Services Research: Psychiatric Comorbidity in Drug Abuse

服务研究：药物滥用中的精神共存疾病

• 批准号: 7221269
• 负责人: ROBERT K BROONER
• 金额: $ 70.55万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-05-05 至 2009-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7221269
• 关键词: Accident and Emergency department; Acute; Adherence; Admission activity; Alcohol abuse; Appointment; Award; Caring; Combined Modality Therapy; Communication; Community Psychiatry; Comorbidity; Condition; Controlled Study; Counseling; Country; Daily; Data; Dependence; Disease; Dose; Drug Abuse Treatment Services; Drug abuse; Drug usage; Effectiveness; Evaluation; Exposure to; Frequencies; Funding; Gender; Grant; Group Therapy; HIV; Health; Health Policy; Health Services; Health Services Research; Healthcare; Hospitalization; Individual; Individual Differences; Inpatients; Intervention; MTCH1 gene; Mental Health; Mental Health Services; Mental disorders; Methadone; Modality; Modeling; Morbidity - disease rate; Numbers; Opiate Addiction; Opioid; Outcome; Outcome Measure; Participant; Patient Self-Report; Patients; Personal Satisfaction; Pharmaceutical Preparations; Psychiatric therapeutic procedure; Psychiatrist; Quality of life; Randomized; Range; Rate; Reporting; Research; Research Personnel; Risk Behaviors; Schedule; Services; Severities; Site; Standards of Weights and Measures; Substance abuse problem; Symptoms; System; Treatment Effectiveness; Treatment outcome; Visit; Week; Work; addiction; base; compliance behavior; cost; design; drug abuser; emotional abuse; health administration; improved; intervention program; medication compliance; mental health center; novel; programs; psychosocial; treatment program; treatment site

DESCRIPTION (provided by applicant): Drug abuse treatment that incorporates adequate doses of daily methadone and weekly counseling is usually effective in managing the pervasive and devastating symptoms of opioid dependence (e.g., Simpson & Sells, 1990). Over two-decades of treatment research has also shown that the presence of a comorbid psychiatric disorder adversely impacts the overall effectiveness of this treatment modality, at least for many of these unfortunate patients (King et al., 2001; Rounsaville et al., 1986). Interventions with much hope of resolving this serious health problem must ultimately change the fact that most of these patients fail to receive any psychiatric care -- even when referred to general psychiatric settings outside of the drug abuse program. The extremely poor patient adherence to psychiatric care is a major health services problem that reaches across patients, programs and countries (e.g., Thompson et al., 2000). One promising approach to reducing the poor adherence that exposes these drug abusers to unnecessarily high levels of morbidity from untreated psychiatric disorders is a fully integrated service delivery approach. Using an integrated model of care, drug abusers with a comorbid disorder could be offered a broad range of standard psychiatric services with the drug abuse program. While practitioners and researchers extol the virtues of integrated systems of drug abuse and psychiatric care, amazingly few controlled studies have been done to evaluate the efficacy of this approach (e.g., Drake et al., 1996, Ley et al., 2001). More importantly, most of these studies were conducted in general psychiatric versus drug abuse programs, and the small number done in drug abuse settings did not use random assignment to evaluate the influence of on- versus off-site services on adherence or outcomes; and all but one of these studies (Saxon et al., 1995) offered a very narrow range of services. The proposed work will be the first known randomized evaluation of the effectiveness of an integrated drug abuse and standard psychiatric treatment approach delivered a drug abuse program. Study participants will be 396 opioid abusers with a current psychiatric disorder; all will be new admissions to the Addiction Services Treatment program (ATS). Using a two-group factorial design, participants will be randomly assigned to either the Integrated Substance Abuse and Psychiatric Care condition (ISAP-Integrated) or the Parallel Substance Abuse and Psychiatric Care condition (PSAP-Parallel). Participants in the ISAP condition will be offered standard psychiatric care in the ATS program; those assigned to the PSAP condition will be offered care in the Community Psychiatry Program (CPP), located on the same campus. The scope and amount of standard psychiatric services will be the same across treatment sites (ATS and CPP); all drug abuse services will be provided in the ATS program. Participants will be evaluated over a 12- month period and compared on a range of adherence and outcome measures: rates of initial engagement in psychiatric care and overall adherence to psychiatric services (therapy sessions and prescribed medications), adherence to scheduled drug abuse treatment services, and a range of objective and self-reported psychiatric and drug abuse treatment outcomes, including utilization rates of high cost intensive ambulatory psychiatric care, acute inpatient psychiatric hospitalization, and emergency room visits for psychiatric or drug abuse problems. This study will produce both timely and scientifically rigorous health services research data on the effectiveness of integrated psychiatric and drug abuse treatment in a drug abuse program; data from this study will inform and guide the treatment field and both local and national health care discussions and decisions that will impact the organization and funding of drug abuse and mental health services.

