Advance Statements to Prevent Treatment Disengagement in Substance Use Disorders

Objectives: Some individuals with substance use disorders find it difficult to engage in outpatient treatment programs. In order to promote clients' recovery they need to be actively involved in illness management. This implies for both client and health care professional identifying possible signs for treatment disengagement and strategies to regain contact with their service providers. We used advance statements (AS) in order to discuss these signs, strategies, and treatment preferences with service users. This study aims to examine the content of AS developed to prevent treatment disengagement. Methods: Thematic analysis of 62 AS developed by service users with addictive disorders and their care team as part of a substudy of a larger trial on transitional case management for individuals with substance use disorders. The AS used predefined questions and were discussed before hospital discharge. Results: The main reasons for loss of contact were relapse, psychiatric, and more general psychological symptoms, loss of therapeutic alliance, as well as social circumstances. Most service users requested to be contacted by their caregiver. Many participants were able to name specific coping strategies in case of loss of contact. The clients' networks can play an important role in regaining contact. Conclusion: There is evidence that the AS-related intervention is a feasible and acceptable tool to help service users assess their risk situations and early warning signs for treatment drop-outs. The AS also allow them to plan the interventions or actions they request in case of such situations. Further studies are needed to examine whether AS lead to less treatment disengagement and whether possible loss of contact with caregivers is shorter and with fewer negative consequences.