Madras Bertha K, Compton Wilson M, Avula Deepa, Stegbauer Tom, Stein Jack B, Clark H Westley
Harvard Medical School-NEPRC, 1 Pine Hill Drive, Southborough, MA 01772, USA.
Drug Alcohol Depend. 2009 Jan 1;99(1-3):280-95. doi: 10.1016/j.drugalcdep.2008.08.003. Epub 2008 Oct 16.
Alcohol screening and brief interventions in medical settings can significantly reduce alcohol use. Corresponding data for illicit drug use is sparse. A Federally funded screening, brief interventions, referral to treatment (SBIRT) service program, the largest of its kind to date, was initiated by the Substance Abuse and Mental Health Services Administration (SAMHSA) in a wide variety of medical settings. We compared illicit drug use at intake and 6 months after drug screening and interventions were administered.
SBIRT services were implemented in a range of medical settings across six states. A diverse patient population (Alaska Natives, American Indians, African-Americans, Caucasians, Hispanics), was screened and offered score-based progressive levels of intervention (brief intervention, brief treatment, referral to specialty treatment). In this secondary analysis of the SBIRT service program, drug use data was compared at intake and at a 6-month follow-up, in a sample of a randomly selected population (10%) that screened positive at baseline.
Of 459,599 patients screened, 22.7% screened positive for a spectrum of use (risky/problematic, abuse/addiction). The majority were recommended for a brief intervention (15.9%), with a smaller percentage recommended for brief treatment (3.2%) or referral to specialty treatment (3.7%). Among those reporting baseline illicit drug use, rates of drug use at 6-month follow-up (4 of 6 sites), were 67.7% lower (p<0.001) and heavy alcohol use was 38.6% lower (p<0.001), with comparable findings across sites, gender, race/ethnic, age subgroups. Among persons recommended for brief treatment or referral to specialty treatment, self-reported improvements in general health (p<0.001), mental health (p<0.001), employment (p<0.001), housing status (p<0.001), and criminal behavior (p<0.001) were found.
SBIRT was feasible to implement and the self-reported patient status at 6 months indicated significant improvements over baseline, for illicit drug use and heavy alcohol use, with functional domains improved, across a range of health care settings and a range of patients.
在医疗环境中进行酒精筛查和简短干预可显著减少酒精使用。关于非法药物使用的相应数据则较为稀少。物质滥用和精神健康服务管理局（SAMHSA）启动了一项由联邦政府资助的筛查、简短干预、转介治疗（SBIRT）服务项目，这是迄今为止此类项目中规模最大的，涉及多种医疗环境。我们比较了药物筛查和干预实施时以及实施6个月后的非法药物使用情况。
SBIRT服务在六个州的一系列医疗环境中实施。对不同的患者群体（阿拉斯加原住民、美洲印第安人、非裔美国人、白种人、西班牙裔）进行了筛查，并根据得分提供逐步升级的干预措施（简短干预、简短治疗、转介至专科治疗）。在对SBIRT服务项目的这项二次分析中，对基线筛查呈阳性的随机抽取人群样本（10%）在入组时和6个月随访时的药物使用数据进行了比较。
在459,599名接受筛查的患者中，22.7%的人在一系列使用情况（有风险/有问题、滥用/成瘾）方面筛查呈阳性。大多数人被建议进行简短干预（15.9%），较少比例的人被建议进行简短治疗（3.2%）或转介至专科治疗（3.7%）。在报告基线非法药物使用情况的人群中，6个月随访时（6个地点中的4个）的药物使用率降低了67.7%（P<0.001），重度酒精使用率降低了38.6%（P<0.001），各地点、性别、种族/族裔、年龄亚组的结果相似。在被建议进行简短治疗或转介至专科治疗的人群中，发现其在总体健康（P<0.001）、心理健康（P<0.001）、就业（P<0.001）、住房状况（P<0.001）和犯罪行为（P<0.001）方面的自我报告有所改善。
SBIRT项目实施可行，患者6个月时的自我报告状况表明，在一系列医疗环境和患者群体中，非法药物使用和重度酒精使用情况相较于基线有显著改善，功能领域也得到了改善。
