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情况，可能需要多次护理，但到目前为止，大多数研究都集中在单次护理上。最近对以结果为基础的合同和/或折价成本合同的强调激发了人们对更好地管理客户的兴趣，这些客户“跨越”多次入院和/或连续护理模式。在其他慢性疾病的治疗中，每季度、每半年或每年一次的检查通常是后续护理的组成部分，检查复发的早期迹象，并在病情和后果恶化之前尝试及早进行再次干预。这项研究的具体目的是从以下方面确定早期再干预(ERI)方案的相对有效性：1)减少治疗重新进入的时间，增加早期治疗再次进入的比率，以及，2)改善与a)药物使用、艾滋病毒危险行为、非法活动、b)培训和就业相关行为、以及c)使用昂贵服务(例如，住院药物滥用治疗、住院精神健康治疗、急诊室入院、住院夜间、监狱天数、子女被寄养或收容机构的天数)有关的长期结果。为了评估ERI，将从两个中央收容单位招募800名患有药物使用障碍的新患者，一个位于芝加哥，另一个位于伊利诺伊州中部。患者将被分成五个严重程度组中的一个(基于药物依赖、酒精依赖和使用频率)，然后随机分配到季度结果监测(OM)和季度结果监测(OM)+ERI，前者为期18个月，评估时间为20-30分钟。每季度将根据参与者对环境影响指数状况的反应来确定参与者的联系援助需求。ERI Linkage经理将为符合条件的参与者提供联系协助，包括对他们目前的药物使用和治疗需求的反馈，说服他们考虑重返治疗的激励性讨论，然后直接帮助他们进行并遵守重新入院预约。通过反馈、社会强化和帮助获得护理，ERI有望减少重新入院的时间，增加早期治疗再次入院率，从而改善长期结果。支持ERI方案的重要发现将使人们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.