Brief interventions ineffective for unhealthy, problem drug use

Two recent studies published in JAMA suggest that brief interventions for unhealthy drug use are ineffective.

Brief intervention with telephone booster

In the first study, Peter Roy-Byrne, MD, of the University of Washington School of Medicine, and colleagues conducted a randomized clinical trial of 868 adults aged 18 years or older to determine the efficacy of a brief counseling intervention for unhealthy drug use compared with enhanced care as usual. Participants were assessed at baseline and 3, 6, 9 and 12 months. The brief intervention used motivational interviewing, a handout with list of substance abuse resources and an attempted 10-minute telephone booster within 2 weeks (n=435). The enhanced care as usual arm also included a handout and list of substance abuse resources (n=433).

Ninety-seven percent of participants randomly assigned to intervention received a brief intervention and 47% received a booster call. Intervention and baseline assessment were conducted during the same visit among 90% of participants.

At baseline, the most common problem drug was used for an average of 14.4 days in the brief intervention group and 13.25 days in the enhanced care group. Following intervention, and through 12 months, average days of drug use did not differ significantly between the two groups.

“A one-time brief intervention with attempted telephone booster call had no effect on drug use in patients seen in safety-net primary care settings,” the researchers wrote. “This finding suggests a need for caution in promoting widespread adoption of this intervention for drug use in primary care.”

Two counseling interventions

In the second study, Richard Saitz, MD, MPH, of the Boston University School of Public Health, and colleagues randomly assigned 528 adult primary care patients to receive either a brief negotiated interview (BNI), an adaption of motivational interviewing (MOTIV), or no brief intervention, to determine their effectiveness on unhealthy drug use.

No significant differences were found between the three groups for mean days using the main drug. Similarly, no significant differences were found between the groups for main drug use and risk for drug dependence.

“Brief intervention did not have efficacy for decreasing unhealthy drug use in primary care patients identified by screening,” the researchers wrote. “These results do not support widespread implementation of illicit drug use and prescription drug misuse screening and brief intervention.”

Future goals

In an accompanying editorial, Ralph Hingson, ScD, MPH, of the National Institute on Alcohol Abuse and Alcoholism, and Wilson M. Compton, MD, MPE, of the National Institute on Drug Abuse, wrote that although there is no direct evidence on the effectiveness of universal drug screening, brief intervention or referral to treatment in either study, it is important to explore drug use among primary care patients.

“The goal for clinical research is to develop and test new interventions with potential for benefiting patients,” they wrote. “Drug screening and brief intervention research that focuses on adolescents and young adults is especially needed because rates of marijuana use among young people and the potency of marijuana have increased at the same time that recognition among youth of the health risks of marijuana use have declined.”

They add that “accessible treatment services with long-term follow-up may be needed, as will development of efficient primary care referral approaches to address risky substance use and related physical and mental comorbidities.”

For more information:

Hingson R. JAMA. 2014;312:488-489.

Roy-Byrne P. JAMA. 2014;312:492-501.

Saitz R. JAMA. 2014;312:502-513.

Disclosure: See the full studies for a complete list of the researchers’ financial disclosures.