Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug Alcohol Depend 77: 49-59

Department of Emergency Medicine, Boston University School of Medicine, 818 Harrison St. (Dowling 1), Boston, MA 02118, USA.
Drug and Alcohol Dependence (Impact Factor: 3.42). 02/2005; 77(1):49-59. DOI: 10.1016/j.drugalcdep.2004.07.006
Source: PubMed


Brief intervention is effective for alcohol misuse, but not adequately tested in the clinical setting with drug using patients. This study tested the impact of a single, structured encounter targeting cessation of drug use, conducted between peer educators and out-of-treatment cocaine and heroin users screened in the context of a routine medical visit.
A randomized, controlled trial was conducted in inner-city teaching hospital outpatient clinics with 3 and 6 months follow-up by blinded observers. Drug abstinence was documented by RIA hair testing. Analysis was limited to enrollees with drug-positive hair at baseline.
Among 23,669 patients screened 5/98-11/00, 1232 (5%) were eligible, and 1175 enrolled. Enrollees (mean age 38 years) were 29% female, 62% non-hispanic black, 23% hispanic, 46% homeless. Among those with positive hair at entry, the follow-up rate was 82%. The intervention group was more likely to be abstinent than the control group for cocaine alone (22.3% versus 16.9%), heroin alone (40.2% versus 30.6%), and both drugs (17.4% versus 12.8%), with adjusted OR of 1.51-1.57. Cocaine levels in hair were reduced by 29% for the intervention group and only 4% for the control group. Reductions in opiate levels were similar (29% versus 25%).
Brief motivational intervention may help patients achieve abstinence from heroin and cocaine.

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Available from: Edward Bernstein, Oct 07, 2015
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    • "With the growing concern regarding the potential impact of maternal mental disorders on pregnancy outcomes , a strong case can be made for integrating screening, brief interventions and referral to treatment (SBIRT) for common mental disorders into these MOUs so that pregnant women with these risks for poor pregnancy outcomes can be detected and immediately assisted at their usual place of care. There is substantial literature showing that SBIRT, particularly for substance-related problems, is both effective and feasible to integrate into primary health care services (Madras et al. 2009; Bing et al. 2001; Bernstein et al. 2005; Estee et al. 2010; Babor et al. 2007). Given the scarcity of mental health professionals working in these settings in LMICs (Lund et al. 2010), task-shifting SBIRT from health professionals to peer counsellors has been proposed as one strategy for overcoming human resource limitations in SA and other similar LMICs (Petersen et al. 2012). "
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    ABSTRACT: There is little evidence of the feasibility and acceptability of integrating screening, brief intervention and referral to treatment services that address depression and alcohol, tobacco and other drug (ATOD) use into antenatal care in South Africa. Data were extracted from program records on the number of eligible women screened and number meeting criteria for depression and self-reported ATOD use. 70 women completed a questionnaire examining their preliminary responses and five MOU personnel were interviewed to identify potential barriers to implementation. Of the 3407 eligible women, 1468 (43 %) women were screened for depression or ATOD use, of whom 302 (21.4 %) screened at risk for depression, 388 (26.4 %) disclosed smoking tobacco, and 29 (2 %) disclosed alcohol or other drugs (AOD). Seventy participants completed the three month follow-up interview. Depression scores decreased significantly following the intervention (t (69) = 8.51, p < 0.001) as did self-reported tobacco use (t (73) = 3.45, p < 0.001), however self-reported AOD use remained unchanged.
    Community Mental Health Journal 03/2015; DOI:10.1007/s10597-015-9853-9 · 1.03 Impact Factor
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    • "feedback letter 8 weeks after first session Bernstein et al. 2005 [17] Cocaine and/or heroin MI session (in-person, average 20 min) and written information Peer, experienced substance use outreach worker also in recovery (authors state training was intensive, systematic, and manual-driven). "
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    ABSTRACT: BackgroundThe purpose of this systematic review is to assess the effectiveness of brief interventions (BIs) as part of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model for reducing the nonmedical use of psychoactive substances.MethodsBibliographic databases (including MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO to April 2012) and gray literature sources were searched. We included randomized controlled trials that opportunistically screened adolescents or adults and then provided a one-to-one, verbal BI to those at risk of substance-use harm. Of interest was the nonmedical use of psychoactive substances (for example, drugs prohibited by international law), excluding alcohol, nicotine, and caffeine. Interventions comprised four or fewer sessions and were compared with no/delayed intervention or provision of information only. Studies were assessed for bias using the Cochrane risk of bias tool. Results were synthesized narratively. Evidence was interpreted according to the GRADE framework.ResultsWe identified 8,836 records. Of these, five studies met our inclusion criteria. Two studies compared BI with no BI, and three studies compared BI with information only. Studies varied in characteristics such as substances targeted, screening procedures, and BI administered. Outcomes were mostly reported by a single study, leading to limited or uncertain confidence in effect estimates.ConclusionsInsufficient evidence exists as to whether BIs, as part of SBIRT, are effective or ineffective for reducing the use of, or harms associated with nonmedical use of, psychoactive substances when these interventions are administered to nontreatment-seeking, screen-detected populations. Updating this review with emerging evidence will be important.Trial registrationCRD42012002414
    Systematic Reviews 05/2014; 3(1):50. DOI:10.1186/2046-4053-3-50
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    • "A randomized study of opioid and cocaine users screened by peer interventionists during an urgent care visit reported a salutary effect of screening and brief intervention on drug use [13]. With the exception of the Bernstein et al. study [13], methodological issues, such as lack of biological confirmation of drug use, short follow-up periods, lack of control groups, and the inability to rule out reactivity to measurement, limit conclusions about intervention effectiveness. "
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    ABSTRACT: BackgroundAlthough screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals.MethodsA total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite.ResultsOf 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12).ConclusionsIn this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome.Trial NCT01683227.
    Addiction science & clinical practice 05/2014; 9(1):8. DOI:10.1186/1940-0640-9-8
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