Klimas Jan, Anderson Rolande, Bourke Margaret, Bury Gerard, Field Catherine Anne, Kaner Eileen, Keane Rory, Keenan Eamon, Meagher David, Murphy Brian, O'Gorman Clodagh Sm, O'Toole Thomas P, Saunders Jean, Smyth Bobby P, Dunne Colum, Cullen Walter
Centre for Interventions in Infection, Immunity and Inflammation (4i) and Graduate Entry Medical School, Faculty of Education & Health Sciences, University of Limerick, Limerick, Ireland.
JMIR Res Protoc. 2013 Aug 2;2(2):e26. doi: 10.2196/resprot.2678.
Alcohol use is an important issue among problem drug users. Although screening and brief intervention (SBI) are effective in reducing problem alcohol use in primary care, no research has examined this issue among problem drug users.
The objective of this study is to determine if a complex intervention including SBI for problem alcohol use among problem drug users is feasible and acceptable in practice. This study also aims to evaluate the effectiveness of the intervention in reducing the proportion of patients with problem alcohol use.
Psychosocial intervention for alcohol use among problem drug users (PINTA) is a pilot feasibility study of a complex intervention comprising SBI for problem alcohol use among problem drug users with cluster randomization at the level of general practice, integrated qualitative process evaluation, and involving general practices in two socioeconomically deprived regions. Practices (N=16) will be eligible to participate if they are registered to prescribe methadone and/or at least 10 patients of the practice are currently receiving addiction treatment. Patient must meet the following inclusion criteria to participate in this study: 18 years of age or older, receiving addiction treatment/care (eg, methadone), or known to be a problem drug user. This study is based on a complex intervention supporting SBI for problem alcohol use among problem drug users (experimental group) compared to an "assessment-only" control group. Control practices will be provided with a delayed intervention after follow-up. Primary outcomes of the study are feasibility and acceptability of the intervention to patients and practitioners. Secondary outcome includes the effectiveness of the intervention on care process (documented rates of SBI) and outcome (proportion of patients with problem alcohol use at the follow-up). A stratified random sampling method will be used to select general practices based on the level of training for providing addiction-related care and geographical area. In this study, general practitioners and practice staff, researchers, and trainers will not be blinded to treatment, but patients and remote randomizers will be unaware of the treatment.
This study is ongoing and a protocol system is being developed for the study. This study may inform future research among the high-risk population of problem drug users by providing initial indications as to whether psychosocial interventions for problem alcohol use are feasible, acceptable, and also effective among problem drug users attending primary care.
This is the first study to examine the feasibility and acceptability of complex intervention in primary care to enhance alcohol SBI among problem drug users. Results of this study will inform future research among this high-risk population and guide policy and service development locally and internationally.
饮酒问题在吸毒问题人群中是一个重要问题。尽管筛查与简短干预（SBI）在初级保健中能有效减少酒精相关问题，但尚无研究在吸毒问题人群中探讨过这一问题。
本研究的目的是确定一项针对吸毒问题人群酒精相关问题的综合干预措施（包括SBI）在实际应用中是否可行且可接受。本研究还旨在评估该干预措施在降低有酒精相关问题患者比例方面的有效性。
吸毒问题人群酒精使用心理社会干预（PINTA）是一项初步可行性研究，涉及一项综合干预措施，即对吸毒问题人群中的酒精相关问题进行SBI，在全科医疗层面进行整群随机分组，进行综合定性过程评估，并纳入两个社会经济贫困地区的全科医疗。如果诊所注册可开具美沙酮且/或该诊所至少有10名患者正在接受成瘾治疗，则这些诊所（N = 16）有资格参与。患者必须符合以下纳入标准才能参与本研究：年龄在18岁及以上，正在接受成瘾治疗/护理（如美沙酮），或已知为吸毒问题人群。本研究基于一项支持对吸毒问题人群中的酒精相关问题进行SBI的综合干预措施（实验组），并与一个“仅评估”对照组进行比较。对照组诊所在随访后将接受延迟干预。本研究的主要结局是干预措施对患者和从业者的可行性和可接受性。次要结局包括干预措施对护理过程（记录的SBI发生率）和结局（随访时有酒精相关问题患者的比例）的有效性。将采用分层随机抽样方法，根据提供成瘾相关护理的培训水平和地理区域选择全科医疗。在本研究中，全科医生、诊所工作人员、研究人员和培训人员对治疗不设盲，但患者和远程随机分组人员对治疗不知情。
本研究正在进行中，且正在为该研究开发一个方案系统。本研究可能通过提供关于针对吸毒问题人群中酒精相关问题的心理社会干预措施在初级保健中的可行性、可接受性以及有效性的初步迹象，为未来针对高危吸毒问题人群的研究提供参考。
这是第一项研究初级保健中综合干预措施以增强吸毒问题人群酒精SBI的可行性和可接受性的研究。本研究结果将为未来针对这一高危人群的研究提供参考，并指导本地和国际的政策及服务发展。
