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Addiction Science & Clinical Practice

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Open Access 01-12-2017 | Research

Changes in Specific Substance Involvement Scores among SBIRT recipients in an HIV primary care setting

Authors: Carol Dawson-Rose, Jessica E. Draughon, Yvette Cuca, Roland Zepf, Emily Huang, Bruce A. Cooper, Paula J. Lum

Published in: Addiction Science & Clinical Practice | Issue 1/2017

Abstract

Background

Substance use is common among people living with HIV (PLHIV) and is associated with worse outcomes along the HIV care continuum. One potentially effective clinic-based approach to addressing unhealthy substance use is screening, brief intervention, and referral to treatment (SBIRT).

Methods

We conducted a two-arm randomized trial to examine the effects of a self-administered, computerized SBIRT intervention compared to a clinician-administered SBIRT intervention in an HIV primary clinic. Patients were surveyed before receiving the intervention and again at 1, 3, and 6 months. We administered the WHO Alcohol, Smoking and Substance Involvement Screening Test to determine Specific Substance Involvement Scores (SSIS) and to assign participants to categories of lower, moderate, or high risk to health and other problems for each substance. We collapsed moderate or severe risk responses into a single moderate–high risk category. Based on low rates of participation in the computerized arm, we conducted an “as treated” analysis to examine 6-month changes in mean SSIS among SBIRT intervention participants.

Results

For the overall sample (n = 208), baseline mean SSIS were in the moderate risk category for alcohol, tobacco, cannabis, cocaine, amphetamine, sedatives and opioids. Of those enrolled, 134 (64.4%) received the intervention, and 109 (52.4%) completed the 6-month follow up. There was a statistically significant decline in mean SSIS for all substances except tobacco and cannabis among participants who were at moderate–high risk at baseline. We also observed a statistically significant increase in mean SSIS for all substances except amphetamines and sedatives among participants who were at lower risk at baseline.

Conclusions

Substance use among patients in this urban, safety-net, HIV primary care clinic was near universal, and moderate risk substance use was common. Among participants who received the SBIRT intervention, mean SSISs decreased among those at moderate–high risk at baseline, but increased among those at lower risk at baseline over the 6-month study period. Additional research should examine the clinical significance of SSIS changes for PLHIV, which SBIRT components drive changes in substance use scores, and what other interventions might support those patients at lower risk to maintain health and engagement along the HIV care continuum.

Trial registration ClinicalTrials.gov study NCT01300806

CDC. HIV in the United States: at a Glance. 2016. http://www.cdc.gov/hiv/statistics/overview/ataglance.html. Accessed 29 Nov 2016.

Strathdee SA, Hallett TB, Bobrova N, Rhodes T, Booth R, Abdool R, et al. HIV and risk environment for injecting drug users: the past, present, and future. Lancet. 2010;376:268–84. https://doi.org/10.1016/s0140-6736(10)60743-x.CrossRefPubMed

Williams EC, Hahn JA, Saitz R, Bryant K, Lira MC, Samet JH. Alcohol use and human immunodeficiency virus (HIV) infection: current knowledge, implications, and future directions. Alcohol Clin Exp Res. 2016;40:2056–72. https://doi.org/10.1111/acer.13204.CrossRefPubMedPubMedCentral

San Francisco Department of Public Health. HIV Epidemiology Annual Report 2015. 2015. https://www.sfdph.org/dph/comupg/oprograms/HIVepiSec/HIVepiSecReports.asp. Accessed 29 Nov 2016.

Westergaard RP, Hess T, Astemborski J, Mehta SH, Kirk GD. Longitudinal changes in engagement in care and viral suppression for HIV-infected injection drug users. AIDS. 2013;27:2559–66. https://doi.org/10.1097/QAD.0b013e328363bff2.CrossRefPubMedPubMedCentral

Christopoulos KA, Massey AD, Lopez AM, Geng EH, Johnson MO, Pilcher CD, et al. “Taking a half day at a time:” patient perspectives and the HIV engagement in care continuum. AIDS Patient Care STDs. 2013;27:223–30. https://doi.org/10.1089/apc.2012.0418.CrossRefPubMedPubMedCentral

Nicholas PK, Willard S, Thompson C, Dawson-Rose C, Corless IB, Wantland DJ, et al. Engagement with care, substance use, and adherence to therapy in HIV/AIDS. AIDS Res Treat. 2014. https://doi.org/10.1155/2014/675739.PubMedPubMedCentral

Mimiaga MJ, Reisner SL, Grasso C, Crane HM, Safren SA, Kitahata MM, et al. Substance use among HIV-infected patients engaged in primary care in the United States: findings from the Centers for AIDS Research Network of Integrated Clinical Systems cohort. Am J Public Health. 2013;103:1457–67. https://doi.org/10.2105/AJPH.2012.301162.CrossRefPubMedPubMedCentral

Risher K, Mayer KH, Beyrer C. HIV treatment cascade in MSM, people who inject drugs, and sex workers. Curr Opin HIV AIDS. 2015;10:420–9. https://doi.org/10.1097/coh.0000000000000200.CrossRefPubMedPubMedCentral

10.

