Chambers Jaclyn E, Brooks Adam C, Medvin Rachel, Metzger David S, Lauby Jennifer, Carpenedo Carolyn M, Favor Kevin E, Kirby Kimberly C
Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA, 19106, USA.
The Institute for Graduate Clinical Psychology, Widener University, One University Place, Chester, PA, 19013, USA.
Addict Sci Clin Pract. 2016 Apr 18;11(1):8. doi: 10.1186/s13722-016-0057-6.
Brief interventions such as Screening, a single session of Brief Intervention, and Referral to Treatment (SBIRT) have shown mixed effectiveness in primary care. However, there are indications that multi-session brief interventions may demonstrate more consistently positive outcomes, and perhaps a more intensive approach would be of benefit in addressing substance use in primary care. This study compared the effectiveness of SBIRT with a single BI session (BI/RT) to a multi-session brief-treatment intervention (BI/RT+) in primary care. We also developed easy-to-use, evidence-based materials to assist clinicians in delivering these interventions.
METHODS/DESIGN: This study was conducted in three Federally Qualified Healthcare Centers (FQHCs). A total of 10,935 patients were screened, and 600 individuals were recruited. The sample was primarily Black/African American (82 %) with a mean age of 40. Patients who attended a healthcare appointment were screened for substance use via the AUDIT and DAST. Patients were eligible for the study if they scored 8 or higher on the AUDIT, were using only marijuana and scored 2 or higher on the DAST, or were using other illicit drugs and scored 1 or higher on the DAST. Participants were randomly assigned to receive one-session BI/RT, or two to six sessions of brief intervention that incorporated elements of motivational enhancement therapy and cognitive-behavioral therapy (BI/RT+). Both interventions were delivered by behavioral health consultants at the FQHCs. Participants completed follow-up assessments every 3 months for 1 year. Primary outcome variables included substance use treatment sessions attended and days of substance use. Secondary outcomes included measures of health, employment, legal, and psychiatric functioning and HIV risk behaviors. Additionally, we will conduct an economic evaluation examining cost-effectiveness and will analyze outcomes from a process evaluation examining patient and provider experiences.
The ability of brief interventions to impact substance use has great potential, but research findings have been mixed. By conducting a large-scale randomized controlled trial in real-world health centers, this study will answer important questions about the effectiveness of expanded BIs for patients who screen positive for risky substance use in primary care. Trial registration NCT01751672.
诸如筛查、单次简短干预及转介治疗（SBIRT）等简短干预措施在初级保健中的效果参差不齐。然而，有迹象表明多疗程简短干预可能会展现出更为一致的积极效果，或许更为强化的方法将有助于解决初级保健中的物质使用问题。本研究比较了初级保健中SBIRT与单次简短干预（BI/RT）及多疗程简短治疗干预（BI/RT+）的效果。我们还开发了易于使用的、基于证据的材料，以协助临床医生实施这些干预措施。
方法/设计：本研究在三个联邦合格医疗中心（FQHC）开展。共筛查了10935名患者，招募了600名个体。样本主要为黑人/非裔美国人（82%），平均年龄40岁。通过AUDIT和DAST对前来就诊的患者进行物质使用筛查。若患者AUDIT评分8分及以上，仅使用大麻且DAST评分2分及以上，或使用其他非法药物且DAST评分1分及以上，则符合研究条件。参与者被随机分配接受单次BI/RT，或接受两至六个疗程的简短干预，该干预纳入了动机增强疗法和认知行为疗法的要素（BI/RT+）。两种干预均由FQHC的行为健康顾问实施。参与者在1年中每3个月完成一次随访评估。主要结局变量包括接受的物质使用治疗疗程数及物质使用天数。次要结局包括健康、就业、法律和精神功能及HIV风险行为的测量指标。此外，我们将进行一项经济评估以检验成本效益，并将分析一项过程评估的结果，该评估考察患者和提供者的体验。
简短干预对物质使用产生影响的能力具有巨大潜力，但研究结果不一。通过在实际的健康中心开展大规模随机对照试验，本研究将回答有关扩大后的简短干预对初级保健中物质使用风险筛查呈阳性患者有效性的重要问题。试验注册号NCT01751672。
