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Effect of telephone follow-up on retention and balance in an alcohol intervention trial.

Fri, 02/05/2016 - 8:30am
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Effect of telephone follow-up on retention and balance in an alcohol intervention trial.

Prev Med Rep. 2015;2:746-9

Authors: Johnson NA, Kypri K, Latter J, McElduff P, Attia J, Saitz R, Saunders JB, Wolfenden L, Dunlop A, Doran C, McCambridge J

Abstract
OBJECTIVES: Telephone follow-up is not currently recommended as a strategy to improve retention in randomized trials. The aims of this study were to estimate the effect of telephone follow-up on retention, identify participant characteristics predictive of questionnaire completion during or after telephone follow-up, and estimate the effect of including participants who provided follow-up data during or after telephone follow-up on balance between randomly allocated groups in a trial estimating the effect of electronic alcohol screening and brief intervention on alcohol consumption in hospital outpatients with hazardous or harmful drinking.
METHOD: Trial participants were followed up 6 months after randomization (June-December 2013) using e-mails containing a hyperlink to a web-based questionnaire when possible and by post otherwise. Telephone follow-up was attempted after two written reminders and participants were invited to complete the questionnaire by telephone when contact was made.
RESULTS: Retention before telephone follow-up was 62.1% (520/837) and 82.8% (693/837) afterward: an increase of 20.7% (173/837). Therefore, 55% (95% CI 49%-60%) of the 317 participants who had not responded after two written reminders responded during or after the follow-up telephone call. Age < 55 years, a higher AUDIT-C score and provision of a mobile/cell phone number were predictive of questionnaire completion during or after telephone follow-up. Balance between randomly allocated groups was present before and after inclusion of participants who completed the questionnaire during or after telephone follow-up.
CONCLUSION: Telephone follow-up improved retention in this randomized trial without affecting balance between the randomly allocated groups.

PMID: 26844146 [PubMed]

Norwegian midwives' use of screening for and brief interventions on alcohol use in pregnancy.

Fri, 02/05/2016 - 6:00am
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Norwegian midwives' use of screening for and brief interventions on alcohol use in pregnancy.

Sex Reprod Healthc. 2015 Oct;6(3):186-90

Authors: Wangberg SC

Abstract
OBJECTIVE: This study assessed the current screening for and brief intervention (BI) on alcohol use in pregnancy among midwives in Norway, as well as perceived barriers for such practice.
DESIGN, SETTING AND PARTICIPANTS: An Internet and telephone survey was conducted among all 200 registered municipal midwives in the Norwegian health regions North, West and South in the period December 2013-May 2014. Of these, 103 midwives were reached and responded (52%).
MEASUREMENT AND FINDINGS: Most of the midwives (97%) asked the pregnant women about their alcohol use at their first consultation. 42% of the midwives reported using a screening instrument. When asked which one, AUDIT or TWEAK was mentioned by 16%. The need for more training in screening tools was reported by 66%. Sixty-four percent of midwives working in municipalities that had received special training compared with 50% among the rest said that they intervened themselves if alcohol use was detected (χ(2) = 0.32, P = .645). Motivational Interviewing was well known and frequently used. Low perceived BI competence and finding it difficult to discuss alcohol use with parents with a different ethnicity both reduced chances of carrying out a BI. Time constraints and lack of organizational support were other frequently mentioned barriers.
KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It seems that the Norwegian midwives find screening and brief interventions for alcohol use to be important and part of their job, but still could use more training, stronger guidelines and more time for following up parents.

PMID: 26842644 [PubMed - in process]

Preventing alcohol problems and improving drinking habits among employees: an evaluation of alcohol education.

Wed, 02/03/2016 - 7:30am
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Preventing alcohol problems and improving drinking habits among employees: an evaluation of alcohol education.

Work. 2016 Jan 22;

Authors: Tinghög ME, Tinghög P

Abstract
BACKGROUND: In a municipality in Sweden there was a concern about the high alcohol consumption among its residents. An alcohol education program was provided to all those employed by the municipality.
OBJECTIVE: To investigate whether a day-long alcohol education program provided to all employed by a Swedish municipality had an effect on alcohol consumption among employees and specifically among employees with low and higher levels of consumption respectively.
METHODS: A quasi-experimental evaluation using pre-test and post-test questionnaires was performed. The municipality's employees were divided in one intervention group (n: 124) and one control group (n: 139). ANOVA with repeated measures was performed on AUDIT-score and on three separate AUDIT-items: frequency of drinking, frequency of binge drinking, and typical amount consumed per drinking occasion.
RESULTS: No significant effect on alcohol consumption was identified for the intervention group as a whole. Stratified analyses showed the intervention had a significant effect on reducing the frequency of binge drinking among those with the highest consumption.
CONCLUSIONS: Compared to many other studies on alcohol education, some results on behaviour were found when performing stratified analyses. The employees with the highest alcohol consumption, although not labelled high consumers, reduced the frequency of binge drinking. It is difficult to speculate whether these results can be generalized to other working populations. The results have to be compared with more direct methods of reaching risk consumers, such as screening and brief interventions. Knowledge about alcohol and the associated risks of alcohol consumption might facilitate the willingness to seek help sooner.

PMID: 26835859 [PubMed - as supplied by publisher]

Screening, brief intervention and referral of emergency department patients with unhealthy drug use: efficacious or not?

Sat, 01/23/2016 - 6:00am
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Screening, brief intervention and referral of emergency department patients with unhealthy drug use: efficacious or not?

Evid Based Ment Health. 2015 Nov;18(4):e8

Authors: D'Onofrio G, Bernstein SL

PMID: 26459472 [PubMed - indexed for MEDLINE]

SBIRT-A: Adapting SBIRT to Maximize Developmental Fit for Adolescents in Primary Care.

Sat, 01/09/2016 - 6:00am

SBIRT-A: Adapting SBIRT to Maximize Developmental Fit for Adolescents in Primary Care.

J Subst Abuse Treat. 2015 Nov 26;

Authors: Ozechowski TJ, Becker SJ, Hogue A

Abstract
The Screening, Brief Intervention and Referral to Treatment (SBIRT) model is widely recommended as part of routine visits in pediatric primary care despite a dearth of evidence on its effectiveness, feasibility, and developmental appropriateness for adolescents in this setting. The purpose of this article is to explicate ways that SBIRT may be tailored to better serve adolescents in primary care under a set of recommended adaptations that we refer to collectively as SBIRT-A or Screening, Brief Intervention, and Referral to Treatment for Adolescents. Each component of the SBIRT-A framework incorporates recommendations to optimize developmental fit with adolescents based on extant empirical research, developmental theory, and well-documented barriers to service delivery in primary care. Commonalities across proposed adaptations include reliance upon proactive methods to identify and engage youth; innovation in service delivery aimed at improving the consistency and reach of interventions; and a family-focused approach to engagement, assessment, and intervention. Specific recommendations include taking advantage of every clinical encounter with the family to screen, involving caregivers in assessments and brief interventions, leveraging technology to administer brief interventions and booster sessions, and patient- and family-centered procedures for treatment referral and engagement. The adaptations proposed in this article have the potential to enhance the detection of adolescents with SU problems in primary care, the consistency of intervention provision, and engagement of this typically recalcitrant population into appropriate treatment.

PMID: 26742723 [PubMed - as supplied by publisher]

A Test of Core Psychopathic Traits as a Moderator of the Efficacy of a Brief Motivational Intervention for Substance-Using Offenders.

Tue, 01/05/2016 - 6:00am

A Test of Core Psychopathic Traits as a Moderator of the Efficacy of a Brief Motivational Intervention for Substance-Using Offenders.

J Consult Clin Psychol. 2016 Jan 4;

Authors: Swogger MT, Conner KR, Caine ED, Trabold N, Parkhurst MN, Prothero LM, Maisto SA

Abstract
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: 26727409 [PubMed - as supplied by publisher]

B-SAFER: A Web-Based Intervention for Drug Use and Intimate Partner Violence Demonstrates Feasibility and Acceptability Among Women in the Emergency Department.

Wed, 12/30/2015 - 6:00am

B-SAFER: A Web-Based Intervention for Drug Use and Intimate Partner Violence Demonstrates Feasibility and Acceptability Among Women in the Emergency Department.

