Telephone monitoring improves drug use, psychiatric symptoms

By Ingrid Grasmo

Patients being treated for a substance use disorder (SUD) achieve significant short-term improvements in their drug use and psychiatric symptoms when receiving telephone continuing care, show study findings.

"The current study provides further support for the use of telephone continuing care," say John McKellar (Stanford University School of Medicine, California, USA) and colleagues.

In total, 667 patients with a SUD were randomly assigned to receive telephone case monitoring (TCM) or standard face-to-face continuing care as usual, and were interviewed over the telephone at baseline, and after 3 and 12 months. The patients were asked to self-report substance use, and completed questionnaires on psychiatric symptoms such as depression, anxiety, psychosis, and paranoia, quality of life, and treatment satisfaction.

Of the enrolled patients, 78% completed a 3-month assessment and 79% completed the 12-month assessment, with no significant differences seen between the groups.

Patients randomly assigned to receive TCM were substantially engaged with face-to-face continuing care, resulting in crossover contamination of the study group. When the team adjusted for this variable, they found a significant 0.43% and 0.42% increase in the number of days spent in abstinence from alcohol and drugs, respectively, at 3 months. However, this was not significant at 12-months follow up.

Similarly, for each telephone call contact at 3-month follow up there was a significant 0.47 decrease in psychiatric symptoms, where 1 equals a psychiatric diagnosis other than SUD and 0 equals no diagnosis, but this was no longer significant by 12 months. TCM did not significantly impact quality of life, including physical health, mental health, or general health.

Furthermore, no significant interaction was found for TCM with psychiatric comorbidity, drug and alcohol disorder, or distance to the clinic.

"As evidence supporting telephone continuing care for SUD grows, a shift in focus will be needed to investigate efficient methods of training counselors, ranging from merely providing telephone protocols, to local/regional training, or using 'train the trainer' methods," conclude the authors in Addictive Behaviours.

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