Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED)

The study builds on the knowledge base in developing and implementing screening and brief interventions for harmful and hazardous alcohol use delivered in emergency departments and trauma centers, by transferring and evaluating these procedures when applied to drug use. The study will contrast substance use and substance-related outcomes among patients endorsing problematic substance use during an emergency department (ED) visit who are randomly assigned to one of three treatment conditions: 1) minimal screening only (MSO); 2) screening, assessment, and referral to treatment (if indicated) (SAR); and 3) screening, assessment, and referral plus a brief intervention (BI) with two telephone follow-up booster sessions (BI-B). The primary outcome is days of use of the patient-defined primary problem drug at 3 months following enrollment. Secondary outcomes include change from baseline in days of use of the primary substance, the number days abstinent from all drugs, days of heavy drinking, total quantity of drug use, objective change in drug use based on analysis of hair samples, self-reported consequences of drug and alcohol use, percent entering treatment among those classified as having probable dependence, and ED and other health care utilization.