Early Re-Intervention Experiment2(ERI-2)

早期再干预实验2(ERI-2)

• 批准号: 7845684
• 负责人: MICHAEL L DENNIS
• 金额: $ 86.7万
• 依托单位: CHESTNUT HEALTH SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-08-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7845684
• 关键词: Admission activity; Adult; Aftercare; Alcohol or Other Drugs use; Area; Biological Markers; Chronic; Control Groups; Data Set; Dependence; Disease remission; Intake; Intervention; Knowledge; Link; Longitudinal Studies; Manuals; Modeling; Modification; Monitor; Needs Assessment; Observational Study; Outcome; Participant; Pattern; Protocols documentation; Public Health; Randomized; Recovery; Recruitment Activity; Relapse; Specialist; Time; base; care episode; checkup examination; design; evidence base; experience; improved; research study; treatment effect; treatment program

Substance use dependence with multiple co-occurring psychiatric problems is increasingly recognized as a chronic, relapsing condition that may last for decades and require multiple episodes of care over many years before reaching a sustained state of remission Observational studies that examined treatment effects across episodes of care found that the sooner after a relapse people return to treatment and the more subsequent treatment and aftercare they receive (particularly over 90 days total), the better their long-term outcomes. Yet, there are less than a dozen long-term studies that look across episodes of care. The Early Re-Intervention experiment 1 (ERI-1) was the first study to experimentally evaluate the ability of a public health model of monitoring and early re-intervention to shorten the relapse, treatment re-entry, and recovery cycle. RMC participants were significantly more likely than those in the control group to return to treatment (64% vs. 51%), to return to treatment sooner (376 vs. 600 days), and to spend more subsequent days in treatment (mean of 62 vs. 40 days). RMC participants also experienced significantly fewer total quarters in need of treatment and were less likely to need treatment 2 years after intake (43% vs. 56%). In spite of the successful linkage rates, only 60% of the linked participants remained in treatment 14 or more days (which is associated with better odds of going into recovery). There were also interactions between the linkage rates and c_occurring psychiatric problems. Under ERI-2, we propose a 5-year extension in order to continue expanding our knowledge in this area. Specifically, we propose recruiting 300 adults with substance use dependence from sequential admissions at Haymarket Center and randomly assigning participants to either quarterly assessments with no RMC intervention (control group) for 4 years or quarterly assessments plus an enhanced revised version of our RMC manual-guided protocol (in Appendix; Scott & Dennis, 2003). While the line of inquiry for ERI-2 parallels ERI-1, we propose several evidence- based modifications to the RMC protocol, including a more theoretically based model, adding biomarkers to the assessment of need, shifting to a longer time frame for observing RMC effects, and adding an Engagement Specialist at the treatment program to help engage and retain participants in treatment. The specific aims of the new experiment are: (1) To examine the impact of recovery management checkups on the cycle of relapse, treatment re-entry, and recovery over the course of 4 years; (2) To assess the impact of recovery management checkups (direct effect) and subsequent treatment (indirect effect) on outcomes; and (3) To explore the (moderating) effects of co-occurring psychiatric problems on the relationship between RMC, patterns of treatment participation, and long-term outcomes.

具有多个共同存在的精神病问题的药物使用依赖性越来越多地被认为是慢性的， 复发状况可能会持续数十年，并且需要多年的多年护理，然后才能达到 持续的缓解状态观察研究研究检查了各种护理事件的治疗效果发现 复发后，人们恢复治疗以及随后的治疗和后期的护理 （尤其是在90天内），他们的长期结果越好。但是，有不到十二个长期研究 看着照顾情节。早期重新干预实验1（ERI-1）是第一个研究 实验评估监测和早期重新干预的公共卫生模型的能力 复发，治疗重新进入和恢复周期。 RMC的参与者比在 对照组恢复治疗（64％vs.51％），更快地恢复治疗（376 vs. 600天），并花费更多 随后的几天治疗（平均62比40天）。 RMC参与者的总数也大大减少 需要治疗的四分之一，摄入量后2年需要治疗的可能性较小（43％比56％）。尽管有 成功的连锁率，只有60％的链接参与者仍留在14岁以上的治疗中（这与 恢复的几率更好）。连锁率与C_OCCURRING之间也存在相互作用 精神病问题。 根据ERI-2，我们提出了5年的延长，以便继续在这一领域扩大我们的知识。 具体而言，我们提议从Haymarket的连续入院中招募300名具有物质使用依赖的成年人 中心并随机将参与者分配给没有RMC干预的季度评估（对照组） 4年或季度评估以及我们RMC手动指导协议的修订版增强（在 附录; Scott＆Dennis，2003年）。尽管ERI-2的询问线相似，但我们提出了一些证据 - 基于对RMC协议的修改，包括一个基于理论上的模型，将生物标志物添加到 评估需求，转移到更长的时间范围以观察RMC效果，并添加参与专家 该治疗计划有助于参与和保留参与者进行治疗。新实验的具体目的是： （1）检查恢复管理检查对复发，治疗重新进入和恢复周期的影响 在4年的过程中； （2）评估恢复管理检查（直接效果）的影响以及随后的 治疗（间接影响）对结局； （3）探索同时发生的精神病的（调节性）效果 RMC，治疗方式和长期结局之间关系的问题。