For the first time in this column, we will examine the research on continuing care. Our literature review uncovered one particular article that did a commendable job of summarizing the research to date on continuing care (McKay, 2009). We outline the key points of that research, tease out a few findings that have practical value and encourage a crack at a small research project for the bold.

One small forewarning: addiction re­search usually presents a mixed bag of results. That mixed bag of results will be reflected here. However, there are a number of moderately solid findings that, if implemented, may well assist the recovery process for your clients.

Continuing care research
It was once referred to as aftercare, but the common term these days is continuing care. This is a phase of treatment that generally follows an intense level of addiction treatment such as inpatient addiction rehabilitation. For a long time, many inpatient programs offered limited ongoing care or simply referred clients to local outpatient programs. Recently, things have begun to change a bit and continuing care is getting the attention it deserves. If there is indeed more attention being given to continuing care, the question becomes, “what is effective at this level of treatment?”

One noteworthy finding indicates that continuing care is not the simple standard approach so often provided by treatment programs, but actually as with other parts of modern addiction treatment, is actually quite complex (McKay, 2009). Another noteworthy finding was that in terms of overall effectiveness, the research indicated that continuing care conducted over longer periods of time holds advantages over shorter durations of intervention, provided the clients remain engaged.

Continuing care interventions that use more direct and active attempts to bring treatment to the client through aggressive outreach (i.e., taking the treatment to the client by visiting the home, or inviting a spouse to session, or through lower burden delivery systems such as using the telephone) all had clear advantages over the old traditional approaches. The traditional formats generally expect clients to show-up-for-a-group session. All the research projects reviewed in McKay’s study used a variety of the aggressive methods mentioned above; none used the show up for a session method. An interesting finding was the aggressive continuing care methods generally ran for 12 months or longer.

One of the mixed bag findings was a clear recognition that despite using the so-called effective interventions, clients varied in their response to continuing care. Some did well, some didn’t. More­over, many didn’t wish to engage in continuing care even when it was available. This was true even with the best of continuing care programs. In most studies, about one-third of the continuing care programs had very good outcomes; about one-third had mixed outcomes; and about one-third did poorly.

There were two other findings that offered a mixed bag of outcomes. First, while many clients wanted to come into residential care, they also wanted to finish, and stop coming to a continuing care clinic for regular sessions. Second, many clients were unable to come to continuing care sessions because of family responsibilities, transportation problems or similar issues. Often, clinicians make generalized and sometimes incorrect assumptions about why clients are not coming to continuing care treatment, such as because they are resisting treatment or are in denial.

Lastly, no particular theoretical approach, such as cognitive behavior therapy or motivational enhancement therapy, appeared to influence continuing care effectiveness. From all the examined research, only a weak effect was noted for the more intense (meaning many sessions) interventions over the not so intense varieties.

McKay also looked at future promising interventions, and noted three things. First, new models of treatment are being developed that may use algorithms to guide counselors in response to progress or lack of progress. Second, medications to reduce relapse, such as Naltrexone, may become an important part of continuing care interventions. Third, there seems to be energy growing around what works and what does not work when it comes to continuing care—a career thought, for a young researcher or enterprising addiction counselor.

Try it
In this section, we apply the research cited above to practical applications you could use without much effort. There seems to be a number of things you can immediately employ.

First, if you are associated with an inpatient rehabilitation program and don’t have a continuing care component, start one. Rely on the methods listed just below, especially the aggressive methods that bring treatment to the client. Second, if you are associated with an inpatient rehabilitation program and have a continuing care component, take some time to examine if you are using any of the methods noted above that have been found to effective. If not, consider using some of the methods outlined in this quick summary:
• Bring your continuing care treatment to the client (aggressive method).
• Don’t put all your theoretical eggs in one basket. That is, do not rely on a single treatment approach.
• If a client stops coming to continuing care sessions, don’t jump to the conclusion that they are in denial. They could well be busy with work, family or any number of life situations.
• Consider the use of Naltrexone.
• If continuing care is becoming more complex, as suggested by McKay, that means placing more emphasis on tailor-made treatment, because simple approaches tend to over generalize address complex issues.

Third, consider that many enterprising individuals who wish to start a program of their own focus on those clients who are early in treatment, or what is commonly referred to as the precontemplation stage of change. The new thought is why not shift direction and start treatment programs that meet the needs of those coming out of intensive inpatient programs. Many rehab programs only offer limited levels of continuing care. Why not start programs that concentrate on this important phase of treatment? Consider creating a national franchise of such programs that exclusively meet the needs of clients fresh out of intensive treatment. It might actually work.

Research you can do
If you have a continuing care component to your program, you probably know the approximate percentage of clients maintain their recovery in one form or another after they leave your program. This simple experiment would be to introduce changes suggested from McKay into your present program and simply note any changes in variables of sobriety from the day you start making your changes. Nothing fancy, just change a few things and see what, if anything, happens.

Of importance in such a project might be an anonymous client survey that would potentially give you vital information. Toward the end of your continuing care program, consider asking your clients to complete a short survey of what they found helpful, not helpful, or liked and what they didn’t like. Be sure to include the following issues:
• the usual demographics (age, gender, married, in a relationship, employed, etc.)
• chemical of choice, how long used
• how many previous treatment programs they attended
• if they had to pick one key component of treatment that made the biggest impact on their new recovery, what it might be
As always, I remain interested in your findings, especially with this subject area.

Mike Taleff has written numerous articles, several books, teaches at the college level, and conducts trainings and workshops (e.g., the latest treatment practices, Critical Thinking and Advanced Ethics). He can be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it , or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Jamie Irvine is job placement specialist who is presently attending Leeward Community College studying to be a
certified substance abuse counselor. She has two adult children also attending college in Hawaii.

References
McKay, J.R. (2009). Continuing care research: What we have learned and where we are going. Journal of Substance Abuse Counseling, 36, 2,131–145

This article is published in Counselor, The Magazine for Addiction Professionals, October 2009, v.10, n.5, pp.36-37.

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Liz Brown  - family support worker   |72.130.240.xxx |2010-09-09 11:56:15 I do outreach services for our clients who have graduated from our program it is a type of conting care in which i go to where the client is at home, sober house, transitional shelter etc. Your rihgt some do well others don't some want the service others don't. I think for them to know that they have the support is somewhat comforting and they do ned help navigating thru the "system" ou there. Reply 0   0

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