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PubMed1997

Community psychiatric nurse aftercare for alcoholics: a five-year follow-up study.

The aim of this study was to determine if community psychiatric nurse (CPN) aftercare for 1 year improved the 5-year outcome in patients following inpatient treatment for alcohol dependence. A 5-year follow-up study, observer blind, with non-random allocation of subjects to aftercare by CPN for 1 year or standard outpatient care, was used. Subjects had all received inpatient treatment for 6 weeks in a rural alcohol treatment unit. Subjects were traced and assessed in the community 5 years after the index admission. The participants consisted of 127 white male alcoholics. All were first admissions, who had been selected for inpatient treatment and who completed a 6-week inpatient stay. Seventy-three subjects received intensive aftercare by CPN for 1 year, 54 subjects received standard outpatient appointments not due to random allocation but because no CPN was available. Data were collected by semi-structured interview at entry to the trial, namely background epidemiological information, details of drinking history, previous hospital admission, educational, employment and criminal information. At 5-year follow-up, data on drinking status, use of other drugs, hospital admissions, criminal behaviour and gambling, attendance at self-help groups, relationships and employment were collected. Thirty-six per cent of the CPN aftercare group was completely abstinent during the 5 years after treatment compared to 6% of the standard aftercare group (p < 0.001). Subjects receiving CPN aftercare were less likely to report blackouts (p < 0.05) or gambling (p < 0.05). They were more likely to attend hospital meetings (p < 0.0001). CPN aftercare is an effective way of maximizing the effects of inpatient treatment. The effects endured for 5 years after treatment.

Adolescent↗
PubMed1988

Posttreatment follow-up, aftercare, and worksite reentry of the recovering alcoholic employee.

A review of literature on the effects of aftercare in the treatment of alcoholism reveals mixed results, with some studies showing positive effects and some showing no effects. However, few studies controlled for bias in the process of selection into aftercare, and many of the studies reveal significant difficulties in engaging patients into aftercare. The relapse prevention model is reviewed as a potentially powerful tool for use in aftercare. The literature on worksite reentry of alcoholics shows a generally positive correlation between employment and recovery, but does not produce unambiguous findings regarding the direction of the relationship. A nontraditional, proactive approach to aftercare is proposed, based on studies of other types of health problems that show improved results with this approach. It is argued that the worksite is the most appropriate place to locate aftercare services for employed alcoholics, particularly worksites with employee assistance programs. However, further research is needed to guide the development of these services.

Aftercare↗
PubMed1979

An analysis of distance variables that affect aftercare attendance.

Recent reserach has examined variables related to attendance of aftercare services because of the correlation between aftercare and posthospitalization treatment success. The present study, which examined aftercare attendance for 40 randomyl selected subjects following discharge from an inpatient alcohol treatment program, extends the list of variables found to influence attendance. A multiple-regression analysis of subject demographic variables and variables of a more programmatic nature found that distance variables (e.g., number of miles to an aftercare agency) significantly influenced aftercare attendance. The results are discussed with respect to aftercare program decisions.

Adult↗
PubMed2007

[The Bochum aftercare questionnaire for cancer in otorhinolaryngology: first results of clinical application].

BACKGROUND: The damage caused by cancer disease is multidimensional, affecting a patient physically, emotionally, and intellectually. A post-cancer documentation system is necessary that takes into account a patient's psychosocial well-being. With this objective in mind, the aftercare journal was developed for tumor diseases in otorhinolaryngology in the Department of Otorhinolaryngology of the Ruhr University Bochum. METHODOLOGY AND PATIENTS: From April 2002 to May 2003, 112 patients received a standardized questionnaire to evaluate the aftercare journal newly introduced in Germany for ENT tumor diseases. Six items were presented: outer appearance, format/size of the journal, clarity in the design, recording areas relevant to the disease, improvement in the tumor aftercare, and personal feeling of safety. An evaluation scale of zero to four points served as the basis for assessment. A high point value represented the higher degree of patient satisfaction for each respective item. RESULTS: In all six items, the assessment of the journal predominantly showed agreement of the patients. Assessing the improvement in tumor aftercare and providing a personal feeling of safety, patients with shorter disease remission had a tendency to allocate low point values. CONCLUSION: The aftercare journal for ENT sets the trend for documentation systems in cancer aftercare. The study proved the need to consider concerns of the disease related to medical and psychosomatic factors in patients as a standard for modern psychosocial oncology.

Adult↗
PubMed1983

Impact of aftercare arrangements on the maintenance of treatment success in abusive drinkers.

