Brief Interventions May Increase Entry into Specialty Addiction Treatment

One assumption underlying large-scale efforts to implement screening and brief intervention (BI) is that people with dependence will improve. To inform the question, investigators in Washington state selected 2 samples (n=2493 each) from over 70,000 adults who either screened positive for unhealthy alcohol or other drug use in the emergency department (ED) or who were not screened (and, therefore, did not receive BI) but who had medical, behavioral-health, or arrest records indicating a substance use disorder. Propensity-score matching was used to ensure similarity between groups. Patients who received BI were divided into 2 additional subgroups: those referred to brief treatment (4–12 sessions of motivational interviewing) who either did (n=265) or did not (n=1100) participate in it. Treatment entry was determined using administrative records of publicly funded treatment.

• Patients who received BI in the ED were more likely to enter specialty addiction treatment in the next 12 months than those who did not (34% versus 23%, respectively).

• Patients who participated in brief treatment were more likely to enter specialty addiction treatment in the next 12 months than those who did not (52% versus 34%, respectively).

Comments:

These data may be the best available so far to show that brief counseling in a screening and BI program increases entry into specialty care. However, despite the sophisticated methods used in this study, only a randomized trial can answer the question definitively. Results of such trials to date have not shown that screening and BI improves linkage to treatment. The question remains important, since universal screening identifies many people for whom BI alone is insufficient.

Richard Saitz MD, MPH

Reference:

Krupski A, Sears JM, Joesch JM, et al. Impact of brief interventions and brief treatment on admissions to chemical dependency treatment. Drug Alcohol Depend. 2010;110(1–2):126–136.