TUESDAY Sept. 17, 2013 — Treating drug and alcohol addiction with a concentrated approach called chronic care management may be no more effective than a single medical appointment and addiction referral, according to a new study.
Results of the year-long study are likely to disappoint those who believe treating addiction more like a chronic disease — with a systematic approach and follow-up — is the better way to go.
“We were completely surprised by the result,” said lead researcher Dr. Richard Saitz, a Boston University professor of medicine and epidemiology. “We put everything into this, and we were surprised that even doing that didn’t lead to differences compared to not doing any of it.”
In the study of nearly 600 adult substance abusers, those receiving chronic care management got intensive medical care at a primary-care clinic plus relapse-prevention counseling and addiction and psychiatric treatment. Others in the study had one medical visit at which they received a list of addiction-treatment resources.
After 12 months, 44 percent of those in the chronic care management group had stopped drinking or using drugs, as did 42 percent of those not receiving intensive care, the researchers said.
Despite these similar findings, Saitz said he still believes chronic care management can be useful for some addictions. However, “we don’t want people to assume that it’s going to be effective when applied everywhere for every person,” he said.
More work is needed to determine the best way to use chronic care management and to identify those who will benefit most from the approach, he said.
“We have to recognize that people with drug or alcohol addictions may be different and it’s not one monolithic disorder,” Saitz said. “I do think that integrated chronic care management, in the future, is going to be efficacious for people with addictions.”
The report was published in the Sept. 18 issue of the Journal of the American Medical Association.
Advocates of chronic care management point out that many substance abusers suffer serious health consequences but receive poor care. By addressing medical, emotional and dependence issues in a coordinated manner, patients would achieve better results, the thinking goes.
One expert thinks motivation is the key to any program to treat addiction. People who are motivated are most likely to start and stick with a program or join a clinical trial, said Dr. James Garbutt, a professor of psychiatry at the University of North Carolina at Chapel Hill.
“That’s an important point because that’s saying they already wanted to make some changes,” Garbutt said. “That’s a huge step in substance-abuse treatment.”
This likely explains why people in both groups seemed to benefit, he said.
Chronic care management has been shown to be effective for chronic medical and mental-health conditions, including depression and tobacco dependence, Saitz said. This led him to believe it might work with drug and alcohol dependence.
To test that theory, the researchers recruited nearly 600 people suffering from drug or alcohol addiction and randomly assigned them to chronic care management or primary care and referral.
Those in the chronic care management group received a variety of on-site services coordinated with their primary medical care. These included motivational therapy, relapse-prevention counseling, addiction and psychiatric treatment, social work assistance, and referrals to drug- or alcohol-abuse programs. Addiction drugs also were prescribed if appropriate.
Patients received reminders, and care providers worked in collaboration with one another.
Those in the other group received a medical care visit, a list of addiction-treatment resources and a phone number for accessing motivational therapy sessions.
Although there was no difference in results between the groups, patients with alcohol dependence in the chronic care management group had fewer alcohol problems, the researchers said.
There were, however, no differences in the severity of addiction, health-related quality of life or drug problems between the groups, they said.