Intervention Review

Case management for persons with substance use disorders

  1. Morten Hesse1,*,
  2. Wouter Vanderplasschen2,
  3. Richard Rapp3,
  4. Eric Broekaert2,
  5. Mats Fridell4

Editorial Group: Cochrane Drugs and Alcohol Group

Published Online: 15 APR 2009

Assessed as up-to-date: 6 AUG 2007

DOI: 10.1002/14651858.CD006265.pub2

Database Title

Additional Information

How to Cite

Hesse M, Vanderplasschen W, Rapp R, Broekaert E, Fridell M. Case management for persons with substance use disorders. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006265. DOI: 10.1002/14651858.CD006265.pub2.

Author Information

  1. 1

    Aarhus University, Centre for Alcohol and Drug Research, København C, Denmark

  2. 2

    Ghent University, Department of Orthopedagogics, Gent, Belgium

  3. 3

    Wright State University, Community Health, Dayton, Ohio, USA

  4. 4

    Lund University, Department of Psychology, Lund, Sweden

*Morten Hesse, Centre for Alcohol and Drug Research, Aarhus University, Købmagergade 26 E, København C, 1150, Denmark. mortenhesse@crf.dk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 15 APR 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Patients with alcohol and other drug use disorders (AOD) frequently have multiple social, physical, and mental health treatment needs, yet have difficulty accessing community services, including drug abuse treatment. One strategy for linking patients with AOD with relevant services is case management, where a single case manager is responsible for linking patients with multiple relevant services.

Objectives

To conduct a systematic review of all RCTs on the use of case management for helping drug abusers in or out of treatment. Outcome criteria included successful linkage with other services, illicit drug use outcomes, and a range of related outcomes.

Search methods

We searched the Cochrane Controlled Trials Register (Cochrane Library, issue 4, 2006), MEDLINE (1966 - 2006), EMBASE (1980 - 2006), LILACS (1982 - 2006), PsycINFO (1973 - 2006), Biological Abstracts (1982 t- 2000). Reference searching; personal communication; conference abstracts; book chapters on case management.

Selection criteria

Randomized controlled studies that compared a specific model of case management with either treatment as usual or another treatment model, included only patients with at least one alcohol or drug related problem.

Data collection and analysis

Two groups of reviewers extracted the data independently . Standardized mean difference was estimated.

Main results

In total, we could extract results from 15 studies. Outcome on illicit drug use was reported from 7 studies with 2391 patients. The effect size for illicit drug use was not significant, and small (standardized mean difference (SMD)=0.12, confidence interval=-0.09,0.29, p=0.20). Substantial heterogeneity was found (I2=69.9%). Linkage to other treatment services was reported in 10 studies with 3132 patients. The effect size for linkage was moderate (SMD=0.42, 95% confidence interval=0.21 to 0.62, p<0.001), but substantial heterogeneity was found (I2=85.2%). Moderator analyses suggested that a part of the heterogeneity found in linkage studies could be explained by the presence or absence of a treatment manual for case management. A single, large trial of case management with two arms, showed that case management was superior to psycho education and drug counselling in reducing drug use.

Authors' conclusions

There is current evidence supporting that case management can enhance linkage with other services. However, evidence that case management reduces drug use or produce other beneficial outcome is not conclusive.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Case mangement for persons with substance use disorders.

Illicit use of drugs such as opioids, cocaine, amphetamines, cannabis and alcohol dependence have health, social and economic complications. Users often have long-term problems in addition to substance abuse. Case management is a client-centred strategy involving assessment, planning, linking to relevant services and community resources and advocacy. Its intent is to improve the co-ordination and continuity of delivery of services. Brokerage case management sets out to help clients identify their needs and broker services in one or two contacts; intensive case management involves a closer interaction between case manager and client; assertive community treatment (provides assertive outreach and direct counselling services; strengths-based case management focuses on self-direction and the use of informal networks rather than agency resources by applying active outreach.
From this review, case management effectively linked people with substance abuse to community and treatment services as compared to treatment as usual or other viable treatment options, such as psycho-education or brief interventions. This conclusion is based on 10 randomised controlled trials involving 3132 participants that compared case management to usual treatment. Two studies compared case management with other specific treatments. Additional analysis of the studies suggested that the use of a manual to guide the delivery of case management could increase linkage. A total of 15 controlled studies that randomised a total of 6694 participants were included in the review. One study was conducted in Europe; all other studies were from North America.
Seven studies with 2391 participants did not find a clear reduction in illicit drug use with case management compared with usual treatment; similarly with alcohol use (two studies). A single, large trial showed that case management for heroin users was superior to psycho-education and drug counselling in reducing drug use. The extent of linkage varied significantly between studies, which is likely to be influenced by the availability of services in the community, the model of case management, how effectively it is applied and its integration in the local network of services.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

