Multidisciplinary Approach to Reduce Injury and Substance Abuse

描述（由申请人提供）：美国外科医生学会（ACS）最近制定了一级创伤中心的要求，为酒精问题提供筛查和简短干预（SBI）。这一任务的动力是证据基础，支持对受伤患者进行简短的酒精干预对减少酒精使用和未来受伤风险以及节省成本的有效性。然而，缺乏关于SBI对药物使用的有效性的证据。此外，几乎没有证据表明药物SBI对艾滋病毒风险和其他与药物使用密切相关的健康结果的有效性。 本申请提出了一项随机临床试验，评价简短建议（BA），简短的动机干预与反馈（BMI），简短的动机干预与反馈和助推器（BMI+B）在药物问题受伤患者中的有效性。该设置是一个创伤中心，为大量不同的患者群体提供服务。关注的主要结局将是随后的药物使用。其他关注的结果包括：（a）HIV相关的风险行为，（B）改善健康结果，包括减少伤害，（c）增加就业，（d）减少参与非法行为，（e）增加药物滥用治疗的利用，以及（e）在3个月、6个月和12个月随访时提高生活质量。 本研究还将探讨潜在的调节和中介作用的病人准备改变，使用经验和行为过程的变化和决策的平衡考虑。此外，本项目还将研究组织层面的实施因素以及BA、BMI和BMI+B的成本效益。 拟议的研究的资金将增加知识基础的有效性，简短的干预受伤的患者与药物使用的问题，从而提供ACS和外地的必要的证据基础，筛选，简短的干预和转诊治疗药物使用的问题，在创伤护理设置。 公共卫生相关性：更多的死亡，疾病和残疾归因于药物滥用比任何其他可预防的条件。这项研究将增加有关在创伤中心和其他医疗环境中对有药物使用问题的受伤患者进行简短筛查和干预的有效性的知识基础，从而减少与药物使用相关的伤害和相关健康结果。

DESCRIPTION (provided by applicant): The American College of Surgeons (ACS) recently established requirements for Level I Trauma Centers to provide screening and brief intervention (SBI) for alcohol problems. The impetus for this mandate was the evidence base supporting the effectiveness of brief alcohol interventions with injured patients on reducing alcohol use and risk of future injury, as well as cost savings. However, there is a lack of evidence regarding the effectiveness of SBI for drug use. In addition, there is little evidence on the effectiveness of drug SBI on HIV risk and other health outcomes strongly associated with drug use. This application proposes a randomized clinical trial evaluating the effectiveness of brief advice (BA), brief motivational intervention with feedback (BMI), and brief motivational intervention with feedback and booster (BMI+B) in injured patients with drug problems. The setting is a trauma center serving a large and diverse patient population. The primary outcome of interest will be subsequent drug use. Other outcomes of interest include: (a) HIV-related risk behaviors, (b) improved health outcomes including injury reduction, (c) increased employment, (d) decreased engagement in illegal behavior (e) increased substance abuse treatment utilization, and (e) enhanced quality of life at three, six, and twelve month follow-ups. This study will also examine the potential moderating and mediating effects of patient readiness to change, use of experiential and behavioral processes of change and decisional balance considerations. In addition, this project will examine implementation factors at the organizational level and the cost effectiveness of BA, BMI, and BMI+B. Funding of the proposed study will increase the knowledge base with regard to the effectiveness of brief intervention among injured patients with drug use problems and, thereby, provide the ACS and the field with the necessary evidence base for screening, brief intervention and referral for treatment for drug use problems in the trauma care setting. PUBLIC HEALTH RELEVANCE: More deaths, illness and disabilities are attributed to substance misuse than any other preventable condition. This study will increase the knowledge base regarding the effectiveness of brief screening and intervention among injured patients with drug use problems in trauma centers and other medical settings, thus leading to reduced injury and related health outcomes associated with drug use.