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Teaching family medicine residents brief interventions for alcohol misuse.

Thu, 07/02/2015 - 6:00am
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Teaching family medicine residents brief interventions for alcohol misuse.

Int J Psychiatry Med. 2015 Jun 30;

Authors: Rule JC, Samuel P

Abstract
Across the lifespan, alcohol misuse affects a large percentage of patients seen in primary care clinics. It can lead to alcohol use disorders, ranging from risky use to alcohol dependence. Alcohol use disorders frequently complicate acute and chronic illnesses of patients seen in FM clinics. Screening patients for alcohol and substance use has become a standard of practice in most primary care settings. This report describes how a family medicine residency program solidified a residency curriculum in substance abuse screening, assessment, and brief intervention by merging three presentation-style didactics into a blended approach. The curriculum combines didactic teaching, motivational interviewing, and behavioral rehearsal of clinical practice skills. Qualitative feedback suggests that the curriculum has been successful in exposing residents to a variety of practical assessment methods and, through rehearsal, has improved resident confidence in addressing alcohol use and misuse in a primary care population.

PMID: 26130770 [PubMed - as supplied by publisher]

Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial.

Wed, 06/24/2015 - 6:00am
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Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial.

J Neurol Neurosurg Psychiatry. 2015 May;86(5):505-12

Authors: Kristoffersen ES, Straand J, Vetvik KG, Benth JŠ, Russell MB, Lundqvist C

Abstract
BACKGROUND: Medication-overuse headache (MOH) is common in the general population. We investigated effectiveness of brief intervention (BI) for achieving drug withdrawal in primary care patients with MOH.
METHODS: The study was double-blind, pragmatic and cluster-randomised controlled. A total of 25,486 patients (age 18-50) from 50 general practitioners (GPs) were screened for MOH. GPs defined clusters and were randomised to receive BI training (23 GPs) or to continue business as usual (BAU; 27 GPs). The Severity of Dependence Scale was applied as a part of the BI. BI involved feedback about individual risk of MOH and how to reduce overuse. Primary outcome measures were reduction in medication and headache days/month 3 months after the intervention and were assessed by a blinded clinical investigator.
RESULTS: 42% responded to the postal screening questionnaire, and 2.4% screened positive for MOH. A random selection of up to three patients with MOH from each GP were invited (104 patients), 75 patients were randomised and 60 patients included into the study. BI was significantly better than BAU for the primary outcomes (p<0.001). Headache and medication days were reduced by 7.3 and 7.9 (95% CI 3.2 to 11.3 and 3.2 to 12.5) days/month in the BI compared with the BAU group. Chronic headache resolved in 50% of the BI and 6% of the BAU group.
CONCLUSIONS: The BI method provides GPs with a simple and effective instrument that reduces medication-overuse and headache frequency in patients with MOH.
TRIAL REGISTRATION NUMBER: NCT01314768.

PMID: 25112307 [PubMed - indexed for MEDLINE]

[Multidimensional family therapy: which influences, which specificities?].

Wed, 06/24/2015 - 6:00am
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[Multidimensional family therapy: which influences, which specificities?].

