Treating Co-occuring Substance Use and Mental Disorders Among Jail Inmates

描述（由申请人提供）：我们建议采用和实施双重诊断动机访谈（DDMI）和综合团体治疗（IGT）来评估监狱到社区治疗连续体对同时发生物质使用和精神障碍（CODs）的成年人的可行性。每年有200多万患有严重精神疾病的成年人被关进监狱，其中大约四分之三的人有药物使用问题。尽管在住院和门诊治疗慢性阻塞性肺病方面取得了进展，但在治疗患有慢性阻塞性肺病的监狱囚犯的科学和实践方面仍然存在差距。很少有人接受以社区重返社会和犯罪风险为重点的综合在押和社区循证治疗。为患有慢性阻塞性肺病的监狱囚犯实现持续的社区任期，需要调整现有的循证做法。DDMI和IGT具有强有力的证据基础，代表了合适的适应候选者。因此，需要一项严格的研究来评估在监狱和社区环境中调整和整合这些项目的可行性和可接受性。在风险-需求-响应模型和基于证据的机构间实施模型的指导下，我们提出了两个连续的目标：目标1：将DDMI和IGT用于监狱囚犯的交付，通过一项研究来检查调整的初步可接受性

DESCRIPTION (provided by applicant): We propose to adapt and implement dual-diagnosis motivational interviewing (DDMI) and integrated group therapy (IGT) to evaluate the feasibility of a jail-to-community treatment continuum for adults with co- occurring substance use and mental disorders (CODs). More than 2 million adults with serious mental illnesses are admitted to jails annually and approximately three-quarters of them have substance use problems. Although improvements have been made in treating CODs in inpatient and outpatient settings, there remains a gap in the science and practice of treating jail inmates with CODs. Too few receive integrated in-custody and in-community evidence-based treatments that focus on community reentry and criminogenic risk. Achieving sustained community tenure for jail inmates with CODs requires adapting existing evidence-based practices. DDMI and IGT have strong evidence bases and represent appropriate adaptation candidates. Thus, a rigorous study is needed to evaluate the feasibility and acceptability of adapting and integrating these programs across jail and community settings. Guided by the risk-need- responsivity model and the Evidence-Based Interagency Implementation Model, we propose two sequential aims: Aim 1: To adapt DDMI and IGT for delivery to jail inmates, examining the initial acceptability of the adaptations through an uncontrolled open trial (N=12), and Aim 2: To conduct a randomized trial (N=60) to establish knowledge in three areas: Aim 2.1: The feasibility and acceptability of the adapted DDMI and IGT; Aim 2.2: The feasibility and acceptability of the proposed research and communication protocols; and Aim 2.3: The effectiveness of and estimated effect sizes associated with the adapted interventions vis-a-vis reductions in substance use, psychiatric symptoms, and re-arrest and improvements in uptake of usual care. We will use an iterative approach to adapt the programs, including consultation with experts and community providers. Our uncontrolled trial will inform subsequent treatment, research, and communication protocol refinements prior to our randomized trial with assignment to treatment condition (i.e., continuum of DDMI-IGT and usual care vs. usual care only). Our application builds in part on our study team's NIH-funded grants and successful collaborations in prevention and treatment of drug and alcohol use and mental health symptoms, the provision of clinical services to jail inmates with CODs, and the adaptation and implementation of clinical treatment programs. Our proposed R34 will complement professional standards calling for evidence-based treatments for adults with CODs. These efforts will improve the field's understanding of the nexus of CODs and arrest and help improve multiple outcomes, including reductions in substance use, mental health symptoms, and justice involvement, and uptake of usual care, all of which will be evaluated in a follow-up R01.