title: Receipt of addiction treatment as a consequence of a brief intervention for drug use in primary care: a randomized trial.
abstract: OBJECTIVE
  Screening, brief intervention and 'referral to treatment' programs have been promoted widely as US federal policy. Little is known about the efficacy of the RT component (referral to treatment) of brief intervention for motivating patients with unhealthy drug use identified by screening to use addiction treatment. This study aimed to compare receipt of addiction treatment following two types of brief intervention for drug use versus a no-intervention control group among primary care patients screening positive for drug use.
  
  
  METHODS
  Secondary analyses from a single-site randomized controlled trial.
  
  
  METHODS
  Massachusetts, USA.
  
  
  METHODS
  A total of 528 adults with Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) drug-specific scores ≥ 4.
  
  
  METHODS
  Random assignment to: (1) a 10-15-minute brief negotiated interview (BNI) conducted by health educators (n = 174), (2) a 30-45-minute adaptation of motivational interviewing by Masters-level counselors (MOTIV) (n = 177) or (3) no BI (n = 177). All received a list of treatment and mutual help resources; both intervention protocols included dedicated staff for treatment referrals.
  
  
  METHODS
  Receipt of any addiction treatment within 6 months after study entry, assessed in a state-wide database and hospital electronic medical record linked to trial data.
  
  
  RESULTS
  Among 528 participants, the main drugs used were marijuana (63%), cocaine (19%) and opioids (17%); 46% met past-year drug dependence criteria (short form Composite International Diagnostic Interview); and 10% of MOTIV, 18% of BNI and 17% of control participants had any addiction treatment receipt within 6 months after study entry. There was no significant difference in addiction treatment receipt for BNI versus control [adjusted odds ratio (AOR) = 1.11; 95% confidence interval (CI) = 0.57, 2.15, Hochberg adjusted P = 0.76]. The MOTIV group had lower odds of linking to treatment (AOR = 0.36, 95% CI = 0.17, 0.78, Hochberg adjusted P = 0.02) compared with the no BI group.
  
  
  CONCLUSIONS
  Brief intervention delivered in primary care for screen-identified drug use did not increase addiction treatment receipt significantly; a motivational interviewing approach appeared to be counterproductive.
authors.affiliation: Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Kim
authors.affiliation: Department of Biostatistics (DMC), Data Coordinating Center (CLT), Department of Community Health Sciences, Boston University School Public Health, Boston, MA, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Bernstein
authors.affiliation: Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine, Boston, MA, USA.|Department of Biostatistics (DMC), Data Coordinating Center (CLT), Department of Community Health Sciences, Boston University School Public Health, Boston, MA, USA.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: Department of Biostatistics (DMC), Data Coordinating Center (CLT), Department of Community Health Sciences, Boston University School Public Health, Boston, MA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Lloyd-Travaglini
authors.affiliation: Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine, Boston, MA, USA.|Department of Biostatistics (DMC), Data Coordinating Center (CLT), Department of Community Health Sciences, Boston University School Public Health, Boston, MA, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.affiliation: Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
authors.forename: Tibor P
authors.initials: TP
authors.lastname: Palfai
authors.affiliation: Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine, Boston, MA, USA.|Department of Biostatistics (DMC), Data Coordinating Center (CLT), Department of Community Health Sciences, Boston University School Public Health, Boston, MA, USA.
authors.forename: Richard
authors.identifier: http://orcid.org/0000-0002-2535-1427
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000534:rehabilitation*
keywords: Addiction treatment; brief intervention; health services research; illicit drug use; motivational interviewing; primary care; randomized trial; referral to treatment