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Addictive Behaviors

Preliminary efficacy of the “Medication Adherence Therapy: Psychosocial Leverage Using a Significant Other (MAT-PLUS)” intervention to support adherence to medications for substance use disorder

(PS6-C58) Preliminary Efficacy of the “medication Adherence Therapy: Psychosocial Leverage Using a Significant Other (MAT-PLUS)” Intervention to Support Adherence to Medications for Substance Use Disorder

Saturday, November 19, 2022

9:00 AM – 10:00 AM EST

Location: Westside Ballroom, 5th Floor

Author(s)

Kevin Wenzel, Ph.D.

Director of Research
Maryland Treatment Centers
Baltimore, Maryland

Co-Author(s)

JT

Julia Thomas, B.S.

Clinical Research Assistant
Maryland Treatment Centers Inc
Baltimore, Maryland
JS

Jennifer Stidham, B.A.

Research Coordinator
Maryland Treatment Centers
Baltimore, Maryland
LL

Luciana Lavorato, LPC

Research Therapist
Mountain Manor Treatment Center
Baltimore, Maryland
Marc Fishman, M.D.

Medical Director
Maryland Treatment Centers
Baltimore, Maryland

Drug and alcohol addiction is a growing public health concern with catastrophic impacts on patients and their families. While relapse prevention medications such as extended-release naltrexone (XR-NTX) are efficacious for treating opioid use disorder (OUD) and alcohol use disorder (AUD), barriers to retention diminish their overall impact. The influence of cognitive behavioral based interventions to improve adherence is considerable, but such approaches are underdeveloped and underutilized in addiction treatment. Specifically, assertive continuing care (e.g., actively reaching out as opposed to passively waiting for patients to show up to clinic-based appointments) and family involvement (e.g., family therapy, coaching sessions, and behavioral skills training) are two approaches that may positively impact XR-NTX retention. The “Medication Adherence Treatment: Psychosocial Leverage Using a Significant Other” (MAT-PLUS) intervention is an innovative approach that combines assertive and family-based approaches to address barriers to XR-NTX adherence in individuals with OUD and/or AUD. In an ongoing study, adults seeking treatment for OUD and/or AUD with XR-NTX are recruited from an inpatient SUD treatment center prior to discharge and randomly assigned to either treatment as usual (TAU) or the MATPLUS intervention and followed for 16 weeks of outpatient treatment. TAU consists of routine group and/or individual counseling and medical visits whereas the MAT-PLUS intervention adds additional layers of (1) assertive multi-channel outreach and continuing care, and (2) treatment significant other (TSO) engagement delivered by a therapist. We hypothesize that individuals in the MAT-PLUS condition compared to TAU will receive more doses of XR-NTX (primary outcome) and will exhibit lower rates of opioid/alcohol relapse (secondary outcome). We are recruiting a convenience sample of 40 patients (20 in each arm) leaving short-term residential treatment. Results from an interim analysis of n=24 patients who ranged in age from 21-58, revealed that individuals randomized to the intervention (n=9) received M=2.22 outpatient doses (SD=1.86) compared to M=1.40 (SD=1.59) for in TAU (n=15). Relapse rates in TAU were 66.7% compared to those in the intervention condition (56.6%). Thus far, the sample primarily is comprised of individuals with OUD or comorbid OUD and AUD as opposed to AUD without OUD. Our small sample is not amenable to statistical analyses, but preliminary examination of the raw data seems promising, and group differences are in the expected direction. It is of vital importance to find successful approaches to addiction treatment. The MAT-PLUS intervention has the potential to improve real-world effectiveness and public health impact of relapse prevention medication by leveraging the natural support of families combined with assertive outreach strategies into a cohesive intervention focused on XR-NTX adherence.