TY - JOUR
T1 - Efficacy and comparative effectiveness of telephone and smartphone remote continuing care interventions for alcohol use disorder
T2 - a randomized controlled trial
AU - McKay, James R.
AU - Gustafson, David H.
AU - Ivey, Megan
AU - Pe-Romashko, Klaren
AU - Curtis, Brenda
AU - Thomas, Tyrone
AU - Oslin, David W.
AU - Polsky, Daniel
AU - Quanbeck, Andrew
AU - Lynch, Kevin G.
N1 - Publisher Copyright:
© 2021 Society for the Study of Addiction.
PY - 2022/5
Y1 - 2022/5
N2 - Background and Aims: Management of alcohol use disorder (AUD) could be enhanced by effective remote treatments. This study tested whether supplementing intensive outpatient programs (IOPs) with continuing care delivered via (1) telephone, (2) smartphone or (3) their combination improves outcomes relative to (4) IOP only. Continuing care conditions were also compared. Design: Randomized controlled trial of four groups with 3-, 6-, 9-, 12- and 18-month follow-ups. Setting: University research center in Philadelphia, PA, USA. Participants: Participants (n = 262) met DSM-V criteria for AUD, were largely male (71%) and African American (82%). Interventions and Comparator: Telephone monitoring and counseling (TMC; n = 59), addiction comprehensive health enhancement support system (ACHESS; n = 68) and TMC + ACHESS (n = 70) provided for 12 months. The control condition received IOP only (TAU; n = 65). Measurement: The primary outcome was percentage of days heavy drinking (PDHD) in months 1–12. Secondary outcomes were any drinking, any drug use, drinking consequences and quality of life. Findings: Mean PDHD in months 1–12 was 10.29 in TAU, 5.41 in TMC, 6.80 in ACHESS and 5.99 in TMC + ACHESS. PDHD was lower in TMC [Cohen's d = 0.35, P = 0.018, 95% confidence interval (CI) = (−1.42, −0.20)], ACHESS [d = 0.31, P = 0.031, 95% CI = (−1.27, −0.06)] and TMC + ACHESS [d = 0.36, P = 0.009, 95% CI = (−1.40, −0.20)] than in TAU. Differences between TMC + ACHESS, TMC and ACHESS were small (d ≤ 0.06) and non-significant. Findings were inconclusive as to whether or not the treatment conditions differed on PDHD at 18 months. A significant effect was obtained on any drinking, which was higher in months 1–12 in TAU than in TMC [odds ratio (OR) = 3.02, standard error (SE) = 0.43, 95% CI = (1.30, 6.99), P = 0.01] and TMC + ACHESS [OR = 2.43, SE = 0.39, 95% CI = (1.12, 5.27), P = 0.025). No other significant effects were obtained on other secondary outcomes during or after treatment. Conclusions: A telephone-delivered intervention and a smartphone-delivered intervention, alone and in combination, provided effective remote continuing care for alcohol use disorder. The combination of both interventions was not superior to either alone and effects did not persist post-treatment.
AB - Background and Aims: Management of alcohol use disorder (AUD) could be enhanced by effective remote treatments. This study tested whether supplementing intensive outpatient programs (IOPs) with continuing care delivered via (1) telephone, (2) smartphone or (3) their combination improves outcomes relative to (4) IOP only. Continuing care conditions were also compared. Design: Randomized controlled trial of four groups with 3-, 6-, 9-, 12- and 18-month follow-ups. Setting: University research center in Philadelphia, PA, USA. Participants: Participants (n = 262) met DSM-V criteria for AUD, were largely male (71%) and African American (82%). Interventions and Comparator: Telephone monitoring and counseling (TMC; n = 59), addiction comprehensive health enhancement support system (ACHESS; n = 68) and TMC + ACHESS (n = 70) provided for 12 months. The control condition received IOP only (TAU; n = 65). Measurement: The primary outcome was percentage of days heavy drinking (PDHD) in months 1–12. Secondary outcomes were any drinking, any drug use, drinking consequences and quality of life. Findings: Mean PDHD in months 1–12 was 10.29 in TAU, 5.41 in TMC, 6.80 in ACHESS and 5.99 in TMC + ACHESS. PDHD was lower in TMC [Cohen's d = 0.35, P = 0.018, 95% confidence interval (CI) = (−1.42, −0.20)], ACHESS [d = 0.31, P = 0.031, 95% CI = (−1.27, −0.06)] and TMC + ACHESS [d = 0.36, P = 0.009, 95% CI = (−1.40, −0.20)] than in TAU. Differences between TMC + ACHESS, TMC and ACHESS were small (d ≤ 0.06) and non-significant. Findings were inconclusive as to whether or not the treatment conditions differed on PDHD at 18 months. A significant effect was obtained on any drinking, which was higher in months 1–12 in TAU than in TMC [odds ratio (OR) = 3.02, standard error (SE) = 0.43, 95% CI = (1.30, 6.99), P = 0.01] and TMC + ACHESS [OR = 2.43, SE = 0.39, 95% CI = (1.12, 5.27), P = 0.025). No other significant effects were obtained on other secondary outcomes during or after treatment. Conclusions: A telephone-delivered intervention and a smartphone-delivered intervention, alone and in combination, provided effective remote continuing care for alcohol use disorder. The combination of both interventions was not superior to either alone and effects did not persist post-treatment.
KW - Alcohol use disorder
KW - continuing care
KW - outcome
KW - smartphone
KW - telephone
KW - treatment
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UR - http://www.scopus.com/inward/citedby.url?scp=85121596948&partnerID=8YFLogxK
U2 - 10.1111/add.15771
DO - 10.1111/add.15771
M3 - Article
C2 - 34859519
AN - SCOPUS:85121596948
SN - 0965-2140
VL - 117
SP - 1326
EP - 1337
JO - Addiction
JF - Addiction
IS - 5
ER -