Quality of Research
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1McKay, J. R., Lynch, K. G., Shepard, D. S., & Pettinati, H. M. (2005). The effectiveness of telephone-based continuing care for alcohol and cocaine dependence: 24-month outcomes. Archives of General Psychiatry, 62(2), 199-207.  Study 2McKay, J. R., Van Horn, D. H., Oslin, D. W., Lynch, K. G., Ivey, M., Ward, K., et al. (2010). A randomized trial of extended telephone-based continuing care for alcohol dependence: Within-treatment substance use outcomes. Journal of Consulting and Clinical Psychology, 78(6), 912-23.
Supplementary Materials Agrawal, S., Sobell, M. B., & Sobell, L. C. (2008). The Timeline Followback: A scientifically and clinically useful tool for assessing substance use. In R. F. Belli, F. P. Stafford, & D. F. Alwin (Eds.), Calendar and time diary methods in life course research (pp. 57-68). Washington DC: SAGE.
ETDD Treatment Adherence Procedures (revised 2/1/10) and Fidelity Checklist
Lynch, K. G., Van Horn, D., Drapkin, M., Ivey, M., Coviello, D., & McKay, J. R. (2010). Moderators of response to telephone continuing care for alcoholism. American Journal of Health Behavior, 34(6), 788-800.
McKay, J. R. (2005). Is there a case for extended interventions for alcohol and drug use disorders? Addiction, 100(11), 1594-1610.
McKay, J. R., Lynch, K. G., Shepard, D. S., Morgenstern, J., Forman, R. F, & Pettinati, H. M. (2005). Do patient characteristics and initial progress in treatment moderate the effectiveness of telephone-based continuing care for substance use disorders? Addiction, 100(2), 216-226.
McKay, J. R., Lynch, K. G., Shepard, D. S., Ratichek, S., Morrison, R., Koppenhaver, J., & Pettinati, H. M. (2004). The effectiveness of telephone-based continuing care in the clinical management of alcohol and cocaine use disorders: 12-month outcomes. Journal of Consulting and Clinical Psychology, 72(6), 967-979.
Mensinger, J. L., Lynch, K. G., TenHave, T. R., & McKay, J. R. (2007). Mediators of telephone-based continuing care for alcohol and cocaine dependence. Journal of Consulting and Clinical Psychology, 75(5), 775-784.
Outcomes
| Outcome 1: Alcohol and cocaine abstinence rates |
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Description of Measures
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Alcohol and cocaine abstinence rates were measured by the Timeline Followback (TLFB) method. The TLFB method uses a calendar-based interview to reconstruct prior days of drinking and drug use over a specified period. Reports of daily alcohol and cocaine use were obtained at baseline (last week of intensive outpatient treatment) for the prior 6 months , at 3 months postbaseline (end of continuing care intervention), and at 6, 9, 12 18, and 24 months postbaseline.
In addition, each client was assigned a composite risk indicator score going into continuing care. To calculate the score, seven items were dichotomously scored 1 or 0 and then summed. Items measured, for example, whether the client was dependent on both alcohol and cocaine at entry into intensive outpatient treatment, whether the client had used any cocaine or any alcohol during intensive outpatient treatment, how many self-help meetings they attended, and how they rated on social support and self-efficacy measures. Higher composite scores indicated higher risk, based on poorer progress toward treatment goals and dependence on both alcohol and cocaine versus just one substance.
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Key Findings
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Following regular group therapy attendance in a 4-week intensive outpatient treatment program for alcohol or cocaine dependence (DSM-IV criteria) and at least 1 week of negative urinalysis, clients were randomly assigned to one of three 12-week continuing care conditions: TMAC, relapse prevention (RP), and standard 12-step-oriented group counseling. Findings from this study included the following:
- TMAC continuing care clients reported higher alcohol and cocaine abstinence rates than clients assigned to standard 12-step-oriented group counseling at all follow-up assessment points (p < .05).
- Clients with low composite risk indicator scores (< 3) achieved higher alcohol and cocaine abstinence rates through month 21 of follow-up if assigned to TMAC than if assigned to standard 12-step-oriented group counseling. Conversely, clients with high composite risk scores (> 4) achieved higher alcohol and cocaine abstinence rates if assigned to standard 12-step-oriented group counseling than if assigned to TMAC (p = .04).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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| Outcome 2: Alcohol use |
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Description of Measures
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In one study, alcohol use was measured among all clients who were diagnosed with alcohol dependence (DSM-IV criteria) at the time of admission into the intensive outpatient treatment program. Measurements were obtained using blood sample assays for gamma-glutamyltransferase (GGT) enzyme levels, an index of heavy alcohol use. Samples were taken at baseline (last week of intensive outpatient treatment) and at 12- and 24-month follow-up.
