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Drug use among HIV+ adults aged 50 and older: findings from the GOLD II study.

Thu, 05/05/2016 - 6:00am

Drug use among HIV+ adults aged 50 and older: findings from the GOLD II study.

AIDS Care. 2016 May 4;:1-5

Authors: Ompad DC, Giobazolia TT, Barton SC, Halkitis SN, Boone CA, Halkitis PN, Kapadia F, Urbina A

Abstract
Understanding the nexus of aging, HIV, and substance use is key to providing appropriate services and support for their aging, HIV seropositive patients. The proportion of PLWHA aged 50 and older is growing due to a variety of factors like decreases in mortality due to highly active retroviral therapy and non-negligible HIV incidence. We describe prevalence of alcohol, tobacco, and other drug use and participation in substance use treatment and 12-step programs among 95 HIV-positive patients aged 50 and older engaged in care. Most (73.7%) smoked cigarettes in their lifetime and 46.3% were current smokers. Most were at medium (81.1%) or high risk (13.7%) for an alcohol use disorder. With respect to illicit drug use, 48.4% had used marijuana, cocaine, crack, methamphetamines, heroin, and/or prescription opiates without a prescription in the last 12 months; 23.2% met criteria for drug dependence. Marijuana was the most commonly reported illicit drug (32.6%) followed by cocaine and crack (10.5% each), heroin and prescription opiates (7.4% each), and methamphetamines (6.3%). Among those who had not used drugs in the past 12 months, 36.7% had been in a substance use treatment program and 26.5% had participated in a 12-step program in their lifetime; 8.2% were currently in treatment and 16.3% were currently participating in a 12-step program. Among those who had used an illicit drug in the past 12 months, 37.0% had never been in treatment, 34.8% had been in treatment in their lifetime, and 28.3% were currently in treatment. With respect to 12-step programs, 27.3% of those meeting dependence criteria had never participated, 45.5% had participated in their lifetimes, and 27.3% were currently participating. Our findings suggest that older adults in HIV care settings could benefit from Screening, Brief Intervention, and Referral to Treatment interventions and/or integrated services for substance abuse and medical treatment.

PMID: 27145363 [PubMed - as supplied by publisher]

Screening and brief intervention for unhealthy substance use in patients with chronic medical conditions: a systematic review.

Wed, 05/04/2016 - 6:00am

Screening and brief intervention for unhealthy substance use in patients with chronic medical conditions: a systematic review.

J Clin Nurs. 2016 May 3;

Authors: Timko C, Kong C, Vittorio L, Cucciare MA

Abstract
AIMS AND OBJECTIVES: This systematic review describes studies evaluating screening tools and brief interventions for addressing unhealthy substance use in primary care patients with hypertension, diabetes or depression.
BACKGROUND: Primary care is the main entry point to the health care system for most patients with comorbid unhealthy substance use and chronic medical conditions. Although of great public health importance, systematic reviews of screening tools and brief interventions for unhealthy substance use in this population that are also feasible for use in primary care have not been conducted.
DESIGN: Systematic review.
METHODS: We systematically review the research literature on evidence-based tools for screening for unhealthy substance use in primary care patients with depression, diabetes and hypertension, and utilising brief interventions with this population.
RESULTS: Despite recommendations to screen for and intervene with unhealthy substance use in primary care patients with chronic medical conditions, the review found little indication of routine use of these practices. Limited evidence suggested the Alcohol Use Disorders Identification Test and Alcohol Use Disorders Identification Test-C screeners had adequate psychometric characteristics in patients with the selected chronic medical conditions. Screening scores indicating more severe alcohol use were associated with health-risk behaviours and poorer health outcomes, adding to the potential usefulness of screening for unhealthy alcohol use in this population.
CONCLUSIONS: Studies support brief interventions' effectiveness with patients treated for hypertension or depression who hazardously use alcohol or cannabis, for both substance use and chronic medical condition outcomes.
RELEVANCE TO CLINICAL PRACTICE: Although small, the international evidence base suggests that screening with the Alcohol Use Disorders Identification Test or Alcohol Use Disorders Identification Test-C and brief interventions for primary care patients with chronic medical conditions, delivered by nurses or other providers, are effective for identifying unhealthy substance use and associated with healthy behaviours and improved outcomes. Lacking are studies screening for illicit drug use, and using single-item screening tools, which could be especially helpful for frontline primary care providers including nurses.

