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Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2014

Open Access 01-12-2014 | Research

Randomized clinical trial of the effects of screening and brief intervention for illicit drug use: the life shift/shift gears study

Authors: Susan I Woodruff, John D Clapp, Kimberly Eisenberg, Cameron McCabe, Melinda Hohman, Audrey M Shillington, C Beth Sise, Edward M Castillo, Theodore C Chan, Michael J Sise, Joey Gareri

Published in: Addiction Science & Clinical Practice | Issue 1/2014

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Abstract

Background

Although screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals.

Methods

A total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite.

Results

Of 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12).

Conclusions

In this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome.

Trial registration

ClinicalTrials.gov NCT01683227.
Appendix
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Literature
1.
2.
3.
Cherpitel CJ, Ye Y: Alcohol-attributable fraction for injury in the U.S. general population: data from the 2005 National alcohol survey. J Stud Alcohol Drugs. 2005, 69: 535-538.CrossRef
4.
Substance Abuse and Mental Health Services Administration (SAMHSA)/Center for Substance Abuse Treatment (CSAT): Treatment Improvement Protocol (TIP) Series 24. A guide to substance abuse services for primary care clinicians. 1997, Rockville: U.S: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, DHHS Publication No. (SMA) 97–3139
5.
Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahme K, Bray J: Screening, brief intervention, and referral to treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007, 28 (3): 7-30. 10.1300/J465v28n03_03.CrossRefPubMed
6.
Longabaugh R, Woolard RF, Nirenberg TD, Minugh AP, Becker B, Clifford PR, Carty K, Licsw , Sparadeo F, Gogineni A: Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department. J Stud Alcohol. 2001, 62: 806-816.CrossRefPubMed
7.
Wilk AI, Jensen NM, Havighurst TC: Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. J Gen Intern Med. 1997, 12 (5): 274-283. 10.1007/s11606-006-5063-z.PubMedCentralCrossRefPubMed
8.
D’Onofrio G, Degutis LC: Preventive care in the emergency department: screening and brief intervention for alcohol problems in the emergency department: a systematic review. Acad Emerg Med. 2002, 9: 627-638. 10.1111/j.1553-2712.2002.tb02304.x.CrossRefPubMed
9.
Saitz R: Screening and brief intervention enter their 5th decade. Subst Abus. 2007, 28 (3): 3-6. 10.1300/J465v28n03_02.CrossRefPubMed
10.
Saitz R, Alford DP, Bernstein J, Cheng DM, Samet J, Palfai T: Screening and brief intervention for unhealthy drug use in primary care settings: randomized clinical trials are needed. J Addict Med. 2010, 4 (3): 123-130. 10.1097/ADM.0b013e3181db6b67.PubMedCentralCrossRefPubMed
11.
Humeniuk R, Ali R, Babor T, Souze-Formigoni ML, de Lacerda RB, Ling W, McRee B, Newcombe D, Pal H, Poznyak V, Simon S, Vendetti J: A randomized controlled trial of a brief intervention for illicit drugs linked to the alcohol, smoking and substance involvement screening test (ASSIST) in clients recruited from primary health-care settings in four countries. Addiction. 2012, 107: 957-966. 10.1111/j.1360-0443.2011.03740.x.CrossRefPubMed
12.
Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW: Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009, 99: 280-295. 10.1016/j.drugalcdep.2008.08.003.PubMedCentralCrossRefPubMed
13.
Bernstein J, Bernstein E, Tassiopoulos K, Heeren T, Levenson S, Hingson R: Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug Alcohol Depend. 2005, 77: 49-59. 10.1016/j.drugalcdep.2004.07.006.CrossRefPubMed
14.
Bernstein E, Bernstein JA, Stein JB, Saitz R: SBIRT in emergency care settings: are we ready to take it to scale?. Acad Emerg Med. 2009, 16: 1072-1077. 10.1111/j.1553-2712.2009.00549.x.CrossRefPubMed
15.
Eisenberg K, Woodruff SI: Randomized controlled trial to evaluate screening and brief intervention for drug-using multiethnic emergency and trauma department patients. Addict Sci Clin Pract. 2013, 8: 8-10.1186/1940-0640-8-8. doi:10.1186/1940-0640-8-8PubMedCentralCrossRefPubMed
16.
Magura S: Validating self-reports of illegal drug use to evaluate national drug control policy: a reanalysis and critique. Eval Program Plann. 2010, 33: 234-237. 10.1016/j.evalprogplan.2009.08.004.CrossRefPubMed
17.
Nutt DJ, King LA, Phillips LD: Independent Scientific Committee on Drugs: drug harms in the UK: a multicriteria decision analysis. Lancet. 2010, 376: 1558-1565. 10.1016/S0140-6736(10)61462-6.CrossRefPubMed
18.
Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG: AUDIT – The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care 2nd Edition. 2001, Geneva, Switzerland: World Health Organization, Department of Mental Health and Substance Dependence
19.
Yudko E, Lozhkina O, Fouts A: A comprehensive review of the psychometric properties of the drug abuse screening test. J Subst Abuse Treat. 2007, 32: 189-198. 10.1016/j.jsat.2006.08.002.CrossRefPubMed
20.