Subst Abus. 2015 Dec 29;:0

Authors: Choo EK, Zlotnick C, Strong DR, Squires DD, Tapé C, Mello MJ

Abstract
BACKGROUND: Addressing violence along with drug use change goals is critical for women with coexisting intimate partner violence (IPV) and substance use disorders (SUD).
METHODS: This was an acceptability and feasibility study of BSAFER, a brief Web-based program and booster phone call addressing violence and drug use. A screening survey identified women with recent drug use and IPV in the emergency department (ED). Participants were randomized to BSAFER or a Web-based control program and booster call providing education about home fire safety. Program completion, usability, satisfaction and MI adherence were primary outcomes. Drug use and IPV outcomes were measured at baseline, one and three months.
RESULTS: Forty women were enrolled (21 BSAFER, 19 control); 50% were non-white and mean age was 30 years. Most commonly used drugs were marijuana (88%) and cocaine (30%); 45% reported physical abuse and 33% severe combined physical and sexual abuse. Thirty-nine (98%) completed the Web program, 30 (75%) completed the booster, and 29 (73%) completed 3-month follow up. Mean System Usability Scale (SUS) for the BSAFER Web program was 84 (95% CI 78-89) of 100; mean Client Satisfaction Questionnaire (CSQ-8) was 28 (95% CI 26-29) of 32. MI adherence scores were high and similar for both the Web program and the booster. Both intervention and control groups had small mean decreases in weekly drug use days (0.7 days vs. 1.5 days); participants using drugs other than marijuana demonstrated greater average reductions in drug use than those using marijuana only.
CONCLUSIONS: An ED Web-based intervention for SUD and IPV in women demonstrated feasibility and acceptability. Future studies will examine efficacy of the BSAFER program and investigate whether specific subgroups of drug using women may be most responsive to ED-based Web interventions.

PMID: 26714233 [PubMed - as supplied by publisher]

Reducing the Risk of Alcohol Use Disorders in Women.

Sun, 12/20/2015 - 6:00am

Reducing the Risk of Alcohol Use Disorders in Women.

Nurs Womens Health. 2015 Dec;19(6):537-41

Authors: Fogger SA

Abstract
Nurses and other clinicians help women to examine their lifestyles and consider changes to promote optimum health. When the question is about drinking alcohol, what is appropriate to recommend? While moderate intake may be beneficial for cardiovascular and bone health, drinking more than the recommended amount increases the risk of harmful effects. This column examines guidelines for moderate alcohol consumption for women, reviews the assessment process and demonstrates an example of a brief intervention. A program of screening, brief intervention and referral to treatment (termed SBIRT by the Substance Abuse and Mental Health Services Administration) should be part of the standard assessment for every woman. Ongoing assessment of alcohol consumption can help to better target behaviors for early intervention.

PMID: 26682661 [PubMed - in process]

The study of primary psychotic disorders with concurrent substance abuse in terms of their diagnostic stability.

Wed, 11/25/2015 - 11:00am

The study of primary psychotic disorders with concurrent substance abuse in terms of their diagnostic stability.

Indian J Psychiatry. 2015 Jul-Sep;57(3):224-228

Authors: Singal A, Bhat PS, Srivastava K, Prakash J

Abstract
BACKGROUND: Co-morbid substance use is common among individuals presenting with symptoms of psychosis. There is a paucity of research in this area.
AIM: To study the longitudinal follow-up of patients over 1-year of first episode psychosis with concurrent substance use in terms of their diagnostic stability.
MATERIALS AND METHODS: Fifty patients having at least one symptom of psychosis at first admission at a General Hospital Psychiatric Unit along with concurrent substance abuse were included and followed up for 1-year. International Classification of Disease-10, diagnostic criteria were used for diagnosis. Semi-structured sociodemographic performa to assess the sociodemographic profile. Brief Psychiatric Rating Scale and Alcohol Use Disorder Identification Test as rating scales were used for the assessment at 6 and 12 months.
RESULTS: Of 50 patients, 31 patients who had a diagnosis of primary psychosis retained their diagnosis at follow-up. The mean age of cases in substance-induced psychosis group was 37.47 years, which was significantly higher than in primary psychosis group at 31.52 years. However, 7 patients of the substance-induced psychosis group required a change in diagnosis to primary psychosis group. The primary psychosis group patients were significantly younger, less educated, had less family support, had greater family mental illness, had more severe symptoms, and less hallucinations.
CONCLUSION: The present study is a forerunner in this area. Salient differences indicated in the study can help in differentiating the diagnosis and in the management of cases. This is particularly relevant in the management setting and for long-term intervention purpose.

