Introduction
Screening, brief intervention, and referral to treatment (SBIRT) in the ED
Case management for patients with substance use disorders (SUDs)
SBCM
Study rationale
Methods
Design overview
Recruitment procedures
Inclusion and exclusion criteria
Screening and baseline procedures
Study assessments
Randomization
Study interventions
SAR intervention
SBCM-ED intervention
SBCM-ED training
SBCM-ED model
Working Alliance Inventory—Short Revised (WAI-SR)
Statistical methods
Power and sample size
Preliminary analyses
Outcomes analyses
Results
Participant recruitment
Demographics
Total (n = 297) | SAR (n = 149) | SBCM-ED (n = 148) | ||||
---|---|---|---|---|---|---|
Characteristic | n | (%) | n | (%) | n | (%) |
Gender | ||||||
Male | 256 | (86.2) | 126 | (84.6) | 130 | (87.8) |
Female | 41 | (13.8) | 23 | (15.4) | 18 | (12.2) |
Age mean years (SD) | 43.7 | (10.8) | 43.0 | (10.8) | 44.4 | (10.8) |
Race/ethnicity | ||||||
Hispanic/Latino | 98 | (33.0) | 46 | (30.9) | 52 | (35.1) |
Black/African-American | 97 | (32.7) | 50 | (33.6) | 47 | (31.8) |
White | 74 | (24.9) | 38 | (25.5) | 36 | (24.3) |
Asian/Asian-Amer./Pacific Islander | 8 | (2.7) | 5 | (3.4) | 3 | (2.0) |
Other | 20 | (6.7) | 10 | (6.7) | 10 | (6.8) |
Income1 mean (SD) | 15,788.70 | (24,018.9) | 15,581.97 | (23,349.91) | 15,942.49 | (24,574.65) |
Education mean years (SD) | 11.7 | (2.6) | 11.8 | (2.6) | 11.5 | (2.6) |
Currently employed | ||||||
Yes | 50 | (16.8) | 25 | (16.8) | 25 | (16.9) |
No | 247 | (82.3) | 124 | (83.2) | 123 | (83.1) |
Stable living situation | ||||||
Yes | 149 | (50.2) | 83 | (55.7) | 66 | (44.6) |
No | 148 | (49.8) | 66 | (44.3) | 82 | (55.4) |
Lifetime opioid treatment (yes) | 230 | (77.4) | 115 | (77.2) | 115 | (77.7) |
Chief complaint at ED visit | ||||||
Seeking detox | 214 | (72.1) | 105 | (70.5) | 109 | (73.6) |
Withdrawal | 17 | (5.7) | 5 | (3.4) | 6 | (4.1) |
Seeking medication/ methadone | 11 | (3.7) | 8 | (5.4) | 9 | (6.1) |
Other | 55 | (18.3) | 31 | (20.8) | 24 | (16.2) |
> 1 day(s) in healthcare institutions | ||||||
Hospital: medical | 27 | (9.1) | 14 | (9.4) | 13 | (8.8) |
Hospital: detox | 21 | (7.1) | 10 | (6.7) | 11 | (7.4) |
Residential detox | 16 | (5.4) | 10 | (6.7) | 6 | (4.1) |
Ambulatory detox | 2 | (0.7) | 2 | (1.3) | 0 | (0.0) |
Residential program | 7 | (2.4) | 4 | (2.7) | 3 | (2.0) |
Residential: alcohol only | 1 | (0.3) | 0 | (0.0) | 1 | (0.7) |
Residential: emotional/psych | 5 | (1.7) | 2 | (1.3) | 3 | (2.0) |
Any institution | 79 | (26.6) | 42 | (28.2) | 37 | (25.0) |
Incarcerated in past 30 days | 15 | (5.1) | 5 | (3.4) | 10 | (6.8) |
Substance use2 | n | % or Mean (SD) | n | % or Mean (SD) | n | % or Mean (SD) |
Street opioid use | ||||||
Use in the last 30 (yes) | 289 | 97.3% | 146 | 98.0% | 143 | 96.6% |
Days in last 30 | 297 | 25.7 (7.9) | 149 | 26.2 (7.2) | 148 | 25.2 (8.6) |
Lifetime months | 293 | 185.3 (141.1) | 147 | 179.4 (135.7) | 146 | 191.3 (146.5) |
Rx opioid use | ||||||
Use in the last 30 (yes) | 93 | 31.3% | 50 | 33.6% | 43 | 29.1% |
Days in last 30 | 297 | 2.6 (6.5) | 149 | 2.74 (6.7) | 148 | 2.5 (6.3) |
Lifetime months | 199 | 85.6 (109.4) | 100 | 75.3 (93.8) | 99 | 96.1 (122.7) |
Alcohol use | ||||||
Use in the last 30 (yes) | 165 | 55.6% | 77 | 51.7% | 88 | 59.5% |
Days in last 30 | 297 | 10.2 (12.6) | 149 | 9.5 (12.5) | 148 | 10.8 (12.8) |
Lifetime months | 277 | 225.6 (149.4) | 139 | 208.8 (142.6) | 138 | 242.4 (154.6) |
Cocaine use | ||||||
Use in the last 30 (yes) | 193 | 65.0% | 94 | 63.1% | 99 | 66.9% |
Days in last 30 | 297 | 9.4 (11.6) | 149 | 9.3 (11.8) | 148 | 9.5 (11.5) |
Lifetime months | 270 | 180.7 (144.0) | 135 | 166.5 (138.3) | 135 | 194.8 (148.7) |
Substance use
Clinical and environmental characteristics
Total (n = 297) | SAR (n = 149) | SBCM-ED (n = 148) | |
---|---|---|---|
Mean (SD) | Mean (SD) | Mean (SD) | |
WHOQoL-Bref | |||
Physical | 11.6 (2.9) | 11.6 (2.9) | 11.6 (2.9) |
Psychological | 10.9 (3.4) | 10.9 (3.4) | 10.9 (3.5) |
Social | 10.7 (3.9) | 10.9 (3.9) | 10.5 (3.8) |
Environment | 10.7 (3.1) | 10.9 (3.2) | 10.5 (3.1) |
Total Quality of Life | 9.3 (4.1) | 9.2 (4.0) | 9.4 (4.2) |
Total Health | 9.6 (4.1) | 9.6 (4.0) | 9.5 (4.2) |
SIP-D | |||
Intrapersonal | 10.9 (1.8) | 10.8 (1.8) | 10.9 (1.7) |
Interpersonal | 10.5 (2.1) | 10.5 (2.1) | 10.5 (2.1) |
Physical | 9.9 (2.1) | 9.9 (2.0) | 10.1 (2.1) |
Social | 11.1 (1.5) | 10.9 (1.7) | 11.2 (1.4) |
Impulse Control | 9.2 (2.4) | 9.3 (2.5) | 9.1 (2.3) |
BTI | |||
Absence of Problem | 1.7 (0.7) | 1.6 (0.7) | 1.7 (0.7) |
Negative Social Support | 1.8 (0.7) | 1.8 (0.7) | 1.8 (0.7) |
Fear of Treatment | 1.9 (0.7) | 1.9 (0.7) | 1.9 (0.8) |
Privacy Concerns | 2.6 (1.1) | 2.7 (1.1) | 2.6 (1.0) |
Time Conflicts | 2.0 (0.8) | 2.0 (0.8) | 2.0 (0.7) |
Treatment Availability | 2.3 (1.0) | 2.3 (1.0) | 2.3 (1.0) |
Admission Difficulty | 2.4 (1.0) | 2.4 (0.9) | 2.5 (1.0) |
Childcare Concerns | 1.8 (0.8) | 1.8 (0.8) | 1.7 (0.8) |
TCU-MA | |||
Problem Recognition | 4.1 (0.6) | 4.1 (0.6) | 4.2 (0.5) |
Desire For Help | 4.3 (0.5) | 4.2 (0.5) | 4.3 (0.5) |
Treatment Readiness | 3.9 (0.6) | 3.9 (0.6) | 4.0 (0.6) |
External Pressure | 2.9 (0.7) | 2.9 (0.6) | 2.9 (0.7) |
Intervention initiation
SBCM-ED (n = 148) | ||
---|---|---|
n | (%) | |
Session attendance | ||
0 sessions | 11 | (7.4) |
> 1 session | 137 | (92.6) |
Session 1 location | ||
Emergency department | 75 | (54.7) |
Hospital (inpatient) | 27 | (19.7) |
Case manager’s office | 25 | (18.2) |
SUD treatment provider | 2 | (1.5) |
Participant’s residence | 1 | (0.7) |
Medical care clinic in hospital | 2 | (1.5) |
Public location | 3 | (2.2) |
Telephone | 0 | (0.0) |
Car/Vehicle | 1 | (0.7) |
Other | 1 | (0.7) |
WAI-SR | n | Mean (SD) |
Bond | 112 | 4.5 (0.1) |
Task | 112 | 4.3 (0.1) |
Goal | 111 | 4.4 (0.1) |