Women are at the highest risk of developing a substance use disorder during their reproductive years (18-44), yet 85% of those who need care for substance misuse neither receive it or feel like they even need it. Reducing substance misuse for this group is especially critical as these women may be either pregnant or contemplating pregnancy.
The Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice used to reduce substance misuse and is an especially important technique for reaching the non-treatment seeking majority. While SBIRT is known to reduce substance misuse, little research exists on its application for women in reproductive health settings.
Dr. Todd Olmstead, CHASP Faculty Fellow and health scholar at the LBJ School of Public Affairs, and his colleagues studied the use of SBIRT with women being treated at two academic hospital-based reproductive healthcare clinics over a period of almost three and a half years. The women were first screened for cigarette smoking, or misuse of alcohol, illicit drugs, or prescription medication, and then randomly allocated to SBIRT delivered electronically (e-SBIRT) or by clinician (SBIRT) or to enhanced usual care.
Their findings were published in the new paper, A Randomized Controlled Trial of an Electronic- and Clinician-delivered Brief Intervention for Women, in the peer-reviewed American Journal of Obstetrics and Gynecology. See below for full abstract.
Dr. Olmstead is an associate professor of public affairs at the LBJ School of Public Affairs at The University of Texas at Austin. He received a Ph.D. in Public Policy from Harvard University, M.S. in Operations Research from The University of North Carolina at Chapel Hill, and M.S. and B.S. in Industrial Engineering from State University of New York at Buffalo.
A Randomized Controlled Trial of an Electronic- and Clinician-delivered Brief Intervention for Women
American Journal of Obstetrics and Gynecology (December 2017)
Screening, Brief Intervention, and Referral to Treatment may reduce substance misuse but has received minimal study among women treated in reproductive health settings.
To determine whether Screening, Brief Intervention and Referral to Treatment delivered either electronically or by clinician is more effective than enhanced usual care in decreasing days of primary substance use.
Women from two reproductive centers who smoked cigarettes or misused alcohol, illicit drugs, or prescription medication were randomly allocated to Screening, Brief Intervention and Referral to Treatment delivered electronically or by clinician or to enhanced usual care. Assessments were completed at baseline, and 1-, 3- and 6- months post-baseline. Co-primary outcomes were days/month of primary substance use and post-intervention treatment utilization. A sample size of 660 women was planned; randomization was stratified by primary substance use and pregnancy status. Screening, Brief Intervention and Referral to Treatment groups were compared to enhanced usual care using generalized estimating equations and effect sizes were calculated using Cohen’s d.
Between September 2011 and January 2015 women randomized included: 143 (16.8% pregnant) in electronic-delivered Screening, Brief Intervention and Referral to Treatment, 145 (18.6% pregnant) in clinician-delivered Screening, Brief Intervention and Referral to Treatment, and 151 (19.2% pregnant) in enhanced usual care; retention was >84%. Based upon the generalized estimating equations model, predicted mean days per month of use at baseline for primary substance were 23.9 (95% CI=22.4-25.5) for electronic-delivered Screening, Brief Intervention and Referral to Treatment, 22.8 (95% CI=21.4-24.3) for clinician-delivered Screening, Brief Intervention and Referral to Treatment and 23.5 (95% CI=22.2, 24.9) for enhanced usual care, which respectively declined to 20.5 (95% CI=19.0-22.2), 19.8 (95% CI=18.5-21.3) , and 21.9 (95% CI=20.7-23.1) at one month, 16.9 (95% CI=15.0-19.0), 16.6 (95% CI=14.8-18.6), and 19.5 (95% CI=18.1-21.1) at three months, and 16.3 (95% CI=14.3-18.7), 16.3 (95% CI=14.4-18.5) , and 17.9 (95% CI=16.1-19.9) at six months. Estimated declines were greater in electronic-delivered Screening, Brief Intervention and Referral to Treatment [β (SE) =-0.090(0.034), p=0.008; Cohen’s d =0.19 at one month, 0.30 at three months, and 0.17 at six months] and clinician-delivered Screening, Brief Intervention and Referral to Treatment [β (SE) = -0.078(0.037), p=0.038; Cohen’s d=0.17 at one month, 0.22 at three months, and 0.06 at six months] compared to enhanced usual care. Treatment utilization did not differ between groups.
Screening, Brief Intervention and Referral to Treatment significantly decreased days of primary substance use among women in reproductive healthcare centers; neither resulted in more treatment utilization than enhanced usual care.
Martino S, Ondersma SJ, Forray A, Olmstead TA, Gilstad-Hayden K, Howell HB, Kershaw T, Yonkers KA, A Randomized Controlled Trial of Screening and Brief Interventions for
Substance Misuse in Reproductive Health, American Journal of Obstetrics and Gynecology(2018), doi: 10.1016/j.ajog.2017.12.005.