Walley AY, Palmisano J, Sorensen-Alawad A, Chaisson C, Raj A, Samet JH, et al. Engagement and substance dependence in a primary care-based addiction treatment program for people infected with HIV and people at high-risk for HIV infection. J Subst Abuse Treat. 2015;59:59–66. https://doi.org/10.1016/j.jsat.2015.07.007.CrossRefPubMed

11.

Cohen SM, Hu X, Sweeney P, Johnson AS, Hall HI. HIV viral suppression among persons with varying levels of engagement in HIV medical care, 19 US jurisdictions. J Acquir Immune Defic Syndr. 2014;67:519–27. https://doi.org/10.1097/qai.0000000000000349.CrossRefPubMed

12.

Golin CE, Liu H, Hays RD, Miller LG, Beck CK, Ickovics J, et al. A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med. 2002;17:756–65.CrossRefPubMedPubMedCentral

13.

Volkow ND, Montaner J. Enhanced HIV testing, treatment, and support for HIV-infected substance users. JAMA. 2010;303:1423–4. https://doi.org/10.1001/jama.2010.421.CrossRefPubMedPubMedCentral

14.

Dombrowski JC, Kitahata MM, Van Rompaey SE, Crane HM, Mugavero MJ, Eron JJ, et al. High levels of antiretroviral use and viral suppression among persons in HIV care in the United States, 2010. J Acquir Immune Defic Syndr. 2013;63:299–306. https://doi.org/10.1097/QAI.0b013e3182945bc7.CrossRefPubMedPubMedCentral

15.

Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality, “The NSDUH Report: HIV/AIDS and Substance Use,” ed. Rockville; 2010.

16.

U.S. Department of Health and Human Services (HHS) Office of the Surgeon General, “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” HHS, ed. Washington; 2016.

17.

Williams EC, Lapham GT, Shortreed SM, Rubinsky AD, Bobb JF, Bensley KM, et al. Among patients with unhealthy alcohol use, those with HIV are less likely than those without to receive evidence-based alcohol-related care: a national VA study. Drug Alcohol Depend. 2017;174:113–20.CrossRefPubMed

18.

Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis. 2013;57:1164–71. https://doi.org/10.1093/cid/cit420.CrossRefPubMed

19.

Carroll K, Ball S, Martino S, Nich C, Babuscio T, Nuro K, et al. Computer-assisted delivery of cognitive-behavioral therapy for addiction: a randomized trial of CBT4CBT. Am J Psychiatry. 2008;165:881–8.CrossRefPubMedPubMedCentral

20.

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;99:280–95. https://doi.org/10.1016/j.drugalcdep.2008.08.003.CrossRefPubMed

21.

Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA. Revisiting our review of screening, brief intervention and referral to treatment (SBIRT): meta-analytical results still point to no efficacy in increasing the use of substance use disorder services. Addiction. 2016;111:181–3. https://doi.org/10.1111/add.13146.CrossRefPubMed

22.

Humeniuk R, Ali R, Babor T, Souza-Formigoni ML, de Lacerda RB, Ling W, et al. 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;107:957–66. https://doi.org/10.1111/j.1360-0443.2011.03740.x.CrossRefPubMed

23.

Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials. Addiction. 2015;110:1404–15. https://doi.org/10.1111/add.12950.CrossRefPubMedPubMedCentral

24.

Williams EC, Lapham GT, Bobb JF, Rubinsky AD, Catz SL, Shortreed SM, et al. Documented brief intervention not associated with resolution of unhealthy alcohol use one year later among VA patients living with HIV. J Subst Abuse Treat. 2017;78:8–14.CrossRefPubMedPubMedCentral

25.

Rahm AK, Boggs JM, Martin C, Price DW, Beck A, Backer TE, et al. Facilitators and barriers to implementing screening, brief intervention, and referral to treatment (SBIRT) in primary care in integrated health care settings. Subst Abuse. 2015;36:281–8. https://doi.org/10.1080/08897077.2014.951140.CrossRef

26.

WHO Assist Working Group. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction. 2002;97:1183–94.CrossRef

27.

McNeely J, Strauss SM, Wright S, Rotrosen J, Khan R, Lee JD, et al. Test–retest reliability of a self-administered Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary care patients. J Subst Abuse Treat. 2014;47:93–101.CrossRefPubMedPubMedCentral

28.

Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed 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;28:7–30.CrossRefPubMed

29.

Humeniuk R, Ali R, Babor TF, Farrell M, Formigoni ML, Jittiwutikarn J, et al. Validation of the Alcohol, Smoking And Substance Involvement Screening Test (ASSIST). Addiction. 2008;103:1039–47. https://doi.org/10.1111/j.1360-0443.2007.02114.x.CrossRefPubMed

30.

Kahn JS, Hilton JF, Van Nunnery T, Leasure S, Bryant KM, Hare CB, et al. Personal health records in a public hospital: experience at the HIV/AIDS clinic at San Francisco General Hospital. J Am Med Inform Assoc. 2010;17:224–8.CrossRefPubMedPubMedCentral

31.

