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Validity of Brief Screening Instrument for Adolescent Tobacco, Alcohol, and Drug Use.

Wed, 04/23/2014 - 6:00am

Validity of Brief Screening Instrument for Adolescent Tobacco, Alcohol, and Drug Use.

Pediatrics. 2014 Apr 21;

Authors: Kelly SM, Gryczynski J, Mitchell SG, Kirk A, O'Grady KE, Schwartz RP

Abstract
BACKGROUND AND OBJECTIVE: The National Institute on Alcohol Abuse and Alcoholism developed an alcohol screening instrument for youth based on epidemiologic data. This study examines the concurrent validity of this instrument, expanded to include tobacco and drugs, among pediatric patients, as well as the acceptability of its self-administration on an iPad.
METHODS: Five hundred and twenty-five patients (54.5% female; 92.8% African American) aged 12 to 17 completed the Brief Screener for Tobacco, Alcohol, and other Drugs (BSTAD) via interviewer-administration or self-administration using an iPad. Diagnostic and Statistical Manual, Fifth Edition substance use disorders (SUDs) were identified using a modified Composite International Diagnostic Interview-2 Substance Abuse Module. Receiver operating characteristic curves, sensitivities, and specificities were obtained to determine optimal cut points on the BSTAD in relation to SUDs.
RESULTS: One hundred fifty-nine (30.3%) adolescents reported past-year use of ≥1 substances on the BSTAD: 113 (21.5%) used alcohol, 84 (16.0%) used marijuana, and 50 (9.5%) used tobacco. Optimal cut points for past-year frequency of use items on the BSTAD to identify SUDs were ≥6 days of tobacco use (sensitivity = 0.95; specificity = 0.97); ≥2 days of alcohol use (sensitivity = 0.96; specificity = 0.85); and ≥2 days of marijuana use (sensitivity = 0.80; specificity = 0.93). iPad self-administration was preferred over interviewer administration (z = 5.8; P < .001).
CONCLUSIONS: The BSTAD is a promising screening tool for identifying problematic tobacco, alcohol, and marijuana use in pediatric settings. Even low frequency of substance use among adolescents may indicate need for intervention.

PMID: 24753528 [PubMed - as supplied by publisher]

Multiple somatic symptoms in employees participating in a randomized controlled trial associated with sickness absence due to non-specific low back pain.

Sun, 04/20/2014 - 2:30pm
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Multiple somatic symptoms in employees participating in a randomized controlled trial associated with sickness absence due to non-specific low back pain.

Spine J. 2014 Apr 14;

Authors: Hedeager Momsen AM, Jensen OK, Nielsen CV, Jensen C

Abstract
BACKGROUND CONTEXT: The prevalence of multiple somatic symptoms is high in primary and hospital outpatient populations. Multiple somatic symptoms may be present in patients sick-listed due to low back pain (LBP), and may be associated with increased risk of not returning to work (RTW).
PURPOSE: The primary aim was to explore whether multiple somatic symptoms in a subset of patients with non-specific LBP was associated with RTW, sickness absence or other social benefits. Study Design/Setting: The study was a cohort study based on a randomized clinical trial (RCT) with a prospective two-year follow-up period. Patients were referred from general practices to the Spine Centre, Regional Hospital Silkeborg, Denmark.
PATIENT SAMPLE: Patients were 285 sick-listed employees (4-12 weeks) with non-specific LBP as their prime reason for sickness absence. Exclusion criteria were: unemployment, radiculopathy, LBP surgery within the past year, previous lumbar fusion, suspected cauda equina syndrome, progressive paresis or other serious back disease, pregnancy, known substance abuse or primary psychiatric diagnosis.
OUTCOME MEASURES: Self-reported health was assessed by the LBP Rating Scale and questions about pain and health in general. Disabilities were measured by the Roland Morris Questionnaire, the Short Form-36, and the Fear-Avoidance Beliefs Questionnaire. Work-related questions comprised expectations about RTW, and risk of losing job due to sickness absence. The Common Mental Disorder Questionnaire (subscale SCL-SOM) was used to assess multiple somatic symptoms (12 items). We categorized multiple somatic symptoms into four groups based on the SCL-SOM sum score: <6, 6-12, 13-18 and >18. Status of sickness absence (SA) (>two weeks) and RTW were gathered from a national database (DREAM).
METHODS: The patients (N=285) were randomized into either multidisciplinary intervention or brief intervention at the Spine Centre (2004-8). Both interventions comprised clinical examination and advice by a physiotherapist and a rheumatologist. Data were collected from questionnaires at baseline (inclusion), and one year after inclusion. Data on sickness absence benefits were gathered from the DREAM database, which contains data on all social transfer payments (such as sick leave benefits and other disability benefits) registered on a weekly basis. The study was supported by a grant from Trygfonden.
RESULTS: All health factors, female gender, and poor work ability were significantly associated with a higher level of multiple somatic symptoms. The percentage of persons with sickness absence increased significantly with symptom score after one year, and the duration of sickness absence remained significantly longer after two years of follow-up between the multiple somatic symptoms groups. The percentages with RTW after one and two years were negatively associated with a higher level of multiple somatic symptoms at baseline. We found no difference between the intervention groups.
CONCLUSIONS: A higher level of multiple somatic symptoms was significantly associated with poor health and work ability at baseline, and with longer duration of sickness absence and unsuccessful RTW through a two-year follow-up period.

