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Talking about screening, brief intervention, and referral to treatment for adolescents: An upstream intervention to address the heroin and prescription opioid epidemic.

Wed, 08/24/2016 - 9:46am

Talking about screening, brief intervention, and referral to treatment for adolescents: An upstream intervention to address the heroin and prescription opioid epidemic.

Prev Med. 2016 Aug 17;

Authors: Harris BR

Abstract
Overdose deaths from heroin and prescription opioids have reached epidemic proportions in recent years.Deaths specifically involving heroin have more than tripled since 2011, and for the first time, drug overdose deaths have exceeded deaths resulting from motor vehicle accidents.This epidemic has been receiving attention among policymakers and the media which has resulted in efforts to provide training and education on prescribing practices, increase the use of naloxone, and expand the availability and use of Medication-Assisted Treatment (MAT).What is not being talked about is the relationship between early initiation of less harmful substances such as alcohol and marijuana and subsequent use of prescription opioids and heroin.Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a model which shows promise for preventing initiation and reducing risky substance use among adolescents before it progresses to use of harder drugs such as heroin.Unfortunately, though recommended by the American Academy of Pediatrics, health care providers are not even screening their adolescent patients for substance use.The heroin and prescription opioid epidemic and the dissemination of information regarding federal, state, and local efforts to combat the epidemic provide a platform for increasing awareness of SBIRT, garnering support for more research, and facilitating uptake and integration into practice.It is time to add SBIRT to the conversation.

PMID: 27544318 [PubMed - as supplied by publisher]

Cannabis Use and Associated Harms among Schizophrenia Patients in a Nigerian Clinical Setting: A Case-Control Study.

Wed, 08/24/2016 - 9:46am

Cannabis Use and Associated Harms among Schizophrenia Patients in a Nigerian Clinical Setting: A Case-Control Study.

Front Psychiatry. 2016;7:136

Authors: Lasebikan V, Aremu OO

Abstract
AIM: The overall aim of this study was to determine the prevalence of cannabis use among patients with schizophrenia with associated levels of harm in a Nigerian clinical setting.
METHOD: In this case-control study, consecutive 150 patients with schizophrenia were matched by age and gender with an equal number of patients that utilized the general outpatient department of the State Hospital, Ring Road Ibadan. The alcohol, smoking and substance involvement screening test (ASSIST) was used to obtain prevalence of cannabis use and level of health risk as determined by the ASSIST score. The positive and negative syndrome scale was used to determine the severity of psychosis.
RESULTS: Prevalence of cannabis use among the cases and control group was 10.0 and 2.7%, respectively, p = 0.03. Mean ASSIST score was significantly higher among the cases compared with the control, p < 0.001. Respondents of male gender and those who were not married were significantly more likely to be cannabis users among patients with schizophrenia (p < 0.001 and p < 0.02), respectively.
CONCLUSION: Cannabis use was prevalent among patients with schizophrenia and was associated with health risks. Thus, routine screening for cannabis use and brief intervention is suggested to be integrated into care for adolescents and adults with schizophrenia.

PMID: 27536254 [PubMed]

Community-Based Screening, Brief Intervention, and Referral for Treatment for Unhealthy Tobacco Use: Single Arm Study Experience and Implementation Success in Rural and Semi-Rural Settings, South-West Nigeria.

Wed, 08/24/2016 - 9:46am

Community-Based Screening, Brief Intervention, and Referral for Treatment for Unhealthy Tobacco Use: Single Arm Study Experience and Implementation Success in Rural and Semi-Rural Settings, South-West Nigeria.

