Computer vs Therapist-Delivered Brief Intervention for Drug Abuse in Primary Care

描述（由申请人提供）：绝大多数患有物质使用障碍的人未被发现和治疗。主动筛查、简短干预和转诊治疗方法（SBIRT）在识别和影响未被发现的药物滥用方面具有巨大的潜力，但将其纳入社区的努力遇到了与培训、时间、成本和接受有关的重大障碍。因此，有两个备选方案值得认真考虑。首先，计算机提供的方法已经显示出对物质使用结果的明显影响（例如，Hester，Squires，& Delaney，2005; Ondersma，Svikis，& Schuster，2007），并且在可复制性、可访问性和成本方面具有巨大的优势。第二，也是最简单的，评估本身越来越多地证明了对物质使用产生积极影响的能力（例如，Clifford等人，2007年）。这两种方法都可以克服上述许多障碍，但还没有直接与传统的人交付SBIRT进行比较。此外，评估对药物使用结果的重大影响意味着，对简短干预方法的真正效果还有待明确评估。因此，目前的提案将680名普通医学城市门诊患者随机分配到仅筛查对照（SC）、仅评估（CA）、评估加计算机提供的BI（CACI）和评估加治疗师提供的BI（CATI）条件下，并在1、3和6个月随访时比较所有组的（a）物质使用结局，通过自我报告和尿液毒理学测量，和（B）成本，使用复杂的经济分析。在这项试验之前，彻底的开发研究将使用患者和专家小组的反馈来修改现有的和以前成功的激励软件（由该小组开发），以针对有大量/问题物质使用风险的初级保健医疗患者。所提出的设计将允许直接评估两种理论上不同的方法，如果疗效与治疗师提供的条件相似，则可以大大增加SBIRT的使用。这一设计也将为迄今为止对SBIRT在初级保健中的真实疗效进行最严格的评估奠定基础。 公共卫生相关性：到目前为止，SBI干预措施，而有效的研究为基础的设置，已太难实际上复制在大多数医疗环境。因此，该国有毒品问题的2200万人中的大多数没有被发现和治疗。拟议的研究将比较两个大大简化的方法，筛选和简短的干预（都利用计算机），以传统的方法。如果这两种新方法中的任何一种都能像通常的方法一样发挥作用，那么它们的简单性将意味着更多有毒品或酒精问题的人将得到帮助。

DESCRIPTION (provided by applicant): The vast majority of persons with substance use disorders go undetected and untreated. Proactive screening, brief intervention, and referral for treatment approaches (SBIRT) have tremendous potential for identifying and influencing undetected substance abuse, but efforts to incorporate them in the community have met with substantial obstacles related to training, time, costs, and acceptance. Two alternatives therefore merit serious consideration. First, computer-delivered approaches have shown clear effects on substance use outcomes (e.g., Hester, Squires, & Delaney, 2005; Ondersma, Svikis, & Schuster, 2007), and have tremendous advantages in terms of replicability, accessibility, and cost. Second-and most parsimoniously-assessment itself is increasingly demonstrating the ability to positively impact substance use (e.g., Clifford et al., 2007). Both approaches could obviate many of the above-noted obstacles, but have yet to be directly compared to traditional person-delivered SBIRT. Further, the significant effects of assessment on substance use outcomes means that there has yet to be a clear evaluation of the true effect of brief intervention approaches. The current proposal will therefore randomly assign 680 general medical urban outpatients into screening-only control (SC), assessment only (CA), assessment plus computer-delivered BI (CACI), and assessment plus therapist-delivered BI (CATI) conditions, and compare all groups at 1, 3, and 6 month follow-up on (a) substance use outcomes, as measured by self-report and urine toxicology, and (b) cost, using sophisticated economic analyses. Prior to this trial, thorough development research will use patient and expert panel feedback to modify existing and previously successful motivational software (developed by this group) to target primary care medical patients at risk for heavy/problem substance use. The proposed design would allow direct evaluation of two theoretically distinct approaches that, if similar in efficacy to the therapist- delivered condition, could greatly increase access to SBIRT. This design would also set the stage for the most stringent evaluation to-date of SBIRT's true efficacy in primary care. PUBLIC HEALTH RELEVANCE: To date, SBI interventions, while effective in research-based settings, have been too difficult to actually replicate in most medical settings. Hence most of the 22 million persons with drug problems in this country go undetected and untreated. The proposed study will compare two greatly simplified approaches to screening and brief intervention (both utilizing computers) to the traditional approach. If either of the two new approaches work even close to as well as the usual approach, their simplicity would mean that many more persons with drug or alcohol problems would get helped.