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Do risky friends change the efficacy of a primary care brief intervention for adolescent alcohol use?

Fri, 10/24/2014 - 6:00am
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Do risky friends change the efficacy of a primary care brief intervention for adolescent alcohol use?

J Adolesc Health. 2014 Apr;54(4):449-53

Authors: Louis-Jacques J, Knight JR, Sherritt L, Van Hook S, Harris SK

Abstract
PURPOSE: To determine if peer risk (having friends who drink or approve of drinking) modifies the effects of a computer-facilitated screening and provider brief advice (cSBA) intervention on adolescent alcohol use.
METHODS: We assessed the intervention effect using logistic regression modeling with generalized estimating equations on a sample of 2,092 adolescents. Effect modification by peer risk was analyzed separately for alcohol initiation (drinking at follow-up in baseline nondrinkers) and cessation (no drinking at follow-up in baseline drinkers) by testing an interaction term (treatment condition by peer risk). Interpretation of the interaction effect was further clarified by subsequent stratification by peer risk.
RESULTS: The intervention effect on alcohol cessation was significantly greater among those with peer risk (adjusted relative risk ratios; risk 1.44, 1.18-1.76 vs. no risk .98, .41-2.36) at 3 months' follow-up. There was no such finding for alcohol initiation.
CONCLUSIONS: Alcohol screening and brief provider counseling may differentially benefit adolescent drinkers with drinking friends.

PMID: 24216313 [PubMed - indexed for MEDLINE]

Teen Options for Change: An Intervention for Young Emergency Patients Who Screen Positive for Suicide Risk.

Fri, 10/17/2014 - 2:30pm
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Teen Options for Change: An Intervention for Young Emergency Patients Who Screen Positive for Suicide Risk.

Psychiatr Serv. 2014 Oct 15;

Authors: King CA, Gipson PY, Horwitz AG, Opperman KJ

Abstract
Objective: Previous research has documented the feasibility of screening in emergency departments for adolescent suicide risk. This randomized trial examined the effectiveness of Teen Options for Change (TOC), an intervention for adolescents seeking general medical emergency services who screen positive for suicide risk.
Methods: Participants were 49 youths, ages 14 to 19, seeking services for nonpsychiatric emergencies. They screened positive for suicide risk because of recent suicidal ideation, suicide attempt, or depression plus substance abuse. Youths were randomly assigned to the TOC intervention or to enhanced treatment as usual. Depression, hopelessness, and suicidal ideation were assessed at baseline and two months later.
Results: Adolescents assigned to TOC showed greater reductions in depression than adolescents assigned to the comparison group (Cohen's d=1.07, a large effect size). Hopelessness, suicidal ideation, and substance abuse outcomes trended positively (nonsignificantly), with small to moderate effect sizes.
Conclusions: TOC may be a promising, brief intervention for adolescents seeking emergency services and at risk of suicide.

PMID: 25321886 [PubMed - as supplied by publisher]

Substance Abuse Screening and Brief Intervention for Adolescents in Primary Care.

Wed, 10/08/2014 - 6:00am

Substance Abuse Screening and Brief Intervention for Adolescents in Primary Care.

Pediatr Ann. 2014 Oct 1;43(10):412

Authors: Pitts S, Shrier LA

Abstract
Adolescent substance use is common and is associated with serious mental, physical, and social risks, warranting systematic screening in the primary care setting. It is important for clinicians to become familiar with Screening, Brief Intervention, and Referral to Treatment (SBIRT), including administration of validated screening tools to identify level of risk associated with substance use and application of appropriate brief interventions. Positive reinforcement and brief advice is indicated for those adolescents with no or minimal risk for a substance use disorder. Providing a brief intervention using motivational interviewing strategies with subsequent close clinical follow-up is warranted when an adolescent meets criteria for a mild to moderate substance use disorder. Referral to treatment is recommended in cases of severe substance use. Immediate action, including breaking confidentiality, may be necessary when an adolescent's behavior raises acute safety concerns. Making time to interview adolescents alone is essential. It is also important to review the limitations of confidentiality with patients and parents/guardians and offer them strategies to discuss sensitive issues with their adolescents. Available resources for adolescents, parents/guardians, and clinicians regarding the risks of adolescent substance use and evidence-based treatment options can be used to support implementation of SBIRT in adolescent primary care. [Pediatr Ann. 2014;43(10):e248-e252.] To read more and to earn CME credit for reading this article, access the full text by going to Healio.com/pedann.

