Brief Interventions in Primary Care May Curb Risky Drug Use
A few minutes of counseling in a primary care setting could go a long way toward steering people away from risky drug use, according to a new study.
People who participated in the Quit Using Drugs Intervention Trial Project QUIT — reduced their risky drug use by one-third, according to Dr. Lillian Gelberg, lead investigator and a professor of family medicine at the David Geffen School of Medicine at University of California, Los Angeles (UCLA).
The program involved primary care doctors and health coaches providing a brief intervention with patients during a routine visit, which was then followed up with two phone calls.
Risky drug use is defined as the casual, frequent, or binge use of drugs such as cocaine, heroin, and methamphetamine, or the misuse of prescription medications, without showing physiological or psychological signs of addiction. There are an estimated 68 million such drug users in the United States, who are at risk not only for becoming addicts, but suffering physical, mental health, and social problems, according to the researchers.
“Risky drug use is a very important health problem because it can develop into drug addiction, which is a chronic relapsing brain disease with permanent effects and that is more costly to treat,” said Gelberg, who is also professor of public health at the UCLA Fielding School of Public Health.
“It is important to reduce risky drug use before it becomes a chronic brain disease, at a time when patients may still have the power to do so.”
For the study, researchers recruited 334 adult primary-care patients at five health centers in Los Angeles County that serve low-income communities with high rates of drug use. People were chosen among those whose scores on a World Health Organization screening indicated risky drug use, the scientists explain.
Patients were randomly assigned to one of two groups: 171 in the intervention group and 163 who served as controls.
Those in the intervention group received brief face-to-face advice from their primary care provider during their visits, a drug health education booklet with a card to report their drug use, and watched a two-minute “video doctor” reinforcing the doctor’s message.
During the brief advice, which typically lasted three to four minutes with only three lasting 10 minutes, the primary care provider discussed drug addiction as a chronic brain disease, the need to reduce or quit using drugs in order to avoid addiction, the physical and mental effects of drug use, and how the use of multiple drugs can accelerate the progression toward addiction.
This was followed up by one or two 20- to 30-minute telephone coaching sessions two and six weeks later.
Patients in the control group were given a two-minute “video doctor” presentation about cancer screening and an information booklet on cancer screening. They were also given information about cancer screening, rather than about drugs, to provide them some level of attention in an area unlikely to affect their drug use.
They did not receive the advice about drug-use reduction from the primary care provider or the follow-up phone coaching sessions until the study was completed.
After three months, those in the intervention group reported they used their favorite drug an average of 3.5 fewer days in the previous month compared to control group participants. This was a 33 percent reduction in their drug use.
The study has some limitations, the researchers concede. The results are based on participants’ self-reporting, so the study may suffer from reporting bias. However, researchers found that, based on urine testing, under-reporting of drug use was low.
There were additional limitations, they note. Not everyone in the clinic waiting rooms agreed to participate, which could impact the study’s generalizability; there was some attrition during the study, though the 75 percent participation rate at follow-up compares to other studies of low income patients and drug use; and the three month follow up was relatively short.
While there is a need for larger trials to gauge the QUIT program’s effectiveness, the project appears to have the potential to fill an important gap in care for patients who use drugs, particularly in low-income communities, Gelberg said.
“In the U.S., the recent expansion of health care coverage through the Affordable Care Act and the Mental Health Parity and Addiction Equity Act has broadened behavioral health coverage to some 62 million people, providing multiple opportunities for brief intervention programs for risky drug use in community health centers and other primary care settings,” she said.
The study, funded by a grant from the National Institute on Drug Abuse of the National Institutes of Health, was published in the journal Addiction.
Wood, J. (2018). Brief Interventions in Primary Care May Curb Risky Drug Use. Psych Central. Retrieved on September 23, 2020, from https://psychcentral.com/news/2015/10/18/brief-interventions-in-primary-care-clinics-could-curb-risky-drug-use/93605.html