Case management in aftercare of involuntarily committed patients with substance abuse. A randomized trial

Abstract

Objective: Case management has since the 1970s been widely used to co-ordinate services for mental health patients. The methodology has expanded to support patients in many different types of conditions. This study is one of very few randomized trials on case management in a European setting. It examined the impact of case management on substance abuse and use of service after discharge from court-ordered institutional care. Methods: Court-ordered patients with substance abuse (n = 36) were randomly assigned to either strengths based case management or treatment-as-usual during 6 months in aftercare. Data was collected at intake, at conclusion of intervention and at 6 month's follow-up with a follow-up rate of 94%. Results: Case management interventions were well received by the patients with no drop-out during intervention. Patients with the support of a case manager seemed to sustain abstinence in a higher degree compared with treatment-as-usual but no differences were detected in regard to use of care. A subgroup analysis showed that patients with a continuous drug abuse did have access to care from both social welfare and hospital care systems. Conclusions: Case management may be useful in order to retain abstinence in aftercare following court-ordered treatment. The social welfare and hospital care systems seem to provide care irrespective of case manager intervention. The study design, interventions and assessments instruments were well received by patients but needs to be replicated with a larger population. Clinical implications: The 100% retention in the case management support group indicates that patients were satisfied with this type of intervention and the methodology seems to be useful in order to retain abstinence.

• Aftercare
• Case management
• Involuntary
• Randomized clinical trial
• Substance abuse

Acknowledgments

The authors would like to thank the case management crew; Camilla Wallin, Susanne Markusson, Pernilla Isendahl, Rolf Köhler, Peter Olsson and Ingela Bernholtz. Grateful thanks are also extended to the staff at the participating institutions and social service offices. A special thank you goes to Bolette Pedersen for advice on statistical methods.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

The study was supported by the Ministry of Health and Social Affairs' task force—Mobilize against Drugs, the National Board of Institutional Care and The Skane county administrative board.

Authors' contributions

MLL and MB* designed the study and MLL carried it out. The analyses were originally performed by MLL and MB and finalized by MLL and HT*. MLL and HT wrote and MB revised the manuscript. All three have approved the final manuscript. *These two senior researchers have given equal major contribution to the content of this paper.