title: Design of NIDA CTN Protocol 0047: screening, motivational assessment, referral, and treatment in emergency departments (SMART-ED).
abstract: BACKGROUND
  Medical settings such as emergency departments (EDs) present an opportunity to identify and provide services for individuals with substance use problems who might otherwise never receive any form of assessment, referral, or intervention. Although screening, brief intervention, and referral to treatment models have been extensively studied and are considered effective for individuals with alcohol problems presenting in EDs and other medical settings, the efficacy of such interventions has not been established for drug users presenting in EDs.
  
  
  OBJECTIVE
  This article describes the design of a NIDA Clinical Trials Network protocol testing the efficacy of an screening, brief intervention, and referral to treatment model in medical EDs, highlighting considerations that are pertinent to the design of other studies targeting substance use behaviors in medical treatment settings.
  
  
  METHODS
  The protocol is described, and critical design decisions are discussed.
  
  
  RESULTS
  Design challenges included defining treatment conditions, study population, and site characteristics; developing the screening process; choosing the primary outcome; balancing brevity and comprehensiveness of assessment; and selecting the strategy for statistical analysis.
  
  
  CONCLUSIONS
  Many of the issues arising in the design of this study will be relevant to future studies of interventions for addictions in medical settings.
  
  
  CONCLUSIONS
  Optimal trial design is critical to determining how best to integrate substance abuse interventions into medical care.
authors.affiliation: Department of Psychiatry, Health Sciences Center, University of New Mexico, Albuquerque, 87131, USA. mbogenschutz@salud.unm.edu
authors.forename: Michael P
authors.initials: MP
authors.lastname: Bogenschutz
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Donovan
authors.forename: Bryon
authors.initials: B
authors.lastname: Adinoff
authors.forename: Cameron
authors.initials: C
authors.lastname: Crandall
authors.forename: Alyssa A
authors.initials: AA
authors.lastname: Forcehimes
authors.forename: Robert
authors.initials: R
authors.lastname: Lindblad
authors.forename: Raul N
authors.initials: RN
authors.lastname: Mandler
authors.forename: Neal L
authors.initials: NL
authors.lastname: Oden
authors.forename: Harold I
authors.initials: HI
authors.lastname: Perl
authors.forename: Robrina
authors.initials: R
authors.lastname: Walker
mesh_terms: D003627:Data Interpretation, Statistical; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D009042:Motivation; D054577:National Institute on Drug Abuse (U.S.); D011446:Prospective Studies; D011614:Psychotherapy, Brief / Q000379:methods; D012107:Research Design; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000628:therapy; D014481:United States