物質使用疾患患者之個案管理

酒精及其他物質使用疾患(alcohol and other drug use disorders (AOD))患者經常有許多社會、身體與心理治療之需求，但卻沒有接觸社區中相關治療資源(包括藥癮治療)的管道。 個案管理正是一種將AOD患者與相關治療連結的方法，它是由一位個案管理師，負責將病人與多種相關的服務連結。

目標

回顧所有RCTs以進行系統性文獻回顧，來了解個案管理幫助藥癮患者接受或退出治療之成效如何。 結果指標的篩選條件為：成功地連結患者與相關的治療服務、非法藥物使用、其他相關的結果。

搜尋策略

針對此一主題個案管理，我們在下列資料庫進行搜尋:Cochrane Controlled Trials Register (Cochrane Library, issue 4, 2006)、 MEDLINE (1966 – 2006)、EMBASE (1980 – 2006)、LILACS (1982 – 2006)、PsycINFO (1973 – 2006)、生物學摘要(1982 – 2000)。另外，也進行參考文獻、個人通信、研討會摘要、教科書章節之搜尋。

選擇標準

只包含酒癮或藥癮相關問題之患者，比較一種特定模式的個案管理與一般療法或其他治療模式的隨機對照研究(randomized controlled studies)。

資料收集與分析

兩組審查者獨立地選出數據，並估計標準化平均差異值(standardized mean difference，SMD)。

主要結論

我們從總共15項研究中摘錄出結果。 有7項研究(包括2391位病患)以非法藥物使用為結果(包括2391位病患)顯示效果小又不顯著(SMD = 0.12, confidence interval = −0.09,0.29, p = 0.20)，異質性大(I2 = 69.9%)。有10項以其他治療服務為結果研究(包括3132位病患)為指標，顯示中等療效(SMD = 0.42, 95% confidence interval = 0.21 to 0.62, p<0.001)，但異質性大(I2 = 85.2%)。 計劃主持人分析建議：這個異質性可能受到個案管理有無治療手冊(treatment manual)所影響。有一個大型的研究顯示個案管理在降低吸毒方面優於精神科衛教和藥物諮詢。

作者結論

當今的證據顯示個案管理能提升患者和其他服務的聯繫。不過，個案管理降低毒品使用(drug use)或者產生其他有利的結果的證據尚不確定。

翻譯人

本摘要由高雄榮民總醫院張正和翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

非法藥物使用例如鴉片類藥物、古柯鹼、安非他命、大麻和酒精成癮會導致健康、社會和經濟等後遺症。藥癮患者除了藥癮之外，經常還有其他長期的問題。 個案管理是一個以客戶為中心的策略並包含 評估、計劃、連結相關服務與社區資源等。它的目的是改進資源提供的協調和連續性。個案管理仲介在一至兩次的接觸內幫助客戶找出他們的需求和提供經紀人服務。 密集式個案管理(intensive case management)的個案管理師提供和個案之間的密切互動；肯定式社區治療(assertive community treatment)提供服務範圍的擴展和直接的諮詢服務； strengthsbased 個案管理著重於自我指導和使用非正式的資源。 這篇回顧顯示:個案管理與其他治療相比(例如:精神科衛教或者短期介入，可以更有效地將藥癮患者與社區和治療服務相連結。 這樣的結論是基於10篇共有3132個參加者的RCTs，這些研究比較個案管理與一般治療(usual treatment)有兩項研究比較個案管理與其他特定的治療。 研究的另外分析顯示:依照?指導手冊?來執行個案管理可以增加連結的成功率。 共有15個RCTs(包括總共6694個參加者)被歸入文獻回顧。其中有一項研究在歐洲進行，其他的研究都是在北美；與一般治療相比較，有7個研究(包括2391位參加者)顯示個案管理無法明顯地降低非法藥物之使用(illicit drug use)，有關酒精濫用的研究亦相同(包括2個研究)。有一個單一的大型研究顯示針對海洛因(heroin)使用者的個案管理，減少藥物濫用的效果優於精神科衛教(psychoeducation)和藥物諮商。連結患者與資源的程度在不同的研究有很大的差異，這可能是因為下列因素的影響: 社區中資源的可近性、個案管理的模式、個案管理執行的效率及其與地區資源結合的程度

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