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ABSTRACT
Background and Objectives: The present study evaluated the effectiveness of a single clinician delivered brief intervention (BI) to reduce problem alcohol use and illicit substance use in an opiate-dependent methadone maintained cohort of patients attending for treatment. Methods: Four addiction treatment centers were randomly assigned to either treatment as usual (TAU; control group) or BI (intervention group). Clinicians screened patients using the alcohol, smoking, and substance involvement screening test (ASSIST) screening tool at baseline and again at three-month follow up. Fidelity checks were performed to ensure that training was delivered effectively and uniformly across all study sites. Feasibility of administering a BI within daily practice was assessed through intervention fidelity checks, patient satisfaction questionnaires and process evaluation. Results: A total of 465 patients were screened (66% of the overall eligible population) with a total of 433 (93%) ASSIST positive cases. Randomization was effective, with no differences in the control versus the intervention arms at baseline for key demographic or clinical indicators including substance us. There was a statistically significant difference between global risk score for the intervention (x = 39.36, sd = 25.91) group and the control group (x = 45.27, SD = 27.52) at 3-month follow-up (t(341) = −2.07, p < .05). Conclusions: This trial provides the first evidence that a single clinician delivered BI can result in a reduction in substance use within a methadone maintained opiate-dependent cohort, and this effect is sustained at three month follow up.
Acknowledgments
We thank the patients and clinicians involved in this research. We also thank Associate Professor Alan Kelly, Bio-statistician, Department of Public Health & Primary Care, Trinity College Dublin for advice on random effects modeling.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
Funding
We thank the Health Research Board in Ireland for funding (Grant No: HRA_PHS/2012/1).
Additional information
Notes on contributors
Catherine D. Darker
Catherine D. Darker is the Adelaide Assistant Professor of Health Services Research in the Department of Public Health & Primary Care, Trinity College Dublin. Her research interests include behavioral change interventions, substance misuse research, health inequalities, developing models of integration between primary and secondary care, and evaluating a number of national disease registers, especially with regard to the major causes of death and disability. She is a Health Psychologist by background training and is a registered member of the Psychological Society of Ireland.
Brion Sweeney
Brion Sweeney is a retired consultant psychiatrist specializing in the treatment of substance misuse and has been Clinical Director of the Health Service Executive Addiction Service for the greater North Dublin area between 2000 and 2012. Dr Sweeney's research interests have included psychosocial interventions for alcohol and cocaine misuse and longer term detoxification and residential programmes for those who are opiate dependent. Dr Sweeney has been published in peer reviewed journals in the area of substance misuse, HIV and hepatitis, and has contributed chapters to books relevant to drug misuse and psychosocial interventions.
Eamon Keenan
Eamon Keenan is a graduate of University College Dublin and has spent the last 20 years working as a Consultant Psychiatrist in Substance Misuse. He is Clinical Director of the National Drug Treatment Centre and Clinical Director of the Health Service Executive Addiction Services in the greater Dublin South and West area. He has a particular interest in the area of New Psychoactive Substances and is currently a member of the National Drugs Strategy working group.'
Lucy Whiston
Lucy Whiston joined the Department of Public Health and Primary Care in Trinity College Dublin in 2012 and is currently a Research Assistant and PhD student in the Department. Her background is in social policy with an undergraduate degree in Sociology and Social Policy and a Masters in Applied Social Research. She is currently undertaking a PhD looking at patient and family participation in healthcare. Other areas of interest include health policy and services research particularly chronic disease management and addiction. Other addiction focused publications include factors associated with methadone retention, benzodiazepine use and adolescents views on substance use etiology.
Rolande Anderson
Rolande Anderson was educated at Mount Temple School and Trinity College, Dublin. He was the Assistant Director of the Chemical Dependence programme in St. Patrick's Hospital, Dublin, where he worked from 1978–1997. He was Assistant Director of the Rutland Centre, Dublin, (1997–1999). He was the National Alcohol Project Director for the Irish College of General Practitioners (2000–2011). He is the author of “Living with a Problem Drinker—Your Survival Guide” (Sheldon Press, U.K., 2010). He has lectured extensively on alcohol and related topics at home and abroad. He currently runs his own private practice.
Joseph Barry
Joseph Barry is the Chair of Population Health Medicine in Trinity College Dublin. He graduated from University College Cork in 1979 and is a Public Health physician by background training. Professor Barry takes a programmatic and thematic approach to research into problem substance use and addiction. The substances range from illicit drugs such as heroin and cocaine, prescribed medications such as methadone and benzodiazepines and also alcohol. Polydrug use is examined. A mixture of quantitative and qualitative techniques are used. All research findings have a publication strategy which includes international peer-review submission and policy direction.