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NRI 96-024 – HSR&D Study

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NRI 96-024
A Brief Motivational Intervention with Cocaine Patients
Nina M. Chychula RN PhD
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
Philadelphia, PA
Funding Period: October 2000 - September 2003

BACKGROUND/RATIONALE:
Outpatient substance abuse treatment clinics are challenged with high pretreatment drop out rates and low treatment retention rates. The inadequate assessment and management of post abstinence/stabilization symptoms is thought to be one reason for high treatment drop out/relapse rates. In this study, brief motivational treatments, developed and found effective as a alcohol treatment modality, are extended to cocaine dependent patients and further enhanced with the integration of treatment strategies aimed at reducing and managing post abstinence/stabilization symptoms. The brief motivational intervention model of this study. Motivational Interventions for Recoveries At-Risk, (MIRA) incorporates a motivational interviewing style, that is non-judgmental and non-critical, rather than a confrontational approach and the use of behavioral self monitoring strategies. Designed to foster patients’ engagement in outpatient treatment, MIRA is delivered by nurse practitioners that provide primary health care and that have an ongoing access to veterans within a Behavioral Health Service.

It is plausible that brief motivational treatments developed and found effective as a alcohol treatment modality can be can be extended to cocaine dependent patients and further enhanced with the integration of treatment strategies aimed at reducing and managing post abstinence/stabilization symptoms. The brief motivational intervention model of this study, Motivational Interventions for Recoveries At-Risk, (MIRA) incorporates a motivational interviewing style, that is non-judgmental and non-critical, rather than a confrontational approach. Designed to foster patients’ engagement in outpatient treatment, MIRA is delivered by nurse practitioners that provide primary health care and that have an ongoing access to veterans within a Behavioral Health Service.

OBJECTIVE(S):
Studies show that outpatient substance abuse treatment clinics are challenged with high pretreatment drop out rates and low treatment retention rates. One reason for high treatment drop out rates in the early abstinence period may be the inadequate assessment and treatment of post abstinence/stabilization symptoms
The purpose of this study is to examine the efficacy of a 6 session brief intervention treatment, Motivational Intervention for a Recovery At-Risk, (MIRA), delivered in the context of the Behavioral Health primary care. The objectives of this study are 1) to determine if cocaine use and treatment drop out rates of patients during 10 weeks of the standard outpatient treatment are reduced to a greater extent in the experimental group than in the control group; 2) to examine and determine whether post abstinence/ stabilization symptoms will be reduced to a greater extent over 10 weeks in the experimental group than in the control group.

METHODS:
This study is a prospective, randomized, controlled trial of 160 subjects: 80 active treatment subjects and 80 control subjects. The independent variable is the treatment intervention, the Motivation Intervention for a Recovery At-Risk (MIRA), that is a standardized brief motivational intervention model incorporating attention to post abstinence symptoms, versus a control group. All subjects completed the research instruments once weekly for 6 weeks and at week 10. All patients were involved in an Intensive Outpatient Program (IOP). The effectiveness of the two study interventions will be compared for the total samples.

FINDINGS/RESULTS:
From February 26, 2001 until June 15, 2003 (the close of active study recruiting), 1209 unique admissions into the Addiction Recovery Unit were screened as potential study participants. From the original 1209, 308 (25%) met eligibility requirements. Of these 308 eligible participants, 153 (50%) agreed to participate in the study. As of August 2003, from the 153 patients who agreed to the study, 102 (66%) completed the baseline protocol and attended 1 week of treatment. Of these 102 patients, 96 (94%) completed the 6 week active phase of treatment. In the 27 months of recruitment from February 26, 2001 until June 15, 2003, we recruited 153 of the targeted 160 subjects (96%). There have been no adverse events in this study.

IMPACT:
This study offers the potential of incorporating an efficient and feasible primary care treatment to newly abstinent veteran patients, who are "at-risk” to relapse and drop out from treatment. Such continued high recidivism continues to burden the VA system with repeated utilization of resources in terms of substance abuse detoxification, psychiatric stabilization costs, and medical care for chronic and progressive disease entities (e.g. HIV/AIDS, hepatitis and cirrhosis, cancer) which are related to substance abuse/dependence.

PUBLICATIONS:

Journal Articles

  1. Chychula NM, Sciamanna C. Help substance abusers attain and sustain abstinence. The Nurse Practitioner. 2002 Nov 1; 27(11):30-47; quiz, 48.
  2. Gariti P, Alterman A, Mulvaney F, Mechanic K, Dhopesh V, Yu E, Chychula N, Sacks D. Nicotine intervention during detoxification and treatment for other substance use. The American journal of drug and alcohol abuse. 2002 Nov 1; 28(4):671-9.


DRA: Substance Abuse and Addiction, Health Systems
DRE: Treatment - Observational
Keywords: Drug abuse, Nursing, Primary care
MeSH Terms: none

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