PMID: 25290131 [PubMed - as supplied by publisher]

A randomized trial of computerized vs. in-person brief intervention for illicit drug use in primary care: Outcomes through 12months.

Mon, 10/06/2014 - 6:00am

A randomized trial of computerized vs. in-person brief intervention for illicit drug use in primary care: Outcomes through 12months.

J Subst Abuse Treat. 2014 Sep 16;

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

Abstract
This study examined outcomes through 12months from a randomized trial comparing computerized brief intervention (CBI) vs. in-person brief intervention (IBI) delivered by behavioral health counselors for adult community health center patients with moderate-level drug misuse (N=360). Data were collected at baseline, 3-, 6-, and 12-month follow-up, and included the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and laboratory analysis of hair samples. Repeated measures analyses examined differential change over time. There were no significant differences in drug-positive hair tests over time or by condition. Global ASSIST scores decreased in both conditions (p<.001), but there were no significant differences between conditions in overall change across 12months of follow-up (p=.13). CBI produced greater overall reductions in alcohol (p=.04) and cocaine (p=.02) ASSIST scores than IBI, with initial differences dissipating over time. Computerized brief interventions present a viable alternative to traditional in-person brief interventions.

PMID: 25282578 [PubMed - as supplied by publisher]

Early intervention to protect the mother-infant relationship following postnatal depression: study protocol for a randomised controlled trial.

Sat, 10/04/2014 - 6:00am

Early intervention to protect the mother-infant relationship following postnatal depression: study protocol for a randomised controlled trial.

Trials. 2014 Oct 3;15(1):385

Authors: Milgrom J, Holt C

Abstract
BACKGROUND: At least 13% of mothers experience depression in the first postnatal year, with accompanying feelings of despair and a range of debilitating symptoms. Serious sequelae include disturbances in the mother-infant relationship and poor long-term cognitive and behavioural outcomes for the child. Surprisingly, treatment of maternal symptoms of postnatal depression does not improve the mother-infant relationship for a majority of women. Targeted interventions to improve the mother-infant relationship following postnatal depression are scarce and, of those that exist, the majority are not evaluated in randomised controlled trials. This study aims to evaluate a brief targeted mother-infant intervention, to follow cognitive behavioural therapy treatment of postnatal depression, which has the potential to improve developmental outcomes of children of depressed mothers.Methods/design: The proposed study is a two-arm randomised controlled trial with follow-up to 6 months. One hundred participants will be recruited via referrals from health professionals including maternal and child health nurses and general practitioners, as well as self-referrals from women who have seen promotional materials for the study. Women who meet inclusion criteria (infant aged <12 months, women 18+ years of age) will complete the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-IV-TR Axis I Disorders. Those with a clinical diagnosis of current major or minor depressive disorder and who do not meet exclusion criteria (that is, currently receiving treatment for depression, significant difficulty with English, medium to high suicide risk, current self-harm, current substance abuse, current post-traumatic stress disorder, current manic/hypomanic episode or psychotic symptoms) will be randomised to receive either a 4-session mother-infant intervention (HUGS: Happiness Understanding Giving and Sharing) or a 4-session attention placebo playgroup (Playtime) following a 12-session postnatal depression group treatment programme. Primary outcome measures are the Parenting Stress Index (self-report measure) and the Parent-child Early Relational Assessment (observational measure coded by a blinded observer). Measurements are taken at baseline, after the postnatal depression programme, post-HUGS/Playtime, and at 6 months post-HUGS/Playtime.
DISCUSSION: This research addresses the need for specific treatment for mother-infant interactional difficulties following postnatal depression. There is a need to investigate interventions in randomised trials to prevent detrimental effects on child development and make available evidence-based treatments.Trial registration: Australia and New Zealand Clinical Trials Register: ACTRN12612001110875. Date Registered: 17 October 2012.

PMID: 25277158 [PubMed - as supplied by publisher]

Intimate Partner Violence During Pregnancy: Maternal and Neonatal Outcomes.

Tue, 09/30/2014 - 6:00am

Intimate Partner Violence During Pregnancy: Maternal and Neonatal Outcomes.

J Womens Health (Larchmt). 2014 Sep 29;

Authors: Alhusen JL, Ray E, Sharps P, Bullock L

Abstract
Abstract The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered "risky," including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient-provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health.

PMID: 25265285 [PubMed - as supplied by publisher]

Addressing Adolescent Substance Use: Teaching SBIRT and MI to Residents.

Sat, 09/27/2014 - 6:00am

Addressing Adolescent Substance Use: Teaching SBIRT and MI to Residents.

Subst Abus. 2014 Sep 26;:0

Authors: Whittle AE, Buckelew SM, Satterfield JM, Lum PJ, O'Sullivan P

Abstract
ABSTRACT. Background: The American Academy of Pediatrics Committee on Substance Use recommends screening, brief intervention, and referral to treatment (SBIRT) at every adolescent preventive and all appropriate urgent visits. We designed an SBIRT curriculum as part of the adolescent block of a pediatric residency that combined online modules with an in-person workshop, faculty feedback on resident interactions with patients, and resident self-reflection on their motivational interviewing (MI) skills. Methods: To evaluate the curriculum, we measured resident satisfaction and self-reported confidence in using SBIRT and MI with teens using a retrospective pre/post questionnaire. We used qualitative analysis to evaluate the written comments from faculty observations of patient-trainee interactions and comments from residents' self-reflections on patient interactions. Results: Thirty-two residents completed the curriculum. Residents reported high satisfaction with the training. Comparing retrospective pre/post scores on the survey of resident self-reported confidence, measures increased significantly in all domains, including for both alcohol and other drug use. Regarding self-reported MI skillfulness also increased significantly. Analysis of specific faculty feedback to residents revealed subthemes such as normalizing confidentiality and focusing more on the patient's perspectives on substance use. Resident reflections on their own abilities with SBIRT/MI focused on using the ruler tool and on adapting the MI style of shared decision-making. Conclusions: A curriculum that combines online training, small group practice, clinical observations and self-reflection is valued by residents and can increase resident self-reported confidence in using SBIRT and MI in adolescent encounters. Future studies should examine to what extent confidence predicts performance using standardized measures of MI skillfulness in patient encounters.

PMID: 25260121 [PubMed - as supplied by publisher]

Employment-based abstinence reinforcement following inpatient detoxification in HIV-positive opioid and/or cocaine-dependent patients.

Sat, 09/27/2014 - 6:00am
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Employment-based abstinence reinforcement following inpatient detoxification in HIV-positive opioid and/or cocaine-dependent patients.

