title: The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial.
abstract: BACKGROUND
  The treatment of substance use disorders is a public health priority, particularly in South Africa where the prevalence of these disorders is high. We tested two peer-counsellor delivered brief interventions (BIs) for risky substance use among adults presenting to emergency departments (EDs) in South Africa.
  
  
  METHODS
  In this randomised controlled trial, we enrolled patients presenting to one of three 24-hour EDs who screened at risk for substance use according to the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Eligible patients were randomly allocated to one of three conditions: Motivational Interviewing (MI), blended MI and Problem Solving Therapy (MI-PST) or a Psycho-educational Control Group (CG). The primary outcome was reduction in ASSIST scores at three months follow-up.
  
  
  RESULTS
  Of the 2736 patients screened, 335 met inclusion criteria, were willing to participate in the intervention and were randomised to one of three conditions: 113 to MI, 112 to MI-PST and 110 to CG. ASSIST scores at three months were lower in the MI-PST group than they were in the MI and CG groups (adjusted mean difference of -1.72, 95 % CI -3.36 - -0.08). We recorded no significant difference in ASSIST scores between the CG and MI group (adjusted mean difference of -0.02, 95 % CI -2.01 - 1.96).
  
  
  CONCLUSIONS
  With the addition of minimal resources, BIs are feasible to conduct in EDs in a low resourced country. These preliminary findings report that MI-PST appears to be an effective BI for reducing substance use among at risk participants. Further research is required to replicate these findings with effort to limit attrition, to determine whether reductions in substance use are persistent at 6 and 12 month follow-up and whether parallel changes occur in other indications of treatment outcomes, such as injury rates and ED presentations.
  
  
  BACKGROUND
  This trial registered with the Pan African Clinical Trial Registry (PACTR201308000591418).
authors.affiliation: Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Groote Schuur Hospital, Cape Town, 7925, South Africa. Katherine.sorsdahl@uct.ac.za.
authors.forename: K
authors.initials: K
authors.lastname: Sorsdahl
authors.affiliation: Department of Psychiatry & Mental Health, University of Cape Town, Groote Schuur Hospital, Cape Town, 7925, South Africa. dan.stein@uct.ac.za.
authors.forename: D J
authors.initials: DJ
authors.lastname: Stein
authors.affiliation: Western Cape Department of Health, 8 Riebeeck Street, Cape Town, 8001, South Africa. joannecor@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Corrigall
authors.affiliation: Department of Clinical Psychology, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands. p.cuijpers@vu.nl.
authors.forename: P
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: Department of Clinical Psychology, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands. n.smits@vu.nl.
authors.forename: N
authors.initials: N
authors.lastname: Smits
authors.affiliation: Western Cape Department of Health, 8 Riebeeck Street, Cape Town, 8001, South Africa. Tracey.Naledi@westerncape.gov.za.
authors.forename: T
authors.initials: T
authors.lastname: Naledi
authors.affiliation: Department of Psychiatry & Mental Health, University of Cape Town, Groote Schuur Hospital, Cape Town, 7925, South Africa. bronwyn.myers@mrc.ac.za.|Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa. bronwyn.myers@mrc.ac.za.
authors.forename: B
authors.initials: B
authors.lastname: Myers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D011340:Problem Solving; D011614:Psychotherapy, Brief; D013019:South Africa; D019966:Substance-Related Disorders / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult