Background
Screening
Brief interventions
Methods
Search strategy
Selection criteria and process
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Study written in English or French.
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Randomized controlled trials (RCTs) or cluster RCTs.
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BIs administered to adolescents (12 to 18 years of age or equivalent by level of schooling), young adults (19 to 24 years of age), or adults (25 years and older) screened at risk of harms related to psychoactive substance use.
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Participants were identified by opportunistic screening regardless of setting (that is, the participants in the study were from a screen-detected population and not a population seeking treatment for substance abuse). We included studies with any screening procedure.
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Intervention was four sessions or less, included at least one of the FRAMES elements, and was delivered as a one-to-one verbal intervention to the individual.
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Intervention was compared with no/delayed intervention or provision of information only.
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Studies assessing alcohol, nicotine, or caffeine only.
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Group interventions or text-only online interventions.
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Studies addressing the effectiveness of the referral to treatment component of the SBIRT model only.
Data extraction and process
Primary outcomes
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Substance use
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Frequency of use
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Quantity of use
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Use-related harms or negative consequences of use
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Changes in behavior likely to result in the reduction of negative substance use-related consequences (positive behavior change)
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Decision to attend treatment
Secondary outcome s
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Use of different substances (including alcohol, caffeine, nicotine) from that for which the client received the intervention
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Intention to reduce substance use
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Other health measures
Adverse outcomes
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Any other reported adverse outcomes
Risk of bias assessment
Evidence synthesis
Protocol modifications
Results
Other study designs
General characteristics of included trials
Author, year; design; funding | Summary of included participants; incentives | Summary of excluded participants | Demographics: mean age (range) of randomized participants; Sex (% female, intervention versus control) | Country | Setting | Number of participants screened | Randomized participants | |
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I | C | |||||||
BI versus no BI
| ||||||||
Baer et al., 2007 [33]; Single site RCT; Government funding | 127 participants who were homeless and with one or more binge drinking episodes or used illicit drugs four or more times in the past 30 days; Incentives offered for enrolling and attending BI and follow-up sessions | Those receiving alcohol or drug treatment in the past 30 days. | 17.9 y (13 to 19 y); 44%a
| United States | Nonprofit, faith-based drop-in center | 254 | 75 | 52 |
Humeniuk et al., 2008 [35]; Multisite RCT; WHO and in-kind contributions and government grants from individual sites | 731 (Australia n = 171, Brazil n = 165, India n = 177, USA n = 218) participants aged 16 to 62 y with a fixed address who scored in the moderate risk range for cannabis, cocaine, amphetamine stimulants, or opioids; Incentives offered for attending BI session and follow-up sessions | Those pending incarceration, with severe behavior, with past-month drug or alcohol treatment, or unable to attend the follow-up appointment. | 31.4 y (16 to 62 y); 27.9%a
