Contracting, prompting and reinforcing substance use disorder continuing care

Area of Science:

• Addiction Medicine
• Clinical Psychology
• Public Health

Background:

• The contracting, prompting, and reinforcing (CPR) aftercare intervention has demonstrated positive effects on treatment adherence in previous clinical trials for substance use disorders.
• Evaluating the efficacy of CPR compared to standard treatment (STX) is crucial for optimizing post-treatment care.

Purpose of the Study:

• To compare the effectiveness of the CPR aftercare intervention against standard treatment (STX) in improving adherence and abstinence rates among individuals with substance use disorders.

Main Methods:

• A multisite randomized clinical trial involving 183 graduates of intensive substance use disorder programs.
• Participants were randomized to receive either CPR aftercare or STX.
• Outcomes measured included aftercare attendance, completion rates, and abstinence rates at 3, 6, and 12 months.

Main Results:

• The CPR group showed a trend towards higher completion rates at 3, 6, and 9 months of aftercare.
• No significant differences were observed in abstinence rates between the CPR and STX groups at any follow-up point (3, 6, and 12 months).
• Exploratory analysis indicated CPR might be more effective for participants not mandated to attend aftercare.

Conclusions:

• While CPR may enhance aftercare attendance and completion, it did not significantly improve long-term abstinence rates compared to standard treatment.
• The cost-effectiveness of CPR warrants further investigation, particularly for specific participant subgroups.
• Further research is needed to refine CPR or identify patient characteristics that predict a better response to this intervention.