I’m Frank Schwebel. As you might have guessed from my last name, I’m Robert’s son — and apparently, the apple didn’t fall far from the tree. I currently work as a Research Assistant Professor at the University of New Mexico’s Center on Alcohol, Substance Use, and Addictions (CASAA), where I study treatment for alcohol and opioid use disorders. You might recognize the CASAA name — Motivational Interviewing was developed there. 

I trained to be a clinical psychologist with Dr. Mary Larimer (who was part of Alan Marlatt’s academic lineage) and later completed a post-doctoral fellow with Dr. Katie Witkiewitz (also a Marlatt trainee). Although Alan passed away before I started graduate school, he’s remembered as one of the first researchers to support harm reduction as a legitimate alternative to abstinence-only approaches. His legacy had a big impact on my training. 

Moving forward, I’ll be taking a more active role in The Seven Challenges. What does that mean? I’ll be getting more involved in all clinical aspects of the program — from developing materials to participating in support calls. So don’t be surprised if you hear my voice or see my face on a call in the coming months! 

My research focuses on treatment for alcohol and opioid use disorders, especially technology-delivered interventions like apps and text messaging (often this is referred to as digital health or mHealth). I also study mindfulness-based approaches to substance use treatment. A big part of my job is staying up-to-date with the latest in treatment research — which means I spend a lot of time thinking about how research findings can actually improve what happens in the therapy room. Let’s dive into an article I came across recently. 

Recent Research on Continued Care

Yolanda Graser and their colleagues wrote an insightful article that explored the use of phone calls and text messaging after discharge from adult residential treatment for alcohol use disorder (Telephone- and Text Message–Based Continuing Care After Residential Treatment for Alcohol Use Disorder: A Randomized Clinical Multicenter Study). The study compared the effects of high-frequency phone calls (10 calls) and low-frequency phone calls (3 calls) phone calls to text messaging contact (10), with a control group receiving a single contact. All communications were made by a treatment team member familiar to the study participant. The high-frequency phone calls occurred weekly for the first month, follow by monthly calls. Each phone call lasted about 30 minutes and focused on reviewing cognitive behavioral therapy (CBT) content from the participant’s treatment. The text messages were designed to support continued self-monitoring and could offer additional support if requested. 

The findings are thought-provoking. Participants who received the high-frequency phone calls were more likely to maintain abstinence than those in the single-contact control group after six months. This suggests that continued contact after discharge can significantly improve the likelihood of achieving long-term goals and maintaining treatment gains. Additionally, both the high-frequency phone call and text message groups had higher self-efficacy to meet their drinking goal at six months compared to the control group. Although the texting group did not show a significant improvement in abstinence rates compared to the control, those who received text messages felt increased confidence in their ability to achieve their drinking goal. Research indicates that higher self-efficacy is generally linked to better treatment outcomes. 

Applications for Treatment Providers and Agencies 

So, what does this mean for you? While the research focused on adults leaving residential treatment, the takeaway may be relevant for a broader range of settings. Even if you don’t work with adults or in a residential setting, the evidence suggests that continued contact after the end of treatment can be beneficial. Notably, the group receiving calls every two months didn’t fare any better than the group with just one call. This suggests that more frequent contact, ideally monthly or more often, may be most effective. However, I understand there may not always be enough hours in the day to maintain regular contact with all of your clients. Perhaps consider trying it with a few clients to see how they respond. You could also schedule brief check-ins. For clients who are doing well, a simple conversation about what’s working for them may suffice. For those struggling, you can help them re-establish care and continue their treatment journey. For agencies, you might want to consider implementing policies or identifying team members that can help provide continuing support to clients. This might also include working with insurance companies to figure out how to bill for this service.  

Ultimately, how you apply this information (or don’t) depends on the specific needs of your clients and the resources available to you (including any agency or insurance limitations). But the evidence here suggests that continued contact can have a significant positive impact on clients’ continued success. 

Moving Forward 

Looking ahead, I plan to write an article for The Seven Challenges regularly. While some will cover research, others may explore different topics — next month, I’m considering a post on self-care. I’d love to hear your thoughts on this research, any other questions you might have, or topics you’d like me to write about. Perhaps you’d even like to contribute a post yourself! Whatever it is, please don’t hesitate to reach out at fschwebel@sevenchallenges.com.