PMID: 24743062 [PubMed - as supplied by publisher]

The Social Health Intervention Project (SHIP): Protocol for a randomized controlled clinical trial assessing the effectiveness of a brief motivational intervention for problem drinking and intimate partner violence in an urban emergency department.

Sun, 04/20/2014 - 2:30pm
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The Social Health Intervention Project (SHIP): Protocol for a randomized controlled clinical trial assessing the effectiveness of a brief motivational intervention for problem drinking and intimate partner violence in an urban emergency department.

BMC Emerg Med. 2014 Apr 18;14(1):10

Authors: Rhodes KV, Rodgers M, Sommers M, Hanlon A, Crits-Christoph P

Abstract
BACKGROUND: There is a strong reciprocal association between two highly prevalent public health problems: intimate partner violence and heavy drinking, both of which remain major sources of morbidity and mortality. Brief interventions in the Emergency Department setting have been found to be effective in reducing alcohol-related injury but neither classic intimate partner violence nor substance abuse interventions have adequately integrated assessment and treatment for these co-occurring conditions. The overall goal of this study is to determine whether a motivational intervention delivered at the time of an Emergency Department visit will reduce heavy drinking and improve the safety of women experiencing intimate partner violence.Methods and design: We are completing data collection for a randomized controlled trial enrolling 600 female patients, age 18-64, presenting to one of two urban Emergency Departments, who self-disclose both problem drinking and intimate partner violence. Eligible patients are randomized to a brief manual-guided motivational intervention, and a phone booster at 10 days. The intervention, which is delivered by masters-level therapists during the Emergency Department visit, is recorded and monitored for fidelity. Primary outcomes are episodes of heavy drinking and incidents of intimate partner violence, assessed weekly by Interactive Voice Response System for 12 weeks and at 3, 6 and 12 months by interviewers blinded to group assignment. To identify the impact of assessment alone, we included a no-contact control group assessed only once at 3 months. Secondary outcomes include violence severity, changes in the Composite Abuse Scale and alcohol quantity/frequency, along with other health-related behaviors. The analysis will also explore the impact of likely mediators and moderators of the intervention.
DISCUSSION: While screening and intervention for intimate partner violence is now recommended for women of child bearing age in health care settings, there is a need for rigorous evaluations of what works for whom. Upon completion, we will have high-quality evidence regarding the effectiveness of a low-intensity, brief motivational intervention, delivered by social workers in the Emergency Department setting, for decreasing episodes of heavy drinking and intimate partner violence. Ultimately, this is a model could be generalizable to other acute health care settings.Trial Registration: ClinicalTrials.gov Registration Number: NCT01207258.

PMID: 24742322 [PubMed - as supplied by publisher]

Screening and Intervention for Comorbid Substance Disorders, PTSD, Depression, and Suicide: A Trauma Center Survey.

Wed, 04/16/2014 - 6:00am

Screening and Intervention for Comorbid Substance Disorders, PTSD, Depression, and Suicide: A Trauma Center Survey.

Psychiatr Serv. 2014 Apr 15;

