Motivational intervention integrated into care of facial injury patients may reduce illicit drug use behaviours

Abstract

Randomised controlled trial. All participants attended two counselling sessions: the first occurred shortly after study entry and the second occurred four to six weeks later. Sessions were provided by a trained practitioner in English or Spanish, participants in the control group received brief health information, subjects in the PMI group received an individualised behavioural intervention. Participants were followed up at six and 12 months. Primary outcomes included changes in patterns of illicit drug use measured using the Texas Christian University Drug Screen (TCUDS) and the number of drug-using days, for all drugs as well as for the primary drug of choice, and changes in patterns of alcohol use measured with the Alcohol Use Disorders Identification Test (AUDIT), days of alcohol use and use of alcohol to intoxication. Two hundred and eighteen were randomised into the intervention (n=118) and control (n =100) groups. 51.7% of the PMI group and 62.0% in the control group completed the six-month follow-up, and 43.2% of the intervention group and 57.0% of controls completed the 12-month follow-up. Those in the PMI group showed statistically significant declines in drug use at both the six- and 12-month assessments. The effect on lowering illicit drug use was greatest at the six-month assessment but had weakened by the one-year follow-up. The efficacy of the PMI was moderated by the severity of an individual's initial drug use, with individuals with greater drug use dependency at baseline seen to have larger intervention effects, as did individuals who were most aware of their drug problem and willing to change their substance use behaviours. Changes in alcohol use did not differ significantly between the intervention and control groups, irrespective of an individuals' recognition of the alcohol problem or willingness to take steps to address it. A culturally competent, motivational intervention integrated into the care of vulnerable patients with facial injury can reduce illicit drug use behaviours. Subgroups of injured patients appear to benefit most from such personalised motivational interventions. A better articulation of target populations, intervention content and delivery would allow for directed interventions and an appropriate focusing of limited time and health care resources.