Recruitment & retention: SMART-ED, NIDA CTN-0047.

Medical settings such as emergency departments (EDs) present an opportunity to identify and provide services for individuals with substance use problems who might otherwise never receive any form of assessment, referral, or intervention. Although Screening, Brief Intervention, and Referral to Treatment (SBIRT) models have been extensively studied and are considered effective for individuals with alcohol problems presenting in emergency departments and other medical settings, there is much less evidence concerning the efficacy of such interventions for drug users presenting in EDs. This presentation describes the design of the National Drug Abuse Treatment Clinical Trials Network protocol “Screening Motivational Assessment and Referral to Treatment in Emergency Departments (SMART-ED)” (CTN-0047), with a focus on the screening, assessment, treatment conditions, and follow-up procedures. 1285 patients who screened positive for current problematic substance use were randomly assigned to: (1) Minimal screen only (MSO), (2) Screening, assessment, and referral to treatment (if indicated) (SAR); or (3) Screening, assessment, and referral plus a brief intervention (BI) with two telephone follow-up booster calls (BI-B). BI-B therapists received considerable training, ongoing supervision and formal fidelity monitoring. The three-arm design was implemented to control for assessment reactivity. Sites recruited an average of approximately 21 participants per site per month. Treatment exposure was nearly universal for the initial BI, but a significant number of participants could not be reached for one or both of the booster sessions. Although follow-up is ongoing, current rates of follow-up exceed those specified in the analysis plan.

Conclusions: The study was completed on time, with good treatment exposure, strong attention to treatment fidelity, and excellent follow-up rates. Study outcomes should provide strong evidence regarding the efficacy of this brief intervention strategy for drug users presenting in medical EDs.

Related protocols: CTN-0047