Two Versions of Brief Intervention for Drug Use: No Better Than Usual Care In Facilitating Treatment Receipt

Mounting evidence suggests that screening, brief intervention, and referral-to-treatment (SBIRT) alone is ineffective in reducing drug use in primary care, but it is unknown whether the referral-to-treatment (RT) component might increase receipt of formal addiction treatment. Researchers randomized drug-screen-positive primary care patients to one of 3 conditions: a 10–15 minute brief negotiated interview (BNI, n=174), a 30–45 minute brief motivational interview (BMI, n=177), or no intervention (control, n=177).

• The main drugs used were marijuana (63%), cocaine (19%), and opioids (17%).
• The BNI group did not differ from controls in addiction treatment engagement within 6 months, but the BMI group had lower odds of treatment receipt (odds ratio, 0.36).
• Treatment receipt was lowest for people with marijuana use and those with greater severity of alcohol use.
• Greater overall severity of total substance use was associated with higher odds of treatment receipt (adjusted odds ratio, 1.14 per 5-unit increase in Global ASSIST score).

Comments: This study found no evidence that referral-to-treatment (RT) as part of a brief intervention (BI) led to increased substance use treatment receipt compared with controls. However, it is difficult to disentangle BI from RT, and unclear as to what constitutes RT – was advising “you should go to treatment/Narcotics Anonymous” enough? Giving a telephone number for a program? Making someone an appointment? We also do not know the extent to which these interventions were performed in the control condition. The finding that motivational interviewing led to less treatment receipt than control seems counterintuitive, until one considers that an approach that “meets people where they are” might unintentionally give non-treatment-seeking patients permission to ignore a provider’s advice to seek treatment. This finding should be interpreted with caution without knowing the extent to which the motivational interviewers provided advice to seek formal treatment as the best option for those with substance use disorder.

Peter D. Friedmann, MD, MPH

Reference: Kim TW, Bernstein J, Cheng DM, et al. Receipt of addiction treatment as a consequence of a brief intervention for drug use in primary care: a randomized trial. Addiction. 2016 [Epub ahead of print]. doi: 10.1111/add.13701.