Barriers to Drug Use Behavior Change Among Primary Care Patients in Urban United States Community Health Centers

Abstract

In 2011 and 2012, 147 patients in urban United States Community Health Centers who misused drugs, but did not meet criteria for drug dependence, received a brief intervention as part of a National Institute on Drug Abuse-funded clinical trial of a screening and brief intervention protocol. Potential study participants were identified using the World Health Organization (WHO) Alcohol, Smoking, and Substance Involvement Screening Test. Data gathered during brief interventions were analyzed using grounded theory strategies to identify barriers patients believed inhibited drug use behavior change. Numerous perceived barriers to drug use behavior change were identified. Study implications and limitations are discussed.

Keywords :

• SBIRT
• brief intervention
• drug use behavior change
• community health centers
• primary care

GLOSSARY

• Affordable Care Act (ACA): National healthcare reform legislation in the United States, enacted in 2010. Also known as “healthcare reform,” the ACA will expand health coverage to millions of Americans, and reorganize the structure and delivery of health services, particularly in publicly funded clinics.

• Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST): A World Health Organization tool that can be used to screen patients in medical settings for SUDs and risky substance use behaviors.

• Community Health Centers (CHCs): A network of primary care clinics funded by the United States Department of Health and Human Services, Health Resources and Services Administration (HRSA). CHCs provide primary care and other health services to many medically underserved, uninsured, and poor patients in the United States. Many individuals who gain access to health care under the ACA will receive care in CHCs.

• Fisher's Exact Test: A test of statistical significance used with data sets that have smaller sample sizes.

• Screening, Brief Intervention, and Referral to Treatment (SBIRT): A comprehensive approach to identifying individuals in medical settings who are at risk because of their substance use behaviors, and providing appropriate treatment. SBIRT involves the use of validated screening instruments to identify individuals who are at risk because of substance use, providing brief intervention services for individuals who are at risk, and providing referrals to specialty substance use disorder care for individuals who are dependent on alcohol or drugs.