PTSD and depression occur frequently and are independently associated with enduring impairments after injury hospitalization. Early acute care interventions targeting these disorders have the potential to improve functional recovery after injury.

IMPORTANCE Although brief intervention is effective for reducing problem alcohol use, few data exist on its effectiveness for reducing problem drug use, a common issue in disadvantaged populations seeking care in safety-net medical settings (hospitals and community health clinics serving low-income patients with limited or no insurance). OBJECTIVE To determine whether brief intervention improves drug use outcomes compared with enhanced care as usual. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial with blinded assessments at baseline and at 3, 6, 9, and 12 months conducted in 7 safety-net primary care clinics in Washington State. Of 1621 eligible patients reporting any problem drug use in the past 90 days, 868 consented and were randomized between April 2009 and September 2012. Follow-up participation was more than 87% at all points. INTERVENTIONS Participants received a single brief intervention using motivational interviewing, a handout and list of substance abuse resources, and an attempted 10-minute telephone booster within 2 weeks (n = 435) or enhanced care as usual, which included a handout and list of substance abuse resources (n = 433). MAIN OUTCOMES AND MEASURES The primary outcomes were self-reported days of problem drug use in the past 30 days and Addiction Severity Index–Lite (ASI) Drug Use composite score. Secondary outcomes were admission to substance abuse treatment; ASI composite scores for medical, psychiatric, social, and legal domains; emergency department and inpatient hospital admissions, arrests, mortality, and human immunodeficiency virus risk behavior. RESULTS Mean days used of the most common problem drug at baseline were 14.40 (SD, 11.29) (brief intervention) and 13.25 (SD, 10.69) (enhanced care as usual); at 3 months postintervention, means were 11.87 (SD, 12.13) (brief intervention) and 9.84 (SD, 10.64) (enhanced care as usual) and not significantly different (difference in differences, β = 0.89 [95% CI, –0.49 to 2.26]). Mean ASI Drug Use composite score at baseline was 0.11 (SD, 0.10) (brief intervention) and 0.11 (SD, 0.10) (enhanced care as usual) and at 3 months was 0.10 (SD, 0.09) (brief intervention) and 0.09 (SD, 0.09) (enhanced care as usual) and not significantly different (difference in differences, β = 0.008 [95% CI, –0.006 to 0.021]). During the 12 months following intervention, no significant treatment differences were found for either variable. No significant differences were found for secondary outcomes. CONCLUSIONS AND RELEVANCE A one-time brief intervention with attempted telephone booster had no effect on drug use in patients seen in safety-net primary care settings. This finding suggests a need for caution in promoting widespread adoption of this intervention for drug use in primary care.

This paper describes findings from a 1994 experimental evaluation of alternative work-search requirements in the Unemployment Insurance (UI) program. Requiring additional employer contacts or verification of contacts reduced UI receipt by one week and $115 per claimant. Because these additional requirements did not entail additional re-employment services, the UI spell reduction can be attributed to increased non-monetary costs for remaining on UI. A job-search workshop requirement reduced UI receipt by half a week and $75 per claimant, and additional results indicate that the effects were due to increased costs of continued UI receipt rather than to enhanced job-search productivity. These treatments did not affect employment or earnings, implying that reduced UI duration led to more intensive job search, rather than a reduction in the reservation wage. In contrast, elimination of the employer contact requirement increased UI receipt and post-UI earnings, suggesting that delayed exit from UI improved job matches.he Unemployment Insurance (UI) program is designed to provide temporary income support to involuntarily unemployed individuals while they search for work. Although the UI program provides only temporary income support for the involuntarily unemployed, it can reduce the incentive to seek employment because UI benefits reduce the cost of being unemployed, resulting in an increase in the reservation wage and longer spells of unemployment. To partially offset the negative impact UI benefits have onjob search, state UI programs typically impose work-search requirements for continued benefit receipt.

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Objective-To assess intensive care unit (ICU)/acute care service-delivery characteristics and pre-ICU factors as predictors of posttraumatic stress disorder (PTSD) and return to usual major activity after ICU admission for trauma.Method-Data from the National Study on the Costs and Outcomes of Trauma was used to evaluate a prospective cohort of 1,906 ICU survivors. We assessed PTSD with the PTSD Checklist. Regression analyses ascertained associations between ICU/acute care service-delivery characteristics, pre-ICU factors, early post-ICU distress, and 12-month PTSD and return to usual activity, while controlling for clinical and demographic characteristics.Results-Approximately 25% of ICU survivors had symptoms suggestive of PTSD. Increased early post-ICU distress predicted both PTSD and diminished usual major activity. Pulmonary artery Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptGen Hosp Psychiatry. Author manuscript; available in PMC 2010 September 1.

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Investments in PBHCI can improve access to outpatient medical care for persons with severe mental illness and may also curb hospitalizations and associated costs in more established programs.

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