Improving Substance Abuse Treatment Access and Retention Using a Case Management Approach
Mejta, Cheryl L, Bokos, Peter J, Mickenberg, Judith, Maslar, Michael E, Senay, Edward, Journal of Drug Issues
The effectiveness of a case management model in improving treatment access, retention, and outcomes was examined within a cohort of 360 intravenous drug users (IDUs) pursuing substance-abuse treatment through a central intake facility. IDUs were randomly assigned either to the case management group or to the comparison group. In the case managed condition, IDUs received assistance from their case manager in identifying and accessing needed services, including substance abuse treatment. In the comparison condition, IDUs received limited referral information for substance abuse treatment. Clients in the case managed group accessed substance abuse treatment in significantly greater numbers and more rapidly than clients in the comparison group. Casemanaged clients also remained in substance abuse treatment nearly twice as long as did comparison group clients. Finally, case-managed clients showed better treatment outcomes including reduced alcohol and drug use.
Treatment outcome research has demonstrated that substance abuse treatment works for many clients (Tims et al. 1991). Two major national, longitudinal treatment outcome studies, the Drug Abuse Reporting Program and the Treatment Outcome Prospective Study, followed over 55,000 clients entering substance abuse programs for up to 12 years after admission into treatment. Substance abuse treatment was found to be effective in reducing or eliminating drug use and associated problems as well as in increasing employment and stabilizing families (Hubbard et al. 1989; Simpson 1988).
Research also has demonstrated that substance abuse treatment is cost effective (Lewis and Klinenberg 1994). In collaboration with the California Department of Alcohol and Drug Programs, the National Opinion Research Center (1994) recently conducted an evaluation of substance-abuse treatment outcomes for four major types of treatment programs (residential programs, residential social model programs, outpatient programs, and outpatient methadone programs) in California. Over 1,850 persons who previously participated in I of 83 substance-abuse treatment programs were interviewed; the average follow-up interview occurred 15 months after treatment discharge, although some interviews occurred as long as 24 months after treatment. The results of the study demonstrated that treatment yields considerable economic benefits. A cost-benefit ratio of 1:7 was found; that is, for every 1 dollar spent on treatment 7 dollars were saved through reductions in criminal activity and improvements in health. And, these savings began the day the person entered treatment.
Clear benefits are derived from substance-abuse treatment by the substance abuser, his or her family, and society. Although treatment may work for many substance abusers, several factors impede admission into treatment. As funding for substance abuse treatment has dwindled, the substance-abuse treatment system has been unable to deliver its services to the many substance abusers in need of those services. The current substance-abuse treatment delivery system is characterized by long waiting periods (3 to 4 weeks) and inadequate access (Schlesinger et al.1991). Treatment waits ranging from several weeks to several months are common (Watkins 1994).
Rapid access to substance-abuse treatment is critical to sustain a substance abuser's motivation for treatment. According to the stages of change model proposed by Prochaska and DiClemente (1985) , motivation to enter treatment dissipates if a substance abuser who has made the decision to enter treatment does not access treatment quickly. Maddux's (1993) research findings supported this contention. Higher rates of treatment admissions were found among substance abusers who were accepted into treatment more rapidly. A 2-week delay in treatment admission resulted in a loss of 25% of the substance abusers who were seeking treatment. Admission within 1 day resulted in 95% of the substance abusers entering treatment. …