PMID: 27140392 [PubMed - as supplied by publisher]

Substance use and at-risk mental state for psychosis in 2102 prisoners: the case for early detection and early intervention in prison.

Tue, 05/03/2016 - 6:00am

Substance use and at-risk mental state for psychosis in 2102 prisoners: the case for early detection and early intervention in prison.

Early Interv Psychiatry. 2016 May 2;

Authors: Cooper J, Jarrett M, Forrester A, di Forti M, Murray RM, Huddy V, Roberts A, Phillip P, Campbell C, Byrne M, McGuire P, Craig T, Valmaggia L

Abstract
AIM: Prisoners exhibit high rates of substance use and mental health problems. In the present study, we sought to gain a detailed understanding of substance use amongst young prisoners to inform early detection and early intervention strategies in a prison setting.
METHODS: This is a cross-sectional study of 2102 prisoners who were screened by the London Early Detection and Prevention in Prison Team (LEAP). Data on the use of substances were collected including age of first use, recent use, duration of use and poly-drug use. The Prodromal Questionnaire - Brief Version was used to screen for the at-risk mental state.
RESULTS: We found high rates of lifetime and recent use and low age of first use of a number of substances. We also found strong associations between substance use and screening positive for an at-risk mental state. Logistic regression analysis confirmed that use of any drug in the last year, poly-drug and early use, as well as heavy alcohol use, were related to an increased risk of screening positive.
CONCLUSIONS: Substance use in the prison population is not only widespread and heavy but is also strongly linked with a higher risk of developing mental health problems. The need for early detection and early intervention in prison is discussed.

PMID: 27136461 [PubMed - as supplied by publisher]

Process evaluation of a technology-delivered screening and brief intervention for substance use in primary care.

Tue, 04/26/2016 - 6:00am

Process evaluation of a technology-delivered screening and brief intervention for substance use in primary care.

Internet Interv. 2016 May 1;4(Pt 1):11-16

Authors: Ondersma SJ, Gryczynski J, Mitchell SG, O'Grady KE, Schwartz RP

Abstract
Psychotherapy process research examines the content of treatment sessions and their association with outcomes in an attempt to better understand the interactions between therapists and clients, and to elucidate mechanisms of behavior change. A similar approach is possible in technology-delivered interventions, which have an interaction process that is always perfectly preserved and rigorously definable. The present study sought to examine the process of participants' interactions with a computer-delivered brief intervention for drug use, from a study comparing computer- and therapist-delivered brief interventions among adults at two primary health care centers in New Mexico. Specifically, we sought to describe the pattern of participants' (N=178) choices and reactions throughout the computer-delivered brief intervention, and to examine associations between that process and intervention response at 3-month follow-up. Participants were most likely to choose marijuana as the first substance they wished to discuss (n = 114, 64.0%). Most participants indicated that they had not experienced any problems as a result of their drug use (n = 108, 60.7%), but nearly a third of these (n = 32, 29.6%) nevertheless indicated a desire to stop or reduce its use; participants who did report negative consequences were most likely to endorse financial or relationship concerns. However, participant ratings of the importance of change or of the helpfulness of personalized normed feedback were unrelated to changes in substance use frequency. Design of future e-interventions should consider emphasizing possible benefits of quitting rather than the negative consequences of drug use, and-when addressing consequences-should consider focusing on the impacts of substance use on relationship and financial aspects. These findings are an early but important step toward using process evaluation to optimize e-intervention content.

PMID: 27110494 [PubMed - as supplied by publisher]

Examining multi-session brief intervention for substance use in primary care: research methods of a randomized controlled trial.

Wed, 04/20/2016 - 6:00am

Examining multi-session brief intervention for substance use in primary care: research methods of a randomized controlled trial.

