Brief Interventions for Substance Abuse: Implications for Health Related Quality of Life

INTRODUCTION. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive public health approach to addressing misuse and abuse of alcohol and other substances (Substance Abuse and Mental Health Services Administration [SAMHSA], 2013). SBIRT programs identify individuals using substances at harmful levels, offer brief interventions (BI), such as motivational interviews (Miller & Rollnick, 2002), and link those requiring more acute treatment with more intensive brief therapy (BT) or referrals for chemical dependence treatment (RT). SBIRT programs are shown to be effective in reducing risky substance use (Vasilaki, Hosier, & Cox, 2006). Whereas evaluations of SBIRT programs typically focus on reductions in substance use, it is likely that intervention-related improvements in substance use also affect a range of other outcomes, including health-related quality of life (Tiffany, Friedman, Greenfield, Hassin, & Jackson, 2011).

METHOD. Data was taken from the quasi-experimental evaluation of the Georgia Brief Assessment, Screening, Intervention, and Continuum of Care System (Georgia BASICS), and funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) from 2009-2013. The sample included patients from two urban emergency departments who screened at moderate or high risk for abuse of alcohol or other drugs: 740 patients received SBIRT services, and a non-randomly assigned comparison group of 712 patients received assessment only. We used full propensity score matching to achieve an optimal balance on multiple covariates including patient demographics, site, baseline HRQOL, and alcohol consumption frequency. Data were analyzed using weighted linear regression and p-values ≤ .05 were considered statistically significant. 

RESULTS. Participants receiving SBIRT services reported significantly higher (B=3.95, SE=.56, p < .001) mental health composite scores at 6-month post-intervention than comparisons. At follow-up, intervention patients had scores just below the population average of 50, meaning that they reported better mental health than about 40% of the population. Comparisons’ scores declined to an average of 35,meaning they had better mental health than only 7% of the population. Differences between Intervention and Comparison patients on physical health composite scores did not reach statistical significance.

DISCUSSION. These results highlight the value of considering a broader range of outcomes in substance abuse prevention and treatment studies.