Program

May 09, 2016

OVERVIEW

Assertive Continuing Care (ACC) is a program that follows either in-patient or out-patient care for substance abuse.  ACC is home based and lasts for 12-14 weeks after completion of the previous treatment program.  It combines the Adolescent Community Reinforcement Approach with case management services, in order to assist both adolescents and their caregivers in being more pro-social, improving abstinence and risk-reduction skills, and connecting patients to needed community services.  In order to do this, providers visit the adolescents in their home weekly to check in, give support, and provide assistance where needed.  In one study, few differences were found between the groups who received ACC and those who did not.  All the groups saw improvement over time, in terms of percent of days abstinent from alcohol or drugs and overall recovery; however, there were no statistically significant differences at the end of the program.  After shorter follow-up periods, there were small differences found. For example, the more intensive therapy saw improvement in terms of the percentage of days abstinent from drug or alcohol use over the first six to nine months.  The programs were also assessed in terms of cost; the shorter program with no follow-up care was the least expensive program.

DESCRIPTION OF PROGRAM

Target population: Youth ages 12 to 18 struggling with substance abuse and addiction

Assertive Continuing Care (ACC) provides care for 12-14 weeks in the patient’s home and community, after an adolescent has finished a formal out-patient program.  Support is provided to reinforce and support skills to continue in recovery within the patient’s environment – providing skills and support to respond to both the physical (for example, in one’s home or school) and social (friends, peers, and families) environments. ACC can be delivered by trained, Bachelor’s level clinicians.

EVALUATION OF PROGRAM

Godley, S. H., Garner, B. R., Passetti, L. L., Funk, R. R., Dennis, M. L., Godley, M. D. (2010). Adolescent outpatient treatment and continuing care: Main findings from a randomized clinical trial. Drug and Alcohol Dependence, 110 (1-2), 44-54.

Evaluated population: Three-hundred twenty adolescents made up the sample for the evaluation. All had been referred to the program from the juvenile justice system, their families, another agency, or other sources.  The average age of participants was 16, and they were mostly male (76 percent), white (73 percent), in school (93 percent), and involved in the criminal justice system (73 percent).  Seventy-five percent met the criteria for marijuana abuse or dependence, 49 percent were dependent on or abused alcohol, and 35 percent met the criteria for abuse or dependence on both.  Over half of the sample also reported other psychological problems (for example, anxiety, depression, trauma, or ADHD).

Approach: In this evaluation, ACC was added to two existing treatment programs: Chestnut’s Bloomington Outpatient Program (CBOP), and the Motivational Enhancement Therapy/Cognitive Behavioral Therapy-7 sessions (MET/CBT7).  Both are outpatient programs to address substance use that incorporate behavioral skill-building, cognitive-behavioral techniques to encourage self-reflection on decision-making processes, family education, and group therapy.  Thus, there were four groups studied: CBOP with ACC, MET/CBP with ACC, MET/CBP without ACC, and CBOP without ACC.

Participants were randomized by blocks, each consisting of six participants.  Data were collected at baseline and at three, six, nine, and 12 months post-baseline.  Urine samples for drug testing were collected at the three- and 12-month interviews.  The outcomes included in the evaluation were the percentage of days abstinent from any alcohol and drugs in the last 90 days, the percent of days abstinent from alcohol use alone in the last 90 days, results on a substance abuse problem scale (comprised of a list of 16 past-month symptoms), and recovery status at the end of the study (defined as living in the community and having no drug use in the last month – confirmed with a urine drug test).  For “false negatives” – those who said they had not used drugs, but who had a positive urine screen – outcomes were re-categorized as having used drugs.

There were few differences among the groups at baseline.  The one difference was the percent of participants with marijuana dependence.  Participants were successfully retained in the program.  Less than 10 percent of the sample was missing at any point.  Follow-up rates were 97 percent, 96 percent, 93 percent, and 91 percent at each of the four follow-up time points, respectively.

Results: There were four outcomes studied:  percent of days abstinent from drugs or alcohol, number of days abstinent from alcohol, the Substance Problem Scale (measuring behavior in the past month), and recovery at the end of the study.

For percentage of days abstinent from drugs and alcohol, there were statistically significant improvements over time in all four of the groups, compared to baseline data.  The only statistically significant difference by group was in the CBOP group.  This was tested with a global test over time detecting any differences in any group so the other groups were statistically similar over time and the differences between the CBOP group moved in both directions relative to the others.  Overall, the increase of percentage of days abstinent from drugs and alcohol appeared higher in the CBOP groups than in the MET/CBT groups, and higher for the ACC groups than the non-ACC groups, but these differences were not statistically significant.

There were no significant differences among groups or over time on the alcohol use alone outcome.  There were improvements over time on the Substance Problem Scale, but there were no statistically significant differences across the groups.  Finally, there were no statistically significant differences by group in terms of recovery status at the end of the program.

SOURCES FOR MORE INFORMATION

References

Godley, S. H., Garner, B. R., Passetti, L. L., Funk, R. R., Dennis, M. L., Godley, M. D. (2010). Adolescent outpatient treatment and continuing care: Main findings from a randomized clinical trial. Drug and Alcohol Dependence, 110 (1-2), 44-54.

Websites:

CBOP Manual:

http://www.chestnut.org/LI/LighthouseInstituteBookstore/ATM-105-CHS-Bloomington

MET/CBT information:

http://www.evidencebasedpracticenetwork.net/Pages/METCBTtrainings.aspx

ACC:

http://www.chestnut.org/Portals/14/PDF_Documents/Lighthouse/Manuals/ACC_manual_revised_2nd_ed_111306.pdf

Contact Information

Dr. Susan H. Godley, Senior Research Scientist and EBT Coordinating Center Director

Chestnut Health Systems

448 Wylie Drive

Normal, IL 61761

Tel: 309-451-7802

sgodley@chestnut.org

KEYWORDS: adolescents, males and females, juvenile offenders, clinic/provider-based, community-based, home-based, counseling/therapy, marijuana/illicit/prescription drugs, mental health (other)

Program information last updated on 5/9/16.