This second Betty Ford Institute conference took place on October 3rd and 4th, 2007. The topic of this conference was continuing care and recovery management for substance use disorders. The goals of the conference were to review evidence for the effectiveness of various approaches to continuing care, discuss new approaches to the long-term management of these disorders, and develop an agenda for future research. As was the case in the first Betty Ford Institute conference, the overarching purpose of this conference was for the participants to arrive at agreement about position statements—this time regarding what is known about effective continuing care and where additional research is needed.
The conference was organized in three sessions. The first focused on evidence from outcome studies, and included presentations by James McKay, Robert DuPont and Michael Dennis. Two of these presentations served as the basis of papers included in this special issue of the Journal of Substance Abuse Treatment. The McKay paper examines the effectiveness of continuing care treatment interventions that were provided after more intensive, initial episodes of care, and reviews various strategies to enhance participation and sustained engagement in continuing care. This paper also examines newer approaches to continuing care, including the use of adaptive protocols and alternative service delivery settings and systems. The DuPont paper describes extended recovery management programs that are used to treat addicted medical professionals. These programs feature rigorous monitoring of substance use and participation in various clinical interventions and self-help programs over extended periods (i.e., five years or more). Dr. Dennis presented information on several major studies that have tested the Recovery Management Checkup protocol, developed by Michael Dennis and Chris Scott, and their colleagues at Chestnut Health Systems. This approach features quarterly “check-ups” provided for two years or more that are used to assess the severity of any substance use and provide active linkage back to treatment for those who have resumed problematic use. Material presented by Dr. Dennis in his talk is available in other published articles (Dennis & Scott, 2007; Scott & Dennis, in press).
The second session focused on strategies for implementing and managing continuing care, and included presentations by Deni Carise, Jack Kemp, and Debra Reynolds. Dr. Carise's presentation described the Focused Continuing Care (FCC) program at Betty Ford, which consists of monthly telephone calls provided for 12 months to all graduates of the program. These calls include a brief multi-dimensional assessment of symptoms, status, and functioning, and feedback and support. Preliminary data from FCC is in press elsewhere (Cacciola et al, in press). The Kemp presentation described a performance-based contracting system that has been implemented in Delaware, in which programs can receive additional funding by achieving certain performance standards, such as increasing utilization and retention, or successfully transitioning a higher percentage of patients from one level of care to the next. Material from Jack Kemp's presentation is included in a recently published article (McLellan et al., 2008). Debra Reynolds, from Continental Airlines, gave a talk that described programs the airline industry has put together to provide treatment and extended monitoring and continuing care for pilots with alcohol or drug use disorders.
The third session focused on the use of community resources to support continuing care. This session was comprised of presentations by William White, and Keith Humphreys and Lee Kaskutas. The White paper, which is included in this issue, draws on historical and contemporary events in the history of addiction treatment and recovery to illuminate the relationship between community supports for recovery and the formal treatment system. Principles and strategies are identified that could guide the development and mobilization of community resources to support the long-term recovery of individuals and families. The presentation by Humphreys and Kaskutas reviewed evidence on the benefits, timing and optimal intensity and extensity of addiction-related mutual help group participation.
Joining the presenters in the discussions of the papers were Beverly Haberle (Bucks County Pennsylvania, Council on Alcoholism), Garret O'Connor (Betty Ford), Barton Pakull (former Federal Aviation Administration Chief Psychiatrist), Ron Armstrong (Recovery Support Services, LLC), Thomas McLellan (Treatment Research Institute), Mady Chalk (Treatment Research Institute), and John Schwartzlose (Betty Ford). These participants, along with the authors of the papers, also took part in integrative discussions after the third session of the conference and worked together to craft the position statements which are found in the last paper in this special issue.
Footnotes
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References
- Cacciola JS, Camilleri AC, Carise D, Rikoon SH, McKay JR, McLellan AT, et al. Extending residential care through telephone counseling: Initial results from the Betty Ford Center Focused Continuing Care Protocol. Addictive Behaviors. doi: 10.1016/j.addbeh.2008.05.004. in press. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dennis ML, Scott CK. Managing addiction as a chronic condition. Addiction Science and Clinical Practice. 2007 December;:45–55. doi: 10.1151/ascp074145. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McLellan AT, Kemp J, Brooks A, Carise D. Improving public addiction treatment through performance contracting: The Delaware experiment. Health Policy. doi: 10.1016/j.healthpol.2008.01.010. in press. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Scott CK, Dennis ML. Results from two randomized clinical trials evaluating the impact of quarterly recovery management checkups with adult chronic substance users. Addiction. doi: 10.1111/j.1360-0443.2009.02525.x. in press. [DOI] [PMC free article] [PubMed] [Google Scholar]