Aftercare to prevent relapse following alcohol treatment has not received adequate experimental investigation. The present study monitored alcohol intake of 50 patients following assignment to either an intensive aftercare recruitment procedure or regular clinic aftercare. The results indicated that those who received the intensive aftercare procedure showed delayed relapse. In addition, regardless of group assignment those who attended aftercare had significantly more success as measured by alcohol intake. The implications of these results for the design of treatment and aftercare programs are discussed.

Adult↗
PubMed1984

Increasing attendance at alcohol aftercare using calendar prompts and home based contracting.

The effect of an appointment-keeping intervention on attendance at aftercare was examined for 50 male participants in an inpatient alcohol treatment program. Subjects received either a calendar prompt and home-based attendance contract intervention (Experimental group, N = 25) or standard aftercare treatment arrangements (Control group, N = 25). Participants were followed for eight aftercare sessions over a 6-month period. Results showed significant attendance differences between groups for the first seven aftercare sessions, with nearly twice as many experimental subjects as control subjects attending aftercare sessions. Further, significantly fewer experimental than control subjects (24% fewer) were dropped from the alcohol program for three consecutive nonattendances. The present study provides an effective technology for increasing aftercare attendance and thus potentially increasing the probability of long term maintenance of alcohol treatment effects.

Adult↗
PubMed1996

Aftercare telephone contacts with problem drinkers can serve a clinical and research function.

Research staff typically gather treatment outcome data, whereas clinicians perform aftercare contacts. To date no alcohol treatment outcome study has examined the utility of therapists collecting outcome data through aftercare contacts. Using the Alcohol Timeline Followback (TLFB) method modified for clinical aftercare contacts, 154 problem drinkers who were part of a cognitive-behavioral intervention completed the modified TLFB with their primary therapist during aftercare telephone contacts conducted 1 and 3 months after their last treatment session. Clients reported their daily alcohol use over the past 30 days using four consumption categories (i.e. 0 drinks, 1-4 drinks, 5-9 drinks and 10+ drinks). At a 6-month follow-up research interview, a trained research assistant gathered standard TLFB data from the clients that included the time period for aftercare contacts. Correlations between the two TLFB formats showed good alternate form reliability, especially for frequency of alcohol use. Discrepancies between reports were positively associated with heavier pre-treatment and post-treatment drinking, suggesting possible memory biases among heavier drinkers. Subject reports also closely paralleled collateral reports of the subjects' drinking. These results support the utility of a brief TLFB instrument for use by therapists in assessing clients' outcomes by telephone during aftercare contacts.

Adolescent↗
PubMed1999

Prison-based substance abuse treatment, residential aftercare and recidivism.

AIMS: This study examined the impact of residential aftercare on recidivism following prison-based treatment for drug-involved offenders. DESIGN: A matched group quasi-experimental design. Survival regression analyses were used to predict time until rearrest. A logistic regression model was constructed for predicting aftercare completion. SETTING: A 9-month in-prison therapeutic community (ITC) and several community-based transitional therapeutic communities (TTCs). PARTICIPANTS: Data were collected from 396 male inmates (293 treated, 103 untreated). MEASUREMENTS: Background information (gender, ethnicity, age, education level, criminal history and risk for recidivism) was abstracted from the state criminal justice databases and a structured interview led by clinical staff. During treatment process measures were based on inmate self-ratings of their counselors, program and peers. A post-treatment interview conducted by field research staff assessed satisfaction with transitional aftercare. Post-release recidivism was based on state-maintained computerized criminal history records. FINDINGS: ITC treatment, especially when followed by residential aftercare, was effective for reducing post-release recidivism rates. Lower satisfaction with transitional aftercare treatment was associated with not completing the residential phase of community-based aftercare. CONCLUSIONS: Corrections-based treatment policy should emphasize a continuum of care model (from institution to community) with high quality programs and services.

Adult↗
PubMed2003

Aftercare attendance and post-treatment functioning of severely substance dependent residential treatment clients.

The present study evaluated the impact of a structured aftercare programme following residential treatment for severe alcohol and/or heroin dependent clients. Over 17 months, 77 participants were recruited to the study and allocated randomly to either a structured aftercare (SA) programme or to unstructured aftercare (UA) of crisis counselling on request. Independent clinicians interviewed participants and collaterals, at 4-month (median) intervals, for 12 months following residential treatment. SA compared to UA was associated with a fourfold increase in aftercare attendance and one-third the rate of uncontrolled principal substance use at follow-up. Participants who attended either type of aftercare relapsed a median of 134 days later than those who attended no aftercare. Overall, 23% of monitored participants remained abstinent throughout, 21% maintained controlled substance use and 56% relapsed, within a median of 36 days following residential treatment. The only significant predictor of days to relapse, controlling for age, was pretreatment use of additional substances. Participants with pretreatment additional substance use relapsed a median of 192 days earlier than those who had used no other substances. The degree of agreement between participant self-reports and collateral reports was fair-to-moderate and moderate among collaterals. Intention-to-treat analyses revealed significant and clinically meaningful reductions in substance use in this sample of severely dependent residential treatment clients. The generalizability of these results is limited because of significant differences in age and presenting substance between the study sample and other clients admitted to the service during the study. This latter group of younger, male, heroin-dependent clients with polydrug use who refuse opioid pharmacotherapy, are more likely to drop out of treatment or relapse early following treatment and continue to present a challenge to treatment services.

