Brief Intervention for Illicit Drug Use in Primary Health Care Settings: Does It Work?

Brief intervention (BI) can decrease alcohol consumption among some patients with non-dependent unhealthy use. But does BI have efficacy for illicit drugs? The World Health Organization published the first randomized trial of drug BI among 731 primary-care patients identified with the >70-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Patients with current cannabis, cocaine, other stimulant, or opioid use were recruited from sexually-transmitted disease and walk-in clinics, a dental clinic, and community primary care sites in Australia, Brazil, the US, and India. Few patients had other drug use (e.g., hallucinogens), but most reported recent tobacco and alcohol use. Patients scoring in the moderate-risk range for drug use were randomly assigned to BI (up to 60 minutes; median, 8–20 minutes) or no BI (until after the study). Patients scoring in either the low- or high-risk range for drug use were excluded.

• Brief intervention was associated with a 3-point greater decrease (compared with delayed BI) in a substance use score with a maximum of 336 points.

• Cannabis and stimulant scores also decreased more for BI subjects (by about 2–3 points on scales with a maximum of 39 points); opioid scores did not.

• Substance use was not significantly impacted by BI in the US.

Comments:

These results suggest that BI for drugs may have some benefit in general health settings, although the clinical significance is unclear. The use of the same interviewers for the BI and follow-up assessments at most sites could introduce a bias favoring BI, and since the source of most patients was not what is usually considered primary care (meaning longitudinal, continuous comprehensive care), whether or not it will have important clinical benefits remains unknown. Nor has the clinical meaning of small differences in substance use scores been established. Screening and BI for illicit drug use is clearly more complex than it is for alcohol.

Richard Saitz, MD, MPH

Reference:

Humeniuk R, Dennington V, Ali R, et al.The Effectiveness of a Brief Intervention for Illicit Drugs Linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in Primary Health Care Settings: A Technical Report of Phase III Findings of the WHO ASSIST Randomized Controlled Trial. Geneva, Switzerland: WHO, 2008.