Anxiety, Depression, Human Immunodeficiency Virus
Conditions
Keywords
Acceptance and Commitment Therapy, HIV, depression, anxiety, distress, avoidance
Brief summary
Many people with HIV infection are not consistently engaged in outpatient HIV care, and avoidance, stigma and denial contribute to poor engagement in HIV care. This project will develop and pilot test a new intervention, THRIVE, for hospitalized persons who are out of HIV care and endorse avoidance, to improve how well they stay in outpatient HIV care after discharge. If successfully developed, the intervention will undergo large scale testing in later studies and could improve the health of persons with HIV infection and help end the HIV epidemic in the United States.
Detailed description
Poor retention in HIV primary care results in lower rates of HIV viral suppression, higher rates of HIV transmission, and exacerbates racial and ethnic disparities in health outcomes, including survival. To date, there are no interventions that effectively relink and retain PWH in care when they are found outside the HIV clinic. Many persons with HIV infection (PWH) are hospitalized with life-threatening but preventable complications of inadequately treated HIV infection. They are among the most important patients to retain in care. Our previous research shows that among PWH who are out of care and hospitalized, avoidance coping, stigma, and mental health difficulties were nearly universal. Further, avoidance coping was a predictor of failure to re-engage in care after discharge. Acceptance and Commitment Therapy (ACT) is a transdiagnostic intervention with the capacity to address a range of psychosocial and behavior-related issues that PWH experience. ACT helps patients overcome avoidance, particularly avoidance of uncomfortable internal states and the situations that trigger such states, by promoting acceptance-based coping and re-engagement in meaningful and valued-life activities. Brief ACT interventions appear to be feasible, acceptable, and at least preliminarily, have efficacy. The investigators propose to develop, refine, and pilot a brief (4-5 contact hours) ACT intervention for hospitalized, out-of-care PWH. 'Targeting HIV Retention and Improved Viral load through Engagement' ('THRIVE') will aim to help patients overcome avoidance, a maladaptive coping strategy implicated in a range of problems, including depression, anxiety, substance abuse, and HIV-related self-stigma, all of which constitute barriers to care. Delivering THRIVE in the hospital with a phone booster session after discharge will increase therapy initiation and completion, the lack of which is often the greatest obstacle to effective delivery of mental health services for PWH. In Aim 1, a brief hospital-based transdiagnostic, individually delivered ACT intervention (THRIVE) tailored specifically for out-of-care hospitalized PWH will be developed. Input from a multi-disciplinary team of expert care providers and PHW will be utilized to create the therapist protocol and patient workbook. The investigators will then pilot THRIVE in 10 hospitalized out-of-care PWH who will provide qualitative feedback on the intervention. The feedback, along with input from patients and the multi-disciplinary team, will be used to refine THRIVE. In Aim 2, the investigators will conduct a pilot randomized clinical trial (RCT) of the refined THRIVE intervention (N=35) compared to treatment as usual (N=35). This pilot RCT will 1) evaluate feasibility and acceptability for a full-scale RCT; and 2) examine trends in outcomes of interest for the definitive RCT. The investigators will then be positioned to submit a separate grant to test the efficacy of THRIVE in a fully powered randomized trial. This work has the potential to decrease HIV morbidity and racial/ethnic disparities and contribute to ending the HIV epidemic in the United States, which are NIH priorities.
Interventions
BEHAVIORALTHRIVE
The ACT components (3-3.5 hours) will focus on clarifying patient values and goals and identifying obstacles that may be getting in the way of living a rich life. Short-and long-term effects of avoidance will be discussed (e.g., avoidance reduces immediate contact with distressing experiences and provides short-term relief but leads to greater dysfunction in long run). Patients will be taught acceptance, mindfulness, and perspective taking to help patient cope with difficult emotions and thoughts that may interfere with living a values-driven life. Individuals will also be encouraged to examine the costs of stigmatization on their life (e.g. avoidance of medical care, sense of isolation). Education will include medical information about HIV, services available at the clinic, and health needs related to comorbidities. This content to be delivered in 30 minutes.
OTHERTreatment as Usual
Patients get usual care at the hospital. Service linkage workers (SLWs) meet with all hospitalized PWH and cover educational aspects of the care.
