Maximizing Effectiveness of Integrated Treatment Approaches

描述（由申请人提供）：本申请涉及广泛的挑战领域（05）：比较有效性研究和具体挑战主题05- da -103：药物滥用和合并症的综合与分离治疗。服务研究有希望的策略，以改善药物依赖患者的护理共病精神障碍仍然是治疗提供者和卫生保健决策者的主要优先事项。这项挑战拨款申请将对这项工作做出重大贡献，通过使用控制良好的实验设计来评估应急管理的有效性，以提高精神科服务的利用率，减少阿片类药物依赖患者在社区药物滥用治疗计划中的精神痛苦和损害。本研究的基本原理和方法基于先前资助的NIH-NIDA申请（随访将于2009年4月完成），这是第一个已知的在社区药物滥用治疗计划中完全整合的物质使用和精神病学服务提供模式的对照和随机评估（服务研究：药物滥用者的精神病学共病，R01 DA 016375）。这项研究揭示了综合护理的许多好处，然而，在综合条件下，患者对精神科服务的总体依从性较差（M = .32）显然损害了这些良好发现的重要性，包括综合护理与药物使用或保留之间缺乏关系。这些结果表明，通过结合其他策略来提高依从性，可以大大改善综合方法。拟议的研究是这项工作的下一个合乎逻辑的步骤。在成瘾治疗服务中心患有任何精神障碍的男性和女性阿片类药物依赖患者（N = 70）将被随机分配到两种精神服务条件中的一种：1)加强现场综合护理（ROIC），每周参加精神治疗会议的代金券奖励；或2)标准现场综合护理（SOIC）。这两种情况的参与者将获得相同的时间表和范围的精神和药物滥用治疗服务。参与者将在随机化后的3个月内进行评估，以确定服务利用率和精神科护理依从性，精神和社会心理问题的范围和严重程度的变化，以及药物使用率和治疗保留率。积极的研究结果将具有相当大的启发式和卫生保健政策和实践意义。整个研究，包括在全国会议上传播主要发现和提交第一份手稿，计划在两年内完成。服务研究有希望的策略，以改善药物依赖患者的护理共病精神障碍仍然是治疗提供者和卫生保健决策者的主要优先事项。这项挑战拨款申请将对这项工作做出重大贡献，通过使用控制良好的实验设计来评估应急管理的有效性，以提高精神科服务的利用率，减少阿片类药物依赖患者在社区药物滥用治疗计划中的精神痛苦和损害。积极的研究结果将具有相当大的启发式和卫生保健政策和实践意义。整个研究，包括在全国会议上传播主要发现和提交第一份手稿，计划在两年内完成。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05): Comparative Effectiveness Research and specific Challenge Topic 05-DA-103: Integrated Versus Separate Treatment of Substance Abuse and Comorbid Conditions. Services research on promising strategies to improve the care of drug-dependent patients with comorbid psychiatric disorders remains a major priority for treatment providers and health care policymakers. This challenge grant application will make several substantial contributions to this work by using a well-controlled experimental design to evaluate the efficacy of contingency management for improving psychiatric service utilization and reducing psychiatric distress and impairment in opioid-dependent patients with any psychiatric disorder at a community-based drug abuse treatment program. The rationale and methodology of this study is based on a previously funded NIH-NIDA application (follow-up will be completed April 2009) that was then the first known controlled and randomized evaluation of a fully-integrated substance use and psychiatric service delivery model within a community-based drug abuse treatment program (Services Research: Psychiatric Comorbidity in Drug Abusers, R01 DA 016375). This study has revealed many benefits of integrated care, yet poor overall patient adherence to psychiatric services in the integrated condition (M = .32) clearly compromised the magnitude of these good findings, including the absence of a relationship between integrated care and drug use or retention. These results suggest that integrated approaches could be substantially improved by incorporating other strategies to improve adherence. The proposed study is the next logical step to this work. Male and female opioid-dependent patients at Addiction Treatment Services with any current psychiatric disorder (N = 70) will be randomly assigned to one of two psychiatric service conditions: 1) reinforced on-site integrated care (ROIC), with voucher incentives contingent on attending weekly psychiatric sessions; or 2) standard on-site integrated care (SOIC). Participants in both conditions will receive access to the same schedule and range of psychiatric and substance abuse treatment services. Participants will be assessed for 3-months post-randomization to determine rates of service utilization and adherence to psychiatric care, changes in scope and severity of psychiatric and psychosocial problems, and rates of drug use and treatment retention. Positive findings would have considerable heuristic and health care policy and practice implications. The entire study, including dissemination of the major findings at a national meeting and submission of the first manuscript, is designed to be completed within 2-years. Services research on promising strategies to improve the care of drug-dependent patients with comorbid psychiatric disorders remains a major priority for treatment providers and health care policymakers. This challenge grant application will make several substantial contributions to this work by using a well-controlled experimental design to evaluate the efficacy of contingency management for improving psychiatric service utilization and reducing psychiatric distress and impairment in opioid-dependent patients with any psychiatric disorder at a community-based drug abuse treatment program. Positive findings would have considerable heuristic and health care policy and practice implications. The entire study, including dissemination of the major findings at a national meeting and submission of the first manuscript, is designed to be completed within 2-years.