Encephale. 2014 Oct;40(5):408-15

Authors: Bonnaire C, Bastard N, Couteron JP, Har A, Phan O

Abstract
BACKGROUND: Among illegal psycho-active drugs, cannabis is the most consumed by French adolescents. Multidimensional family therapy (MDFT) is a family-based outpatient therapy which has been developed for adolescents with drug and behavioral problems. MDFT has shown its effectiveness in adolescents with substance abuse disorders (notably cannabis abuse) not only in the United States but also in Europe (International Cannabis Need of Treatment project). MDFT is a multidisciplinary approach and an evidence-based treatment, at the crossroads of developmental psychology, ecological theories and family therapy. Its psychotherapeutic techniques find its roots in a variety of approaches which include systemic family therapy and cognitive therapy.
OBJECTIVE: The aims of this paper are: to describe all the backgrounds of MDFT by highlighting its characteristics; to explain how structural and strategy therapies have influenced this approach; to explore the links between MDFT, brief strategic family therapy and multi systemic family therapy; and to underline the specificities of this family therapy method.
DISCUSSION: The multidimensional family therapy was created on the bases of 1) the integration of multiple therapeutic techniques stemming from various family therapy theories; and 2) studies which have shown family therapy efficiency. Several trials have shown a better efficiency of MDFT compared to group treatment, cognitive-behavioral therapy and home-based treatment. Studies have also highlighted that MDFT led to superior treatment outcomes, especially among young people with severe drug use and psychiatric co-morbidities. In the field of systemic family therapies, MDFT was influenced by: 1) the structural family therapy (S. Minuchin), 2) the strategic family theory (J. Haley), and 3) the intergenerational family therapy (Bowen and Boszormenyi-Nagy). MDFT has specific aspects: MDFT therapists think in a multidimensional perspective (because an adolescent's drug abuse is a multidimensional disorder), they work with the system and the subsystem, focusing on the emotional expression and the parental and adolescent enactment (a principle of change and intervention). MDFT includes four modules (adolescent, parent, family interaction, and extra-familial systems) in three steps (1) build the foundation, (2) prompt action and change by working the themes, and (3) seal the changes and exit). The supervision philosophy and methodology is also based on the principle of multidimensionality. Indeed, many different supervision methods are used in a coordinated way to produce the required adherence and clinical skill (written case conceptualizations, videotape presentation and live supervision).
CONCLUSION: Family vulnerability and chronicity factors are a major challenge of modern research. MDFT questions the reciprocal adjustments that have to be made by the subject and his/her familial environment. It also helps to clarify the therapeutic interventions in order to enhance better adolescent development. For this purpose, MDFT offers a specific therapeutic frame, for it is a family therapy focused on adolescents with cannabis abuse problems. Its action and questioning on parental practices and adolescents lead to better psycho-educational support. It focuses the therapeutic process on emotions and family capacity for change.

PMID: 23993339 [PubMed - indexed for MEDLINE]

Pilot Validation of a Brief Screen Tool for Substance Use Detection in Emergency Care.

Wed, 06/10/2015 - 6:00am
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Pilot Validation of a Brief Screen Tool for Substance Use Detection in Emergency Care.

J Emerg Med. 2015 Jun 5;

Authors: Broderick KB, Richmond MK, Fagan J, Long AW

Abstract
BACKGROUND: Screening and brief intervention for substance use in health care systems is recommended to identify and intervene with patients who abuse alcohol and other substances. However, there is limited research on the utility of short, single-item questions to identify illicit substance users.
OBJECTIVE: Pilot validation of two single-item screening questions to detect illicit substance use, one for marijuana and one for other illicit drugs. The goal was to identify sensitive, time-efficient screening questions that can be easily integrated into busy health care settings.
METHODS: A cross-sectional design was used. At intake, along with questions for tobacco and alcohol, nurses administered two brief screen questions to adult patients seen in designated areas in a large urban medical center. After patients were triaged to rooms, health educators (blind to brief screen responses) administered the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) as the reference standard.
RESULTS: On the ASSIST, 14% and 9% of participants reported risky marijuana and illicit (nonmarijuana) drug use, respectively. Sensitivity values for the marijuana and street drug questions were 72% (95% confidence interval [CI] 67% to 78%) and 40% (95% CI 32% to 48%), respectively. Specificity values for the marijuana and street drug questions were 96% (95% CI 95% to 97%) and 99% (95% CI 98% to 99%), respectively. Values differed minimally as a function of patient characteristics.
CONCLUSIONS: It is important to use validated questions to identify substance misuse so that individuals are not missed in the screening process. It is the possible that administration protocols play a role in detection rates. Future research is needed to identify easy-to-administer drug use screening questions.

PMID: 26054313 [PubMed - as supplied by publisher]

Evaluation of an intervention for patients with alcohol-related injuries: results of a mixed methods study.

