Impact of Group Motivational Interviewing and In-Home-Messaging-Devices for Dually Diagnosed Veterans
Condition: Alcohol Dependence; Dual Diagnosis; Drug Dependence
MeSH terms: Alcoholism; Substance-Related Disorders
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Arm 1 GMI; Arm 2 IHMD; Arm 3 TCC
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Participants randomized to GMI received four structured, back-to-back, 75-minute sessions in one week consistent with the central principles and spirit of MI (Miller & Rollnick 2013) and based on a manualized protocol (Martino & Santa Ana 2013; Santa Ana & Martino, 2009). Designed for dually diagnosed patients, a focus of the intervention is to examine the relationship between the substance use and the co-existing psychiatric disorder(s) and the importance of proactively treating both conditions.; Participants randomized to IHMD received a 27 day VA Care Coordination Home Telehealth (CCHT) program targeting acute recovery from alcohol and other drug disorders. IHMD consisted of daily assessment combined with dialogues consisting of motivational interviewing, cognitive behavioral therapy, and 12-step (mutual self-help) facilitation.; TCC consisted of a 4-session psychoeducational group (75 minutes per session). Material was delivered using a power point presentation on topics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: MI; IHMD