A substantial body of research has established the effectiveness of brief interventions (BI) for hazardous alcohol use in patients seen in medical settings, prompting the implementation of dissemination projects of screening and brief intervention for "substance abuse" on a widespread scale. However, there are few studies examining the efficacy of BI for problem drug use and abuse in medical settings, and there is considerable variability in what actually constitutes a BI (i.e., what are the important or active therapeutic ingredients). The potential costs related to untreated drug abuse in medical settings are substantial. Although there is great human suffering and morbidity for the abuser, it is likely that potential healthcare cost savings and decreased adverse healthcare outcomes related to BI will be the major drivers of policy change to improve provision of BI treatment. Accordingly, this application proposes to conduct a policy-relevant clinical trial with broad external validity (a hybrid "efficacy-effectiveness" study) informed by the literature on BI and alcohol use, to evaluate the efficacy of BI and referral to treatment when indicated, in patients with problem drug use and abuse seen in the primary care medical setting at a large safety-net hospital. The study has four aims: (1) to determine if BI is effective in reducing drug use and increasing completed referral to treatment (i.e., treatment initiation);(2) to test whether higher fidelity to a BI model that emphasizes motivational interviewing is more effective than lower fidelity;(3) to estimate the impact of BI on several public health outcomes;(4) to estimate the costs of the intervention, potential cost offsets, and incremental cost-effectiveness from the payer perspective based on health care service use and drug use frequency.

Public Health Relevance

This project is evaluating the effectiveness of an intervention that has recently been approved as a billable service in the medical care setting, despite the absence of data supporting its use in drug abuse and dependence. The results of the study will have implications for whether it is advisable to expand its application beyond hazardous alcohol abuse to include abuse of drugs.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA026014-05
Application #
8291373
Study Section
Special Emphasis Panel (ZDA1-JXR-D (12))
Program Officer
Denisco, Richard A
Project Start
2008-09-01
Project End
2014-06-30
Budget Start
2012-07-01
Budget End
2014-06-30
Support Year
5
Fiscal Year
2012
Total Cost
$477,505
Indirect Cost
$171,412
Name
University of Washington
Department
Psychiatry
Type
Schools of Medicine
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
Lord, Sarah Peregrine; Can, Do?an; Yi, Michael et al. (2015) Advancing methods for reliably assessing motivational interviewing fidelity using the motivational interviewing skills code. J Subst Abuse Treat 49:50-7
Roy-Byrne, Peter; Bumgardner, Kristin; Krupski, Antoinette et al. (2014) Brief intervention for problem drug use in safety-net primary care settings: a randomized clinical trial. JAMA 312:492-501
Atkins, David C; Steyvers, Mark; Imel, Zac E et al. (2014) Scaling up the evaluation of psychotherapy: evaluating motivational interviewing fidelity via statistical text classification. Implement Sci 9:49