Authors: Love J, Zatzick D

Abstract
OBJECTIVE Few investigations have examined screening and intervention procedures for comorbid substance use and mental disorders at trauma centers in the United States, although these disorders are endemic among survivors of traumatic injury. In 2006, the American College of Surgeons (ACS) mandated that level I and level II trauma centers screen for alcohol use problems and that level I centers provide brief intervention for those who screen positive. The ACS is expected to recommend best practice policy guidelines for screening for drug use problems and posttraumatic stress disorder (PTSD). This study examined screening and intervention procedures for the full spectrum of comorbid mental and substance use disorders at U.S. trauma centers. METHODS Respondents at all level I and level II trauma centers (N=518) in the United States were asked to complete a survey describing screening and intervention procedures for alcohol and drug use problems, suicidality, depression, and PTSD. RESULTS There were 391 (75%) respondents. Over 80% of trauma centers routinely screened for alcohol and drug use problems. Routine screening and intervention for suicidality, depression, and PTSD were markedly less common; in fact, only 7% of centers reported routine screening for PTSD. Consistent with ACS policy, level I centers were significantly more likely than level II centers to provide alcohol intervention. CONCLUSIONS Alcohol screening and intervention occurred frequently at U.S. trauma centers and appeared to be responsive to ACS mandates. In the future, efforts to orchestrate clinical investigation and policy could enhance screening and intervention procedures for highly prevalent, comorbid mental disorders.

PMID: 24733143 [PubMed - as supplied by publisher]

Attachment security and problematic substance use in low-income, suicidal, African American women.

Tue, 04/15/2014 - 6:00am

Attachment security and problematic substance use in low-income, suicidal, African American women.

Am J Addict. 2014 May;23(3):294-9

Authors: Massey SH, Compton MT, Kaslow NJ

Abstract
BACKGROUND AND OBJECTIVES: While secure attachment may buffer the effect of adverse early experiences on the development of behavioral problems in children, whether attachment security may provide resilience against problematic substance use in adulthood is less clear, and addressed by this study.
METHODS: We examined relations between attachment security and problematic substance use in 356 African American women recruited for a suicide prevention/intervention study. Problematic substance use was defined as a positive screen on either the Brief Michigan Alcoholism Screening Test or the Drug Abuse Screening Test-10. Attachment security was assessed using the Secure Subscale of the Relationship Scales Questionnaire. Associations between demographic and psychosocial variables (age, education, unemployment, homelessness, attachment security, past childhood maltreatment, current exposure to intimate partner violence, and depressive symptoms) and problematic substance use were determined using logistic regression analyses.
RESULTS: Participants averaged 35.1 ± 10.0 years of age, and exhibited significant psychosocial challenges. More secure attachment was independently associated with a lower likelihood of problematic drug use (OR = .516, 95% CI (.343-.777), p ≤ .01); and the problematic use of either alcohol or drugs (OR = .563, 95% CI (.374-.849), p ≤ .01). Attachment security, along with childhood maltreatment, age, and homelessness, accounted for 25.5% of the variance in problematic substance use.
DISCUSSION AND CONCLUSIONS: Participants who reported greater attachment security were significantly less likely to engage in problematic substance use.
SCIENTIFIC SIGNIFICANCE: Future research should explore attachment security as a resilience factor against problematic substance use. (Am J Addict 2014;23:294-299).

PMID: 24724888 [PubMed - in process]

The feasibility and acceptability of a brief intervention for clients of substance use services experiencing symptoms of post traumatic stress disorder.

Tue, 03/25/2014 - 6:15am

The feasibility and acceptability of a brief intervention for clients of substance use services experiencing symptoms of post traumatic stress disorder.

Addict Behav. 2014 Mar 12;

Authors: Mills KL, Ewer P, Dore G, Teesson M, Baker A, Kay-Lambkin F, Sannibale C

Abstract
BACKGROUND: Trauma exposure and post traumatic stress disorder (PTSD) are common among clients of substance use services. Existing treatments for these co-occurring conditions tend to be lengthy, treatment retention is relatively poor, and they require extensive training and clinical supervision. The aim of the present study was to conduct a preliminary examination of the feasibility and acceptability of a brief intervention for PTSD symptoms among individuals seeking substance use treatment.
METHODS: An uncontrolled open-label pilot study was conducted among 29 inpatients of a medicated detoxification unit in Sydney, Australia. All participants completed a baseline interview followed by the brief intervention. The intervention consists of a single, one-hour manualised session providing psychoeducation pertaining to common trauma reactions and symptom management. PTSD and substance use outcomes were assessed at 1-week, 1-month and 3-month post-intervention.
RESULTS: PTSD symptom severity (assessed using the Clinicians Administered PTSD Scale) decreased significantly from baseline to 1-week follow up (β -10.87, 95%CI: -19.75 to -1.99) and again between the 1-week and 3-month follow-ups (β -15.38, 95%CI: -23.20 to -7.57). Despite these reductions, the majority of participants continued to meet criteria for a diagnosis of PTSD and there was no change in participants' negative post-traumatic cognitions. Participants expressed high levels of satisfaction with the intervention.
CONCLUSIONS: Brief psychoeducation for traumatised clients attending substance use services appears to be feasible, acceptable, and may be of some benefit in reducing PTSD symptoms. However, participants continued to experience symptoms at severe levels; thus, brief intervention may best be conceptualised as a "stepping stone" to further trauma treatment.

