Early Re-Intervention Experiment2(ERI-2)

早期再干预实验2(ERI-2)

• 批准号: 7541045
• 负责人: MICHAEL L DENNIS
• 金额: $ 80.1万
• 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/7541045
• 关键词: Admission activity; Adult; Aftercare; Alcohol or Other Drugs use; Appendix; Area; Biological Markers; Chronic; Condition; 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; Rate; Recovery; Recruitment Activity; Relapse; Specialist; Time; base; care episode; checkup examination; day; design; 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.

物质使用依赖与多种同时发生的精神问题越来越被认为是一种慢性、 复发性疾病可能持续数十年，需要多年多次护理才能达到预期效果 持续缓解状态 观察性研究检查了不同护理阶段的治疗效果，发现 复发后，人们越早恢复治疗，接受的后续治疗和善后护理就越多 （特别是总计超过 90 天），其长期结果就越好。然而，只有不到十项长期研究 跨越护理的各个阶段。早期再干预实验 1 (ERI-1) 是第一项研究 通过实验评估公共卫生模型的监测和早期再干预的能力，以缩短 复发、再次治疗和恢复周期。 RMC 参与者的可能性明显高于 对照组返回治疗（64% vs. 51%）、更快返回治疗（376 天 vs. 600 天）以及花费更多 随后的治疗天数（平均 62 天与 40 天）。 RMC 参与者的总体体验也显着减少 需要治疗的季度，并且在摄入后 2 年后需要治疗的可能性较小（43% 对 56%）。尽管 成功的关联率，只有 60% 的关联参与者仍接受治疗 14 天或更长时间（这与 恢复的可能性更大）。连锁率和 c_occurring 之间也存在交互作用 精神问题。 根据 ERI-2，我们建议延长 5 年，以继续扩展我们在该领域的知识。 具体来说，我们建议从 Haymarket 的连续入院招募 300 名患有药物依赖的成年人 集中并随机分配参与者进行季度评估，无需 RMC 干预（对照组） 为期 4 年或每季度评估加上 RMC 手动指导协议的增强修订版（在 附录;斯科特和丹尼斯，2003）。虽然 ERI-2 的调查路线与 ERI-1 相似，但我们提出了几个证据： 基于对 RMC 协议的修改，包括更加基于理论的模型，将生物标志物添加到 评估需求，转向更长的时间范围来观察 RMC 效果，并在 帮助吸引和留住参与者参与治疗的治疗计划。新实验的具体目标是： (1) 检查康复管理检查对复发、再进入治疗和康复周期的影响 4年内； (2) 评估恢复管理检查的影响（直接效果）和后续 治疗（间接影响）对结果的影响； (3) 探讨同时发生的精神疾病的（调节）作用 RMC、治疗参与模式和长期结果之间关系的问题。