Brief Intervention in Primary Care for Problem Drug Use and Abuse

描述（由申请人提供）：大量的研究已经确定了在医疗环境中对危险酒精使用的短暂干预（BI）的有效性，促进了对大规模“药物滥用”进行筛查和短暂干预的传播项目的实施。然而，很少有研究检查BI对医疗环境中问题药物使用和滥用的功效，并且在实际构成BI的内容（即，重要或有效的治疗成分是什么）方面存在相当大的差异。与医疗环境中未经治疗的药物滥用有关的潜在费用是巨大的。尽管施虐者遭受了巨大的人类痛苦和发病率，但潜在的医疗保健费用节约和与BI相关的不良医疗保健结果的减少很可能是政策变化的主要驱动力，以改善BI治疗的提供。因此，本申请建议开展一项具有广泛外部有效性的政策性临床试验（一项混合“疗效-有效性”研究），根据有关BI和酒精使用的文献，评估BI的疗效，并在指征时转诊治疗，在一家大型安全网医院的初级保健医疗机构中发现有问题的药物使用和滥用患者。该研究有四个目的：(1)确定BI在减少药物使用和增加完全转诊治疗（即开始治疗）方面是否有效；(2)检验高保真度对强调动机访谈的BI模型是否比低保真度更有效；(3)估计BI对若干公共卫生结果的影响；(4)基于医疗服务使用和用药频次，从支付方角度估算干预成本、潜在成本抵消和增量成本效益。公共卫生相关性：本项目正在评估一项干预措施的有效性，该干预措施最近被批准为医疗保健环境中的收费服务，尽管没有数据支持其在药物滥用和依赖方面的使用。这项研究的结果将对是否应将其应用范围从有害的酒精滥用扩大到包括滥用药物产生影响。

DESCRIPTION (provided by applicant): A substantial body of research has established the effectiveness of brief interventions (BI) for hazardous alcohol use in patients seen in medical settings, prompting the implementation of dissemination projects of screening and brief intervention for "substance abuse" on a widespread scale. However, there are few studies examining the efficacy of BI for problem drug use and abuse in medical settings, and there is considerable variability in what actually constitutes a BI (i.e., what are the important or active therapeutic ingredients). The potential costs related to untreated drug abuse in medical settings are substantial. Although there is great human suffering and morbidity for the abuser, it is likely that potential healthcare cost savings and decreased adverse healthcare outcomes related to BI will be the major drivers of policy change to improve provision of BI treatment. Accordingly, this application proposes to conduct a policy-relevant clinical trial with broad external validity (a hybrid "efficacy-effectiveness" study) informed by the literature on BI and alcohol use, to evaluate the efficacy of BI and referral to treatment when indicated, in patients with problem drug use and abuse seen in the primary care medical setting at a large safety-net hospital. The study has four aims: (1) to determine if BI is effective in reducing drug use and increasing completed referral to treatment (i.e., treatment initiation); (2) to test whether higher fidelity to a BI model that emphasizes motivational interviewing is more effective than lower fidelity; (3) to estimate the impact of BI on several public health outcomes; (4) to estimate the costs of the intervention, potential cost offsets, and incremental cost-effectiveness from the payer perspective based on health care service use and drug use frequency. PUBLIC HEALTH RELEVANCE: This project is evaluating the effectiveness of an intervention that has recently been approved as a billable service in the medical care setting, despite the absence of data supporting its use in drug abuse and dependence. The results of the study will have implications for whether it is advisable to expand its application beyond hazardous alcohol abuse to include abuse of drugs.