Progress Assessment Tool Shows Promise for Substance Use Disorder Treatment

A recently developed 10-item progress assessment tool that monitors substance use disorder (SUD) factors shows promise as a helpful tool in SUD treatment, according to study data published in Psychiatry Research.

Growing evidence demonstrates that progress monitoring may improve SUD medication adherence and outcomes while also providing valuable feedback to clinicians and patients. Authors of a recent study developed a multidimensional assessment tool that monitors patients’ progress while also respecting both patients’ and clinicians’ need for brevity, flexibility, and clinical relevance.

Used at the beginning of sessions, the assessment tool measures both risk factors for relapse ─ such as poor medical or mental health treatment adherence, depression, craving, being in high-risk situations, and low abstinence self-efficacy ─ and positive factors that promote recovery, including active coping, attendance at self or mutual help meetings, spending time with a sponsor, other abstinence-oriented social and recreational activities, and pursuing recovery-oriented personal goals. The tool also assesses items that relate to recent substance use.

The researchers evaluated data on 158 adults (78% men), aged 18 to 65 years, who completed up to 24 months of telephone-based continuing care for cocaine dependence. Participants had completed 2 weeks of intense outpatient treatment, met criteria for lifetime DSM-5 cocaine dependence, and used cocaine within 6 months before entering treatment. Treatment outcomes were assessed via urine toxicology every 3 months.

Mean risk and protective scores were 1.84±1.76 and 7.00±2.15, respectively, on a 1 to 10 scale. No significant effects of either period or condition for the risk or protective score were noted.

Urine samples were obtained for 86%, 81%, 77%, and 77% of participants at 3-, 6-, 9-, and 12-month visits, respectively. There was no demonstrated significant association between average risk score and missing urine drug screen (odds ratio, 1.10; 95% CI, 0.82-1.48; P =.52) Investigators also found that when participants had lower protective factors, such as failure to attend outpatient treatment, they had higher rates of continuing care completion. This suggests participants may have self-selected more involved continuing care.

Despite a large sample size and good adherence, the study included “overwhelmingly” lower income African American men and excluded opioid use disorders. Further research is needed to determine the effectiveness of the tool in a diverse population.

“As administered in an effectiveness trial…the [progress assessment] risk and protective scales predicted substance use status. The 10-item progress assessment shows promise as a pragmatic clinical tool for ongoing monitoring in continuing care for substance dependence,” the researchers concluded.

Reference

Van Horn DHA, Goodman J, Lynch KG, et al. The predictive validity of the progress assessment, a clinician administered instrument for use in measurement-based care for substance use disorders [published online July 5, 2020]. Psychiatry Res. doi: 10.1016/j.psychres.2020.11.3282