Effect of screening, brief intervention and referral to treatment for unhealthy alcohol and other drug use in mental health treatment settings: a randomized controlled trial

Abstract

Aims To test the efficacy of a brief intervention to reduce alcohol or drug use and to promote use of addiction services among patients seeking mental health treatment. Design and setting A multi‐centre, longitudinal, two‐group randomized controlled trial with randomization within each of two mental health treatment systems located in Ventura County and Los Angeles County in California, USA. Participants A total of 718 patients (49.2% female) aged 18 and older with a mental health diagnosis and either a heavy drinking day or any use of cannabis or stimulants in the past 90 days. Intervention and comparator A motivation‐based brief intervention with personalized feedback (screening, brief intervention and referral to treatment (SBIRT) condition) (n = 354) or a health education session (control condition) (n = 364). Measurements Primary outcomes included frequency of heavy drinking days, days of cannabis use and days of stimulant use at the primary end‐point 3 months post‐baseline. Secondary outcomes included frequency and abstinence from substance use out to a 12‐month follow‐up and the use of addiction treatment services. Findings Participants in the SBIRT condition had fewer heavy drinking days [odds ratio (OR) = 0.53; 95% credible interval (CrI) = 0.48–0.6] and fewer days of stimulant use (OR = 0.58; 95% CrI = 0.50–0.66) at the 3‐month follow‐up compared with participants in the health education condition. Participants in the SBIRT condition did not comparatively reduce days of cannabis use at the 3‐month follow‐up (OR = 0.93; 95% CrI = 0.85–1.01). Secondary outcomes indicated sustained effects of SBIRT on reducing the frequency of heavy drinking days and days of stimulant use. No effects were observed on abstinence rates or use of addiction treatment services. Conclusions Screening and brief intervention for unhealthy alcohol and drug use in mental health treatment settings were effective at reducing the frequency of heavy drinking and stimulant use.

Online interventions for cannabis use among adolescents and young adults: Systematic review and meta‐analysis

“…An important future direction is therefore to examine which intervention techniques are most effective, to improve CU treatments. Karno et al (2020) found positive effects of the Screening, Brief Intervention, and Referral to Treatment upon reduction of alcohol and other substance use, but not for CU. These findings suggest that CU treatment may need to be more targeted, and specifically that a focus on CU and the inclusion of MI, CBT and MET strategies is likely to be of benefit (Gates et al, 2016).…”

Variation in brief treatment for substance use disorder: a qualitative investigation of four federally qualified health centers with SBIRT services

“…Future research in this area should seek to understand BT as practiced among a larger sample of different provider types, as well as patients’ direct experiences and perspectives. Regardless of research needs, the BT practice variations and relatively weak internal standards identified lend support issues raised in prior research [ 12 , 13 , 32 ], thus reinforcing the need for more consistent implementation and quality assurance guidelines in FQHCs and other settings where BT is implemented. Finally, the importance of a client’s stage of change for determining BT appropriateness and content suggests the use of standardized assessments could be employed to guide clinical decision making in this area (see [ 51 ]).…”

“…Yet, other research has provided no clear example of how BT was operationalized or simply accepted that it was delivered when reported so by service providers [4,[25][26][27][28][29][30][31]. This inconsistent operationalization combined with a noted lack of fidelity measurement [32] in prior BT research raise validity and reliability concerns that hamper the quality of evidence on the intervention's efficacy.…”

Role of Early Brief Psychological Interventions in Substance Use Disorders

“…22 A RCT conducted on 718 individuals comparing brief interventions including motivation interviewing and health informational care sessions found both of them effective at reducing frequency or abstinence of heavy drinking and stimulant use but had no effect on cannabis use. 23 Anderson et al established that primary care training and support in alcohol screening and brief advice had an impactful effect on patients who received the intervention that was sustained even after 9 months. 24 This study also showed that early and brief interventions at the level of filter clinics or emergency departments can be helpful in reducing substance use disorders.…”