Screening to Augment Referral to Treatment- Project START
Condition: Alcohol Abuse; Tobacco Use Disorder; Marijuana Abuse; Substance-Related Disorders
MeSH terms: Marijuana Abuse; Alcoholism; Substance-Related Disorders; Tobacco Use Disorder
Study type: Interventional

Summary: 
      The investigators propose to use obstetric-gynecological clinics to conduct a randomized
      clinical trial that would compare two SBIRTS (Screening, Brief Intervention, Referral and
      Treatment), delivered either by a trained nurse or by computer, to usual care (a control
      condition). As part of this trial, the investigators will include outcomes that allow us to
      assess the cost effectiveness of these three conditions.
    

Detailed description: 
      Aim 1: To assess whether SBIRT, based upon motivational interviewing and delivered either by
      computer or a trained nurse, leads to decreased use of a subject's primary drug of abuse.

      Hypothesis #1a: Referrals based upon motivational principles and delivered by computer, as
      compared to usual care (health brochure with treatment resources), will lead to greater
      reductions in a woman's primary substance of abuse.

      Hypothesis #1b: Referrals based upon motivational principles and delivered by nurse, as
      compared to usual care (health brochure with treatment resources), will lead to greater
      reductions in a woman's primary substance of abuse.

      Aim 2: To determine whether SBIRT based upon motivational interviewing and delivered either
      by computer or by a nurse will promote substance abuse treatment utilization for the primary
      drug of abuse.

      Hypothesis #2a: Treatment utilization (eg. treatment initiation, attendance, use of quit-line
      or medication) will be higher if a woman receives the computer delivered brief intervention
      than if she receives usual care only.

      Hypothesis #2b: Treatment utilization (eg. treatment initiation, attendance, use of quit-line
      or medication) will be higher if a woman receives the nurse delivered brief intervention than
      if she receives usual care only.

      Secondary Aim 3: To evaluate whether SBI leads to a decrease in HIV/AIDS risk

      Hypothesis #3: Rates of sexually transmitted diseases, injection drug use and risky sexual
      behavior will be lower at follow up for subjects who receive either computer or a nurse
      delivered brief intervention than usual care subjects.

      Secondary Aim 4: To compare the relative cost-effectiveness of the three interventions.

      Hypothesis #4a: Screening and usual care will be the most cost-effective intervention method
      when the value of an additional unit of effect for the given individual's outcome is
      relatively low.

      Hypotheses #4b: Screening, and a brief intervention delivered by computer, will be the most
      cost-effective treatment method when the value of an additional unit of effect is relatively
      high.

      Hypotheses #4c: Screening, and a brief intervention delivered by a nurse, will be less
      cost-effective than a brief intervention delivered by computer.
    

Intervention name(s): Motivational Interview; Treatment as Usual
Intervention type(s): Behavioral; Other
Intervention description(s): Motivational Interview provided by either a Nurse or Computer; Subjects given a brochure listing relevant recovery resources in the local area.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment