• Michael P Bogenschutz, Dennis M Donovan, Bryon Adinoff, Cameron Crandall, Alyssa A Forcehimes, Robert Lindblad, Raul N Mandler, Neal L Oden, Harold I Perl, and Robrina Walker.
• Department of Psychiatry, Health Sciences Center, University of New Mexico, Albuquerque, 87131, USA. mbogenschutz@salud.unm.edu
• Am J Drug Alcohol Abuse. 2011 Sep 1; 37 (5): 417-25.

BackgroundMedical settings such as emergency departments (EDs) present an opportunity to identify and provide services for individuals with substance use problems who might otherwise never receive any form of assessment, referral, or intervention. Although screening, brief intervention, and referral to treatment models have been extensively studied and are considered effective for individuals with alcohol problems presenting in EDs and other medical settings, the efficacy of such interventions has not been established for drug users presenting in EDs.ObjectivesThis article describes the design of a NIDA Clinical Trials Network protocol testing the efficacy of an screening, brief intervention, and referral to treatment model in medical EDs, highlighting considerations that are pertinent to the design of other studies targeting substance use behaviors in medical treatment settings.MethodsThe protocol is described, and critical design decisions are discussed.ResultsDesign challenges included defining treatment conditions, study population, and site characteristics; developing the screening process; choosing the primary outcome; balancing brevity and comprehensiveness of assessment; and selecting the strategy for statistical analysis.ConclusionMany of the issues arising in the design of this study will be relevant to future studies of interventions for addictions in medical settings.Scientific SignificanceOptimal trial design is critical to determining how best to integrate substance abuse interventions into medical care.

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