Motivational Interviewing to Reduce Substance Use Among Depression Patients

描述（申请人提供）：。我们提出了一项为期3年的随机研究，在筛查，短暂干预和转诊治疗（SBIRT）模型的背景下，提供简短动机干预（BMI），以减少健康维护组织的大型门诊精神病学诊所治疗抑郁症的门诊患者的危险饮酒。患有抑郁症的患者即使在亚诊断水平饮酒，也会影响抑郁症的治疗，并且酒精相关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群中进行过测试。BMI是一种创新的方法，可以减少酒精的使用，改善这些危险饮酒患者的预后。BMI可以促进有严重酒精问题的患者开始化学依赖护理，包括必要时的依赖，这与SBIRT模型一致；而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危险饮酒（即女性每天饮酒3次，男性每天饮酒4次），以及饮酒时出现中度至重度抑郁症状。在这项对照试验中，280名患者将被随机分组，在8周内接受一次面对面的BMI测试和两次电话BMI增强测试（干预）或一本关于酒精使用风险的小册子（对照组）。我们预计，相对于对照组患者，在3个月、6个月和12个月的随访访谈中，干预措施将有效减少危险饮酒的频率；以及减轻抑郁症状；增加抑郁症治疗保留（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）；促进患者开始化学依赖计划治疗；降低急诊室和住院病人的使用率以及整体医疗保健成本。如果证明了有效性，BMI可能会对抑郁症患者的服务产生重大影响。

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.