Motivational Interviewing to Reduce Substance Use Among Depression Patients

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DESCRIPTION (provided by applicant):.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 hazardous drinking among outpatients in treatment for depression in a health maintenance organization's large outpatient psychiatry clinic. Patients with depression who use alcohol even at sub-diagnostic levels can compromise depression treatment and are at high risk for escalation of alcohol-related problems. But interventions have not been tested in this large and vulnerable population. BMI is an innovative approach that could decrease alcohol use and improve outcomes for these patients with hazardous drinking. BMI can facilitate initiation of chemical dependency care for patients with significant alcohol problems including dependence, as needed, consistent with the SBIRT model; and may be cost-effective. But this promising intervention has never been tested among patients with depression. Study inclusion criteria are based on hazardous drinking (i.e., = 3 drinks in a day for women and = 4 drinks in a day for men), and moderate to severe depression symptoms at the time of intake. In this controlled trial, 280 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 alcohol use (control). We anticipate that the intervention will be effective in reducing frequency of hazardous drinking at 3-, 6- and 12-month follow-up interviews, relative to patients in the control group; as well as decreasing depression symptoms; increasing depression treatment retention (number of psychiatry visits recorded in the electronic medical record, based on Healthcare Effectiveness Data and Information Set (HEDIS) standards); facilitating patient initiation of chemical dependency program treatment; and decreasing emergency room and inpatient utilization and overall health care costs. If effectiveness is demonstrated, BMI could have a major impact on services for patients with depression. PUBLIC HEALTH RELEVANCE: Alcohol use among depression patients is very prevalent and puts patients at risk for worsening alcohol-related problems and poor mental health outcomes. The study intervention (BMI) is an innovative treatment with significant potential to reduce hazardous alcohol use in this population. If effectiveness of the treatment and cost-effectiveness are demonstrated, the intervention could improve services for patients with depression, prevent escalation of alcohol problems and improve health outcomes.