Brief Interventions May Not Be Useful in Counteracting Drug Use: Studies

Doctor consulting with a patient.

Two new studies published in the Journal of the American Medical Association suggest that brief counseling may not be effective in counteracting drug use. Previous research has shown brief interventions can help some problem drinkers, NPR reports.

Public health officials have been urging primary care doctors and hospital emergency rooms to ask patients about drug use, and to immediately give those with a drug problem a 10- to 15-minute counseling session, known as a brief intervention.

One of the new studies looked at more than 500 people who were determined to have a drug problem, based on a verbal screening at a primary care clinic. They were divided into three groups. The first two groups received brief counseling, while the third group received no counseling. After six months, those who had received brief counseling had not reduced drug use any more than people who received no counseling.

A second study found people who received brief counseling and a short phone call two weeks later did not reduce their drug use more than people who did not receive counseling. People with the most severe drug problems who received counseling were more likely to seek specialty care later on.

“I think it was wishful thinking that a problem as complex could be solved with a simple intervention,” said Richard Saitz of Boston University, author of the first study. He said some patients who come in for a routine checkup and are told they have a serious drug problem may be overwhelmed by the information. For these patients, a brief counseling session is unlikely to help.

Dr. H. Westley Clark, Director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration, told NPR the brief intervention model is very useful for many patients. “But as you popularize the intervention, you want to refine your approach,” he noted. Clark says brief interventions may not work for severe cases of drug use. He called for better training for health care providers to help them match patients with the best treatment.

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    Dave Finch

    August 14, 2014 at 2:11 PM

    This article and discussion seem way too superficial. If the counselor can reach the addict to the extent of persuading her to do the work of avoiding cues and focusing on incentives, that is, if the subject is one who is ready to quit and motivated enough to do the hard work, counseling is unquestionably a helpful part of rehab. But, why should we expect a brief talk to have lasting effect in those addicts who are not yet ready to work on it. These studies simply tell us not to hold too high an expectation for brief counseling. They should not be used to discourage the use of it. And they certainly do not prove that formal therapy or professional treatment is necessary for the majority of addicts. Most addicts mature out on their own. Counseling can help speed that process.

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    Jose G. Carreon

    August 7, 2014 at 2:05 PM

    I would recommend that physicians still do that brief intervention because it will help down the road to break through a patient’s defense mechanism and start their way to recovery. Brief intervention is what we used to call ” planting the seed”, the more you plant the seed and the more people in the life of a problem drug take the time to ” plant the seed”, the more likely that it will grow. Sometimes we are to quick to say this does not work, when we should say this does not work right away but it will help with time. As a drug and alcohol counselor I would love that a physician took the time and talked to their patients about their drug use. Brief intervention by a physician will plant the seed and make my job a little easier down the road.

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    David Turner, LCSW

    August 7, 2014 at 1:37 PM

    It’s taken close to a century for the AMA to realize that substance abuse (“addiction” is more lifestyle than “disease,” that it takes far more than meds targeting this or that vehicle of self-destruct to modify the course of the addict’s life? Of course “short-term” “therapy” has at best limited utility beyond getting “patients” in and getting them out. Of course such a course of “treatment” is still necessary to satisfy insurance company and governmental mandates based on medical diagnostics.

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    Jill yeagley

    August 7, 2014 at 12:26 PM

    Dr. Clark is right to suggest that the intervention needs to be tailored to the individual. There is also something noted that is a very positive finding, I think, and begs for further exploration — the fact that those with the more severe problems who received counseling were more likely to seek specialty care later on. This finding fits with what many of us in the field have observed, i.e. the “planting of a seed.”

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