Janice Vendetti

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

AIMS This study evaluated the effectiveness of a brief intervention (BI) for illicit drugs (cannabis, cocaine, amphetamine-type stimulants and opioids) linked to the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST screens for problem or risky use of 10 psychoactive substances, producing a score for each substance that falls into either a low-, moderate- or high-risk category. DESIGN Prospective, randomized controlled trial in which participants were either assigned to a 3-month waiting-list control condition or received brief motivational counselling lasting an average of 13.8 minutes for the drug receiving the highest ASSIST score. SETTING Primary health-care settings in four countries: Australia, Brazil, India and the United States. PARTICIPANTS A total of 731 males and females scoring within the moderate-risk range of the ASSIST for cannabis, cocaine, amphetamine-type stimulants or opioids. MEASUREMENTS ASSIST-specific substance involvement scores for cannabis, stimulants or opioids and ASSIST total illicit substance involvement score at baseline and 3 months post-randomization. FINDINGS Omnibus analyses indicated that those receiving the BI had significantly reduced scores for all measures, compared with control participants. Country-specific analyses showed that, with the exception of the site in the United States, BI participants had significantly lower ASSIST total illicit substance involvement scores at follow-up compared with the control participants. The sites in India and Brazil demonstrated a very strong brief intervention effect for cannabis scores (P < 0.005 for both sites), as did the sites in Australia (P < 0.005) and Brazil (P < 0.01) for stimulant scores and the Indian site for opioid scores (P < 0.01). CONCLUSIONS The Alcohol, Smoking and Substance Involvement Screening Test-linked brief intervention aimed at reducing illicit substance use and related risks is effective, at least in the short term, and the effect generalizes across countries.

The SBIRT program matrix: a conceptual framework for program implementation and evaluation

BACKGROUND AND AIMS Screening, Brief Intervention and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of services to those at risk for the adverse consequences of alcohol and other drug use, and for those with probable substance use disorders. Research on successful SBIRT implementation has lagged behind studies of efficacy and effectiveness. This paper (1) outlines a conceptual framework, the SBIRT Program Matrix, to guide implementation research and program evaluation and (2) specifies potential implementation outcomes. METHODS Overview and narrative description of the SBIRT Program Matrix. RESULTS The SBIRT Program Matrix has five components, each of which includes multiple elements: SBIRT services; performance sites; provider attributes; patient/client populations; and management structure and activities. Implementation outcomes include program adoption, acceptability, appropriateness, feasibility, fidelity, costs, penetration, sustainability, service provision and grant compliance. CONCLUSIONS The Screening, Brief Intervention and Referral to Treatment Program Matrix provides a template for identifying, classifying and organizing the naturally occurring commonalities and variations within and across SBIRT programs, and for investigating which variables are associated with implementation success and, ultimately, with treatment outcomes and other impacts.

Program- and service-level costs of seven screening, brief intervention, and referral to treatment programs

This paper examines the costs of delivering screening, brief intervention, and referral to treatment (SBIRT) services within the first seven demonstration programs funded by the US Substance Abuse and Mental Health Services Administration. Service-level costs were estimated and compared across implementation model (contracted specialist, inhouse specialist, inhouse generalist) and service delivery setting (emergency department, hospital inpatient, outpatient). Program-level costs were estimated and compared across grantee recipient programs. Service-level data were collected through timed observations of SBIRT service delivery. Program-level data were collected during key informant interviews using structured cost interview guides. At the service level, support activities that occur before or after engaging the patient comprise a considerable portion of the cost of delivering SBIRT services, especially short duration services. At the program level, average costs decreased as more patients were screened. Comparing across program and service levels, the average annual operating costs calculated at the program level often exceeded the cost of actual service delivery. Provider time spent in support of service provision may comprise a large share of the costs in some cases because of potentially substantial fixed and quasifixed costs associated with program operation. The cost structure of screening, brief intervention, and referral to treatment is complex and discontinuous of patient flow, causing annual operating costs to exceed the costs of actual service provision for some settings and implementation models.

Screening and brief intervention for patients with tobacco and at-risk alcohol use in a dental setting

Despite the relevance of screening and brief intervention (SBI) to the prevention of dental pathology, particularly with tobacco and at-risk alcohol use, there has been little attention to the determination of its effectiveness in dental settings. Further, most SBI research efforts have focused on the treatment of single risk factors despite the fact that use of psychoactive substances tends to co-occur. There is also debate about the optimal timing of interventions for multiple risk behaviors, i.e., whether to intervene simultaneously or sequentially. This study was designed to test the efficacy of SBI practices aimed at dental patients who were both smokers and at-risk drinkers. Participants (N = 288) were randomized into four experimental conditions to test the efficacy of comparative interventions for tobacco and at-risk alcohol use when delivered separately and in combined forms, and to compare the effects of sequential versus simultaneous interventions. The results indicated that individuals in each of three active brief intervention (BI) groups (alcohol BI, tobacco BI, and combined alcohol and tobacco BI) significantly reduced self-reported drinks per week and cigarettes per day compared with those in the wait-list control group. There was no advantage to the combined versus single-substance focused interventions as individuals changed both behaviors regardless of the treatment intervention received. No significant differences in self-reported drinks per week or cigarettes per day were found between those receiving simultaneous versus sequential interventions. These findings have implications for the design of BI aimed at multiple substance use and imply that no matter where a provider begins with respect to behavior-change focus, she or he may affect change in patients across multiple substance use behaviors.

Screening, brief intervention, and referral to treatment (SBIRT) implementation models and work flow processes: commonalities and variations

The Substance Abuse and Mental Health Services Administration (SAMHSA) sponsored a cross-site evaluation of the grantees of their Screening, brief intervention, and referral to treatment (SBIRT) program for alcohol and other drugs funded in 2008. As part of this evaluation, the cross-site evaluation team was tasked with understanding the implementation and service delivery protocols and work flow processes related to SBIRT service delivery. SBIRT programs have been implemented in a variety of different settings and performance sites, and each has adjusted the flow of SBIRT services to meet the needs of the particular setting. This presentation will focus on the variations in SBIRT program activities and work flow by three performance site types: (1) Emergency Departments; (2) Inpatient Hospitals; and (3) Outpatient Clinics. Descriptions of the service providers involved in the various SBIRT service components are presented.