title: Testing the effects of brief intervention in primary care for problem drug use in a randomized controlled trial: rationale, design, and methods.
abstract: BACKGROUND
  A substantial body of research has established the effectiveness of brief interventions for problem alcohol use. Following these studies, national dissemination projects of screening, brief intervention (BI), and referral to treatment (SBIRT) for alcohol and drugs have been implemented on a widespread scale in multiple states despite little existing evidence for the impact of BI on drug use for non-treatment seekers. This article describes the design of a study testing the impact of SBIRT on individuals with drug problems, its contributions to the existing literature, and its potential to inform drug policy.
  
  
  METHODS
  The study is a randomized controlled trial of an SBIRT intervention carried out in a primary care setting within a safety net system of care. Approximately 1,000 individuals presenting for scheduled medical care at one of seven designated primary care clinics who endorse problematic drug use when screened are randomized in a 1:1 ratio to BI versus enhanced care as usual (ECAU). Individuals in both groups are reassessed at 3, 6, 9, and 12 months after baseline. Self-reported drug use and other psychosocial measures collected at each data point are supplemented by urine analysis and public health-related data from administrative databases.
  
  
  CONCLUSIONS
  This study will contribute to the existing literature by providing evidence for the impact of BI on problem drug use based on a broad range of measures including self-reported drug use, urine analysis, admission to drug abuse treatment, and changes in utilization and costs of health care services, arrests, and death with the intent of informing policy and program planning for problem drug use at the local, state, and national levels.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00877331.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA. krupski@u.washington.edu
authors.forename: Antoinette
authors.initials: A
authors.lastname: Krupski
authors.forename: Jutta M
authors.initials: JM
authors.lastname: Joesch
authors.forename: Chris
authors.initials: C
authors.lastname: Dunn
authors.forename: Dennis
authors.initials: D
authors.lastname: Donovan
authors.forename: Kristin
authors.initials: K
authors.lastname: Bumgardner
authors.forename: Sarah Peregrine
authors.initials: SP
authors.lastname: Lord
authors.forename: Richard
authors.initials: R
authors.lastname: Ries
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
mesh_terms: D002985:Clinical Protocols; D003219:Confidentiality; D003362:Cost-Benefit Analysis; D006801:Humans; D007258:Informed Consent; D008403:Mass Screening; D009042:Motivation; D011320:Primary Health Care / Q000458:organization & administration*; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012107:Research Design; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000628:therapy*