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Brief Interventions for Cannabis Use in Healthcare Settings: Systematic Review and Meta-analyses of Randomized Trials. J Addict Med 2021; 14:78-88. [PMID: 32012140 DOI: 10.1097/adm.0000000000000527] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The efficacy of brief interventions for cannabis use was assessed in a systematic review and meta-analyses. METHODS Systematic searches in academic databases were conducted, and reference lists of included studies were reviewed. Randomized trials were included that compared brief interventions with minimal control interventions for improving cannabis-specific outcomes among participants recruited from healthcare settings. Mean differences (MDs) based on change-from-baseline measurements were pooled using random-effects meta-analyses, with stratification by short term (≤3 months) and long term (>3 months). RESULTS Ten reports from 9 studies were included. Most studies were conducted in the United States, including participants who were adults and were recruited from primary care or emergency departments. There were no significant effects of brief interventions on cannabis-specific Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores in the short term (MD -1.27 points; 95% confidence interval [CI] -3.75, 1.21; I 84.40%). The null pattern of findings was also observed for number of days of cannabis use in the past 30 days in the short term (MD -0.22 days; 95% CI -2.27, 1.82; I 60.30%) and long term (MD -0.28 days; 95% CI -2.42, 1.86; I 60.50%). The evidence base for other outcomes not subjected to meta-analyses was limited and mixed. CONCLUSIONS Brief interventions did not result in reductions in cannabis-specific ASSIST scores or number of days of cannabis use, whereas the evidence base for other outcomes was limited and mixed. As such, brief interventions in healthcare settings may not be efficacious for cannabis use.
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Frost MC, Glass JE, Bradley KA, Williams EC. Documented brief intervention associated with reduced linkage to specialty addictions treatment in a national sample of VA patients with unhealthy alcohol use with and without alcohol use disorders. Addiction 2020; 115:668-678. [PMID: 31642124 PMCID: PMC7725424 DOI: 10.1111/add.14836] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/28/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Alcohol screening, brief intervention (BI) and referral to treatment is often considered stepped care, such that BI with referral links patients to treatment. A meta-analysis of randomized trials found no evidence that BI increases treatment for alcohol use disorder (AUD). This study aimed to determine whether BI is associated with receipt of treatment for AUD among patients receiving BI as part of routine care. DESIGN Regression analysis. SETTING US Veterans Health Administration (VA), in which BI is supported by performance measurement and electronic clinical reminders. PARTICIPANTS VA outpatients with positive Alcohol Use Disorders Identification Test Consumption screens (≥ 5) (n = 830,825) documented nationally from 1 October 2009 to 30 May 2013. MEASUREMENTS Regression models estimated the prevalence of receiving VA specialty addictions treatment within 0-365 days for patients with documented BI (advice to reduce/abstain within 0-14 days) compared to those without. Models clustered on patient and adjusted for demographics and mental health and substance use conditions were fit among all patients and stratified across documented past-year AUD diagnosis. Multiple secondary analyses assessed robustness of findings, including assessing repeated BI as a predictor. FINDINGS Among 830,825 VA outpatients with unhealthy alcohol use (1,172,606 positive screens), documented BI was associated with lower likelihood of receiving VA specialty addictions treatment [adjusted incidence rate ratio (aIRR) = 0.84, 95% confidence interval (CI) = 0.83-0.84]. Associations were similar for those with and without AUD (aIRR = 0.83, 95% CI = 0.82-0.84 and aIRR = 0.86, 95% CI = 0.83-0.88, respectively) and in most secondary analyses. However, among patients without AUD, documentation of more than one BI was associated with greater likelihood of treatment relative to no BI (aIRR = 1.75, 95% CI = 1.68-1.83). CONCLUSIONS In a national sample of US Veterans Health Administration patients with unhealthy alcohol use, documented brief intervention for alcohol use was associated with lower likelihood of receiving specialty addictions treatment regardless of alcohol use disorder diagnosis.