Front Psychiatry. 2016;7:134

Authors: Lasebikan VO, Ola BA

Abstract
OBJECTIVE: To determine whether screening, brief intervention, and referral for treatment can reduce the prevalence of tobacco use in rural and semi-rural settings.
METHOD:
DESIGN AND PARTICIPANTS: A non-randomized clinical trial with assessments at baseline and post-intervention assessments at 3 and 6 months was conducted in a rural and semi-rural district in South-West of Nigeria. A representative sample of 1203 persons consented to the study and had alcohol, smoking, and substance involvement screening test (ASSIST) administered to them by trained community health-care extension workers between October 2010 and April 2011. Follow-up participation was more than 99% at all points.
INTERVENTION: Participants received a single ASSIST-linked brief intervention (BI) and referral for treatment (RT) at entry, and a booster ASSIST BI and RT at 3 months.
MAIN OUTCOMES AND MEASURES: The primary outcome was self-reported scores on ASSIST.
RESULTS: At baseline, out of 1203 respondents, lifetime prevalence and current prevalence of any tobacco products were 405 (33.7%) and 248 (20.6%), respectively. Of the current users, on the ASSIST, 79 (31.9%) scored 0-3 (low health risk), 130 (52.4%) scored 4-26 (moderate risk), and 39 (15.7%) scored 27+ (high risk). At 3 months, out of 1199 respondents, prevalence of current users was 199 (16.5%) and out of 1195 respondents, was 169 (14.1%) at 6 months. Prevalence of tobacco use reduced significantly at 3 months Z = -3.1, p = 0.01 and at 6 months when compared with baseline Z = 4.2, p = 0.001, but not at 6 months compared with at 3 months, Z = 2.1, p = 0.09. Multivariate analysis revealed that age at initiation of tobacco use, gender, marital status, setting of dwelling, and socioeconomic status were the only variables that were associated with current tobacco use at baseline, 3 and 6 months.
CONCLUSION: A one-time BI with a booster at 3 months had a significant effect on tobacco use in persons living in community settings. This finding suggests a need for promoting the adoption of this intervention for tobacco use in rural and semi-rural community settings.

PMID: 27531984 [PubMed]

Disentangling Alcohol-Related Needs Among Pre-trial Prisoners: A Longitudinal Study.

Wed, 08/24/2016 - 9:46am
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Disentangling Alcohol-Related Needs Among Pre-trial Prisoners: A Longitudinal Study.

Alcohol Alcohol. 2014 Nov;49(6):639-44

Authors: Kissell A, Taylor PJ, Walker J, Lewis E, Hammond A, Amos T

Abstract
AIMS: To disentangle the alcohol-related needs of short stay, revolving door, male prisoners, and offer a theoretically driven but practical approach for allocation of scarce service resources.
METHODS: A prospective longitudinal interview, questionnaire and records study of pre-trial men newly imprisoned in Wales and SW England.
RESULTS: Two hundred and forty-one pre-trial men completed an interview and questionnaires within a week of a new reception into prison; 170 completed follow-up 3 weeks later. Questions about problems with alcohol or illicit drugs revealed that problem drinkers were less likely than problem drug users to recognize their difficulty or seek or get help for this during their first month of imprisonment. Co-morbidity was common, but a third of the men had alcohol problems alone. Use of the Alcohol Use Disorders Identification Test (AUDIT) questionnaire identified 80% (195/241) men likely to require some intervention, twice the number identified by direct questions relying on prisoners' judgment about problem use. Furthermore it allowed categorization according to likely risk (dependency), need (problem recognition) and responsivity (wish for help).
CONCLUSION: Alcohol misuse is recognized, worldwide, as fuelling crime and more common among prisoners than the general population. In England and Wales, it is a particular factor in brief but recurrent periods of imprisonment. There have been calls to pay more attention to its use in this context, albeit without any increase in resources. Adding two questions to standard screening enables application of the risk-need-responsivity model to problem drinkers and may identify those most likely to benefit from treatment.

PMID: 25150166 [PubMed - indexed for MEDLINE]

Presentation of Coping Strategies Associated with Physical and Mental Health During Health Check-ups.

Wed, 08/17/2016 - 9:47am
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Presentation of Coping Strategies Associated with Physical and Mental Health During Health Check-ups.

Community Ment Health J. 2016 Aug 11;

Authors: Ito M, Matsushima E

Abstract
We identified coping behaviors during regular health check-ups and examined whether they were related to physical and mental health. We assessed coping strategies with the Brief COPE scale in 201 people who underwent a regular health check-up in a clinic. We found several significant relationships between coping and physical/psychological conditions presented in health check-up: Humor and systolic blood pressure, Substance use and high-density lipoprotein cholesterol, Venting and low-density lipoprotein cholesterol, Self-blame and depression, and Behavioral disengagement and sleep disorder. By evaluating coping strategies and screening depression as part of a regular health check-up, General practitioner can provide psychological intervention such as cognitive behavioral therapy which may improve both mental and physical health of the people.

PMID: 27514834 [PubMed - as supplied by publisher]

Immediate Versus Delayed Computerized Brief Intervention for Illicit Drug Misuse.