Exp Clin Psychopharmacol. 2014 Feb;22(1):75-85

Authors: Dunn KE, Fingerhood M, Wong CJ, Svikis DS, Nuzzo P, Silverman K

Abstract
Employment-based reinforcement interventions have been used to promote abstinence from drugs among chronically unemployed injection drug users. The current study used an employment-based reinforcement intervention to promote opioid and cocaine abstinence among opioid and/or cocaine-dependent, HIV-positive participants who had recently completed a brief inpatient detoxification. Participants (n = 46) were randomly assigned to an abstinence and work group that was required to provide negative urine samples in order to enter the workplace and to earn incentives for work (n = 16), a work-only group that was permitted to enter the workplace and to earn incentives independent of drug use (n = 15), and a no-voucher control group that did not receive any incentives for working (n = 15) over a 26-week period. The primary outcome was urinalysis-confirmed opioid, cocaine, and combined opioid/cocaine abstinence. Participants were 78% male and 89% African American. Results showed no significant between-groups differences in urinalysis-verified drug abstinence or HIV risk behaviors during the 6-month intervention. The work-only group had significantly greater workplace attendance, and worked more minutes per day when compared to the no-voucher group. Several features of the study design, including the lack of an induction period, setting the threshold for entering the workplace too high by requiring immediate abstinence from several drugs, and increasing the risk of relapse by providing a brief detoxification that was not supported by any continued pharmacological intervention, likely prevented the workplace from becoming established as a reinforcer that could be used to promote drug abstinence. However, increases in workplace attendance have important implications for adult training programs.

PMID: 24490712 [PubMed - indexed for MEDLINE]

Sy02-2assist & chronic diseases in eastern part of indonesia.

Tue, 09/16/2014 - 1:30pm
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Sy02-2assist & chronic diseases in eastern part of indonesia.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i4

Authors: Sarasvita R, Raharjo B, Savitri LM, Viora E, Isfandari S, Susami H

Abstract
BACKGROUND: Alcohol prevalence In Indonesia was 4.6% (Basic Health Research, 2007), whereas smoking prevalence was 36.3% (Basic Health Research, 2013). Compared to 2.2% prevalence of illicit drug use (BNN, 2011), attention and strategies addressed to alcohol use and smoking were lacking. In 2013, the Ministry of Health Republic of Indonesia (MoH-RI) developed a pilot project to implement screening tool using ASSIST in internal health care of Primary Care and General Hospital in Manado and Gorontalo. Main objective of this project was to increase health workers capacity in acknowledging substance use history, particularly alcohol and smoking use as one of risk factors of chronic diseases.
METHODS: Method of the study was clinic-based survey, using ASSIST tool to any of chronic patients in selected health facilities. Screening was done for three months (May to July 2013). Total chronic patients received ASSIST were 398.
RESULTS: 46% of patient's age ranged from 31 to 50 years old. Chronic symptoms were varied, from respiratory problems(21.9%) and digestive system (21.4%) to nervous system (3.8%). 96.7% of patients had smoking history and 93.4% had alcohol use history. Among patients with smoking history, 60.2% were active smokers with daily smoking habit in the last 3 months. Among patients with alcohol use history, 27.6% were active drinker with daily drinking habit in the last 3 months.
CONCLUSIONS: Implementation of ASSIST and brief intervention strategy for chronic disease patients is necessary, in order to reduce one of the major risks of non-communicable diseases.

PMID: 25221158 [PubMed - in process]

Sy03-1-2isam fellowship the association between clinical improvement in substance-related problems and psychiatric symptoms in psychosis: a post-hoc analysis.

Tue, 09/16/2014 - 1:30pm
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Sy03-1-2isam fellowship the association between clinical improvement in substance-related problems and psychiatric symptoms in psychosis: a post-hoc analysis.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i4-i5

Authors: Tantirangsee N, Assanangkornchai S, Marsden J

Abstract
OBJECTIVE: To demonstrate the association between clinical improvement in substance-related problems and psychiatric symptoms in psychotic patients.
METHODS: The data was gathered from randomised controlled trial of brief intervention for substance-related problem in psychosis. The Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) was used to identify substance use in the moderate risk range among psychotic patients. 169 participants were randomised to treatment-as-usual (TAU), single-session Brief Intervention (BI), or single-session BI with family support (BI-FS). The Jacobson & Truax Reliable Chang Index (RCI) was used to explore the clinical significant individual change from baseline to six months of the ASSIST score and classified into "Clinically improved - CI" or "Not improved - NI". The outcome was the change score of Brief Psychiatric Rating Scale (BPRS). A two level mixed effects model was fit to determine differences in outcomes between RCI outcomes.
RESULTS: 54 participants (32%) were classified into CI. Compared to NI, participants in CI reported a significant reduction in both total and all subscales of BPRS score. The interaction term was significant in total, positive and negative symptoms subscale between CI and BI-FS.
CONCLUSION: Improvement in substance-related problems can improve psychotic symptoms. BI-FS had an additive effect to improve some subscales.

