DOMS EARLY REINTERVENTION (ERI) EXPERIMENT

虽然大多数临床医生认为药物使用是一种慢性复发状况，可能需要多次护理，但迄今为止大多数研究都集中在单次护理上。最近对基于结果的合同和/或资本成本合同的重视，激发了人们对“跨”多次入院和/或连续护理模式更好地管理客户的兴趣。在其他慢性疾病的治疗中，每季度、每半年或每年的检查通常是术后护理的组成部分，检查早期复发的迹象，并在病情和后果恶化之前尝试早期再干预。本研究的具体目的是确定早期再干预（ERI）方案在以下方面的相对有效性：1)缩短重新接受治疗的时间并提高早期重新接受治疗的比率；2)改善与以下方面有关的长期结果：a)药物使用、艾滋病毒风险行为、非法活动；b)与培训和就业有关的行为；c)使用昂贵的服务（例如，住院药物滥用治疗、住院精神健康治疗、急诊室入院、住院夜、监禁天数、子女在寄养或机构的天数）。为了评估ERI，将从两个中心接收单位招募800名有物质使用障碍的新客户，一个位于芝加哥，另一个位于伊利诺伊州中部。客户将被分为五个严重程度组（基于药物依赖、酒精依赖和使用频率）之一，然后随机分配到每季度结果监测（OM）中进行20-30分钟的评估，为期18个月，或每季度OM加ERI。参与者在ERI条件下的反应将用于确定参与者每季度的联动援助需求。ERI联系经理将为合格的参与者提供联系援助，包括对他们目前的物质使用和治疗需求的反馈，激励讨论以说服他们考虑返回治疗，然后直接帮助他们制定和保持再入院预约。通过反馈、社会强化和帮助获得护理，ERI有望减少再入院时间，增加早期治疗的再入院率，从而改善长期结果。支持ERI方案的重要发现将更好地理解结果监测的临床价值，并为提高药物治疗的长期有效性提供一个简单、可复制的方案。

While most clinicians view substance use as a chronic relapsing condition that may require multiple episodes of care, most research to date has focused on single episodes of care. Recent emphasis on outcome based contracts and/or capitated cost contracts has stimulated interest in better managing clients "across" multiple admissions and/or in a continuum of care model. In the treatment of other chronic illnesses quarterly, semi-annual or annual check-ups are often integral parts of aftercare which check for early indications of relapse and attempt early re-intervention before the condition and consequences worsen. The specific aims of this study are to determine the relative effectiveness of an Early Re-Intervention (ERI) protocol in terms of its ability to: 1) reduce the time to treatment re-entry and increase the rates of early treatment re-entry, and, 2) improve long-term outcomes related to a) substance use, HIV risk behaviors, illegal activity, b) training- and employment-related behaviors, and c) utilization of expensive services (e.g., inpatient substance abuse treatment, inpatient mental health treatment, emergency room admissions, hospital nights, days in jail, days of their children being in foster care or institutions). To evaluate ERI, 800 new clients with substance use disorders will be recruited from two central intake units, one located in Chicago and another in Central Illinois. Clients will be blocked into one of five severity groups (based on drug dependence, alcohol dependence, and frequency of use) then randomly assigned to either quarterly outcome monitoring (OM) with 20-30 minute assessments for 18 months or quarterly OM plus ERI. Response of participants in the ERI condition will be used to determine the participants linkage assistance needs every quarter. ERI Linkage Managers will provide the qualified participants with linkage assistance including feedback on their current substance use and need for treatment, motivational discussions to convince them to consider returning to treatment, and then direct assistance in helping them make and keep a readmission appointment. Through feedback, social reinforcement, and assistance to access care, ERI is expected to reduce the time to readmission, increase the rate of early treatment re-admissions, and consequently, improve long-term outcomes. Significant findings in favor of the ERI protocol would provide a better understanding of the clinical value of outcome monitoring and a straightforward, replicable protocol for improving the long-term effectiveness of drug treatment.