PMID: 24657001 [PubMed - as supplied by publisher]

Cognitive-behavioral group depression prevention compared to bibliotherapy and brochure control: Nonsignificant effects in pilot effectiveness trial with college students.

Tue, 03/25/2014 - 6:15am

Cognitive-behavioral group depression prevention compared to bibliotherapy and brochure control: Nonsignificant effects in pilot effectiveness trial with college students.

Behav Res Ther. 2014 Apr;55:48-53

Authors: Rohde P, Stice E, Shaw H, Gau JM

Abstract
OBJECTIVE: Conduct a pilot trial testing whether a brief cognitive-behavioral (CB) group reduced depressive symptoms and secondary outcomes relative to bibliotherapy and brochure controls in college students with elevated depressive symptoms.
METHOD: 82 college students (M age = 19.0, SD = 0.9; 70% female, 80% White) with elevated self-assessed depressive symptoms were randomized to a 6-session CB group, bibliotherapy, or educational brochure control condition, completing assessments at pretest, posttest, and at 6- and 12-month follow-up.
RESULTS: Planned contrasts found no significant effects for CB group on depressive symptoms compared to either bibliotherapy or brochure controls at posttest (d = -.08 and .06, respectively) or over follow-up (d = -.04 and -.10, respectively). There were no intervention effects for social adjustment and substance use, though CB group participants had improved knowledge of CB concepts at posttest, versus brochure controls. Condition differences in major depression onset were nonsignificant but suggested support for CB interventions (CB group = 7.4%, bibliotherapy = 4.5%, brochure control = 15.2%).
CONCLUSIONS: Unexpectedly modest support was found for a brief CB group depression prevention intervention, compared to bibliotherapy or brochure control, when provided to self-selected college students, suggesting that alternative screening or interventions approaches are needed for this population.

PMID: 24655464 [PubMed - in process]

Internet-based screening and brief intervention for illicit drug users: a randomized controlled trial with 12-month follow-up.

Sat, 03/22/2014 - 6:00am

Internet-based screening and brief intervention for illicit drug users: a randomized controlled trial with 12-month follow-up.

J Stud Alcohol Drugs. 2014 Mar;75(2):313-8

Authors: Sinadinovic K, Wennberg P, Berman AH

Abstract
ABSTRACT. Objective: This trial investigated the effects of access to an Internet-based screening and brief intervention site for illicit drug users. This article adds to previously published results from the 3- and 6-month follow-ups by extending the follow-up period to 12 months and reporting changes in substance use between the 6- and 12-month follow-ups. Method: In total, 202 Internet help-seekers with illicit drug use, 15-70 years old, were randomly assigned to either an intervention group that received Internet-based screening and brief intervention via eScreen.se or to an assessment-only control group. The primary outcome measure was the Drug Use Disorders Identification Test consumption questions (DUDIT-C) score, and secondary outcome measures were the DUDIT, Alcohol Use Disorders Identification Test consumption questions (AUDIT-C), and AUDIT scores, as well as the proportion of drug abstainers and participants making a clinically significant change in their alcohol and other drug use. Results: DUDIT-C, DUDIT, AUDIT-C, and AUDIT scores remained stable between the 6- and 12-month follow-ups. However, 12 months after recruitment, 34.3% of those who used eScreen.se had changed their alcohol use to a clinically lower level compared with the 21.8% of the controls. Also, none of the eScreen.se users increased their level of alcohol use during this 12-month period, whereas 5.0% in the control group did so. Conclusions: Despite no changes in illicit drug use from the 6- to 12-month follow-up for both the intervention and control group, eScreen.se seems to be more effective than assessment only for reducing alcohol use among illicit drug users over a 12-month period. (J. Stud. Alcohol Drugs, 75, 313-318, 2014).

PMID: 24650825 [PubMed - in process]

Alcohol, tobacco, and drug use among emergency department patients.

Fri, 03/07/2014 - 3:15pm
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Alcohol, tobacco, and drug use among emergency department patients.

