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Project ASSERT

An early intervention program model, developed at Boston Medical Center, that identifies those at risk for alcohol and drug-related consequences, provides a brief intervention, and connects them to treatment and comprehensive services when appropriate 

Project ASSERT (Alcohol and Substance Abuse Services, Education, and Referral to Treatment) is a program co-located to the emergency department at Boston Medical Center (BMC) which aids in early intervention for substance use disorder (SUD) and substance misuse through screening, counseling, and referral to treatment.

This program has serviced more than 80,000 patients in the emergency department since it began in 1994. Those that provide the intervention are Health Promotion Advocates, specifically Massachusetts DPH licensed alcohol and drug counselors, whose aim is to establish a rapport and build a relationship with the patient.

The counselors collaborate with BMC clinicians to advocate for the patient and provide access to a continuum of care and comprehensive services. Staff are co-located to the emergency department from 8am until midnight, seven days a week. They approach identified patients with potential substance use problems in a non-judgmental manner, screen the patient, educate the patient, and connect them to treatment, if desired, as well as serve as navigators for other comprehensive services.

This model has been replicated in other emergency departments across the nation. More information can be found in this case study of the program. 

The intervention group was more likely than the control group to be abstinent from cocaine and heroin at follow up.

Continuum of Care
Treatment
Type of Evidence
Peer-reviewed
Replicated
Response Approach
Comprehensive services
Early Intervention
Recovery coaching
Peer-reviewed Article
Project ASSERT: An ED-Based Intervention to Increase Access to Primary Care, Preventive Services, and the Substance Abuse Treatment System
Evaluation of a Brief Intervention in an Inner-City Emergency Department
Related Resources
Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare
Facing Addiction Community Convening Guide: Substance Use Prevention, Screening, and Early Intervention
The Opioid Use Disorder Prevention Playbook
Emergency department screening and interventions for substance use disorders
Guidelines for Medication for Addiction Treatment for Opioid Use Disorder within the Emergency Department
Hospitals’ Role in Addressing the Opioid Crisis: Buprenorphine in the Emergency Department
Emergency Discharge Protocols for Patients with Substance Use Disorders and Opioid Overdoses in Maryland’s Hospitals
Integrating Substance Use Disorder Treatment and Primary Care

Evidence of Program Effectiveness

"Between March 1, 1995, and February 29, 1996, 7,118 adult ED patients were screened. Substance abuse was detected among 2,931 patients (41%), and 1,096 (37% of detected patients) were enrolled. A total of 8,848 referrals were made: 3,189 to primary care, 2,018 to a variety of substance abuse treatment services, 2,253 for smoking cessation, 339 for mammography, and 689 to other support services (eg, psychiatric nurse, social worker, battered women's advocate or shelter). Comparison of enrollment and follow-up scores for the 245 enrollees who kept a follow-up appointment demonstrated significant reductions, including a 45% reduction in severity of drug problem, a 56% reduction in alcohol use, and a 64% reduction in the frequency of drinking six or more drinks at one sitting. At follow-up, patients expressed satisfaction with Project ASSERT: 91% were satisfied with their referrals; 93% thought the HPAs explained things well; and 99% thought the HPAs respected them as individuals. Among the follow-up group, 50% self-reported that they had kept an appointment for treatment.” (Bernstein et al., 1997)

This study used a brief intervention specific for those who are cocaine and heroin users. “Among 23,669 patients screened 5/98–11/00, 1232 (5%) were eligible, and 1175 enrolled. Enrollees (mean age 38 years) were 29% female, 62% non-hispanic black, 23% hispanic, 46% homeless. Among those with positive hair at entry, the follow-up rate was 82%. The intervention group was more likely to be abstinent than the control group for cocaine alone (22.3% versus 16.9%), heroin alone (40.2% versus 30.6%), and both drugs (17.4% versus 12.8%), with adjusted OR of 1.51–1.57. Cocaine levels in hair were reduced by 29% for the intervention group and only 4% for the control group. Reductions in opiate levels were similar (29% versus 25%)…Brief motivational intervention may help patients achieve abstinence from heroin and cocaine.” (Bernstein et al., 2005)