Integrating brief motivational interviewing into primary care to address alcohol and cannabis use among diverse adolescents : study protocol for a randomized controlled trial

Background Regular alcohol and cannabis (AC) use during adolescence is associated with significant life-long consequences including psychosocial, health, financial, and emotional problems. Although primary care (PC) settings offer unique opportunities for screening and brief interventions (BI), there is often not enough time and/or training. In addition, significant disparities exist in delivery of these services, particularly for racially and ethnically diverse young people and sexual and gender diverse (SGD) adolescents. This paper describes the protocol for a randomized controlled trial (RCT) evaluating the effectiveness of CHAT (a brief motivational interviewing intervention) delivered by behavioral health staff in the health care setting compared to enhanced usual care (EUC) among diverse adolescents in PC settings. Methods This is a two-arm, parallel-group RCT that will recruit 500 adolescents aged 12–19 from PC organizations in Southern California and Pittsburgh. Participants who screen positive on the CRAFFT screener for AC use risk will be randomized in blocks of 10, with 5 assigned to CHAT (a 15-minute MI-based intervention) and 5 to EUC (educational brochure) within each block. The study employs an advanced mixed-methods design with qualitative data collection to ensure patient-centeredness and stakeholder engagement. Primary outcomes include alcohol use, cannabis use, and alcohol and cannabis consequences measured at baseline, 3-, 6-, and 12-months post-randomization. Discussion This study addresses critical gaps in the literature regarding BI effectiveness for diverse adolescent populations in PC settings when delivered by staff in the health care system. The patient-centered approach, involving teens, parents, and providers throughout the research process will provide essential information about implementation feasibility, acceptability, and sustainability of brief interventions in real-world clinical settings. Trial Registration and Location ClinicalTrials.gov Identifier: NCT06699251; 11/18/24 Protocol Date November 2023 Protocol Version 1.0