Computer vs Therapist-Delivered Brief Intervention for Drug Abuse in Primary Care

绝大多数患有药物使用障碍的人未被发现和治疗。积极主动 筛查、短期干预和转诊治疗方法（SBIRT）具有巨大的潜力 确定和影响未被发现的药物滥用，但努力将其纳入 社区在培训、时间、成本和接受方面遇到了巨大的障碍。两 因此，其他办法值得认真考虑。首先，计算机交付的方法表明， 对药物使用结果的明显影响，并在可复制性、可获得性和成本方面具有巨大优势。 第二个？最吝啬的是什么评估本身越来越显示出， 积极影响物质使用。这两种方法都可以克服上述许多障碍，但还没有直接与传统的人交付SBIRT进行比较。 此外，评估对药物使用结果的重大影响意味着，对简短干预方法的真正效果还有待明确评估。因此，目前的建议将680名普通医疗城市门诊患者随机分配到仅筛查对照（SC）、仅评估（CA）、评估加计算机提供的BI（CACI）和评估加治疗师提供的BI（CATI）条件下，并在1、3和6个月随访时比较所有组的（a）物质使用 结果，通过自我报告和尿液毒理学测量，和（B）成本，使用复杂的经济学方法 分析。在本试验之前，彻底的开发研究将使用患者和专家小组的反馈， 修改现有的和以前成功的激励软件（由该小组开发）， 有大量/问题物质使用风险的初级保健医疗患者。拟议的设计将允许 直接评价两种理论上不同的方法，如果疗效与治疗师提供的相似， 条件，可以大大增加获得SBIRT。这一设计也将为 最严格的评估SBIRT？在初级保健中的真正功效。

The vast majority of persons with substance use disorders go undetected and untreated. Proactive screening, brief intervention, and referral for treatment approaches (SBIRT) have tremendous potential for identifying and influencing undetected substance abuse, but efforts to incorporate them in the community have met with substantial obstacles related to training, time, costs, and acceptance. Two alternatives therefore merit serious consideration. First, computer-delivered approaches have shown clear effects on substance use outcomes, and have tremendous advantages in terms of replicability, accessibility, and cost. Second?and most parsimoniously?assessment itself is increasingly demonstrating the ability to positively impact substance use. Both approaches could obviate many of the above-noted obstacles, but have yet to be directly compared to traditional person-delivered SBIRT. Further, the significant effects of assessment on substance use outcomes means that there has yet to be a clear evaluation of the true effect of brief intervention approaches. The current proposal will therefore randomly assign 680 general medical urban outpatients into screening-only control (SC), assessment only (CA), assessment plus computer-delivered BI (CACI), and assessment plus therapist-delivered BI (CATI) conditions, and compare all groups at 1, 3, and 6 month follow-up on (a) substance use outcomes, as measured by self-report and urine toxicology, and (b) cost, using sophisticated economic analyses. Prior to this trial, thorough development research will use patient and expert panel feedback to modify existing and previously successful motivational software (developed by this group) to target primary care medical patients at risk for heavy/problem substance use. The proposed design would allow direct evaluation of two theoretically distinct approaches that, if similar in efficacy to the therapist-delivered condition, could greatly increase access to SBIRT. This design would also set the stage for the most stringent evaluation to-date of SBIRT?s true efficacy in primary care.