Skinner HA: The drug abuse screening test. Addict Behav. 1982, 7 (4): 363-371. 10.1016/0306-4603(82)90005-3.CrossRefPubMed
21.
Moher D, Schulz KF, Altman DG: CONSORT group: the CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. BMC Med Res Methodol. 2001, 1: 2-10.1186/1471-2288-1-2.PubMedCentralCrossRefPubMed
22.
McLellan AT, Luborsky L, Woody GE, O’Brien CP: An improved diagnostic evaluation instrument for substance abuse patients: the addiction severity index. J Nerv Ment Dis. 1980, 168 (1): 26-33. 10.1097/00005053-198001000-00006.CrossRefPubMed
23.
Murphy SA, Collins LM, Rush AJ: Editorial: customizing treatment to the patient: adaptive treatment strategies. Drug Alcohol Depend. 2007, 88 (2): S1-S3.PubMedCentralCrossRefPubMed
24.
Prochaska JO, DiClemente CC, Norcross JC: In search of how people change: applications to addictive behaviors. Am Psychol. 1992, 47 (9): 1102-1114.CrossRefPubMed
25.
26.
Miller WR, Rollnick S: Motivational interviewing: preparing people for change (2nd ed). 2002, New York: Guilford Press
27.
Lawton R, Parker D, Manstead ASR, Stradling SG: The role of affect in predicting social behaviors: the case of road traffic violations. J Appl Soc Psychol. 1997, 27 (14): 1258-1276. 10.1111/j.1559-1816.1997.tb01805.x. doi: 10.1111/j.1559-1816.1997.tb01805.xCrossRef
28.
Parker D, Reason JT, Manstead ASR, Stradling SG: Driving errors, driving violations and accident involvement. Ergonomics. 1995, 38 (5): 1036-1048. 10.1080/00140139508925170. doi: 10.1080/00140139508925170CrossRef
29.
Reason JT, Manstead ASR, Stradling SG, Baxter JS, Campbell K: Errors and violations on the road: a real distinction?. Ergonomics. 1990, 33: 1315-1332. 10.1080/00140139008925335. doi: 10.1080/00140139008925335CrossRefPubMed
30.
Cacciola JS, Alterman AI, McLellan AT, Lin YT, Lynch KG: Initial evidence for the reliability and validity of a “lite” version of the addiction severity index. Drug Alcohol Depend. 2007, 16: 297-302.CrossRef
31.
32.
McLellan AT, Cacciola JC, Alterman AI, Rikoon SH, Carise C: The addiction severity index at 25: origins, contributions and transitions. Am J Addict. 2006, 15 (2): 113-124. 10.1080/10550490500528316.CrossRefPubMed
33.
Victorin K, Haag-Gronlund M, Skerfving S: Methods for health risk assessment of chemicals: are they relevant for alcohol?. Alcohol Clin Exp Res. 1998, 22 (7): 270S-276S. 10.1111/j.1530-0277.1998.tb03923.x.CrossRefPubMed
34.
Wish ED, Hoffman JA, Nemes S: The validity of self-reports of drug use at treatment admission and at follow-up: comparisons with urinalysis and hair assays. Validity of Self-Reported Drug Use: Improving the Accuracy of Survey Estimates, Research Monograph 167L. Edited by: Harrison , Hughes A. 1997, Rockville: National Institute on Drug Abuse, 200-226. NIH Publication No. 97–4147
35.
Pragst F, Balikova MA: State of the art in hair analysis for detection of drug and alcohol abuse. Clin Chim Acta. 2006, 370: 17-49. 10.1016/j.cca.2006.02.019.CrossRefPubMed
36.
Aleksa K, Walasek P, Fulga N, Kapur B, Gareri J, Koren G: Simultaneous detection of seventeen drugs of abuse and metabolites in hair using solid phase micro extraction (SPME) with GC/MS. Forensic Sci Int. 2012, 218 (1–3): 31-36.CrossRefPubMed
37.
Coon GM, Pena D, Illich PA: Self-efficacy and substance abuse: assessment using a brief phone interview. J Subst Abuse Treat. 1998, 15 (5): 385-391. 10.1016/S0740-5472(97)00285-7.CrossRefPubMed
38.
Rubin RB: Multiple Imputation for Nonresponse in Surveys. 1987, New York: John Wiley and Sons, Inc.CrossRef
39.
Bray JW, Cowell AJ, Hinde JM: A systematic review and meta-analysis of health care utilization outcomes in alcohol screening and brief intervention trials. Med Care. 2011, 49 (3): 287-294. 10.1097/MLR.0b013e318203624f. doi: 10.1097/MLR.0b013e318203624fCrossRefPubMed
40.
Polen MR, Whitlock EP, Wisdom JP, Nygren P, Bougatsos C: Screening in primary care settings for illicit drug use: staged systematic review for the United States preventive services task force. Evidence Synthesis No. 58, Part 1. 2008, Agency for Healthcare Research and Quality: Rockville
41.
Hinden R, McCusker J, Vickers-Lahti M, Bigelow C, Garfield F, Lewis B: Radioimmunoassay of hair for determination of cocaine, heroin, and marijuana exposure: comparison with self-report. Int J Addict. 1994, 29 (6): 771-789.
42.
Rounsaville BJ, Petry NM, Carroll KM: Single versus multiple drug focus in substance abuse clinical trials research. Drug Alcohol Depend. 2003, 70 (2): 117-125. 10.1016/S0376-8716(03)00033-4.PubMedCentralCrossRefPubMed
43.
Bootzin RR: The role of expectancy in behavior change. Placebo: Theory, Research and Mechanisms. Edited by: White L, Tursky B, Schwartz GE. 1985, New York: Guilford Press, 196-210.
Metadata
Title
Randomized clinical trial of the effects of screening and brief intervention for illicit drug use: the life shift/shift gears study
Authors
Susan I Woodruff
John D Clapp
Kimberly Eisenberg
Cameron McCabe
Melinda Hohman
Audrey M Shillington
C Beth Sise
Edward M Castillo
Theodore C Chan
Michael J Sise
Joey Gareri
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2014
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/1940-0640-9-8

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