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

This study has been completed.
National Institute on Drug Abuse (NIDA)
Information provided by (Responsible Party):
Michael Bogenschutz, University of New Mexico Identifier:
First received: September 21, 2010
Last updated: May 22, 2013
Last verified: May 2013

Misuse of drugs and alcohol has a tremendous impact on individual health and on society, in terms of both human suffering and economic cost. Most substance abusers never seek specialty addiction treatment, but a large percentage of them receives some form of medical care, frequently in emergency room settings. There is considerable evidence showing that Screening, Brief Intervention, Referral, and Treatment (SBIRT) interventions in medical settings result in decreased drinking and alcohol-related problems among those with alcohol abuse or dependence. However, there are few studies using these models focusing on drug users. Although drug users are seen in large numbers in emergency departments, there have been no randomized controlled trials of SBIRT models for drug users presenting in Emergency Departments (EDs).

This study is designed to assess the effects of Assessment, Referral, and a Brief Intervention on substance use of individuals screening positive for drug use during a medical ED visit. The Southwest Node of the NIDA Clinical Trials Network, located at UNM CASAA, is taking the lead on this study. Six sites across the country will participate in this study, including the ED of UNM Hospital. A total of 1285 ED patients who screen positive for current drug use problems will be randomly assigned to receive 1) minimal screening only, 2) assessment of substance use and referral to treatment, or 3) assessment and referral combined with a 30-minute counseling session (Brief Intervention) and two follow-up telephone counseling sessions. Outcomes will be assessed at 3, 6, and 12 months after the ED visit. We hypothesize that those who receive the Brief Intervention will have the least drug use at follow-up, that those who receive minimal screening only (the usual current practice) will have the most drug use, and that those receiving assessment and referral without the Brief intervention will have intermediate outcomes.

Condition Intervention
Drug Abuse
Behavioral: screening
Behavioral: assessment
Behavioral: referral
Behavioral: Brief intervention
Behavioral: booster sessions

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments

Resource links provided by NLM:

Further study details as provided by University of New Mexico:

Primary Outcome Measures:
  • days of use of the primary drug of abuse [ Time Frame: 30 days preceding 3-month follow-up ]
    Assessed by Time-line Follow-back method

Secondary Outcome Measures:
  • Days of use of the primary drug of abuse [ Time Frame: 6 months, 12 months ]
  • number days abstinent from all drugs [ Time Frame: 3, 6, 12 months ]
  • days of heavy drinking [ Time Frame: 3, 6, 12 months ]
  • total quantity of drug use [ Time Frame: 3, 6, 12 months ]
  • objective change in drug use based on analysis of hair samples [ Time Frame: 3, 6, 12 months ]
  • self-reported consequences of drug and alcohol use [ Time Frame: 3, 6, 12 months ]
  • percent entering treatment among those classified as having probable dependence [ Time Frame: 3, 6, 12 months ]
  • ED and other health care utilization [ Time Frame: 3, 6, 12 months ]

Enrollment: 1285
Study Start Date: October 2010
Study Completion Date: March 2013
Primary Completion Date: June 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Minimal screening only (MSO)
Minimal screening
Behavioral: screening
Brief screening to assess eligibility and collect minimal baseline data
Active Comparator: Screening, assessment, and referral (SAR) Behavioral: screening
Brief screening to assess eligibility and collect minimal baseline data
Behavioral: assessment
comprehensive substance use assessment
Behavioral: referral
referral to treatment if indicated or requested
Experimental: Brief intervention plus telephone boosters (BI-B) Behavioral: screening
Brief screening to assess eligibility and collect minimal baseline data
Behavioral: assessment
comprehensive substance use assessment
Behavioral: referral
referral to treatment if indicated or requested
Behavioral: Brief intervention
30-minute brief intervention session in ED
Behavioral: booster sessions
two 15-minute booster counseling sessions conducted by telephone

  Show Detailed Description


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Registration as patient in the ED during study screening hours
  2. Positive screen (≥3) for problematic use of a non-alcohol, non-nicotine drug based on the Drug Abuse Screening Test (DAST)
  3. At least one day of problematic drug use (excluding alcohol and nicotine) in the past 30 days
  4. Age 18 years or older
  5. Adequate English proficiency
  6. Ability to provide informed consent
  7. Access to phone (for booster sessions)

Exclusion Criteria:

  1. Inability to participate due to emergency treatment
  2. Significant impairment of cognition or judgment rendering the person incapable of informed consent. (e.g., traumatic brain injury, delirium, intoxication)
  3. Status as a prisoner or in police custody at the time of treatment.
  4. Current engagement in addiction treatment
  5. Residence more than 50 miles from the location of follow-up visits
  6. Inability to provide sufficient contact information (must provide at least 2 reliable locators).
  7. Prior participation in the current study.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01207791

United States, Florida
Jackson Memorial Hospital
Miami, Florida, United States
United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States
United States, New Mexico
University of New Mexico Hospital
Albuquerque, New Mexico, United States, 87131
United States, New York
Belleview Hospital
New York, New York, United States
United States, Ohio
University of Cincinnati Hospital
Cincinnati, Ohio, United States
United States, Washington
University of Washington
Seattle, Washington, United States
United States, West Virginia
West Virginia University Hospital
Morgantown, West Virginia, United States
Sponsors and Collaborators
University of New Mexico
National Institute on Drug Abuse (NIDA)
Principal Investigator: Michael P. Bogenschutz, M.D. University of New Mexico
  More Information

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Michael Bogenschutz, PI, University of New Mexico Identifier: NCT01207791     History of Changes
Other Study ID Numbers: NIDA CTN Protocol 0047
U10DA015833 ( US NIH Grant/Contract Award Number )
U10DA013732 ( US NIH Grant/Contract Award Number )
Study First Received: September 21, 2010
Last Updated: May 22, 2013

Keywords provided by University of New Mexico:
drug abuse
emergency department
brief intervention
motivational interviewing

Additional relevant MeSH terms:
Substance-Related Disorders
Disease Attributes
Pathologic Processes
Chemically-Induced Disorders
Mental Disorders processed this record on May 25, 2017