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).