Screening and brief intervention for unhealthy drug use: little or no efficacy.

Richard Saitz

doi:10.3389/fpsyt.2014.00121

Abstract

Unhealthy drug use ranges from use that risks health harms through severe drug use disorders. This narrative review addresses whether screening and brief intervention (SBI), efficacious for risky alcohol use, has efficacy for reducing other drug use and consequences. Brief intervention among those seeking help shows some promise. Screening tools have been validated though most are neither brief nor simple enough for use in general health settings. Several randomized trials have tested the efficacy of brief intervention for unhealthy drug use identified by screening in general health settings (i.e., in people not seeking help for their drug use). Substantial evidence now suggests that efficacy is limited or non-existent. Reasons likely include a range of actual and perceived severity (or lack of severity), concomitant unhealthy alcohol use and comorbid mental health conditions, and the wide range of types of unhealthy drug use (e.g., from marijuana, to prescription drugs, to heroin). Although brief intervention may have some efficacy for unhealthy drug users seeking help, the model of SBI that has effects in primary care settings on risky alcohol use may not be efficacious for other drug use.

Highlights

Screening and brief intervention (SBI) for unhealthy alcohol use in primary care is among the most effective and cost-effective of preventive services [1]
Numerous studies in primary care find efficacy for BI vs. no BI among patients identified by screening for modest reductions in self-reported alcohol consumption [3]
EFFICACY OF BRIEF INTERVENTION FOR DRUG USE Randomized trials of brief intervention in people seeking help can suggest possible efficacy, but they should not be taken as evidence for SBI in unselected patients identified by screening

Summary

INTRODUCTION

Screening and brief intervention (SBI) for unhealthy alcohol use in primary care is among the most effective and cost-effective of preventive services [1]. Numerous studies in primary care find efficacy for BI vs no BI among patients identified by screening for modest reductions in self-reported alcohol consumption [3]. Efficacy has yet to be demonstrated for moderate to severe alcohol use disorders ( known as dependence) [4,5,6], the conceptual model includes referral to specialty treatment as one of the goals of brief intervention for those with more severe conditions. EFFICACY OF BRIEF INTERVENTION FOR DRUG USE Randomized trials of brief intervention in people seeking help can suggest possible efficacy, but they should not be taken as evidence for SBI in unselected patients identified by screening. BI studies in special populations have had mixed results [24]

Screening and intervention for drugs

Single BI done by health promotion advocate

Findings

CONCLUSION AND IMPLICATIONS