Drug Alcohol Depend. 2014 Feb 12;

Authors: Sanjuan PM, Rice SL, Witkiewitz K, Mandler RN, Crandall C, Bogenschutz MP

Abstract
BACKGROUND: The prevalence of alcohol, tobacco, and other drug (ATOD) use among emergency department (ED) patients is high and many of these patients have unrecognized and unmet substance use treatment needs. Identification of patients in the ED with problem substance use is not routine at this time.
METHODS: We examined screening data, including standardized measures of ATOD use (HSI, AUDIT-C, DAST-10), from 14,866 ED patients in six hospitals across the United States. We expected younger age, male gender, higher triage acuity, and other substance use severity (ATOD) to be associated both with use versus abstinence and with severity of each substance use type. We used negative binomial hurdle models to examine the association between covariates and (1) substance use versus abstinence (logistic submodel) and with (2) severity among those who used substances (count submodel).
RESULTS: Rates of use and problem use in our sample were similar to or higher than other ED samples. Younger patients and males were more likely to use ATOD, but the association of age and gender with severity varied across substances. Triage level was a poor predictor of substance use severity. Alcohol, tobacco, and drug use were significantly associated with using other substances and severity of other substance use.
CONCLUSION: Better understanding of the demographic correlates of ATOD use and severity and the patterns of comorbidity among classes of substance can inform the design of optimal screening and brief intervention procedures addressing ATOD use among ED patients. Tobacco may be an especially useful predictor.

PMID: 24594289 [PubMed - as supplied by publisher]

Brief intervention and social work: a primer for practice and policy.

Fri, 03/07/2014 - 3:15pm
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Brief intervention and social work: a primer for practice and policy.

Soc Work Public Health. 2013;28(3-4):248-63

Authors: Cochran G, Field C

Abstract
Most individuals in need of help for alcohol use disorders do not receive care. Screening and brief intervention (SBI) is an evidence-based practice for reducing at-risk drinking and alcohol-related risk behaviors. Health care reform sets the stage for a large expansion of SBI to individuals in the United States. Social workers have the opportunity to play an important role in helping establish SBI nationally, but they must become more involved in its delivery, educating new social workers with respect to SBI practice, and taking part in research to expand the field's knowledge of this service.

PMID: 23731418 [PubMed - indexed for MEDLINE]

Challenges and Opportunities for Integrating Preventive Substance-Use-Care Services in Primary Care through the Affordable Care Act.

Tue, 03/04/2014 - 6:15am

Challenges and Opportunities for Integrating Preventive Substance-Use-Care Services in Primary Care through the Affordable Care Act.

J Health Care Poor Underserved. 2014;25(1 Suppl):36-45

Authors: Ghitza UE, Tai B

Abstract
Undertreated or untreated substance use disorders (SUD) remain a pervasive, medically-harmful public health problem in the United States, particularly in medically underserved and low-income populations lacking access to appropriate treatment. The need for greater access to SUD treatment was expressed as policy in the Final Rule on standards related to essential health benefits, required to be covered through the 2010 Affordable Care Act (ACA) health insurance exchanges. SUD treatment services have been included as an essential health benefit, in a manner that complies with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. Consequently, with the ACA, a vast expansion of SUD-care services in primary care is looming. This commentary discusses challenges and opportunities under the ACA for equipping health care professionals with appropriate workforce training, infrastructure, and resources to support and guide science-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) for SUD in primary care.

PMID: 24583486 [PubMed - in process]

Screening, Brief Intervention, and Referral to Treatment (SBIRT) as an Integral Part of Nursing Practice.

Tue, 03/04/2014 - 6:15am

Screening, Brief Intervention, and Referral to Treatment (SBIRT) as an Integral Part of Nursing Practice.

Subst Abus. 2014 Feb 28;

Authors: Finnell DS, Nowzari S, Reimann B, Fischer L, Pace E, Goplerud E

Abstract
ABSTRACT Substance use screening, brief intervention and referral to treatment (SBIRT) should be an integral part of the scope of nursing practice. This commentary is an appeal for nurses to advance their knowledge and competencies related to SBIRT. The question of how to move SBIRT into the mainstream of nursing practice was posed to several leaders of federal agencies, healthcare and nursing organizations, nurse educators, and nurse leaders. We provide recommendations for moving this set of clinical strategies (i.e., SBIRT) into day-to-day nursing practice.

PMID: 24580067 [PubMed - as supplied by publisher]

Implementing the Alcohol, Smoking, Substance Involvement Screening Test and linked brief intervention service in primary care in Thailand.

Fri, 02/28/2014 - 6:15am

Implementing the Alcohol, Smoking, Substance Involvement Screening Test and linked brief intervention service in primary care in Thailand.

