Integrating Substance Abuse Assessment & Intervention in Primary Care Settings

This project has several specific aims. First, investigators plan to implement a high
fidelity Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol with
computerized screening technology into three primary care clinics in urban Philadelphia, and
to train three Behavioral Health Consultants (BHCs) in an expanded brief intervention
protocol (SBIRT+). Second, investigators will conduct a randomized controlled trial to
address the following hypotheses: 1) patients assigned to SBIRT+ will attend more specialty
substance abuse intervention and treatment sessions (excluding SBIRT+ sessions) over the 12
month follow-up than patients assigned to SBIRT; 2) patients assigned to SBIRT+ will
demonstrate larger reductions in drug use by point prevalence urine samples and by reported
days using over the 12-month follow-up compared to patients in SBIRT; 3) SBIRT+ will have
positive net social benefits relative to SBIRT alone (i.e., will be cost-effective); 4)
patients assigned to SBIRT+ will demonstrate improved medical, employment, legal, and
psychiatric functioning, as well as reduced HIV risk over the 12-month follow-up compared to
patients in SBIRT. Thirdly, investigators will also determine whether SBIRT and SBIRT+ are
sustainable in primary care clinics as research funding for behavioral health consultants is
phased out in Year 4 of the project. Investigators will also conduct a process evaluation
of SBIRT+ at the three collaborating clinics consisting of focus groups and structured
interviews to assess implementation barriers and workforce attitudinal shifts. This will
inform methods to further disseminate SBIRT or SBIRT+, should the trial prove it is
sustainable and cost-effective. Finally, investigators will provide an excellent clinical
research training environment for undergraduate and graduate students from Lincoln
University; this experience will balance hands-on clinical data collection and didactic
training.

Inclusion Criteria:

- patient is 18 years or older

- Alcohol and/or Drug screening score that indicates at least mild problem severity.

Exclusion Criteria:

- medical or psychiatric complications

- substance use is mild enough that further intervention is not warranted

- patient reports plans to leave the area within the next 12 months

- patient is unable to provide valid informed consent