Maarten J. M. Merkx

Feasibility and validity of low-budget telephonic follow-up interviews in routine outcome monitoring of substance abuse treatment

AIMS Routine outcome monitoring (ROM) is receiving growing attention. However, follow-up interviews are time-consuming and costly. This study examines the feasibility and validity of low-budget telephonic follow-up interviews for ROM in a substance abuse treatment centre (SATC). DESIGN Observational study using data collected for routine outcome monitoring. SETTING The study was performed in a SATC in an urban area in the Netherlands. Participants Feasibility and validity were assessed on data of 2325 patients. MEASUREMENTS Data on pre-treatment socio-demographic and clinical characteristics were collected using electronic patient records (EPRs) and the European version of the Addiction Severity Index (EuropASI). Data on intensity of treatment were also collected through the EPRs. Telephonic follow-up interviews were conducted between 9 and 10 months after intake. FINDINGS A 53% follow-up rate was achieved; 35% of the patients could not be contacted, 3% explicitly refused and in 8% other reasons accounted for non-participation. About 50% of the interviews took place in the intended time-frame. Costs were Euro 40 (57 US dollars) per completed interview. There were indications of selection bias, because patients with cocaine as their primary problem and patients with polysubstance abuse were under-represented in the follow-up sample; the presence of these disorders is associated with negative treatment outcome. CONCLUSIONS Implementing telephonic low-budget follow-up interviews for ROM is feasible, but selection bias threatens internal validity of data, limiting generalization to the total treatment population. Increased efforts to track patients for follow-up may improve generalization.

Guidelines for allocating outpatient alcohol abusers to levels of care: Predictive validity

The purpose of this study was to assess the predictive validity of guidelines for allocating outpatients with an alcohol-use disorder to different levels of care in routine alcohol outpatient treatment facilities. It was hypothesized that patients matched to the recommended level of care would have (a) better outcomes than patients treated at a less intensive level of care, and (b) outcomes equivalent to patients treated at a more intensive level of care. Patients at two Dutch substance-abuse treatment centers who completed intake and were allocated at either a brief or standard outpatient treatment (n=471) were followed prospectively to determine differential outcomes for those who were and were not treated at the recommended level of car. The former patients were allocated according to an algorithm based on their treatment history, addiction severity, psychiatric impairment and social stability at baseline. 52.9% of the original sample was successfully contacted for follow-up 11 months after intake. Outcome was measured in terms of self-reported alcohol use 30 days prior to follow up and changes in number of excessive and nonexcessive drinking days between intake and follow up. Only 21% of the patients were matched to the level of care according to the guidelines. Patients allocated to the recommended level of care did not have better outcomes than those treated at a less intensive level of care, but they had outcomes comparable to patients treated at a more intensive level of care. The a priori allocation guidelines were followed for only a minority of the patients, and using them did not improve treatment outcome. Further work is needed to improve the content of the treatment allocation guidelines.

Predictive validity of treatment allocation guidelines on drinking outcome in alcohol-dependent patients

The purpose of this study was to establish the predictive validity of guidelines for allocating patients to outpatient or inpatient treatment for an alcohol-use disorder. It was hypothesized that patients who were matched to the recommended level of care would have (a) better outcomes than patients treated at a less intensive level of care, and (b) outcomes equivalent to those of patients treated at a more intensive level of care. Matched patients were allocated according to an algorithm based on their treatment history, addiction severity, psychiatric impairment, and social stability at baseline. Outcome was measured in terms of self-reported alcohol use 30days prior to follow-up and changes in number of abstinent and heavy drinking days between intake and follow up. Of the 2,310 patients, 65.4% were successfully followed up 9.67months after intake. Only 22% of the patients were treated according to the level of care prescribed by the guidelines; 49% were undertreated; and 29% were overtreated. The results were not in line with our hypotheses. Patients treated at a more intensive level of care than recommended had favorable outcomes compared to patients treated at the recommended level of care (55.5% vs. 43.9% success). Patients allocated to the recommended level of care did not have better outcomes than those treated at a less intensive level of care (43.9% vs. 38.3% success). Based on these results, we suggest ways to improve the algorithm for allocating patients to treatment.

Multidisciplinaire richtlijn stoornissen in het gebruik van alcohol: Een kritische bespreking

Afgelopen voorjaar verscheen de multidisciplinaire richtlijn stoornissen in het gebruik van alcohol.1 De verslavingszorg als ook andere professionals die werken met cliënten met problematisch alcoholgebruik hebben hiermee een mooi en gedegen overzicht welke interventies effectief worden geacht bij de behandeling en begeleiding van hun cliënten. In deze bijdrage bespreken we de verschillende (kern)aanbevelingen en gaan we in op de vraag in hoeverre de richtlijn strookt met de dagelijkse praktijk in de verslavingszorg.

Motiverende gespreksvoering in de forensische verslavingszorg

Motiverende gespreksvoering is een directieve en clientgerichte benadering, bedoeld om mensen te helpen hun problemen te onderkennen en hen vervolgens aan te zetten tot en te ondersteunen bij gedragsverandering. In een motiverend gesprek wordt ‘verandertaal’ uitgelokt – uitspraken die betrekking hebben op de intentie te veranderen. Deze uitspraken zijn voorspellend voor gedragsverandering. Binnen de forensische (verslavings)zorg wordt motiverende gespreksvoering toepast bij diverse doelgroepen. De effectiviteit ervan is tot nu toe beperkt aangetoond. Na training vertonen hulpverleners verbetering in motiverende gespreksvaardigheden, die echter niet altijd resulteren in daadwerkelijke gedragsverandering bij gedetineerden. Langdurige supervisie na training is noodzakelijk om het niveau van gespreksvaardigheden te handhaven en te verbeteren.

How Motivational Interviewing emerged

SamenvattingOp 2 september 2005 organiseerde de sectie Verslaving van de Vereniging voor Gedragstherapie en Cognitieve Therapie in Amsterdam een symposium over Motivational Interviewing (MI). William R. (‘Bill’) Miller, grondlegger van deze effectieve, cliënt-centerend maar ook directieve hulpverleningsmethodiek hield een publiekslezing nadat hij het eerste exemplaar van de Nederlandse vertaling van zijn boek Motivational Interviewing in ontvangst had genomen. Gerard Schippers, hoogleraar verslavingsgedrag en zorgevaluatie leidde de middag in met een overzicht over motiverende gespreksvoering in Nederland.