J Public Health (Oxf). 2014 Feb 25;

Authors: Assanangkornchai S, Balthip Q, Edwards JG, With the assistance of the ASSIST-SBI Development Co-investigators

Abstract
BACKGROUND: This paper reports findings on the implementation, acceptability and uptake of the screening and brief intervention programme based on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to help decrease substance misuse in primary care in Thailand.
METHODS: Action research involving selection of suitable study areas; obtaining support for its introduction and corporation at national and local levels; training and monitoring of healthcare providers; delivery of the ASSIST-BI (brief intervention) procedure and assessments of acceptability and uptake of the procedure by patients and staff.
RESULTS: Between October 2011 and October 2012, 5931 patients (2.5% of all patients attending primary care units) were screened with the ASSIST. Of these, 29.6 and 3.4% were in the moderate- and high-risk groups, respectively, and were offered BI or other treatment. The most popular substances used were tobacco and alcohol. Less than 1% screened positively for illicit substances.
CONCLUSION: The ASSIST detected many substance users capable of benefiting from intervention. The programme was well received by patients and staff. The development of the project from conception to inclusion in Thailand's national public health strategy is described and suggested as a model for introducing similar procedures into developing countries.

PMID: 24573365 [PubMed - as supplied by publisher]

Prospective associations among approach coping, alcohol misuse and psychiatric symptoms among veterans receiving a brief alcohol intervention.

Tue, 02/25/2014 - 6:00am

Prospective associations among approach coping, alcohol misuse and psychiatric symptoms among veterans receiving a brief alcohol intervention.

J Subst Abuse Treat. 2014 Jan 17;

Authors: Mason AE, Boden MT, Cucciare MA

Abstract
Brief alcohol interventions (BAIs) target alcohol consumption and may exert secondary benefits including reduced depression and posttraumatic stress disorder (PTSD) symptoms among non-veteran and veteran populations. This study examined whether approach coping, alcohol misuse, and an interaction of these two factors prior to the administration of a BAI (i.e., baseline) would predict depression and PTSD symptoms 6-months post BAI (i.e., follow-up). Veterans (N=166) received a BAI after screening positive for alcohol misuse during a primary care visit and completed assessments of alcohol misuse, approach coping, and depression and PTSD symptoms at baseline and follow-up. Baseline substance misuse, but not approach coping, significantly predicted depression and PTSD symptoms at follow-up. Approach coping moderated associations between baseline alcohol misuse and psychiatric symptoms: Veterans reporting more alcohol misuse and more (relative to less) approach coping at baseline evidenced fewer psychiatric symptoms at follow-up after accounting for symptoms assessed at baseline.

PMID: 24560128 [PubMed - as supplied by publisher]

Moving Toward Integrated Behavioral Intervention for Treating Multimorbidity Among Chronic Pain, Depression, and Substance-use Disorders in Primary Care.

Sat, 02/22/2014 - 6:15am

Moving Toward Integrated Behavioral Intervention for Treating Multimorbidity Among Chronic Pain, Depression, and Substance-use Disorders in Primary Care.

Med Care. 2014 Feb 19;

Authors: Haibach JP, Beehler GP, Dollar KM, Finnell DS

Abstract
INTRODUCTION:: The importance of using integrated treatment for multimorbidity has been increasingly recognized. One prevalent cluster of health conditions is multimorbidity of chronic pain, depression, and substance-use disorders, a common triad of illnesses among primary care patients. This brief report brings attention to an emerging treatment method of an integrated behavioral approach to improve health outcomes for individuals with these 3 conditions in the outpatient setting, particularly primary care.
METHODS:: A multidatabase search was conducted to identify studies of behavioral interventions targeting co-occurrence or multimorbidity among the 3 health conditions in the adult outpatient setting. An independent screening of the articles was accomplished by all authors with consensus on the final inclusion for review.
RESULTS:: Three studies met formal inclusion criteria for this review. The included studies evaluated cognitive behavioral therapy or combined motivational interviewing with cognitive behavioral therapy. Key findings from other reviews and additional studies are also included in this review to further inform the development of a common approach for treating this triad of conditions in primary care.
CONCLUSIONS:: Although there has been increased recognition for more effective and practical behavioral treatments for patients with multiple chronic health conditions, the evidence-base to inform practice remains limited. The findings from this review suggest that a common approach, rather than a distinct intervention for chronic pain, depression, or substance-use disorders, is indicated and that best care can be provided within the context of a coordinated, interdisciplinary, and patient-centered primary care team.

PMID: 24556895 [PubMed - as supplied by publisher]

Prescription opioid abuse: challenges and opportunities for payers.

Thu, 02/20/2014 - 6:15am
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Prescription opioid abuse: challenges and opportunities for payers.