| Australia, United States, Brazil, and India | One primary, urban general health outpatient hospital setting (Brazil); 31 primary, urban, general health-care units/clinics (Brazil, USA); one walk-in clinic associated with a drug treatment program (USA); several general medicine and dental urban clinics (USA); three clinics/centers specializing in sexually transmitted diseases (Australia, Brazil). | NR | 372 | 359 |
BI versus Written Information
| ||||||||
Bernstein et al., 2009 [34]; Single site RCT; Government funding | 210 participants who reported ‘3 to 5 days per month of cannabis use were included; Incentives offered for enrolling and attending follow-up sessions | Those institutionalized, in custody, in residential treatment, receiving a rape exam or were evaluated for suicide precautions. | Mean NR (14 to 21 y); 63.2% versus 67.6% | United States | Pediatric emergency department in an urban academic hospital. | 7,804 | 68 | 71 |
Zahradnik et al., 2008 [37]; Cluster RCT (randomization by hospital ward); Government funding | 126 participants (2 hospitals; 17 randomized wards) who consumed opioids, anxiolytics, hypnotics and sedatives, or caffeine with addiction potential for more than 60 days in the last 3 months or met criteria for DSM-IV dependence or abuse; Incentives offered for enrolling and attending BI and follow-up sessions | Those using opioids for cancer, with a terminal disease, with dependence on or use of illegal drugs, or receiving substance use treatment. | 55.13 y (18 to 69 y); 64.9% versus 60% | Germany | Two hospitals (general and university); internal, surgical, and gynecological wards | 6,042 | NR | NR |
Bernstein et al., 2005 [17]; Single-site RCT; Government funding | 1,175 participants who self-reported use of cocaine and/or heroin in the last 30 days, and scored ≥3 on the DAST instrument; Incentives offered for enrolling and attending follow-up sessions | Those in drug use treatment or protective custody. | Mean NR (>18 y); 30.6% versus 28.2% | United States | Three walk-in clinics (urgent care, women’s clinic, homeless clinic) at an urban teaching hospital | 23,669 | 590 | 585 |
Participants and setting
Screening
Author, year | Screening procedure | Screening instrument(s) | Screening criteria | Validation of screening instrument |
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BI versus No BI
| ||||
Baer et al. 2007 [33] | NR | Investigator developed instrument that included questions about binge drinking and past month use of illicit drugs | One or more binge drinking episodes or used illicit ‘street’ drugs four or more times in the past 30 days. | Not validated |
Humeniuk et al. 2008 [35] | Questionnaires were either self-administered (Australia, USA) or by trained personnel (Brazil, India) with other demographic questions at primary care clinics in the various sites. | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST V3.0 [39]) | ASSIST score in the moderate risk range (4 to 26) for cannabis, cocaine, amphetamine stimulants, or opioids. Those with scores in the low and high risk (except tobacco) ranges and those who frequently injected drugs were excluded. | The validity of the ASSIST has been assessed in primary healthcare settings and demonstrated good concurrent, construct, predictive, and discriminative validity [40] |
Among participants who scored moderate-risk for more than one substance, the focus of the intervention was the highest scoring or the substance of most concern to the participant. | ||||
BI versus Written Information
| ||||
Bernstein et al. 2009 [34] | NR | Investigator developed instrument referred to by authors as the ‘Youth and Young Adult Health and Safety Needs Survey’. Included unspecified risk items from the USA Centers for Disease Control, Youth Behavioral Risk Factor Surveillance Survey (YBRFS; [41]). | Did not report ‘at risk alcohol use’; smoked cannabis ≥3 times in the last 30 days; reported risky behavior associated with cannabis use; reported ‘3 to 5 days per month’ of cannabis use. | Not validated |
Zahradnik et al. 2008 [37] | Participants were asked to complete a self-report screening questionnaire. Those meeting screening criteria were given a diagnostic interview. |
