SBIRT for Substance Abuse in Mental Health Treatment Settings

描述(由申请人提供)：精神健康治疗环境中药物滥用的SBIRT项目描述估计40%的精神健康治疗环境中的患者涉及危险酒精和/或药物使用。然而，精神卫生诊所通常不为这些患者提供干预或转介到特殊物质使用障碍(SUD)治疗。一种已被证明在医疗环境中有效的减少酒精使用和/或促进参与成瘾治疗的干预模式是筛查、短暂干预和转介治疗(SBIRT)。尽管SBIRT在医疗环境中对危险的酒精使用有效，但关于SBIRT对药物使用的有效性的研究有限，对于SBIRT在精神健康治疗环境中的有效性的研究还没有。鉴于相当多的精神健康患者也从事危险物质使用，而精神卫生诊所对物质使用问题的关注有限，需要进行研究，为这些环境中的患者找到适当和有效的物质使用干预。这项拟议的研究使用随机对照试验来检验世界卫生组织的SBIRT模型、ASSIST(酒精、吸烟和物质参与筛查测试)及其相关的简短行为干预措施在多大程度上导致精神健康环境中普遍存在的物质：酒精、大麻和兴奋剂(即可卡因和甲基苯丙胺)的减少。这项研究还将研究SBIRT在改善精神症状、提高生活质量以及那些药物滥用程度表明需要治疗、启动和参与SUD治疗服务的人方面的效果。符合条件的参与者将是精神健康患者，他们报告在过去一年中曾使用过大麻或兴奋剂，或在过去一年中至少有一天酗酒。这项研究的一个探索性目的是确定SBIRT对酒精、大麻或兴奋剂风险最高的患者的效果大小。符合资格标准的精神健康患者(n=1,080)将被登记并随机分配到SBIRT干预条件或健康教育注意控制条件。参与者将在基线上接受药物使用、精神症状和生活质量的评估。每个参与者都将在3个月、6个月和12个月的随访点接受酒精和药物使用、是否参与SUD治疗服务、精神症状的严重程度和生活质量的评估。随机效应增长模型将被用来检验研究假设。如果成功，这项研究将对SBIRT在精神健康治疗环境中的有效性产生有价值的新知识，并将促进精神健康患者幸福感的改善。此外，这项研究将为SBIRT在减少非法药物使用方面的有效性提供证据。这项研究的结果将被用作在心理健康环境中更广泛地传播和开展SBIRT的基础。 公共卫生相关性：社区精神卫生诊所是接触物质使用障碍高危人群的合适场所，因为在美国，精神健康和物质使用共存的比率很高(SAMHSA，2010)。这项拟议的研究是美国第一个在精神健康环境中进行筛查、短暂干预和转介t治疗(SBIRT)干预的随机对照试验。这项研究将确定SBIRT在减少药物使用、参与药物滥用治疗以及改善在公共资助的精神健康诊所寻求治疗的个人的精神健康状况和生活质量方面的有效性。

DESCRIPTION (provided by applicant): SBIRT for Substance Abuse in Mental Health Treatment Settings Project Description An estimated 40% of patients in mental health treatment settings engage in hazardous alcohol and/or drug use. Yet mental health clinics often do not provide intervention or referral to specialty substance use disorder (SUD) treatment for these patients. One model of intervention that has been shown effective in medical settings to reduce alcohol use and/or promote engagement in addiction treatment is screening, brief intervention, and referral to treatment (SBIRT). Despite the effectiveness of SBIRT for risky alcohol use in medical settings, there has been limited research on the effectiveness of SBIRT for drug use and no research on the effectiveness of SBIRT in mental health treatment settings. Given the proportionately large number of mental health patients who also engage in hazardous substance use and the limited attention given to substance use issues in mental health clinics, research is needed to find an appropriate and effective substance use intervention for patients in these settings. The proposed study uses a randomized controlled trial to examine the extent to which the World Health Organization's SBIRT model, the ASSIST (Alcohol, Smoking, and Substance Involvement Screening Test) and its associated brief behavioral intervention, leads to reductions in substances prevalent in mental health settings: alcohol, cannabis and stimulants (i.e., cocaine and methamphetamine). The study will also examine the effect of SBIRT on improvement in psychiatric symptoms, improved quality of life and for those whose level of substance misuse indicates a need for treatment, initiation and engagement into SUD treatment services. Eligible participants will be mental health patients who report any past year use of cannabis or stimulants or at least one heavy drinking day in the past year. An exploratory aim of the study is to identify effect sizes of SBIRT for patients whose highest risk is for alcoho, cannabis or stimulants. Mental health patients (n = 1,080) who meet eligibility criteria will be enrolled and randomly assigned to either the SBIRT intervention condition or to a health education attention control condition. Participants will be assessed at baseline on substance use, psychiatric symptoms and quality of life. Each participant will be assessed at 3-, 6- and 12- month follow up points for alcohol and drug use, involvement in SUD treatment services, severity of psychiatric symptoms and quality of life. Random effects growth models will be used to test the study hypotheses. If successful this study will yield valuable new knowledge about the effectiveness of SBIRT in mental health treatment settings and will promote improved well being of mental health patients. Further, the study will provide evidence on the effectiveness of SBIRT for reducing illicit drug use. Results from this research will be used as the basis for broader dissemination and of SBIRT in mental health settings. PUBLIC HEALTH RELEVANCE: Community mental health clinics are opportune settings to reach individuals at high risk for substance use disorders because of the high rate of co-occurring mental health and substance use in the U.S. (SAMHSA, 2010). The proposed study is the first U.S.-based randomized controlled trial of a screening, brief intervention, and referral t treatment (SBIRT) intervention in mental health settings. The study will determine the effectiveness of SBIRT for the reduction of substance use, engagement in substance abuse treatment, and improvement in mental health status and quality of life for individuals seeking care in publicly-funded mental health clinics.