Subscribe to Screening and Brief Intervention News Feed from PubMed feed Screening and Brief Intervention News Feed from PubMed
NCBI: db=pubmed; Term=screening brief intervention substance
Updated: 4 days 15 hours ago

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]

Part 2: Screening, Brief Intervention and Referral to Treatment Plus Recovery Management: A Proposed Model for Recovery-Oriented Primary Care.

Thu, 06/09/2016 - 3:30pm

Part 2: Screening, Brief Intervention and Referral to Treatment Plus Recovery Management: A Proposed Model for Recovery-Oriented Primary Care.

J Addict Nurs. 2016 Apr-Jun;27(2):86-93

Authors: Fornili KS

Abstract
Part 1 of this two-part series (The Theoretical Basis for Recovery-Oriented Management of Substance Use Disorders in the Primary Care) explored the theoretical foundations for evidence-based substance Screening, Brief Intervention and Referral to Treatment (SBIRT) services. The aim was to produce possible explanations for why traditional SBIRT works well for individuals with unhealthy alcohol use but not as well for individuals who have more serious substance use disorders, including drug use and alcohol/drug dependence. Building on that analysis, through meaningful application of recovery management (RM) concepts within an integrated primary care/behavioral health context, a new, theory-based, recovery-oriented framework for primary care SBIRT is now introduced in Part 2. The proposed SBIRT Plus Recovery Management (SBIRT + RM) model moves traditional SBIRT from its original, limited, and narrow focus only on substance detection, brief intervention, and referral to its rightful, structured placement within a comprehensive, multidimensional, recovery-oriented system of care clinical practice environment. SBIRT+RM describes relevant strategies for improving recovery outcomes for individuals identified through primary care substance screening and defines primary care provider roles and responsibilities for sustained recovery support and long-term recovery maintenance.

PMID: 27272992 [PubMed - as supplied by publisher]

Part 1: The Theoretical Basis for Recovery-Oriented Management of Substance Use Disorders in Primary Care.

Thu, 06/09/2016 - 3:30pm

Part 1: The Theoretical Basis for Recovery-Oriented Management of Substance Use Disorders in Primary Care.

J Addict Nurs. 2016 Apr-Jun;27(2):78-85

Authors: Fornili KS

Abstract
There is strong evidence in the literature that screening and brief counseling interventions are effective in detecting alcohol problems and decreasing alcohol consumption among patients in primary care settings but somewhat weaker evidence regarding screening and brief intervention for drug problems. In 2014, two published studies made news and caused concern among proponents of substance Screening, Brief Intervention and Referral to Treatment (SBIRT) programs, when their authors concluded that brief interventions were not effective for decreasing drug use among primary care patients identified through screening, and advised that widespread adoption of screening and brief intervention for drug use was not warranted.An evaluation of the theoretical foundations for evidence-based SBIRT services was conducted to produce possible explanations for why traditional SBIRT works well for individuals with unhealthy alcohol use but not as well for those with more serious substance use disorders, including drug use and alcohol/drug dependence. Smith and Liehr's evaluation framework for middle-range theory was utilized to analyze the Chronic Care Model, which was featured prominently in early SBIRT literature, and the newer Recovery Management model, which provides a philosophical framework for organizing modern addictions services and quality-of-life enhancements (Part 1 of this two-part series).Programs are more likely to succeed if guided by theory, and examination of relevant components of theory-based interventions can be useful in developing practical strategies for meeting program objectives. A new, theory-based, recovery-oriented framework for primary care SBIRT is introduced in Part 2 ("SBIRT+RM(C): A Proposed Model for Recovery-Oriented Primary Care").

PMID: 27272991 [PubMed - as supplied by publisher]

Strategies in primary healthcare to implement early identification of risky alcohol consumption: why do they work or not? A qualitative evaluation of the ODHIN study.

Thu, 06/09/2016 - 3:30pm

Strategies in primary healthcare to implement early identification of risky alcohol consumption: why do they work or not? A qualitative evaluation of the ODHIN study.