PMID: 25221157 [PubMed - in process]

Sy02-1the association between clinical improvement in substance-related problems and psychiatric symptoms in psychosis: a post-hoc analysis.

Tue, 09/16/2014 - 1:30pm
Related Articles

Sy02-1the association between clinical improvement in substance-related problems and psychiatric symptoms in psychosis: a post-hoc analysis.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i3-i4

Authors: Tantirangsee N, Assanangkornchai S, Marsden J

Abstract
INTRODUCTION: This study aimed to demonstrate the association between clinical improvement in substance-related problems and psychiatric symptoms in psychotic patients.
METHODS: The data was gathered from randomised controlled trial of brief intervention for substance-related problem in psychosis. The Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) was used to identify substance use in the moderate risk range among psychotic patients. 169 participants were randomised to treatment-as-usual (TAU), single-session Brief Intervention (BI), or single-session BI with family support (BI-FS). The Jacobson and Truax Reliable Chang Index (RCI) was used to explore the clinical significant individual change from baseline to six months of the ASSIST score and classified into Clinically improved (CI) or Not improved (NI). The outcome was the change score of Brief Psychiatric Rating Scale (BPRS). A two level mixed effects model was fit to determine differences in outcomes between RCI outcomes.
RESULTS: 54 participants (32%) were classified into CI. Compared to NI, participants in CI reported a significant reduction in both total and all sub-scales of BPRS score. The interaction term was significant in total, positive and negative symptoms sub-scales between CI and BI-FS.
CONCLUSIONS: Improvement in substance-related problems can improve psychotic symptoms. BI-FS had additive effect to improve some sub-scales.

PMID: 25221099 [PubMed - in process]

CANABIC: CANnabis and Adolescents: effect of a Brief Intervention on their Consumption--study protocol for a randomized controlled trial.

Tue, 09/16/2014 - 1:30pm
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CANABIC: CANnabis and Adolescents: effect of a Brief Intervention on their Consumption--study protocol for a randomized controlled trial.

Trials. 2014;15:40

Authors: Laporte C, Vaillant-Roussel H, Pereira B, Blanc O, Tanguy G, Frappé P, Costa D, Gaboreau Y, Badin M, Marty L, Clément G, Dubray C, Falissard B, Llorca PM, Vorilhon P

Abstract
BACKGROUND: Cannabis is the most consumed illegal substance in France. General practitioners (GPs) are the health professionals who are most consulted by adolescents. Brief intervention (BI) is a promising care initiative for the consumption of cannabis, and could be a tool for GPs in caring for adolescents who consume cannabis. The aim of the CANABIC study is to measure the impact of a BI carried out by a GP on the consumption of cannabis by adolescents of 15 to 25 years of age.
METHODS: A randomized clustered controlled trial, stratified over three areas (Auvergne, Languedoc-Roussillon, and Rhône - Alpes), comparing an intervention group, which carries out the BI in consultation, and a control group, which ensures routine medical care. The main assessment criterion is the consumption of cannabis by amount of joints per month, at 12 months. The amount necessary to highlight a significant difference between the two groups of 30% of consumption at 12 months is 250 patients (50 GPs, 5 patients per GP; risk α = 5%; power = 90%; intra-cluster correlation coefficient ρ = 0.2; Hawthorne effect = 15%; lost to follow-up rates for GPs = 10% and for patients = 20%). This plan is replicated for the three areas, and therefore a total of 750 patients are expected.The secondary criteria for judgment are the associated consumption of tobacco and alcohol, the perception of the consequences of consumption, and the driving of a vehicle following consumption.
DISCUSSION: Research about BI for young cannabis users is underway. The aim of the CANABIC study is to validate a BI suited to adolescents who consume cannabis, which may be performed in the general practice. This would provide a tool for their treatment by a GP, which could be widely distributed during initial or further medical training.
TRIAL REGISTRATION: CANABIC is a randomized clustered trial (NCT01433692, registered 2011 Sept 12), PHRC funded: Clinical Research Hospital Program (Governmental Fund, Health Ministry). Date first patient randomized: March 2012.

