Development of a trial application to assess the effectiveness and cost-effectiveness of adult dRug scrEening and brief interventionS in key hEalth, social care and justice setTings: The RESET PROJECT

Background
In England and Wales, alcohol-related crime is estimated to cost society £27.4 billion and drugs £20 billion annually. Effective interventions therefore have the potential to reduce the costs relating to substance use and increase individual social welfare.

Brief drug use interventions are a secondary prevention activity, which are aimed at those individuals who are using substances in a pattern that is likely to be harmful to health and/or well-being. At present there is limited evidence regarding the effects and most of the work has been carried out outside the UK. We examined the evidence to develop a trial to test effectiveness of brief drug interventions.

Methods
We carried out two systematic reviews of the literature and examined effectiveness, barriers and facilitators, screening tools and active ingredients of interventions. We also carried out qualitative work to examine this issue.

Results
The quantitative review included 46 papers (mostly from the USA) and the qualitative review included 14. We ascertained that the ASSIST screening tool was the best tool to use for screening . We carried out interviews with practitioners, policy makers and individuals who have had experience of mental health, criminal justice and family services which were identified as the services we should work with for a definitive trial. Key issues community members perceived included the need to address trauma, the efficacy of interventions, how stigma and societal views affect individuals, the importance of support from various institutions, and how community involvement and personal responsibility play a role in the recovery process.Stakeholders emphasised the need for interventions to be brief yet personalised, underlining the importance of trust and effective evaluation.

Conclusions
We used the findings from the reviews and qualitative work to develop a robust pilot trial application.

Plain Language Summary
In England and Wales, alcohol-related crime costs society £27.4 billion a year. Drugs cost £20 billion. If we can find interventions that work this will help individuals and could save a lot of money.

We examined evidence around brief drug interventions. We did not include those that are dependent on drugs. At present there is limited evidence regarding the effects. Most of the work has been carried out outside the UK. We looked at what has been done. This was to develop a trial to find out if they do make a difference.

We carried out reviews of literature. One looked at whether brief interventions work for drug use. The other looked at what people thought about them. We then carried out a lot of interviews with people who had been involved in them.

The quantitative review included 46 papers (mostly from the USA). The qualitative review included 14 papers. We found that the ASSIST tool was the best tool to use for screening. We found that mental health, criminal justice and family services were the best sites for the future study.

We carried out interviews with practitioners, policy makers and individuals. Community members want interventions that address trauma. They wanted to look at how stigma and societal views affect individuals. Finally, they also told us the importance of support from various institutions, and how community involvement and personal responsibility play a role in the recovery process. Stakeholders told us that interventions need to be brief yet personalised. This showed the importance of trust.

We used the findings of our work and have submitted a funding application to NIHR PHR to see if it can make a difference.