PMID: 26600573 [PubMed - as supplied by publisher]

Pilot randomised trial of a brief intervention for comorbid substance misuse in psychiatric in-patient settings.

Mon, 11/23/2015 - 6:00am

Pilot randomised trial of a brief intervention for comorbid substance misuse in psychiatric in-patient settings.

Acta Psychiatr Scand. 2015 Nov 21;

Authors: Graham HL, Copello A, Griffith E, Freemantle N, McCrone P, Clarke L, Walsh K, Stefanidou CA, Rana A, Birchwood M

Abstract
OBJECTIVE: This proof of principle study evaluated the effectiveness and feasibility of a brief motivational intervention, delivered in mental health in-patient settings, to improve engagement in treatment for drug and alcohol misuse.
METHOD: A randomised controlled trial using concealed randomisation, blind, independent assessment of outcome at 3 months. Participants were 59 new adult admissions, to six acute mental health hospital units in one UK mental health service, with schizophrenia related or bipolar disorder diagnoses, users of community mental health services and also misusing alcohol and/or drugs. Participants were randomised to Brief Integrated Motivational Intervention (BIMI) with Treatment As Usual (TAU), or TAU alone. The BIMI took place over a 2-week period and encouraged participants to explore substance use and its impact on mental health.
RESULTS: Fifty-nine in-patients (BIMI n = 30; TAU n = 29) were randomised, the BIMI was associated with a 63% relative odds increase in the primary outcome engagement in treatment [OR 1.63 (95% CI 1.01-2.65; P = 0.047)], at 3 months. Qualitative interviews with staff and participants indicated that the BIMI was both feasible and acceptable.
CONCLUSION: Mental health hospital admissions present an opportunity for brief motivational interventions focussed on substance misuse and can lead to improvements in engagement.

PMID: 26590876 [PubMed - as supplied by publisher]

The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial.

Thu, 11/19/2015 - 6:30am

The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial.

Subst Abuse Treat Prev Policy. 2015;10(1):46

Authors: Sorsdahl K, Stein DJ, Corrigall J, Cuijpers P, Smits N, Naledi T, Myers B

Abstract
BACKGROUND: The treatment of substance use disorders is a public health priority, particularly in South Africa where the prevalence of these disorders is high. We tested two peer-counsellor delivered brief interventions (BIs) for risky substance use among adults presenting to emergency departments (EDs) in South Africa.
METHODS: In this randomised controlled trial, we enrolled patients presenting to one of three 24-hour EDs who screened at risk for substance use according to the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Eligible patients were randomly allocated to one of three conditions: Motivational Interviewing (MI), blended MI and Problem Solving Therapy (MI-PST) or a Psycho-educational Control Group (CG). The primary outcome was reduction in ASSIST scores at three months follow-up.
RESULTS: Of the 2736 patients screened, 335 met inclusion criteria, were willing to participate in the intervention and were randomised to one of three conditions: 113 to MI, 112 to MI-PST and 110 to CG. ASSIST scores at three months were lower in the MI-PST group than they were in the MI and CG groups (adjusted mean difference of -1.72, 95 % CI -3.36 - -0.08). We recorded no significant difference in ASSIST scores between the CG and MI group (adjusted mean difference of -0.02, 95 % CI -2.01 - 1.96).
CONCLUSION: With the addition of minimal resources, BIs are feasible to conduct in EDs in a low resourced country. These preliminary findings report that MI-PST appears to be an effective BI for reducing substance use among at risk participants. Further research is required to replicate these findings with effort to limit attrition, to determine whether reductions in substance use are persistent at 6 and 12 month follow-up and whether parallel changes occur in other indications of treatment outcomes, such as injury rates and ED presentations.
TRIAL REGISTRATION: This trial registered with the Pan African Clinical Trial Registry (PACTR201308000591418).

