Effects of brief substance use interventions delivered in general medical settings: a systematic review and meta‐analysis

Abstract

Aims To estimate effects of brief substance use interventions delivered in general medical settings. Methods A systematic review and meta‐analysis of randomized trials conducted since 1990 of brief substance use interventions in patients of any age or severity level recruited in general medical settings. Primary outcomes were any measure of substance use or substance‐related consequences (indexed with Hedges’ g and risk ratios). Mixed‐effects meta‐regressions were used to estimate overall effects and predictors of effect variability. Analyses were conducted separately by brief intervention (BI) target substance: alcohol only or drugs. Findings A total of 116 trials (64 439 participants) were identified; 111 (62 263 participants) provided effect size data and were included in the meta‐analysis. Drug‐targeted BIs yielded significant small improvements in multiple drug/mixed substance use (Hedges' g true(trueg¯) = 0.08; 95% CI = 0.002, 0.15), but after adjusting for multiple comparisons, they did not produce significant effects on cannabis use ( trueg¯ = 0.06; 95% CI = 0.001, 0.12), alcohol use ( trueg¯ = 0.08; 95% CI = −0.0003, 0.17), or consequences ( trueg¯ = 0.05; 95% CI = 0.01, 0.10). Drug‐targeted BIs yielded larger improvements in multiple drug/mixed substance use when delivered by a general practitioner ( trueg¯ = 0.19; 95% CI = 0.187, 0.193). Alcohol‐targeted BIs yielded small beneficial effects on alcohol use ( trueg¯ = 0.12; 95% CI 0.08, 0.16), but no evidence of an effect on consequences ( trueg¯ = 0.05; 95% CI = −0.04, 0.13). However, alcohol‐targeted BIs only had beneficial effects on alcohol use when delivered in general medical settings true(trueg¯ = 0.17; 95% CI = 0.10, 0.24); the findings were inconclusive for those delivered in emergency department/trauma centers ( trueg¯ = 0.05; 95% CI = 0.00, 0.10). Conclusions When delivered in general medical settings, alcohol‐targeted brief interventions may produce small beneficial reductions in drinking (equivalent to a reduction in 1 drinking day per month). There is limited evidence regarding the effects of drug‐targeted brief interventions on drug use.

Effect of a Peer-Led Behavioral Intervention for Emergency Department Patients at High Risk of Fatal Opioid Overdose

“…In addition, previous studies of ED-based behavioral interventions for SUD have had mixed results, calling into question this approach. 32 It is also unknown whether the overdose visit itself is the most appropriate opportunity for many patients; the psychosocial and physiologic circumstances of the overdose event may actually make it a difficult time to successfully engage patients. Indeed, patients with OUD may not perceive the ED as a suitable location for OUD treatment, in part because of prior experiences of stigmatization and discrimination by ED staff, minimization of their medical needs, and inadequate resources for EDs to provide treatment for OUD.…”

Prevalence and characteristics of hazardous and harmful drinkers receiving general practitioners’ brief advice on and support with alcohol consumption in Germany: results of a population survey

“…The implementation of brief interventions in primary healthcare settings is both an effective [9][10][11][12][13] and costeffective 4 approach to reducing hazardous and harmful drinking. Brief interventions usually include feedback on consumption, brief advice to reduce or quit drinking, motivational enhancement and goal setting and further support such as referral to specialised treatment or the development of a personal reduction plan.…”

Prevalence and characteristics of hazardous and harmful drinkers receiving general practitioners’ brief advice on and support with alcohol consumption in Germany: results of a population survey

“…The implementation of brief interventions in primary healthcare settings is both an effective [9][10][11][12][13] and cost-effective [4] approach to reducing hazardous and harmful drinking. Brief interventions usually include feedback on consumption, brief advice to reduce or quit drinking, motivational enhancement and goal setting, and further support such as referral to specialised treatment or the development of a personal reduction plan.…”