Improving Treatment Engagement in Opioid-Dependent Outpatients with a Motivated Stepped-Care Adaptive Treatment Model
Abstract:Background: Substance abuse treatment programs that provide long term care that includes methadone routinely treat patients with both the chronic and severe form of opioid dependence disorder. In the early 1990s the Addiction Treatment Services clinic at Johns Hopkins Bayview Medical Center began experiencing a growing problem with poor counseling attendance and high rates of continuing opioid and other drug use, primarily cocaine.
Methods: A comprehensive and adaptive treatment model was developed that adjusts the amount of individual counseling and group therapy, medication dose, and overall monitoring, and integrates them with clinic-based behavioral reinforcement procedures to increase patients' attendance. This model of care (Motivated Stepped Care [MSC]), an adaptive stepped-care treatment approach, was implemented in 1995.
Results: The MSC model has demonstrated large improvements in counseling attendance and rates of urine specimens testing negative for drug use. Additional work has extended the model's evaluation to other common problems—continuing unemployment and limited access to and participation in drug-free social support.
Conclusion: The MSC adaptive treatment model is a viable and effective alternative to standard treatment approaches. It is integrated with performance improvement monitoring to inform and adjust the amount of services necessary to achieve and sustain good clinical response to treatment during months and years of care.
Document Type: Research Article
Publication date: 2008-04-01
More about this publication?
- The Joint Commission Journal on Quality and Patient Safety will be published by Elsevier beginning in 2017! For readers who receive access to the journal through their institutions, the journal can now be found on ScienceDirect (http://www.sciencedirect.com/science/journal/15537250). For librarians looking to subscribe to the journal for their institutions please contact your Elsevier Account Manager or visit www.myelsevier.com for more information. All other readers, please visit http://www.jointcommissionjournal.com/ to subscribe to the journal or to claim your access for an existing subscription.
- Editorial Board
- Information for Authors
- Subscribe to this Title
- Information for Advertisers
- Reprints and Permissions
- Ingenta Connect is not responsible for the content or availability of external websites