Maximizing Effectiveness of Integrated Treatment Approaches

描述(由申请人提供)：本申请涉及广泛的挑战领域(05)：比较有效性研究和具体挑战主题05-DA-103：药物滥用和共病情况的综合治疗与单独治疗。关于改善患有精神障碍的药物依赖患者的护理的有前景的战略的服务研究仍然是治疗提供者和卫生保健政策制定者的主要优先事项。这项挑战拨款申请将通过使用受控良好的实验设计来评估应急管理在社区药物滥用治疗计划中改善精神服务利用率和减少阿片类药物依赖患者的精神痛苦和损害的有效性，从而为这项工作做出几项实质性贡献。这项研究的基本原理和方法是基于先前资助的美国国立卫生研究院-美国国立卫生研究院申请(后续将于2009年4月完成)，这是当时已知的第一次对社区药物滥用治疗计划内完全整合的药物使用和精神科服务提供模式的受控和随机评估(服务研究：药物滥用者的精神共病，R01 DA 016375)。这项研究揭示了综合护理的许多好处，但在综合条件(M=.32)下，患者对精神科服务的总体依从性较差，显然损害了这些良好结果的重要性，包括综合护理与药物使用或保留之间没有关系。这些结果表明，通过结合其他战略来提高遵从性，综合方法可以得到实质性改进。拟议的研究是这项工作的下一个合乎逻辑的步骤。成瘾治疗服务中心的男性和女性阿片依赖患者目前有任何精神障碍(N=70)，将被随机分配到两种精神科服务条件之一：1)加强现场综合护理(ROIC)，凭单奖励取决于每周参加精神病学会议；或2)标准现场综合护理(SOIC)。这两种情况下的参与者将获得相同的时间表和范围的精神和药物滥用治疗服务。参与者将在随机化后的3个月内接受评估，以确定服务利用率和对精神护理的坚持程度、精神和心理社会问题的范围和严重程度的变化，以及药物使用率和治疗保留率。积极的发现将具有相当大的启发式和卫生保健政策和实践意义。整个研究计划在两年内完成，包括在全国会议上传播主要研究结果和提交第一份手稿。关于改善患有精神障碍的药物依赖患者的护理的有前景的战略的服务研究仍然是治疗提供者和卫生保健政策制定者的主要优先事项。这项挑战拨款申请将通过使用受控良好的实验设计来评估应急管理在社区药物滥用治疗计划中改善精神服务利用率和减少阿片类药物依赖患者的精神痛苦和损害的有效性，从而为这项工作做出几项实质性贡献。积极的发现将具有相当大的启发式和卫生保健政策和实践意义。整个研究计划在两年内完成，包括在全国会议上传播主要研究结果和提交第一份手稿。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05): Comparative Effectiveness Research and specific Challenge Topic 05-DA-103: Integrated Versus Separate Treatment of Substance Abuse and Comorbid Conditions. Services research on promising strategies to improve the care of drug-dependent patients with comorbid psychiatric disorders remains a major priority for treatment providers and health care policymakers. This challenge grant application will make several substantial contributions to this work by using a well-controlled experimental design to evaluate the efficacy of contingency management for improving psychiatric service utilization and reducing psychiatric distress and impairment in opioid-dependent patients with any psychiatric disorder at a community-based drug abuse treatment program. The rationale and methodology of this study is based on a previously funded NIH-NIDA application (follow-up will be completed April 2009) that was then the first known controlled and randomized evaluation of a fully-integrated substance use and psychiatric service delivery model within a community-based drug abuse treatment program (Services Research: Psychiatric Comorbidity in Drug Abusers, R01 DA 016375). This study has revealed many benefits of integrated care, yet poor overall patient adherence to psychiatric services in the integrated condition (M = .32) clearly compromised the magnitude of these good findings, including the absence of a relationship between integrated care and drug use or retention. These results suggest that integrated approaches could be substantially improved by incorporating other strategies to improve adherence. The proposed study is the next logical step to this work. Male and female opioid-dependent patients at Addiction Treatment Services with any current psychiatric disorder (N = 70) will be randomly assigned to one of two psychiatric service conditions: 1) reinforced on-site integrated care (ROIC), with voucher incentives contingent on attending weekly psychiatric sessions; or 2) standard on-site integrated care (SOIC). Participants in both conditions will receive access to the same schedule and range of psychiatric and substance abuse treatment services. Participants will be assessed for 3-months post-randomization to determine rates of service utilization and adherence to psychiatric care, changes in scope and severity of psychiatric and psychosocial problems, and rates of drug use and treatment retention. Positive findings would have considerable heuristic and health care policy and practice implications. The entire study, including dissemination of the major findings at a national meeting and submission of the first manuscript, is designed to be completed within 2-years. Services research on promising strategies to improve the care of drug-dependent patients with comorbid psychiatric disorders remains a major priority for treatment providers and health care policymakers. This challenge grant application will make several substantial contributions to this work by using a well-controlled experimental design to evaluate the efficacy of contingency management for improving psychiatric service utilization and reducing psychiatric distress and impairment in opioid-dependent patients with any psychiatric disorder at a community-based drug abuse treatment program. Positive findings would have considerable heuristic and health care policy and practice implications. The entire study, including dissemination of the major findings at a national meeting and submission of the first manuscript, is designed to be completed within 2-years.