Motivational Interviewing to Reduce Substance Use Among Depression Patients

描述(由申请人提供)：我们提出了一项为期3年的随机研究，在筛查、简短干预和转诊到治疗(SBIRT)模式的背景下提供的短暂动机干预(BMI)，以减少在健康维护组织的大型门诊精神科诊所治疗抑郁症的门诊患者中的危险饮酒。抑郁症患者即使在亚诊断水平也会饮酒，这可能会影响抑郁症的治疗，并有很高的风险升级与酒精有关的问题。但干预措施尚未在这一庞大而脆弱的人群中进行测试。BMI是一种创新的方法，可以减少酒精使用，并改善这些危险饮酒患者的预后。BMI可以根据需要促进对有严重酒精依赖问题的患者进行化学依赖护理，包括依赖，与SBIRT模型一致；并且可能具有成本效益。但这种有希望的干预措施从未在抑郁症患者中进行过测试。纳入研究的标准是基于有害饮酒(即女性一天喝3杯酒，男性一天喝4杯酒)，以及摄入时的中度到重度抑郁症症状。在这项对照试验中，280名患者将随机接受一次面对面的BMI治疗和两次电话BMI强化治疗，治疗时间在摄入后8周内(干预)或一本关于饮酒风险的小册子(对照)内。我们预计，干预措施将有效减少与对照组患者相比，在3个月、6个月和12个月的后续访谈中危险饮酒的次数；减少抑郁症状；增加抑郁症治疗保留时间(根据医疗实效数据和信息集(HEDIS)标准，电子病历中记录的精神科就诊次数)；促进患者启动化学依赖计划治疗；降低急诊室和住院患者的使用率以及总体医疗成本。如果效果得到证明，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：抑郁症患者中酒精使用非常普遍，并使患者面临与酒精相关的问题恶化和精神健康结果不佳的风险。研究干预(BMI)是一种创新的治疗方法，在减少这一人群中危险酒精的使用方面具有巨大的潜力。如果治疗的有效性和成本效益得到证明，干预可以改善对抑郁症患者的服务，防止酒精问题升级，并改善健康结果。

DESCRIPTION (provided by applicant):.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 hazardous drinking among outpatients in treatment for depression in a health maintenance organization's large outpatient psychiatry clinic. Patients with depression who use alcohol even at sub-diagnostic levels can compromise depression treatment and are at high risk for escalation of alcohol-related problems. But interventions have not been tested in this large and vulnerable population. BMI is an innovative approach that could decrease alcohol use and improve outcomes for these patients with hazardous drinking. BMI can facilitate initiation of chemical dependency care for patients with significant alcohol problems including dependence, as needed, consistent with the SBIRT model; and may be cost-effective. But this promising intervention has never been tested among patients with depression. Study inclusion criteria are based on hazardous drinking (i.e., = 3 drinks in a day for women and = 4 drinks in a day for men), and moderate to severe depression symptoms at the time of intake. In this controlled trial, 280 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 alcohol use (control). We anticipate that the intervention will be effective in reducing frequency of hazardous drinking at 3-, 6- and 12-month follow-up interviews, relative to patients in the control group; as well as decreasing depression symptoms; increasing depression treatment retention (number of psychiatry visits recorded in the electronic medical record, based on Healthcare Effectiveness Data and Information Set (HEDIS) standards); facilitating patient initiation of chemical dependency program treatment; and decreasing emergency room and inpatient utilization and overall health care costs. If effectiveness is demonstrated, BMI could have a major impact on services for patients with depression. PUBLIC HEALTH RELEVANCE: Alcohol use among depression patients is very prevalent and puts patients at risk for worsening alcohol-related problems and poor mental health outcomes. The study intervention (BMI) is an innovative treatment with significant potential to reduce hazardous alcohol use in this population. If effectiveness of the treatment and cost-effectiveness are demonstrated, the intervention could improve services for patients with depression, prevent escalation of alcohol problems and improve health outcomes.