Bridging the Gap: Phone-Based Continuing Care Reduces Relapse Following Residential Treatment for Alcohol Use Disorder

High-frequency telephone support from a familiar psychotherapist reduces the risk of relapse after inpatient treatment for alcohol use disorder (AUD), according to a study reported in Alcoholism: Clinical and Experimental Research. Many patients resume drinking within the first few months after residential treatment, so continuous care in this high-risk period is crucial. Typically, this involves face-to-face counselling, but compliance is often low and there is a need for alternative options to improve outcomes during the vulnerable phase. Individualized phone-based support from staff or volunteers, and automated text message-based support, are two lower-cost and user-friendly approaches. In pilot studies these appear to be well accepted and feasible, but data on efficacy have varied, probably because of differences in program delivery and patient populations. The latest study compared the effectiveness of phone and text-based continuing care programs following a 12-week residential AUD program in two specialized Swiss treatment centers. This is the first study in which phone contact was delivered by a psychotherapist already known to the patient from the inpatient setting.

Included were 240 adult patients with AUD who had successfully completed residential treatment, and whose goal was to abstain from alcohol for at least six months. Patients were randomly assigned to one of four continuing care groups for six months: High-frequency phone support (HF-TEL), low-frequency phone support (LF-TEL), text-based support (TEX), or a control group. Phone-support involved 30-minute calls based around cognitive behavioral therapy (CBT) components. Patients in the HF-TEL group were called nine times in total, and in the LF-TEL group three times. Text support consisted of messages asking if the patient had abstained, sent nine times, to which patients could reply ‘yes’, ‘no’, or ‘I need support’; patients replying ‘yes’ were sent a congratulatory  message, while those who did not received a phone call from the psychotherapist. Control group patients were not contacted until follow-up, although any patient could request support if needed. Alcohol outcomes were assessed after six months.

The rate of abstinence after six months was highest in the HF-TEL group (57%),  followed by the LF-TEL (48%), TEX (46%) and control (36%) groups. The difference was statistically significant for the HF-TEL (but not the LF-TEL or TEX) group compared with the control group. The HF-TEL group did not differ significantly from the LF-TEL or TEX groups. Among patients who relapsed, those in the HF-TEL group tended to relapse later than control group patients. Of note, the six-month surveys showed significantly higher alcohol-related ‘self-efficacy’ among the HF-TEL and TEX groups. Self-efficacy – the extent to which a person believes that they will be successful – has previously been shown to be one of the strongest predictors of abstinence after residential treatment.

The findings highlight the importance of a closely monitored, high-frequency continuous care program after residential treatment for bridging the gap to the outpatient environment and working life. It appears that the proactive and frequent phone contact provided by the psychotherapist from the residential setting helped patients overcome the vulnerable post-discharge phase. The existing therapeutic relationship may enhance compliance to continuing care and lead to better outcomes. For patients who do relapse, frequent contact may help them stay connected to health services and aid rapid recovery.

Telephone- and text message-based continuing care after residential treatment for alcohol use disorder: A randomized clinical multi-center study

Y. Graser, S. Stutz, S. Rösner, F. Moggi, L. M. Soravia (pages xxx).

ACER-20-4303.R3