Wed, 08/10/2016 - 9:46am
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Immediate Versus Delayed Computerized Brief Intervention for Illicit Drug Misuse.

J Addict Med. 2016 Aug 8;

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

Abstract
OBJECTIVE: Computerized brief interventions are a promising approach for integrating substance use interventions into primary care settings. We sought to examine the effectiveness of a computerized brief intervention for illicit drug misuse, which prior research showed performed no worse than a traditional in-person brief intervention.
METHODS: Community health center patients were screened for eligibility using the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Participants were adult patients (aged 18-62 years; 53% female) with moderate-risk illicit drug use (N = 80), randomized to receive the computerized brief intervention either immediately or at their 3-month follow-up. Assessments were conducted at baseline, 3, and 6-month follow-up, and included the ASSIST and drug hair testing.
RESULTS: Most participants in the sample (90%) reported moderate-risk marijuana use. Although the sample as a whole reported significant decreases in ASSIST Global Drug Risk scores and ASSIST marijuana-specific scores, no significant differences were detected between "immediate" and "delayed" conditions on either of these measures. Likewise, no significant differences were detected between conditions in drug-positive hair test results at either follow-up.
CONCLUSIONS: This study did not find differences between immediate versus delayed computerized brief intervention in reducing drug use or associated risks, suggesting potential regression to the mean or reactivity to the consent, screening, or assessment process. The findings are discussed in light of the study's limitations and directions for future research.

PMID: 27504925 [PubMed - as supplied by publisher]

Substance Use as a Risk Factor for Sleep Problems Among Adolescents Presenting to the Emergency Department.

Wed, 08/10/2016 - 9:46am
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Substance Use as a Risk Factor for Sleep Problems Among Adolescents Presenting to the Emergency Department.

J Addict Med. 2016 Aug 8;

Authors: Zhabenko O, Austic E, Conroy DA, Ehrlich P, Singh V, Epstein-Ngo Q, Cunningham RM, Walton MA

Abstract
OBJECTIVES: To determine correlates of sleep problems among adolescents. Specifically, to assess the relative strength of associations between sleep problems and dating victimization, reasons for emergency department (ED) visit, depression, unhealthy alcohol use, and other drug use (marijuana, nonmedical use of prescription opioids, stimulants, and tranquilizers).
METHODS: A total of 1852 adolescents aged 14 to 20 years presenting for care to the University of Michigan Emergency Department, Ann Arbor, Michigan, during 2011-2012, self-administered a computerized health survey. Sleep problems were identified if any of the 4 items on the Sleep Problems Questionnaire were rated by a patient as greater than 3 on a 0 to 5 scale. Adolescents who were too sick to be screened in the ED were eligible to participate in the study during their inpatient stay. Exclusion criteria for baseline included insufficient cognitive orientation precluding informed consent, not having parent/guardian present if younger than 18 years, medical severity precluding participation, active suicidal/homicidal ideation, non-English-speaking, deaf/visually impaired, or already participated in this study on a prior visit.
RESULTS: 23.5% of adolescents reported clinically significant sleep problems. Female gender, depression, dating victimization, tobacco use, nonmedical use of prescription medication, and an ED visit for medical reasons were each associated with sleep problems among adolescents, even while controlling for age, other types of drug use, receiving public assistance, and dropping out of school.
CONCLUSIONS: These exploratory findings indicate that ED-based screening and brief intervention approaches addressing substance use and/or dating victimization may need to account for previously undiagnosed sleep problems.

PMID: 27504924 [PubMed - as supplied by publisher]

Developing psychological services following facial trauma.

Wed, 08/10/2016 - 9:46am
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Developing psychological services following facial trauma.

BMJ Qual Improv Rep. 2016;5(1)

Authors: Choudhury-Peters D, Dain V

Abstract
Adults presenting to oral and maxillofacial surgery services are at high risk of psychological morbidity. Research by the Institute of Psychotrauma and the centre for oral and maxillofacial surgery trauma clinic at the Royal London hospital (2015) demonstrated nearly 40% of patients met diagnostic criteria for either depression, post traumatic stress disorder (PTSD), anxiety, alcohol misuse, or substance misuse, or were presenting with facial appearance distress. Most facial injury patients were not receiving mental health assessment or treatment, and the maxillofacial team did not have direct access to psychological services. Based on these research findings, an innovative one-year pilot psychology service was designed and implemented within the facial trauma clinic. The project addressed this need by offering collaborative medical and psychological care for all facial injury patients. The project provided brief screening, assessment, and early psychological intervention. The medical team were trained to better recognise and respond to psychological distress.

