A multi-centre, phase 3, randomised controlled trial of the effectiveness and cost-effectiveness of Recovery Check-In aftercare intervention for people completing community treatment for alcohol and drug dependence. The SUbstance dependence ProsPective Outcome Recovery Trial (SUPPORT).

RESEARCH QUESTION. For patients successfully completing treatment for alcohol, cannabis, ococaine or opioid use disorder, the SUbstance dependence ProsPective Outcome Recovery Trial (SUPPORT) will determine if a 12-month Recovery Check-In (RCI) intervention is effective and cost-effective. BACKGROUND. Substance use disorders (SUDs) are hard-to-treat, with many people experiencing cycles of remission, relapse and re-admission. Could an aftercare support intervention help people maintain their remission and recover? An aftercare recovery model has been developed and successfully evaluated in the USA – but not in the UK. AIMS AND OBJECTIVES. Compared with treatment-as-usual (TAU]) offer of information about local services only, the primary aim of SUPPORT is to determine if a UK-adapted Recovery Check-In (RCI) intervention is associated with more abstinence from alcohol, cannabis, cocaine and opioids, and is cost-effective. Exploratory secondary outcomes include whether the RCI is associated with reduced substance use; more remission; earlier time to (any) re-admission; and improvements in health, resilience, social support, and recovery. RCI effect moderation and mediation analyses of abstinence investigate change processes. A qualitative evaluation investigates participants’ experiences during follow-up. METHODS. This is a Patient and Public Involvement and Engagement co-designed, multi-centre (20 NHS and Third Sector service), two-arm, parallel group, superiority randomised controlled trial. A target of 1,938 adult participants identified as successfully completing treatment will be randomly allocated (1:1 with stratification) to aftercare information only (n=969; TAU), or aftercare information and a RCI intervention (n=969; experimental condition). An internal pilot trial (n=120; 6 site) will address uncertainty about recruitment, adherence, retention and collection of outcome data. The RCI is a 23-contact, fidelity monitored, peer and professional worker delivered one-to-one, with 1 face-to-face meeting, then telephone contacts (month 1–2; fortnightly month 3–6; once per month in months 7–12). Researcher-administered telephone (optionally online and mail) interviews after 1 month (then quarterly to 12 months) record outcomes. The primary outcome is the total count of days after randomisation to 12 months on which the participant reports no use of alcohol, cannabis, cocaine and opioids by the field gold-standard Timeline Follow-Back interview. In the intention-to-treat population, an adjusted interval rate ratio (95% CI; two-sided alpha 0.05) from a mixed-effects regression model with multiple-imputation will estimate the RCI intervention effect. An economic evaluation will compute Quality Adjusted Life Years and Incremental Cost-Effectiveness Ratios. TIMELINES FOR DELIVERY. The study will be completed in 46 months (June 2025–March 2029). First and last participants are enrolled in October 2025 and October 2027, respectively. The last participant completes follow-up in October 2028. ANTICIPATED IMPACT AND DISSEMINATION. With evidence for effectiveness and cost-effectiveness, an envisaged NICE Technology Appraisal will enable the RCI to become the aftercare standard for SUD treatment. Study findings will be presented at a study conference; reported to medical and field journals; and produced in summary and in graphical formats to appeal to wide audiences.