This application by a new investigator responds to PA-08-263, Health Services Research on the Prevention and Treatment of Drug and Alcohol Abuse (R01). We propose a 3-year randomized study of Brief Motivational Intervention (BMI) delivered in the context of the Screening, Brief Intervention and Referral to Treatment (SBIRT) model to reduce drug use and hazardous drinking among outpatients in treatment for depression in a health maintenance organization's large outpatient psychiatry clinic. Patients with depression who use drugs or alcohol even at sub-diagnostic levels can compromise depression treatment and are at high risk for escalation of substance problems. But interventions have not been tested in this large and vulnerable population. BMI is an innovative approach that could decrease drug and alcohol use and improve outcomes for these patients with hazardous drinking and drug use. BMI can facilitate initiation of chemical dependency care for patients with significant substance problems including dependence, as needed, consistent with the SBIRT model. This promising intervention has never been tested among patients with depression. Study inclusion criteria are based on drug use (including any illicit drug use and non-prescribed use of prescription drugs) and hazardous drinking (i.e., e 3 drinks in a day for women and e 4 drinks in a day for men), and moderate to severe depression symptoms at the time of intake. In this controlled trial, 350 patients will be randomized to receive one in-person BMI session and two telephone BMI booster sessions within 8 weeks of intake (intervention) or a brochure on risks of drug and alcohol use (control). We anticipate that the intervention will be effective in reducing frequency of drug use and hazardous drinking at 3-, 6- and 12-month follow-up interviews, relative to patients in the control group;improving mood and functional outcomes;increasing depression treatment retention (number of psychiatry visits recorded in the electronic medical record, based on Healthcare Effectiveness Data and Information Set (HEDIS) standards);and facilitating patient initiation of chemical dependency program treatment. If effectiveness is demonstrated, BMI could have a major impact on services for patients with depression.
Drug and alcohol use among depression patients is very prevalent and puts patients at risk for worsening substance problems and poor mental health outcomes. The study intervention (BMI) is an innovative treatment with significant potential to reduce drug and alcohol use in this population. If effectiveness is demonstrated, the intervention could improve services for patients with depression, prevent escalation of drug and alcohol problems and improve health outcomes.
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