Efficacy/Effectiveness of Unhealthy Drug Use Screening/Brief Intervention Models

在初级保健患者中对药物使用进行短暂干预的有效性尚不清楚。因此，国家 专业机构并不建议进行全面检查。然而，一个强有力的理论案例可以被提出来， 对于这种筛查：药物使用是常见的，并与许多健康后果有关，患者通常 不要寻求帮助，筛查和短暂干预已被证明对其他物质使用有效（例如， 酒精）。政策已经在这个案例的基础上取得了进展：联邦政府努力传播筛查和简报， 干预措施正在进行中，保险公司为这些活动补偿临床医生的补偿代码 已经被开发出来了。科学和这些政策发展之间的差异强调了 需要在通过筛查确定的患者中测试短暂干预的有效性。这项研究的目的是， 评估筛查加短暂干预对停止药物使用的有效性（ASPIRE）研究， 确定两种短期干预模式在减少药物使用及其后果方面的效果， 初级保健患者。与一个国家项目合作，实施筛查和简短干预， 作为一项联邦计划的一部分，我们将在一家大型医院的初级保健实践中对患者进行药物使用筛查。 然后，我们将招募1，800名筛查阳性受试者，将他们随机分配到3组中的1组，并随访他们 6个月一个干预组的受试者将被分配到一个标准的简短干预模型， 由受过训练的健康促进倡导者进行，作为当地实施广泛传播的 联邦项目。在另一组中，受试者将被分配到一个增强的，更密集的简短干预 一种模式，包括一个助推器接触，并由硕士级辅导员进行培训和监测 进行激励性访谈。控制组将接收信息（即，一份书面名单， 当地资源，以帮助人们使用药物），并在六个月结束时，如果他们是 还在吸毒主要结果是戒毒和吸毒后果，包括艾滋病毒- 6个月时的危险行为，以及接受物质依赖治疗（在有依赖的人中）。 我们还将比较与每组相关的成本和结果。主要假设是：1） 强化的简短干预模式将比单独的筛查和资源信息更有效 （控制）增加药物戒断，减少药物使用的后果（包括艾滋病毒风险行为）， 和增加接受治疗，2）一个标准的简短干预模式将有更大的疗效比 控制相同的结果，和3）加强简短的干预将有更大的疗效比标准 简短的干预。我们还假设，增强的简短干预将有更高的执行 成本，但净干预成本（实施，未来的医疗保健和犯罪成本）低于其他 组本研究结果药物使用短期干预的效果和成本将是至关重要的 就在初级保健环境中传播药物使用筛查和简短干预作出决定。项目叙述 使用毒品的代价很高，可能造成很大的伤害，而且往往得不到治疗。简要 在初级保健环境中提供的干预措施可惠及许多吸毒者。 这项拟议的临床试验将评估这些简短干预措施的有效性， 因为如果这些简短的干预措施被证明是有效的， 传播可大大减少国家的吸毒负担。

The efficacy of brief intervention for drug use among primary care patients is not known. As a result, national professional organizations do not recommend universal screening. Yet a strong theoretical case can be made for such screening: drug use is common and associated with numerous health consequences, patients usually do not seek help, and screening and brief intervention has proven efficacy for other substance use (e.g., alcohol). Policy has advanced based on this case: large federal efforts to disseminate screening and brief intervention are underway, and reimbursement codes for insurers to compensate clinicians for these activities have been developed. The discrepancy between the science and these policy developments underscore the need to test brief intervention's efficacy among patients identified by screening. The objective of this study, the Assessing Screening Plus brief Intervention's Resulting Efficacy to stop drug use (the ASPIRE) Study, is to determine the efficacy of two models of brief intervention for decreasing drug use and consequences in primary care patients. In collaboration with a state project implementing screening and brief intervention as part of a federal program, we will screen patients in a large hospital-based primary care practice for drug use. We will then enroll 1,800 screen-positive subjects, randomly assign them to 1 of 3 groups, and follow them for 6 months. Subjects in one intervention group will be assigned to a standard brief intervention model, conducted by trained health promotion advocates as part of local implementation of a widely disseminated federal program. In another group, subjects will be assigned to an enhanced, more-intensive brief intervention model that includes a booster contact and is conducted by master's-level counselors trained and monitored intensively to perform motivational interviewing. The control group will receive information (i.e., a written list of local resources to help people using drugs) and, at the end of six months, standard brief intervention if they are still using drugs. Primary outcomes are abstinence from drug use and drug use consequences including HIV- risk behaviors at 6 months, and receipt of substance dependence treatment (among those with dependence). We will also compare costs and outcomes associated with each group. The main hypotheses are that 1) an enhanced brief intervention model will have greater efficacy than screening and resource information alone (control) for increasing drug abstinence, decreasing drug use consequences (including HIV-risk behaviors), and increasing receipt of treatment, 2) a standard brief intervention model will have greater efficacy than control for the same outcomes, and 3) an enhanced brief intervention will have greater efficacy than a standard brief intervention. We also hypothesize that the enhanced brief intervention will have higher implementation costs but lower net intervention costs (implementation, future healthcare, and crime costs) than the other groups. Results of this studyefficacy and costs of brief intervention for drug usewill be essential for making decisions about disseminating drug use screening and brief intervention in primary care settings. Project Narrative Drug use is very costly, can cause much harm, and often goes untreated. Brief interventions offered in primary care settings could reach many people who use drugs. This proposed clinical trial will assess the effectiveness of these brief interventions and is thus relevant because if these brief interventions are proven effective, their dissemination could significantly decrease the national burden of drug use.