PMID: 24479702 [PubMed - indexed for MEDLINE]

Nursing Students' Experiences With Screening, Brief Intervention, and Referral to Treatment for Substance Use in the Clinical/Hospital Setting.

Wed, 09/10/2014 - 6:00am

Nursing Students' Experiences With Screening, Brief Intervention, and Referral to Treatment for Substance Use in the Clinical/Hospital Setting.

J Addict Nurs. 2014 July/September;25(3):122-129

Authors: Braxter BJ, Puskar K, Mitchell AM, Hagle H, Gotham H, Terry MA

Abstract
Although Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective early intervention when used across healthcare settings, its implementation has been difficult, in part because of lack of training, healthcare providers' feelings of low self-efficacy in performing SBIRT, and negative attitudes about people who use alcohol and drugs. This study used qualitative descriptive methods to examine baccalaureate nursing students' experiences with practicing SBIRT in clinical rotations following in-depth classroom work and skill-based training. Fifty-five junior level nursing students participated in four focus groups. Three overarching themes describe students' experiences with SBIRT. Students expressed a positive impact of the training on their attitudes and feelings of self-efficacy regarding the use of SBIRT, differences in opinions about whether SBIRT should be used universally with all patients or as a targeted intervention with only some patients, and that SBIRT is a nursing responsibility. These results suggest that education and training can affect attitudes and efficacy, but that attention needs to be paid to how SBIRT is implemented within different healthcare settings.

PMID: 25202808 [PubMed - as supplied by publisher]

Prevalence of unhealthy alcohol use in hospital outpatients.

Sun, 09/07/2014 - 6:00am

Prevalence of unhealthy alcohol use in hospital outpatients.

Drug Alcohol Depend. 2014 Aug 28;

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 - as supplied by publisher]

Brief Intervention for Patients With Problematic Drug Use Presenting in Emergency Departments: A Randomized Clinical Trial.

Wed, 09/03/2014 - 6:00am

Brief Intervention for Patients With Problematic Drug Use Presenting in Emergency Departments: A Randomized Clinical Trial.

JAMA Intern Med. 2014 Sep 1;

Authors: Bogenschutz MP, Donovan DM, Mandler RN, Perl HI, Forcehimes AA, Crandall C, Lindblad R, Oden NL, Sharma G, Metsch L, Lyons MS, McCormack R, Konstantopoulos WM, Douaihy A