PMID: 27493750 [PubMed]

Prevalence of Alcohol Misuse and Follow-Up Care in a National Sample of OEF/OIF VA Patients With and Without TBI.

Wed, 08/03/2016 - 9:46am

Prevalence of Alcohol Misuse and Follow-Up Care in a National Sample of OEF/OIF VA Patients With and Without TBI.

Psychiatr Serv. 2016 Aug 1;:appips201500290

Authors: Grossbard J, Malte CA, Lapham G, Pagulayan K, Turner AP, Rubinsky AD, Bradley KA, Saxon AJ, Hawkins EJ

Abstract
OBJECTIVE: Information on prevalence and management of alcohol misuse among Afghanistan and Iraq veterans with traumatic brain injury (TBI) is limited. This study compared rates of alcohol misuse and follow-up care-brief intervention (BI) and addiction treatment-among Afghanistan and Iraq veterans with and without TBI receiving care from the Department of Veterans Affairs (VA).
METHODS: The sample included veterans ages 18 and older screened with the Alcohol Use Disorders Identification Test alcohol consumption questions (AUDIT-C) in 2012 who received VA health care in the prior year (N=358,417). Overall and age-specific estimates of alcohol misuse (AUDIT-C score ≥5) were compared for men and women with and without TBI by logistic regression. BI and addiction treatment after screening were compared between groups by using multivariable logistic regression.
RESULTS: Alcohol misuse was higher among men with TBI than among men without TBI (20.3%, 95% confidence interval [CI]=19.9-20.8, versus 16.4%, CI=16.3-16.6) and among women with TBI than among women without TBI (6.8%, CI=5.8-8.1, versus 5.6%, CI=5.4-5.8); younger (age <30) patients with TBI had the highest rates. BI rates did not differ by TBI status (76.4%-80.2%). Addiction treatment rates for those with severe misuse were higher among those with TBI (men, 20.0%, CI=18.4-21.6, versus 15.4%, CI=14.9-15.9; women, 36.6%, CI=21.8-51.3, versus 21.1%, CI=18.2-24.0).
CONCLUSIONS: Alcohol misuse is common among Iraq and Afghanistan veterans with TBI, particularly young men. BI rates were high and did not vary by TBI status, although addiction treatment rates were higher among patients with TBI than among those without TBI.

PMID: 27476804 [PubMed - as supplied by publisher]

Age moderates the association of depressive symptoms and unhealthy alcohol use in the National Guard.

Wed, 08/03/2016 - 9:46am
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Age moderates the association of depressive symptoms and unhealthy alcohol use in the National Guard.

Addict Behav. 2016 Jul 17;63:102-106

Authors: Sahker E, Acion L, Arndt S

Abstract
Unhealthy drinking is a significant problem contributing to poor health and performance of military personnel. The Iowa Army National Guard and the Iowa Department of Public Health have collaborated with the Substance Abuse and Mental Health Administration to better identify unhealthy substance use via Screening, Brief Intervention, and Referral to Treatment program (SBIRT). Yet, little research has been conducted on the Guard's use of SBIRT. This study examined depression, age, deployment status, and sex as factors contributing to unhealthy drinking. Of the Guardsmen who took part in SBIRT, 3.7% (n=75) met the criteria for unhealthy drinking and 3.9% (n=78) had some level of depression. The overall multivariate model significantly predicted unhealthy drinking (χ(2)(5)=41.41, p<0.001) with age moderating the association of depressive symptoms and unhealthy alcohol (Wald χ(2)(1)=7.16, p=0.007). These findings add to the existing understanding of factors contributing to unhealthy drinking suggesting the association between the presence of depression and unhealthy drinking depends on age of the Guradsman. This age and depression interaction may be an important diagnostic feature to consider for unhealthy drinking in the Guard. Furthermore, previous research on the general military population finds similar percentages, providing support for SBIRT as an effective screening tool in the Guard.

PMID: 27450908 [PubMed - as supplied by publisher]

Clinical management of alcohol use disorders in the neurology clinic.

Wed, 08/03/2016 - 9:46am
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Clinical management of alcohol use disorders in the neurology clinic.