Addict Sci Clin Pract. 2016;11(1):8

Authors: Chambers JE, Brooks AC, Medvin R, Metzger DS, Lauby J, Carpenedo CM, Favor KE, Kirby KC

Abstract
BACKGROUND: Brief interventions such as Screening, a single session of Brief Intervention, and Referral to Treatment (SBIRT) have shown mixed effectiveness in primary care. However, there are indications that multi-session brief interventions may demonstrate more consistently positive outcomes, and perhaps a more intensive approach would be of benefit in addressing substance use in primary care. This study compared the effectiveness of SBIRT with a single BI session (BI/RT) to a multi-session brief-treatment intervention (BI/RT+) in primary care. We also developed easy-to-use, evidence-based materials to assist clinicians in delivering these interventions.
METHODS/DESIGN: This study was conducted in three Federally Qualified Healthcare Centers (FQHCs). A total of 10,935 patients were screened, and 600 individuals were recruited. The sample was primarily Black/African American (82 %) with a mean age of 40. Patients who attended a healthcare appointment were screened for substance use via the AUDIT and DAST. Patients were eligible for the study if they scored 8 or higher on the AUDIT, were using only marijuana and scored 2 or higher on the DAST, or were using other illicit drugs and scored 1 or higher on the DAST. Participants were randomly assigned to receive one-session BI/RT, or two to six sessions of brief intervention that incorporated elements of motivational enhancement therapy and cognitive-behavioral therapy (BI/RT+). Both interventions were delivered by behavioral health consultants at the FQHCs. Participants completed follow-up assessments every 3 months for 1 year. Primary outcome variables included substance use treatment sessions attended and days of substance use. Secondary outcomes included measures of health, employment, legal, and psychiatric functioning and HIV risk behaviors. Additionally, we will conduct an economic evaluation examining cost-effectiveness and will analyze outcomes from a process evaluation examining patient and provider experiences.
DISCUSSION: The ability of brief interventions to impact substance use has great potential, but research findings have been mixed. By conducting a large-scale randomized controlled trial in real-world health centers, this study will answer important questions about the effectiveness of expanded BIs for patients who screen positive for risky substance use in primary care. Trial registration NCT01751672.

PMID: 27090097 [PubMed - in process]

Missed Opportunities: Screening and Brief Intervention for Risky Alcohol Use in Women's Health Settings.

Tue, 04/19/2016 - 6:00am
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Missed Opportunities: Screening and Brief Intervention for Risky Alcohol Use in Women's Health Settings.

J Womens Health (Larchmt). 2015 Aug;24(8):648-54

Authors: Hettema J, Cockrell S, Russo J, Corder-Mabe J, Yowell-Many A, Chisholm C, Ingersoll K

Abstract
BACKGROUND: Although women's health settings could provide access to women for screening, brief intervention, and referral to treatment (SBIRT) for risky alcohol use, little is known about rates of alcohol use or associated risk for alcohol-exposed pregnancy (AEP) among women's health patients, receipt of SBIRT services in these settings, or patient attitudes towards SBIRT services.
METHODS: This study reports the results of a self-administered survey to a convenience sample of women's health patients attending public clinics for family planning or sexually transmitted infection visits.
RESULTS: Surveys were analyzed for 199 reproductive-aged women who had visited the clinic within the past year. The rate of risky drinking among the sample was (44%) and risk for AEP was (17%). Despite this, many patients did not receive SBIRT services, with more than half of risky drinking patients reporting that they were not advised about safe drinking limits (59%) and similar rates of patients at risk for AEP reporting that their medical provider did not discuss risk factors of AEP (53%). Patient attitudes towards receipt of SBIRT services were favorable; more than 90% of women agreed or strongly agreed that if their drinking was affecting their health, their women's health provider should advise them to cut down.
CONCLUSIONS: Women's health clinics may be an ideal setting to implement SBIRT and future research should address treatment efficacy in these settings.

PMID: 26230758 [PubMed - indexed for MEDLINE]

Psychological distress among victimized women on probation and parole: A latent class analysis.

Tue, 04/19/2016 - 6:00am
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Psychological distress among victimized women on probation and parole: A latent class analysis.

Am J Orthopsychiatry. 2015 Jul;85(4):382-91

Authors: Golder S, Engstrom M, Hall MT, Higgins GE, Logan TK

Abstract
Latent class analysis was used to identify subgroups of victimized women (N = 406) on probation and parole differentiated by levels of general psychological distress. The 9 primary symptom dimensions from the Brief Symptom Inventory (BSI) were used individually as latent class indicators (Derogatis, 1993). Results identified 3 classes of women characterized by increasing levels of psychological distress; classes were further differentiated by posttraumatic stress disorder symptoms, cumulative victimization, substance use and other domains of psychosocial functioning (i.e., sociodemographic characteristics; informal social support and formal service utilization; perceived life stress; and resource loss). The present research was effective in uncovering important heterogeneity in psychological distress using a highly reliable and easily accessible measure of general psychological distress. Differentiating levels of psychological distress and associated patterns of psychosocial risk can be used to develop intervention strategies targeting the needs of different subgroups of women. Implications for treatment and future research are presented.

