SBIRT for Substance Abuse in Mental Health Treatment Settings

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DESCRIPTION (provided by applicant): SBIRT for Substance Abuse in Mental Health Treatment Settings Project Description An estimated 40% of patients in mental health treatment settings engage in hazardous alcohol and/or drug use. Yet mental health clinics often do not provide intervention or referral to specialty substance use disorder (SUD) treatment for these patients. One model of intervention that has been shown effective in medical settings to reduce alcohol use and/or promote engagement in addiction treatment is screening, brief intervention, and referral to treatment (SBIRT). Despite the effectiveness of SBIRT for risky alcohol use in medical settings, there has been limited research on the effectiveness of SBIRT for drug use and no research on the effectiveness of SBIRT in mental health treatment settings. Given the proportionately large number of mental health patients who also engage in hazardous substance use and the limited attention given to substance use issues in mental health clinics, research is needed to find an appropriate and effective substance use intervention for patients in these settings. The proposed study uses a randomized controlled trial to examine the extent to which the World Health Organization's SBIRT model, the ASSIST (Alcohol, Smoking, and Substance Involvement Screening Test) and its associated brief behavioral intervention, leads to reductions in substances prevalent in mental health settings: alcohol, cannabis and stimulants (i.e., cocaine and methamphetamine). The study will also examine the effect of SBIRT on improvement in psychiatric symptoms, improved quality of life and for those whose level of substance misuse indicates a need for treatment, initiation and engagement into SUD treatment services. Eligible participants will be mental health patients who report any past year use of cannabis or stimulants or at least one heavy drinking day in the past year. An exploratory aim of the study is to identify effect sizes of SBIRT for patients whose highest risk is for alcoho, cannabis or stimulants. Mental health patients (n = 1,080) who meet eligibility criteria will be enrolled and randomly assigned to either the SBIRT intervention condition or to a health education attention control condition. Participants will be assessed at baseline on substance use, psychiatric symptoms and quality of life. Each participant will be assessed at 3-, 6- and 12- month follow up points for alcohol and drug use, involvement in SUD treatment services, severity of psychiatric symptoms and quality of life. Random effects growth models will be used to test the study hypotheses. If successful this study will yield valuable new knowledge about the effectiveness of SBIRT in mental health treatment settings and will promote improved well being of mental health patients. Further, the study will provide evidence on the effectiveness of SBIRT for reducing illicit drug use. Results from this research will be used as the basis for broader dissemination and of SBIRT in mental health settings. PUBLIC HEALTH RELEVANCE: Community mental health clinics are opportune settings to reach individuals at high risk for substance use disorders because of the high rate of co-occurring mental health and substance use in the U.S. (SAMHSA, 2010). The proposed study is the first U.S.-based randomized controlled trial of a screening, brief intervention, and referral t treatment (SBIRT) intervention in mental health settings. The study will determine the effectiveness of SBIRT for the reduction of substance use, engagement in substance abuse treatment, and improvement in mental health status and quality of life for individuals seeking care in publicly-funded mental health clinics.