This study will examine the effectiveness of a brief intervention in a primary care setting to reduce drug use or abuse compared to enhanced care as usual.
A substantial body of research has established the efficacy and effectiveness of brief interventions (BI) for excessive or "hazardous" alcohol use in patients seen in medical settings. Dissemination projects of brief interventions for alcohol and drugs have recently been implemented on a widespread scale. This rapid progression of brief intervention for drugs other than alcohol has outstripped its evidence base. The aims of the study as outlined in the grant are: 1. To examine whether BI is effective at improving outcomes (self-reported drug use and attendance in drug abuse treatment) in individuals with a wide range of problem drug use over and above enhanced care as usual. The enhanced control condition will consist of routine screening, patient notification, and referral for treatment. 2. To test whether fidelity to the BI model or lower severity of drug use is associated with better outcomes. 3. To estimate the impact of BI on several public health outcomes that are directly related to the hazardous effects of illicit drug use, including the use of acute health care services, involvement in the criminal justice system, employment, HIV risk behavior, and mortality. 4. To estimate the costs of the intervention, potential cost offsets, and its incremental cost-effectiveness versus enhanced usual care from the payer perspective based on health care service use and drug use frequency.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
868
One brief, in-person motivational interviewing session (30-45 minutes) in conjunction with the medical appointment. Plus one brief follow-up phone call one week later.
Harborview Medical Center
Seattle, Washington, United States
Use of illicit drugs in the past 30 days
Use of illicit drugs in the past 30 days will be measured by self-reported days of use in the past 30 days and validated by urine toxicological screen.
Time frame: baseline, 3, 6, 9, and 12 months
Enrollment in formal substance abuse treatment
Enrollment in formal substance abuse treatment will be measured as an admission to chemical dependency treatment as recorded in the Washington State TARGET database.
Time frame: baseline up to 2 years post-intervention
Medical, legal, employment, social, and psychiatric outcomes
Medical, legal, employment, social, and psychiatric outcomes will be measured by composite scores on the Addiction Severity Index (ASI) Lite.
Time frame: baseline, 3, 6, 9, and 12 months
Public health outcomes
Public health outcomes will be measured by administrative data sources (emergency room visits, hospitalizations, hospital days, HIV risk behavior, arrests, and death).
Time frame: baseline up to 2 years post-intervention
Cost of the intervention
Cost of the intervention will be measured using methods previously employed in the COMBINE study.
Time frame: baseline up to 2 years post-intervention
Incremental cost-effectiveness
Incremental cost-effectiveness will be measured from the payer perspective based on health care service use and drug use frequency.
Time frame: baseline up to 2 years post-intervention
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