Medical Research: What are the main findings of the study?
Dr. Saitz: We found that brief counseling interventions had no efficacy for reducing the frequency of illicit drug use or drug use consequences among primary care patients identified by screening as using drugs.
Medical Research: Were any of the findings unexpected?
Dr. Saitz: The findings were unexpected because brief interventions in this circumstance seem to work for risky alcohol use. In addition, the US has been funding and disseminating this exact approach (called SBIRT, or screening, brief intervention referral and treatment) for over a decade and calling it an evidence-based practice. But the evidence was largely from observational studies. Our study, and another published in the same issue of the journal, suggest the approach does not improve any measurable outcomes.
Medical Research: What should clinicians and patients take away from your report?
Dr. Saitz: They should not come away from this report thinking that we shouldn’t address drug use in medical settings. We absolutely should because drug use affects health and interferes with the care of other conditions. But a brief conversation is just insufficient to take care of an issue as complex as drug use. So it is not a good idea to think we can solve the problem by screening and brief intervention. Such programs should be re-thought as to whether resources might better be spent elsewhere. In clinical practice, we will likely need to address drug use in a more resource intensive and longitudinal manner, much like we address other risk factors and chronic conditions.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Saitz: I recommend that we study more specific interventions in general health settings for drugs. Unhealthy drug use is not one monolithic condition—there are numerous conditions (e.g. marijuana use, prescription drug disorder) and each may need its own approach.