Handb Clin Neurol. 2014;125:659-70

Authors: Lembke A, Stanford M

Abstract
Alcohol misuse adversely affects health outcomes, but alcohol misuse and alcohol use disorders (AUDs) are often ignored by healthcare providers in primary and specialty ambulatory care clinics. Data show that early identification and brief intervention for alcohol misuse in these settings can effectively reduce alcohol consumption and its medical sequelae. The aim of this chapter is to review the epidemiology of problematic alcohol use in ambulatory care settings, the diagnostic criteria for AUDs, the approach called SBIRT (screening, brief intervention and referral to treatment) as a model program to target alcohol misuse in everyday clinical practice, when and how to refer patients to resources beyond the clinic for their alcohol use problems, and the medical illnesses associated with AUDs.

PMID: 25307603 [PubMed - indexed for MEDLINE]

Design of the NIDA clinical trials network validation study of tobacco, alcohol, prescription medications, and substance use/misuse (TAPS) tool.

Mon, 07/25/2016 - 1:10pm
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Design of the NIDA clinical trials network validation study of tobacco, alcohol, prescription medications, and substance use/misuse (TAPS) tool.

Contemp Clin Trials. 2016 Jul 18;

Authors: Wu LT, McNeely J, Subramaniam GA, Sharma G, VanVeldhuisen P, Schwartz RP

Abstract
BACKGROUND: Substance use and its associated use disorders are under-detected and under-treated in primary care. There is a need for a clinically useful brief screening and assessment instrument to identify primary care patients with substance use, sub-threshold substance use disorder (SUD), and SUD to facilitate brief intervention and treatment.
METHODS: We describe the design of the recently completed National Drug Abuse Treatment Clinical Trials Network's tobacco, alcohol, prescription medications, and substance use/misuse screen and brief assessment tool validation study. Study aims included to: develop a 2-stage screening and brief assessment tool (TAPS Tool) to detect substance use, problem use, and SUD among adult primary care patients; examine the validity of both the screen component and the TAPS Tool by comparing them to reference standard screening and assessment measures of no use, problem use, and SUD; and determine the feasibility and acceptability of the self-administration and interviewer-administration of the tool. The design included a pilot testing phase (n=30) and the main study of 2000 adult primary care participants who were randomly assigned in counter-balanced order to have the interviewer-administration or the self-administration of the TAPS Tool followed by the other administration format. Participants' views of feasibility, acceptability and preference for format of self-administration versus interviewer-administration of the TAPS Tool were assessed. Criterion measures of use and DSM-5 SUDs were administered.
DISCUSSION: The TAPS Tool study builds on prior work to develop a 2-stage clinical tool for facilitating the adoption of screening, brief assessment and treatment for SUDs in primary care.

PMID: 27444426 [PubMed - as supplied by publisher]

A Novel Brief Therapy for Patients Who Attempt Suicide: A 24-months Follow-Up Randomized Controlled Study of the Attempted Suicide Short Intervention Program (ASSIP).

Mon, 07/18/2016 - 1:10pm
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A Novel Brief Therapy for Patients Who Attempt Suicide: A 24-months Follow-Up Randomized Controlled Study of the Attempted Suicide Short Intervention Program (ASSIP).