In another study, alcohol use was measured by the TLFB method, which uses a calendar-based interview to reconstruct prior days of drinking and drug use over a specified period. Four alcohol use measures were derived from the TLFB data for the 3 months prior to each assessment: (1) days of alcohol use; (2) days of heavy alcohol use, defined as 5 or more drinks per day for men and 4 or more drinks per day for women; (3) any alcohol use; and (4) any heavy alcohol use. Assessments occurred at baseline (week 3 or 4 of intensive outpatient treatment) and at 3-month intervals thereafter to 18 months postbaseline (end of continuing care intervention).
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Key Findings
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In one study, following regular group therapy attendance in a 4-week intensive outpatient treatment program for alcohol or cocaine dependence (DSM-IV criteria) and at least 1 week of negative urinalysis, clients were randomly assigned to one of three 12-week continuing care conditions: TMAC, relapse prevention (RP), and standard 12-step-oriented group counseling. At 24-month follow-up, TMAC clients had significantly lower GGT enzyme levels than RP clients (p = .005). Although TMAC clients also had lower GGT enzyme levels at the 24-month follow-up than standard 12-step-oriented group counseling clients, the difference was not statistically significant.
In another study, at 3 to 4 weeks into a 4-month intensive outpatient treatment program, alcohol-dependent clients (DSM-IV criteria) were randomly assigned to one of three conditions: 8 months of outpatient treatment as usual (TAU) only, TAU plus 36 sessions of adjunctive TMAC over 18 months, and TAU plus 36 sessions of adjunctive telephone monitoring without counseling (TM) over 18 months. TAU consisted of 9 hours of weekly group-based treatment for the first 4 months followed by one group counseling session weekly for the second 4 months of treatment. Among the findings from this study are the following:
- TMAC clients reported fewer days of alcohol use than TAU clients during follow-up months 10-12 (p = .018), months 13-15 (p = .0002), and months 16-18 (p < .004). These group differences were associated with small to medium effect sizes (Cohen's d = 0.42, 0.65, 0.50, respectively).
- TMAC clients reported fewer days of alcohol use (p = .02) and fewer days of heavy alcohol use (> 5 drinks per day for men and > 4 drinks per day for women, p = .01) than TM clients at the 6-month follow-up (covering months 4-6). These group differences were associated with small effect sizes (Cohen's d = 0.39 and 0.43).
- TMAC clients reported fewer days of heavy alcohol use (> 5 drinks per day for men and > 4 drinks per day for women) than TAU clients during follow-up months 13-15 (p = .0009) and months 16-18 (p = .006). These group differences were associated with medium and small effect sizes, respectively (Cohen's d = 0.59 and 0.46).
- TMAC clients reported the fewest days of any alcohol use (p = .016) and the fewest days of any heavy alcohol use (p = .038) compared with TAU clients at all follow-up assessments. These group differences were associated with small effect sizes (odds ratio = 1.88 and 1.74).
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Studies Measuring Outcome
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Study 1, Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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3.4
(0.0-4.0 scale)
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| Outcome 3: Cocaine use |
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Description of Measures
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Cocaine use was measured among all clients diagnosed with cocaine dependence (DSM-IV criteria) at the time of admission into the intensive outpatient treatment program. Measurements were obtained using urinalysis for the cocaine metabolite benzoylecgonine by fluorescence polarization immunoassay (FPIA) or enzyme multiple immunoassay test (EMIT). Urine samples were collected at baseline (last week of intensive outpatient treatment) and at 3, 6, 9, 12 18, and 24 months postbaseline.
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Key Findings
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Following regular group therapy attendance in a 4-week intensive outpatient treatment program for alcohol or cocaine dependence (DMS-IV criteria) and at least 1 week of negative urinalysis, clients were randomly assigned to one of three 12-week continuing care conditions: TMAC, relapse prevention (RP), and standard 12-step-oriented group counseling. The rate of cocaine-positive urine samples increased more slowly in TMAC clients relative to RP clients across successive follow-up assessments (p = .03).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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26-55 (Adult)
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82.6% Male
17.4% Female
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77% Black or African American
21% White
2% Race/ethnicity unspecified
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Study 2
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26-55 (Adult)
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64.3% Male
35.7% Female
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88.9% Black or African American
11.1% Race/ethnicity unspecified
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Alcohol and cocaine abstinence rates
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3.5
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3.0
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3.0
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3.5
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3.0
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3.5
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3.3
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2: Alcohol use
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3.5
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3.0
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3.8
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3.5
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3.0
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3.8
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3.4
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3: Cocaine use
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3.5
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3.0
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3.0
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3.5
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3.0
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3.5
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3.3
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Study Strengths The TLFB method is considered the gold standard for self-reporting alcohol use and has strong reliability and good validity. The use of self-report, collateral report, and biological convergent measures (urine and blood samples) add to the psychometric strength of each individual measure. Urinalysis was conducted by large, well-known independent laboratories, and a standardized protocol was used for handling blood samples. Treatment was manual guided, and attention to fidelity was strong. Attrition was relatively low in both studies and handled by a sophisticated pattern mix statistical analysis in the second study. Both studies were well designed and executed, using randomization with additional analyses of potential confounds. The approach to data analysis was strong in both studies and state of the art in the second study.