Sponsors
University of Iowa
Brown University
University of Texas
National Institute of Mental Health (NIMH)
Baylor College of Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Hospitalized at Ben Taub Hospital, Houston, TX; * at least 18 years of age; * able to speak English or Spanish; * HIV infected; * able to provide informed consent and participate in the study (patients who are temporarily unable to participate will be followed and approached for enrollment if and when they are cognitively and physically capable of consenting and participating); * HIV VL\>1000 c/mL; * never in care or currently out of HIV care, defined as not meeting the 'visit constancy' measure (≥1 completed HIV primary care visit at Thomas Street Health Center (TSHC), Houston, TX, in each of the three 4-month intervals preceding admission); or ≥2 no shows to HIV primary care visits at TSHC in the last year. * endorse one of two avoidance coping statements with the highest factor loadings on the Avoidant Coping Subscale from the Coping with HIV/AIDS scale
Exclusion criteria
* intending to use a source of HIV primary care other than TSHC after discharge, because their outcomes cannot be evaluated; * in the opinion of the primary medical team caring for the patient, likely to be discharged to an institutional setting, die in the hospital or enter hospice; * incarcerated or expected to be discharged to prison or jail; * enrolled in another research study with prospective follow-up; * pregnant, since pregnant women receive additional efforts to be linked and retained in care; * admitted with acute psychosis which would preclude informed consent or meaningful participation with the intervention.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Acceptability of Enrollment and Randomization: Eligible But Declined Participation | 6 months | The number of eligible PWH who agree and decline to participate, and reasons for declining; |
| Acceptability of Enrollment and Randomization: Completion Sessions | 6 months | Completion of at least 3 out of 4 intervention sessions in the THRIVE group |
| Acceptability of the Intervention: 6 Month Follow-up | 6 months | The completion of participant 6-month follow-up assessments |
| Acceptability of the Intervention | 6 months | Mean duration of contact for participants who completed all four sessions |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Viral Load Improvement | 6 months | Viral load less than 200 copies/mL at 180 days +/- 42 days of follow up |
| Number of Patients Who Are Retained in HIV Care | 6 months | Number of patients who complete at least 2 visits with an HIV clinician within 6 months, including 1 visit within 30 days of discharge |
Other
| Measure | Time frame | Description |
|---|---|---|
| Internalized AIDS-Related Stigma Scale (IARSS) | 6 months | The Internalized AIDS-Related Stigma Scale (IARSS) is a 6-item scale with scores that range between 0 and 6. There are 6 questions in the stigma scale. Each question answered yes counts as one point. A higher total sum suggests more internalized stigma, which is not beneficial. |
| Client Satisfaction Questionnaire (CSQ) | 2 weeks | The Client Satisfaction Questionnaire (CSQ) scale has 8 items. Each item is scored 1, 2, 3, or 4. The score is calculated by adding each item's score. The range of scores for the total scale is between 8 and 32. Higher scores represent greater satisfaction with the THRIVE intervention. |
| Depression Anxiety and Stress Scale (DASS-21). | 6 months | The Depression Anxiety and Stress Scale (DASS-21) has 21 items. Each item is scored 1, 2, or 3. The score is calculated by adding each item's score, multiplied by 2. The range of scores for the total scale is between 0 and 126. Each subscale (depression, anxiety, and stress) has 7 items with a range of scores between 0 and 42. Higher scores suggest higher depression, anxiety, and stress, which are not beneficial. |
| Alcohol Use Disorders Identification Test (AUDIT) | 6 months | This 3-item screener that identifies problem alcohol use for both men and women. Participants respond on a 5-point scale. Higher numbers represent more difficulty. |
| The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | 6 months | This measure asks about substance use of 7 categories of drugs in the previous 3 months and in a person's life time. Participants respond YES or NO to each category of drugs. |
| Coping With HIV/AIDS Scale: Coping and Social Support | 6 months | The coping with HIV/AIDS positive coping scale scores range between 0 and 5. There are 5 questions in the positive coping subscale. Each question answered often or a lot of the time counts as one point. A higher total sum suggests more positive coping, which is beneficial. The coping with HIV/AIDS avoidance coping scale scores range between 0 and 9. There are 9 questions in the avoidance coping subscale. Each question answered often or a lot of the time counts as one point. A higher total sum suggests more avoidance coping, which is not beneficial. |