PMID: 25915692 [PubMed - indexed for MEDLINE]

Costs of screening and brief intervention for illicit drug use in primary care settings.

Tue, 04/19/2016 - 6:00am
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Costs of screening and brief intervention for illicit drug use in primary care settings.

J Stud Alcohol Drugs. 2015 Mar;76(2):222-8

Authors: Zarkin G, Bray J, Hinde J, Saitz R

Abstract
OBJECTIVE: In this article, the authors estimate implementation costs for illicit drug screening and brief intervention (SBI) and identify a key source of variation in cost estimates noted in the alcohol SBI literature. This is the first study of the cost of SBI for drug use only.
METHOD: Using primary data collected from a clinical trial of illicit drug SBI (n = 528) and a hybrid costing approach, we estimated a per-service implementation cost for screening and two models of brief intervention. A taxonomy of activities was first compiled, and then resources and prices were attached to estimate the per-activity cost. Two components of the implementation cost, direct service delivery and service support costs, were estimated separately.
RESULTS: Per-person cost estimates were $15.61 for screening, $38.94 for a brief negotiated interview, and $252.26 for an adaptation of motivational interviewing. (Amounts are in 2011 U.S. dollars.) Service support costs per patient are 5 to 7.5 times greater than direct service delivery costs per patient. Ongoing clinical supervision costs are the largest component of service support costs.
CONCLUSIONS: Implementation cost estimates for illicit drug brief intervention vary greatly depending on the brief intervention method, and service support is the largest component of SBI costs. Screening and brief intervention cost estimates for drug use are similar to those published for alcohol SBI. Direct service delivery cost estimates are similar to costs at the low end of the distribution identified in the alcohol literature. The magnitude of service support costs may explain the larger cost estimates at the high end of the alcohol SBI cost distribution.

PMID: 25785797 [PubMed - indexed for MEDLINE]

Communicating About Screening, Brief Intervention and Referral to Treatment: Messaging Strategies to Raise Awareness and Promote Voluntary Adoption and Implementation Among New York School-based Health Center Providers.

Thu, 04/14/2016 - 6:00am
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Communicating About Screening, Brief Intervention and Referral to Treatment: Messaging Strategies to Raise Awareness and Promote Voluntary Adoption and Implementation Among New York School-based Health Center Providers.

Subst Abus. 2016 Apr 12;:0

Authors: Harris BR

Abstract
BACKGROUND: School-based health centers (SBHCs) are satellite primary care clinics conveniently located within high-risk schools. Providing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in SBHCs has the potential to greatly increase identification and intervention among adolescents with problem substance use. Nevertheless, only 11% of New York State SBHC providers report the use of SBIRT. This study identifies strategies for communicating about SBIRT with the goal of raising awareness and promoting voluntary adoption and implementation among both SBHC program directors and clinicians.
METHODS: All 162 New York State SBHC program directors and clinicians serving middle and high school students were surveyed between May and June 2013 (40% response rate). Program directors were asked which factors were most important to them in their decision to adopt new practices, and both program directors and clinicians were asked to rank-order statements in two categories: (1) Substance use and its effects and (2) SBIRT integration and outcomes.
RESULTS: Student need was valued far more than any other factor in program director's decisions to adopt new practices. Both program directors and clinicians perceived the association between substance use and risky sexual behavior and the benefits and cost-effectiveness of SBIRT compared to other preventive health screenings as the strongest motivators to adopt and implement SBIRT.
CONCLUSIONS: Findings from this study suggest that SBIRT awareness-raising strategies present the cost-effectiveness of SBIRT, highlight student need, particularly the connection between substance use and risky sexual behaviors, and be communicated by state health departments and professional organizations.

PMID: 27070491 [PubMed - as supplied by publisher]

Adapting a blended motivational interviewing and problem-solving intervention to address risky substance use amongst South Africans.

Fri, 04/08/2016 - 6:00am
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Adapting a blended motivational interviewing and problem-solving intervention to address risky substance use amongst South Africans.

Psychother Res. 2015;25(4):435-44

Authors: Sorsdahl K, Myers B, Ward CL, Matzopoulos R, Mtukushe B, Nicol A, Cuijpers P, Stein DJ

Abstract
The purpose of this study was to examine the acceptability and initial substance use outcomes of a blended motivational interviewing (MI) and problem-solving therapy (PST) intervention, delivered by peer counsellors. Twenty people who scored at risk for substance use according to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) received a five session blended MI-PST intervention and were assessed at baseline and at three months. An open-ended semi-structured interview, designed to identify possible factors that may hinder or promote the acceptability of the intervention was also conducted. Fifteen participants completed the intervention and the three-month follow-up. According to ASSIST scores, participants significantly reduced their substance use (p > 0.001) at the three-month follow-up. Randomized controlled trials are needed to evaluate the effect of this intervention more rigorously.

PMID: 24708408 [PubMed - indexed for MEDLINE]

Predictors and longitudinal course of cognitive functioning in schizophrenia spectrum disorders, 10years after baseline: The OPUS study.

Thu, 04/07/2016 - 11:00am

Predictors and longitudinal course of cognitive functioning in schizophrenia spectrum disorders, 10years after baseline: The OPUS study.

Schizophr Res. 2016 Apr 2;

Authors: Bergh S, Hjorthøj C, Sørensen HJ, Fagerlund B, Austin S, Secher RG, Jepsen JR, Nordentoft M

Abstract
BACKGROUND: Identifying baseline predictors of the long-term course of cognitive functioning in schizophrenia spectrum disorders is important because of associations between cognitive functioning (CF) and functional outcome. Determining whether CF remains stable or change during the course of illness is another matter of interest.
METHODS: Participants from The Danish OPUS Trial, aged 18-45years, with a baseline ICD-10 schizophrenia spectrum diagnosis, were assessed on psychopathology, social and vocational functioning at baseline, and cognitive functioning 5 (N=298) and 10years (N=322) after baseline. Uni- and multi-variable regression analyses of potential baseline predictors of 10-year CF were performed. Also, changes in CF and symptomatology between 5 and 10years of follow-up were assessed.
FINDINGS: Baseline predictors of impaired CF after 10years included male gender, unemployment, poor premorbid achievement and later age of onset. Having finished high school and receiving early intervention treatment was associated with better CF. Age, growing up with both parents, number of family and friends, primary caregivers education, premorbid social function, negative symptoms, GAF (symptoms, function) and substance abuse, were associated with CF in univariable analyses. Non-participants generally suffered from more severe dysfunction. Longitudinally, amelioration in negative symptoms was associated with improved speed of processing and executive functions. Symptom scores generally improved with time, while scores for all cognitive tests remained stable.
CONCLUSION: The current study identifies several robust associations between baseline characteristics and 10-year cognitive outcome. Several other variables were univariably associated with 10-year cognitive outcome. Also, we found evidence for stability of CF over time.

PMID: 27050475 [PubMed - as supplied by publisher]

Development and Evaluation of Two Instruments for Assessing SBIRT Competency.

Thu, 03/24/2016 - 6:00am

Development and Evaluation of Two Instruments for Assessing SBIRT Competency.

Subst Abus. 2016 Mar 23;:0

Authors: Pringle JL, Seale JP, Shellenberger S, Grasso KM, Kowalchuk A, Laufman L, Bray JH

Abstract
BACKGROUND: Screening, Brief Intervention and Referral to Treatment (SBIRT) is shown to be effective in identifying, intervening with, and making appropriate referrals for patients with unhealthy alcohol use. (1-5) SBIRT training consists of knowledge-based and skill-based components (6,7) which has increased the use of screening and intervention skills in clinical settings. (8) This paper reports on the development and evaluation of two SBIRT proficiency checklists for use across institutions to assess SBIRT skills in both simulated and clinical encounters.
METHODS: A national panel of 16 experts identified 137 discrete SBIRT skills items for the checklists. From this final list, two proficiency checklists were derived: the SBIRT Proficiency Checklist (SPC) composed of 22 questions for videotaped interviews, and the Clinical SBIRT Proficiency Checklist (CSPC) composed of 13 questions for direct clinical observation. An evaluation was conducted to test the reliability of the SPC and to assess the utility of the CSPC.
RESULTS: Two checklists for assessing SBIRT proficiency were developed by a collaborative workgroup. Fleiss' Kappa analyses indicated moderate agreement. In addition, faculty recorded satisfaction with the CSPC for assessing residents on their SBIRT performance during clinical encounters.
CONCLUSIONS: The SPC and the CSPC are practical tools for assessing competence with SBIRT and are easily integrated as standard instruments in a wide range of training settings. Future advancements to the checklist and their evaluation include modification of the SPC rating scale to be consistent with the CSPC, developing a training program for using the checklists, and further testing to improve interrater reliability.

