The objective of this study is to test whether a chronic disease management (CDM) program for substance abusers in primary care leads to improved alcohol and drug-related outcomes (such as reduced consumption and health problems) and health care utilization patterns.
Chronic disease management (CDM) is a collaborative, longitudinal, proven effective approach to the treatment of chronic medical illnesses that addresses individual patient and health systems barriers to receipt of needed treatment. The objective of this Addiction Health Evaluation And Disease management (AHEAD) Study is to test the effectiveness of CDM for substance dependence in primary care. The study will enroll and randomize subjects to attend a substance dependence CDM program (the AHEAD Unit) integrated into a real-world primary care clinic or to referral to usual primary care. All subjects will be assessed regarding alcohol and/or drug diagnosis, consumption and problems, readiness to change, health-related quality of life, and medical and substance abuse treatment utilization. Primary outcomes are alcohol and drug use, alcohol and drug-related problems, emergency department visits, and hospitalizations. Additional outcomes are health-related quality of life, readiness to change, medical and psychiatric comorbidity, HIV risk behaviors, and treatment utilization and costs. The hypothesis is that compared with standard care, a health services intervention -- chronic disease management for alcohol and drug dependence integrated in primary care -- will decrease alcohol and drug use and related problems, and improve health care utilization patterns. This study contains two studies (and study populations): * 1\. 320 alcohol dependent subjects with current risky drinking, and * 2\. 320 drug dependent subjects with current drug use.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
569
Referral to primary medical care \& longitudinal, multidisciplinary care for persons with substance dependence.
Referral to primary medical care for persons with substance dependence.
Boston Medical Center / Boston University
Boston, Massachusetts, United States
Alcohol and drug use
Time frame: 3, 6, and 12 months after baseline
Alcohol and drug-related problems
Time frame: 3, 6, and 12 months after baseline
Nights Hospitalized
Time frame: 3, 6, and 12 months after baseline and up to 2 years after the last subject is enrolled
Emergency department visits
Time frame: 3, 6, and 12 months after baseline and up to 2 years after the last subject is enrolled
Health-related quality of life
Time frame: 3, 6, and 12 months after baseline
Readiness to change
Time frame: 3, 6, and 12 months after baseline
Medical comorbidity
Time frame: 3, 6, and 12 months after baseline
Psychiatric comorbidity
Time frame: 3, 6, and 12 months after baseline
HIV risk behaviors
Time frame: 3, 6, and 12 months after baseline
Treatment utilization and costs
Time frame: 3, 6, and 12 months after baseline, and up to 2 years after the last subject is enrolled
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