Full length articleEvaluation of a brief intervention to reduce the negative consequences of drug misuse among adult emergency department patients☆
Introduction
Validating anecdote and conventional wisdom, recent research has documented a high prevalence of drug use/misuse among adult emergency department (ED) patients in the United States (US; Blow et al., 2011, Wu et al., 2012, Johnson et al., 2013, Hankin et al., 2013, Sanjuan et al., 2014, Macias Konstantopoulos et al., 2014), which in some EDs is greater than the underlying general population that they serve (Bernardino et al., 2014). Despite this high prevalence, few ED patients with drug misuse problems have accessed drug treatment that might help them reduce or eliminate their drug use/misuse and its concomitant negative consequences (Rockett et al., 2003, Breton et al., 2007). In recognition of the high drug use/misuse prevalence and low access to treatment among ED patients, substance misuse researchers and clinicians have advocated for research to further understand how to capitalize on the captive audience of ED patients by identifying those who need treatment, providing initial interventions and encouraging follow up with treatment sources as they are available (Cunningham et al., 2009, Bernstein et al., 2009). Given the many devastating negative financial, health, psychological and social consequences of drug use/misuse, it is important that ED-based interventions not only are effective in reducing or eliminating drug use/misuse, but also have a meaningful impact on decreasing its negative consequences.
Insight into the creation of potential effective drug use/misuse interventions might be drawn from experience with ED-based alcohol use/misuse interventions. Although their use has been recommended (Cunningham et al., 2009), brief interventions (BIs) have had mixed results in reducing or eliminating alcohol consumption among adolescent and ED patients (Nilsen et al., 2007, Havard et al., 2008, Yuma-Guerrero et al., 2012, Cochran et al., 2014, Dent et al., 2008, Wojnar and Jakubczyk, 2014, D’Onofrio and Degutis, 2002, Taggart et al., 2013, D’Onofrio et al., 2012, D’Onofrio et al., 2008, Sommers et al., 2013, Bernstein et al., 2010, Academic ED SBIRT Research Collaborative, 2010, Newton et al., 2013). Furthermore, researchers have identified either decreases (Longabaugh et al., 2001, Blow et al., 2006) or no impact (Mello et al., 2013, D’Onofrio et al., 2012) of BIs on ED adult patient reported negative consequences of alcohol consumption as compared to control conditions. In a review of applicable studies, Havard et al. (2008) concluded that BIs, as compared to standard care, could reduce (Odds ratio [OR 0.59]) subsequent alcohol-related injuries among ED patients in the succeeding 6–12 months, but found that due to study heterogeneity conducting a meta-analysis on the impact of BIs on decreasing the negative consequences of alcohol use/misuse was not possible.
The impact of BIs on reducing or eliminating drug/misuse among ED patients has been less well studied. In a recent randomized, controlled trial, Bogenschutz et al. (2014) found that a BI with a telephone booster was not more efficacious in reducing self-reported days of drug use over a one-year period than minimal screening only or screening, assessment and referral to treatment. However, there are no published studies that have assessed if BIs can decrease the negative consequences of drug use/misuse among adult ED patients. Further research is needed to examine the efficacy of BIs in reducing drug use/misuse as well as their negative consequences before this approach can be recommended – or not recommended – for ED patients.
This investigation focused on evaluating the efficacy of a BI in reducing the negative consequences of drug use/misuse in a randomized, controlled trial: the Brief Intervention for Drug Misuse for the Emergency Department (BIDMED) study. The primary aim was to ascertain if a BI aimed at reducing drug use/misuse negative consequences among adult ED patients was more efficacious than no BI (study questionnaires only) over a one-year period. The secondary aim was to determine if there were demographic or clinical factors associated with decreases in the negative consequences of their drug misuse, such as severity of drug misuse at baseline enrollment and participation in a drug program, which might identify a sub-group of ED patients for whom a BI or other intervention is more beneficial.
Section snippets
Study design and setting
BIDMED was a randomized clinical trial conducted over a 30-month period from July, 2010 to December, 2012 in The Miriam Hospital and the Rhode Island Hospital EDs. The hospital institutional review board approved the study.
Study population
A random sample of ED patients was screened for study eligibility, recruited and enrolled from 8:00 am to midnight seven days a week when research assistants (RAs) were available to conduct the study. Prior to each shift of data collection, the RAs generated lists of the
Enrollment and follow-up retention
The enrollment and follow-up diagram is displayed in Fig. 1. Of the 511 participants in the control arm, 62.3%, 55.9%, 58.0%, and 59.8% participants completed the 3, 6, 9, and 12-month follow-ups, respectively, and of the 515 participants in the treatment arm, these percentages were 59.4%, 57.9%, 54.9%, and 56.5%, respectively. The majority of the participants were male (54.2%), white/non-Hispanic (56.8%); most had twelve or more years of formal education (36.4%) and had governmental healthcare
Discussion
Although it is disappointing to report and conclude, the BI employed in this study did not lead to greater reductions in the negative consequences of drug misuse than no BI (screening/answering questionnaires alone). This finding complements those from our investigation from this same population and study that observed no short-term (3-month follow-up) benefit from the BI in regards to reduced drug use or greater utilization of drug treatment services (Merchant et al., 2015). Likewise, Woodruff
Role of funding source
This research was supported by grants from the National Institute on Drug Abuse (R01 DA026066) and the Lifespan/Tufts/Brown Centers for AIDS Research (P30 AI042853). ClinicalTrials.gov identifier: NCT01124591. The funders had no role in the design or execution of the study, nor in the preparation or review of the manuscript. This manuscript was prepared in partial fulfillment of Mr. Wentao Guan's thesis requirements for his Master's of Science in Biostatistics degree from Brown University.
Contributors
Wentao Guan, MSc, Conduct of analyses, Preparation of manuscript.
Tao Liu, PhD, Supervision of analyses, Review of manuscript.
Janette R. Baird, PhD, Supervision of data collection, Supervision of intervention delivery, Review of manuscript.
Roland C. Merchant, MD, MPH, ScD, Design of study, Supervision of study, Supervision of analyses, Supervision of manuscript preparation.
Conflict of interest statement
No conflict declared.
Acknowledgements
The research team gratefully acknowledges the assistance of Ms. Vera Bernardino for preparing the data for analysis and publication, the research assistants who assessed patients for the study and helped coordinate the study (Naira Arellano, Vera Bernardino, Rosalie Berrios-Candelaria, Vianella Burgos, Ian Donaghy, Dora Estrela, Cindy Gonzalez, Alyssa Hozey, Michelle Leveillee, Stefanie Paolino, Ayanaris Reyes, and Becca Rose), and the support of the staff and patients at our two hospitals. The
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2018, Drug and Alcohol DependenceCitation Excerpt :The success of BIs targeting drug use is rather mixed. Some U.S. studies have reported no significant effects of BIs for drugs (Guan et al., 2015; Humeniuk et al., 2012; Saitz, 2014; Saitz et al., 2014; Woodruff et al., 2014), including BIs followed by boosters (Bogenschutz et al., 2014; Roy-Byrne et al., 2014). Other results are more promising; for example, a drug BI for post-partum women reduced illicit drug use (Ondersma et al., 2007; Ondersma et al., 2014).
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2023, Cochrane Database of Systematic ReviewsEfficacy of Brief Intervention for Unhealthy Drug Use in Outpatient Medical Care: a Systematic Review and Meta-analysis
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Supplementary material can be found by accessing the online version of this paper at http://dx.doi.org and by entering doi: 10.1016/j.drugalcdep.2015.10.007.