Self-report questionnaire. Assessed prescription drug intake by asking ‘have you been taking prescription drugs like hypnotics, sedatives, or analgesics regularly within the last four weeks?’ and screened for disorders using: | Participants were included if they: | SDS - scale’s psychometric properties published in Gossop et al. [42] However, psychometric properties of translated/adapted version unknown. |
1) met criteria for prescription drug dependence or abuse (3+ points on the adapted SDS and 5+ points on the QPM and were deemed depended via diagnostic interview) or, | ||||
2) consumed prescription drugs with addiction potential for at least 60 days in the last 3 months. | ||||
QPM - According to authors the QPM was validated; however, this was impossible to verify as results are published in a German study [44]. | ||||
2) A questionnaire for prescription drug misuse (QPM; [44]) | ||||
Diagnostic interview. Section E of SCID-I (Structured Clinical Interview for DSM-IV for Axis I Disorders [45]). | ||||
Bernstein et al. 2005 [17] | NR | ‘Standard substance abuse screening questions for quantity and frequency in the last month’ that were integrated as part of a health needs history. Exact questions not reported. | Current use of drugs (as determined by the screening questions) and ≥3 on the 10-item DAST | ‘Standard substance abuse screening questions’ - not validated |
Those screening positive were administered the 10-item Drug Abuse Severity Test (DAST-10 [46]) |
Brief intervention
Author and year | Target substance | Intervention | Individual delivering BI (training provided) | Intervention content | Treatment approach | Measure of intervention fidelity | Control group |
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BI versus No BI
| |||||||
Baer et al. 2007 [33] | Alcohol, cannabis, and other drugs | MI session (in-person, average 17 min) | Master’s level clinician or project director (all trained in MI techniques). | The interventions included feedback on behavior and consequences, self-efficacy for change, and advice (with permission). Youth provided feedback on the menu of options for discussion, and counselors addressed up to 6 topics in total across sessions. Visuals were also used to demonstrate risk relationships and normative comparisons. | Authors cite Miller et al. [49] regarding MI and the substance use check-up model. | Regular review of session audio tapes by supervisor. Extent of adherence NR. |
no BI
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Showers and laundry facilities, meals, prayer, open social time, and brief counseling and case management if the youth desired ita. | |||||||
+ | |||||||
2nd MI session (in-person, average 32 min.) | |||||||
+ | |||||||
3rd MI session (in-person, average 32 min.) | |||||||
+ | |||||||
4th MI session (in-person, average 32 min.) | |||||||
All four sessions scheduled within 4 weeks from first session. | |||||||
Humeniuk et al. 2008 [35] | Cannabis, cocaine, amphetamine-type stimulants, or opioids depending on ASSIST score and concern of participant | ASSIST-linked BI (in-person, 5 to 15 min.) and written information | Healthcare clinic staff (US, Australia, India); Clinicians and Researchers (Brazil); training was provided to all those conducting interventions. | Intervention session incorporated MI techniques and was adapted culturally within each country. The session included feedback on behavior and consequences and advice and used the ASSIST Feedback Report Card during the discussion. Participants left session with a copy of the Report Card, specific drug information booklets, and a take-home guide (Self-help Strategies for Cutting Down or Stopping Substance Use) | Checklist of intervention details was used to maintain consistency across sites. Extent of adherence NR. |
no BI + Delayed intervention
| |
Could contact the clinical interviewer if concerns regarding the study or their substance use. Intervention received after completing the ASSIST questionnaire at follow-up (3 months). | |||||||
BI versus Written Information
