Early Re-intervention Experiment2(ER12)

描述(由申请人提供)： 人们越来越认识到，药物依赖与多种精神问题并存是一种慢性复发性疾病，可能会持续数十年，在达到持续缓解状态之前需要多年的多次护理。对不同护理阶段的治疗效果进行的观察性研究发现，复发后患者越早恢复治疗，接受的后续治疗和后续护理(特别是总共超过90天)越多，他们的长期结果就越好。然而，只有不到12项长期研究着眼于护理的各个阶段。早期再干预实验1(ERI-1)是第一项对监测和早期再干预的公共卫生模式缩短复发、治疗再入和恢复周期的能力进行实验评估的研究。RMC参与者比对照组更有可能重新接受治疗(的比例为51%)，更早地恢复治疗(376vs.600天)，以及在随后的治疗中花费更多天数(平均为62vs.40天)。RMC参与者需要治疗的总季度数也明显减少，而且在服药两年后需要治疗的可能性也较小(43%对56%)。尽管有成功的联结率，但只有60%的有关联的参与者继续接受治疗14天或更长时间(这与进入康复的可能性更大有关)。在连锁率和共同发生的精神问题之间也存在交互作用。 根据ERI-2，我们提议延长5年，以继续扩大我们在这一领域的知识。具体地说，我们建议从Haymarket Center的连续招生中招募300名有药物使用依赖的成年人，并随机分配参与者，或者四年内没有RMC干预的季度评估(控制组)，或者季度评估加上我们RMC手动指导方案的增强修订版(见附录；Scott&Dennis，2003)。虽然ERI-2的调查路线与ERI-1相似，但我们对RMC方案提出了几项基于证据的修改，包括更基于理论的模型、在需求评估中增加生物标记物、转向观察RMC效果的更长时间框架，以及在治疗计划中增加一名参与专家以帮助参与者参与和留住治疗。新实验的具体目的是：(1)检查康复管理检查对4年期间复发、治疗重新进入和恢复周期的影响；(2)评估恢复管理检查(直接影响)和随后治疗(间接影响)对结果的影响；以及(3)探索共生精神问题对RMC、治疗参与模式和长期结果之间关系的(调节)影响。

DESCRIPTION (provided by applicant): Substance use dependence with multiple co-occurring psychiatric problems is increasingly recognized as a chronic relapsing condition that may last for decades and require multiple episodes of care over many years before reaching a sustained state of remission. Observational studies that examined treatment effects across episodes of care found that the sooner after a relapse people return to treatment and the more subsequent treatment and aftercare they receive (particularly over 90 days total), the better their long term outcomes. Yet, there are less than a dozen long-term studies that look across episodes of care. The Early Re-Intervention experiment 1 (ERI-1) was the first study to experimentally evaluate the ability of a public health model of monitoring and early re-intervention to shorten the relapse, treatment re-entry, and recovery cycle. RMC participants were significantly more likely than those in the control group to return to treatment (64 percent vs. 51 percent), to return to treatment sooner (376 vs. 600 days), and to spend more subsequent days in treatment (mean of 62 vs. 40 days). RMC participants also experienced significantly fewer total quarters in need of treatment and were less likely to need treatment 2 years after intake (43 percent vs. 56 percent). In spite of the successful linkage rates, only 60 percent of the linked participants remained in treatment 14 or more days (which is associated with better odds of going into recovery). There were also interactions between the linkage rates and co-occurring psychiatric problems. Under ERI-2, we propose a 5-year extension in order to continue expanding our knowledge in this area. Specifically, we propose recruiting 300 adults with substance use dependence from sequential admissions at Haymarket Center and randomly assigning participants either quarterly assessments with no RMC intervention (control group) for 4 years or quarterly assessments plus an enhanced revised version of our RMC manual-guided protocol (in Appendix; Scott & Dennis, 2003). While the line of inquiry for ERI-2 parallels ERI-1, we propose several evidence-based modifications to the RMC protocol, including a more theoretically based model, adding biomarkers to the assessment of need, shifting to a longer time frame for observing RMC effects, and adding an Engagement Specialist at the treatment program to help engage and retain participants in treatment. The specific aims of the new experiment are: (1) To examine the impact of recovery management checkups on the cycle of relapse, treatment re-entry, and recovery over the course of 4 years; (2) To assess the impact of recovery management checkups (direct effect) and subsequent treatment (indirect effect) on outcomes; and (3) To explore the (moderating) effects of co-occurring psychiatric problems on the relationship between RMC, patterns of treatment participation, and long-term outcomes.