Early Re-Intervention Experiment2(ERI-2)

药物依赖与多种并发精神问题越来越被认为是一种慢性， 复发性疾病可能持续数十年，需要多年的多次护理， 持续缓解状态检查治疗效果的观察性研究发现， 复发后人们越早恢复治疗，他们接受的后续治疗和善后护理就越多 （特别是超过90天），他们的长期结果越好。然而，只有不到12项长期研究 that look across横过episodes插曲of care护理.早期再干预实验1（ERI-1）是第一个 实验性评估监测和早期再干预公共卫生模式的能力，以缩短 复发、治疗再进入和恢复周期。RMC的参与者比那些 对照组返回治疗（64% vs. 51%），更早返回治疗（376 vs. 600天），花费更多 随后的治疗天数（平均62 vs 40天）。RMC参与者也经历了显着较少的总 四分之一需要治疗，并且在摄入后2年不太可能需要治疗（43%对56%）。尽管有 成功的联系率，只有60%的联系参与者保持治疗14天或更长时间（这是相关的 有更好的恢复机会）。连锁率与C_发生率之间也存在交互作用 精神问题 根据ERI-2，我们建议延长5年，以继续扩大我们在这一领域的知识。 具体来说，我们建议从干草市场的连续入院中招募300名有物质使用依赖的成年人 中心和随机分配参与者进行季度评估，无RMC干预（对照组） 4年或季度评估，以及我们的RMC手册指导方案的增强修订版（ 附录; Scott & Dennis，2003年）。虽然ERI-2的调查路线与ERI-1平行，但我们提出了几个证据- 基于RMC方案的修改，包括一个更基于理论的模型，将生物标志物添加到 评估需求，转向更长的时间框架来观察RMC效果，并在 治疗计划，以帮助参与者参与和留住治疗。新实验的具体目标是： (1)检查恢复管理检查对复发、重新开始治疗和恢复周期的影响 （2）评估恢复管理检查的影响（直接影响）和后续影响 治疗（间接影响）的结果;（3）探讨（调节）的影响，同时发生的精神 RMC，治疗参与模式和长期结果之间的关系问题。

Substance use dependence with multiple co-occurring psychiatric problems is increasingly recognized as a chronic, relapsing condition that may last for decades and require multiple episodes of care over many years before reaching a sustained state of remission Observational studies that examined treatment effects across episodes of care found that the sooner after a relapse people return to treatment and the more subsequent treatment and aftercare they receive (particularly over 90 days total), the better their long-term outcomes. Yet, there are less than a dozen long-term studies that look across episodes of care. The Early Re-Intervention experiment 1 (ERI-1) was the first study to experimentally evaluate the ability of a public health model of monitoring and early re-intervention to shorten the relapse, treatment re-entry, and recovery cycle. RMC participants were significantly more likely than those in the control group to return to treatment (64% vs. 51%), to return to treatment sooner (376 vs. 600 days), and to spend more subsequent days in treatment (mean of 62 vs. 40 days). RMC participants also experienced significantly fewer total quarters in need of treatment and were less likely to need treatment 2 years after intake (43% vs. 56%). In spite of the successful linkage rates, only 60% of the linked participants remained in treatment 14 or more days (which is associated with better odds of going into recovery). There were also interactions between the linkage rates and c_occurring psychiatric problems. Under ERI-2, we propose a 5-year extension in order to continue expanding our knowledge in this area. Specifically, we propose recruiting 300 adults with substance use dependence from sequential admissions at Haymarket Center and randomly assigning participants to either quarterly assessments with no RMC intervention (control group) for 4 years or quarterly assessments plus an enhanced revised version of our RMC manual-guided protocol (in Appendix; Scott & Dennis, 2003). While the line of inquiry for ERI-2 parallels ERI-1, we propose several evidence- based modifications to the RMC protocol, including a more theoretically based model, adding biomarkers to the assessment of need, shifting to a longer time frame for observing RMC effects, and adding an Engagement Specialist at the treatment program to help engage and retain participants in treatment. The specific aims of the new experiment are: (1) To examine the impact of recovery management checkups on the cycle of relapse, treatment re-entry, and recovery over the course of 4 years; (2) To assess the impact of recovery management checkups (direct effect) and subsequent treatment (indirect effect) on outcomes; and (3) To explore the (moderating) effects of co-occurring psychiatric problems on the relationship between RMC, patterns of treatment participation, and long-term outcomes.