PMID: 27007596 [PubMed - as supplied by publisher]

Alcohol consumption in upper aerodigestive tract cancer: Role of head and neck surgeons' recommendations.

Sun, 03/20/2016 - 6:00am

Alcohol consumption in upper aerodigestive tract cancer: Role of head and neck surgeons' recommendations.

Alcohol. 2016 Mar;51:51-6

Authors: López-Pelayo H, Miquel L, Altamirano J, Blanch JL, Gual A, Lligoña A

Abstract
This study aims to describe the prevalence of alcohol consumption in patients diagnosed with an upper aerodigestive tract cancer (UADTC) and evaluate the clinical impact of head and neck surgeons' recommendations on alcohol intake. An observational, retrospective, and cross-sectional study was conducted. Socio-demographic data, type of cancer, psychiatric history, substance-use history, and DSM-IV-TR criteria for alcohol dependence were recorded. Patients were asked to report their alcohol consumption before UADTC diagnosis and during their follow-up. All patients were asked if they had received from the specialist any recommendation to reduce or stop their alcohol consumption. One hundred ninety-one patients were included. Laryngeal cancer was the most frequent. 85.3% of patients were alcohol consumers before being diagnosed, 39.8% were risky drinkers, and 13.1% had alcohol dependence. The prevalence of alcohol use decreased by 16.7% after the UADTC was diagnosed. The proportion of risky drinkers decreased from 46.6% to 24.5%. Almost half of the patients did not recall having received any recommendation regarding alcohol consumption. Receiving a recommendation was independently associated with a positive response (reduced or stopped alcohol consumption) with an Odds Ratio 3.7; p < 0.001. Prevalence of alcohol dependence and risky drinking (39.8%) is high in UADTC patients, compared to the general population. Otorhinolaryngologists and head and neck surgeons frequently provide recommendations about alcohol consumption, which has a relevant impact on the reduction of alcohol intake. Further prospective studies focused on brief advice should be performed in order to demonstrate effectiveness in this population.

PMID: 26992700 [PubMed - in process]

Alcohol use disorders.

Sat, 03/19/2016 - 6:00am
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Alcohol use disorders.

Lancet. 2016 Mar 5;387(10022):988-98

Authors: Connor JP, Haber PS, Hall WD

Abstract
Alcohol use disorders are common in developed countries, where alcohol is cheap, readily available, and heavily promoted. Common, mild disorders often remit in young adulthood, but more severe disorders can become chronic and need long-term medical and psychological management. Doctors are uniquely placed to opportunistically assess and manage alcohol use disorders, but in practice diagnosis and treatment are often delayed. Brief behavioural intervention is effective in primary care for hazardous drinkers and individuals with mild disorders. Brief interventions could also encourage early entry to treatment for people with more-severe illness who are underdiagnosed and undertreated. Sustained abstinence is the optimum outcome for severe disorder. The stigma that discourages treatment seeking needs to be reduced, and pragmatic approaches adopted for patients who initially reject abstinence as a goal. To engage people in one or more psychological and pharmacological treatments of equivalent effectiveness is more important than to advocate a specific treatment. A key research priority is to improve the diagnosis and treatment of most affected people who have comorbid mental and other drug use disorders.

PMID: 26343838 [PubMed - indexed for MEDLINE]

Adolescent inhalant use prevention, assessment, and treatment: A literature synthesis.

Sun, 03/13/2016 - 6:00am

Adolescent inhalant use prevention, assessment, and treatment: A literature synthesis.