Adult↗
PubMed1989

Factors associated with better compliance with psychiatric aftercare.

The rate of compliance with aftercare following hospitalization is disturbingly low despite its proven efficacy in preventing relapse and rehospitalization. This study of 134 emergency admissions to a New York City municipal hospital examined the impact of patient characteristics, clinical variables, and attitudes toward treatment on compliance with aftercare in the six months following discharge. Excluding 31 patients who required rehospitalization, 70 percent of patients attended their first aftercare appointment, and 40 percent completed six months of aftercare. Factors associated with better compliance with aftercare were continuity of care, as reflected in less time between discharge and the first aftercare appointment; increased number of prior hospitalizations; increased length of hospital stay; less denial of need for treatment; and greater perceived need for medications. Recommendations for improving compliance with after care are presented.

Aftercare↗
PubMed1994

Increasing alcoholic patients' aftercare attendance.

Of a sample of 100 patients on an inpatient alcohol rehab unit, 50 were assigned to a weekly group therapy session in the aftercare clinic. Those inpatients with aftercare clinic exposure prior to discharge were more likely to return for aftercare. In a second study of 100 inpatients the effect of having a counselor who would continue to follow them in aftercare was explored. Half the sample had a counselor whose primary assignment was in the aftercare clinic and thus could work with them on a continuing basis. The other half had a counselor whose primary assignment was on the inpatient unit and would not be able to continue with them. Counselor continuity had no impact on aftercare follow through.

Adult↗
PubMed1985

Job satisfaction, prestige, and the aftercare clinician.

Few would disagree that programs designed to assist deinstitutionalized mental-health patients have been seen as the step-children of community mental health. Many community mental-health programs were built quickly to rise to the challenge of the flood emerging from the hospitals. Unfortunately, this resulted in programs being poorly defined and reactive rather than responsive in nature. One of the issues that emerges as crucial is the status afforded to the aftercare clinician by other mental-health professionals. Personal experiences shared by community mental-health personnel suggest that clinicians who work with aftercare patients or who work in aftercare settings are attributed less prestige than their outpatient counterparts. The authors review the pertinent literature and reveal the results of a survey suggesting that aftercare clinicians view themselves as expert, but the rest of the system does not, leading to the inconsistent status profile. The problem then emerges that the aftercare clinician must "market" his or her expertise and specialized skills so that other clinicians recognize the unique therapeutic contribution of aftercare. The authors offer recommendations.

Aftercare↗
PubMed1987

Evaluation of effectiveness of aftercare in alcoholism treatment.

Providing aftercare to alcoholic patients upon discharge is seen as an important factor in recovery. The purpose of this study was to investigate whether providing contractual aftercare would increase the aftercare attendance and influence their drinking. The subjects were 55 patients who underwent inpatient treatment over a one year period. They either signed a contract to attend a specified number of meetings and upon failure to do so were actively followed up (contract group, n = 28) or did not sign a contract but were only verbally encouraged to attend the meetings (control group, n = 27). Six months after discharge, patients in both groups were followed up and data obtained on drinking and social stability measured. A multiple regression analysis showed that although the use of a contract was effective in increasing patients' return rate to the unit, attendance of aftercare meetings was not a significant predictor of drinking. The significant predictor was the employment situation. Patients' perceptions of aftercare provided was evaluated and the necessity for providing aftercare based on patients' needs was seen as important.

Adult↗
PubMed2000

Developing psychosocial aftercare for children surviving cancer and their families.

More children than ever are surviving childhood cancer. However, the medical and psychosocial consequences of their longer survival are becoming clear for former patients and their families, underlining the need for aftercare. Whereas the need for medical follow-up programs is widely recognized, psychosocial aftercare is still in its infancy. This paper presents a systematic approach to developing psychosocial aftercare based on evidence from research studies. First, the family member most in need of aftercare is identified. Research findings indicate that the child surviving cancer is most seriously affected by the cancer experience, followed by mothers and fathers, whereas siblings are least affected. Accordingly, former patients and parents should be the primary target groups. Second, different types of interventions need to be developed based on the nature of the problems of the target groups and the individual's level of adjustment. Finally, psychosocial aftercare programs need to demonstrate their effectiveness in reducing late effects and improving the quality of life after treatment ends. If our aim is to cure the child truly of cancer, than the development of psychosocial aftercare, its clinical application, and evaluation of its effectiveness will be the challenge for paediatric psycho-oncology in years to come.

