Training Program for Self-management of Substance Addiction Consequences – a Randomized Controlled Trial Pilot Study

Background
According to the World Report on Drug and Alcohol Problems, millions of people in the world have serious physical, mental and social problems with complex daily needs, most of which stem from harmful substance use. For these people, nurse-led interventions to support self-management of the consequences of addiction are scarce.
Objective
To present the results of a pilot randomized controlled trial to evaluate a Training Program for the Self-Management of the Consequences of Substance Dependence. 
Methods
This pilot trial was carried out over the last 18 months in a single outpatient center specialized in addiction care. A parallel group design was used, comparing patients who received the Substance Addiction Consequences Program (ADSProgram), with others who received treatment as usual (TAU). Participants were randomly assigned. A total of 15 participants were expected in each group. The program was intended to last between 8 and 21 weeks.  Eligibility criteria: having at least 18 years old, a substance use disorder and being enrolled in a medication-based program for at least 5 weeks. The severity of the consequences was assessed using the Substance Addiction Consequences Scale (SAC), in which higher scores correspond to lower severity. Nursing diagnoses were considered before and after the program. 
Results
Eligibility criteria were applied to 236 patients. 72 were randomized and allocated, 38 to the ADSProgram and 34 to TAU. There were no significant differences in the mean age of participants between groups (49.5; SD=1.5 vs. 50.3; SD=1.7). Participants in the ADS Program attended more appointments (6 vs. 3) and patients who completed the ADSProgram (n=25) improved their  SAC Scale score from mean=35.6 (SD=6.18) to 47. 6 (SD 9.02) (t-test for paired samples p<0.001; Cohen's d 10.45). However, TAU patients (n=16) also improved their score from mean=37.56 (SD=7.05) to mean=52.5 (SD=11.78) (p<0.001; Cohen's d 9.39). The most common diagnoses were: Impaired self-management of disease; Impaired autonomy (related to self-sufficiency/work); Impaired acceptance of health status; Impaired health knowledge; Substance abuse; Anxiety; and Loneliness. 44% of patients showed a reduction in the severity of the diagnosis.
Conclusions
The ADS program seems to be an important support for self-management of the consequences of substance dependence, allowing to reduce the severity of these patient’s condition. The retention rate in appointments was higher in patients assigned to the ADSP program, which seems to indicate that closer monitoring allows for a deeper relationship and understanding of the person. This relationship also allows for the identification of other diagnoses that indicate a severity that may initially go undetected.
Preliminary results point the need to reduce the number of sessions initially planned. A larger sample size is needed for more consistent results. Also, this program should also be tested in a multicenter study.