Brief Interventions May Be Effective for Lower-risk Non-cannabis Substance Use

Brief interventions (BI) alone, and as part of screening and referral to treatment (SBIRT), have been shown to be effective for certain types of unhealthy alcohol use, but studies in a variety of settings have failed to show consistent effects on the use of other substances. Two recent studies provided promising results for individuals with lower-risk substance use.

Karno et al studied SBIRT in 718 adults with an affective or psychotic disorder who reported any past 90-day use of cannabis or stimulants, or ≥1 heavy drinking days. Participants were randomly assigned to either SBIRT delivered by trained clinicians, or a health education session (control).

• Compared with the control group, participants who received SBIRT had significantly fewer heavy drinking days at 3-month follow-up (odds ratio [OR], 0.53) and less frequent stimulant use (OR, 0.58), but cannabis use did not differ (OR, 0.93). At 6 months, heavy drinking days and stimulant use remained significantly lower. At 12 months, only stimulant use was significantly lower.
• There were no significant differences in rates of abstinence or receipt of addiction-focused treatment.

Bertholet et al conducted a pilot trial in a primary care clinic among 61 individuals with lower-risk substance use, defined as a score of 2 or 3 on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants were randomly assigned to one of the following: 1) a brief negotiated interview delivered by trained health educators; 2) adaptation of motivational interviewing delivered by master’s degree-level counselors; or 3) no BI.

• At 6-month follow-up, participants in the 2 BI groups reported significantly fewer days of use of their primary substance, compared with the group that received no BI. When stratified by primary substance, the difference was significant for “cocaine, opioids and other,” but not for cannabis.
• Identification rates of any primary substance on follow-up hair analyses were lower in the 2 BI groups, but the difference was not significant.
• There were no significant differences in substance-related problems.

Comments: These studies suggest that brief interventions may be effective for lower-risk use of substances other than cannabis. This is consistent with previous studies showing BI to be effective for unhealthy alcohol use that does not meet criteria for alcohol use disorder. It is important to note that these interventions were delivered by trained staff and not by patients’ regular clinicians.

Darius A. Rastegar, MD

References: Karno MP, Rawson R, Rogers B, et al. Effect of screening brief intervention and referral to treatment for unhealthy alcohol and other drug use in mental health treatment settings: a randomized controlled trial. Addiction. 2020 [Epub ahead of print]. doi: 10.1111/add.15114.

Bertholet N, Meli S, Palfai TP, et al. Screening and brief intervention for lower-risk drug use in primary care: a pilot randomized trial. Drug Alcohol Depend. 2020;213:108001.