Gryczynski Jan, Mitchell Shannon Gwin, Ondersma Steven J, O'Grady Kevin E, Schwartz Robert P
Friends Research Institute, Baltimore, MD, USA.
Friends Research Institute, Baltimore, MD, USA.
J Subst Abuse Treat. 2015 Aug;55:39-44. doi: 10.1016/j.jsat.2015.02.003. Epub 2015 Feb 23.
The societal benefits of substance use interventions are largely driven not by reducing use per se, but by the broader implications of those reductions. This encompasses "potential radiating effects of misusing substances" (PREMiS) such as utilization of high-cost hospital and emergency care, injury, productivity losses, incarceration, and driving while impaired.
This study is a secondary analysis from a randomized trial comparing in-person vs. computerized brief intervention among 360 adult community health center patients with moderate-risk illicit drug use (N = 302 with complete data through 12 months of follow-up). This study aims to examine four aspects of PREMiS outcomes in this sample: (1) their frequency; and their association with (2) type of brief intervention received (by random assignment), (3) type of drug misused, and (4) baseline drug problem severity (within the moderate risk range).
12-month prevalence was 18.5% for hospitalization (399 cumulative days), 33.1% for emergency department utilization (166 cumulative visits), 39.1% for injury (1818 injury-days), and 8.3% for incarceration (278 days of detention). There were 729 missed work days among those who reported employment. Fifty percent reported driving under the influence (DUI) of substances. There were no differences in PREMiS outcomes by type of brief intervention. Participants with only marijuana misuse at baseline were not at lower risk of experiencing PREMiS events than participants with other drug misuse. Higher baseline drug problem severity was predictive of future hospitalization (p < .05) and number of hospitalization days (p < .01).
This community health center sample with moderate-risk illicit drug use reported considerable high-cost healthcare utilization, injury, missed work, and DUI. Interventions are needed that can reliably lower risk of negative outcomes among drug users.
物质使用干预措施对社会的益处很大程度上并非源于减少物质使用本身，而是源于这些减少所带来的更广泛影响。这包括“物质滥用的潜在辐射效应”（PREMiS），如使用高成本的医院和急诊护理、受伤、生产力损失、监禁以及在受影响状态下驾驶。
本研究是一项对随机试验的二次分析，该试验比较了360名有中度风险非法药物使用的成年社区卫生中心患者（N = 302，有12个月随访的完整数据）接受面对面干预与计算机化简短干预的效果。本研究旨在考察该样本中PREMiS结果的四个方面：（1）其发生频率；以及它们与（2）所接受的简短干预类型（通过随机分配）、（3）滥用药物类型和（4）基线药物问题严重程度（在中度风险范围内）的关联。
12个月的患病率为：住院18.5%（累计399天），急诊部门就诊33.1%（累计166次），受伤39.1%（1818个受伤日），监禁8.3%（278天拘留）。报告有工作的人中有729个工作日缺勤。50%的人报告在物质影响下驾驶（DUI）。PREMiS结果在简短干预类型方面没有差异。基线时仅滥用大麻的参与者经历PREMiS事件的风险并不低于其他药物滥用的参与者。较高的基线药物问题严重程度可预测未来住院情况（p < 0.05）和住院天数（p < 0.01）。
这个有中度风险非法药物使用的社区卫生中心样本报告了相当多的高成本医疗保健使用、受伤、缺勤和DUI情况。需要采取能够可靠降低吸毒者负面结果风险的干预措施。