StataCorp. Stata Statistical Software: Release 14. College Station: StataCorp LP; 2015.

32.

Hox J. Multilevel analysis: techniques and applications. 2nd ed. New York: Routledge Academic, Taylor & Francis Group; 2010.

33.

Rabe-Hesketh S, Skrondal A. Multilevel and longitudinal modeling using Stata. 3rd ed. College Station: Stata Press; 2012.

34.

Singer JD, Willett JB. Applied longitudinal data analysis: modeling change and event occurrence. New York: Oxford University Press; 2003.CrossRef

35.

Carpenter J, Bithell J. Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Stat Med. 2000;19:1141–64.CrossRefPubMed

36.

Efron B. The bootstrap and modern statistics. J Am Stat Assoc. 2000;95:1293–6.CrossRef

37.

Wehrens R, Putter H, Buydens LM. The bootstrap: a tutorial. Chemom Intell Lab Syst. 2000;54:35–52. https://doi.org/10.1016/s0169-7439(00)00102-7.CrossRef

38.

Wood M. Bootstrapped confidence intervals as an approach to statistical inference. Organ Res Methods. 2005;8:454–70. https://doi.org/10.1177/1094428105280059.CrossRef

39.

Zhu WM. Making bootstrap statistical inferences: a tutorial. Res Q Exerc Sport. 1997;68:44–55.CrossRefPubMed

40.

Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382:1575–86. https://doi.org/10.1016/S0140-6736(13)61611-6.CrossRefPubMed

41.

Academic ED SBIRT Research Collaborative. The impact of screening, brief intervention, and referral for treatment on emergency department patients’ alcohol use. Ann Emerg Med. 2007;50:699–710 (e6).CrossRef

42.

Saitz R, Palfai TP, Cheng DM, Alford DP, Bernstein JA, Lloyd-Travaglini CA, et al. Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial. JAMA. 2014;312:502–13. https://doi.org/10.1001/jama.2014.7862.CrossRefPubMedPubMedCentral

43.

Roy-Byrne P, Bumgardner K, Krupski A, Dunn C, Ries R, Donovan D, et al. Brief intervention for problem drug use in safety-net primary care settings: a randomized clinical trial. JAMA. 2014;312:492–501. https://doi.org/10.1001/jama.2014.7860.CrossRefPubMedPubMedCentral

44.

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. https://doi.org/10.1016/j.drugalcdep.2004.07.006.CrossRefPubMed

45.

Cropsey KL, Hendricks PS, Jardin B, Clark CB, Katiyar N, Willig J, et al. A pilot study of screening, brief intervention, and referral for treatment (SBIRT) in non-treatment seeking smokers with HIV. Addict Behav. 2013;38:2541–6. https://doi.org/10.1016/j.addbeh.2013.05.003.CrossRefPubMedPubMedCentral

46.

Manuel JK, Lum PJ, Hengl NS, Sorensen JL. Smoking cessation interventions with female smokers living with HIV/AIDS: a randomized pilot study of motivational interviewing. AIDS Care. 2013;25:820–7. https://doi.org/10.1080/09540121.2012.733331.CrossRefPubMed

47.

Whitlock EP, Polen MR, Green CA, Orleans T, Klein J, Force USPST. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004;140:557–68.CrossRefPubMed

48.

Finney JW. Regression to the mean in substance use disorder treatment research. Addiction. 2008;103:42–52. https://doi.org/10.1111/j.1360-0443.2007.02032.x.CrossRefPubMed

49.

Dawson Rose C, Cuca YP, Kamitani E, Eng S, Zepf R, Draughon J, et al. Using interactive web-based screening, brief intervention and referral to treatment in an urban, safety-net HIV clinic. AIDS Behav. 2015;19(Suppl 2):186–93. https://doi.org/10.1007/s10461-015-1078-y.CrossRefPubMed

50.

Altice FL, Bruce RD, Lucas GM, Lum PJ, Korthuis PT, Flanigan TP, et al. HIV treatment outcomes among HIV-infected, opioid-dependent patients receiving buprenorphine/naloxone treatment within HIV clinical care settings: results from a multisite study. J Acquir Immune Defic Syndr. 1999;2011(56):S22.

51.

Korthuis PT, Lum PJ, Vergara-Rodriguez P, Ahamad K, Wood E, Kunkel LE, et al. Feasibility and safety of extended-release naltrexone treatment of opioid and alcohol use disorder in HIV clinics: a pilot/feasibility randomized trial. Addiction. 2017;112:1036–44. https://doi.org/10.1111/add.13753.CrossRefPubMed

Title: Changes in Specific Substance Involvement Scores among SBIRT recipients in an HIV primary care setting
Authors: Carol Dawson-Rose
Jessica E. Draughon
Yvette Cuca
Roland Zepf
Emily Huang
Bruce A. Cooper
Paula J. Lum
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Addiction Science & Clinical Practice / Issue 1/2017
Electronic ISSN: 1940-0640
DOI: https://doi.org/10.1186/s13722-017-0101-1

ACC 2024 Congress

Springer Medicine

Changes in Specific Substance Involvement Scores among SBIRT recipients in an HIV primary care setting

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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