Motivational Interviewing to Reduce Substance Use Among Depression Patients

描述（由申请人提供）：本申请由一名新研究者提交，以回应PA-08-263，药物和酒精滥用预防和治疗的卫生服务研究（R 01）。我们提出了一个为期3年的随机研究的简短的动机干预（BMI）的背景下提供的筛选，简短的干预和转诊治疗（SBIRT）模式，以减少药物使用和危险饮酒的门诊患者在治疗抑郁症的健康维护组织的大型门诊精神病诊所。抑郁症患者使用药物或酒精，即使在亚诊断水平也会影响抑郁症治疗，并且物质问题升级的风险很高。但干预措施尚未在这一庞大而脆弱的人口中进行测试。BMI是一种创新的方法，可以减少药物和酒精的使用，并改善这些危险饮酒和药物使用患者的预后。BMI可以促进对具有显著物质问题（包括依赖性）的患者开始化学依赖性护理，根据需要，与SBIRT模型一致。这种有前途的干预措施从未在抑郁症患者中进行过测试。研究入选标准基于药物使用（包括任何非法药物使用和处方药的非处方使用）和危险饮酒（即，女性每天喝3杯，男性每天喝4杯），以及摄入时出现中度至重度抑郁症状。在这项对照试验中，350名患者将随机接受一次面对面的BMI会议和两次电话BMI助推器会议（干预）或关于药物和酒精使用风险的小册子（对照）。我们预计，相对于对照组患者，干预措施将在3个月、6个月和12个月的随访中有效减少药物使用和危险饮酒的频率;改善情绪和功能结果;增加抑郁症治疗的保留率。（根据医疗保健有效性数据和信息集（HEDIS）标准，电子病历中记录的精神病学就诊次数）;以及促进患者开始化学依赖性程序治疗。如果有效性得到证明，BMI可能会对抑郁症患者的服务产生重大影响。 公共卫生相关性：抑郁症患者中的药物和酒精使用非常普遍，使患者面临物质问题恶化和精神健康状况不良的风险。研究干预（BMI）是一种创新治疗，具有显著减少该人群药物和酒精使用的潜力。如果有效性得到证明，干预措施可以改善对抑郁症患者的服务，防止药物和酒精问题的升级，并改善健康状况。

DESCRIPTION (provided by applicant): This application by a new investigator responds to PA-08-263, Health Services Research on the Prevention and Treatment of Drug and Alcohol Abuse (R01). We propose a 3-year randomized study of Brief Motivational Intervention (BMI) delivered in the context of the Screening, Brief Intervention and Referral to Treatment (SBIRT) model to reduce drug use and hazardous drinking among outpatients in treatment for depression in a health maintenance organization's large outpatient psychiatry clinic. Patients with depression who use drugs or alcohol even at sub-diagnostic levels can compromise depression treatment and are at high risk for escalation of substance problems. But interventions have not been tested in this large and vulnerable population. BMI is an innovative approach that could decrease drug and alcohol use and improve outcomes for these patients with hazardous drinking and drug use. BMI can facilitate initiation of chemical dependency care for patients with significant substance problems including dependence, as needed, consistent with the SBIRT model. This promising intervention has never been tested among patients with depression. Study inclusion criteria are based on drug use (including any illicit drug use and non-prescribed use of prescription drugs) and hazardous drinking (i.e., e 3 drinks in a day for women and e 4 drinks in a day for men), and moderate to severe depression symptoms at the time of intake. In this controlled trial, 350 patients will be randomized to receive one in-person BMI session and two telephone BMI booster sessions within 8 weeks of intake (intervention) or a brochure on risks of drug and alcohol use (control). We anticipate that the intervention will be effective in reducing frequency of drug use and hazardous drinking at 3-, 6- and 12-month follow-up interviews, relative to patients in the control group; improving mood and functional outcomes; increasing depression treatment retention (number of psychiatry visits recorded in the electronic medical record, based on Healthcare Effectiveness Data and Information Set (HEDIS) standards); and facilitating patient initiation of chemical dependency program treatment. If effectiveness is demonstrated, BMI could have a major impact on services for patients with depression. PUBLIC HEALTH RELEVANCE: Drug and alcohol use among depression patients is very prevalent and puts patients at risk for worsening substance problems and poor mental health outcomes. The study intervention (BMI) is an innovative treatment with significant potential to reduce drug and alcohol use in this population. If effectiveness is demonstrated, the intervention could improve services for patients with depression, prevent escalation of drug and alcohol problems and improve health outcomes.