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Open Access Study protocol

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

Hermine L Graham1*, Max Birchwood2, Emma Griffith3, Nick Freemantle4, Paul McCrone5, Chrysi A Stefanidou1, Kathryn Walsh1, Latoya Clarke6, Arsal Rana1 and Alex Copello1

Author Affiliations

1 University of Birmingham, Edgbaston, Birmingham B15 2TT, UK

2 Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK

3 University of Bath, Claverton Down Bath BA2 7AY, UK

4 Department of Primary Care and Population Health, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London NW3 2PF, UK

5 Health Service and Population Research Department, Institute of Psychiatry, Kings College London, London, UK

6 University of Birmingham, Edgbaston B15 2TT, Birmingham, UK

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Trials 2014, 15:308  doi:10.1186/1745-6215-15-308

Published: 1 August 2014

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/Design

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.

Discussion

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.

Trial registration

ISRCTN43548483 Date of ISRCTN assignation: 4/17/2014.

Keywords:
Inpatient; Comorbid; intervention; Brief motivational intervention; Treatment; Randomized controlled trial; Dual diagnosis; Substance misuse; Severe mental health condition; Schizophrenia; Psychiatric hospital admission