Brief Intervention in Primary Care for Problem Drug Use and Abuse

Study Overview
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Brief Summary
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This study will examine the effectiveness of a brief intervention in a primary care setting to reduce drug use or abuse compared to enhanced care as usual.

Detailed Description
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A substantial body of research has established the efficacy and effectiveness of brief interventions (BI) for excessive or hazardous alcohol use in patients seen in medical settings. Dissemination projects of brief interventions for alcohol and drugs have recently been implemented on a widespread scale. This rapid progression of brief intervention for drugs other than alcohol has outstripped its evidence base. The aims of the study as outlined in the grant are: To examine whether BI is effective at improving outcomes (self-reported drug use and attendance in drug abuse treatment) in individuals with a wide range of problem drug use over and above enhanced care as usual. The enhanced control condition will consist of routine screening, patient notification, and referral for treatment. To test whether fidelity to the BI model or lower severity of drug use is associated with better outcomes. To estimate the impact of BI on several public health outcomes that are directly related to the hazardous effects of illicit drug use, including the use of acute health care services, involvement in the criminal justice system, employment, HIV risk behavior, and mortality. To estimate the costs of the intervention, potential cost offsets, and its incremental cost-effectiveness versus enhanced usual care from the payer perspective based on health care service use and drug use frequency.

Official Title
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Brief Intervention in Primary Care for Problem Drug Use and Abuse

Conditions
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Substance-Related Disorders

Intervention / Treatment
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* Behavioral: Brief intervention using motivational interviewing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: at least 18 years old receive medical care at one of the participating primary care clinics at Harborview Medical Center/University of Washington Medical Center will maintain care at the clinic for one year have a phone or easy access to phone, voicemail, or email used recreational drugs in the last 3 months used prescription medications not as prescribed in the last 3 months Exclusion Criteria: participation in any formal substance abuse treatment programs in the last 30 days (excluding 12-step or self-help groups) terminal illness

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Brief intervention using motivational interviewing. One in-person session (30-45 minutes) with a brief phone follow-up one week later. | Behavioral: Brief intervention using motivational interviewing<br>* One brief, in-person motivational interviewing session (30-45 minutes) in conjunction with the medical appointment. Plus one brief follow-up phone call one week later.<br>|
| No Intervention: 2<br>Enhanced care as usual. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Use of illicit drugs in the past 30 days | Use of illicit drugs in the past 30 days will be measured by self-reported days of use in the past 30 days and validated by urine toxicological screen. | baseline, 3, 6, 9, and 12 months | 
| Enrollment in formal substance abuse treatment | Enrollment in formal substance abuse treatment will be measured as an admission to chemical dependency treatment as recorded in the Washington State TARGET database. | baseline up to 2 years post-intervention | 
| Medical, legal, employment, social, and psychiatric outcomes | Medical, legal, employment, social, and psychiatric outcomes will be measured by composite scores on the Addiction Severity Index (ASI) Lite. | baseline, 3, 6, 9, and 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Public health outcomes | Public health outcomes will be measured by administrative data sources (emergency room visits, hospitalizations, hospital days, HIV risk behavior, arrests, and death). | baseline up to 2 years post-intervention | 
| Cost of the intervention | Cost of the intervention will be measured using methods previously employed in the COMBINE study. | baseline up to 2 years post-intervention | 
| Incremental cost-effectiveness | Incremental cost-effectiveness will be measured from the payer perspective based on health care service use and drug use frequency. | baseline up to 2 years post-intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Drug Abuse, Drug Addiction, Drug Dependence, Drug Usage, Drug Use Disorders, Substance Abuse, Substance Addiction, Substance Dependence, Substance Use Disorders