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

对初级保健患者的药物使用进行短暂干预的效果尚不清楚。因此，国家 专业组织不建议进行普遍筛查。然而，可以提出一个强有力的理论理由。 对于这样的筛查：药物使用很常见，并与许多健康后果相关，患者通常 不寻求帮助，筛查和短暂干预已证明对其他物质使用有效(例如， 酒精)。基于此案的政策已经推进：大规模的联邦努力传播筛查和简报 干预正在进行中，保险公司为补偿临床医生的这些活动而制定了补偿代码 已经被开发出来了。科学和这些政策发展之间的差异突显了 需要在筛查确定的患者中测试简单干预的有效性。这项研究的目标是 评估筛查加短暂干预导致的戒毒疗效(ASPIRE)研究，旨在 确定两种短期干预模式减少药物使用的有效性和后果 初级保健病人。与实施筛查和简短干预的国家项目合作 作为联邦计划的一部分，我们将对以医院为基础的大型初级保健诊所的患者进行药物使用筛查。 然后，我们将招募1,800名筛查阳性的受试者，将他们随机分配到3组中的1组，并对他们进行跟踪 六个月。一个干预组的受试者将被分配到标准的短暂干预模式， 由训练有素的健康促进倡导者进行，作为当地实施广泛传播的 联邦计划。在另一组中，受试者将被分配到强化的、更密集的短暂干预中 包括助推器接触的模式，由经过培训和监督的硕士级别的顾问进行 紧锣密鼓地进行激励性采访。控制组将接收信息(即，书面列表 当地资源，以帮助吸毒者)，并在六个月结束时，如果他们是 还在吸毒。主要结果是戒除吸毒和吸毒后果，包括艾滋病毒- 6个月后有危险行为，并接受物质依赖治疗(在有依赖者中)。 我们还将比较与每组相关的成本和结果。主要假设是1)和 增强的简短干预模式将比单独的筛查和资源信息具有更大的效果 (控制)增加戒毒，减少吸毒后果(包括艾滋病毒危险行为)， 和更多的接受治疗，2)标准的短期干预模式将比 控制相同的结果，以及3)加强的短期干预将比标准的干预效果更好 短暂的干预。我们还假设，强化的短暂干预将有更高的执行率 成本，但净干预成本(实施、未来医疗保健和犯罪成本)低于其他成本 组。这项研究的结果对药物使用的短暂干预的有效性和成本将是至关重要的 在初级保健环境中作出关于传播药物使用筛查和简短干预的决定。项目叙事 吸毒成本很高，危害很大，而且经常得不到治疗。简介 在初级保健环境中提供的干预措施可以惠及许多吸毒者。 这项拟议的临床试验将评估这些简短干预措施的有效性和 因此是相关的，因为如果这些简短的干预被证明有效，他们的 传播可以显著减轻国家的毒品使用负担。

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.