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Bernstein et al. 2009 [34] | Cannabis | Structured conversation (in-person, 20 to 30 min.) and written information | Peer educators (<25y). Most completed undergraduate education (received one month of training). | Initial conversation included feedback on behavior and consequences, menu of options to bring about change, self-efficacy for change, and developing a behavior change plan. Questions from the CRAFFT [52] and a Readiness to Change ruler were used as part of initial conversation. Booster call included reviewing the change plan, inquiring as to progress, and offered referrals. | Adherence to intervention was assessed weekly by investigators and the project coordinator. Taped recordings were scored against an adherence checklist of key intervention elements. All initial sessions met the required 80/100 points on the adherence checklist. |
no BI + Written Information (risks of cannabis use, available community resources, and list of adolescent treatment facilities). | |
+ | |||||||
telephone call (5 to 10 min.) 10 days later. | |||||||
Zahradnik et al. 2008 [37] | Prescription drugs (opioids, anxiolytics, hypnotics and sedatives, and caffeine) | MI session (in-person, 30 to 40 min) | Four psychologists, expertise in clinical treatment and research (two weeks of training in MI) | Verbal interventions were MI. Specific content not described. | With participant consent, sessions were audio taped and coded for consistency by other researchers. Extent of adherence NR. |
no BI + Written Information (booklet about prescription drugs). | |
+ | Feedback letter included strategies for improving self-efficacy and maintaining changes, where appropriate. | ||||||
2nd MI (by telephone, 20 to 30 min) 4 weeks later | |||||||
+ | |||||||
Throughout the intervention, psychologists communicated the necessity a medical professional supervision when discontinuing or reducing use of prescription medication. | |||||||
feedback letter 8 weeks after first session | |||||||
Bernstein et al. 2005 [17] | Cocaine and/or heroin | MI session (in-person, average 20 min) and written information | Peer, experienced substance use outreach worker also in recovery (authors state training was intensive, systematic, and manual-driven). |
Initial session. A semi-scripted motivational interview tailored to individual behavior, risks, culture and language. Intervention included self-efficacy for change and an action plan for behavior change. Participants received referrals, if desired, and written information (treatment options and harm reduction information about safe sex and needle exchange). | None provided. Intervention first developed for Project ASSERT in the emergency department [58] to help patients to recognize and change behaviors posing health risks. | Adherence determined through role plays with simulated patients, supervised patient interviews, and completion of a form per patient addressing 12 required elements. Extent of adherence NR. |
no BI + Written Information
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Interventionist indicated to participants ‘based on your screening responses, you would benefit from help with your drug use’. Written information regarding treatment options (for example, detox, AA/NA, acupuncture, and residential treatment facilities) and harm reduction information about safe sex and needle exchange were provided. | |||||||
+ | |||||||
telephone call (5 to 10 min.) 10 days later | |||||||
Telephone call. Reviewed the action plan and addressed alternative referrals, if needed. |
Comparison groups
Risk of bias assessments
Effects of brief interventions
Outcomea
| Follow up | Event rates BI versus no BI | Effect Estimate (95% CI) | Studies (people) | Quality of evidence | Comments |
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PRIMARY OUTCOMES | ||||||
Substance use
| ||||||
Not reported in any studies
| n/a | n/a | Not estimable | 0 (0) | n/a | |
Frequency of use
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Change in days of use - Cannabis
| 1 mo | -3.7 versus -6.1 d (fewer d at 1 mo) | MD 2.40 (-3.80 to 8.61)c
| 1 (89) | Very Low | (+) value for MD means fewer days of use with control |
Self-report, past 30 d | ||||||
Change in mean from baselineb[33] | ||||||
3 mo | -2.6 versus -5.9 d (fewer d at 3 mo) | MD 3.30 (-2.84 to 9.44)c
| 1 (89) | Very Low | ||
Change in days of use - Other drugs
d
| 1 mo | -2.3 versus -3 d (fewer d at 1 mo) | MD 0.70 (-2.95 to 4.35)c
| 1 (89) | Very Low | |
Self-report, past 30 d. | ||||||
3 mo | -2.8 versus -2.3 d (fewer d at 3 mo) | MD -0.50 (-4.30 to 3.30)c
| 1 (89) | Very Low | ||
Change in mean from baselineb[33] | ||||||
Change in days abstinent
e
| 1 mo | 3.7 versus 6.4 d (more d at 1 mo) | MD -2.70 (-8.21 to 2.81)c
