The WIDUS: Indirect Screening for Perinatal Drug Use

描述（由申请人提供）：短期干预药物滥用的有效性是公认的。此外，有许多机会可以短暂接触到比例很高的物质使用障碍患者；一个理想的例子是产后，在此期间，几乎所有养育子女的妇女都住院治疗。然而，三个因素限制了短期干预的潜力。首先，进行此类干预的能力取决于披露吸毒情况的意愿。这是一个重大障碍，因为有证据表明，只有不到一半的药物阳性个体——尤其是围产期妇女——报告使用药物。其次，即使是实施简短的干预计划也存在后勤和财政障碍，特别是在培训和提供者意愿方面。第三，超过一半的符合条件的患者没有完成需要参加不止一次机会性会议的简短干预。因此，目前的研究将制定和试点测试方法，以解决以下问题：(a)需要确定吸毒者，而不管他们是否愿意透露；(b)需要一种可行的、可复制的、低成本的、不需要披露药物使用情况的单次干预。具体来说，这项探索性/发展性（R21）研究将开发和验证Wayne间接药物使用筛选器（WIDUS），该筛选器将被设计用于预测药物使用风险，而不依赖于自我披露。将编制一份与药物使用失调有关的间接因素综合清单，并对300名产后妇女进行头发和尿液分析。最能预测头发和尿液分析的10-30项将在另外100名产后妇女的样本中进行交叉验证。此外，现有的旨在建立产后吸毒者改变动机的软件将被修改，以便在不假定吸毒的情况下建立动机。这种逻辑上可行、可复制、低成本的短期干预措施将进行I期初步测试，为未来的II期临床试验做准备。如果得到验证，WIDUS及其相关的基于计算机的间接干预可以为不希望透露非法药物使用情况的人提供一种成本效益高、可复制且无害的干预方法。这样，就可以减少对母亲和儿童使用非法药物的危险，即使有一大群妇女由于不愿透露情况，否则不会被查明或进行干预。

DESCRIPTION (provided by applicant): The efficacy of brief interventions for substance abuse is well-established. Further, numerous opportunities exist for brief access to high proportions of individuals with substance use disorders; an ideal example is the post-partum period, during which nearly all parenting women are hospitalized. However, three factors limit the potential of brief interventions. First, the ability to conduct such interventions is dependent upon willingness to disclose drug use. This is a significant obstacle given evidence that as few as half of drug positive individuals-particularly women in the perinatal period-report that use. Second, there are logistic and financial obstacles to implementing even brief intervention programs, particularly with regard to training and provider willingness. Third, over half of eligible patients do not complete brief interventions that require attendance at more than a single opportunistic session. The current study will thus develop and pilot test methods for addressing (a) the need to identify drug users regardless of willingness to disclose; and (b) the need for a feasible, replicable, and low-cost single-session intervention that does not require disclosure of drug use. Specifically, this exploratory/developmental (R21) study will develop and validate the Wayne Indirect Drug Use Screener, or WIDUS, which will be designed to predict drug use risk without relying on self-disclosure. A comprehensive checklist of indirect factors associated with drug use disorders will be developed, and tested against hair and urinalysis in a sample of 300 post-partum women. The 10-30 items most predictive of hair and urinalysis will be cross-validated in an additional sample of 100 post-partum women. In addition, existing software designed to build motivation to change among post-partum drug users will be modified so as to build motivation without presuming drug use. This logistically feasible, replicable, and low-cost brief intervention will be subjected to Phase I preliminary testing in preparation for a future Phase II clinical trial. If validated, the WIDUS and its associated computer-based indirect intervention could provide a cost-effective, replicable, and inoffensive method for intervening with persons who do not wish to disclose illicit drug use. In this way, the risks of illicit drug use to both mother and child could be reduced, even with the large group of women who would not otherwise have been identified or intervened with because of hesitancy to disclose.