Treating Co-occuring Substance Use and Mental Disorders Among Jail Inmates

治疗监狱囚犯中同时发生的药物滥用和精神障碍

• 批准号: 8769694
• 负责人: Richard Van Dorn
• 金额: $ 19.07万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8769694
• 关键词: Adult; Alcohol abuse; Alcohol consumption; Alcohol or Other Drugs use; Area; Caring; Clinical Services; Clinical Treatment; Collaborations; Communication; Communication Research; Communities; Complement; Consultations; County; Dimensions; Drug usage; Effectiveness; Enrollment; Ensure; Evaluation; Evidence based practice; Evidence based treatment; Funding; Gap Junctions; Goals; Grant; Group Therapy; Health Personnel; Inpatients; Institutes; Intervention; Jail; Justice; Knowledge; Mental Health; Mental disorders; Modeling; Outcome; Outpatients; Pharmaceutical Preparations; Population; Postdoctoral Fellow; Prevention; Prisoner; Process; Program Effectiveness; Protocols documentation; Provider; Qualitative Methods; Randomized; Randomized Controlled Trials; Research; Risk; Science; Services; Staging; Symptoms; United States National Institutes of Health; Vulnerable Populations; base; community living; community reentry; community setting; dual diagnosis; evidence base; follow-up; high risk; improved; innovation; motivational enhancement therapy; prevent; programs; psychosocial; public health relevance; randomized trial; research and development; severe mental illness; therapy development; treatment as usual; treatment program; uptake

DESCRIPTION (provided by applicant): We propose to adapt and implement dual-diagnosis motivational interviewing (DDMI) and integrated group therapy (IGT) to evaluate the feasibility of a jail-to-community treatment continuum for adults with co- occurring substance use and mental disorders (CODs). More than 2 million adults with serious mental illnesses are admitted to jails annually and approximately three-quarters of them have substance use problems. Although improvements have been made in treating CODs in inpatient and outpatient settings, there remains a gap in the science and practice of treating jail inmates with CODs. Too few receive integrated in-custody and in-community evidence-based treatments that focus on community reentry and criminogenic risk. Achieving sustained community tenure for jail inmates with CODs requires adapting existing evidence-based practices. DDMI and IGT have strong evidence bases and represent appropriate adaptation candidates. Thus, a rigorous study is needed to evaluate the feasibility and acceptability of adapting and integrating these programs across jail and community settings. Guided by the risk-need- responsivity model and the Evidence-Based Interagency Implementation Model, we propose two sequential aims: Aim 1: To adapt DDMI and IGT for delivery to jail inmates, examining the initial acceptability of the adaptations through an uncontrolled open trial (N=12), and Aim 2: To conduct a randomized trial (N=60) to establish knowledge in three areas: Aim 2.1: The feasibility and acceptability of the adapted DDMI and IGT; Aim 2.2: The feasibility and acceptability of the proposed research and communication protocols; and Aim 2.3: The effectiveness of and estimated effect sizes associated with the adapted interventions vis-a-vis reductions in substance use, psychiatric symptoms, and re-arrest and improvements in uptake of usual care. We will use an iterative approach to adapt the programs, including consultation with experts and community providers. Our uncontrolled trial will inform subsequent treatment, research, and communication protocol refinements prior to our randomized trial with assignment to treatment condition (i.e., continuum of DDMI-IGT and usual care vs. usual care only). Our application builds in part on our study team's NIH-funded grants and successful collaborations in prevention and treatment of drug and alcohol use and mental health symptoms, the provision of clinical services to jail inmates with CODs, and the adaptation and implementation of clinical treatment programs. Our proposed R34 will complement professional standards calling for evidence-based treatments for adults with CODs. These efforts will improve the field's understanding of the nexus of CODs and arrest and help improve multiple outcomes, including reductions in substance use, mental health symptoms, and justice involvement, and uptake of usual care, all of which will be evaluated in a follow-up R01.

描述（由申请人提供）：我们建议调整和实施双诊断动机访谈（DIGH）和综合团体治疗（IGT），以评估监狱到社区治疗连续体的可行性，用于同时发生物质使用和精神障碍（COD）的成年人。每年有200多万患有严重精神疾病的成年人被关进监狱，其中约四分之三有药物使用问题。虽然在住院和门诊治疗COD方面取得了进展，但在治疗患有COD的监狱囚犯的科学和实践方面仍然存在差距。接受集中于重返社区和犯罪风险的综合羁押和社区循证治疗的人太少。为患有COD的监狱囚犯实现持续的社区任期需要调整现有的循证实践。糖尿病和糖耐量低减有很强的证据基础，代表了适当的适应候选者。因此，需要进行严格的研究，以评估在监狱和社区环境中调整和整合这些方案的可行性和可接受性。在风险-需求-反应模型和基于证据的机构间实施模型的指导下，我们提出了两个连续的目标：目标1：调整DIGT和IGT用于监狱囚犯的交付，通过一个 非对照开放试验（N=12）和目标2：进行随机试验（N=60），以建立以下三个方面的知识：目标2.1：适应性胰岛素抵抗和IGT的可行性和可接受性;目标2.2：拟定研究和交流方案的可行性和可接受性;目标2.3：与适应性干预措施相关的有效性和估计效应量与物质使用、精神症状和再逮捕的减少以及常规护理的改善有关。我们将使用迭代方法来调整计划，包括咨询专家和社区提供者。我们的非对照试验将在我们的随机试验分配到治疗条件（即，DDMI-IGT和常规护理的连续性对比仅常规护理）。我们的申请部分建立在我们的研究团队的NIH资助的赠款和成功的合作，在预防和治疗药物和酒精使用和心理健康症状，提供临床服务的监狱囚犯与COD，以及适应和实施临床治疗计划。我们提出的R34将补充专业标准，要求对患有COD的成年人进行循证治疗。这些努力将提高现场对COD和逮捕之间关系的理解，并有助于改善多种结果，包括减少药物使用，心理健康症状和司法参与，以及接受常规护理，所有这些都将在后续R 01中进行评估。