This document describes a cluster randomized controlled trial that assessed the effectiveness of training family doctors to deliver brief interventions addressing excessive substance use in young patients aged 15-24. 600 young patients were recruited from 32 family practices randomized to an intervention or control arm. Doctors in the intervention arm received 5 hours of training in brief intervention techniques. The trial found no evidence that the brief interventions reduced excessive substance use at 3, 6, or 12-month follow-ups compared to the control arm among those who were excessive substance users at baseline. However, the study suggests primary care physicians may still play a role in modifying young people's substance use trajectories over the long term.

1. TRAINING FAMILY DOCTORS TO USE BRIEF
INTERVENTION TO ADDRESS EXCESSIVE
SUBSTANCE USE IN YOUNG PEOPLE: A CLUSTER
RANDOMISED CONTROLLED TRIAL (PRISM-ADO)
• PD Dr Dagmar M. Haller
• Dr Anne Meynard
• Dr Obioha C Ukoumunne
• Dr Danièle Lefebvre
• PD Dr Françoise Narring
• PD Dr Barbara Broers
• Unité Santé Jeunes
• Unité des Dépendances
DMCPRU & DEA

2. BINGE DRINKING

3. BINGE DRINKING
CONSOMMATION DE
CANNABIS

4. BINGE DRINKING
15 ans: 1x/mois->
 1/3 garçons
 1/4 filles
HBSC 2009-2010

5. BINGE DRINKING
15 ans: 1x/mois->
 1/3 garçons
 1/4 filles
HBSC 2009-2010
CONSOMMATION DE
CANNABIS
15 ans: déjà essayé->
 1/3 garçons
 1/4 filles
HBSC 2009-2010

6. Chen & Jacobson,
JAH 2012

7. Chen & Jacobson,
JAH 2012

8. PRISM-Ado_objective
(Primary care Intervention addressing Substance
Misuse in Adolescents)
 To assess the
effectiveness of
training family
doctors to deliver a
brief intervention
addressing binge
drinking and/or
excessive cannabis
use in young
people

9. Cluster randomised trial in 32 family medicine
practice in French-speaking part of Switzerland
32 family doctors
16 doctors
randomised to
intervention arm
5 hrs training in
using brief
intervention with
adolescents
Recruitment of
patients 15-24
years consulting
for any reason
16 randomised to
wait list control arm
Wait-list for the
training
Recruitment of
patients 15-24
years consulting
for any reason

10. PRISM-Ado:
PRimary care Intervention addressing
Substance Misuse in Adolescents
 600 young people (15 to 24 years) recruited
 Completed confidential survey before
consultation
 Follow-up: 3, 6 & 12 months (tel)
 Outcomes: binge drinking &/or cannabis
use in past 30 days
10

11. Definition of excessive use
In past 30 days:
 Alcohol: ≥ 1episode of binge drinking
 Cannabis: ≥ 1X/week
Based on studies showing this threshold for
negative outcomes in adulthood
Bonomo Y. et al. Addiction 2004
Viner R. et al. J. Epi Com Health 2007
Coffey C et al. Br. J. Psy 2003

12. Analysis
 Separately for those who were excessive users
at baseline and those who were not
 Regression analysis comparing alcohol and
cannabis use at 3, 6 and 12 months in the
intervention and the control arms.
 “marginal models using Generalised
Estimating Equations (GEE) with robust
estimates of standard errors to allow for
clustering”

13. RESULTS

14. Recruitment & follow-up
BASELINE
3 months
6 months
12 months
600 patients
15-24 ans
recruited
16 intervention
practices
INTERVENTION
287 patients
16 control
practices
CONTROL
307 patients
223 = 78%
249 = 87%
211 = 74%
6 patients excluded
(non-valid
questionnaire)
270=88%
250 = 82%
220 = 72%
< 10% declined
or excluded