PMID: 26576946 [PubMed - as supplied by publisher]

Using electronic health records data for substance use screening, brief intervention, and referral to treatment among adults with type 2 diabetes: Design of a national drug abuse treatment clinical trials network study.

Sat, 11/14/2015 - 6:00am

Using electronic health records data for substance use screening, brief intervention, and referral to treatment among adults with type 2 diabetes: Design of a national drug abuse treatment clinical trials network study.

Contemp Clin Trials. 2015 Nov 9;

Authors: Wu LT, Brady KT, Spratt SE, Dunham AA, Heidenfelder B, Batch BC, Lindblad R, VanVeldhuisen P, Rusincovitch SA, Killeen TK, Ghitza UE

Abstract
BACKGROUND: The Affordable Care Act encourages healthcare systems to integrate behavioral and medical healthcare, as well as to employ electronic health records (EHRs) for health information exchange and quality improvement. Pragmatic research paradigms that employ EHRs in research are needed to produce clinical evidence in real-world medical settings for informing learning healthcare systems. Adults with comorbid diabetes and substance use disorders (SUDs) tend to use costly inpatient treatments; however, there is a lack of empirical data on implementing behavioral healthcare to reduce health risk in adults with high-risk diabetes. Given the complexity of high-risk patients' medical problems and the cost of conducting randomized trials, a feasibility project is warranted to guide practical study designs.
METHODS: We describe the study design, which explores the feasibility of implementing substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) among adults with high-risk type 2 diabetes mellitus (T2DM) within a home-based primary care setting. Our study includes the development of an integrated EHR datamart to identify eligible patients and collect diabetes healthcare data, and the use of a geographic health information system to understand the social context in patients' communities. Analysis will examine recruitment, proportion of patients receiving brief intervention and/or referrals, substance use, SUD treatment use, diabetes outcomes, and retention.
DISCUSSION: By capitalizing on an existing T2DM project that uses home-based primary care, our study results will provide timely clinical information to inform the designs and implementation of future SBIRT studies among adults with multiple medical conditions.

PMID: 26563446 [PubMed - as supplied by publisher]

Integrating intervention for substance use disorder in a healthcare setting: practice and outcomes in New York City STD clinics.

Thu, 11/12/2015 - 6:00am

Integrating intervention for substance use disorder in a healthcare setting: practice and outcomes in New York City STD clinics.

Am J Drug Alcohol Abuse. 2015 Nov 10;:1-7

Authors: Yu J, Appel P, Rogers M, Blank S, Davis C, Warren B, Freeman A, Harris B, Hussain S

Abstract
OBJECTIVE: This article reports the integration and outcomes of implementing intervention services for substance use disorder (SUD) in three New York City public sexually transmitted disease (STD) clinics.
METHODS: The screening, brief intervention, and referral to treatment (SBIRT) service model was implemented in the STD clinics in 2008. A relational database was developed, which included screening results, service dispositions, face-to-face interviews with 6-month follow-ups, and treatment information.
RESULTS: From February 2008 to the end of September 2012, 146 657 STD clinic patients 18 years or older were screened for current or past substance use disorders; 15 687 received a brief intervention; 954 received referrals to formal substance abuse treatment; 2082 were referred to substance abuse support services such as Alcoholics Anonymous (AA), and 690 were referred to mental health, social or HIV awareness services. Intervention services delivered through SBIRT resulted in improvements in multiple outcomes at 6 month follow-up. Patients who received interventions had reduced SUD risks, fewer mental health problems, and fewer unprotected sexual contacts.
CONCLUSION: Delivery of SUD services in a public health setting represents a significant policy and practice change and benefits many individuals whose SUDs might otherwise be overlooked. Intervention services for substance use disorder were integrated and highly utilized in the STD setting. Further research needs to focus on the long-term impact of SUD interventions in the STD setting, their cost effectiveness, and the extent they are financially sustainable under the new healthcare law.

PMID: 26555138 [PubMed - as supplied by publisher]

Screening, Brief Intervention, and Referral to Treatment in a rural Ryan White Part C HIV clinic.

