Randomized clinical trial of the effects of screening and brief intervention for illicit drug use: the life shift/shift gears study

Abstract

BackgroundAlthough screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals.MethodsA total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite.ResultsOf 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12).ConclusionsIn this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome.Trial registrationClinicalTrials.gov NCT01683227.

Screening and Brief Intervention for Unhealthy Drug Use: Little or No Efficacy

“…One had 58% loss to follow-up and found no benefit of SBI (40). The other, a multi-site trial, has not yet had results published (41) .…”

Impact of a brief intervention on reducing alcohol use and increasing alcohol treatment services utilization among alcohol- and drug-using adult emergency department patients

“…(Babor et al, 2007) ED-based BIs for alcohol use have shown efficacy in some studies, (Academic, 2010; Bazargan-Hejazi et al, 2005; Bernstein et al, 2010; D'Onofrio et al, 2012; Longabaugh et al, 2001; Mello et al, 2013) but not in others. (Landy, Davey, Quintero, Pecora, & McShane, 2016; Nilsen et al, 2008) ED-based (Bogenschutz et al, 2014; Woodruff et al, 2014) and outpatient BIs (Roy-Byrne et al, 2014; Saitz et al, 2014) for drug use have not been efficacious, at least not as previously attempted. In a previous randomized, controlled trial evaluating a BI for adult ED patients in need of an intervention for their drug use (per World Health Organization (WHO) criteria), (Humeniuk, 2010) we also found that participants who received an alcohol and drug use BI did not decrease their drug use more than those in an assessment only condition (completed questionnaires but did not receive a BI).…”

Readiness to change is a predictor of reduced substance use involvement: Findings from a randomized controlled trial of patients attending South African emergency departments

“…This suggests that although brief interventions may be adequate for helping individuals reduce their alcohol use, they may not be sufficient for helping people change their drug use. This finding is not altogether surprising given evidence from other settings that brief interventions in non-treatment seeking populations are efficacious for reducing alcohol use [13][14][15][16], but not for reducing illicit drug use [19][20][21][22][23]. However, it remains unclear why these interventions are effective for reducing alcohol use only.…”

“…In contrast, there is currently insufficient evidence to draw conclusions about the effectiveness of BIs for reducing illicit drug use among non-treatment-seeking populations [19]. Recent trials conducted predominantly in the U.S. found that BIs had no significant effect on illicit drug use [20][21][22][23], although one study [24] found that individuals with more severe drug use problems had improved utilization of substance abuse treatment and lower utilization of emergency services subsequent to receiving a BI. However, all of these studies included participants with a variety of substance use problems.…”