Int J Drug Policy. 2016 Feb 18;

Authors: Nguyen J, O'Brien C, Schapp S

Abstract
Inhalant use refers to the use of substances such as gases, glues, and aerosols in order to achieve intoxication, while inhalant use disorder (IUD) encompasses both DSM-IV-TR criteria for inhalant abuse and dependence. Inhalant use among adolescents is an international public health concern considering the severe medical and cognitive consequences and biopsychosocial correlates. In this paper, we summarize the current state of the literature on inhalant use among adolescents focusing on social context, prevention, assessment, and treatment strategies. Psychoeducation, skills training, and environmental supply reduction are helpful strategies for preventing adolescent inhalant use, while parent and adolescent self-report as well as physician report of medical signs and symptoms can aid in assessment and diagnosis. Although research has only begun to explore the treatment of inhalant use, preliminary findings suggest that a multimodal approach involving individual counselling (i.e., CBT brief intervention), family therapy, and activity and engagement programs is the first-line treatment, with residential treatment programs indicated for more severe presentations. The limited nature of treatments developed specifically for inhalant use combined with high prevalence rates and potential for significant impairment within the adolescent population indicate the need for further research. Research should focus on understanding the social context of use, establishing the efficacy of current adolescent substance use treatments adapted for inhalant use, and exploring long-term outcomes.

PMID: 26969125 [PubMed - as supplied by publisher]

Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study.

Sat, 03/12/2016 - 6:00am
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Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study.

Alcohol Alcohol. 2015 Jul;50(4):430-7

Authors: Bendtsen P, Anderson P, Wojnar M, Newbury-Birch D, Müssener U, Colom J, Karlsson N, Brzózka K, Spak F, Deluca P, Drummond C, Kaner E, Kłoda K, Mierzecki A, Okulicz-Kozaryn K, Parkinson K, Reynolds J, Ronda G, Segura L, Palacio J, Baena B, Slodownik L, van Steenkiste B, Wolstenholme A, Wallace P, Keurhorst MN, Laurant MG, Gual A

Abstract
AIMS: To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals.
METHODS: Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment.
RESULTS: The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%.
CONCLUSION: The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation.

PMID: 25787012 [PubMed - indexed for MEDLINE]

Adding urine and saliva toxicology to SBIRT for drug screening of new patients.

Sat, 03/05/2016 - 6:00am
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Adding urine and saliva toxicology to SBIRT for drug screening of new patients.

Am J Addict. 2015 Aug;24(5):396-9

Authors: Magura S, Achtyes ED, Batts K, Platt T, Moore TL

Abstract
BACKGROUND AND OBJECTIVES: To determine illicit drug use among new patients in primary medical care who denied using "street drugs" during Screening, Brief Intervention and Referral to Treatment (SBIRT).
METHODS: 96 new patients who denied use of "street drugs" were tested for drugs as part of routine SBIRT screening.
RESULTS: Of those tested, 14.6% of those with urine specimens and 4.1% of those with saliva specimens tested positive for illicit drugs.
DISCUSSION AND CONCLUSIONS: Drug toxicology can detect unreported illicit drug use during SBIRT screening, with urine being superior to saliva.
SCIENTIFIC SIGNIFICANCE: Drug toxicology can increase the effectiveness of SBIRT screening in primary care medical clinics.

PMID: 26095001 [PubMed - indexed for MEDLINE]

Staff Views of Acceptability and Appropriateness of a Computer-Delivered Brief Intervention for Moderate Drug and Alcohol Use.

Wed, 03/02/2016 - 7:00am
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Staff Views of Acceptability and Appropriateness of a Computer-Delivered Brief Intervention for Moderate Drug and Alcohol Use.

J Psychoactive Drugs. 2015 Sep-Oct;47(4):301-7

Authors: Mitchell SG, Monico LB, Gryczynski J, O'Grady KE, Schwartz RP

Abstract
The use of computers for identifying and intervening with stigmatized behaviors, such as drug use, offers promise for underserved, rural areas; however, the acceptability and appropriateness of using computerized brief intervention (CBIs) must be taken into consideration. In the present study, 12 staff members representing a range of clinic roles in two rural, federally qualified health centers completed semi-structured interviews in a qualitative investigation of CBI vs. counselor-delivered individual brief intervention (IBI). Thematic content analysis was conducted using a constant comparative method, examining the range of responses within each interview as well as data across interview respondents. Overall, staff found the idea of providing CBIs both acceptable and appropriate for their patient population. Acceptability by clinic staff centered on the ready availability of the CBI. Staff also believed that patients might be more forthcoming in response to a computer program than a personal interview. However, some staff voiced reservations concerning the appropriateness of CBIs for subsets of patients, including older patients, illiterate individuals, or those unfamiliar with computers. Findings support the potential suitability and potential benefits of providing CBIs to patients in rural health centers.

PMID: 26375411 [PubMed - indexed for MEDLINE]

Risk of antenatal psychosocial distress in indigenous women and its management at primary health care centres in Australia.

