Preventing Drug Use in Low Income Clinic Populations

描述(由申请人提供)：戒毒干预试验(QUIT)将是美国第一个随机对照试验，旨在检测初级保健临床医生在洛杉矶县2个安全网诊所为减少低收入成年患者(18岁及以上)的“高危”药物使用和与药物相关的伤害而提供的简短干预方案的效果。在这项小型试验中，我们将对使用兴奋剂(可卡因或安非他明)的“有风险”的患者进行抽样，这是我们诊所的患者中最常用的严重药物。在这项研究中，“危险”兴奋剂的使用被定义为目前(过去90天)兴奋剂的使用，以世界卫生组织酒精物质参与筛查试验(ASSISE)中自我报告的总分为4到26分来衡量。总共有8,000名患者将接受筛查，以产生为期12个月的有效样本，每种情况下有200名符合条件的患者(1)干预情况或(2)需要照常护理的对照情况。在干预条件下，在非常简短(不到5分钟)的关于戒除兴奋剂的临床医生建议之后，将在访问后2周和6周举行两次关于戒除兴奋剂的健康教育会议，并告诫不要使用其他“危险”物质，如酒精和烟草。被分配到控制条件的患者将在与临床医生进行基线访问时接受药物使用的标准护理，随后将进行两次访问后电话健康教育课程，其持续时间与干预课程相同，但将涉及健康饮食、体育活动和安全带使用。后续评估将在随机化后6个月和12个月进行。戒烟项目的框架是社会行动理论，简短的干预方案基于NIDA关于预防研究的原则和5A方法在临床环境中协助患者行为改变(询问、建议、评估、协助、安排)的效用。如果在社区卫生中心的设置中被发现是有效的，这种临床医生和电话兴奋剂使用的健康教育计划可以成为健康促进活动的典范。这将扩大到所有“危险”物质的使用，并在社区卫生中心之间共享。公共卫生相关性：拟议的研究将解决在城市初级保健安全网诊所减少非法药物使用，特别是兴奋剂使用的迫切需要，以及在低收入、种族多样化的患者群体中发生与药物有关的伤害。一旦开始吸毒，低收入、种族多样化的人群就有可能加速药物依赖的轨迹，这对公共卫生政策制定者和毒品使用预防工作特别令人担忧。这项研究将是此类研究的第一个标准化药物筛选和医生对不同种族的“危险”兴奋剂使用者的短暂干预，即在没有依赖的生理或心理表现的情况下随意或频繁使用，它可能有效地中断他们的依赖途径。

DESCRIPTION (provided by applicant): The Quit Using Drugs Intervention Trial (QUIT) will be the first randomized controlled trial in the U.S. that is powered to detect the effect of a primary care clinician delivered brief intervention protocol for reducing `at risk' drug use and drug-related harm among low-income adult patients (ages 18 and older) at 2 safety net clinics in Los Angeles County. For this small trial, we will sample patients with `at risk' use of stimulants (cocaine or amphetamines), the most commonly used serious drugs among patients at our clinic sites. "At risk" stimulant use is defined in this study as current use (past 90 days) of stimulants measured as a self-reported total score of 4 to 26 on the WHO Alcohol Substance Involvement Screening Test (ASSIST). A total of 8,000 patients will be approached for screening to yield a 12-month effective sample size of 200 eligible patients per condition (1) an intervention condition or (2) a control condition involving care as usual. In the intervention condition, very brief (less than 5 minutes) clinician advice regarding quitting stimulants use will be followed by two 2 and 6 week post-visit drug health education sessions on quitting stimulant use and cautioning against use of other `at risk' substance use such as alcohol and tobacco. Patients assigned to the control condition will receive standard care for drug use at the baseline visit with their clinician, which will be followed by two post-visit telephone health education sessions that will be of equal duration as the intervention sessions but will address healthy eating, physical activity, and seat belt use. Follow- up assessments will be conducted at 6 and 12 months post-randomization. The framework for the QUIT project is the Social Action Theory, and the brief intervention protocol is based on NIDA's principles on prevention research and the utility of the 5 A's approach for assisting behavioral changes among patients (Ask, Advise, Assess, Assist, Arrange) in the clinic setting. If found to be effective in the community health center setting, this clinician and telephone stimulant-use health education program could become a model for health promotion activities. that would be expanded to all `at risk' substance use and shared between community health centers. PUBLIC HEALTH RELEVANCE: The proposed study will address the critical need to reduce illegal drug use, in particular stimulant use, and the occurrence of drug-related harm in low-income racially diverse patient populations at urban primary care safety-net clinics. At risk for accelerated trajectories to drug dependence once drug use begins, low-income racially diverse populations pose particular concern for public health policy makers and drug-use prevention efforts. The study will be the first of its kind to standardize drug screening and physician brief intervention among racially diverse "at risk" stimulant users, that is casual or frequent use without the physiological or psychological manifestations of dependence, and it may effectively interrupt their pathway to dependence.