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Systematic Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00186

A meta-analysis of the efficacy of case management for substance use disorders: a recovery perspective

  • 1Ghent University, Belgium
  • 2Wright State University, United States
  • 3Boonshoft School of Medicine, United States
  • 4Hogeschool Gent, Belgium
  • 5KU Leuven Kulak, Belgium

Background
Case management is a client-centered strategy to improve the coordination and continuity of service delivery, especially for persons with substance use disorders and multiple and complex needs. This intervention supports individuals by helping them identify needed services, facilitate linkage with services and promote continued retention in services. However, it is questionable whether case management is equally effective in promoting recovery and aspects of personal functioning. The objective was to conduct an updated meta-analysis and to assess whether case management was more effective than treatment as usual (TAU) among persons with substance use disorders (SUD) for improving treatment-related (e.g. successful linkage with and retention in treatment) as well as personal functioning outcomes (e.g. substance use).
Methods
This meta-analysis focuses on randomized controlled trials that included persons with alcohol or drug use disorders and compared case management with treatment as usual. To be eligible, interventions had to meet core case management functions as defined in the literature. We conducted searches of the following databases to May 2017: the Cochrane Drugs and Alcohol Specialized Register, CENTRAL, PubMed, Embase, CINAHL and Web of Science. Also, reference lists of retrieved publications were scanned for relevant (un)published studies.
Results
The overall effect size for case management compared to treatment as usual (TAU) across all outcome categories and moments was small and positive (SMD=0.18, 95% CI 0.07 - 0.28), but statistically significant. Effects were considerably larger for treatment tasks (SMD=0.33, 95% CI 0.18 - 0.48) than for personal functioning outcomes (SMD=0.06, 95% CI -0.02 – 0.15). The largest effect sizes were found for retention in substance abuse treatment and linkage with substance abuse services. Moderator effects of case management models and conditions were assessed, but no significant differences were observed.
Conclusions
The primary results from earlier meta-analyses were supported: case management is more effective than TAU conditions for improving outcomes, but this effect is significantly larger for treatment-related tasks than for personal functioning outcomes. Case management can be an important supplement to available services for improving linkage and retention, although further research is needed to assess its potential for supporting recovery from a longitudinal perspective.

Keywords: Case Management, community-based care, Addiction, Systematic review, Recovery, Substance use disorder (SUD), Substance Abuse Treatment, effectiveness

Received: 09 Sep 2018; Accepted: 14 Mar 2019.

Edited by:

Louise Penzenstadler, Geneva University Hospitals (HUG), Switzerland

Reviewed by:

Laura Orsolini, University of Hertfordshire, United Kingdom
Giuseppe Carrà, University of Milano-Bicocca, Italy  

Copyright: © 2019 Vanderplasschen, Rapp, De Maeyer and Van Den Noortgate. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Wouter Vanderplasschen, Ghent University, Ghent, Belgium, wouter.vanderplasschen@ugent.be