15. Proportion of excessive substance users
among participants (N=594)
Excessive use in past 30 days
Proportion
% (95%CI)
 Alcool (≥1 binge drinking) 44.9 (40.8-49.0)
 Cannabis (≥1x/week) 11.1 (8.5-13.6)
 Alcool &/or cannabis 48.9 (44.7-53.0)
15

16. 3,6 & 12 months outcome amongst
those who were excessive substance
users at baseline (n=279)
73.9
76.2
79.0
64.9 65.0 66.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
baseline 3 months 6 months 12 months
intervention
control

17. Chen & Jacobson,
JAH 2012

18. Table: Proportion with the outcome in those with excessive substance use at baseline (n=279) and
odds ratios for this outcome in the intervention compared to the control arm
OUTCOME
Intervention
Arm (n=130)
Control
Arm (n=149)
Adjusted OR p-value
EXCESSIVE ALCOHOL and / or
CANNABIS USE % % OR (95% CI)
- at 3 months 73.9 64.9 1.2 (0.7- 2.1) 0.50
- at 6 months 76.2 65.0 1.4 (0.8- 2.7) 0.25
- at 12 months 79.0 66.0 1.6 (0.8- 3.3) 0.21

19. PRISM-Ado : Conclusions
• Excessive substance = frequent
• Despite recommendations, still no evidence that
brief interventions delivered by primary care
physicians are effective!
• Yet study suggests a role for primary care in
modifying young people’s substance use
trajectories.
• Longitudinal studies could help specify this role in
the future.

20. Références
 Haller DM, Meynard A, Lefebvre D, Tylee A, Narring F,
Broers B.
Brief intervention addressing excessive cannabis use
in young people consulting family practitioners: a
pilot study
Br J Gen Pract. 2009;59(560):166-72.
 Haller DM, Meynard A, Lefebvre D, Ukoumunne OC,
Narring F, Broers B.
Effectiveness of training family physicians to deliver a
brief intervention to address excessive substance use
among young patients: a cluster randomized
controlled trial.
CMAJ 2014. Epub 2014/03/13.

21. PRISM-Ado team & funders
PILOT TEAM
 Dr Delphine Mottu
 Dr France Le Broccard
 Dr Risako Suzuki
 Dr Alain Michaud
 Dr François George
 Dr Florence Maggi
 Dr Liliane Regard
 Dr Daphné du Pasquier
 Dr Yves Beyeler
 Dr Arabelle Rieder
 Mme Gwendolyn Thys
Dentand
 Dr Gaëtan Conti
 Mmes Laure Vieux, Claudine
Calvet, Clothilde Hamion,
Stéphanie d’Incau, Coralie
Salomon
 M. Jean-Marc Schwob, Lucien
Widmer, Damien Fayolle
Study funded by:
•Safra Foundation & Geneva University
Hospitals,
•Käthe-Zingg-Schwichtenberg Fund
(Swiss Academy for Medical Sciences)
•Swiss Federal Office of Public Health

22. Family doctors involved
(general internists & paediatricians)
 Dr S. Antonini Revaz
 Dr F. Balavoine
 Dr T. Battisti
 Dr P. Berchtold
 Dr M. Birchmeier
 Dr F. Bovet Boone
 Dr M. Bungener
 Dr M. Chalier
 Dr R. Chevalley
 Dr C. Cuendet
 Dr M. Dafflon
 Dr P. Dussoix
 Dr C. Extermann
 Dr I. Favre
 Dr C. Feroiu
 Dr A. Golcea-Chittaro
Dr P. Guilbert
Dr Y. Heller
Dr L. Herzig
Dr C. Jacquier
Dr S. Jotterand
Dr V. Kirchner
Dr P. Klauser
Dr. J. Meizoz
Dr P. Membrez
Dr V. Paris
Dr M. Perin-Minisini
Dr F. Quinodoz
Dr A. Rieder-Zanone
Dr L. Terraz
Dr R. Vasquez
Dr A. Vilaseca

23. dagmar.haller-hester@hcuge.ch