CENTER ON THE CONTINUUM OF CARE (C3 CENTER)
MONITORING AND ADAPTING ADDICTION TREATMENT
Director: John Cacciola, Ph.D.
Addiction may present in many forms and levels of severity; however, contemporary treatments have not been conceptualized, structured, or delivered to meet the differing needs of individuals along that continuum. Treatment is typically not adapted over time to address the changing needs of patients as they move through periods in which their symptoms improve or worsen. Additionally, treatment providers and regulatory agencies traditionally have measured progress and demonstrated accountability by assessing results at some point after patients leave treatment. The resulting outcomes have limited clinical and administrative value.
TRI investigators are developing and evaluating practical, empirically suggested care options for individuals at all points in the severity continuum and recovery process. Several C3 projects employ designs to develop:
- adaptive, stepped care models that adjust treatment over time on the basis of change in patient symptoms and status;
- affordable extended care models of continuous telephone and internet-based monitoring;
- user friendly data collection systems that are clinically meaningful, reduce provider burden, and offer clinically and administratively useful reports.
This adaptive approach to addiction treatment aims to maximize patients’ short and long term participation in appropriate services and improve their outcomes (e.g., patient retention), while holding down costs.
Two active C3 projects are utilizing a web-based concurrent recovery monitoring system for outpatient substance abuse treatment (RecoveryTrack™), a system that clinicians can easily incorporate into their usual practice - something they use with, rather than instead of, their existing skills. It is best considered a clinical intervention, the essence of which is the regular completion of a client monitoring instrument and the clinician’s review of the information with the client (feedback). C3 investigators are also exploring development of a modified version of RecoveryTrack™ to expand use beyond clients “in” or attending treatment (i.e., counselor employment of the system over the phone with clients even if they drop out).
In addition to the above, C3 describes and evaluates innovative treatment approaches across the continuum of addiction treatment. Community recovery centers and recovery homes are two such treatment approaches and, if pursued, would provide (for recovery homes) the most comprehensive examination of these homes and their residents to date, helping to define the parameters of recovery homes and more clearly indicate their place on the substance use services continuum of care.
