Exploring the components of an efficacious computer brief intervention for reducing marijuana use among adults in the emergency department

Rebecca Waller; Erin E Bonar; Anne C Fernandez; Maureen A Walton; Stephen T Chermack; Rebecca M Cunningham; Frederic C Blow

doi:10.1016/j.jsat.2019.01.014

Exploring the components of an efficacious computer brief intervention for reducing marijuana use among adults in the emergency department

J Subst Abuse Treat. 2019 Apr:99:67-72. doi: 10.1016/j.jsat.2019.01.014. Epub 2019 Jan 18.

Authors

Rebecca Waller¹, Erin E Bonar², Anne C Fernandez³, Maureen A Walton², Stephen T Chermack⁴, Rebecca M Cunningham⁵, Frederic C Blow⁶

Affiliations

¹ Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA; Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA. Electronic address: rwaller@sas.upenn.edu.
² Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
³ Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
⁴ Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA.
⁵ Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Place, Flint, MI 48503, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
⁶ Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA.

Abstract

Objective: To examine the efficacious components of a computer-delivered brief intervention (CBI) for reducing marijuana use among adults presenting to a low-income urban emergency department (ED), which a prior report found to decrease marijuana use at a 6-month follow-up.

Method: Participants were 237 ED patients reporting recent drug use (46% male; 54% African-American; mean age, 30.7) who were randomized to receive a CBI consisting of an interactive program guided by a virtual health counselor. The primary outcome was past 30-day marijuana use at 6-month follow-up assessed using the Timeline Follow-Back (TLFB). Intervention components related to change in marijuana use at 6 month follow-up examined in the current study included participant responses to items within five CBI domains that were rooted in motivational interviewing: goals for change, strengths, evoking-change (concerns about use and benefits of change), challenges, and tools for change.

Results: The evoking-change domain was related to significant reductions in marijuana use at 6 months (B = -2.91, SE = 1.10, p < .01). Within this domain, items focused on concerns about family and friends were related to reductions in marijuana use of up to 5.5 fewer days of marijuana use in the past month (B = -5.49, SE = 1.63, p < .01).

Conclusions: An ED-based brief intervention, delivered by computer, was effective in reducing marijuana use. Intervention components focused on perceived concerns about use and benefits of change in relation to family and friends were critical domains within a CBI associated with reductions in marijuana use at 6-month follow-up.

Keywords: Brief intervention; Computer; Emergency department; Marijuana; Motivational interviewing; Substance use.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Computers, Handheld
Emergency Service, Hospital
Female
Goals*
Humans
Male
Marijuana Use*
Motivational Interviewing
Poverty*
Substance-Related Disorders / therapy*
Therapy, Computer-Assisted*
Time Factors
Urban Population

Abstract

Publication types

MeSH terms

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