Randomized Trial of Screening and Brief Intervention to Reduce Injury and Substance Abuse in an urban Level I Trauma Center.

BACKGROUND

The TIP (Traumatic Injury Prevention) Project evaluated the impact on post-injury drug use of two brief motivational interventions compared to brief advice (BA) among injured patients who use drugs.

METHOD

Three-group, single blind, randomized controlled trial in a Level 1Trauma Center enrolled 395 admitted patients with drug positive toxicology screen or verbal report of drug use in the previous 30 days. 34% were Hispanic, 45% non-Hispanic White, 16% non-Hispanic Black. 88% smoked marijuana, 28% used cocaine and 11% prescription opioids. Brief Advice (BA) provided advice to abstain from drugs, educational materials and referral to community resources. Brief Motivational Intervention (BMI) additionally included a 30-45 minute session, with assessment feedback, based on motivational interviewing. BMI + B included a telephone booster 4-weeks post-intervention. Drug use as measured by percent days abstinent and total abstinence, derived from the Timeline Follow back was the primary outcome.

RESULTS

A significant reduction from baseline was observed at 3, 6, and 12 months in the primary outcomes of any drug use (excluding alcohol); cannabis and cocaine, the most frequently used drugs, were analyzed individually. There were no between group differences or group X time interactions. Similarly, there were no between groups differences on secondary outcomes including perceived health status, re-injury, arrest, incarceration, alcohol and drug treatment, employment, AA attendance, homelessness, physical abuse, and problems associated with alcohol and drug use.

CONCLUSIONS

The study does not support use of these enhanced motivational interventions over brief advice for trauma patients with a positive screen for drug use.