Computerized Screening, Brief Intervention, and Referral to Treatment in Primary Care

This is a randomized, controlled clinical trial to evaluate the effect of a computerized
screening, assessment, and brief intervention on substance use in patients recruited from a
primary care clinic. Study participants will be assigned to one of the following 4 study
groups: computerized health screening alone (standard care) (SC); computerized
assessment-only intervention (CA); computerized assessment followed by a computer-directed
motivational intervention (CACI); or computerized assessment followed by a
therapist-delivered motivational intervention (CATI). Data regarding substance use, medical
and psychosocial functioning, and economic outcomes will be collected.

The investigators hypothesize that patients randomized to CACI and CATI will be more likely
to report drug abstinence at the 3-month follow-up visit and will show greater reductions in
drug use at 1, 3 and 6 months follow-up than patients assigned to CA or SC. Similarly,
patients in the CACI and CATI groups will report greater reductions in HIV risk behaviors,
lower rates of medical and psychosocial problems, and increased economic gains at the
6-month follow-up. In addition, patients in the assessment only intervention (CA) will have
outcomes superior to those found for SC patients. A cost-effectiveness analysis will also be
done comparing economic costs associated with CA, CACI and CATI and their relationship to
substance use reductions and related improvements in medical and psychosocial outcomes at
the 6 month follow-up.