title: A pilot study to assess the feasibility and impact of a brief motivational intervention on problem drug and alcohol use in adult mental health inpatient units: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Substance misuse in those with severe mental health problems is common and associated with poor engagement in treatment and treatment outcomes. Up to 44% of those admitted into psychiatric inpatient facilities have coexisting substance-misuse problems. However, this is not routinely addressed as part of their treatment plan. A mental health admission may present a window of opportunity for inpatients to reevaluate the impact of their substance use. This study will aim to evaluate the effectiveness of a targeted brief motivational intervention in improving engagement in treatment and to assess how feasible and acceptable this intervention is to inpatients and staff as a routine intervention.
  
  
  METHODS
  This randomized controlled trial will use concealed randomization; blind, independent assessment of outcome at 3 months; characterization of refusers and dropouts; and be analyzed according to the intention-to-treat principle. After baseline assessments, eligible participants will be randomized either to the Brief Integrated Motivational Intervention plus Treatment As Usual, or Treatment as Usual alone. Eligible participants will be those who are new admissions; >18 years; ICD-10 diagnosis of -schizophrenia or related disorder, bipolar affective disorder, recurrent depressive disorder, and DSM-IV diagnosis of substance abuse or dependence over the last 3 months. The primary outcome is engagement in treatment for substance misuse, and secondary outcomes include readiness to change substance misuse together with a cost-effectiveness analysis. Qualitative interviews with staff and participants will assess the acceptability of the intervention.
  
  
  CONCLUSIONS
  This pilot randomized trial will provide the first robust evidence base for inpatient care of people with severe mental health problems and co-morbid substance misuse and provide the groundwork for confirmatory trials to evaluate a potentially feasible, cost-effective, and easy-to-implement treatment option that may be readily integrated into standard inpatient and community-based care.
  
  
  BACKGROUND
  ISRCTN43548483 Date of ISRCTN assignation: 4/17/2014.
authors.affiliation: University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. H.L.GRAHAM@bham.ac.uk.
authors.forename: Hermine L
authors.initials: HL
authors.lastname: Graham
authors.forename: Max
authors.initials: M
authors.lastname: Birchwood
authors.forename: Emma
authors.initials: E
authors.lastname: Griffith
authors.forename: Nick
authors.initials: N
authors.lastname: Freemantle
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.forename: Chrysi A
authors.initials: CA
authors.lastname: Stefanidou
authors.forename: Kathryn
authors.initials: K
authors.lastname: Walsh
authors.forename: Latoya
authors.initials: L
authors.lastname: Clarke
authors.forename: Arsal
authors.initials: A
authors.lastname: Rana
authors.forename: Alex
authors.initials: A
authors.lastname: Copello
mesh_terms: D000437:Alcoholism / Q000523:psychology / Q000628:therapy*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008603:Mental Health; D009042:Motivation; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*
references.citation: Addiction. 1993 Jun;88(6):791-804
references.pmid: 8329970
references.citation: Community Ment Health J. 1996 Jun;32(3):291-306; discussion 307-10
references.pmid: 8790970
references.citation: J Nerv Ment Dis. 1995 Dec;183(12):762-7
references.pmid: 8522938
references.citation: Br J Psychiatry. 2001 Dec;179:540-4
references.pmid: 11731359
references.citation: Psychiatr Serv. 2001 Apr;52(4):469-76
references.pmid: 11274491
references.citation: Psychiatr Serv. 2002 May;53(5):602-8
references.pmid: 11986511
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2001 Sep;36(9):448-55
references.pmid: 11766977
references.citation: J Nerv Ment Dis. 1999 Oct;187(10):630-5
references.pmid: 10535657
references.citation: Drug Alcohol Rev. 2004 Jun;23(2):151-5
references.pmid: 15370020
references.citation: J Consult Clin Psychol. 2000 Oct;68(5):898-908
references.pmid: 11068976
references.citation: Addiction. 1995 May;90(5):607-14
references.pmid: 7795497
references.citation: J Consult Clin Psychol. 1992 Dec;60(6):845-56
references.pmid: 1460148
references.citation: JAMA. 1990 Nov 21;264(19):2511-8
references.pmid: 2232018
references.citation: Cochrane Database Syst Rev. 2008 Jan 23;(1):CD001088
references.pmid: 18253984
references.citation: Drug Alcohol Rev. 2000 Dec;19(4):451-455
references.pmid: 28474444
references.citation: Drug Alcohol Rev. 2010 Mar;29(2):169-76
references.pmid: 20447225
references.citation: Acta Psychiatr Scand. 1983 Jun;67(6):361-70
references.pmid: 6880820
references.citation: Br J Clin Psychol. 1998 Sep;37(3):269-84
references.pmid: 9784883
references.citation: Acta Psychiatr Scand. 1994 Jan;89(1):62-7
references.pmid: 7908156
references.citation: Br J Psychiatry. 2003 Feb;182:123-8
references.pmid: 12562739
references.citation: Addiction. 2002 Mar;97(3):265-77
references.pmid: 11964100
references.citation: Addiction. 2010 Mar;105(3):452-65
references.pmid: 20402989
references.citation: Addiction. 1997 Mar;92(3):353
references.pmid: 9219397
references.citation: Patient Educ Couns. 1997 Jul;31(3):191-203
references.pmid: 9277242
references.citation: J Nerv Ment Dis. 2006 Mar;194(3):164-72
references.pmid: 16534433
references.citation: Alcohol Clin Exp Res. 2003 Sep;27(9):1428-35
references.pmid: 14506403
references.citation: Am J Orthopsychiatry. 1998 Apr;68(2):201-15
references.pmid: 9589759
references.citation: Health Policy. 1990 Dec;16(3):199-208
references.pmid: 10109801
references.citation: Schizophr Bull. 2000;26(1):179-92
references.pmid: 10755680
references.citation: Addiction. 1998 Dec;93(12):1857-67
references.pmid: 9926574
references.citation: Community Ment Health J. 2003 Jun;39(3):189-202
references.pmid: 12836801
references.citation: J Stud Alcohol Drugs. 2010 Sep;71(5):713-9
references.pmid: 20731976