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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    • "Moreover, preliminary findings have shown that MI-based treatments may be particularly effective with hostile or angry individuals, suggesting they may be indicated for persons in the criminal justice system (Project MATCH Research Group, 1997). Brief motivational interventions (BMIs) are MI-based interventions that combine normative-based feedback on substance use with MI's client-centered principles and more-directive behavioral strategies in order to rapidly activate and enhance intrinsic motivation to change (Bernstein et al., 2005; Miller & Rollnick, 2002). BMIs have garnered significant empirical support as stand-alone treatments for alcohol use and have received some support in the treatment of other harmful substance use (Burke et al., 2003). "
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    ABSTRACT: Objective: In a randomized controlled trial we studied a brief motivational intervention (BMI) for substance use, examining core psychopathic traits as a moderator of treatment efficacy. Method: Participants were 105 males and females who were 18 years of age and older and in a pretrial jail diversion program. The sample was approximately 52% Black and other minorities and 48% White. Outcome variables at a 6-month follow-up were frequency of substance use (assessed with the Timeline Follow-back Interview and objective toxicology screens), substance use consequences (Short Inventory of Problems-Alcohol and Drug version), and self-reported participation in nonstudy mental health and/or substance use treatment. Psychopathy was assessed using the Psychopathy Checklist-Revised (PCL-R). Results: BMI interacted with core psychopathic traits to account for 7% of the variance in substance use at follow-up. Treatment was associated with greater use among individuals with high levels of core psychopathic traits. Toxicology screening results were consistent with self-report data. The treatment and standard care groups did not differ on substance use consequences or nonstudy treatment participation at follow-up, and no moderation was found with these outcomes. An exploratory analysis indicated that low levels of affective traits of psychopathy were associated with benefit from the BMI in terms of decreased substance use. Discussion: Findings suggest that caution is warranted when applying BMIs among offenders; individuals with high levels of core psychopathic traits may not benefit and may be hindered in recovery. Conversely, they indicate that a low-psychopathy subgroup of offenders benefits from these brief and efficient treatments for substance use. (PsycINFO Database Record
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    • "Osoby szkolone otrzymały wydrukowany protokół opisujący interwencję krok po kroku. Pozwalało to w każdej chwili posłużyć się tym przewodnikiem, aby odświeżyć wiedzę o każdym z kroków i nie pominąć żadnego z nich [28]. W razie potrzeby wprowadzano dodatkowe sesje szkoleniowe. "
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    ABSTRACT: Little has been reported on the efficacy of brief intervention (BI) among heavy episodic drinkers, although this drinking style is known to be especially harmful in relation to negative consequences including alcohol-related injuries. The comparative efficacy of BI is analyzed in two similar randomized controlled clinical trials of emergency department (ED) patients in two different cultures, both of which exhibit similar drinking styles of heavy episodic drinking: Poland and Mexican-Americans in the U.S. Improvements in drinking and problem outcomes are analyzed at 3-month and 12-month follow-up, using random effects modeling, among 446 Polish patients and 698 Mexican-American patients, randomized to screened only, assessment, and intervention conditions in each study. In Poland significant improvement was observed in all outcome measures for the assessed condition at 3-months compared to baseline, but only in the two problem variables at 12-months, while for the intervention condition, significant improvement was found in all outcome measures at both time periods; however, estimates of the interaction terms were not statistically significant. In the Mexica-American study, while significant improvement in nearly all outcome measures were observed at 3 months and 12 months for both conditions, estimates of the interaction terms suggest that for all drinking variables, but not problem variables, outcomes were significantly improved for the intervention condition over the assessed condition at 12 months, suggesting a 12-month intervention effect. Findings here are non-conclusive regarding a treatment effect of BI for heavy episodic drinking in ED patients. Given the mixed findings for BI in other ED studies, future studies need to explore the efficacy of BI in other populations and cultures exhibiting different drinking patterns to help identify what type of drinker would most benefit from BI in the ED setting.
    Full-text · Article · Sep 2015 · Addiction science & clinical practice
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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.
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