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

Abstract

Unhealthy drug use ranges from use that risks health harms through severe drug use disorders. This narrative review addresses whether screening and brief intervention (SBI), efficacious for risky alcohol use, has efficacy for reducing other drug use and consequences. Brief intervention among those seeking help shows some promise. Screening tools have been validated though most are neither brief nor simple enough for use in general health settings. Several randomized trials have tested the efficacy of brief intervention for unhealthy drug use identified by screening in general health settings (i.e., in people not seeking help for their drug use). Substantial evidence now suggests that efficacy is limited or non-existent. Reasons likely include a range of actual and perceived severity (or lack of severity), concomitant unhealthy alcohol use and comorbid mental health conditions, and the wide range of types of unhealthy drug use (e.g., from marijuana, to prescription drugs, to heroin). Although brief intervention may have some efficacy for unhealthy drug users seeking help, the model of SBI that has effects in primary care settings on risky alcohol use may not be efficacious for other drug use.

Epidemiology ofDSM-5Drug Use Disorder

“…In contrast to alcohol and tobacco, evidence is limited for the effectiveness of brief interventions in reducing drug use and problems among nonhelp-seeking individuals in primary care. 53,54 Nevertheless, identifying and addressing drug use are essential components of good clinical practice for reasons including appropriate diagnosis of medical and psychiatric conditions, safe prescribing of medications, and enabling referrals to DUD treatment when indicated. 53,55 The prevalence of DUD in this study underscores the need for continued efforts to develop and implement screening tools and protocols to refer individuals with DUDs to appropriate treatment.…”

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.…”

Potential Radiating Effects of Misusing Substances Among Medical Patients Receiving Brief Intervention

“…Although there is good evidence supporting brief interventions for alcohol misuse in adult primary care patients (Moyer, 2013), the evidence is weak for illicit drug misuse (Saitz, 2014). Although some randomized trials have found support for brief interventions reducing drug use (Bernstein et al, 2005; Humeniuk et al, 2012), others have not (Roy-Byrne et al, 2014; Saitz et al, 2014).…”

“…Although some randomized trials have found support for brief interventions reducing drug use (Bernstein et al, 2005; Humeniuk et al, 2012), others have not (Roy-Byrne et al, 2014; Saitz et al, 2014). Nevertheless, the lack of scientific consensus has not been a barrier to the expansion of SBIRT, which has continued with substantial government investment (Humphreys & McLellan, 2010; Saitz, 2014). …”