Case management for persons with substance use disorders.

Area of Science:

• Addiction Medicine
• Public Health
• Health Services Research

Background:

• Patients with alcohol and other drug use disorders (AOD) often face complex, interconnected health and social needs.
• Accessing community services, including substance abuse treatment, presents significant challenges for individuals with AOD.
• Case management, a strategy involving a dedicated case manager, aims to connect these patients with necessary services.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) evaluating case management for individuals with drug abuse issues.
• To assess the impact of case management on successful linkage to services, illicit drug use, and other relevant outcomes.

Main Methods:

• A comprehensive search of multiple databases (Cochrane, MEDLINE, EMBASE, LILACS, PsycINFO, Biological Abstracts) was conducted.
• Included randomized controlled studies comparing case management to treatment as usual or alternative models for patients with alcohol or drug problems.
• Data extraction was performed independently by two reviewer groups, with standardized mean differences calculated.

Main Results:

• Fifteen studies were included. Case management did not significantly reduce illicit drug use (SMD=0.12, p=0.20), with substantial heterogeneity observed.
• Linkage to other treatment services was significantly improved by case management (SMD=0.42, p<0.001), though heterogeneity was also substantial.
• Moderator analyses indicated that the presence of a treatment manual influenced heterogeneity in linkage outcomes. One large trial showed case management superior to psychoeducation and counseling in reducing drug use.

Conclusions:

• Evidence supports case management's effectiveness in enhancing connections to other services for individuals with AOD.
• The impact of case management on reducing drug use and achieving other beneficial outcomes remains inconclusive.
• Further research may be needed to clarify the conditions under which case management yields broader positive effects.