IMPROVING PUBLICLY FUNDED SUBSTANCE-ABUSE TREATMENT - THE VALUE OF CASE-MANAGEMENT

Objectives. This study evaluated the impact of case management on clie nt retention in-treatment and short-term relapse for clients in the pu blicly funded substance abuse treatment system. Methods. A retrospecti ve cohort design was used to study clients discharged from the followi ng four modalities in 1993 and 1994: shortterm. residential (3112 clie nts), longterm residential (2888 clients), outpatient (7431 clients), and residential deter (7776 clients). Logistic regression models were used to analyze the impact of case management after controlling for ba seline characteristics. Results. The odds that case-managed clients re ached a length of stay previously identified as associated with more s uccessful treatment were 1.6 (outpatient programs) to 3.6 (short-term residential programs) times higher than the odds for non-case-managed clients. With the exception of outpatient clients, the odds of case-ma naged clients' being admitted to deter:within 90 days after discharge (suggesting relapse) were about two thirds those of non-case-managed c lients; The odds of case-managed deter clients' transitioning to post- deter treatment (a good outcome) were 1.7 times higher than the odds f or non-case-managed clients. Conclusions. Case management is a low-cos t enhancement that improves short-term outcomes of substance abuse tre atment programs.