Fri, 06/05/2015 - 6:00am
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Evaluation of an intervention for patients with alcohol-related injuries: results of a mixed methods study.

Aust N Z J Public Health. 2015 Jun;39(3):216-21

Authors: Whitty M, Nagel T, Ward L, Jayaraj R, Kavanagh D

Abstract
OBJECTIVE: To explore the effect of education and training on the delivery of alcohol screening and brief intervention and referral to high-risk patients in a hospital setting. Main outcome measures included; delivery of training; practice change in relation to staff performing alcohol screening, brief intervention and referrals.
METHODS: Observational study design using mixed methods set in a tertiary referral hospital. Pre-post assessment of medical records and semi-structured interviews with key informants.
RESULTS: Routine screening for substance misuse (9% pre / 71.4% post) and wellbeing concerns (6.6% pre / 15 % post) was more frequent following the introduction of resources and staff participation in educational workshops. There was no evidence of a concomitant increase in delivery of brief intervention or referrals to services. Implementation challenges, including time constraints and staff attitudes, and enablers such as collaboration and visible pathways, were identified.
CONCLUSION: Rates of patient screening increased, however barriers to delivery of brief intervention and referrals remained. Implementation strategies targeting specific barriers and enablers to introducing interventions are both required to improve the application of secondary prevention for patients in acute settings.
IMPLICATIONS: Educational training, formalised liaison between services, systematised early intervention protocols, and continuous quality improvement processes will progress service delivery in this area.

PMID: 26041086 [PubMed - in process]

Hazardous alcohol use in general psychiatric outpatients.

Wed, 05/20/2015 - 6:00am

Hazardous alcohol use in general psychiatric outpatients.

J Ment Health. 2015 Jun;24(3):162-167

Authors: Eberhard S, Nordström G, Öjehagen A

Abstract
BACKGROUND: Hazardous alcohol use in psychiatric patients may increase the risk of the development of a substance use disorder and negatively affect the course of the psychiatric disorder.
AIMS: To investigate the prevalence of hazardous alcohol and drug use in a Swedish psychiatric outpatient population with particular focus on hazardous alcohol consumption and assess relationships of hazardous alcohol use to sex, age and psychiatric diagnosis.
METHODS: General psychiatric outpatients, n = 1,679, completed a self-rating Alcohol Use Disorders Identification Test (AUDIT).
RESULTS: Hazardous or harmful alcohol habits occurred among 22% of all women and 30% of all men with higher prevalence among younger patients. Nine percent of all women and 22 % of all men reported binge drinking. Binge drinking was more frequent in younger subjects. Women with a personality disorder diagnosis had a higher frequency of at risk drinking. Apart from that, psychiatric diagnosis was unrelated to rate of hazardous drinking.
CONCLUSIONS: Hazardous alcohol use was common in this psychiatric outpatient population. With regard to possible risks related to drinking in psychiatric patients, alcohol habits should be assessed as a part of good clinical practice.

PMID: 25989493 [PubMed - as supplied by publisher]

Psychosocial Interventions for Problem Alcohol Use in Primary Care Settings (PINTA): Baseline Feasibility Data.

Wed, 05/20/2015 - 6:00am
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Psychosocial Interventions for Problem Alcohol Use in Primary Care Settings (PINTA): Baseline Feasibility Data.

J Dual Diagn. 2015 Apr-Jun;11(2):97-106

Authors: Klimas J, Marie Henihan A, McCombe G, Swan D, Anderson R, Bury G, Dunne C, Keenan E, Saunders J, Shorter GW, Smyth BP, Cullen W