BMC Fam Pract. 2016;17(1):70

Authors: Keurhorst M, Heinen M, Colom J, Linderoth C, Müssener U, Okulicz-Kozaryn K, Palacio-Vieira J, Segura L, Silfversparre F, Słodownik L, Sorribes E, Laurant M, Wensing M

Abstract
BACKGROUND: Screening and brief interventions (SBI) in primary healthcare are cost-effective in risky drinkers, yet they are not offered to all eligible patients. This qualitative study aimed to provide more insight into the factors and mechanisms of why, how, for whom and under what circumstances implementation strategies work or do not work in increasing SBI.
METHODS: Semi-structured interviews were conducted between February and July 2014 with 40 GPs and 28 nurses in Catalonia, the Netherlands, Poland, and Sweden. Participants were purposefully selected from the European Optimising Delivery of Healthcare Interventions (ODHIN) trial. This randomised controlled trial evaluated the influence of training and support, financial reimbursement and an internet-based method of delivering advice on SBI. Amongst them were 38 providers with a high screening performance and 30 with a low screening performance from different allocation groups. Realist evaluation was combined with the Tailored Implementation for Chronic Diseases framework for identification of implementation determinants to guide the interviews and analysis. Transcripts were analysed thematically with the diagram affinity method.
RESULTS: Training and support motivated SBI by improved knowledge, skills and prioritisation. Continuous provision, sufficient time to learn intervention techniques and to tailor to individual experienced barriers, seemed important T&S conditions. Catalan and Polish professionals perceived financial reimbursement to be an additional stimulating factor as well, as effects on SBI were smoothened by personnel levels and salary levels. Structural payment for preventive services rather than a temporary project based payment, might have increased the effects of financial reimbursement. Implementing e-BI seem to require more guidance than was delivered in ODHIN. Despite the allocation, important preconditions for SBI routine seemed frequent exposure of this topic in media and guidelines, SBI facilitating information systems, and having SBI in protocol-led care. Hence, the second order analysis revealed that the applied implementation strategies have high potential on the micro professional level and meso-organisational level, however due to influences from the macro- level such as societal and political culture the effects risks to get nullified.
CONCLUSIONS: Essential determinants perceived for the implementation of SBI routines were identified, in particular for training and support and financial reimbursement. However, focusing only on the primary healthcare setting seems insufficient and a more integrated SBI culture, together with meso- and macro-focused implementation process is requested.
TRIAL REGISTRATION: ClinicalTrials.gov. Trial identifier: NCT01501552 .

PMID: 27267887 [PubMed - as supplied by publisher]

Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the ODHIN five country cluster randomized factorial trial.

Tue, 05/31/2016 - 6:00am

Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the ODHIN five country cluster randomized factorial trial.

Addiction. 2016 May 30;

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

Abstract
AIM: To test if training and support, financial reimbursement, and option of referring screen positive patients to an internet-based method of giving advice (eBI) can increase primary health care providers' delivery of AUDIT-C based screening and advice to heavy drinkers.
DESIGN: Cluster randomized factorial trial with 12-week implementation and measurement period.
SETTING: Primary health care units (PHCU) in different locations throughout Catalonia, England, Netherlands, Poland and Sweden.
PARTICIPANTS: 120 PHCU, 24 in each of Catalonia, England, Netherlands, Poland and Sweden.
INTERVENTIONS: PHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR), and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI.
MEASUREMENTS: The primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen positive patients advised; and, proportion of consulting adult patients given an intervention (screening and advice to screen positives) during the same 12-week implementation period.
FINDINGS: During a 4-week baseline measurement period, 5.9 (95% CI 3.4 to 8.4) per 100 adult patients consulting per PHCU were screened for their alcohol consumption. Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CI 1.13 to 1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was2.00 (95% CI 1.56 to 2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was2.34 (95% CI 1.77 to 3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CI 1.11 to 2.53).
CONCLUSIONS: Providing primary health care units with training, support and financial reimbursement for delivering AUDIT-C based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health care units with the option of referring screen positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption. (†) Trial registration ClinicalTrials.gov. Trial identifier: NCT01501552.

PMID: 27237081 [PubMed - as supplied by publisher]

Dual Diagnosis: Coexisting Substance Use Disorders and Psychiatric Disorders.

Sat, 05/28/2016 - 6:00am

Dual Diagnosis: Coexisting Substance Use Disorders and Psychiatric Disorders.

Nurs Clin North Am. 2016 Jun;51(2):237-47

Authors: Antai-Otong D, Theis K, Patrick DD

Abstract
Dual diagnosis is a prevalent and serious health problem. These disorders challenge psychiatric mental health and addiction nurses to treat 2 distinct disorders. Despite advances in the treatment of these disorders, there remains a void in the ideal approach. This article offers psychiatric nurses opportunities to improve their expertise in the identification of vulnerable or high-risk populations by using integrated screening and brief interventions to discern treatment options. Patients who require comprehensive treatment to stabilize 1 or both disorders further challenge nurses to have a basic understanding of the powerful effects of substance use on psychiatric conditions and vice versa.

PMID: 27229278 [PubMed - in process]

Substance Use Screening, Brief Intervention, and Referral to Treatment Among Medicaid Patients in Wisconsin: Impacts on Healthcare Utilization and Costs.

