More than 10% of the U.S. population meets DSM-IV criteria for substance use disorders, according to recent estimates. Although effective interventions have been identified for substance abuse, a significant percentage of patients respond poorly to them. This variability in patient response highlights the need for adaptive models of care—that is, tailored interventions based on treatment algorithms that specify treatment modifications triggered by the patient's initial response and changes in symptoms.
In addition, because relapse is common, addiction interventions should extend beyond the acute phase of care and address functioning over time. Continuing care solidifies and sustains recovery by helping the patient develop and maintain recovery-oriented behaviors and sources of support.
This book provides a comprehensive review of the latest research on both standard approaches to continuing care and newer adaptive models that emphasize
- More flexible protocols
- Less treatment burden and greater convenience for patients
- More attention to patient preference with regard to components of care
- Use of settings other than traditional specialty care programs
- Greater reliance on communication technology
- Greater emphasis on the role of self-care in a disease management approach
A useful appendix presents a detailed description of an adaptive, telephone-based continuing care protocol. This book will be invaluable both to clinical researchers and to clinicians and administrators of addiction programs, who will learn how to develop and evaluate their own adaptive treatment algorithms to better help their patients.
Table of Contents
I. The Case for Continuing Care in Addiction Treatment
- The Course of Substance Use Disorders and Implications for Continuing Care
II. Approaches to Continuing Care
- Traditional Approaches to Addiction Treatment and Continuing Care
- The Therapeutic Process and Participation in Continuing Care
- New Models of Extended Treatment
III. Adaptive Treatment Models
- Initial Attempts to Individualize Treatment for Substance Use Disorders
- Adaptive Models of Treatment
- Adaptive Treatment in the Addictions
IV. Developing and Improving Adaptive Continuing Care Interventions
- A Detailed Look at Current Adaptive Treatment Studies
- Developing Adaptive Treatment Protocols for Clinic or Practice
- Challenges in Designing, Implementing, and Evaluating Adaptive Protocols
V. New Developments and Future Directions
- Other Developments in Disease Management for Substance Use Disorders
- Summary of Key Points and Future Directions
Appendix: Providing Telephone-Based Adaptive Continuing Care
About the Author
James R. McKay, PhD, is a professor of psychology in psychiatry at the University of Pennsylvania. He is the director of the Penn Center on the Continuum of Care in the Addictions and the director of the Philadelphia Veterans Affairs Center of Excellence in Substance Abuse Treatment and Education.
Dr. McKay received a doctorate from Harvard University. He completed a clinical psychology internship at McLean Hospital and a postdoctoral fellowship in treatment outcome research at Brown University. He is the recipient of a K02 Independent Scientist Award from the National Institute on Drug Abuse (NIDA), as well as numerous research grants from NIDA and National Institute on Alcohol Abuse and Alcoholism, including a P01 Center on Adaptive Treatment for Alcoholism.
Dr. McKay has published widely on the development and evaluation of continuing care interventions for alcohol and cocaine use disorders. His most recent work has focused on adaptive approaches to the long-term management of substance use disorders and the degree to which patients' treatment preferences influence retention and outcome.