Fri, 02/26/2016 - 6:00am
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Risk of antenatal psychosocial distress in indigenous women and its management at primary health care centres in Australia.

Gen Hosp Psychiatry. 2015 Jul-Aug;37(4):335-9

Authors: Gausia K, Thompson SC, Nagel T, Schierhout G, Matthews V, Bailie R

Abstract
OBJECTIVE: This study explored the risk of antenatal psychosocial distress (APD) and associated potential factors and examined management aspects of risk of APD in women attending Aboriginal primary health care services in Australia.
METHOD: Audits of medical records of 797 pregnant women from 36 primary health centres in five jurisdictions (NSW, QLD, SA, WA and NT) were undertaken as part of a quality improvement programme. Information collected included mental health assessed by a standard screening tools, enquiry regarding social and emotional well-being (SEWB), depression management (including antidepressant medications) and referral.
RESULTS: Around 18% (n=141) of women were at risk of APD based on assessment using a standard screening tool or by SEWB enquiry. There was a significant association between risk of distress and women's life style behaviours (e.g., alcohol, illicit drug use) and health centre characteristics. Of the 141 women, 16% (n= 22) were prescribed antidepressant drugs during pregnancy. A range of nonpharmaceutical mental health interventions were also recorded, including brief intervention of 61% (n=86), counselling of 57% (n=80) and cognitive behaviour therapy of 5% (n=7). About 39% (n=55) of women with APD were referred to external services for consultations with a psychiatrist, psychologist or social worker or to a women's refuge centre.
CONCLUSIONS: The higher risk of APD associated with women's life style behaviour indicates that the better understanding of mental health in its cultural context is essential.

PMID: 25920681 [PubMed - indexed for MEDLINE]

"A test of core psychopathic traits as a moderator of the efficacy of a brief motivational intervention for substance-using offenders": Correction to Swogger et al. (2016).

Fri, 02/19/2016 - 6:00am

"A test of core psychopathic traits as a moderator of the efficacy of a brief motivational intervention for substance-using offenders": Correction to Swogger et al. (2016).

J Consult Clin Psychol. 2016 Mar;84(3):210

Authors:

Abstract
Reports an error in "A Test of Core Psychopathic Traits as a Moderator of the Efficacy of a Brief Motivational Intervention for Substance-Using Offenders" by Marc T. Swogger, Kenneth R. Conner, Eric D. Caine, Nicole Trabold, Melissa N. Parkhurst, Laurel M. Prothero and Stephen A. Maisto (Journal of Consulting and Clinical Psychology, Advanced Online Publication, Jan 4, 2016, np). The sentence in the 1st paragraph of the Intervention and Control Conditions section, "Over the course of the study, individuals in the intervention condition averaged 3.8 (SD 0.40) sessions." It should read, "2.5 (SD 1.1) sessions." (The following abstract of the original article appeared in record 2015-58971-001.) Objective: In a randomized controlled trial we studied a brief motivational intervention (BMI) for substance use, examining core psychopathic traits as a moderator of treatment efficacy.
METHOD: Participants were 105 males and females who were 18 years of age and older and in a pretrial jail diversion program. The sample was approximately 52% Black and other minorities and 48% White. Outcome variables at a 6-month follow-up were frequency of substance use (assessed with the Timeline Follow-back Interview and objective toxicology screens), substance use consequences (Short Inventory of Problems-Alcohol and Drug version), and self-reported participation in nonstudy mental health and/or substance use treatment. Psychopathy was assessed using the Psychopathy Checklist-Revised (PCL-R).
RESULTS: BMI interacted with core psychopathic traits to account for 7% of the variance in substance use at follow-up. Treatment was associated with greater use among individuals with high levels of core psychopathic traits. Toxicology screening results were consistent with self-report data. The treatment and standard care groups did not differ on substance use consequences or nonstudy treatment participation at follow-up, and no moderation was found with these outcomes. An exploratory analysis indicated that low levels of affective traits of psychopathy were associated with benefit from the BMI in terms of decreased substance use.
DISCUSSION: Findings suggest that caution is warranted when applying BMIs among offenders; individuals with high levels of core psychopathic traits may not benefit and may be hindered in recovery. Conversely, they indicate that a low-psychopathy subgroup of offenders benefits from these brief and efficient treatments for substance use. (PsycINFO Database Record

PMID: 26890639 [PubMed - as supplied by publisher]

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