Motivational Interviewing to Reduce Substance Use Among Depression Patients

描述（由申请人提供）：本申请由一名新调查员响应PA-08-263，药物和酒精滥用的预防和治疗卫生服务研究（R01）。我们提出了一项为期3年的随机研究，在筛选、短暂干预和转诊治疗（SBIRT）模式的背景下，通过简短动机干预（BMI）来减少一家健康维护机构的大型门诊精神病学诊所治疗抑郁症的门诊患者的药物使用和危险饮酒。使用药物或酒精的抑郁症患者，即使是在亚诊断水平，也会损害抑郁症的治疗，并有物质问题升级的高风险。但干预措施尚未在这一庞大而脆弱的人群中进行过测试。BMI是一种创新的方法，可以减少药物和酒精的使用，并改善这些危险饮酒和药物使用患者的预后。根据需要，BMI可以促进有严重物质问题（包括依赖）的患者开始化学依赖护理，这与SBIRT模型一致。这种有希望的干预措施从未在抑郁症患者中进行过测试。纳入研究的标准是基于药物使用（包括任何非法药物使用和处方药的非处方使用）和危险饮酒（即女性每天喝3杯酒，男性每天喝4杯酒），以及在摄入时出现中度至重度抑郁症状。在这项对照试验中，350名患者将被随机分为两组，在8周内接受一次面对面的BMI测试和两次电话BMI增强测试（干预），或接受关于药物和酒精使用风险的小册子（对照组）。我们预计，相对于对照组患者，在3个月、6个月和12个月的随访访谈中，干预措施将有效减少药物使用和危险饮酒的频率；改善情绪和功能结果；增加抑郁症治疗保留（根据医疗保健有效性数据和信息集（HEDIS）标准，电子病历中记录的精神病学就诊次数）；促进病人开始化学药物依赖项目治疗。如果证明了有效性，BMI可能会对抑郁症患者的服务产生重大影响。

DESCRIPTION (provided by applicant): This application by a new investigator responds to PA-08-263, Health Services Research on the Prevention and Treatment of Drug and Alcohol Abuse (R01). We propose a 3-year randomized study of Brief Motivational Intervention (BMI) delivered in the context of the Screening, Brief Intervention and Referral to Treatment (SBIRT) model to reduce drug use and hazardous drinking among outpatients in treatment for depression in a health maintenance organization's large outpatient psychiatry clinic. Patients with depression who use drugs or alcohol even at sub-diagnostic levels can compromise depression treatment and are at high risk for escalation of substance problems. But interventions have not been tested in this large and vulnerable population. BMI is an innovative approach that could decrease drug and alcohol use and improve outcomes for these patients with hazardous drinking and drug use. BMI can facilitate initiation of chemical dependency care for patients with significant substance problems including dependence, as needed, consistent with the SBIRT model. This promising intervention has never been tested among patients with depression. Study inclusion criteria are based on drug use (including any illicit drug use and non-prescribed use of prescription drugs) and hazardous drinking (i.e., e 3 drinks in a day for women and e 4 drinks in a day for men), and moderate to severe depression symptoms at the time of intake. In this controlled trial, 350 patients will be randomized to receive one in-person BMI session and two telephone BMI booster sessions within 8 weeks of intake (intervention) or a brochure on risks of drug and alcohol use (control). We anticipate that the intervention will be effective in reducing frequency of drug use and hazardous drinking at 3-, 6- and 12-month follow-up interviews, relative to patients in the control group; improving mood and functional outcomes; increasing depression treatment retention (number of psychiatry visits recorded in the electronic medical record, based on Healthcare Effectiveness Data and Information Set (HEDIS) standards); and facilitating patient initiation of chemical dependency program treatment. If effectiveness is demonstrated, BMI could have a major impact on services for patients with depression. PUBLIC HEALTH RELEVANCE: Drug and alcohol use among depression patients is very prevalent and puts patients at risk for worsening substance problems and poor mental health outcomes. The study intervention (BMI) is an innovative treatment with significant potential to reduce drug and alcohol use in this population. If effectiveness is demonstrated, the intervention could improve services for patients with depression, prevent escalation of drug and alcohol problems and improve health outcomes.