PLoS Med. 2016 Mar;13(3):e1001968

Authors: Gysin-Maillart A, Schwab S, Soravia L, Megert M, Michel K

Abstract
BACKGROUND: Attempted suicide is the main risk factor for suicide and repeated suicide attempts. However, the evidence for follow-up treatments reducing suicidal behavior in these patients is limited. The objective of the present study was to evaluate the efficacy of the Attempted Suicide Short Intervention Program (ASSIP) in reducing suicidal behavior. ASSIP is a novel brief therapy based on a patient-centered model of suicidal behavior, with an emphasis on early therapeutic alliance.
METHODS AND FINDINGS: Patients who had recently attempted suicide were randomly allocated to treatment as usual (n = 60) or treatment as usual plus ASSIP (n = 60). ASSIP participants received three therapy sessions followed by regular contact through personalized letters over 24 months. Participants considered to be at high risk of suicide were included, 63% were diagnosed with an affective disorder, and 50% had a history of prior suicide attempts. Clinical exclusion criteria were habitual self-harm, serious cognitive impairment, and psychotic disorder. Study participants completed a set of psychosocial and clinical questionnaires every 6 months over a 24-month follow-up period. The study represents a real-world clinical setting at an outpatient clinic of a university hospital of psychiatry. The primary outcome measure was repeat suicide attempts during the 24-month follow-up period. Secondary outcome measures were suicidal ideation, depression, and health-care utilization. Furthermore, effects of prior suicide attempts, depression at baseline, diagnosis, and therapeutic alliance on outcome were investigated. During the 24-month follow-up period, five repeat suicide attempts were recorded in the ASSIP group and 41 attempts in the control group. The rates of participants reattempting suicide at least once were 8.3% (n = 5) and 26.7% (n = 16). ASSIP was associated with an approximately 80% reduced risk of participants making at least one repeat suicide attempt (Wald χ21 = 13.1, 95% CI 12.4-13.7, p < 0.001). ASSIP participants spent 72% fewer days in the hospital during follow-up (ASSIP: 29 d; control group: 105 d; W = 94.5, p = 0.038). Higher scores of patient-rated therapeutic alliance in the ASSIP group were associated with a lower rate of repeat suicide attempts. Prior suicide attempts, depression, and a diagnosis of personality disorder at baseline did not significantly affect outcome. Participants with a diagnosis of borderline personality disorder (n = 20) had more previous suicide attempts and a higher number of reattempts. Key study limitations were missing data and dropout rates. Although both were generally low, they increased during follow-up. At 24 months, the group difference in dropout rate was significant: ASSIP, 7% (n = 4); control, 22% (n = 13). A further limitation is that we do not have detailed information of the co-active follow-up treatment apart from participant self-reports every 6 months on the setting and the duration of the co-active treatment.
CONCLUSIONS: ASSIP, a manual-based brief therapy for patients who have recently attempted suicide, administered in addition to the usual clinical treatment, was efficacious in reducing suicidal behavior in a real-world clinical setting. ASSIP fulfills the need for an easy-to-administer low-cost intervention. Large pragmatic trials will be needed to conclusively establish the efficacy of ASSIP and replicate our findings in other clinical settings.
TRIAL REGISTRATION: ClinicalTrials.gov NCT02505373.

PMID: 26930055 [PubMed - indexed for MEDLINE]

Cultural Adaptation of Screening, Brief Intervention and Referral to Treatment Using Motivational Interviewing.

Mon, 07/18/2016 - 1:10pm
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Cultural Adaptation of Screening, Brief Intervention and Referral to Treatment Using Motivational Interviewing.

J Addict Med. 2015 Sep-Oct;9(5):352-7

Authors: Satre DD, Manuel JK, Larios S, Steiger S, Satterfield J

Abstract
This clinical case presentation and discussion illustrates a culturally adapted alcohol and drug use intervention using the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach, incorporating motivational interviewing skills. This case conference serves to complement the accompanying review article on SBIRT with diverse cultural groups, placing information from the review in the context of a typical clinical setting. In this example, SBIRT is provided in a primary care clinic to a Latino patient who reports hazardous drinking, depression, chronic pain and use of prescription opioids.

PMID: 26428360 [PubMed - indexed for MEDLINE]

Usability Testing of a National Substance Use Screening Tool Embedded in Electronic Health Records.

Mon, 07/11/2016 - 1:09pm

Usability Testing of a National Substance Use Screening Tool Embedded in Electronic Health Records.

JMIR Hum Factors. 2016;3(2):e18

Authors: Press A, DeStio C, McCullagh L, Kapoor S, Morley J, SBIRT NY-II Team, Conigliaro J

Abstract
BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) is currently being implemented into health systems nationally via paper and electronic methods.
OBJECTIVE: The purpose of this study was to evaluate the integration of an electronic SBIRT tool into an existing paper-based SBIRT clinical workflow in a patient-centered medical home.
METHODS: Usability testing was conducted in an academic ambulatory clinic. Two rounds of usability testing were done with medical office assistants (MOAs) using a paper and electronic version of the SBIRT tool, with two and four participants, respectively. Qualitative and quantitative data was analyzed to determine the impact of both tools on clinical workflow. A second round of usability testing was done with the revised electronic version and compared with the first version.
RESULTS: Personal workflow barriers cited in the first round of testing were that the electronic health record (EHR) tool was disruptive to patient's visits. In Round 2 of testing, MOAs reported favoring the electronic version due to improved layout and the inclusion of an alert system embedded in the EHR. For example, using the system usability scale (SUS), MOAs reported a grade "1" for the statement, "I would like to use this system frequently" during the first round of testing but a "5" during the second round of analysis.
CONCLUSIONS: The importance of testing usability of various mediums of tools used in health care screening is highlighted by the findings of this study. In the first round of testing, the electronic tool was reported as less user friendly, being difficult to navigate, and time consuming. Many issues faced in the first generation of the tool were improved in the second generation after usability was evaluated. This study demonstrates how usability testing of an electronic SBRIT tool can help to identify challenges that can impact clinical workflow. However, a limitation of this study was the small sample size of MOAs that participated. The results may have been biased to Northwell Health workers' perceptions of the SBIRT tool and their specific clinical workflow.

