Examining multi-session brief intervention for substance use in primary care: research methods of a randomized controlled trial

Abstract

BackgroundBrief interventions such as Screening, a single session of Brief Intervention, and Referral to Treatment (SBIRT) have shown mixed effectiveness in primary care. However, there are indications that multi-session brief interventions may demonstrate more consistently positive outcomes, and perhaps a more intensive approach would be of benefit in addressing substance use in primary care. This study compared the effectiveness of SBIRT with a single BI session (BI/RT) to a multi-session brief-treatment intervention (BI/RT+) in primary care. We also developed easy-to-use, evidence-based materials to assist clinicians in delivering these interventions.Methods/designThis study was conducted in three Federally Qualified Healthcare Centers (FQHCs). A total of 10,935 patients were screened, and 600 individuals were recruited. The sample was primarily Black/African American (82 %) with a mean age of 40. Patients who attended a healthcare appointment were screened for substance use via the AUDIT and DAST. Patients were eligible for the study if they scored 8 or higher on the AUDIT, were using only marijuana and scored 2 or higher on the DAST, or were using other illicit drugs and scored 1 or higher on the DAST. Participants were randomly assigned to receive one-session BI/RT, or two to six sessions of brief intervention that incorporated elements of motivational enhancement therapy and cognitive-behavioral therapy (BI/RT+). Both interventions were delivered by behavioral health consultants at the FQHCs. Participants completed follow-up assessments every 3 months for 1 year. Primary outcome variables included substance use treatment sessions attended and days of substance use. Secondary outcomes included measures of health, employment, legal, and psychiatric functioning and HIV risk behaviors. Additionally, we will conduct an economic evaluation examining cost-effectiveness and will analyze outcomes from a process evaluation examining patient and provider experiences.DiscussionThe ability of brief interventions to impact substance use has great potential, but research findings have been mixed. By conducting a large-scale randomized controlled trial in real-world health centers, this study will answer important questions about the effectiveness of expanded BIs for patients who screen positive for risky substance use in primary care.Trial registration NCT01751672

Contexts of Marijuana Use and Cessation among Frequently-Using Youth in Primary Care

“…Individual interventions designed to be used in a primary care setting such as Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs are relatively straightforward to implement (Pfarrwaller et al, 2019). Evidence of the efficaciousness of SBIRT for substance use reduction, however, is mixed (Chambers et al, 2016), with some studies finding them effective (Aldridge et al, 2017; Bernstein, 2009) and others finding them ineffective (Haller et al, 2014; Kim et al, 2017). Motivational Interviewing (MI) and Motivational Enhancement Therapy are well suited to the primary care setting and have shown promise in helping youth reduce or abstain from marijuana use (Aldridge et al, 2017; D’Amico et al, 2018; Kells et al, 2019; Walker et al, 2011).…”

Integration of Hepatitis C Treatment in a Primary care Federally Qualified Health Center; Philadelphia, Pennsylvania, 2015-2017

“…A brief motivational interviewing intervention was enacted by the BHCs to explore patient readiness to consider sobriety and explore what supports might be needed to make HCV treatment an attainable goal. 14 In other cases, a brief problem solving intervention may be needed to address obstacles to medication adherence and modifications of their daily routine, such as matching up medication times with a meal time or using an automated cell phone reminder. Further assistance was provided throughout the patient’s course of treatment to promote adherence and engagement, as requested by the primary care providers.…”

Efficacy of brief intervention for harmful and hazardous alcohol use: a systematic review and meta‐analysis of studies from low middle‐income countries

“…Previous reviews suggested that, whereas content and settings of brief intervention did not influence the outcome, the practitioner group and age group of the population moderated the effect [15,30]. There is contradictory evidence of efficacy of BI being moderated by the number of sessions [4,15]. None of these reviews focussed mainly on the LMIC countries.…”