In the Journals

Brief intervention reduces drug use among occasional users

Nicholas Bertholet

A brief intervention appeared associated with lower drug use after 6 months among occasional users, according to study results published in Drug and Alcohol Dependence.

"Clinicans are encouraged to screen for substance use in primary care," Nicolas Bertholet, MD, physician-researcher and senior lecturer at Lausanne University Hospital in Switzerland, told Healio Psychiatry. "Among individuals identified with substance use, there will be those at lower risk, as well as those at higher risk or with substance use disorders who will be in need of treatment. Before our study, we didn’t know whether a brief intervention would help to decrease or prevent an increase in drug use among those at lower risk."

According to Bertholet and colleagues from Boston University, the U.S. Preventive Services Task Force issued a draft recommendation for comment that suggested screening for illicit drug use among adults when services for accurate diagnosis and effective treatment are available; however, prior trials largely included a high proportion of individuals at high risk and with a disorder while excluding those at lower risk. This trial design structure has resulted in limited data regarding the efficacy of screening and brief intervention.

In the current study, the investigators aimed to test the efficacy of two brief interventions for drug use compared with no brief intervention among primary care patients with lower-risk drug use. They randomly assigned 61 adults (54% men; 77% black), identified by screening with Alcohol Smoking and Substance Involvement Screening Test drug-specific scores of two or three, to a brief negotiated interview or an adaptation of motivational interviewing. Number of days of main drug use in the past 30 days as determined by validated calendar method at 6 months served as the primary outcome. The investigators performed analyses using negative binomial regression adjusted for baseline use and main drug.

Cannabis was the main drug used, with 70% of participants reporting use, followed by cocaine (15%), prescription opioid (10%) and injection drug use (7%). Mean days of main drug use was 3.4. Bertholet and colleagues reported that 93% of participants completed follow up at 6 months, and adjusted mean days of main drug use were 6.4 for no brief intervention vs. 2.1 for brief negotiated interview (incidence rate ratio [IRR] = 0.33; 95% CI, 0.15-0.74) and 2.3 for motivational interviewing (IRR = 0.36; 95% CI, 0.15-0.85).

"These findings must be replicated, but the study results suggest that a brief motivational intervention is promising in preventing an increase in drug use among individuals at lower risk," Bertholet told Healio Psychiatry. "As primary care patients often suffer from multiple health conditions, it is important to be able to reduce drug use-related risk, as well as to determine what can be done with other important health risk factors related to substance use, such as tobacco and alcohol use.” – by Joe Gramigna

Disclosures: One study author reports serving on data safety monitoring boards for Janssen Research & Development. The other authors report no relevant financial disclosures.

Nicholas Bertholet

A brief intervention appeared associated with lower drug use after 6 months among occasional users, according to study results published in Drug and Alcohol Dependence.

"Clinicans are encouraged to screen for substance use in primary care," Nicolas Bertholet, MD, physician-researcher and senior lecturer at Lausanne University Hospital in Switzerland, told Healio Psychiatry. "Among individuals identified with substance use, there will be those at lower risk, as well as those at higher risk or with substance use disorders who will be in need of treatment. Before our study, we didn’t know whether a brief intervention would help to decrease or prevent an increase in drug use among those at lower risk."

According to Bertholet and colleagues from Boston University, the U.S. Preventive Services Task Force issued a draft recommendation for comment that suggested screening for illicit drug use among adults when services for accurate diagnosis and effective treatment are available; however, prior trials largely included a high proportion of individuals at high risk and with a disorder while excluding those at lower risk. This trial design structure has resulted in limited data regarding the efficacy of screening and brief intervention.

In the current study, the investigators aimed to test the efficacy of two brief interventions for drug use compared with no brief intervention among primary care patients with lower-risk drug use. They randomly assigned 61 adults (54% men; 77% black), identified by screening with Alcohol Smoking and Substance Involvement Screening Test drug-specific scores of two or three, to a brief negotiated interview or an adaptation of motivational interviewing. Number of days of main drug use in the past 30 days as determined by validated calendar method at 6 months served as the primary outcome. The investigators performed analyses using negative binomial regression adjusted for baseline use and main drug.

Cannabis was the main drug used, with 70% of participants reporting use, followed by cocaine (15%), prescription opioid (10%) and injection drug use (7%). Mean days of main drug use was 3.4. Bertholet and colleagues reported that 93% of participants completed follow up at 6 months, and adjusted mean days of main drug use were 6.4 for no brief intervention vs. 2.1 for brief negotiated interview (incidence rate ratio [IRR] = 0.33; 95% CI, 0.15-0.74) and 2.3 for motivational interviewing (IRR = 0.36; 95% CI, 0.15-0.85).

"These findings must be replicated, but the study results suggest that a brief motivational intervention is promising in preventing an increase in drug use among individuals at lower risk," Bertholet told Healio Psychiatry. "As primary care patients often suffer from multiple health conditions, it is important to be able to reduce drug use-related risk, as well as to determine what can be done with other important health risk factors related to substance use, such as tobacco and alcohol use.” – by Joe Gramigna

Disclosures: One study author reports serving on data safety monitoring boards for Janssen Research & Development. The other authors report no relevant financial disclosures.

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