The WIDUS: Indirect Screening for Perinatal Drug Use

描述(由申请人提供)：针对药物滥用的简短干预的有效性是公认的。此外，有许多机会可以短暂接触到高比例的药物使用障碍患者；一个理想的例子是产后，在此期间，几乎所有育儿妇女都要住院。然而，有三个因素限制了短暂干预的潜力。首先，进行此类干预的能力取决于披露药物使用情况的意愿。这是一个重大障碍，因为有证据表明，只有少至一半的药物阳性个人--特别是围产期妇女--报告使用这种药物。其次，实施哪怕是短暂的干预计划也存在后勤和财务障碍，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在一个以上的机会性会议上参加的简短干预。因此，目前的研究将开发和试行测试方法，以解决以下问题：(A)无论是否愿意披露，都需要查明吸毒者；(B)需要一种可行、可复制和低成本的单次干预措施，不要求披露药物使用情况。具体地说，这项探索性/发展性(R21)研究将开发和验证韦恩间接药物使用筛查(WIDUS)，该筛查将被设计为在不依赖自我披露的情况下预测药物使用风险。将制定一份与药物使用障碍有关的间接因素的全面清单，并在300名产后妇女样本中进行头发和尿液分析测试。最能预测头发和尿检的10-30项指标将在另外100名产后妇女的样本中进行交叉验证。此外，将对现有的旨在建立产后吸毒者改变动力的软件进行修改，以便在不假定使用毒品的情况下建立动力。这种后勤上可行、可复制和低成本的短暂干预将接受第一阶段初步测试，为未来的第二阶段临床试验做准备。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愿披露非法药物使用情况的人提供一种具有成本效益、可复制和无害的干预方法。通过这种方式，可以降低对母亲和儿童使用非法药物的风险，即使是对因不愿披露而本来不会被确认或干预的一大批妇女也是如此。

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.