Computer vs Therapist-Delivered Brief Intervention for Drug Abuse in Primary Care

绝大多数有药物使用障碍的人没有被发现，也没有得到治疗。主动出击 筛查、短期干预和转诊治疗方法(SBIRT)具有巨大的潜力 识别和影响未被发现的药物滥用，但将其纳入 社区在培训、时间、成本和接受度方面遇到了很大的障碍。二 因此，替代方案值得认真考虑。首先，计算机提供的方法已经表明 对物质使用结果有明显影响，在可复制性、可获得性和成本方面具有巨大优势。第二--也是最吝啬的--评估本身越来越显示出这样的能力 对物质使用产生积极影响。这两种方法都可以消除上述许多障碍，但尚未与传统的人工交付SBIRT进行直接比较。此外，评估对物质使用结果的重大影响意味着尚未对短暂干预方法的真正效果进行明确评估。因此，目前的提案将把680名城市普通内科门诊患者随机分配到仅筛查对照(SC)、仅评估(CA)、评估加计算机提供的BI(CACI)和评估加治疗师提供的BI(CATI)条件下，并比较所有组在1、3和6个月对(A)物质的使用情况 结果，通过自我报告和尿毒学来衡量，以及(B)成本，使用复杂的经济 分析。在此试验之前，全面的开发研究将使用患者和专家小组的反馈来 修改现有和以前成功的激励软件(由该小组开发)以确定目标 初级保健医疗患者有大量/有问题的物质使用风险。拟议的设计将允许 直接评估两种理论上不同的方法，如果疗效与治疗师提供的方法相似 条件，可以大大增加获得SBIRT的机会。这一设计还将为 目前最严格的评估标准是SBIRT？S在初级保健中的真实疗效。

The vast majority of persons with substance use disorders go undetected and untreated. Proactive screening, brief intervention, and referral for treatment approaches (SBIRT) have tremendous potential for identifying and influencing undetected substance abuse, but efforts to incorporate them in the community have met with substantial obstacles related to training, time, costs, and acceptance. Two alternatives therefore merit serious consideration. First, computer-delivered approaches have shown clear effects on substance use outcomes, and have tremendous advantages in terms of replicability, accessibility, and cost. Second?and most parsimoniously?assessment itself is increasingly demonstrating the ability to positively impact substance use. Both approaches could obviate many of the above-noted obstacles, but have yet to be directly compared to traditional person-delivered SBIRT. Further, the significant effects of assessment on substance use outcomes means that there has yet to be a clear evaluation of the true effect of brief intervention approaches. The current proposal will therefore randomly assign 680 general medical urban outpatients into screening-only control (SC), assessment only (CA), assessment plus computer-delivered BI (CACI), and assessment plus therapist-delivered BI (CATI) conditions, and compare all groups at 1, 3, and 6 month follow-up on (a) substance use outcomes, as measured by self-report and urine toxicology, and (b) cost, using sophisticated economic analyses. Prior to this trial, thorough development research will use patient and expert panel feedback to modify existing and previously successful motivational software (developed by this group) to target primary care medical patients at risk for heavy/problem substance use. The proposed design would allow direct evaluation of two theoretically distinct approaches that, if similar in efficacy to the therapist-delivered condition, could greatly increase access to SBIRT. This design would also set the stage for the most stringent evaluation to-date of SBIRT?s true efficacy in primary care.