Early Re-Intervention Experiment2(ERI-2)

物质使用依赖与多种共生的精神问题日益被认为是一种慢性、 可能持续数十年并需要多年多次护理才能达到 持续缓解状态观察研究检查了护理期间的治疗效果，发现 复发后越早返回治疗，他们接受的后续治疗和后续护理就越多 (特别是总共超过90天)，他们的长期结果就越好。然而，只有不到12项长期研究。 看着不同时期的护理。早期再干预实验1(ERI-1)是第一个 从实验上评估监测和早期再干预的公共卫生模式缩短 复发、治疗再入和康复周期。RMC参与者明显比那些在 对照组恢复治疗(%比51%)，恢复治疗更快(376天比600天)，花费更多时间 随后的治疗天数(平均62天对40天)。RMC参与者的总体体验也明显减少 需要治疗的四分之一，并且在摄取2年后不太可能需要治疗(43%对56%)。尽管有 成功联结率，只有60%的关联参与者在治疗14天或更长时间(这是相关的 进入复苏的可能性更大)。连锁率与c_2之间也存在交互作用 精神问题。 根据ERI-2，我们提议延长5年，以继续扩大我们在这一领域的知识。 具体地说，我们建议从Haymarket的连续招生中招募300名有药物使用依赖的成年人 中心，并随机分配参与者参加任何一个季度评估，不进行RMC干预(控制组) 为期4年或每季度进行评估，外加我们的RMC手动指导方案的增强修订版(在 附录；Scott&Dennis，2003)。虽然对ERI-2的调查路线与ERI-1相似，但我们提出了几个证据- 基于RMC协议的修改，包括更基于理论的模型，将生物标志物添加到 评估需求，转向更长的时间框架来观察RMC效果，并在以下位置增加一名参与专家 帮助参与者参与和留住治疗的治疗计划。新实验的具体目标是： (1)研究康复管理检查对复发、治疗再入和康复周期的影响 在4年期间；(2)评估恢复管理检查的影响(直接影响)及随后 治疗(间接效应)对结果的影响；以及(3)探讨精神疾病共病的(缓和)效应。 关于RMC、治疗参与模式和长期结果之间的关系的问题。

Substance use dependence with multiple co-occurring psychiatric problems is increasingly recognized as a chronic, relapsing condition that may last for decades and require multiple episodes of care over many years before reaching a sustained state of remission Observational studies that examined treatment effects across episodes of care found that the sooner after a relapse people return to treatment and the more subsequent treatment and aftercare they receive (particularly over 90 days total), the better their long-term outcomes. Yet, there are less than a dozen long-term studies that look across episodes of care. The Early Re-Intervention experiment 1 (ERI-1) was the first study to experimentally evaluate the ability of a public health model of monitoring and early re-intervention to shorten the relapse, treatment re-entry, and recovery cycle. RMC participants were significantly more likely than those in the control group to return to treatment (64% vs. 51%), to return to treatment sooner (376 vs. 600 days), and to spend more subsequent days in treatment (mean of 62 vs. 40 days). RMC participants also experienced significantly fewer total quarters in need of treatment and were less likely to need treatment 2 years after intake (43% vs. 56%). In spite of the successful linkage rates, only 60% of the linked participants remained in treatment 14 or more days (which is associated with better odds of going into recovery). There were also interactions between the linkage rates and c_occurring psychiatric problems. Under ERI-2, we propose a 5-year extension in order to continue expanding our knowledge in this area. Specifically, we propose recruiting 300 adults with substance use dependence from sequential admissions at Haymarket Center and randomly assigning participants to either quarterly assessments with no RMC intervention (control group) for 4 years or quarterly assessments plus an enhanced revised version of our RMC manual-guided protocol (in Appendix; Scott & Dennis, 2003). While the line of inquiry for ERI-2 parallels ERI-1, we propose several evidence- based modifications to the RMC protocol, including a more theoretically based model, adding biomarkers to the assessment of need, shifting to a longer time frame for observing RMC effects, and adding an Engagement Specialist at the treatment program to help engage and retain participants in treatment. The specific aims of the new experiment are: (1) To examine the impact of recovery management checkups on the cycle of relapse, treatment re-entry, and recovery over the course of 4 years; (2) To assess the impact of recovery management checkups (direct effect) and subsequent treatment (indirect effect) on outcomes; and (3) To explore the (moderating) effects of co-occurring psychiatric problems on the relationship between RMC, patterns of treatment participation, and long-term outcomes.