Adolescent↗
PubMed2003

Aftercare of depressed inpatients--service delivery and unmet needs.

BACKGROUND: In contrast to acute treatment, delivery of aftercare to depressed patients has not been well studied. Poor care may contribute to poor outcomes for treated depression. METHODS: One hundred and two patients discharged from hospital with unipolar depression were followed up 18 months later and were interviewed in detail regarding aftercare and treatment received. Unmet needs were assessed on the community version of the MRC Needs for Care Assessment. RESULTS: In the first month after discharge approximately 70 % of subjects received contacts with mental health services and in the first 3 months over 80 % received at least one contact. About 40 % were in contact with mental health services at 18 months. Needs assessment found comparatively low unmet needs, reaching highest levels (around 25 % in any 6-month period) for medication. Two-thirds of unmet needs for medication and psychotherapy were due to patient refusal or non-compliance. Aftercare levels were higher in those with more previous admissions and were unrelated to presence of personality disorder. CONCLUSIONS: There were some deficiencies in service aftercare for depressed patients in a British NHS setting, although unmet need was not high. Some aftercare failures reflect patient reluctance to receive further treatment, representing a challenge to overcome in patients entitled to autonomous choices.

Adolescent↗
PubMed2007

Brief family treatment intervention to promote aftercare among male substance abusing patients in inpatient detoxification: A quasi-experimental pilot study.

We developed a brief family treatment (BFT) intervention for substance abusing patients in inpatient detoxification to promote aftercare treatment post-detox. BFT consisted of meeting with the patient and a family member (spouse or parent) with whom the patient lived to review and recommend potential aftercare plans for the patient. A phone conference was used when logistics prevented an in-person family meeting. Results indicated that male substance abusing patients who received BFT (N=14), as compared with a matched treatment as usual (TAU) comparison group (N=14) that did not, showed a trend toward being more likely to enter an aftercare program and to attend more days of aftercare in the 3 months after detoxification. The magnitude of these differences favoring BFT over TAU was midway between a medium and a large effect size. Days using alcohol or drugs in the 3 months after detox were lower for treatment-exposed BFT patients who had an in-person family meeting than TAU counterparts (trend, medium effect), and for patients who entered aftercare regardless of treatment condition (significant large effect).

Aftercare↗
PubMed1982

Who receives the aftercare? Utilization of services by discharged in-patients.

A prospective one-year follow-up of 216 in-patients showed that utilization of aftercare was significantly associated with certain clinical and social factors in the year after discharge from hospital. Rural domicile, a diagnosis of schizophrenia, long dependence on services, and ease of access to care comprised an aftercare dependency syndrome with substantial predictive power. Alcoholic and personality disordered patients were light users of services. Staff-patient relationships and attitudes of staff and patients to the need for aftercare were important. Depot neuroleptics were associated with high levels of aftercare for patients with chronic schizophrenia. The findings reveal the steady silting up of a new area service for the adult mentally ill by patients with a combination of social disadvantage and severe chronic psychosis. Family doctors played very little part in the delivery of aftercare. Some implications of the findings for the future development of community-based psychiatric services are discussed.

Adolescent↗
PubMed1998

Psychiatric co-morbidity and aftercare among alcoholics: a prospective study of a nationwide representative sample.

AIMS: To study prospectively the type and extent of aftercare sought by patients following their admission for alcohol and other substance abuse treatment as a function of psychiatric co-morbidity. DESIGN: Prospective cohort study with follow-up after 16 months. SETTING AND PARTICIPANTS: A nationwide sample of alcoholics discharged from inpatient treatment (N = 351) in Iceland. MEASUREMENTS: The Diagnostic Interview Schedule was used to assign psychiatric diagnoses at the time of index admission. A questionnaire on the type and number of aftercare attendances was mailed to all participants to obtain information about aftercare. FINDINGS: A combination of attendance at Alcoholics Anonymous (AA) and professional care was the most common aftercare (49%); while only 8% received no aftercare whatsoever. The mean number of AA attendances was over 24 while it was less than 3 for the various professional appointments. Patients with a diagnosis of schizophrenia had a lower rate of attendance at AA. Other types of co-morbidity did not affect AA attendance but did increase rates of professional help-seeking. CONCLUSIONS: Better professional treatment attendance might be gained by integrating AA concepts while AA might benefit from professional input to address the prevalent co-morbid psychiatric disorders.

Adult↗