Thu, 05/26/2016 - 6:00am

Substance Use Screening, Brief Intervention, and Referral to Treatment Among Medicaid Patients in Wisconsin: Impacts on Healthcare Utilization and Costs.

J Behav Health Serv Res. 2016 May 24;

Authors: Paltzer J, Brown RL, Burns M, Moberg DP, Mullahy J, Sethi AK, Weimer D

Abstract
Unhealthy substance use in the USA results in significant mortality and morbidity. This study measured the effectiveness of paraprofessional-administered substance use screening, brief intervention, and referral to treatment (SBIRT) services on subsequent healthcare utilization and costs. The pre-post with comparison group study design used a population-based sample of Medicaid patients 18-64 years receiving healthcare services from 33 clinics in Wisconsin. Substance use screens were completed by 7367 Medicaid beneficiaries, who were compared to 6751 randomly selected treatment-as-usual Medicaid patients. Compared to unscreened patients, those screened changed their utilization over the 24-month follow-up period by 0.143 outpatient days per member per month (PMPM) (p < 0.001), -0.036 inpatient days PMPM (p < 0.05), -0.001 inpatient admissions PMPM (non-significant), and -0.004 emergency department days PMPM (non-significant). The best estimate of net annual savings is $391 per Medicaid adult beneficiary (2014 dollars). SBIRT was associated with significantly greater outpatient visits and significant reductions in inpatient days among working-age Medicaid beneficiaries in Wisconsin.

PMID: 27221694 [PubMed - as supplied by publisher]

Effectiveness of a Web-Based Screening and Fully Automated Brief Motivational Intervention for Adolescent Substance Use: A Randomized Controlled Trial.

Thu, 05/26/2016 - 6:00am

Effectiveness of a Web-Based Screening and Fully Automated Brief Motivational Intervention for Adolescent Substance Use: A Randomized Controlled Trial.

J Med Internet Res. 2016;18(5):e103

Authors: Arnaud N, Baldus C, Elgán TH, De Paepe N, Tønnesen H, Csémy L, Thomasius R

Abstract
BACKGROUND: Mid-to-late adolescence is a critical period for initiation of alcohol and drug problems, which can be reduced by targeted brief motivational interventions. Web-based brief interventions have advantages in terms of acceptability and accessibility and have shown significant reductions of substance use among college students. However, the evidence is sparse among adolescents with at-risk use of alcohol and other drugs.
OBJECTIVE: This study evaluated the effectiveness of a targeted and fully automated Web-based brief motivational intervention with no face-to-face components on substance use among adolescents screened for at-risk substance use in four European countries.
METHODS: In an open-access, purely Web-based randomized controlled trial, a convenience sample of adolescents aged 16-18 years from Sweden, Germany, Belgium, and the Czech Republic was recruited using online and offline methods and screened online for at-risk substance use using the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) screening instrument. Participants were randomized to a single session brief motivational intervention group or an assessment-only control group but not blinded. Primary outcome was differences in past month drinking measured by a self-reported AUDIT-C-based index score for drinking frequency, quantity, and frequency of binge drinking with measures collected online at baseline and after 3 months. Secondary outcomes were the AUDIT-C-based separate drinking indicators, illegal drug use, and polydrug use. All outcome analyses were conducted with and without Expectation Maximization (EM) imputation of missing follow-up data.
RESULTS: In total, 2673 adolescents were screened and 1449 (54.2%) participants were randomized to the intervention or control group. After 3 months, 211 adolescents (14.5%) provided follow-up data. Compared to the control group, results from linear mixed models revealed significant reductions in self-reported past-month drinking in favor of the intervention group in both the non-imputed (P=.010) and the EM-imputed sample (P=.022). Secondary analyses revealed a significant effect on drinking frequency (P=.037) and frequency of binge drinking (P=.044) in the non-imputation-based analyses and drinking quantity (P=.021) when missing data were imputed. Analyses for illegal drug use and polydrug use revealed no significant differences between the study groups (Ps>.05).
CONCLUSIONS: Although the study is limited by a large drop-out, significant between-group effects for alcohol use indicate that targeted brief motivational intervention in a fully automated Web-based format can be effective to reduce drinking and lessen existing substance use service barriers for at-risk drinking European adolescents.
TRIAL REGISTRATION: International Standard Randomized Controlled Trial Registry: ISRCTN95538913; http://www.isrctn.com/ISRCTN95538913 (Archived by WebCite at http://www.webcitation.org/6XkuUEwBx).

PMID: 27220276 [PubMed - in process]

Preventing alcohol-exposed pregnancy among an American Indian/Alaska Native population: effect of a screening, brief intervention, and referral to treatment intervention.

