Computerized versus in‐person brief intervention for drug misuse: a randomized clinical trial

Abstract

Background and aims Several studies have found that brief interventions (BIs) for drug misuse have superior effectiveness to no-treatment controls. However, many health centers do not provide BIs for drug use consistently due to insufficient behavioral health staff capacity. Computerized BIs for drug use are a promising approach, but their effectiveness compared with in-person BIs has not been established. This study compared the effectiveness of a computerized brief intervention (CBI) to an in-person brief intervention (IBI) delivered by a behavioral health counselor. Methods Two-arm randomized clinical trial, conducted in two health centers in New Mexico, USA. Participants were 360 adult primary care patients with moderate-risk drug scores on the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) who were randomly assigned on a 1:1 basis to a computerized brief intervention (CBI) or to an in-person brief intervention (IBI) delivered by a behavioral health counselor. Assessments were conducted at baseline and 3-month follow-up, and included the ASSIST and drug testing on hair samples. Results The IBI and CBI conditions did not differ at 3 months on global ASSIST drug scores (b=−1.79; 95% CI=−4.37,0.80) or drug-positive hair tests (OR=.97; 95% CI= 0.47,2.02). There was a statistically significant advantage of CBI over IBI in substance-specific ASSIST scores for marijuana (b=−1.73; 95% CI= −2.91,−0.55; Cohen’s d=.26; p=.004) and cocaine (b= −4.48; 95% CI= −8.26,−0.71; Cohen’s d=.50; p=.021) at 3 months. Conclusions Computerized brief intervention can be an effective alternative to in-person brief intervention for addressing moderate drug use in primary care.

A systematic review of smartphone applications for smoking cessation

“…tobacco, the scalability of in-person interventions is limited [8,11,12]. Mobile health interventions delivered via smartphone may help to alleviate this issue.…”

“…However, functionality is limited to simple communication with text-based programs. While few studies have examined mobile app interventions [8,19], smartphone apps offer many additional advantages, including interactive and customizable tools to support smokers throughout the multi-stage process of quitting tobacco, including tools for self-monitoring, progress tracking, and daily reminders, in addition to social support [8].…”

“…The proliferation of the smartphone and the advent of mobile health interventions have made treatment for smoking cessation and other conditions more accessible than ever before [8]. Tobacco users can access apps in their own time, without having to leave the comfort and security of their home.…”

“…However, fewer than 10% are successful [2], likely due to the underutilization of proven treatment strategies [2, 6,7]. Limited data exists regarding the content quality and intervention effectiveness of mobile applications (apps) for smoking cessation [8][9][10]. A recent content analysis of such apps revealed low levels of adherence to evidence-based treatment guidelines [9,10].…”

Brief Interventions for Alcohol Use: Where, When, and How?

“…Perhaps most importantly, computerized BI may be comparable to BI delivered by a therapist. 15 Because many high-risk drinkers present to the ED at night, computerized BI is a desirable option because it delivers evidence-supported care without relying on therapists outside usual work hours. Computerized BI also promises fidelity across different settings and providers, ensuring that 16 The other question worth considering is whether the ED is the best location for SBIRT.…”