| Coping With HIV/AIDS Scale | 6 months | There are 2 questions in the seeking social support subscale. We report the number of participants who answer each question often or a lot of the time. More responses often or a lot of the time suggests seeking more social support, which is beneficial. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| THRIVE Acceptance and Commitment Therapy plus Education about HIV A master's level mental health professional will provide the 4-5 hour intervention for out-of-care PWH during a hospitalization. There are two important components to the intervention: Acceptance and Commitment Therapy (ACT) content, targeting avoidance with acceptance-based coping and active engagement in values-based living, and HIV education. | 35 |
| Treatment as Usual Patients get usual care at the hospital. Service linkage workers (SLWs) meet with all hospitalized PWH and cover educational aspects of the care. | 35 |
| Total | 70 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death before hospital discharge | 1 | 0 |
| Overall Study | Protocol Violation | 1 | 0 |
| Overall Study | Viral load in hospital not over 1000 | 2 | 1 |
Baseline characteristics
| Characteristic | THRIVE | Total | Treatment as Usual |
|---|---|---|---|
| Age, Continuous | 47.2 Years STANDARD_DEVIATION 12.3 | 44.7 Years STANDARD_DEVIATION 12.1 | 42.1 Years STANDARD_DEVIATION 11.8 |
| Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) Ever Used Alcoholic beverages | 29 Participants | 56 Participants | 27 Participants |
| Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) Ever Used Cannabis/Cocaine/Amphetamine/Inhalants/S | 35 Participants | 68 Participants | 33 Participants |
| Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) Ever Used Tobacco products | 19 Participants | 42 Participants | 23 Participants |
| Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) Used in past 3 months Alcoholic beverages | 7 Participants | 9 Participants | 2 Participants |
| Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) Used in past 3 months Cannabis/Cocaine/Amphetamine | 7 Participants | 12 Participants | 5 Participants |
| Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) Used in past 3 months Tobacco products | 14 Participants | 24 Participants | 10 Participants |
| AUDIT (Hazardous Alcohol Use) Alcohol use (at least monthly) | 20 Participants | 30 Participants | 10 Participants |
| AUDIT (Hazardous Alcohol Use) Consumption at Hazardous level | 7 Participants | 13 Participants | 6 Participants |
| Coping with HIV/AIDS Scale - Avoidance Coping | 2 units on a scale | 3 units on a scale | 3 units on a scale |
| Coping with HIV/AIDS Scale - Positive Coping | 2 units on a scale | 2 units on a scale | 3 units on a scale |
| Coping with HIV/AIDS Scale - Seeking Social Support Subscale Seeking Social Support - Often or a lot for 1 of the 2 subscale items | 10 Participants | 16 Participants | 6 Participants |
| Coping with HIV/AIDS Scale - Seeking Social Support Subscale Seeking Social Support - Often or a lot for 2 of the 2 subscale items | 1 Participants | 4 Participants | 3 Participants |
| Depression Anxiety and Stress Scale (DASS-21) DASS-21 Anxiety | 10 units on a scale | 10 units on a scale | 10 units on a scale |
| Depression Anxiety and Stress Scale (DASS-21) DASS-21 Depression | 8 units on a scale | 10 units on a scale | 10 units on a scale |
| Depression Anxiety and Stress Scale (DASS-21) DASS-21 Stress | 10 units on a scale | 10 units on a scale | 10 units on a scale |
| Depression Anxiety and Stress Scale (DASS-21) DASS Total | 26 units on a scale | 31 units on a scale | 36 units on a scale |
| Ethnicity (NIH/OMB) Hispanic or Latino | 9 Participants | 18 Participants | 9 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 26 Participants | 52 Participants | 26 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Internalized AIDS-Related Stigma Scale (IARSS) | 2 units on a scale | 3 units on a scale | 3 units on a scale |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 2 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 18 Participants | 38 Participants | 20 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) White | 15 Participants | 28 Participants | 13 Participants |
| Sex: Female, Male Female | 8 Participants | 15 Participants | 7 Participants |
| Sex: Female, Male Male | 27 Participants | 55 Participants | 28 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 2 / 35 | 1 / 35 |
| other Total, other adverse events | 0 / 35 | 0 / 35 |
| serious Total, serious adverse events | 0 / 35 | 0 / 35 |
Outcome results
Primary
Acceptability of Enrollment and Randomization: Completion Sessions
Completion of at least 3 out of 4 intervention sessions in the THRIVE group
Time frame: 6 months
Population: 80% of THRIVE participants received at least 3 of 4 sessions. Participants randomized to the Treatment as Usual arm were not analyzed and did not receive the intervention (sessions).
