Feasibility and Efficacy of Critical Time Intervention for People with Substance Use Disorders Transitioning from Residential Treatment

Background: Although residential substance abuse treatment (RSAT) has been shown to improve substance use and other outcomes, relapse following discharge is common. Few evidence-based practices exist to adequately address the unique needs of persons transitioning from RSAT. This paper describes the adaptation and development of Critical Time Intervention-Residential (CTI-R) for persons transitioning from RSAT and reports the preliminary outcomes from a randomized trial of CTI-R versus Recovery Support (RS) services.

Methods: We conducted semi-structured interviews with 17 staff working in outpatient and residential substance abuse treatment settings and 32 individuals receiving long-term residential treatment in New York City. Transcriptions of interviews were formally analyzed by three analysts using framework analysis. Using participatory planning methods via a Residential Transition Advisory Board, we used the qualitative findings to adapt CTI for the local RSAT context. Residents who were within 3 months of discharge volunteered and consented to participate in the study, completed a baseline interview and were randomized to either CTI-R (n=30) or RS (n=30) using 1:1 random assignment stratified by gender. Assessments at 3-, 6-, 9-, and 12-months post-baseline included measures of substance use and mental health severity, use of aftercare services, readiness to change, drug use self-efficacy, social support, housing and employment/vocational stability. To examine differences between treatment and comparison groups, we conducted chi-square and independent samples t-tests, two-tailed, with alpha set at .05. Feasibility data on study recruitment and retention, as well as 3-month outcomes will be presented.

Results: The presentation provides a systematic process, using participatory planning methods, for intervention translational research with the following steps: 1) understanding barriers and facilitators to transition; 2) developing a strong theoretical basis; 3) adapting the intervention manual and fidelity protocol; and 4) developing an implementation plan. In our qualitative study, participants reported primary areas of intervention at multiple levels, including increasing access to housing and employment, providing linkages to aftercare services and community resources, repairing and strengthening positive support networks, and providing individually-tailored discharge preparation and in-vivo transitional services. Participants in the RCT are an average age of 45 years, mostly male (57%)—proportional to the residential population—and self-identify primarily as African American, Black or Latino (78%). are mandated to treatment (59%) and reported mental health (68%) and physical health (47%) needs, as well as being homeless (81%) and unemployed (66%) before admission to RSAT. The most prevalent substances used were alcohol, heroin, crack/cocaine, and marijuana. Preliminary outcomes at 3- and 6-months suggest that CTI-R participants were significantly more likely to receive substance use aftercare and mental health services and less likely to be homeless compared to those in the RS group. CTI-R participants also reported significantly lower rates of alcohol/drug use.

Conclusion and Implications: CTI-R is a potentially useful model which is based on theory and grounded in harm reduction principles and evidence-based practices to provide reentry services for persons transitioning from RSAT. This systematic adaptation process provides an innovative model of tailoring CTI to a new population and setting.