DOMS EARLY REINTERVENTION (ERI) EXPERIMENT

虽然大多数临床医生认为物质使用是一种慢性复发性疾病，可能需要多次护理，但迄今为止的大多数研究都集中在单次护理上。 最近强调成果为基础的合同和/或资本成本合同，激发了兴趣，更好地管理客户“跨”多次入院和/或在一个连续的护理模式。在治疗其他慢性疾病时，每季度、每半年或每年进行一次检查往往是善后护理的一个组成部分，检查复发的早期迹象，并在病情和后果恶化之前尝试早期重新干预。 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）减少重新开始治疗的时间，提高早期治疗重新开始的比率，2）改善与a）物质使用、艾滋病毒风险行为、非法活动，B）培训和就业相关行为，以及c）利用昂贵的服务（例如，住院药物滥用治疗、住院精神健康治疗、急诊室入院、住院天数、监禁天数、子女在寄养或机构中的天数）。为了评估ERI，将从两个中心摄入单位招募800名患有物质使用障碍的新客户，一个位于芝加哥，另一个位于伊利诺斯州中部。 患者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），然后随机分配到每季度一次的结果监测（OM），进行18个月的20-30分钟评估，或每季度一次的OM加ERI。 参与者在ERI条件下的响应将用于确定每个季度参与者的联系援助需求。 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，动机讨论，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、社会强化和获得护理的援助，ERI有望减少再入院时间，提高早期治疗再入院率，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局监测的临床价值，并为改善药物治疗的长期有效性提供一种简单、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.