Tue, 11/10/2015 - 6:00am

Screening, Brief Intervention, and Referral to Treatment in a rural Ryan White Part C HIV clinic.

AIDS Care. 2015 Nov 7;:1-5

Authors: Graham LJ, Davis AL, Cook PF, Weber M

Abstract
About 24% of people living with HIV nationally are identified as needing treatment for alcohol or illicit drug use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) has evolved as a strategy to assess and intervene with substance abuse behaviors in various clinical settings. However, less is known about the processes and outcomes of using the SBIRT intervention in outpatient HIV clinics. This paper presents a descriptive analysis of de-identified existing SBIRT results data from an outpatient HIV clinic located in western Colorado. From 2008 to 2013, a total of 1616 SBIRT evaluations were done, which included duplicate patients because some individual patients were screened more than once in a given year. Over this time period, 37-49% of encounters per year were notable for tobacco use, 8-21% for alcohol use, 6-16% for marijuana use, 3-9% for amphetamine use, and 0-2% for illicit opioid use. Unique, unduplicated patient data from 2013 revealed 40% of patients used tobacco, 16% used alcohol, and 11% used methamphetamine. Analyses highlighted that the majority of our patient population (58% in 2013) used and/or abused tobacco, alcohol, and/or illicit substances. An alarming finding was the increase in methamphetamine use over time with more than 50-fold prevalence of use in our population compared to national rates.

PMID: 26548426 [PubMed - as supplied by publisher]

Implementation of Screening, Brief Intervention, and Referral to Treatment for Adolescents in Pediatric Primary Care: A Cluster Randomized Trial.

Thu, 11/05/2015 - 6:00pm
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Implementation of Screening, Brief Intervention, and Referral to Treatment for Adolescents in Pediatric Primary Care: A Cluster Randomized Trial.

JAMA Pediatr. 2015 Nov 2;169(11):e153145

Authors: Sterling S, Kline-Simon AH, Satre DD, Jones A, Mertens J, Wong A, Weisner C

Abstract
IMPORTANCE: Early intervention for substance use is critical to improving adolescent outcomes. Studies have found promising results for Screening, Brief Intervention, and Referral to Treatment (SBIRT), but little research has examined implementation.
OBJECTIVE: To compare SBIRT implementation in pediatric primary care among trained pediatricians, pediatricians working in coordination with embedded behavioral health care practitioners (BHCPs), and usual care (UC).
DESIGN, SETTING, AND PARTICIPANTS: The study is a 2-year (November 1, 2011, through October 31, 2013), nonblinded, cluster randomized, hybrid implementation and effectiveness trial examining SBIRT implementation outcomes across 2 modalities of implementation and UC. Fifty-two pediatricians from a large general pediatrics clinic in an integrated health care system were randomized to 1 of 3 SBIRT implementation arms; patients aged 12 to 18 years were eligible.
INTERVENTIONS: Two modes of SBIRT implementation, (1) pediatrician only (pediatricians trained to provide SBIRT) and (2) embedded BHCP (BHCP trained to provide SBIRT), and (3) UC.
MAIN OUTCOMES AND MEASURES: Implementation of SBIRT (primary outcome), which included assessments, brief interventions, and referrals to specialty substance use and mental health treatment.
RESULTS: The final sample included 1871 eligible patients among 47 pediatricians; health care professional characteristics did not differ across study arms. Patients in the pediatrician-only (adjusted odds ratio [AOR], 10.37; 95% CI, 5.45-19.74; P < .001) and the embedded BHCP (AOR, 18.09; 95% CI, 9.69-33.77; P < .001) arms had higher odds of receiving brief interventions compared with patients in the UC arm. Patients in the embedded BHCP arm were more likely to receive brief interventions compared with those in the pediatrician-only arm (AOR, 1.74; 95% CI, 1.31-2.31; P < .001). The embedded BHCP arm had lower odds of receiving a referral compared with the pediatrician-only (AOR, 0.58; 95% CI, 0.43-0.78; P < .001) and UC (AOR, 0.65; 95% CI, 0.48-0.89; P = .006) arms; odds of referrals did not differ between the pediatrician-only and UC arms.
CONCLUSIONS AND RELEVANCE: The intervention arms had better screening, assessment, and brief intervention rates than the UC arm. Patients in the pediatrician-only and UC arms had higher odds of being referred to specialty treatment than those in the embedded BHCP arm, suggesting lingering barriers to having pediatricians fully address substance use in primary care. Findings also highlight age and ethnic groups less likely to receive these important services.
TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02408952.

