Extended Care Treatment of Multiple Risk Behaviors in Complex Patients

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The theme of this Center, continuing and extended care models for drug abuse treatment, affords greater opportunity to address the broader health needs of patients over time. Risk behaviors tend to co-occur, and people who abuse alcohol or other drugs are likely to carry additional risks, such as tobacco use, poor diet, physical inactivity, stress and distress, and poor sleep quality. Targeting change in multiple risks offers the potential of increased health benefits, maximized health promotion, and reduced medical costs. Yet, controversies remain regarding how to, and even whether to, assess and treat the multiple comorbid conditions with which patients present. Proceeding in two phases, this Integrative component will provide unique information on the multiple behavioral risks, health functioning, and comprehensive treatment needs of 1200 clients in drug abuse treatment in three very different systems of care: a county public health buprenorphine clinic, a large non-profit integrated managed care health plan, and a Veteran's Affairs medical center. In Phase I, 900 participants from Drs. Hall's and Weisner's components will complete a health risk assessment of 16 behaviors that also assesses participants' stage of change. The primary aims are to examine: the prevalence of multiple risk behaviors and motivation to change among individuals in drug treatment; the association between multiple risk behaviors and health-related quality of life; covariation in changes in risk behaviors; and the medical costs associated with multiple risks and changes over 18-months time. Findings will identify treatment needs and prioritize intervention targets for the pilot study in Phase II. Phase II pilots and evaluates, in a randomized controlled thai, an Innovative, online, extended-care, computer-delivered and stage-tailored health risk intervention (S-HRI) with 300 participants in drug abuse treatment. The S-HRI provides feedback on participants' stages of change for each risk with recommendations on the single most important step they can take to begin progressing. A counselor will review the report with participants and provide motivational interviewing (Ml) coaching and referrals to relevant behavior change services. Intervention participants will complete the S-HRI and Ml-coaching sessions at baseline, 3, 6 and 12 months follow-up. Primary hypotheses are that, relative to usual care, the Intervention will result in greater: (1) client engagement with behavior change service referrals, (2) behavioral changes in multiple risks, and (3) improvements In health-related quality of life at 3, 6, 12, and 18 months follow-up. A secondary aim will examine retention In addictions treatment by condition.