A significant gap exists in the United States between people who need treatment for illicit drug abuse/dependence and those who actually receive treatment for these serious problems. Many of those in the treatment gap have no understanding about how to effect the connection to needed assessment, referral, and treatment services. Outside of the criminal justice system, there are only a few venues in which out-of-treatment substance abusers can be identified and referred for treatment. There is a pressing need to test methods that will optimally link and engage out-of- treatment substance abusers with services. The Emergency Department (ED) is an ideal location in which to target screening and linkage to assessment and treatment services because of the large heterogeneous proportion of people seen in this setting who have drug-related problems. There is good evidence from the literature that patients who abuse substances and present with injuries in the ED do not receive needed services to access the initial steps in the treatment continuum: assessment, and treatment entry. Given the potential of the ED as a """"""""window of opportunity"""""""" for identification and early intervention for injured individuals who abuse substances, it is important to determine which intervention, of varying intensities and types, is most effective in linking these out-of-treatment substance abusers to assessment and facilitating treatment entry and follow-through. The proposed study will compare three alternative interventions in the ED to promote linkage to substance abuse assessment, referral, and treatment entry for those who meet abuse/dependence criteria for stimulants, cannabis, and/or non-injected opioids: 1) a 5-session Strengths-Based Case Management (SBCM) model; 2) a 2-session Brief Motivational Enhancement (BME); or 3) a one-time Brief Informational Feedback (BIF) session. Patients who present to a large inner-city ED with injuries will be screened (N=7,120) using a structured survey about substance use and consequences. Eligible subjects will receive a baseline assessment and, using stratified randomization by gender, will have a voluntary urine drug screen, and will be assigned to one of the three study conditions (n=300/condition). Three- and 6-month outcomes will be assessed. The primary outcome variables for this trial include receiving an assessment and referral, treatment entry, degree of treatment completion, substance-related measures, health services utilization, health status changes, and psychosocial factors. The secondary aims of the study are to determine which baseline predisposing, enabling, and need factors predict follow through with assessment and treatment entry. Brief pre-treatment interventions have received little study as a part of the linkage process that helps patients, at a teachable moment, access assessment and treatment services, address barriers to receiving these services, and promote positive life outcomes. This study will provide critically important information on how to best facilitate linkage to the essential first steps in the treatment process for out-of-treatment substance abusers, and will inform public health measures to facilitate treatment seeking for the nation's substance abusing population.
