Brief Intervention in Primary Care for Problem Drug Use and Abuse

A substantial body of research has established the efficacy and effectiveness of brief
interventions (BI) for excessive or "hazardous" alcohol use in patients seen in medical
settings. Dissemination projects of brief interventions for alcohol and drugs have recently
been implemented on a widespread scale. This rapid progression of brief intervention for
drugs other than alcohol has outstripped its evidence base.

The aims of the study are:

1. To examine whether BI is effective at improving outcomes in individuals with a wide
range of problem drug use over and above enhanced care as usual. The enhanced control
condition will consist of routine screening, patient notification, and referral for
treatment.

2. To test whether fidelity to the BI model is associated with better outcomes.

3. To estimate the impact of BI on several public health outcomes that are directly
related to the hazardous effects of illicit drug use, including the use of acute health
care services, involvement in the criminal justice system, employment, HIV risk
behavior, and mortality.

4. To estimate the costs of the intervention, potential cost offsets, and its incremental
cost-effectiveness versus enhanced usual care from the payer perspective based on
health care service use and drug use frequency.

Inclusion Criteria:

- at least 18 years old

- receive medical care at one of the four participating primary care clinics at
Harborview Medical Center (Adult Medicine Clinic, Family Medicine Clinic, Women's
Clinic, and Pioneer Square Clinic)

- will maintain care at Harborview Medical Center for one year

- have a phone or easy access to phone, voicemail, or email

- used recreational drugs in the last 3 months

- used prescription medications not as prescribed in the last 3 months

Exclusion Criteria:

- participation in any formal substance abuse treatment programs in the last 30 days
(excluding 12-step or self-help groups)

- terminal illness