Healthier You: Optimizing Screening, Brief Interventions, and Referral to Treatment (SBIRT) in the Emergency Department
- Conditions
- Drug Abuse
- Interventions
- Behavioral: Computer-delivered Brief Intervention (CBI)Behavioral: Intervener-delivered Brief Intervention (IBI)Behavioral: Enhanced Usual Care (EUC)Behavioral: Adapted Motivational Enhancement Therapy (AMET)
- Registration Number
- NCT01113190
- Lead Sponsor
- University of Michigan
- Brief Summary
Screening, brief interventions, and referral to treatment (SBIRT) for drug use/abuse offers opportunities for early detection, brief intervention/treatment, and substance use treatment referrals for patients in medical settings. Although SBIRT components, particularly screening and brief interventions, have been shown to be effective strategies for addressing alcohol misuse in primary care, data are limited on using all of the components of SBIRT for drug-using patients, particularly in the Emergency Department (ED). Further, because of the often chaotic environment of EDs, many logistical and practical impediments exist for the adoption of the entire SBIRT model in this setting.
- Detailed Description
The proposed study will use computerized screening using touch screen computer tablets with audio (\~4,900 patients) and will test intervention strategies in a two-factorial design (3x2). Specifically, 900 patients aged 18-60 in an inner-city ED who screen positive for drug use in the past 3 months will be randomized to the combinations of three ED-based conditions (computer brief intervention-CBI; intervener brief intervention-IBI; enhanced usual care-EUC), and two follow-up conditions (adapted motivational enhancement therapy-AMET; enhanced usual care-EUC) that will take place 3 months post-ED. All individuals who meet criteria for a drug use disorder will additionally receive the "referral to treatment" or "RT" component of SBIRT. Stratified random assignment \[by gender and diagnosis of a drug use disorder (yes/no)\] will take place at baseline for all ED based and follow-up conditions. All participants will receive written information including substance abuse and other community resources, and HIV prevention materials. Recognizing that brief interventions are important, but not necessarily sufficient, for change in all patients who use drugs, the primary specific aims of the proposed study will determine the independent effectiveness of immediate "on-the-spot" ED-based brief intervention conditions, 3-month followup brief treatment conditions, and combinations of conditions, for decreasing drug use and improving health-related outcomes (including physical and mental health, and HIV risk behavior) at 6 and 12 months.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 878
- patients age 18-60 years presenting to the HMC for medical care (except exclusions as noted below)
- ability to provide informed consent. Additional inclusion criteria for intervention: past 3-month use of illicit drugs or misuse of psychoactive prescription drugs
- patients who do not understand English (less than 1% in our prior work) -
- prisoners
- patients classified by medical staff as "Level 1 trauma" (e.g., unconscious, intubated on respirators, in need of immediate lifesaving procedures such as surgery)
- patients deemed unable to provide informed consent as stated above (e.g., intoxication, mental incompetence)
- patients treated in the ED for suicide attempts or sexual assault
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description CBI in ED with AMET at 3 months Computer-delivered Brief Intervention (CBI) computer-delivered brief intervention (CBI) at baseline with adapted motivational enhancement therapy-AMET at 3 months EUC in ED with AMET at 3 months Enhanced Usual Care (EUC) enhanced usual care (EUC) at baseline with adapted motivational enhancement therapy-AMET at 3 months EUC in ED with EUC at 3 months Enhanced Usual Care (EUC) enhanced usual care (EUC) at baseline with EUC at 3 months CBI in ED with AMET at 3 months Adapted Motivational Enhancement Therapy (AMET) computer-delivered brief intervention (CBI) at baseline with adapted motivational enhancement therapy-AMET at 3 months IBI in ED with AMET at 3 months Adapted Motivational Enhancement Therapy (AMET) intervener-delivered brief intervention (IBI) at baseline with adapted motivational enhancement therapy-AMET at 3 months IBI in ED with EUC at 3 months Intervener-delivered Brief Intervention (IBI) intervener-delivered brief intervention (IBI) at baseline with enhanced usual care-EUC at 3 months EUC in ED with AMET at 3 months Adapted Motivational Enhancement Therapy (AMET) enhanced usual care (EUC) at baseline with adapted motivational enhancement therapy-AMET at 3 months CBI in ED with EUC at 3 months Computer-delivered Brief Intervention (CBI) computer-delivered brief intervention (CBI) at baseline with enhanced usual care-EUC at 3 months CBI in ED with EUC at 3 months Enhanced Usual Care (EUC) computer-delivered brief intervention (CBI) at baseline with enhanced usual care-EUC at 3 months IBI in ED with AMET at 3 months Intervener-delivered Brief Intervention (IBI) intervener-delivered brief intervention (IBI) at baseline with adapted motivational enhancement therapy-AMET at 3 months IBI in ED with EUC at 3 months Enhanced Usual Care (EUC) intervener-delivered brief intervention (IBI) at baseline with enhanced usual care-EUC at 3 months
- Primary Outcome Measures
Name Time Method drug use - number of days used change over time (3, 6 and 12 months post-baseline) drug use change over time (3, 6 and 12 months post-baseline) Drug use is measured using the NIDA-Modified ASSIST (Alcohol, Smoking and Substance Involvement Screening Test).
- Secondary Outcome Measures
Name Time Method health related outcomes (physical health) change over time (3, 6 and 12 months post-baseline) Physical health is measured using the Short Form Health Survey (SF-12).
health related outcomes (mental health) change over time (3, 6 and 12 months post-baseline) Mental health is measured using the Patient Health Questionnaire (PHQ-9).
HIV risk behaviors change over time (3, 6 and 12 months post-baseline) HIV risk behaviors are measured using the Health Related Behavior Survey (HRBS).
Trial Locations
- Locations (1)
Hurley Medical Center Emergency Department
🇺🇸Flint, Michigan, United States