PMID: 27393643 [PubMed]

Interprofessional Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education for Registered Nurses and Behavioral Health Professionals.

Mon, 07/11/2016 - 1:09pm

Interprofessional Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education for Registered Nurses and Behavioral Health Professionals.

Issues Ment Health Nurs. 2016 Jul 7;:1-6

Authors: Puskar K, Kane I, Lee H, Mitchell AM, Albrecht S, Frank L, Hagle H, Lindsay D, Houze MP

Abstract
Although substance use is prevalent in the United States, the majority of people who misuse substances do not receive appropriate treatment. This paper describes, (1) an interprofessional education (IPE) program for health professionals to provide Screening Brief Intervention and Referral to Treatment to rural substance use patients, and (2) compares registered nurses' [RNs] and behavioral health professionals' [BHPs] attitudes to work with those patients and their perceptions on IPE. A data analysis of 62 RNs and 36 BHPs shows statistically significant increases in both attitudes and perceptions. This paper discusses the implications of the IPE program vis-á-vis substance use treatment.

PMID: 27387524 [PubMed - as supplied by publisher]

Predictive Validity of Clinical AUDIT-C Alcohol Screening Scores and Changes in Scores for Three Objective Alcohol-related Outcomes in a Veterans Affairs (VA) Population.

Mon, 07/04/2016 - 1:09pm
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Predictive Validity of Clinical AUDIT-C Alcohol Screening Scores and Changes in Scores for Three Objective Alcohol-related Outcomes in a Veterans Affairs (VA) Population.

Addiction. 2016 Jun 27;

Authors: Bradley KA, Rubinsky AD, Lapham GT, Berger D, Bryson C, Achtmeyer C, Hawkins EJ, Chavez LJ, Williams EC, Kivlahan DR

Abstract
AIMS: To evaluate the association between AUDIT-C alcohol screening scores, collected as part of routine clinical care, and three outcomes in the following year (Aim 1), and the association between changes in AUDIT-C risk group at one year follow-up and the same outcomes in the subsequent year (Aim 2).
DESIGN: Cohort study SETTING: Twenty-four US Veterans Affairs (VA) healthcare systems (2004-2007), before systematic implementation of brief intervention PARTICIPANTS: 486,115 outpatients with AUDIT-Cs documented in their electronic health records (EHRs) on two occasions ≥12 months apart ("baseline" and "follow-up") MEASUREMENTS: Independent measures were baseline AUDIT-C scores and change in standard AUDIT-C risk groups (no use, low risk use, and mild, moderate, severe misuse) from baseline to follow-up. Outcome measures were 1) high density lipoprotein cholesterol (HDL), 2) alcohol-related gastrointestinal hospitalizations ("GI hospitalizations") and 3) physical trauma, each in the years after baseline and follow-up.
FINDINGS: Baseline AUDIT-C scores had a positive association with outcomes in the following year. Across AUDIT-C scores 0 to 12, mean HDL ranged from 41.4 (95% Cl 41.3-41.5) to 53.5 (51.4-55.6) mg/L, and probabilities of GI hospitalizations from 0.49% (0.48-0.51%) to 1.8% (1.3-2.3%), and trauma from 3.0% (2.95-3.06%) to 6.0% (5.2-6.8%). At follow-up, patients who increased to moderate or severe alcohol misuse had consistently higher mean HDL and probabilities of subsequent GI hospitalizations or trauma compared with those who did not (p-values all < 0.05). For example, among those with baseline low-risk use, in those with persistent low-risk use vs. severe misuse at follow-up, the probabilities of subsequent trauma were 2.65% (2.54-2.75%) vs. 5.15% (3.86-6.45%), respectively. However, for patients who decreased to lower AUDIT-C risk groups at follow-up, findings were inconsistent across outcomes, with only mean HDL decreasing in most groups that decreased use (p-values all < 0.05).
CONCLUSIONS: When AUDIT-C screening is conducted in clinical settings, baseline AUDIT-C scores and score increases to moderate-severe alcohol misuse at follow-up screening appear to have predictive validity for HDL cholesterol, alcohol-related gastrointestinal hospitalizations, and physical trauma. Decreasing AUDIT-C scores collected in clinical settings appear to have predictive validity for only HDL.

