Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Implementation and Cluster-Randomized Trial

Nearly 22 million Americans age 12 and older (8.1%) need treatment for a substance use disorder (SUD). While only 10%-11% of individuals requiring treatment for a SUD receive it, an estimated two-thirds see a primary care or urgent care provider every 6 months. Primary care providers are in a unique position to perform Screening, Brief Intervention, and Referral to Treatment (SBIRT). With Phase I contract funding, Pro-Change developed and piloted-tested a mobile- delivered Substance Use Intervention (SURI) designed to reduce barriers to SBIRT in primary care by delivering universal screening and feedback on SUD risk to patients at home or in the clinic. For patients at risk, the program also delivers: 1) a brief intervention based on the Transtheoretical Model of Behavior Change (TTM) to facilitate progress through the stages of change for quitting their most problematic drug, and for seeking treatment if indicated; and 2) 30 days of stage-matched text messages and four online activities addressing key topics (e.g., managing cravings). For providers, the intervention prototype includes a Clinical Dashboard that summarizes the patient’s SUD risk scores and stage of change data, and provides stage-matched scripts to guide a brief in-person intervention session. The program was well- received in a small pilot test. The goals in Phase I of this Fast-Track project are to program additional SURI features and functions–including Electronic Health Record (EHR) integration–required for effective integration into clinical practice and to establish the feasibility of our approach in a clinic-wide implementation in one federally qualified health center site. If feasibility is established the intervention will be tested in a cluster-randomized trial among 1300 patients recruited by 20 FQHCs randomly assigned to treatment or usual care. Outcomes will include days of use of the patient’s most problematic drug and other measures of substance use and well-being at 9 months follow-up.