Study Weaknesses In the study that used blood sample assays to test for GGT, the blood sampling procedures were implemented late in the study and used with only 54% of the participants with alcohol dependence. TMAC treatment differed in the two studies, limiting the ability to directly compare outcomes between the studies. Both studies compared treatments of unequal intensity, raising the concern that findings might reflect differences in the duration or demand for treatment rather than differences in the content of the treatment sessions.
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Readiness for Dissemination
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Drapkin, M. L. (n.d.). A brief introduction to dancing (a.k.a. motivational interviewing) [PowerPoint slides].
Drapkin, M. L., & McKay, J. R. (n.d.). Continuing care research [PowerPoint slides].
ETDD Treatment Adherence Procedures
McKay, J. R. (2009, March). California Access to Recovery Effort (CARE) Telephone Monitoring & Adaptive Counseling (TMAC) client workbook. Philadelphia, PA: Center on the Continuum of Care in the Addictions, University of Pennsylvania.
McKay, J. R. (2009, March). California Access to Recovery Effort (CARE) Telephone Monitoring & Adaptive Counseling (TMAC) clinician manual. Philadelphia, PA: Center on the Continuum of Care in the Addictions, University of Pennsylvania.
McKay, J. R., Drapkin, M., Long, M., Lynch, K., Van Horn, D., & Oslin, D. (2010, April 15). Telephone continuing care [PowerPoint slides].
McKay, J. R., Gotham, H., & Stilen, P. (2008, July). Client workbook: Arkansas continuing care Telephone Monitoring & Adaptive Counseling. Kansas City, MO: Mid-America ATTC, University of Missouri--Kansas City.
McKay, J. R., Gotham, H., & Stilen, P. (2008, July). Clinician manual: Arkansas continuing care Telephone Monitoring & Adaptive Counseling. Kansas City, MO: Mid-America ATTC, University of Missouri--Kansas City.
McKay, J. R., Van Horn, D. H. A., & Morrison, R. (2010). Telephone continuing care therapy for adults (with CD-ROM). Center City, MN: Hazelden.
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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3.5
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3.8
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2.5
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3.3
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Dissemination Strengths The clinical manual includes ample theory and rationale for the intervention along with step-by-step guidance for implementation. Forms are provided electronically for easy reproduction. The developer offers consultation with organizations prior to adoption of the program to explore fit with the agency structure and client population. New implementers receive on-site training and ongoing support throughout implementation. An array of consultation and support services contribute to fidelity to the model in new implementation settings, and some guidance for monitoring treatment outcomes is provided to support quality assurance.
Dissemination Weaknesses The materials do not provide any information for administrators tasked with securing the infrastructure necessary for implementing this program. No guidance is provided on adapting the intervention to address the unique needs of diverse cultural groups or women. Training presentations focus on the evidence base of the intervention more than on step-by-step implementation guidance. A formalized curriculum or trainer manual is not available to support standardized training for new sites. Guidance and tools for supporting fidelity and outcome monitoring are limited.
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Costs
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.
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Item Description
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Cost
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Required by Developer
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Telephone Continuing Care Therapy for Adults (book with CD-ROM; includes electronic copies of client workbook, intervention research articles, supplementary implementation tools, and quality assurance materials)
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$39.95 each
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Yes
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Training and implementation package, which includes:
- 1.5- to 2-day on-site training
- Site-tailored therapist and patient workbooks, handouts, and confidential client recordings for training purposes
- Ongoing consultative support
- Monthly coaching calls for 6 months after training and monthly thereafter
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$6,000-$8,000, including travel expenses
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No
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Treating Substance Use Disorders with Adaptive Continuing Care (book)
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$49.95 each
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No
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Preimplementation consultation with developer
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$1,000
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No
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Additional Information The approximate cost of providing a 3-month TMAC program to one client is $426, or $35 to 36 per session. Actual costs may vary considerably from site to site.
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Replications
Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.
* McKay, J. R., Lynch, K. G., Shepard, D. S., & Pettinati, H. M. (2005). The effectiveness of telephone-based continuing care for alcohol and cocaine dependence: 24-month outcomes. Archives of General Psychiatry, 62(2), 199-207.
* McKay, J. R., Van Horn, D. H., Oslin, D. W., Lynch, K. G., Ivey, M., Ward, K., et al. (2010). A randomized trial of extended telephone-based continuing care for alcohol dependence: Within-treatment substance use outcomes. Journal of Consulting and Clinical Psychology, 78(6), 912-23.
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