Medical treatment settings such as Emergency Departments (EDs) present important opportunities to address problematic substance use. Currently, EDs do not typically intervene beyond acute medical stabilization.
To contrast the effects of a brief intervention with telephone boosters (BI-B) to those of screening, assessment, and referral to treatment (SAR) and minimal screening only (MSO) among drug-using ED patients.
Between October 2010 and February 2012, 1285 patients were randomized to MSO (n = 431), SAR (n = 427), or BI-B (n = 427). Follow-up assessments were conducted at 3, 6, and 12 months by blinded interviewers.
EDs of six academic hospitals in the U.S.
Participants were adult ED patients scoring ≥ 3 on the 10-item Drug Abuse Screening Test (indicating moderate to severe problems related to drug use) and currently using drugs.
Following screening, MSO participants received only an informational pamphlet. SAR participants received assessment plus referral to addiction treatment if indicated. BI-B participants received assessment and referral as in SAR, plus a manual-guided counseling session based on motivational interviewing principles and up to 2 “booster” sessions by telephone during the month following the ED visit.
MAIN OUTCOMES AND MEASURES
Outcomes evaluated at follow-up visits included self-reported days using the patient-defined primary problem drug, days using any drug, days of heavy drinking, and drug use based on analysis of hair samples.
Follow-up rates were 88%, 86%, and 81% at 3, 6, and 12 months, respectively. There were no significant differences between groups in self-reported days using the primary drug, days using any drug, or heavy drinking days at 3, 6, or 12 months. At the 3-month follow-up, participants in the SAR group had a higher rate of hair samples positive for their primary drug of abuse (265/280, 95%) than did participants in the MSO group (253/287, 88%) or the BI-B group (244/275, 89%). Hair analysis differences between groups at other time points were not significant.
CONCLUSIONS AND RELEVANCE
In this sample of drug users seeking emergency medical treatment, a relatively robust brief intervention did not improve substance use outcomes. More work is needed to determine how drug use disorders may be addressed effectively in the ED.