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Affiliation(s)
- Madeline C. Frost
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
| | - Joseph E. Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101
| | - Katharine A. Bradley
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195,Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101,Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195
| | - Emily C. Williams
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
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Drislane LE, Waller R, Martz ME, Bonar EE, Walton MA, Chermack ST, Blow FC. Therapist and computer-based brief interventions for drug use within a randomized controlled trial: effects on parallel trajectories of alcohol use, cannabis use and anxiety symptoms. Addiction 2020; 115:158-169. [PMID: 31400240 PMCID: PMC6933089 DOI: 10.1111/add.14781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/11/2019] [Accepted: 08/02/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS Despite their high comorbidity, the effects of brief interventions (BI) to reduce cannabis use, alcohol use and anxiety symptoms have received little empirical attention. The aims of this study were to examine whether a therapist-delivered BI (TBI) or computer-guided BI (CBI) to address drug use, alcohol consumption (when relevant) and HIV risk behaviors, relative to enhanced usual care (EUC), was associated with reductions in parallel trajectories of alcohol use, cannabis use and anxiety symptoms, and whether demographic characteristics moderated reductions over time. DESIGN Latent growth curve modeling was used to examine joint trajectories of alcohol use, cannabis use and anxiety symptoms assessed at 3, 6 and 12 months after baseline enrollment. SETTING Hurley Medical Center Emergency Department (ED) in Flint, MI, USA. PARTICIPANTS The sample was 780 drug-using adults (aged 18-60 years; 44% male; 52% black) randomly assigned to receive either a TBI, CBI or EUC through the HealthiER You study. INTERVENTIONS AND COMPARATOR ED-delivered TBI and CBIs involved touchscreen-delivered and audio-assisted content. The TBI was administered by a Master's-level therapist, whereas the CBI was self-administered using a virtual health counselor. EUC included a review of health resources brochures in the ED. MEASUREMENTS Assessments of alcohol use (10-item Alcohol Use Disorders Identification Test), cannabis use (past 30-day frequency) and anxiety symptoms (Brief Symptom Inventory-18) occurred at baseline and 3-, 6- and 12-month follow-up. FINDINGS TBI, relative to EUC, was associated with significant reductions in cannabis use [B = -0.49, standard error (SE) = 0.20, P < 0.05) and anxiety (B = -0.04, SE = 0.02, P < 0.05), but no main effect for alcohol use. Two of 18 moderation tests were significant: TBI significantly reduced alcohol use among males (B = -0.60, SE = 0.19, P < 0.01) and patients aged 18-25 years in the TBI condition showed significantly greater reductions in cannabis use relative to older patients (B = -0.78, SE = 0.31, P < 0.05). Results for CBI were non-significant. CONCLUSIONS Emergency department-based therapist-delivered brief interventions to address drug use, alcohol consumption (when relevant) and HIV risk behaviors may also reduce alcohol use, cannabis use and anxiety over time, accounting for the overlap of these processes.
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Affiliation(s)
- Laura E. Drislane
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109
| | - Rebecca Waller
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109,University of Pennsylvania, Department of Psychology, Stephen A. Levin Building, 425 S University Ave, Philadelphia, PA 19104
| | - Meghan E. Martz
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109
| | - Erin E. Bonar
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109
| | - Maureen A. Walton
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109
| | - Stephen T. Chermack
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109,Veterans Health Administration, Center for Clinical Management Research, Health Services Research & Development, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800,Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, 2215 Fuller Rd, Ann Arbor, MI 48105
| | - Frederic C. Blow
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109,Veterans Health Administration, Center for Clinical Management Research, Health Services Research & Development, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800
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Blow FC, Walton MA, Bohnert ASB, Ignacio RV, Chermack S, Cunningham RM, Booth BM, Ilgen M, Barry KL. A randomized controlled trial of brief interventions to reduce drug use among adults in a low-income urban emergency department: the HealthiER You study. Addiction 2017; 112:1395-1405. [PMID: 28127808 DOI: 10.1111/add.13773] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/20/2016] [Accepted: 01/26/2017] [Indexed: 11/27/2022]
Abstract
AIMS To examine efficacy of drug brief interventions (BIs) among adults presenting to a low-income urban emergency department (ED). DESIGN Randomized controlled trial on drug use outcomes at 3, 6 and 12 months. Participants were assigned to (1) computer-delivered BI (Computer BI), (2) therapist-delivered, computer-guided BI (Therapist BI) or (3) enhanced usual care (EUC-ED) for drug-using adults. Participants were re-randomized after the 3-month assessment to either adapted motivational enhancement therapy (AMET) booster or enhanced usual care booster (EUC-B). SETTING Patients recruited from low-income urban emergency departments (ED) in Flint, Michigan, USA. PARTICIPANTS A total of 780 ED patients reporting recent drug use, 44% males, mean age = 31 years. INTERVENTIONS Computer BI consisted of an interactive program guided by a virtual health counselor. Therapist BI included computer guidance. The EUC-ED conditions included review of community health and HIV prevention resources. The BIs and boosters were based on motivational interviewing, focusing on reduction of drug use and HIV risk behaviors. MEASUREMENTS Primary outcome was past 90 days using drugs at 6 and 12 months and secondary outcomes were weighted drug-days and days of marijuana use. FINDINGS Percentage changes in mean days used any drug from baseline to 12 months were: Computer BI + EUC-B: -10.9%, P = 0.0844; Therapist BI + EUC-B: -26.7%, P = 0.0041, for EUC-ED + EUC-B: -20.9, P = 0.0011. In adjusted analyses, there was no significant interaction between ED intervention and booster AMET for primary and secondary outcomes. Compared with EUC-ED, Therapist BI reduced number of days using any drug [95% confidence interval (CI) = -0.41, -0.07, P = 0.0422] and weighted drug-days (95% CI = -0.41, -0.08, P = 0.0283). Both Therapist and Computer BI had significantly fewer number of days using marijuana compared to EUC-ED (Therapist BI: 95% CI = -0.42, -0.06, P = 0.0104, Computer BI: 95% CI = -0.34, -0.01, P = 0.0406). Booster effects were not significant. CONCLUSIONS An emergency department-based motivational brief intervention, delivered by a therapist and guided by computer, appears to reduce drug use among adults seeking emergency department care compared with enhanced usual care.