Am J Manag Care. 2013 Apr;19(4):295-302

Authors: Katz NP, Birnbaum H, Brennan MJ, Freedman JD, Gilmore GP, Jay D, Kenna GA, Madras BK, McElhaney L, Weiss RD, White AG

Abstract
OBJECTIVES: Prescription opioid abuse and addiction are serious problems with growing societal and medical costs, resulting in billions of dollars of excess costs to private and governmental health insurers annually. Although difficult to accurately assess, prescription opioid abuse also leads to increased insurance costs in the form of property and liability claims, and costs to state and local governments for judicial, emergency, and social services. This manuscript's objective is to provide payers with strategies to control these costs, while supporting safe use of prescription opioid medications for patients with chronic pain.
METHOD: A Tufts Health Care Institute Program on Opioid Risk Management meeting was convened in June 2010 with private and public payer representatives, public health and law enforcement officials, pain specialists, and other stakeholders to present research and develop recommendations on solutions that payers might implement to combat this problem.
RESULTS: While protecting access to prescription opioids for patients with pain, private and public payers can implement strategies to mitigate financial risks associated with opioid abuse, using internal strategies such as formulary controls, claims data surveillance, and claims matching; and external policies and procedures that support and educate physicians on reducing opioid risks among patients with chronic pain.
CONCLUSIONS: Reimbursement policies, incentives, and health technology systems that encourage physicians to use universal precautions, to consult prescription monitoring program (PMP) data, and to implement Screening, Brief Intervention, and Referral to Treatment protocols have a high potential to reduce insurer risks while addressing a serious public health problem.

PMID: 23725361 [PubMed - indexed for MEDLINE]

Computerized v. In-person Brief Intervention for Drug Misuse: A Randomized Clinical Trial.

Fri, 02/14/2014 - 6:15am

Computerized v. In-person Brief Intervention for Drug Misuse: A Randomized Clinical Trial.

Addiction. 2014 Feb 12;

Authors: Schwartz RP, Gryczynski J, Mitchell SG, Gonzales A, Moseley A, Peterson TR, Ondersma SJ, O'Grady KE

Abstract
BACKGROUND AND AIMS: Several studies have found that brief interventions (BIs) for drug misuse have superior effectiveness to no-treatment controls. However, many health centers do not provide BIs for drug use consistently due to insufficient behavioral health staff capacity. Computerized BIs for drug use are a promising approach, but their effectiveness compared with in-person BIs has not been established. This study compared the effectiveness of a computerized brief intervention (CBI) to an in-person brief intervention (IBI) delivered by a behavioral health counselor.
METHODS: Two-arm randomized clinical trial, conducted in two health centers in New Mexico, USA. Participants were 360 adult primary care patients with moderate-risk drug scores on the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) who were randomly assigned on a 1:1 basis to a computerized brief intervention (CBI) or to an in-person brief intervention (IBI) delivered by a behavioral health counselor. Assessments were conducted at baseline and 3-month follow-up, and included the ASSIST and drug testing on hair samples.
RESULTS: The IBI and CBI conditions did not differ at 3 months on global ASSIST drug scores (b=-1.79; 95% CI=-4.37,-0.80) or drug-positive hair tests (OR=.97; 95% CI= 0.47,1.94). There was a statistically significant advantage of CBI over IBI in substance-specific ASSIST scores for marijuana (b=-1.73; 95% CI= -2.91,-0.55; Cohen's d=.26; p=.004) and cocaine (b= -4.48; 95% CI= -8.26,-0.71; Cohen's d=.50; p=.037) at 3 months.
CONCLUSIONS: Computerized brief intervention can be an effective alternative to in-person brief intervention for addressing moderate drug use in primary care.

PMID: 24520906 [PubMed - as supplied by publisher]

Screening, brief intervention, and referral to treatment (SBIRT) for offenders: protocol for a pragmatic randomized trial.

Fri, 02/07/2014 - 6:00am

Screening, brief intervention, and referral to treatment (SBIRT) for offenders: protocol for a pragmatic randomized trial.

