Abstract
BackgroundThe treatment of substance use disorders is a public health priority, particularly in South Africa where the prevalence of these disorders is high. We tested two peer-counsellor delivered brief interventions (BIs) for risky substance use among adults presenting to emergency departments (EDs) in South Africa.MethodsIn this randomised controlled trial, we enrolled patients presenting to one of three 24-hour EDs who screened at risk for substance use according to the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Eligible patients were randomly allocated to one of three conditions: Motivational Interviewing (MI), blended MI and Problem Solving Therapy (MI-PST) or a Psycho-educational Control Group (CG). The primary outcome was reduction in ASSIST scores at three months follow-up.ResultsOf the 2736 patients screened, 335 met inclusion criteria, were willing to participate in the intervention and were randomised to one of three conditions: 113 to MI, 112 to MI-PST and 110 to CG. ASSIST scores at three months were lower in the MI-PST group than they were in the MI and CG groups (adjusted mean difference of −1.72, 95 % CI −3.36 - -0.08). We recorded no significant difference in ASSIST scores between the CG and MI group (adjusted mean difference of −0.02, 95 % CI −2.01 - 1.96).ConclusionWith the addition of minimal resources, BIs are feasible to conduct in EDs in a low resourced country. These preliminary findings report that MI-PST appears to be an effective BI for reducing substance use among at risk participants. Further research is required to replicate these findings with effort to limit attrition, to determine whether reductions in substance use are persistent at 6 and 12 month follow-up and whether parallel changes occur in other indications of treatment outcomes, such as injury rates and ED presentations.Trial registrationThis trial registered with the Pan African Clinical Trial Registry (PACTR201308000591418)
Highlights
The treatment of substance use disorders is a public health priority, in South Africa where the prevalence of these disorders is high
A phase one study that aimed to assess the feasibility, acceptability and substance use outcomes of a blended motivational interviewing (MI)-Problem Solving Therapy (PST) intervention among 15 patients presenting to emergency room settings in Cape Town, South Africa found that MI and Problem Solving Therapy (MI-PST) was associated with significant reductions in substance use involvement at the three month follow-up [27]
Outcomes While ASSIST scores decreased from baseline to followup in all three arms, Helmert contrasts under an Ancova model found that ASSIST scores at three months were significantly lower in the MI-PST group than they were in the MI and Control Group (CG) groups (t (332) = −2.08, p = 0.04) with an adjusted mean difference of −1.72
Summary
The treatment of substance use disorders is a public health priority, in South Africa where the prevalence of these disorders is high. In previous South African studies, between 33.0 % and 78.9 % of patients presenting with recent injuries at EDs tested positive for recent alcohol or other drug use [6, 8]. These findings highlight the need for brief interventions (BI) that reduce the risk of further substance-related injuries among these at-risk patients [9]. A phase one study that aimed to assess the feasibility, acceptability and substance use outcomes of a blended MI-PST intervention among 15 patients presenting to emergency room settings in Cape Town, South Africa found that MI-PST was associated with significant reductions in substance use involvement at the three month follow-up [27]
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