| 1 (89) | Very Low | (-) value for MD means more days abstinent with control |
Self-report, past 30 d. | ||||||
Change in mean from baselineb[33] | ||||||
3 mo | 2.7 versus 6 d (more d at 3 mo) | MD -3.30 (-8.73 to 2.13)c
| 1 (89) | Very Low | ||
Quantity of use
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Not reported in any studies
| n/a | n/a | Not estimable | 0 (0) | n/a | |
User-related harms or negative consequences of use
| ||||||
Not reported in any studies
| n/a | n/a | Not estimable | 0 (0) | n/a | |
Positive behavior change
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Not reported in any studies
| n/a | n/a | Not estimable | 0 (0) | n/a | |
Decision to attend treatment
| ||||||
Not reported in any studies
| n/a | n/a | Not estimable | 0 (0) | n/a | |
Composite outcome
| ||||||
ASSIST Tool Score
f
- All substances
| 3 mo | -7.8 versus -4.6 (fewer points at 3 mo) | MD -3.20, 95% CI (-6.77 to 0.37) | 1 (628) | Low | Higher score = higher substance involvement. |
Sum score, range 0 to 27+ points. | ||||||
(-) value for MD means greater reduction in change score with BI | ||||||
Change in means from baselineb[35] | ||||||
SECONDARY OUTCOMES
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Use of different substances
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Not reported in any studies
| n/a | n/a | Not estimable | 0 (0) | n/a | |
Intention to reduce use
| ||||||
Not reported in any studies
| n/a | n/a | Not estimable | 0 (0) | n/a | |
Other health measures
| ||||||
Use of drop-in centre services
| 1 mo | 0.9 versus -0.2 d (more versus fewer d) | MD 1.10 (-1.88 to 4.08)cg
| 1 (89) | Very Low | (+) value for MD means greater use with BI |
Objective, past 30 d. | ||||||
Change in means from baselineb[33] | 3 mo | −1.1 versus -1 d (fewer d at 3 mo) | MD -0.10 (-3.23 to 3.03)cg
| 1 (89) | Very Low | |
Use of drop-in additional services
| 1 mo | 0 versus 0.1 d (more d at 1 mo) | MD -0.10 (-0.72 to 0.52)cg
| 1 (89) | Very Low | |
Objective, past 30 d. | ||||||
Change in means from baselineb[33] | 3 mo | 0.5 versus -0.1 d (more versus fewer d) | MD 0.60 (-0.15 to 1.35)cg
| 1 (89) | Very Low | |
Use of other agency services
| 1 mo | −2.4 versus -7 d (fewer d at 1 mo) | MD 4.60 (-5.05 to 14.25)cg
| 1 (89) | Very Low | |
Self-report, past 30 d. | ||||||
Change in means from baselineb[33] | 3 mo | −3.4 versus -8.2 d (fewer d at 3 mo) | MD 4.80 (-4.44 to 14.04)cg
| 1 (89) | Very Low | |
ADVERSE OUTCOMES
| ||||||
Not reported in any studies
| n/a | n/a | Not estimable | 0 (0) | n/a |
Outcomea
| Follow up | Event rates BI versus info | Effect estimate (95% CI) | Studies (people) | Quality of evidence | Comments |
---|---|---|---|---|---|---|
PRIMARY OUTCOMES
| ||||||
Substance use
| ||||||
Abstinence - All substances
| 3 mo | Range 14 to 18% versus 9 to 13% | RR 1.12 (0.41 to 3.09) | 2 (223) | Very low | Two studies not statistically significant. |
RR 2.08c
| ||||||
Cannabis (Self-reportb, past 30 d, [34]). | See Comments | |||||
Sedatives/hypnotics/opioidsd (NR, period not provided, [37]) | ||||||
Abstinence - Cocaine/heroin
| 6 mo | 17% versus 13%f
| Adj RR 1.41 (0.98 to 1.95)gh
| 1 (778) | Low | |
Objectivee, past 30d [17] | ||||||
Abstinence - All substances
| 12 mo | Range 25 to 45% versus 20 to 22% | RR 2.05 (1.13 to 3.70) | 2 (228) | Very low | Mixed results between studies. |
Adj RR 1.30cgi
| ||||||
Cannabis (Self-reportb, past 30d, [34]) | ||||||
See Comments | ||||||
Sedatives/hypnotics/opioidsd (NR, assessment period NR, [37]) | ||||||
High on cannabis
| 3 mo | 36/42 (86%) versus 46/55 (84%)f
| Adj RR 1.05 (0.82 to 1.15)gj
| 1 (102) | Low | |
Self-reportb, past 30d [34] | ||||||
12 mo | 25/47 (53%) versus 41/55 (75%)f
| Adj RR 0.72 (0.45 to 0.97)gj
| 1 (102) | Very low | ||
Reducing use >25% - Sedatives/hypnotics/opioids
d
| 3 mo | 29/56 (52%) versus 21/70 (30%) | RR 1.73c
| 1 (126) | Very low | Results favor BI over control. |
NR, period of assessment not provided [37] | 12 mo | 28/56 (50%) versus 34/70 (49%)f
| Adj RR 0.96cgi
| 1 (126) | Very low | Results NS |
Frequency of use
| ||||||
Change in cannabis consumption. Mean change from baselinek, self-reportb, past 30 d [34] | 3 mo | -5 versus -0.8 d (fewer d at 3 mo) | MD -4.2 (-8.1 to -0.3) | 1 (95) | Low | (−) value for MD indicates fewer d consumption with BI |