Addict Sci Clin Pract. 2013;8(1):16

Authors: Prendergast ML, Cartier JJ

Abstract
BACKGROUND: Although screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based technique that, in some health-care settings, has been shown to cost-effectively reduce alcohol and drug use, research on the efficacy of SBIRT among criminal offender populations is limited. Such populations have a high prevalence of drug and alcohol use but limited access to intervention, and many are at risk for post-release relapse and recidivism. Thus, there exists a need for treatment options for drug-involved offenders of varying risk levels to reduce risky behaviors or enter treatment.
METHODS/DESIGN: This protocol describes an assessment of SBIRT feasibility and effectiveness in a criminal justice environment. Eight-hundred persons will be recruited from a large metropolitan jail, with the experimental group receiving an intervention depending on risk level and the control group receiving minimal intervention. The intervention will assess the risk level for drug and alcohol misuse by inmates, providing those at low or medium risk a brief intervention in the jail and referring those at high risk to community treatment following release. In addition, a brief treatment (eight-session) option will be available. Using data from a 12-month follow-up interview, the primary study outcomes are a reduction in drug and alcohol use, while secondary outcomes include participation in treatment, rearrest, quality of life, reduction in HIV risk behaviors, and costs of SBIRT.
EXPECTED VALUE: Individual reductions in alcohol and drug use can have significant effects on public health and safety when observed over a large population at risk for substance-use problems. With wider dissemination statewide or nationwide, a relatively low-cost intervention such as SBIRT could offer demonstrated benefits in this population.
TRIAL REGISTRATION: Clinical Trials Government Identifier, NCT01683643.

PMID: 24499609 [PubMed - in process]

Using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to Determine Substance Abuse Prevalence in the RI Trauma Population.

Wed, 02/05/2014 - 6:15am

Using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to Determine Substance Abuse Prevalence in the RI Trauma Population.

R I Med J (2013). 2014;97(2):42-4

Authors: Rogers R, Baird J, He JK, Adams C, Mello M

Abstract
Background: Level I trauma centers are required to provide screening and brief interventions for alcohol abuse. The World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is a validated screening measure for all substances of abuse. This study is the first to use the ASSIST to screen a trauma population. Methods: A cross-sectional screening study using the ASSIST was conducted which included all patients admitted to the trauma service at Rhode Island Hospital during July and August 2012 who met inclusion criteria. Results: The ASSIST categorized 25% of participants as needing a brief intervention for alcohol and an additional 6.3% as needing more intensive treatment. At least a brief intervention was indicated for at least one other substance besides alcohol in 37% of participants. Conclusions: The ability of the ASSIST to identify misuse of multiple substances makes it a good candidate for the screening measure used by trauma centers. [Full text available at http://rimed.org/rimedicaljournal-2014-02.asp, free with no login].

PMID: 24494214 [PubMed - in process]

The ability of single screening questions for unhealthy alcohol and other drug use to identify substance dependence in primary care.

Wed, 01/15/2014 - 10:00am
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The ability of single screening questions for unhealthy alcohol and other drug use to identify substance dependence in primary care.

J Stud Alcohol Drugs. 2014 Jan;75(1):153-7

Authors: Saitz R, Cheng DM, Allensworth-Davies D, Winter MR, Smith PC

Abstract
ABSTRACT. Objective: Single screening questions (SSQs) are recommended for the evaluation of unhealthy alcohol use and other drug use (risky use through dependence). In addition, SSQs could provide information on severity that is necessary for brief intervention, information thought to be available only from longer questionnaires. We assessed SSQ accuracy for identifying dependence. Method: In a cross-sectional study, 286 primary care patients were administered SSQs for alcohol and for other drugs (each asks how many times they were used in the past year), the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), the Drug Abuse Screening Test (DAST), and a diagnostic interview reference standard for dependence. For each test, we calculated area under the receiver operating characteristic (ROC) curve and the ability to discriminate dependence at an optimal cutoff. Results: The prevalence of alcohol and other drug dependence was 9% and 12%, respectively. Optimal cut points were eight or more times for the alcohol SSQ, a score of three or more for AUDIT-C, three or more times for the other drug SSQ, and a score of four or more for the DAST. The areas under the ROC curve ranged from 0.87 to 0.96. Sensitivity, specificity, and positive and negative likelihood ratios at optimal cut points for the alcohol SSQ were 88%, 84%, 5.6, and 0.1, respectively; for the other drug SSQ were 97%, 79%, 4.6, 0.04, respectively; for the AUDIT-C were 92%, 71%, 3.2, 0.1, respectively; and for the DAST were 100%, 84%, 6.3, 0, respectively. Alcohol SSQ and AUDIT-C positive likelihood ratio 95% confidence intervals did not overlap. Conclusions: SSQs can identify substance dependence as well as and sometimes better than longer screening tools. SSQs may be useful for both screening and preliminary assessment, thus overcoming a barrier (seen with lengthy questionnaires) to dissemination of screening and brief intervention in primary care settings. (J. Stud. Alcohol Drugs, 75, 153-157, 2014).

PMID: 24411807 [PubMed - in process]