Continuing Care Project: A randomised controlled trial of a continuing care telephone intervention following residential substance dependence treatment.

INTERVENTION: Arm 1. 12‐session continuing care telephone intervention. Whilst the person is still attending the residential facility, they will develop a written continuing care plan with the continuing care worker (approximately 1‐hour session). This plan involves reviewing the reasons that the participant wants to change their alcohol and/or substance use, identifying and discussing strategies to manage high risk situations, reviewing rewarding activities that the person can engage in once they leave residential treatment, establishing recovery goals, and identifying support people for the participant. Once the person leaves the residential facility they will be offered 12 telephone sessions over a 3‐month period. These sessions include a general check in, and a review of risk factors and protective factors for the person. Participants are encouraged to identify and plan for high‐risk situations and reflect on and set substance‐related goals. These telephone sessions will take between 15 to 30 minutes to complete. The procedures also include offering face‐to‐face appointments or more frequent telephone contact with participants if they are at significant risk of relapse or adverse events. The continuing care plan and continue care telephone sessions are based on the protocols developed by McKay et al., 2010. Arm 2. 4‐session continuing care telephone intervention. The 4‐session arm consists of the same procedures outlined above (i.e. initial face‐to‐face session). However, participants will only be offered 4‐telephone continuing care sessions over a 1‐month period after they leave the residential program. Intervention delivery: Drug and alcohol workers have been recruited from within The Salvation Army and We Help Ourselves to work as Continuing Care Workers. These people will be based at sites. Training will cover research procedures and role‐plays of assessment instrument administration, the initial face‐to‐face session, additional face‐to‐face sessions if needed, and telephone treatment sessions. Audiotaped feedback will be used to enhance training. Session checklists will be employed to guide weekly supervision provided by the chief investigators and project coordinator. The training will involve a minimum of 4 face to face full day training sessions. It will be supported by weekly supervision sessions (approximately an hour a week) and simulated role plays of sessions using the telephone. Training will be provided just prior to the commencement of the trial. The training and ongoing supervision will be led by a Clinical Psychologist. Treatment fidelity: Prior to commencement of the study the Continuing Care Workers and the Research Clinician will be trained to competency in both the assessment and intervention protocols. This will include auditing practice sessions conducted by the clinicians. Once the study commences, all assessment and intervention sessions will be audiotaped. Independent psychologists will rate a random allocation of treatment of sessions for fidelity and competence, and provide feedback to the Continuing Care Workers throughout the study to maintain fidelity. These tapes will also be reviewed within supervision to support adherence. CONDITION: Alcohol dependence Substance dependence PRIMARY OUTCOME: The primary outcome will be percentage of days abstinent from alcohol and other drugs (excluding tobacco) over the 28‐day period immediately prior to the 6‐month follow‐up. This will be measured using the Timeline Follow‐Back Method. SECONDARY OUTCOME: A within trial cost‐effectiveness analysis will be based on the relative change, between baseline and six‐month post intervention, in the primary outcome variable: percentage days abstinent. This measure will be used for both control and intervention participants who meet the study’s inclusion criteria. A cost model will capture the resources required to deliver the intervention and this will include any intervention‐related costs borne by patients. Patient expenses will be recorded at each participant contact point and collected using a modified Client Services Receipt Inventory (CSRI). Confidence using the Drug Taking Confidence Questionnaire (DTCQ‐8) Health literacy using the the Health Literacy Questionnaire Involvement in community based services and legal services following residential treatment using the Lifetime Drug Use History questionnaire. Patient report recovery outcomes using the Substance Use Recovery Evaluator (SURE) Percentage of days abstinent from alcohol and other drugs (excluding tobacco) over the 28‐day period immediately prior to the 3‐month follow‐up. This will be measured using the Timeline Follow‐Back Method. Physical health using the Short From‐12 Psychological distress using the Kessler‐10 Quality of Life using the EUROHIS Quality of Life 8‐item Index INCLUSION CRITERIA: Participants will be required to be attending residential services provided by The Salvation Army or We Help Ourselves (WHOS). Participants will be required to: (1) have a substance use disorder (i.e. not be attending the service for only a gambling problem), (2) have stayed in the residential facility for at least 4‐weeks, (3). have access to a telephone to complete the intervention when they leave the residential program.