title: Brief intervention for patients with problematic drug use presenting in emergency departments: a randomized clinical trial.
abstract: OBJECTIVE
  Medical treatment settings such as emergency departments (EDs) present important opportunities to address problematic substance use. Currently, EDs do not typically intervene beyond acute medical stabilization.
  
  
  OBJECTIVE
  To contrast the effects of a brief intervention with telephone boosters (BI-B) with those of screening, assessment, and referral to treatment (SAR) and minimal screening only (MSO) among drug-using ED patients.
  
  
  METHODS
  Between October 2010 and February 2012, 1285 adult ED patients from 6 US academic hospitals, who scored 3 or greater on the 10-item Drug Abuse Screening Test (indicating moderate to severe problems related to drug use) and who were currently using drugs, were randomized to MSO (n = 431), SAR (n = 427), or BI-B (n = 427). Follow-up assessments were conducted at 3, 6, and 12 months by blinded interviewers.
  
  
  METHODS
  Following screening, MSO participants received only an informational pamphlet. The SAR participants received assessment plus referral to addiction treatment if indicated, and the BI-B participants received assessment and referral as in SAR, plus a manual-guided counseling session based on motivational interviewing principles and up to 2 "booster" sessions by telephone during the month following the ED visit.
  
  
  METHODS
  Outcomes evaluated at follow-up visits included self-reported days using the patient-defined primary problem drug, days using any drug, days of heavy drinking, and drug use based on analysis of hair samples. The primary outcome was self-reported days of use of the patient-defined primary problem drug during the 30-day period preceding the 3-month follow-up.
  
  
  RESULTS
  Follow-up rates were 89%, 86%, and 81% at 3, 6, and 12 months, respectively. For the primary outcome, estimated differences in number of days of use (95% CI) were as follows: MSO vs BI-B, 0.72 (-0.80 to 2.24), P (adjusted) = .57; SAR vs BI-B, 0.70 (-0.83 to 2.23), P (adjusted) = .57; SAR vs MSO, -0.02 (-1.53 to 1.50), P (adjusted) = .98. There were no significant differences between groups in self-reported days using the primary drug, days using any drug, or heavy drinking days at 3, 6, or 12 months. At the 3-month follow-up, participants in the SAR group had a higher rate of hair samples positive for their primary drug of abuse (265 of 280 [95%]) than did participants in the MSO group (253 of 287 [88%]) or the BI-B group (244 of 275 [89%]). Hair analysis differences between groups at other time points were not significant.
  
  
  CONCLUSIONS
  In this sample of drug users seeking emergency medical treatment, a relatively robust brief intervention did not improve substance use outcomes. More work is needed to determine how drug use disorders may be addressed effectively in the ED.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier:NCT01207791.
authors.affiliation: Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque2Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Bogenschutz
authors.affiliation: Alcohol & Drug Abuse Institute, University of Washington, Seattle4Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Donovan
authors.affiliation: National Institute on Drug Abuse, Bethesda, Maryland.
authors.forename: Raul N
authors.initials: RN
authors.lastname: Mandler
authors.affiliation: National Institute on Drug Abuse, Bethesda, Maryland.
authors.forename: Harold I
authors.initials: HI
authors.lastname: Perl
authors.affiliation: Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque2Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque.
authors.forename: Alyssa A
authors.initials: AA
authors.lastname: Forcehimes
authors.affiliation: Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Cameron
authors.initials: C
authors.lastname: Crandall
authors.affiliation: The EMMES Corporation, Rockville, Maryland.
authors.forename: Robert
authors.initials: R
authors.lastname: Lindblad
authors.affiliation: The EMMES Corporation, Rockville, Maryland.
authors.forename: Neal L
authors.initials: NL
authors.lastname: Oden
authors.affiliation: The EMMES Corporation, Rockville, Maryland.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Sharma
authors.affiliation: Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Lisa
authors.initials: L
authors.lastname: Metsch
authors.affiliation: Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lyons
authors.affiliation: Department of Emergency Medicine, New York University School of Medicine, New York.
authors.forename: Ryan
authors.initials: R
authors.lastname: McCormack
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston12Harvard Medical School, Boston, Massachusetts.
authors.forename: Wendy
authors.initials: W
authors.lastname: Macias-Konstantopoulos
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Antoine
authors.initials: A
authors.lastname: Douaihy
mesh_terms: D000328:Adult; D004632:Emergency Medical Services / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D006197:Hair / Q000737:chemistry; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D020380:Needs Assessment; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult