Impact of Group Motivational Interviewing and In-Home-Messaging-Devices for Dually Diagnosed Veterans
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 70 |
| Updated: | 8/10/2018 |
| Start Date: | May 3, 2010 |
| End Date: | September 30, 2013 |
Impact of Group Motivational Interviewing for Dually Diagnosed Veterans
Two approaches for providing evidence-based substance abuse treatment (EBT), group
motivational interviewing (GMI) and the In-Home-Messaging-Device (IHMD), are interventions
that have the characteristic ability for increasing accessibility to evidence-based treatment
among patients with substance use problems and are proposed for investigation. GMI is based
on motivational interviewing, an intervention that has shown consistent significant effects
in promoting treatment retention and reduced substance use among individuals with substance
use disorders, and is delivered in a group format. IHMD is a user-friendly computerized
Tele-mental Health communication tool that allows interaction through the telephone line
between a Veteran and the health care provider in an individual's home or residential
placement. The current proposal aims to determine whether GMI and IHMD lead to a
significantly greater increase in treatment engagement and reduction in alcohol use compared
to a treatment control condition (TCC) among Veterans with a substance use problem and a
co-existing psychiatric disorder.
motivational interviewing (GMI) and the In-Home-Messaging-Device (IHMD), are interventions
that have the characteristic ability for increasing accessibility to evidence-based treatment
among patients with substance use problems and are proposed for investigation. GMI is based
on motivational interviewing, an intervention that has shown consistent significant effects
in promoting treatment retention and reduced substance use among individuals with substance
use disorders, and is delivered in a group format. IHMD is a user-friendly computerized
Tele-mental Health communication tool that allows interaction through the telephone line
between a Veteran and the health care provider in an individual's home or residential
placement. The current proposal aims to determine whether GMI and IHMD lead to a
significantly greater increase in treatment engagement and reduction in alcohol use compared
to a treatment control condition (TCC) among Veterans with a substance use problem and a
co-existing psychiatric disorder.
Dually diagnosed Veterans (N = 178) will be recruited from the Charleston, SC VAMC Outpatient
Substance Abuse Treatment Center (SATC) and block randomized to TAU, GMI, or IHMD. Patients
with alcohol dependence or abuse (including drug abuse) and a nonsubstance-related major Axis
I disorder (e.g., bipolar disorder, depression, psychotic disorder) will be eligible for the
study. Participants, who were referred to the study at time of triage or during the
orientation phase of SATC, will be evaluated at baseline and approximately at a 1 and 3-month
follow-up. Primary outcome measures will be alcohol use and treatment utilization as measured
by number of days of alcohol use, number of binge alcohol drinking days, and quantity of
alcohol consumed (in standard drinks, or SECs), and treatment attendance sessions based on
objective CPRS patient medical records (i.e., number of all substance abuse outpatient, other
mental health [e.g., PTSD, depression], and other substance abuse treatment sessions), and
self-reported 12-step (number of self-help AA/NA) sessions, including days consulting with a
12-step or mutual self-help sponsor. Exploratory outcomes measures include number of illicit
drug use days (e.g., cocaine, crack, marijuana, opiates, and sedatives).
Primary questions:
A. Does GMI lead to a significantly greater reduction in alcohol use and an increase in
treatment engagement outcomes in the 3-month follow-up period compared to participants
assigned to TCC?
Hypothesis: Participants who receive GMI will consume less alcohol and will be engaged in and
attend more continuous treatment than participants in TCC in the 3-month follow-up period.
B. Does IHMD lead to a significantly greater reduction in alcohol use and an increase in
treatment engagement outcomes in the 3-month follow-up period compared to participants
assigned to TCC?
Hypothesis: Participants who receive IHMD will consume less alcohol and will be engaged in
and attend more continuous treatment than participants in TCC in the 3-month follow-up
period.
Exploratory question:
Compared to TCC, will GMI and IHMD lead to significantly fewer days of illicit drug use by
3-month follow-up?
Hypothesis: Compared to TCC, GMI and IHMD will result in a significant reduction in days of
illicit drug use by 3-month follow-up.
Substance Abuse Treatment Center (SATC) and block randomized to TAU, GMI, or IHMD. Patients
with alcohol dependence or abuse (including drug abuse) and a nonsubstance-related major Axis
I disorder (e.g., bipolar disorder, depression, psychotic disorder) will be eligible for the
study. Participants, who were referred to the study at time of triage or during the
orientation phase of SATC, will be evaluated at baseline and approximately at a 1 and 3-month
follow-up. Primary outcome measures will be alcohol use and treatment utilization as measured
by number of days of alcohol use, number of binge alcohol drinking days, and quantity of
alcohol consumed (in standard drinks, or SECs), and treatment attendance sessions based on
objective CPRS patient medical records (i.e., number of all substance abuse outpatient, other
mental health [e.g., PTSD, depression], and other substance abuse treatment sessions), and
self-reported 12-step (number of self-help AA/NA) sessions, including days consulting with a
12-step or mutual self-help sponsor. Exploratory outcomes measures include number of illicit
drug use days (e.g., cocaine, crack, marijuana, opiates, and sedatives).
Primary questions:
A. Does GMI lead to a significantly greater reduction in alcohol use and an increase in
treatment engagement outcomes in the 3-month follow-up period compared to participants
assigned to TCC?
Hypothesis: Participants who receive GMI will consume less alcohol and will be engaged in and
attend more continuous treatment than participants in TCC in the 3-month follow-up period.
B. Does IHMD lead to a significantly greater reduction in alcohol use and an increase in
treatment engagement outcomes in the 3-month follow-up period compared to participants
assigned to TCC?
Hypothesis: Participants who receive IHMD will consume less alcohol and will be engaged in
and attend more continuous treatment than participants in TCC in the 3-month follow-up
period.
Exploratory question:
Compared to TCC, will GMI and IHMD lead to significantly fewer days of illicit drug use by
3-month follow-up?
Hypothesis: Compared to TCC, GMI and IHMD will result in a significant reduction in days of
illicit drug use by 3-month follow-up.
Inclusion Criteria:
- ability to provide informed consent
- reading level at least at the 5th grade level
- ability to identify at least one collateral contact
- ability to be contacted by telephone at follow-up
- access to a working telephone line in the home or residential placement
- alcohol use or alcohol and drug use in the 28 days prior to hospitalization and
current alcohol dependence (or abuse) or alcohol and drug abuse
Exclusion Criteria:
- auditory or visual impairment that would interfere with study procedures
- scheduled for discharge within 72 hours of initial screening
- diagnosis of dementia
- inability to speak or understand English
- unable to access a landline telephone for the IHMD treatment group
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