Integrating Substance Abuse Assessment & Intervention in Primary Care Settings

• Change in Treatment Session Attendance from Baseline [ Time Frame: 0, 3, 6, 9, 12 months ] [ Designated as safety issue: No ]
  Treatment sessions attended for alcohol or drug use issues over time.
  
  

• Change in Urinalysis from Baseline [ Time Frame: 0, 3, 6, 9, 12 months ] [ Designated as safety issue: No ]
  Urinalysis results for cocaine, marijuana, opiates, sedatives, and hallucinogens over time.
  
  
• Change in Cost-Effectiveness from Baseline [ Time Frame: 0, 3, 6, 9, 12 months ] [ Designated as safety issue: No ]
  Cost-effectiveness of the interventions compared to standard care over time.
  
  

This project has several specific aims. First, investigators plan to implement a high fidelity Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol with computerized screening technology into three primary care clinics in urban Philadelphia, and to train three Behavioral Health Consultants (BHCs) in an expanded brief intervention protocol (SBIRT+). Second, investigators will conduct a randomized controlled trial to address the following hypotheses: 1) patients assigned to SBIRT+ will attend more specialty substance abuse intervention and treatment sessions (excluding SBIRT+ sessions) over the 12 month follow-up than patients assigned to SBIRT; 2) patients assigned to SBIRT+ will demonstrate larger reductions in drug use by point prevalence urine samples and by reported days using over the 12-month follow-up compared to patients in SBIRT; 3) SBIRT+ will have positive net social benefits relative to SBIRT alone (i.e., will be cost-effective); 4) patients assigned to SBIRT+ will demonstrate improved medical, employment, legal, and psychiatric functioning, as well as reduced HIV risk over the 12-month follow-up compared to patients in SBIRT. Thirdly, investigators will also determine whether SBIRT and SBIRT+ are sustainable in primary care clinics as research funding for behavioral health consultants is phased out in Year 4 of the project. Investigators will also conduct a process evaluation of SBIRT+ at the three collaborating clinics consisting of focus groups and structured interviews to assess implementation barriers and workforce attitudinal shifts. This will inform methods to further disseminate SBIRT or SBIRT+, should the trial prove it is sustainable and cost-effective. Finally, investigators will provide an excellent clinical research training environment for undergraduate and graduate students from Lincoln University; this experience will balance hands-on clinical data collection and didactic training.