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| THRIVE | Acceptability of Enrollment and Randomization: Completion Sessions | 28 Participants |
| Treatment as Usual | Acceptability of Enrollment and Randomization: Completion Sessions | 0 Participants |
Primary
Acceptability of Enrollment and Randomization: Eligible But Declined Participation
The number of eligible PWH who agree and decline to participate, and reasons for declining;
Time frame: 6 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| THRIVE | Acceptability of Enrollment and Randomization: Eligible But Declined Participation | 0 Participants |
| Treatment as Usual | Acceptability of Enrollment and Randomization: Eligible But Declined Participation | 0 Participants |
Primary
Acceptability of the Intervention
Mean duration of contact for participants who completed all four sessions
Time frame: 6 months
Population: Treatment as usual participants did not get any intervention.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| THRIVE | Acceptability of the Intervention | 135.5 minutes |
Primary
Acceptability of the Intervention: 6 Month Follow-up
The completion of participant 6-month follow-up assessments
Time frame: 6 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| THRIVE | Acceptability of the Intervention: 6 Month Follow-up | 21 Participants |
| Treatment as Usual | Acceptability of the Intervention: 6 Month Follow-up | 26 Participants |
Secondary
Number of Patients Who Are Retained in HIV Care
Number of patients who complete at least 2 visits with an HIV clinician within 6 months, including 1 visit within 30 days of discharge
Time frame: 6 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| THRIVE | Number of Patients Who Are Retained in HIV Care | 13 Participants |
| Treatment as Usual | Number of Patients Who Are Retained in HIV Care | 16 Participants |
Secondary
Viral Load Improvement
Viral load less than 200 copies/mL at 180 days +/- 42 days of follow up
Time frame: 6 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| THRIVE | Viral Load Improvement | 12 Participants |
| Treatment as Usual | Viral Load Improvement | 14 Participants |
Other Pre-specified
Alcohol Use Disorders Identification Test (AUDIT)
This 3-item screener that identifies problem alcohol use for both men and women. Participants respond on a 5-point scale. Higher numbers represent more difficulty.
Time frame: 6 months
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| THRIVE | Alcohol Use Disorders Identification Test (AUDIT) | Alcohol use (at least monthly) | 8 Participants |
| THRIVE | Alcohol Use Disorders Identification Test (AUDIT) | Consumption at Hazardous level | 6 Participants |
| Treatment as Usual | Alcohol Use Disorders Identification Test (AUDIT) | Alcohol use (at least monthly) | 13 Participants |
| Treatment as Usual | Alcohol Use Disorders Identification Test (AUDIT) | Consumption at Hazardous level | 9 Participants |
Other Pre-specified
Client Satisfaction Questionnaire (CSQ)
The Client Satisfaction Questionnaire (CSQ) scale has 8 items. Each item is scored 1, 2, 3, or 4. The score is calculated by adding each item's score. The range of scores for the total scale is between 8 and 32. Higher scores represent greater satisfaction with the THRIVE intervention.
Time frame: 2 weeks
Population: CSQ was only measured in the THRIVE arm.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| THRIVE | Client Satisfaction Questionnaire (CSQ) | 31 units on a scale |
Other Pre-specified
Coping With HIV/AIDS Scale
There are 2 questions in the seeking social support subscale. We report the number of participants who answer each question often or a lot of the time. More responses often or a lot of the time suggests seeking more social support, which is beneficial.
Time frame: 6 months
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| THRIVE | Coping With HIV/AIDS Scale | Seeking Social Support - Often/a lot for 1 of 2 items | 4 Participants |
| THRIVE | Coping With HIV/AIDS Scale | Seeking Social Support - Often/a lot for 2 of 2 items | 2 Participants |
| Treatment as Usual | Coping With HIV/AIDS Scale | Seeking Social Support - Often/a lot for 1 of 2 items | 4 Participants |
| Treatment as Usual | Coping With HIV/AIDS Scale | Seeking Social Support - Often/a lot for 2 of 2 items | 2 Participants |
Other Pre-specified
Coping With HIV/AIDS Scale: Coping and Social Support
The coping with HIV/AIDS positive coping scale scores range between 0 and 5. There are 5 questions in the positive coping subscale. Each question answered often or a lot of the time counts as one point. A higher total sum suggests more positive coping, which is beneficial. The coping with HIV/AIDS avoidance coping scale scores range between 0 and 9. There are 9 questions in the avoidance coping subscale. Each question answered often or a lot of the time counts as one point. A higher total sum suggests more avoidance coping, which is not beneficial.
