Screening, Brief Intervention, and Referral to Treatment for Drug Use

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive,
integrated public health approach to identify and deliver a spectrum of early detection and
intervention services for substance use in general medical care settings. These settings,
such as emergency department visits, offer a potential "teachable moment" because patients
may have perceptions of vulnerability about their health, and therefore be particularly
receptive to screening and counseling. There is mounting scientific evidence suggesting
SBIRT is effective in reducing alcohol use at varying levels of severity in a myriad of
health care settings including primary care, emergency departments, and trauma centers.
Although the SBIRT approach has shown promise for alcohol, relatively little is known about
its effectiveness for adult illicit drug use specifically.

This will be among the first studies to rigorously test the SBIRT approach for drug use. It
will evaluate the effectiveness of SBIRT for drug use and related factors for 700
multi-ethnic ED patients using a two-group randomized repeated-measures design in which
biologically-validated drug use abstinence and related outcomes of an intervention group are
compared to those of an attention-placebo control group. Over a 14-month period,
bilingual/bicultural Health Educators recruited participants who reported past 30-day
illicit drug use in excess of risky alcohol use from the waiting areas of two large
hospital's ED and trauma units. Following consent procedures and standardized baseline
assessments, Health Educators randomly assigned participants to one of the two conditions.
The intervention group received "Life Shift," an SBIRT drug use intervention matched to the
participant's drug use risk level. The control group received the same type and quantity of
intervention in an unrelated area—Driving and Traffic Safety ("Shift Gears" program), also
matched to their driving/traffic risk level. A 6-month face-to-face follow-up visit by
trained measurement technicians blind to the participant's assigned condition collected
standardized self-report past 30-day drug use measures (ASI-Lite)and hair samples for
validating self-reported abstinence. Additional outcome variables are changes in the
frequency of drug use, functional status measures (i.e., medical problems, psychiatric
problems, and alcohol use), and health care utilization.