PMID: 26523821 [PubMed - in process]

Prevalence of unhealthy alcohol use in hospital outpatients.

Sat, 10/31/2015 - 12:30pm
Related Articles

Prevalence of unhealthy alcohol use in hospital outpatients.

Drug Alcohol Depend. 2014 Nov 1;144:270-3

Authors: Johnson NA, Kypri K, Latter J, McElduff P, Saunders JB, Saitz R, Attia J, Dunlop A, Doran C, Wolfenden L, McCambridge J

Abstract
BACKGROUND: Few studies have examined the prevalence of unhealthy alcohol use in the hospital outpatient setting. Our aim was to estimate the prevalence of unhealthy alcohol use among patients attending a broad range of outpatient clinics at a large public hospital in Australia.
METHODS: Adult hospital outpatients were invited to complete the Alcohol Use Disorders Identification Test Consumption questions (AUDIT-C) using an iPad as part of a randomised trial testing the efficacy of alcohol electronic screening and brief intervention. Unhealthy alcohol use was defined as an AUDIT-C score ≥5 among men and ≥4 among women.
RESULTS: Sixty percent (3616/6070) of invited hospital outpatients consented, of whom 89% (3206/3616) provided information on their alcohol consumption (either reported they had not consumed any alcohol in the last 12 months or completed the AUDIT-C). The prevalence of unhealthy alcohol use was 34.7% (95% confidence interval [CI]: 33.0-36.3%). The prevalence among men aged 18-24 years, 25-39 years, 40-59 years and 60 years and older, was 74.4% (95% CI: 68.4-80.4%), 54.3% (95% CI: 48.7-59.8%), 44.1% (95% CI: 39.9-48.3%), and 27.0% (95% CI: 23.6-30.4%), respectively (43.1% overall; 95% CI: 40.8-45.5%). The prevalence among women aged 18-24 years, 25-39 years, 40-59 years, and 60 years and older, was 48.6% (95% CI: 39.2-58.1%), 36.9% (95% CI: 31.2-42.6%), 25.2% (95% CI: 21.5-29.0%) and 14.5% (95% CI: 11.7-17.3%), respectively (24.9% overall; 95% CI: 22.7-27.1%).
CONCLUSION: A large number of hospital outpatients who are not currently seeking treatment for their drinking could benefit from effective intervention in this setting.

PMID: 25193718 [PubMed - indexed for MEDLINE]

Implementation of a Brief Treatment Counseling Toolkit in Federally Qualified Healthcare Centers: Patient and Clinician Utilization and Satisfaction.

Thu, 10/29/2015 - 6:00am

Implementation of a Brief Treatment Counseling Toolkit in Federally Qualified Healthcare Centers: Patient and Clinician Utilization and Satisfaction.

J Subst Abuse Treat. 2015 Sep 8;

Authors: Brooks AC, Chambers JE, Lauby J, Byrne E, Carpenedo CM, Benishek LA, Medvin R, Metzger DS, Kirby KC

Abstract
INTRODUCTION: The need to integrate behavioral health care within medical settings is widely recognized, and integrative care approaches are associated with improved outcomes for a range of disorders. As substance use treatment integration efforts expand within primary care settings, training behavioral health providers in evidence-based brief treatment models that are cost-effective and easily fit within the medical flow is essential.
METHODS: Guided by principles drawn from Diffusion of Innovations theory (Rogers, 2003) and the Consolidated Framework of Implementation Research (Damschroder et al., 2009), we adapted elements of Motivational Enhancement Therapy, cognitive-behavioral therapy, and 12-step facilitation into a brief counseling toolkit. The toolkit is a menu driven assortment of 35 separate structured clinical interventions that each include client takeaway resources to reinforce brief clinical contacts. We then implemented this toolkit in the context of a randomized clinical trial in three Federally Qualified Healthcare Centers. Behavioral Health Consultants (BHCs) used a pre-screening model wherein 10,935 patients received a brief initial screener, and 2011 received more in-depth substance use screening. Six hundred patients were assigned to either a single session brief intervention or an expanded brief treatment encompassing up to five additional sessions. We conducted structured interviews with patients, medical providers, and BHCs to obtain feedback on toolkit implementation.
RESULTS: On average, patients assigned to brief treatment attended 3.29 sessions. Fifty eight percent of patients reported using most or all of the educational materials provided to them. Patients assigned to brief treatment reported that the BHC sessions were somewhat more helpful than did patients assigned to a single session brief intervention (p=.072). BHCs generally reported that the addition of the toolkit was helpful to their work in delivering screening and brief treatment.
DISCUSSION: This work is significant because it provides support to clinicians in delivering evidence-based brief interventions and has been formatted into presentation styles that can be presented flexibly depending on patient need.