Fri, 05/20/2016 - 6:00am
Related Articles

Preventing alcohol-exposed pregnancy among an American Indian/Alaska Native population: effect of a screening, brief intervention, and referral to treatment intervention.

Alcohol Clin Exp Res. 2015 Jan;39(1):126-35

Authors: Montag AC, Brodine SK, Alcaraz JE, Clapp JD, Allison MA, Calac DJ, Hull AD, Gorman JR, Jones KL, Chambers CD

Abstract
BACKGROUND: Fetal alcohol spectrum disorders are the result of alcohol-exposed pregnancies (AEP) and believed to be the leading known cause of developmental disabilities in the United States. Our objective was to determine whether a culturally targeted Screening, Brief Intervention, and Referral to Treatment (SBIRT) intervention may reduce risky drinking and vulnerability to AEP among American Indian/Alaska Native (AIAN) women in Southern California.
METHODS: Southern California AIAN women of childbearing age who completed a survey including questions regarding alcohol consumption and contraceptive use were randomized into intervention or treatment as usual groups where the former group completed an online SBIRT intervention, and were followed up at 1, 3, and 6 months postintervention.
RESULTS: Of 263 women recruited and 247 with follow-up data, one-third were at high risk of having an AEP at baseline. Both treatment groups decreased self-reported risky drinking behavior (drinks per week, p < 0.001; frequency of heavy episodic [binge] drinking episodes per 2 weeks, p = 0.017 and risk of AEP p < 0.001 at 6 months postintervention) in the follow-up period. There was no difference between treatment groups. Baseline factors associated with decreased risk of an AEP at follow-up included the perception that other women in their peer group consumed a greater number of drinks per week, having reported a greater number of binge episodes in the past 2 weeks, and depression/impaired functionality.
CONCLUSIONS: Participation in assessment alone may have been sufficient to encourage behavioral change even without the web-based SBIRT intervention. Randomization to the SBIRT did not result in a significantly different change in risky drinking behaviors. The importance of perception of other women's drinking and one's own depression/functionality may have implications for future interventions.

PMID: 25623412 [PubMed - indexed for MEDLINE]

Social Workers as Workplace-Based Instructors of Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Emergency Medicine Residents.

Thu, 05/19/2016 - 6:00am

Social Workers as Workplace-Based Instructors of Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Emergency Medicine Residents.

Teach Learn Med. 2016 May 18;:1-11

Authors: Duong DK, O'Sullivan PS, Satre DD, Soskin P, Satterfield J

Abstract
PROBLEM: Residency education is challenged by a shortage of personnel and time, particularly for teaching behavioral interventions such as screening, brief intervention, and referral to treatment (SBIRT) to reduce hazardous drinking and drug use. However, social workers may be well placed to teach SBIRT in clinical training settings.
INTERVENTION: We describe a curriculum with social workers as SBIRT trainers of emergency medicine (EM) residents during actual clinical shifts in an EM residency training program. The curriculum required 1 EM faculty member working with social workers and 1 additional hour of formal residency conference teaching time.
CONTEXT: We implemented the curriculum at both a university tertiary care hospital emergency department and a county trauma center. We trained 8 social workers at both sites as SBIRT superusers to teach and assess EM resident SBIRT performance with actual patients. We measured the length and number of sessions to attain SBIRT competence, residents' satisfaction, and resident comments (coded by authors).
OUTCOME: Five of the 8 social workers trained residents between June 2013 and May 2014, 31 EM residents trained to a level indicating SBIRT competence with 114 patients. Each patient interaction averaged 8.8 minutes and residents averaged 3.13 patients. Twenty-four (77%) residents gave ratings of 1.58 (SD = .58) for the quality of teaching, 2.33 (SD = .87) for recommending the training to a colleague, 1.38 (SD = .49) for superusers' knowledge, 1.88 (SD = .95) for usefulness of instruction, 1.54 (SD = .72) for workplace learning, and 1.58 (SD = .78) for valuing learning from social workers (on a scale of 1 [very satisfied/strongly agree] to 5 [very dissatisfied/strongly disagree]). Residents preferred learning SBIRT during the 1st and 2nd training years and in the workplace.
LESSONS LEARNED: Social work colleagues can be effective in teaching SBIRT to residents in the workplace, and our residents highly valued learning from social workers, who all had prior training in motivational interviewing. In the implementation of this curriculum, the clinical demands of residents must be taken into account when teaching occurs, and having multiple social worker instructors was instrumental.

