A daily client check-in system for outpatient substance abuse treatment

摘要 酒精和非法药物的使用在美国仍然非常普遍，流行病学监测调查显示， 估计超过2060万人（约占美国人口的8%）符合标准诊断阈值， 物质使用障碍（SAMHSA，2011年）。门诊药物滥用治疗是主要方法 在美国治疗SUD，通常涉及临床医生和客户之间的间歇性接触， 每周一次的个人和/或团体治疗（SAMHSA，2012）。不幸的是，复发和过早 治疗中断在门诊治疗中相当常见（Scott等，2005;白色，2008）。然而，在这方面， 临床医生和客户之间的强烈情感纽带（即，治疗联盟）早期治疗已经 发现可增强治疗保留和有效性（Barber等人，2001; Meier等人，2005;米勒等人， 2006; Thompson等人，2007年）。建立和维护门诊治疗联盟 由于每周接触的间歇性，治疗具有挑战性，使临床医生缺乏 关于客户端恢复的信息。每周会议之间的定期客户端监控可以纠正这种情况 缺陷和减少客户复发的可能性，为临床医生提供及时和准确的数据，以告知客户- 集中治疗。拟议的客户登记监测系统将使用基于电话的交互式 语音应答（IVR）技术，用于在每周治疗期间获取客户数据， 动机，渴望，风险/保护因素和物质使用行为。系统将生成 自动化简要报告，以协助临床医生评估治疗需求和定制服务。的 拟议的技术最终可以部署在整个国家网络的门诊物质， 虐待治疗提供者促进提供以客户为中心的护理，加强治疗联盟， 提高客户参与度，改善治疗保留率和结果。因此，所提出的技术 可能会对公众健康产生重大影响。

Abstract Alcohol and illicit drug use remain highly prevalent in the US, and epidemiological surveillance surveys estimate that over 20.6 million individuals (~ 8% of the US population) meet standard diagnostic thresholds for substance use disorders (SAMHSA, 2011). Outpatient substance abuse treatment is the predominate method of treatment in the US for SUDs, typically involving intermittent contact between clinician and client through weekly individual and/or group therapy sessions (SAMHSA, 2012). Unfortunately, relapse and premature treatment discontinuation are quite common in outpatient treatment (Scott et al., 2005; White, 2008). However, a strong emotional bond between clinician and client (i.e., therapeutic alliance) early in treatment has been found to enhance treatment retention and effectiveness (Barber et al., 2001; Meier et al., 2005; Miller et al., 2006; Thompson et al., 2007). Establishing and maintaining a strong therapeutic alliance in outpatient treatment is challenging due to the intermittent nature of weekly contact, leaving clinicians with a deficit of information regarding client recovery. Regular client monitoring between weekly sessions could correct such deficits and reduce the likelihood of client relapse by giving clinicians timely and accurate data to inform client- centered treatment. The proposed client check-in monitoring system (CIMS) will use phone-based interactive voice response (IVR) technology to obtain client data between weekly treatment sessions regarding motivations, cravings, risk/protective factors, and substance use behaviors. The system will generate automated brief summary reports to assist clinicians in assessing treatment needs and tailoring services. The proposed technology could ultimately be deployed throughout the national network of outpatient substance abuse treatment providers to facilitate the delivery of client-centered care, strengthen therapeutic alliance, enhance client engagement, and improve treatment retention and outcomes. Thus, the proposed technology could have high public health impact.