A randomized trial of assertive continuing care and contingency management for adolescents with substance use disorders

Objective: Most adolescents relapse within 90 days of discharge from residential substance use treatment. We hypothesized that contingency management (CM), assertive continuing care (ACC), and their combination (CM + ACC) would each be more effective than usual continuing care (UCC).

Method: Following residential treatment, 337 adolescents were randomized to 4 continuing care conditions: UCC alone, CM, ACC, or CM + ACC. UCC was available across all conditions. Outcome measures over 12 months included percentage of days abstinent from alcohol, heavy alcohol, marijuana, and any alcohol or other drugs (AOD) using self-reports and toxicology testing and remission status at 12 months.

Results: CM had significantly higher rates of abstinence than UCC for heavy alcohol use, t(297) = 2.50, p < .01, d = 0.34; any alcohol use, t(297) = 2.58, p < .01, d = 0.36; or any AOD use, t(297) = 2.12, p = .01, d = 0.41; and had a higher rate in remission, odds ratio (OR) = 2.45, 90% confidence interval (CI) [1.18, 5.08], p = .02. ACC had significantly higher rates of abstinence than UCC from heavy alcohol use, t(297) = 2.66, p < .01, d = 0.31; any alcohol use, t(297) = 2.63, p < .01, d = 0.30; any marijuana use, t(297) = 1.95, p = .02, d = 0.28; or any AOD use, t(297) = 1.88, p = .02, d = 0.30; and had higher rates in remission, OR = 2.31, 90% CI [1.10, 4.85], p = .03. The ACC + CM condition was not significantly different from UCC on any outcomes.

Conclusions: CM and ACC are promising continuing care approaches after residential treatment. Future research should seek to further improve their effectiveness.