PMID: 27349855 [PubMed - as supplied by publisher]

Substance Use Screening, Brief Intervention, and Referral to Treatment.

Mon, 06/27/2016 - 1:09pm
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Substance Use Screening, Brief Intervention, and Referral to Treatment.

Pediatrics. 2016 Jun 20;

Authors: COMMITTEE ON SUBSTANCE USE AND PREVENTION

Abstract
The enormous public health impact of adolescent substance use and its preventable morbidity and mortality show the need for the health care sector, including pediatricians and the medical home, to increase its capacity related to substance use prevention, detection, assessment, and intervention. The American Academy of Pediatrics published its policy statement "Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians" in 2011 to introduce the concepts and terminology of screening, brief intervention, and referral to treatment (SBIRT) and to offer clinical guidance about available substance use screening tools and intervention procedures. This policy statement is a revision of the 2011 SBIRT statement. An accompanying clinical report updates clinical guidance for adolescent SBIRT.

PMID: 27325638 [PubMed - as supplied by publisher]

Substance Use Screening, Brief Intervention, and Referral to Treatment.

Mon, 06/27/2016 - 1:09pm
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Substance Use Screening, Brief Intervention, and Referral to Treatment.

Pediatrics. 2016 Jun 20;

Authors: Levy SJ, Williams JF, COMMITTEE ON SUBSTANCE USE AND PREVENTION

Abstract
The enormous public health impact of adolescent substance use and its preventable morbidity and mortality highlight the need for the health care sector, including pediatricians and the medical home, to increase its capacity regarding adolescent substance use screening, brief intervention, and referral to treatment (SBIRT). The American Academy of Pediatrics first published a policy statement on SBIRT and adolescents in 2011 to introduce SBIRT concepts and terminology and to offer clinical guidance about available substance use screening tools and intervention procedures. This clinical report provides a simplified adolescent SBIRT clinical approach that, in combination with the accompanying updated policy statement, guides pediatricians in implementing substance use prevention, detection, assessment, and intervention practices across the varied clinical settings in which adolescents receive health care.

PMID: 27325634 [PubMed - as supplied by publisher]

Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial.

Mon, 06/20/2016 - 1:07pm

Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial.

BMJ Open. 2016;6(6):e010271

Authors: Bendtsen P, Müssener U, Karlsson N, López-Pelayo H, Palacio-Vieira J, Colom J, Gual A, Reynolds J, Wallace P, Segura L, Anderson P

Abstract
OBJECTIVES: The objective of the present study was to explore whether the possibility of offering facilitated access to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increased the proportion of consulting adults who were screened and given brief advice.
DESIGN: The study was a 12-week implementation study. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands, Poland and Sweden) were asked to screen adults who attended the PHCU for risky drinking.
SETTING: A total of 120 primary healthcare centres from 5 jurisdictions in Europe.
PARTICIPANTS: 746 individual providers (general practitioners, nurses or other professionals) participated in the study.
PRIMARY OUTCOME: Change in the proportion of patients screened and referred to eBI comparing a baseline 4-week preimplementation period with a 12-week implementation period.
RESULTS: The possibility of referring patients to the eBI was not found to be associated with any increase in the proportion of patients screened. However, it was associated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole (p<0.05), mainly driven by a significant increase in brief intervention rates in England from 87% to 96% (p<0.01). The study indicated that staff displayed a low level of engagement in this new technology. Staff continued to offer face-to-face advice to a larger proportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among the referred patients; on average, 18% of the patients logged on to the website with a mean log-on rate across the different countries between 0.58% and 36.95%.
CONCLUSIONS: Referral to eBI takes nearly as much time as brief oral advice and might require more introduction and training before staff are comfortable with referring to eBI.
TRIAL REGISTRATION NUMBER: NCT01501552; Post-results.

PMID: 27311902 [PubMed - in process]

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