Abstract
Importance: Medical treatment settings such as emergency departments (EDs) present important opportunities to address problematic substance use. Currently, EDs do not typically intervene beyond acute medical stabilization.
Objective: To contrast the effects of a brief intervention with telephone boosters (BI-B) with those of screening, assessment, and referral to treatment (SAR) and minimal screening only (MSO) among drug-using ED patients.
Design, Setting, and Participants: Between October 2010 and February 2012, 1285 adult ED patients from 6 US academic hospitals, who scored 3 or greater on the 10-item Drug Abuse Screening Test (indicating moderate to severe problems related to drug use) and who were currently using drugs, were randomized to MSO (n = 431), SAR (n = 427), or BI-B (n = 427). Follow-up assessments were conducted at 3, 6, and 12 months by blinded interviewers.
Interventions: Following screening, MSO participants received only an informational pamphlet. The SAR participants received assessment plus referral to addiction treatment if indicated, and the BI-B participants received assessment and referral as in SAR, plus a manual-guided counseling session based on motivational interviewing principles and up to 2 "booster" sessions by telephone during the month following the ED visit.
Main Outcomes and Measures: Outcomes evaluated at follow-up visits included self-reported days using the patient-defined primary problem drug, days using any drug, days of heavy drinking, and drug use based on analysis of hair samples. The primary outcome was self-reported days of use of the patient-defined primary problem drug during the 30-day period preceding the 3-month follow-up.
Results: Follow-up rates were 89%, 86%, and 81% at 3, 6, and 12 months, respectively. For the primary outcome, estimated differences in number of days of use (95% CI) were as follows: MSO vs BI-B, 0.72 (-0.80 to 2.24), P (adjusted) = .57; SAR vs BI-B, 0.70 (-0.83 to 2.23), P (adjusted) = .57; SAR vs MSO, -0.02 (-1.53 to 1.50), P (adjusted) = .98. There were no significant differences between groups in self-reported days using the primary drug, days using any drug, or heavy drinking days at 3, 6, or 12 months. At the 3-month follow-up, participants in the SAR group had a higher rate of hair samples positive for their primary drug of abuse (265 of 280 [95%]) than did participants in the MSO group (253 of 287 [88%]) or the BI-B group (244 of 275 [89%]). Hair analysis differences between groups at other time points were not significant.
Conclusions and Relevance: In this sample of drug users seeking emergency medical treatment, a relatively robust brief intervention did not improve substance use outcomes. More work is needed to determine how drug use disorders may be addressed effectively in the ED.
Trial Registration: clinicaltrials.gov Identifier: NCT01207791.

PMID: 25179753 [PubMed - as supplied by publisher]

Vida PURA: A Cultural Adaptation of Screening and Brief Intervention to Reduce Unhealthy Drinking among Latino Day Laborers.

Tue, 08/26/2014 - 6:00am

Vida PURA: A Cultural Adaptation of Screening and Brief Intervention to Reduce Unhealthy Drinking among Latino Day Laborers.

Subst Abus. 2014 Aug 25;:0

Authors: Ornelas IJ, Allen C, Vaughan C, Williams EC, Negi N

Abstract
ABSTRACT Background: Brief intervention is known to reduce drinking in primary care, however because health care access is limited for Latino immigrants, traditional brief interventions are unlikely to reach this population. Methods: Using Barrera and Castro's framework, our study aims to culturally adapt a screening and brief intervention program to reduce unhealthy alcohol use among Latino day laborers, a particularly vulnerable group of Latino immigrant men. We conducted 18 interviews with Latino day laborers and 13 interviews with mental health and substance use providers that serve Latino immigrant men. Interviews were conducted until saturation of themes was reached. Themes from interviews were used to identify sources of mismatch between traditional screening and brief intervention and our target population. Results: Unhealthy alcohol use was common,culturally accepted, and helped relieve immigration-related stressors. Men had limited knowledge about how to change their behavior. Men preferred to receive information from trusted providers in Spanish. Men faced significant barriers to accessing health and social services, but were open to receiving brief interventions in community settings. Findings were used to design Vida PURA, a preliminary adaptation design of brief intervention for Latino day laborers. Key adaptations include providing brief intervention at a day labor worker center, by promotores trained to incorporate the social and cultural context of drinking for Latino immigrant men. Conclusions: Culturally adapted brief intervention may help reduce unhealthy drinking in this underserved population.

PMID: 25153904 [PubMed - as supplied by publisher]

Baylor Pediatric SBIRT Medical Residency Training Program: Model Description and Evaluation.

Tue, 08/26/2014 - 6:00am
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Baylor Pediatric SBIRT Medical Residency Training Program: Model Description and Evaluation.

Subst Abus. 2014 Aug 22;:0

Authors: Bray JH, Kowalchuk A, Waters V, Allen E, Laufman L, Shilling EH

Abstract
ABSTRACT Background: The Baylor College of Medicine SBIRT Medical Residency Training Program is a multi-level project that trains residents and faculty in evidenced-based screening, brief intervention and referral to treatment methods for alcohol and substance use problems.  Methods: This paper describes the training program created for pediatric residents and provides an evaluation of the program. Ninety-five first year pediatric residents participated in the training program. They were assessed on satisfaction with the program, self-rated skills, observed competency, and implementation into clinical practice. Results: The program was successfully incorporated into the residency curricula in two pediatric residencies. Evaluations indicate a high degree of satisfaction with the program; self- reported improvement in SBIRT skills, observed proficiency in SBIRT skills and utilization of SBIRT skills in clinical practice. Conclusions: SBIRT skills training can be incorporated into pediatric residency training, and residents are able to learn and implement the skills in clinical practice.

