by patients; • intensive role induction, the first session of which took place on the same day as their medical assessment; guided by a manual, counsellors educated patients about detoxification and treatment, addressed their concerns and barriers to continued treatment, and emphasised the value of continuing care beyond detoxification to solidify recovery; • intensive role induction combined with case management, both delivered by the same counsellor in the same sessions starting on the same day as the medical assessment; the case management elements aimed to promote (through advocacy and other concrete means) access to community resources (not just those available at the clinic) which might support the patient's efforts at recovery. To avoid obscuring distinctions between the three counselling options, different counsellors were trained in and delivered each option. All the patients were also offered intensive outpatient group therapy for the five weeks of detoxification, and afterwards at least weekly individual and group counselling for an expected six months or indefinitely if needed