Time frame: 6 months
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| THRIVE | Coping With HIV/AIDS Scale: Coping and Social Support | Coping with HIV - Positive Coping | 4 Medan, ICR |
| THRIVE | Coping With HIV/AIDS Scale: Coping and Social Support | Coping with HIV - Avoidance Coping | 3 Medan, ICR |
| Treatment as Usual | Coping With HIV/AIDS Scale: Coping and Social Support | Coping with HIV - Positive Coping | 3.5 Medan, ICR |
| Treatment as Usual | Coping With HIV/AIDS Scale: Coping and Social Support | Coping with HIV - Avoidance Coping | 3 Medan, ICR |
Other Pre-specified
Depression Anxiety and Stress Scale (DASS-21).
The Depression Anxiety and Stress Scale (DASS-21) has 21 items. Each item is scored 1, 2, or 3. The score is calculated by adding each item's score, multiplied by 2. The range of scores for the total scale is between 0 and 126. Each subscale (depression, anxiety, and stress) has 7 items with a range of scores between 0 and 42. Higher scores suggest higher depression, anxiety, and stress, which are not beneficial.
Time frame: 6 months
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| THRIVE | Depression Anxiety and Stress Scale (DASS-21). | DASS-21 Total | 28 units on a scale |
| THRIVE | Depression Anxiety and Stress Scale (DASS-21). | DASS-21 Depression | 8 units on a scale |
| THRIVE | Depression Anxiety and Stress Scale (DASS-21). | DASS-21 Stress | 10 units on a scale |
| THRIVE | Depression Anxiety and Stress Scale (DASS-21). | DASS-21 Anxiety | 8 units on a scale |
| Treatment as Usual | Depression Anxiety and Stress Scale (DASS-21). | DASS-21 Anxiety | 11 units on a scale |
| Treatment as Usual | Depression Anxiety and Stress Scale (DASS-21). | DASS-21 Total | 32 units on a scale |
| Treatment as Usual | Depression Anxiety and Stress Scale (DASS-21). | DASS-21 Stress | 12 units on a scale |
| Treatment as Usual | Depression Anxiety and Stress Scale (DASS-21). | DASS-21 Depression | 10 units on a scale |
Other Pre-specified
Internalized AIDS-Related Stigma Scale (IARSS)
The Internalized AIDS-Related Stigma Scale (IARSS) is a 6-item scale with scores that range between 0 and 6. There are 6 questions in the stigma scale. Each question answered yes counts as one point. A higher total sum suggests more internalized stigma, which is not beneficial.
Time frame: 6 months
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| THRIVE | Internalized AIDS-Related Stigma Scale (IARSS) | 2 units on a scale |
| Treatment as Usual | Internalized AIDS-Related Stigma Scale (IARSS) | 3 units on a scale |
Other Pre-specified
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)
This measure asks about substance use of 7 categories of drugs in the previous 3 months and in a person's life time. Participants respond YES or NO to each category of drugs.
Time frame: 6 months
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| THRIVE | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | Ever Used Tobacco products | 10 Participants |
| THRIVE | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | Ever Used Alcoholic beverages | 12 Participants |
| THRIVE | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | Ever Used Cannabis/Cocaine/Amphetamine/Inhalants/Sedatives | 20 Participants |
| THRIVE | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | Used in past 3 months Tobacco products | 7 Participants |
| THRIVE | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | Used in past 3 months Alcoholic beverages | 4 Participants |
| THRIVE | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | Used in past 3 months Cannabis/Cocaine/Amphetamine/Inhalants/Sedatives | 7 Participants |
| Treatment as Usual | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | Used in past 3 months Alcoholic beverages | 3 Participants |
| Treatment as Usual | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | Ever Used Tobacco products | 13 Participants |
| Treatment as Usual | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | Used in past 3 months Tobacco products | 11 Participants |
| Treatment as Usual | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | Ever Used Alcoholic beverages | 20 Participants |
| Treatment as Usual | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | Used in past 3 months Cannabis/Cocaine/Amphetamine/Inhalants/Sedatives | 7 Participants |
| Treatment as Usual | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) | Ever Used Cannabis/Cocaine/Amphetamine/Inhalants/Sedatives | 26 Participants |