Screening, brief intervention, and referral to treatment for risky stimulant use in a Skid Row community health center
KeywordsCocaine Community Health Center Meet Study Criterion Health Education Session Type Stimulant
The University of California at Los Angeles Quit Using Drugs Intervention Trial (QUIT) aims to conduct a randomized controlled trial of a primary-care based very brief intervention protocol for reducing risky stimulant use and drug-related harm in low-income, racially diverse primary care patients attending safety-net clinics in the east central Skid Row area of Los Angeles. The QUIT trial emphasizes screening, very brief clinician advice (2-3 minutes), and two telephone drug-use health education sessions versus usual-care in the control group (240 patients per condition). Between February 18 and April 28, 2011, pre-visit screening of adults in the waiting room was conducted using a touch-screen Tablet PC. “At risk” drug use was defined as casual, frequent, or binge use without the physiological or psychological manifestations of dependence (a score of 4 to 26 on the World Health Organization’s Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). A total of 920 adult patients were approached: 89% were 40+ years old; 68% were male; 62% were black, 21% were Latino, and 17% were white. Of patients approached, 706 were excluded due to pregnancy, because it was a nonprimary care visit, or because they refused to participate. Among the 214 who completed the ASSIST, substance use scores were none or low risk in 11% of participants, moderate risk in 42%, and dependence-level in 47%. The number of participants in each score range by substance were, respectively, tobacco 55, 101, and 58; alcohol 62, 98, and 54; cannabis 94, 77, and 43; cocaine 89, 74, and 51; methamphetamine/amphetamine type stimulants 145, 45, and 23; inhalants 185, 20, and 9; sedatives 143, 45, and 26; hallucinogens 174, 30, and 10; and opioids 130, 54, and 30. Participants who were older than 50 years were more likely to use tobacco, alcohol, cannabis, and cocaine; younger patients were more likely to use amphetamines, inhalants, sedatives, hallucinogens, and opioids. Twenty-seven patients (3% of those approached) met study criteria of past three-month risky stimulant use. Seventy percent were homeless, and 30% were marginally housed. In Skid Row, only 3% of patients qualified for risky stimulant use intervention.
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