The efficacy of brief intervention for drug use among primary care patients is not known. As a result, national professional organizations do not recommend universal screening. Yet a strong theoretical case can be made for such screening: drug use is common and associated with numerous health consequences, patients usually do not seek help, and screening and brief intervention has proven efficacy for other substance use (e.g., alcohol). Policy has advanced based on this case: large federal efforts to disseminate screening and brief intervention are underway, and reimbursement codes for insurers to compensate clinicians for these activities have been developed. The discrepancy between the science and these policy developments underscore the need to test brief intervention's efficacy among patients identified by screening. The objective of this study, the Assessing Screening Plus brief Intervention's Resulting Efficacy to stop drug use (the ASPIRE) Study, is to determine the efficacy of two models of brief intervention for decreasing drug use and consequences in primary care patients. In collaboration with a state project implementing screening and brief intervention as part of a federal program, we will screen patients in a large hospital-based primary care practice for drug use. We will then enroll 1,800 screen-positive subjects, randomly assign them to 1 of 3 groups, and follow them for 6 months. Subjects in one intervention group will be assigned to a standard brief intervention model, conducted by trained health promotion advocates as part of local implementation of a widely disseminated federal program. In another group, subjects will be assigned to an enhanced, more-intensive brief intervention model that includes a booster contact and is conducted by master's-level counselors trained and monitored intensively to perform motivational interviewing. The control group will receive information (i.e., a written list of local resources to help people using drugs) and, at the end of six months, standard brief intervention if they are still using drugs. Primary outcomes are abstinence from drug use and drug use consequences including HIV- risk behaviors at 6 months, and receipt of substance dependence treatment (among those with dependence). We will also compare costs and outcomes associated with each group. The main hypotheses are that 1) an enhanced brief intervention model will have greater efficacy than screening and resource information alone (control) for increasing drug abstinence, decreasing drug use consequences (including HIV-risk behaviors), and increasing receipt of treatment, 2) a standard brief intervention model will have greater efficacy than control for the same outcomes, and 3) an enhanced brief intervention will have greater efficacy than a standard brief intervention. We also hypothesize that the enhanced brief intervention will have higher implementation costs but lower net intervention costs (implementation, future healthcare, and crime costs) than the other groups. Results of this study?efficacy and costs of brief intervention for drug use?will be essential for making decisions about disseminating drug use screening and brief intervention in primary care settings. Project Narrative Drug use is very costly, can cause much harm, and often goes untreated. Brief interventions offered in primary care settings could reach many people who use drugs. This proposed clinical trial will assess the effectiveness of these brief interventions and is thus relevant because if these brief interventions are proven effective, their dissemination could significantly decrease the national burden of drug use.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA025068-05
Application #
8261983
Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Denisco, Richard A
Project Start
2008-07-15
Project End
2014-04-30
Budget Start
2012-05-01
Budget End
2014-04-30
Support Year
5
Fiscal Year
2012
Total Cost
$820,952
Indirect Cost
$191,775
Name
Boston Medical Center
Department
Type
DUNS #
005492160
City
Boston
State
MA
Country
United States
Zip Code
02118
Fuster, Daniel; Cheng, Debbie M; Wang, Na et al. (2016) Brief intervention for daily marijuana users identified by screening in primary care: A subgroup analysis of the ASPIRE randomized clinical trial. Subst Abus 37:336-42
Palfai, Tibor P; Cheng, Debbie M; Bernstein, Judith A et al. (2016) Is the quality of brief motivational interventions for drug use in primary care associated with subsequent drug use? Addict Behav 56:8-14
Kim, Theresa W; Bernstein, Judith; Cheng, Debbie M et al. (2016) Receipt of Addiction Treatment as a Consequence of a Brief Intervention for Drug Use in Primary Care: A Randomized Trial. Addiction :
Alford, Daniel P; German, Jacqueline S; Samet, Jeffrey H et al. (2016) Primary Care Patients with Drug Use Report Chronic Pain and Self-Medicate with Alcohol and Other Drugs. J Gen Intern Med 31:486-91
Walter, Angela Wangari; Cheng, Debbie M; Lloyd-Travaglini, Christine A et al. (2016) Are decreases in drug use risk associated with reductions in HIV sex risk behaviors among adults in an urban hospital primary care setting? Prev Med Rep 4:410-6
Harris, Sion Kim; Knight Jr, John Rogers; Van Hook, Shari et al. (2016) Adolescent substance use screening in primary care: Validity of computer self-administered versus clinician-administered screening. Subst Abus 37:197-203
Bernstein, Judith; Cheng, Debbie M; Wang, Na et al. (2015) Recreational drug use among primary care patients: implications of a positive self-report. Ann Fam Med 13:257-60
Kim, Theresa W; Samet, Jeffrey H; Cheng, Debbie M et al. (2015) The spectrum of unhealthy drug use and quality of care for hypertension and diabetes: a longitudinal cohort study. BMJ Open 5:e008508
Park, Tae Woo; Cheng, Debbie M; Lloyd-Travaglini, Christine A et al. (2015) Changes in health outcomes as a function of abstinence and reduction in illicit psychoactive drug use: a prospective study in primary care. Addiction 110:1476-83
Hinde, Jesse M; Bray, Jeremy W; Aldridge, Arnie et al. (2015) The Impact of a Mandated Trauma Center Alcohol Intervention on Readmission and Cost per Readmission in Arizona. Med Care 53:639-45

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