Enhanced ASSIST-linked brief intervention and referral to treatment for illicit Drugs and alcohol use in prison population: a double-blind randomized clinical trial (HAMDARD)

Introduction:

A systematic review & meta-analysis foundthat the prevalence of drug use in prisons ranges from 10%-60% among men and30%-70% among women. Moreover, many prisoners would have been imprisonedbecause of their drug use (in countries where drug use has been criminalized,e.g., India). The drug-related deaths increased three to eight-fold in thefirst two weeks of discharge,6. Therefore substance use in prison poses asevere risk to public health and society. Indian prisons lack a systemicapproach to dealing with substance use disorders. An otherwise effectiveintervention, the ASSIST-linked enhanced SBIRT, could be tested in theresource-limited prison settings of India. If it is effective, it can addressthe treatment gap and reduce substance use and other substance-related complicationsin the prison population. A study of the predictors of response to the SBIRTshould help optimize the available resources. SBIRTcould also creates a windowof opportunity for the decriminalization of drug use by making treatmentavailable, accessible, acceptable, and affordable to those imprisoned for thepossession of small quantities of drugs.

Objectives:

To develop and test the enhanced-SBIRT for riskysubstance use.

To explore the barriers and facilitators of theintervention.

Methods:

The study will consist of formative,intervention, and post-intervention phases. The formative stage will havein-depth interviews and focus group discussions. The manually coded transcribeddata will generate the themes and sub-themes for developing the “enhancedâ€component of the SBIRT. The intervention phase will be a double-blind,individual-based, parallel-design RCT (n=188 in each arm after powercalculation). Results access may begin at 12 and 24 weeks after intervention.This phase is to determine the feasibility and preliminary efficacy of theintervention. Capability, Opportunity, Motivation-Behaviour change theoreticalframework will be used to understand the processes in the final phase of thepost-intervention process evaluation.

Expected outcome:

The newly developed enhanced-SBIRT should befeasible and acceptable to the Indian prison population. It will reduce theseverity, frequency of substance use, and will have a significant reduction inhigh-risk behaviour and overdose risk. The intervention will be tested at thestate and even at the national level.