Screening and Brief Intervention for Drug Use in Primary Care: The ASPIRE Randomized Clinical Trial
Open accessAbstract
IMPORTANCE: The United States has invested substantially in screening and brief intervention for illicit drug use and prescription drug misuse, based in part on evidence of efficacy for unhealthy alcohol use. However, it is not a recommended universal preventive service in primary care because of lack of evidence of efficacy. OBJECTIVE: To test the efficacy of 2 brief counseling interventions for unhealthy drug use (any illicit drug use or prescription drug misuse)-a brief negotiated interview (BNI) and an adaptation of motivational interviewing (MOTIV)-compared with no brief intervention. DESIGN, SETTING, AND PARTICIPANTS: This 3-group randomized trial took place at an urban hospital-based primary care internal medicine practice; 528 adult primary care patients with drug use (Alcohol, Smoking, and Substance Involvement Screening Test [ASSIST] substance-specific scores of ≥4) were identified by screening between June 2009 and January 2012 in Boston, Massachusetts. INTERVENTIONS: Two interventions were tested: the BNI is a 10- to 15-minute structured interview conducted by health educators; the MOTIV is a 30- to 45-minute intervention based on motivational interviewing with a 20- to 30-minute booster conducted by master's-level counselors. All study participants received a written list of substance use disorder treatment and mutual help resources. MAIN OUTCOMES AND MEASURES: Primary outcome was number of days of use in the past 30 days of the self-identified main drug as determined by a validated calendar method at 6 months. Secondary outcomes included other self-reported measures of drug use, drug use according to hair testing, ASSIST scores (severity), drug use consequences, unsafe sex, mutual help meeting attendance, and health care utilization. RESULTS: At baseline, 63% of participants reported their main drug was marijuana, 19% cocaine, and 17% opioids. At 6 months, 98% completed follow-up. Mean adjusted number of days using the main drug at 6 months was 12 for no brief intervention vs 11 for the BNI group (incidence rate ratio [IRR], 0.97; 95% CI, 0.77-1.22) and 12 for the MOTIV group (IRR, 1.05; 95% CI, 0.84-1.32; P = .81 for both comparisons vs no brief intervention). There were also no significant effects of BNI or MOTIV on any other outcome or in analyses stratified by main drug or drug use severity. CONCLUSIONS AND RELEVANCE: Brief intervention did not have efficacy for decreasing unhealthy drug use in primary care patients identified by screening. These results do not support widespread implementation of illicit drug use and prescription drug misuse screening and brief intervention. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00876941.
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Two recent large randomized trials found no significant effect of SBIRT on illicit drug use in primary healthcare settings.
“The positive findings from this earlier body of research, however, have not been supported by two recent large randomized trials that found no significant effect on illicit drug use in primary healthcare settings (Roy-Byrne et al., 2014; Saitz et al., 2014).”
From A randomized study of the use of screening, brief intervention, and referral to treatment (SBIRT) for drug and alcohol use with jail inmates (2017) · cites this paper as Saitz et al., 2014
The results of this study lend support to studies that found SBIRT to have no significant impact on drug use in medical settings or on alcohol among probationers.
“The results of this study lend support to those studies that have found SBIRT to have no significant impact on drug use in medical settings (Roy-Byrne et al., 2014; Saitz et al., 2014) or on alcohol among probationers (Newbury-Birch et al., 2014; Stein et al., 2010).”
From A randomized study of the use of screening, brief intervention, and referral to treatment (SBIRT) for drug and alcohol use with jail inmates (2017) · cites this paper as Saitz et al., 2014
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- Authors
- Saitz, R., Palfai, T. P. A., Cheng, D. M., Alford, D. P., Bernstein, J. A., Lloyd-Travaglini, C. A., Meli, S. M., Chaisson, C. E., & Samet, J. H.
- Affiliations
- Boston University (US)
- Corresponding author
- Saitz, Richard
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2014-08-06
- Volume
- 312
- Issue
- 5
- Pages
- 502
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC4667772
- OpenAlex
- W2083318583
- Cited by
- 280
- References
- 39
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 4 · 2023: 9 · 2022: 10 · 2021: 17 · 2020: 18 · 2019: 42 · 2018: 28 · 2017: 48 · 2016: 37 · 2015: 46 · 2014: 6
- FWCI
- 34.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01DA025068)
- National Center for Research Resources (M01RR000533, UL1RR025771)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- screening and brief intervention, illicit drug use, prescription drug misuse, motivational interviewing, primary care, substance use disorders, cannabis use, cocaine use, opioid use, ASSIST screening, hair analysis, self-help groups, health care utilization, substance use consequences, unprotected sex, health educators, counselors, calendar method, harm reduction, internal medicine practice, urban primary care
- MeSH terms
- Adult, Female, Health Services, Hospitals, Urban, Humans, Male, Mass Screening, Middle Aged, Primary Health Care, Treatment Outcome, Substance-Related Disorders, Unsafe Sex, Self Report, Motivational Interviewing
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