PMID: 27191587 [PubMed - as supplied by publisher]

Screening and Brief Interventions for Illicit Drug Use and Alcohol Use in Methadone Maintained Opiate-Dependent Patients: Results of a Pilot Cluster Randomized Controlled Trial Feasibility Study.

Tue, 05/10/2016 - 6:00am

Screening and Brief Interventions for Illicit Drug Use and Alcohol Use in Methadone Maintained Opiate-Dependent Patients: Results of a Pilot Cluster Randomized Controlled Trial Feasibility Study.

Subst Use Misuse. 2016 May 9;:1-12

Authors: Darker CD, Sweeney B, Keenan E, Whiston L, Anderson R, Barry J

Abstract
BACKGROUND AND OBJECTIVES: The present study evaluated the effectiveness of a single clinician delivered brief intervention (BI) to reduce problem alcohol use and illicit substance use in an opiate-dependent methadone maintained cohort of patients attending for treatment.
METHODS: Four addiction treatment centers were randomly assigned to either treatment as usual (TAU; control group) or BI (intervention group). Clinicians screened patients using the alcohol, smoking, and substance involvement screening test (ASSIST) screening tool at baseline and again at three-month follow up. Fidelity checks were performed to ensure that training was delivered effectively and uniformly across all study sites. Feasibility of administering a BI within daily practice was assessed through intervention fidelity checks, patient satisfaction questionnaires and process evaluation.
RESULTS: A total of 465 patients were screened (66% of the overall eligible population) with a total of 433 (93%) ASSIST positive cases. Randomization was effective, with no differences in the control versus the intervention arms at baseline for key demographic or clinical indicators including substance us. There was a statistically significant difference between global risk score for the intervention (x = 39.36, sd = 25.91) group and the control group (x = 45.27, SD = 27.52) at 3-month follow-up (t(341) = -2.07, p < .05).
CONCLUSIONS: This trial provides the first evidence that a single clinician delivered BI can result in a reduction in substance use within a methadone maintained opiate-dependent cohort, and this effect is sustained at three month follow up.

PMID: 27158853 [PubMed - as supplied by publisher]

The future of screening, brief intervention and referral to treatment in adolescent primary care: research directions and dissemination challenges.

Sat, 05/07/2016 - 8:30am

The future of screening, brief intervention and referral to treatment in adolescent primary care: research directions and dissemination challenges.

Curr Opin Pediatr. 2016 May 5;

Authors: DʼSouza-Li L, Harris SK

Abstract
PURPOSE OF REVIEW: Screening, brief intervention and referral to treatment (SBIRT) offers a practical, integrated model for addressing substance use in primary care settings. This review provides an update of the research on SBIRT for adolescents in primary care, examines current dissemination challenges and suggests future research directions.
RECENT FINDINGS: A number of brief screening tools for adolescents have been developed and tested relative to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) substance use disorders. Computerized previsit screening promotes standardization and is a more time-efficient alternative to provider interview. The adolescent brief intervention literature is growing, particularly with respect to technology-based tools, but is still limited, with evidence greatest for alcohol, and for motivational enhancement therapy interventions. Increasing SBIRT implementation in pediatric primary care remains a challenge. Using nonphysician behavioral health providers to deliver SBIRT, and embedding a screener and decision support tool in electronic medical record systems are strategies being investigated to promote SBIRT implementation.
SUMMARY: Substance use begins in adolescence, and pediatric SBIRT could help to achieve a population-level reduction of substance use-related harms. With a growing number of available tools, adolescent SBIRT effectiveness and feasibility are increasing, but more studies are needed to grow its evidence base, and elucidate strategies to increase implementation.

PMID: 27152620 [PubMed - as supplied by publisher]

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

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

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

AIDS Care. 2016 May 4;:1-5

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

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

PMID: 27145363 [PubMed - as supplied by publisher]

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

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

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

J Clin Nurs. 2016 May 3;

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

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

PMID: 27140392 [PubMed - as supplied by publisher]

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

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

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

Early Interv Psychiatry. 2016 May 2;

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

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

PMID: 27136461 [PubMed - as supplied by publisher]

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

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

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

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

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

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

PMID: 27110494 [PubMed - as supplied by publisher]

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

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

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

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

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

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

PMID: 27090097 [PubMed - in process]

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

Tue, 04/19/2016 - 6:00am
Related Articles

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

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

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

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

PMID: 26230758 [PubMed - indexed for MEDLINE]

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

Tue, 04/19/2016 - 6:00am
Related Articles

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

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

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

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

PMID: 25915692 [PubMed - indexed for MEDLINE]

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

Tue, 04/19/2016 - 6:00am
Related Articles

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

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

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

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

PMID: 25785797 [PubMed - indexed for MEDLINE]

Pages