Illicit-Drug Brief Intervention Reduced Risk Score among Some Patients in a Randomized Trial

The efficacy of brief intervention (BI) among patients with drug use identified by screening is largely unknown. Investigators randomized 731 patients from sexually-transmitted disease, dental, primary-care, and other outpatient clinics in 4 countries (India, Brazil, the US, and Australia) who scored positive for illicit drugs on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to a single brief motivational intervention or no intervention.

• Except in the US, where there was no significant effect of BI despite having the largest number of patients, BI was associated with larger reductions than no intervention on

• a substance use risk score (by 7%).
• a cannabis use risk score (by 8%) (not significant in India).
• a stimulant risk score (by 14%) (not studied in India).
• an opioid risk score (by 24%) in India (not studied elsewhere).

Comments:

This study suggests BI for drug use in outpatient settings has some promise. Unfortunately, the results are difficult to interpret due to variable efficacy and the use of a “risk score” that has unclear meaning; nor are the results widely applicable to primary care or to the US. The investigators speculate that lack of BI effects in the US were due to informed consent procedures, but many prior US BI studies using similar consent procedures found efficacy for alcohol BI. Finally, 2 major methodological problems limit the ability to draw conclusions: 1) patients who used too much or too little, or had too many or too few consequences (low or high risk), were excluded; and 2) staff who administered the BI were usually those who assessed the outcomes, making it possible, if not likely, that the benefit attributable to BI is really an artifact of patients in the BI group wanting to please their assessors. I continue to hope BI can work for drugs in primary care settings. Future studies will determine if that hope is supported by scientific evidence.

Richard Saitz MD, MPH

Reference:

Humeniuk R, Ali R, Babor T, et al. A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health-care settings in four countries. Addiction. 2012;107(5):957–966.