12 mo | -7.1 versus -1.8 d (fewer d at 12 mo) | MD -5.3 (-0.6 to 10) | 1 (102) | Low | ||
Quantity of use
| ||||||
Defined daily dosage - Sedatives/hypnotics/opioids
d
| 3 mo | 0.42 versus 0.12 (dosage higher at 3 mo) | MD 0.30c
| 1 (126) | Very low | Results NS |
Mean change from baselinek, NR | ||||||
Patient’s dose of a given prescription drug per day (in mg) divided by the product-specific WHO measure [37] | 12 mo | Not provided | See Comment | 1 (126) | Very low | Authors state no significant difference between groups, P = 0.330 |
Change in drug level - Cocaine
| 6 mo | -180 versus -21 ng/ 10 mg (less at 6 mo) | See Comment | 1 (376) | Low | Authors state adjusted P = 0.058, likely representing multiple adjusted analysesm
|
Change in mean from baselinel, objectivee[17] | ||||||
Change in drug level - Opioids
| 6 mo | -7.6 versus -7.8 ng/ 10 mg (less at 6 mo) | See Comment | 1 (189) | Low | Authors state adjusted P = 0.186, likely representing multiple adjusted analysesm
|
Change in mean from baselinel, objectivee[17] | ||||||
Use-related harms or negative consequences of use
| ||||||
Carried a weapon (gun, knife, club) | 3 mo | 5/42 (12%) versus 17/55 (31%)f
| Adj RR 0.44 (0.15 to 1.09)gn
| 1 (97) | Very Low | |
Self-report, past 30 d [34] | ||||||
12 mo | 5/47 (11%) versus 11/55 (20%)f
| Adj RR 0.62 (0.20 to 1.60)gn
| 1 (102) | Very Low | ||
Drove a car after using cannabis. Self-report, past 30 d [34] | 3 mo | 6/42 (14%) versus 10/55 (18%)f
| Adj RR 0.85 (0.28 to 2.08)gn
| 1 (97) | Very Low | |
12 mo | 8/47 (17%) versus 13/55 (24%)f
| Adj RR 0.67 (0.26 to 1.48)gn
| 1 (102) | Very Low | ||
Rode in a car with a person drunk/high after cannabis use. Self-report, past 30 d [34] | 3 mo | 11/42 (26%) versus 13/55 (24%)f
| Adj RR 1.01 (0.46 to 1.88)gn
| 1 (97) | Very Low | |
12 mo | 10/47 (21%) versus 13/55 (24%) | Adj RR 0.85 (0.37 to 1.67)gn
| 1 (102) | Very Low | ||
Physical fight. Self-report, past 30 d [34] | 3 mo | 9/42 (21%) versus 14/55 (25%)f
| Adj RR 0.91 (0.39 to 1.76)gn
| 1 (97) | Very Low | |
12 mo | 6/47 (13%) versus 19/55 (35%)f
| Adj RR 0.35 (0.12 to 0.87)gn
| 1 (102) | Low | ||
Positive behavior change
| ||||||
Tried to cut back on cannabis use. Self-report, past 3 and 12 mo [34] | 3 mo | 29/42 (69%) versus 28/55 (51%)f
| Adj RR 1.36 (0.96 to 1.64)gn
| 1 (97) | Low | |
12 mo | 34/47 (72%) versus 33/55 (60%)f
| Adj RR 0.96 (0.91 to 1.45)gn
| 1 (102) | Low | ||
Tried to stop using cannabis. Self-report, past 3 and 12 mo [34] | 3 mo | 23/42 (55%) versus 19/55 (35%)f
| Adj RR 1.58 (1.01 to 2.12)gn
| 1 (97) | Low | |
12 mo | 25/47 (53%) versus 21/55 (38%)f
| Adj RR 1.42 (0.92 to 1.90)gn
| 1 (102) | Low | ||
‘Tried to be careful about situations you got into when using marijuana’
| 3 mo | 32/42 (76%) versus 38/55 (69%)f
| Adj RR 1.13 (0.84 to 1.30)gn
| 1 (97) | Low | |
Self-report, past 3 and 12 mo [34] | 12 mo | 34/47 (72%) versus 38/55 (69%)f
| Adj RR 1.05 (0.76 to 1.24)gn
| 1 (102) | Low | |
Decision to attend treatment
| ||||||
6 mo | n/a | Not estimable | 1 (118) | n/a | Data poorly reported, not provided by group. | |
SECONDARY OUTCOMES
| ||||||
Use of different substances
| ||||||
Change in type of drug from baseline to follow-up - Cocaine/opioids
| 6 mo | n/a | Not estimable | 1 (118) | n/a | Poorly reported by authors. |
Change from baseline [17] | ||||||
Intention to reduce use
| ||||||
Not reported in any studies
| n/a | n/a | Not estimable | 0 (0) | n/a | |
Other health measures
| ||||||
Felt unsafe
| 3 mo | 14/42 (33%) versus 25/55 (45%)f
| Adj RR 0.67 (0.33 to 1.16)gn
| 1 (97) | Low | |
Self-report, past 30 d [34] | ||||||
12 mo | 11/47 (23%) versus 29/55 (53%)f
| Adj RR 0.35 (0.16 to 0.72)gn
| 1 (102) | Low | ||
Change in ASI composite score from baseline - Cocaine and/or heroin
| 3 mo | Not reported | Not estimable; See Comment | 1 (854) | Low | Authors state not statistically significant |
Change from baseline | Drug - 6 mo | 49% versus 46% reduction from baseline | Not estimable; See Comment | 1 (562) | Low | Authors state P = 0.06 |
Drug and medical subscales [17] | ||||||
Med - 6 mo | 56% versus 50% reduction from baseline | Not estimable; See Comment | 1 (562) | Low | Authors state P = 0.055 | |
Other adverse outcomes
| ||||||
Not reported in any studies
| n/a | Not estimable | 0 (0) | n/a |