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Affiliation(s)
- Frederic C Blow
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Maureen A Walton
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA
| | - Amy S B Bohnert
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Rosalinda V Ignacio
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Stephen Chermack
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, USA
| | - Rebecca M Cunningham
- Injury Center, University of Michigan, Ann Arbor, MI, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, MI and Hurley Hospital, Flint, MI, USA.,School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Mark Ilgen
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Kristen L Barry
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA
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Stringfellow EJ, Kim TW, Gordon AJ, Pollio DE, Grucza RA, Austin EL, Johnson NK, Kertesz SG. Substance use among persons with homeless experience in primary care. Subst Abus 2016; 37:534-541. [PMID: 26914448 PMCID: PMC4999348 DOI: 10.1080/08897077.2016.1145616] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Community survey data suggest high prevalence of substance use disorders among currently homeless individuals. There are less data regarding illicit drug and alcohol use problems of homeless-experienced persons engaged in primary care. They may have less severe use and require different care responses from primary care teams. METHODS The authors surveyed currently and formerly homeless, i.e., homeless-experienced, persons engaged in primary care at five federally funded programs in the United States, administering the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST definitions of lower, moderate, and high risk were used to assess a spectrum of lifetime and recent substance use, from any use to likely dependence, and to identify sociodemographic and health status characteristics associated with severity of use. RESULTS Almost one half of the sample (N = 601) had recently (within the past three months) used alcohol, and one third had recently used an illicit drug. The most commonly used illicit drugs in the past three months were cannabis (19%), cocaine (16%), and opioids (7.5%). Over one half (59%) of respondents had ASSIST-defined moderate- or high-risk substance use. A significant proportion (31%) of those identified as at moderate risk had no recent substance use, but did report past problematic use. Ten percent of the lower-risk group had past problematic use of alcohol. Severity of use was associated with worse health status, but not with housing status or type of homelessness experienced. CONCLUSIONS Less severe (moderate-risk) use and past problematic use, potentially indicative of remitted substance use disorders, were more common than high-risk use in this primary care, homeless-experienced sample. These findings highlight the urgency of identifying effective ways to reduce risky substance use and prevent relapse in homeless-experienced persons.
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Affiliation(s)
- Erin J. Stringfellow
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Theresa W. Kim
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Adam J. Gordon
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David E. Pollio
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard A. Grucza
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | | | - Stefan G. Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA
- School of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Grant S, Pedersen ER, Osilla KC, Kulesza M, D'Amico EJ. It is time to develop appropriate tools for assessing minimal clinically important differences, performance bias and quality of evidence in reviews of behavioral interventions. Addiction 2016; 111:1533-5. [PMID: 27095296 DOI: 10.1111/add.13380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/01/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Sean Grant
- RAND Corporation, Santa Monica Office, Headquarters Campus Pardee RAND Graduate School, Santa Monica, CA, USA.
| | - Eric R Pedersen
- RAND Corporation, Santa Monica Office, Headquarters Campus Pardee RAND Graduate School, Santa Monica, CA, USA
| | - Karen Chan Osilla
- RAND Corporation, Santa Monica Office, Headquarters Campus Pardee RAND Graduate School, Santa Monica, CA, USA
| | - Magdalena Kulesza
- RAND Corporation, Santa Monica Office, Headquarters Campus Pardee RAND Graduate School, Santa Monica, CA, USA
| | - Elizabeth J D'Amico
- RAND Corporation, Santa Monica Office, Headquarters Campus Pardee RAND Graduate School, Santa Monica, CA, USA
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