title: Potential radiating effects of misusing substances among medical patients receiving brief intervention.
abstract: BACKGROUND
  The societal benefits of substance use interventions are largely driven not by reducing use per se, but by the broader implications of those reductions. This encompasses "potential radiating effects of misusing substances" (PREMiS) such as utilization of high-cost hospital and emergency care, injury, productivity losses, incarceration, and driving while impaired.
  
  
  METHODS
  This study is a secondary analysis from a randomized trial comparing in-person vs. computerized brief intervention among 360 adult community health center patients with moderate-risk illicit drug use (N = 302 with complete data through 12 months of follow-up). This study aims to examine four aspects of PREMiS outcomes in this sample: (1) their frequency; and their association with (2) type of brief intervention received (by random assignment), (3) type of drug misused, and (4) baseline drug problem severity (within the moderate risk range).
  
  
  RESULTS
  12-month prevalence was 18.5% for hospitalization (399 cumulative days), 33.1% for emergency department utilization (166 cumulative visits), 39.1% for injury (1818 injury-days), and 8.3% for incarceration (278 days of detention). There were 729 missed work days among those who reported employment. Fifty percent reported driving under the influence (DUI) of substances. There were no differences in PREMiS outcomes by type of brief intervention. Participants with only marijuana misuse at baseline were not at lower risk of experiencing PREMiS events than participants with other drug misuse. Higher baseline drug problem severity was predictive of future hospitalization (p < .05) and number of hospitalization days (p < .01).
  
  
  CONCLUSIONS
  This community health center sample with moderate-risk illicit drug use reported considerable high-cost healthcare utilization, injury, missed work, and DUI. Interventions are needed that can reliably lower risk of negative outcomes among drug users.
authors: Friends Research Institute, Baltimore, MD, USA. Electronic address: jgryczynski@friendsresearch.org.
authors: Jan
authors: J
authors: Gryczynski
authors: Friends Research Institute, Baltimore, MD, USA.
authors: Shannon Gwin
authors: SG
authors: Mitchell
authors: Wayne State University, Detroit, MI, USA.
authors: Steven J
authors: SJ
authors: Ondersma
authors: University of Maryland, College Park, Department of Psychology, College Park, MD, USA.
authors: Kevin E
authors: KE
authors: O'Grady
authors: Friends Research Institute, Baltimore, MD, USA.
authors: Robert P
authors: RP
authors: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003151:Community Health Centers / Q000706:statistics & numerical data*; D000066448:Driving Under the Influence / Q000706:statistics & numerical data*; D004526:Efficiency / Q000187:drug effects*; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D002189:Marijuana Abuse / Q000150:complications / Q000628:therapy; D008875:Middle Aged; D009516:New Mexico; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011614:Psychotherapy, Brief / Q000379:methods*; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy*; D014947:Wounds and Injuries / Q000191:economics / Q000209:etiology*; D055815:Young Adult
chemical_list: D013287:Illicit Drugs
keywords: Brief intervention; Drug misuse; Hospitalization; Injury; Potential Radiating Effects of Misusing Substances (PREMiS); Primary care; Productivity losses