PMID: 25148650 [PubMed - as supplied by publisher]

Screening and brief intervention and referral to treatment for drug use in primary care: back to the drawing board.

Tue, 08/26/2014 - 6:00am
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Screening and brief intervention and referral to treatment for drug use in primary care: back to the drawing board.

JAMA. 2014 Aug 6;312(5):488-9

Authors: Hingson R, Compton WM

PMID: 25096687 [PubMed - indexed for MEDLINE]

From policy to practice: implementing frontline community health services for substance dependence¿study protocol.

Thu, 08/21/2014 - 6:00am

From policy to practice: implementing frontline community health services for substance dependence¿study protocol.

Implement Sci. 2014 Aug 20;9(1):108

Authors: Gill KJ, Campbell E, Gauthier G, Xenocostas S, Charney D, Macaulay AC

Abstract
BackgroundSubstance abuse is a worldwide public health concern. Extensive scientific research has shown that screening and brief interventions for substance use disorders administered in primary care provide substantial benefit at relatively low cost. Frontline health clinicians are well placed to detect and treat patients with substance use disorders. Despite effectiveness shown in research, there are many factors that impact the implementation of these practices in real-world clinical practice. Recently, the Ministry of Health and Social Services in Quebec, Canada, issued two policy documents aimed at introducing screening and early intervention for substance abuse into frontline healthcare clinics in Quebec. The current research protocol was developed in order to study the process of implementation of evidence-based addiction treatment practices at three primary care clinics in Montreal (Phase 1). In addition, the research protocol was designed to examine the efficacy of overall policy implementation, including barriers and facilitators to addictions program development throughout Quebec (Phase 2).Methods/DesignPhase 1 will provide an in-depth case study of knowledge translation and implementation. The study protocol will utilize an integrated knowledge translation strategy to build collaborative mechanisms for knowledge exchange between researchers, addiction specialists, and frontline practitioners (guided by the principles of participatory-action research), and directly examine the process of knowledge uptake and barriers to transfer using both qualitative and quantitative methodologies. Evaluation will involve multiple measures, time points and domains; program uptake and effectiveness will be determined by changes in healthcare service delivery, sustainability and outcomes. In Phase 2, qualitative methods will be utilized to examine the contextual facilitators and barriers that frontline organizations face in implementing services for substance dependence. Phase 2 will provide the first study exploring the wide-scale implementation of frontline services for substance dependence in the province of Quebec and yield needed information about how to effectively implement mandated policies into clinical practice and impact public health.DiscussionFindings from this research program will contribute to the understanding of factors associated with implementation of frontline services for substance dependence and help to inform future policy and organizational support for the implementation evidence-based practices.

PMID: 25138688 [PubMed - as supplied by publisher]

Addiction Disorders.

Wed, 08/20/2014 - 6:00am

Addiction Disorders.

Med Clin North Am. 2014 Sep;98(5):1097-1122

Authors: Merrill JO, Duncan MH

Abstract
Substance use disorders are common in primary care settings, but detection, assessment, and management are seldom undertaken. Substantial evidence supports alcohol screening and brief intervention for risky drinking, and pharmacotherapy is effective for alcohol use disorders. Substance use disorders can complicate the management of chronic noncancer pain, making routine monitoring and assessment for substance use disorders an important aspect of long-term opioid prescribing. Patients with opioid use disorders can be effectively treated with methadone in opioid treatment programs or with buprenorphine in the primary care setting.

PMID: 25134875 [PubMed - as supplied by publisher]

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