描述（由申请人提供）： 纳入足够剂量的每日美沙酮和每周咨询的药物滥用治疗通常可以有效地管理阿片类药物依赖的普遍性和破坏性症状（例如Simpson＆Sells，1990年）。超过两个十年的治疗研究还表明，合并症的精神障碍的存在对这种治疗方式的总体有效性产生了不利影响，至少对于许多不幸的患者而言（King等，2001; Rounsaville等，1986）。有很大希望解决这个严重健康问题的干预措施必须最终改变这样的事实，即这些患者中的大多数未能接受任何精神病护理 - 即使在毒品滥用计划之外提到了一般精神科环境。患者对精神病护理的依从性极差是一个主要的医疗服务问题，在患者，计划和国家 /地区都涉及（例如Thompson等，2000）。一种有前途的方法是减少较差的依从性，该方法使这些滥用者从未经治疗的精神病患者中脱颖而出，这是一种完全集成的服务提供方法。使用综合护理模型，可以通过毒品滥用计划为患有合并症的吸毒者提供广泛的标准精神病服务。尽管从业人员和研究人员赞扬了药物滥用和精神病护理综合体系的优点，但很少进行对照研究来评估这种方法的疗效（例如，Drake等，1996； Ley等，2001）。更重要的是，这些研究大多数是在普通精神病和滥用药物滥用计划中进行的，在药物滥用环境中所做的少量并没有使用随机分配来评估现场服务对依从性或结果的影响；这些研究中的所有研究（Saxon等，1995）提供了非常狭窄的服务。拟议的工作将是对综合药物滥用和标准精神病治疗方法的有效性的首次已知的随机评估，提供了药物滥用计划。研究参与者将是396名患有精神疾病的阿片类药物滥用者；所有这些都是成瘾服务治疗计划（ATS）的新入学。使用两组阶乘设计，参与者将被随机分配到综合药物滥用和精神病护理状况（ISAP融合）或平行的药物滥用和精神病护理条件（PSAP-Paralallel）。在ATS计划中将为ISAP条件的参与者提供标准的精神病护理；分配给PSAP条件的人将在同一校园的社区精神病学计划（CPP）中提供护理。在治疗站点（ATS和CPP）中，标准精神病服务的范围和数量将相同；所有药物滥用服务将在ATS计划中提供。 Participants will be evaluated over a 12- month period and compared on a range of adherence and outcome measures: rates of initial engagement in psychiatric care and overall adherence to psychiatric services (therapy sessions and prescribed medications), adherence to scheduled drug abuse treatment services, and a range of objective and self-reported psychiatric and drug abuse treatment outcomes, including utilization rates of high cost intensive ambulatory psychiatric care, acute住院的精神病住院和急诊室就精神病或药物滥用问题就诊。这项研究将及时和科学严格的卫生服务研究数据有关在药物滥用计划中综合精神病和药物滥用治疗的有效性；这项研究的数据将为治疗领域以及本地和国家医疗保健讨论以及将影响滥用药物滥用和精神卫生服务的资金的本地和国家医疗保健讨论和决策。

项目成果

Using enhanced and integrated services to improve response to standard methadone treatment: changing the clinical infrastructure of treatment networks.

使用增强的综合服务来改善对标准美沙酮治疗的反应：改变治疗网络的临床基础设施。

• DOI: 10.1016/j.jsat.2009.07.003
• 发表时间: 2010
• 期刊: Journal of substance abuse treatment
• 影响因子: 3.9
• 作者: Neufeld,Karin;Kidorf,Michael;King,Van;Stoller,Ken;Clark,Michael;Peirce,Jessica;Brooner,RobertK
• 通讯作者: Brooner,RobertK

Effect of traumatic event reexposure and PTSD on substance use disorder treatment response.

• DOI: 10.1016/j.drugalcdep.2015.11.006
• 发表时间: 2016-01-01
• 期刊: Drug and alcohol dependence
• 影响因子: 4.2
• 作者: Peirce JM;Brooner RK;King VL;Kidorf MS
• 通讯作者: Kidorf MS

Comparison of methods to assess psychiatric medication adherence in methadone-maintained patients with co-occurring psychiatric disorder.

• DOI: 10.1016/j.drugalcdep.2016.01.016
• 发表时间: 2016-03-01
• 期刊: Drug and alcohol dependence
• 影响因子: 4.2
• 作者: Dunn KE;King VL;Brooner RK
• 通讯作者: Brooner RK

Assessing traumatic event exposure: comparing the Traumatic Life Events Questionnaire to the Structured Clinical Interview for DSM-IV.

评估创伤性事件暴露：将创伤性生活事件问卷与 DSM-IV 的结构化临床访谈进行比较。

• DOI: 10.1037/a0015578
• 发表时间: 2009-06
• 期刊: PSYCHOLOGICAL ASSESSMENT
• 影响因子: 3.6
• 作者: Peirce, Jessica M.;Burke, Christopher K.;Stoller, Kenneth B.;Neufeld, Karin J.;Brooner, Robert K.
• 通讯作者: Brooner, Robert K.