PMID: 26508714 [PubMed - as supplied by publisher]

Residents' knowledge of standard drink equivalents: implications for screening and brief intervention for at-risk alcohol use.

Fri, 10/23/2015 - 6:00am
Related Articles

Residents' knowledge of standard drink equivalents: implications for screening and brief intervention for at-risk alcohol use.

Am J Addict. 2014 Mar-Apr;23(2):194-6

Authors: Welsh C, Earley K, Delahanty J, Wright KS, Berens T, Williams AA, Barnett B, DiClemente CC

Abstract
BACKGROUND AND OBJECTIVES: Screening and brief intervention for reducing alcohol consumption has been demonstrated to be effective in various medical settings. The NIAAA has recommended that physicians screen all patients for at-risk and problem drinking. Often, screening is based on the concept of a "standard drink."
METHODS: We administered a survey to residents (N=270) in order to assess their knowledge of standard drink equivalents and quantities of alcohol in various sizes of bottles.
RESULTS: Although 89% of the responders stated that they had previously learned about screening for at-risk alcohol use, the majority did not know basic facts about standard drink equivalents.
DISCUSSION AND CONCLUSIONS: Many trainees are not familiar with typical standard drink equivalents. This can have a significant impact on the screening of patients for problem drinking using screening tools that rely on standard drink equivalents.

PMID: 24112850 [PubMed - indexed for MEDLINE]

Project WINGS (Women Initiating New Goals of Safety): A randomised controlled trial of a screening, brief intervention and referral to treatment (SBIRT) service to identify and address intimate partner violence victimisation among substance-using women...

Wed, 10/21/2015 - 6:00am

Project WINGS (Women Initiating New Goals of Safety): A randomised controlled trial of a screening, brief intervention and referral to treatment (SBIRT) service to identify and address intimate partner violence victimisation among substance-using women receiving community supervision.

Crim Behav Ment Health. 2015 Dec 10;25(4):314-29

Authors: Gilbert L, Shaw SA, Goddard-Eckrich D, Chang M, Rowe J, McCrimmon T, Almonte M, Goodwin S, Epperson M

Abstract
BACKGROUND: The high rate of intimate partner violence (IPV) victimisation found among substance-using women receiving community supervision underscores the need for effective IPV victimisation screening, brief intervention and referral to treatment services (SBIRT) for this population.
AIMS: This randomised controlled trial (RCT) aims to assess the feasibility, safety and efficacy of a single-session computerised self-paced IPV SBIRT (Computerised WINGS) in identifying IPV victimisation among women under community supervision and increasing access to IPV services, compared to the same IPV SBIRT service delivered by a case manager (Case Manager WINGS).
METHODS: This RCT was conducted with 191 substance-using women in probation and community court sites in New York City.
RESULTS: No significant differences were found between Computerised and Case Manager WINGS arms on any outcomes. Both arms reported identical high rates of any physical, sexual or psychological IPV victimisation in the past year (77% for both arms) during the intervention. Both arms experienced significant increases from baseline to the 3-month follow-up in receipt of IPV services, social support, IPV self-efficacy and abstinence from drug use.
CONCLUSIONS: Findings suggest that both modalities of WINGS show promise in identifying and addressing IPV victimisation among substance-using women receiving community supervision.Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

PMID: 26482019 [PubMed - in process]