In this comparison of assertive continuing care (ACC) with usual continuing care (UCC) on linkage, retention and a measure of continuing care adherence, outcome analyses tested the direct and indirect effects of both conditions and level of adherence on early (months 1–3) and longer-term (months 4–9) abstinence.
A two-group randomized design involved 11 counties surrounding a community-based residential treatment program in the Midwestern section of the United States. The study involved 183 adolescents, ages 12–17 years old, with one or more Diagnostic and Statistical Manual version IV (DSM-IV) substance-use dependence disorder and met American Society for Addiction Medicine (ASAM) placement criteria for non-medical residential treatment. Prior to discharge from residential treatment, participants were randomly assigned to receive either UCC, which was available at outpatient clinics in the 11-county study area, or ACC via home visits. Self-reported interview data were collected at intake and 3, 6, and 9 months post-residential discharge. Urine test data and interviews with a caregiver were conducted at baseline and 3 months. ACC led to significantly greater continuing care linkage and retention, as well as longer-term abstinence from marijuana. ACC also resulted in significantly better adherence to continuing care criteria, which predicted superior early abstinence. Superior early abstinence outcomes for both conditions predicted longer-term abstinence. The overall conclusion is that ACC is an effective alternative to UCC for linking, retaining, and increasing adherence to continuing care. Replication with larger samples is needed to investigate further the direct and indirect effects of ACC found in this study. (publisher abstract modified)