SBIRT Does Not Reduce Alcohol And Drug Use Among Jail Inmates

Around one half of incarcerated individuals meet criteria for substance use disorder or alcohol use disorder. Many others have used substances in amounts or ways that increase risk for health consequences. This study randomized 732 jail inmates within 4 weeks of release to screening, brief intervention, and referral to treatment (SBIRT), or screening and information on how to reduce their risk only (controls). All participants received a baseline interview and were assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). In the SBIRT group those with low or medium risk received a brief intervention in jail; participants at high risk were referred to community treatment following release and received the opportunity to participate in brief treatment (8 sessions).

• 57% of participants did not have unhealthy alcohol use; 29% reported occasional or no drug use; and 40% reported high-risk amphetamine use.
• At 12 months, 28% (104 participants in the intervention arm and 100 participants in the control arm) were lost to follow-up.
• Although there were some differences in baseline characteristics with regard to severity of alcohol and drug use, there were no differences in primary or secondary outcomes between the 2 groups after controlling for these differences.
• Over the 12-month follow-up, few SBIRT and control participants reported attending inpatient treatment (15%) or outpatient treatment (9% versus 11%). In that time, 62% of SBIRT and 54% of control participants were rearrested. All comparisons were non-significant.

Comments: The results of this study are difficult to interpret since unhealthy substance use was not an entry criterion and the authors did not report the overall levels of substance use risk for participants.  However, this randomized trial adds to the literature that SBIRT is not effective for reducing illicit drug use particularly when it is more severe, or unhealthy alcohol use in patients with more significant medical and psychosocial needs outside of general medical settings.

Jeanette M. Tetrault, MD

Reference: Prendergast ML, McCollister K, Warda U. A randomized study of the use of screening, brief intervention, and referral to treatment (SBIRT) for drug and alcohol use with jail inmates. J Subst Abuse Treat. 2017;74:54–64.