No Clear Advantage of In-Person Versus Computer-Based Brief Interventions for Illicit Drug Use

The implementation of screening, brief intervention, and referral to treatment for illicit drug use in primary care has been supported by the US government despite a clear evidence base, and several barriers to delivery exist, notably medical providers’ time constraints or the need to hire behavioral health counselors. These barriers may be overcome with the use of computer-based brief interventions. Researchers compared computer-based with in-person brief interventions in a parallel randomized controlled trial among 360 adult primary care patients with Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores of 4–26, indicating “moderate risk” drug use. At baseline, 88% of patients scored in the moderate risk range for marijuana use, 28% for alcohol, 20% for opioids, 18% for cocaine, 12% for sedatives, and 11% for amphetamines or methamphetamines.

• There was no change in the overall prevalence of drug-positive hair tests from baseline to 3 months (62% positive at both baseline and follow-up, no difference by treatment group).
• At 3 months, there were no differences in global ASSIST drug use scores or hair tests for drug use between participants who received the in-person and those who received the computer-based brief interventions.
• There were significant advantages for the computer-based over the in-person brief intervention for specific ASSIST scores for marijuana use (mean difference = -1.73 [n = 314]) and cocaine use (mean difference = -4.48 [n = 66]). No differences were observed on other specific ASSIST scores (alcohol, amphetamines or methamphetamines, sedatives, or opioids).

Comments:

By comparing two modes of brief intervention delivery, this study did not demonstrate efficacy of screening and brief intervention for drug use or the superiority of an in-person or computer-based intervention. Additional evidence of the efficacy of screening and brief intervention for drug use, independent of its delivery mode, is still needed.

Nicolas Bertholet, MD, MSc

Reference:

Schwartz RP, Gryczynski J, Mitchell SG, et al. Computerized versus in-person brief intervention for drug misuse: a randomized clinical trial. Addiction. 2014;109(7):1091–1098.