Adaptive Treatment for Alcohol and Cocaine Dependence

NCT ID: NCT01032135

Last Updated: 2017-09-05

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2/PHASE3

Total Enrollment

500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-10-31

Study Completion Date

2013-12-31

Brief Summary

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1. Primary objective #1: Determine the relative effectiveness of MI-IOP and MI-PC in the full study sample with regard to treatment engagement over weeks 1-12 and cocaine/alcohol use over weeks 1-24.

* Hypothesis 1: An intervention that explores several possible treatment options with the patient and provides the chosen option (e.g., MI-PC) will produce higher rates of treatment engagement than an intervention focused on engagement in IOP only (e.g., MI-IOP).
* Hypothesis 2: An intervention that explores several possible treatment options with the patient and provides the chosen option (e.g., MI-PC) will produce better cocaine/alcohol use outcomes than an intervention focused on engagement in IOP only (MI-IOP).
* Secondary analysis 1: Among the Non-engaged patients, determine rates of selection of each of the three options in MI-PC, retention rates within each option, and cocaine/alcohol use outcomes in each option.
* Secondary analysis 2: Among the Engaged patients, determine rates of selection of each of the three options in MI-PC, retention rates within each option, and cocaine/alcohol use outcomes in each option.
2. Primary objective #2: Determine whether the relative effectiveness of MI-IOP and MI-PC varies as a function of engagement group, with regard to treatment engagement over weeks 1-12 and cocaine/alcohol use outcomes over weeks 1-24.

* Hypothesis 1: The predicted main effect on retention favoring MI-PC over MI-IOP will be significantly larger among patients in the Non-engaged group than among those in the Engaged group.
* Hypothesis 2: The predicted main effect on cocaine/alcohol use outcomes favoring MI-PC over MI-IOP will be significantly larger among patients in the Non-engaged group than among those in the Engaged group.

Detailed Description

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3\. Secondary objective #1: Examine outcomes on three secondary measures: percent days abstinent from all substances, negative consequences of drug use, and HIV high risk behaviors.

* Hypothesis 1: Outcomes on the secondary measures will be better in MI-PC than in MI-IOP.

4\. Secondary objective #2: Test hypotheses concerning potential mediators of the predicted main effect favoring MI-PC over MI-IOP.
* Hypothesis 1: The predicted advantage of MI-PC over MI-IOP will be mediated by greater increases in motivation, self-efficacy, commitment to abstinence, and self-help involvement in MI-PC.

5\. Secondary objective #3: Test hypotheses concerning effect of additional MI intervention after initial non-engagement persists through 12 weeks.
* Hypothesis 1: A second telephone MI intervention will produce higher rates of subsequent engagement and less cocaine use than no further MI.

Conditions

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Substance Use Disorders

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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1-MI-IOP Engaged

Randomized to treatment as usual, and they attend regularly but dropped out of treatment after randomization.

Group Type ACTIVE_COMPARATOR

Motivational Interviewing

Intervention Type BEHAVIORAL

2 sessions at week 2, potential 2 sessions at week 8 if the participant drops out.

2-MI-IOP Non-Engaged

Randomized to treatment as usual, and do not attend.

Group Type EXPERIMENTAL

Motivational Interviewing

Intervention Type BEHAVIORAL

2 sessions at week 2, potential 2 sessions at week 8 if the participant drops out.

Telephone counseling

Intervention Type BEHAVIORAL

one telephone counseling session per week for 10 weeks.

Cognitive Behavioral Therapy (CBT) Counseling

Intervention Type BEHAVIORAL

One CBT session per week, for 10 weeks.

medication management

Intervention Type DRUG

Prescription for naltrexone

Intensive OutPatient Therapy

Intervention Type BEHAVIORAL

Return to IOP, group therapy 3 times weekly for about three hours a day.

3-MI-PC Engaged

Randomized to treatment choice, but remain attending treatment as usual then dropped out of treatment after randomization.

Group Type ACTIVE_COMPARATOR

Motivational Interviewing

Intervention Type BEHAVIORAL

2 sessions at week 2, potential 2 sessions at week 8 if the participant drops out.

Telephone counseling

Intervention Type BEHAVIORAL

one telephone counseling session per week for 10 weeks.

Cognitive Behavioral Therapy (CBT) Counseling

Intervention Type BEHAVIORAL

One CBT session per week, for 10 weeks.

4-MI-PC Non-engaged

Randomized to treatment choice, and do not attend treatment as usual, so the choice option is used.

Group Type EXPERIMENTAL

Motivational Interviewing

Intervention Type BEHAVIORAL

2 sessions at week 2, potential 2 sessions at week 8 if the participant drops out.

Telephone counseling

Intervention Type BEHAVIORAL

one telephone counseling session per week for 10 weeks.

Cognitive Behavioral Therapy (CBT) Counseling

Intervention Type BEHAVIORAL

One CBT session per week, for 10 weeks.

medication management

Intervention Type DRUG

Prescription for naltrexone

Intensive OutPatient Therapy

Intervention Type BEHAVIORAL

Return to IOP, group therapy 3 times weekly for about three hours a day.

Interventions

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Motivational Interviewing

2 sessions at week 2, potential 2 sessions at week 8 if the participant drops out.

Intervention Type BEHAVIORAL

Telephone counseling

one telephone counseling session per week for 10 weeks.

Intervention Type BEHAVIORAL

Cognitive Behavioral Therapy (CBT) Counseling

One CBT session per week, for 10 weeks.

Intervention Type BEHAVIORAL

medication management

Prescription for naltrexone

Intervention Type DRUG

Intensive OutPatient Therapy

Return to IOP, group therapy 3 times weekly for about three hours a day.

Intervention Type BEHAVIORAL

Other Intervention Names

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MI Telephone based stepped care. CBT MM IOP

Eligibility Criteria

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Inclusion Criteria

1. meet DSM-IV criteria for lifetime cocaine or alcohol dependence and have used cocaine or alcohol in the prior 6 months;
2. be \> 18 years of age;
3. be judged clinically appropriate for IOP (e.g., no current psychotic disorder or evidence of severe dementia, and no acute medical problem requiring inpatient treatment;
4. have no regular IV heroin use during the past year;
5. have access to a telephone;
6. be willing to be randomized and participate in research; and
7. no current participation in methadone or other forms of DA treatment, other than IOP. Finally, because of study follow-up requirements, subjects will
8. be required to be metropolitan area residents, and

Exclusion Criteria

1. have a current psychotic disorder (as assessed with the psychotic screen from the MINI) or evidence of dementia severe enough to prevent participation in outpatient treatment;
2. have acute medical problem requiring immediate inpatient treatment; or
3. are currently participating in methadone or other forms of DA treatment, other than IOP.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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University of Pennsylvania

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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James R. McKay, Ph.D

Role: PRINCIPAL_INVESTIGATOR

University of Pennsylvania

Locations

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Presbyterian Medical Center

Philadelphia, Pennsylvania, United States

Site Status

VAMC

Philadelphia, Pennsylvania, United States

Site Status

NorthEast Treatment Center

Philadelphia, Pennsylvania, United States

Site Status

Countries

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United States

Other Identifiers

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IND: 101,486

Identifier Type: -

Identifier Source: secondary_id

807092

Identifier Type: -

Identifier Source: org_study_id

NCT02689674

Identifier Type: -

Identifier Source: nct_alias

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