Table of Contents Author Guidelines Submit a Manuscript
Psychiatry Journal
Volume 2014, Article ID 692423, 16 pages
http://dx.doi.org/10.1155/2014/692423
Review Article

The Continuing Care Model of Substance Use Treatment: What Works, and When Is “Enough,” “Enough?”

1Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA
2CRC Health Group Inc., 6185 Paseo Del Norte, Suite 150, Carlsbad, CA 92011, USA

Received 9 October 2013; Accepted 18 January 2014; Published 27 March 2014

Academic Editor: Claude Robert Cloninger

Copyright © 2014 Steven L. Proctor and Philip L. Herschman. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

There is little disagreement in the substance use treatment literature regarding the conceptualization of substance dependence as a cyclic, chronic condition consisting of alternating episodes of treatment and subsequent relapse. Likewise, substance use treatment efforts are increasingly being contextualized within a similar disease management framework, much like that of other chronic medical conditions (diabetes, hypertension, etc.). As such, substance use treatment has generally been viewed as a process comprised of two phases. Theoretically, the incorporation of some form of lower intensity continuing care services delivered in the context of outpatient treatment after the primary treatment phase (e.g., residential) appears to be a likely requisite if all stakeholders aspire to successful long-term clinical outcomes. Thus, the overarching objective of any continuing care model should be to sustain treatment gains attained in the primary phase in an effort to ultimately prevent relapse. Given the extant treatment literature clearly supports the contention that treatment is superior to no treatment, and longer lengths of stay is associated with a variety of positive outcomes, the more prudent question appears to be not whether treatment works, but rather what are the specific programmatic elements (e.g., duration, intensity) that comprise an adequate continuing care model. Generally speaking, it appears that the duration of continuing care should extend for a minimum of 3 to 6 months. However, continuing care over a protracted period of up to 12 months appears to be essential if a reasonable expectation of robust recovery is desired. Limitations of prior work and implications for routine clinical practice are also discussed.