title: Examining multi-session brief intervention for substance use in primary care: research methods of a randomized controlled trial.
abstract: BACKGROUND
  Brief interventions such as Screening, a single session of Brief Intervention, and Referral to Treatment (SBIRT) have shown mixed effectiveness in primary care. However, there are indications that multi-session brief interventions may demonstrate more consistently positive outcomes, and perhaps a more intensive approach would be of benefit in addressing substance use in primary care. This study compared the effectiveness of SBIRT with a single BI session (BI/RT) to a multi-session brief-treatment intervention (BI/RT+) in primary care. We also developed easy-to-use, evidence-based materials to assist clinicians in delivering these interventions.
  
  
  METHODS
  This study was conducted in three Federally Qualified Healthcare Centers (FQHCs). A total of 10,935 patients were screened, and 600 individuals were recruited. The sample was primarily Black/African American (82 %) with a mean age of 40. Patients who attended a healthcare appointment were screened for substance use via the AUDIT and DAST. Patients were eligible for the study if they scored 8 or higher on the AUDIT, were using only marijuana and scored 2 or higher on the DAST, or were using other illicit drugs and scored 1 or higher on the DAST. Participants were randomly assigned to receive one-session BI/RT, or two to six sessions of brief intervention that incorporated elements of motivational enhancement therapy and cognitive-behavioral therapy (BI/RT+). Both interventions were delivered by behavioral health consultants at the FQHCs. Participants completed follow-up assessments every 3 months for 1 year. Primary outcome variables included substance use treatment sessions attended and days of substance use. Secondary outcomes included measures of health, employment, legal, and psychiatric functioning and HIV risk behaviors. Additionally, we will conduct an economic evaluation examining cost-effectiveness and will analyze outcomes from a process evaluation examining patient and provider experiences.
  
  
  CONCLUSIONS
  The ability of brief interventions to impact substance use has great potential, but research findings have been mixed. By conducting a large-scale randomized controlled trial in real-world health centers, this study will answer important questions about the effectiveness of expanded BIs for patients who screen positive for risky substance use in primary care. Trial registration NCT01751672.
authors.affiliation: Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA, 19106, USA. jchambers@tresearch.org.
authors.forename: Jaclyn E
authors.initials: JE
authors.lastname: Chambers
authors.affiliation: Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA, 19106, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Brooks
authors.affiliation: Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA, 19106, USA.|The Institute for Graduate Clinical Psychology, Widener University, One University Place, Chester, PA, 19013, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Medvin
authors.affiliation: Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA, 19106, USA.|Department of Psychiatry, University of Pennsylvania School of Medicine, 3900 Chestnut Street, Philadelphia, PA, 19104, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Metzger
authors.affiliation: Public Health Management Corporation, Centre Square East, 1500 Market St. 15th Floor, Philadelphia, PA, 19102, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lauby
authors.affiliation: Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA, 19106, USA.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Carpenedo
authors.affiliation: Lincoln University, 1570 Baltimore Pike, Lincoln University, PA, 19352, USA.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Favor
authors.affiliation: Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, PA, 19106, USA.|Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA.
authors.forename: Kimberly C
authors.initials: KC
authors.lastname: Kirby
mesh_terms: D000328:Adult; D001741:Black or African American; D000437:Alcoholism / Q000175:diagnosis / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004651:Employment; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000175:diagnosis / Q000628:therapy; D008603:Mental Health; D062405:Motivational Interviewing; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration*; D012107:Research Design; D012309:Risk-Taking; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000208:ethnology / Q000628:therapy*; D013997:Time Factors
keywords: Brief intervention; Brief treatment; Primary care; SBIRT; Substance abuse