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Table 5 Evidence table for brief intervention (BI) versus written information in participants screened for at-risk substance use

From: Effectiveness of brief interventions as part of the Screening, Brief Intervention and Referral to Treatment (SBIRT) model for reducing the nonmedical use of psychoactive substances: a systematic review

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

Abstinence obtained by substance use treatment, including detox [[17]]

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

 
  1. aFor change from baseline data, means for baseline and follow-up timepoints are shown in Table S5, where possible.
  2. bSelf-report using Timeline Followback Calendar.
  3. cConfidence interval not presented due to unit of analysis error.
  4. dA small proportion (1.5%) of participants were assessed for caffeine use in this study.
  5. eObjective measure by biochemical hair analysis.
  6. fUnadjusted event rates.
  7. gAdjusted RR calculated from authors’ adjusted OR.
  8. hAdjusted for health insurance and homelessness.
  9. iAdjusted for prescription drug dependence according to the Structured Clinical Interview for DSM-IV Axis I disorders.
  10. jUnclear what variables were adjusted for.
  11. kMean change analysis first calculates the change between follow-up and baseline values for each participant and then computes the mean across those data.
  12. lChange in mean analysis calculated the reported mean at follow-up minus the mean at baseline.
  13. mUnclear but likely adjusts for gender, race, age, EuroQol scores, previous psychiatric history, randomization status, education level, drug route, drug problem severity (Drug Abuse Severity Test score at baseline, polydrug use, injection drug use, baseline Addiction Severity Index drug score, number of previous treatment episodes) and readiness to change.
  14. nUnclear what variables adjusted for. adj, adjusted; ASI, addiction severity index; BI, brief intervention; CI, confidence interval; d, days; info, information; med, medical; MD, mean difference; mo, months; NS, not significant; RR, risk ratio.