Case management for persons with substance use disorders

Hesse M, Vanderplasschen W, Rapp R, Broekaert E, Fridell M

Summary

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.