Treatment of youth with substance use disorder and co-existing mental disorder: the MOVE programme.

Background: Substance use disorder (SUD) in young people is a substantial problem in Denmark as well as in many other countries. Completion rates of a 6 month treatment program is often less than 25 % and some Danish studies have shown that less than 30 % are abstinent when leaving the treatment program. In addition, the prevalence of mental disorder among youth seeking treatment is in Denmark about 40 %. This group of young people is at particular risk of not benefiting from the treatment.

Research question: To what extent does the MOVE program improve outcome for treatment seeking youth with dual diagnosis measured by abstinence from illicit drug use 21 month after admission?

Methods: 381 patients between 15 and 25 years of age from nine Danish municipalities were randomly allocated into one of four treatment conditions (TC). They were all followed in the Danish Addiction Treatment Register (DATR) and The Danish Psychiatric Central Research Register. 240 were found and accepted to participate in a follow-up interview 21 month after they were admitted to the TC.

All patients were offered 12 counseling sessions using motivational interviewing (MI) and cognitive behavioral therapy (CBT) (basic) and all went through a thorough assessment procedure at intake. TC1 included only basic, TC2 basic + voucher, TC3 basic + CARS (Contract, Aftercare, Reminders, and Status letters) and MOVE basic + voucher + CARS.

MOVE was defined as a particular combination of MI, CBT and CM (Contingency Management). Vouchers had a value of 27 euro. CARS: Contract included a mutually accepted treatment plan signed by both the patient and the counselor. Aftercare included a 6-month aftercare program consisting of a combination of personal counseling sessions and telephone/skype counseling sessions. Reminders included SMS text messages or telephone calls the day prior or on the day of the scheduled counseling session. Status letters included a written status every four weeks describing the patient’s progress on goals and future challenges. The patients were contacted again 3, 6, 9 and 21 months after intake.

Results: 149 of the 381 patients were identified in the Danish Psychiatric Central Research Register. In addition, 32 patients reported that they had been diagnosed by a psychiatrist but were not identified in the Psychiatric Register. They were all identified in the Pharmaceutical Statistics Register (receiving prescribed psychotropics) or in the Health Insurance Register (referred to private psychiatric treatment). We included both groups in the analysis (n=181).

The presentation will include an analysis of length of treatment, abstinence among patients with dual diagnosis, by treatment conditions and by different mental disorders, contact to the psychiatric service system before and after admission, and a preliminary cost-effectiveness analysis.