Abstract
OBJECTIVE: Many individuals receiving methadone maintenance receive their treatment through their primary care provider. As many also drink alcohol excessively, there is a need to address alcohol use to improve health outcomes for these individuals. We examined problem alcohol use and its treatment among people attending primary care for methadone maintenance treatment, using baseline data from a feasibility study of an evidence-based complex intervention to improve care.
METHODS: Data on addiction care processes were collected by (1) reviewing clinical records (n = 129) of people who attended 16 general practices for methadone maintenance treatment and (2) administering structured questionnaires to both patients (n = 106) and general practitioners (GPs) (n = 15).
RESULTS: Clinical records indicated that 24 patients (19%) were screened for problem alcohol use in the 12 months prior to data collection, with problem alcohol use identified in 14 (58% of those screened, 11% of the full sample). Of those who had positive screening results for problem alcohol use, five received a brief intervention by a GP and none were referred to specialist treatment. Scores on the Alcohol Use Disorders Identification Test (AUDIT) revealed the prevalence of hazardous, harmful, and dependent drinking to be 25% (n = 26), 6% (n = 6), and 16% (n = 17), respectively. The intraclass correlation coefficient (ICC) for the proportion of patients with negative AUDITs was 0.038 (SE = 0.01). The ICCs for screening, brief intervention, and/or referral to treatment (SBIRT) were 0.16 (SE = 0.014), -0.06 (SE = 0.017), and 0.22 (SE = 0.026), respectively. Only 12 (11.3%) AUDIT questionnaires concurred with corresponding clinical records that a patient had any/no problem alcohol use. Regular use of primary care was evident, as 25% had visited their GP more than 12 times during the past 3 months.
CONCLUSIONS: Comparing clinical records with patients' experience of SBIRT can shed light on the process of care. Alcohol screening in people who attend primary care for substance use treatment is not routinely conducted. Interventions that enhance the care of problem alcohol use among this high-risk group are a priority.

PMID: 25985200 [PubMed - in process]

SBIRT as a Vital Sign for Behavioral Health Identification, Diagnosis, and Referral in Community Health Care.

Wed, 05/13/2015 - 6:00am

SBIRT as a Vital Sign for Behavioral Health Identification, Diagnosis, and Referral in Community Health Care.

Ann Fam Med. 2015 May;13(3):261-3

Authors: Dwinnells R

Abstract
The purpose of this quasi-experimental design study was to examine the effectiveness of the behavioral health Screening, Brief Intervention, and Referral to Treatment (SBIRT) program at a community health center. The study group was twice as likely (25.3%) to have depression and substance abuse diagnosed compared with the control group (11.4%) (P <.001). Referral rates for the study group were more likely to occur (12.4%) compared with referral rates for the control group (1.0%) (P <.001); however, the kept appointment rates by patients for behavioral health problems referrals remained low for both groups. SBIRT was effectively utilized in a community health center, resulting in increased rates for diagnosis of behavioral health problems and referrals of patients.

PMID: 25964405 [PubMed - in process]

Using Interactive Web-Based Screening, Brief Intervention and Referral to Treatment in an Urban, Safety-Net HIV Clinic.

Wed, 05/13/2015 - 6:00am

Using Interactive Web-Based Screening, Brief Intervention and Referral to Treatment in an Urban, Safety-Net HIV Clinic.

AIDS Behav. 2015 May 12;

Authors: Dawson Rose C, Cuca YP, Kamitani E, Eng S, Zepf R, Draughon J, Lum P

Abstract
Substance use among people living with HIV is high, and screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach to addressing the issue. We examined whether patients would participate in a technology-based SBIRT program in an urban HIV clinic. An SBIRT intervention was programmed into the clinic's web-based patient portal linked to their personal health record. We examined: demographic, health, HIV, and substance use characteristics of participants who completed the web-based intervention compared to those who did not. Fewer than half of the 96 participants assigned to the web-based SBIRT completed it (n = 39; 41 %). Participants who completed the web-based intervention had significantly higher amphetamine SSIS scores than those who did not complete the intervention. Participants whose substance use is more harmful may be more motivated to seek help from a variety of sources. In addition, it is important that technology-based approaches to behavioral interventions in clinics take into consideration feasibility, client knowledge, and comfort using technology.

PMID: 25963770 [PubMed - as supplied by publisher]

Alcohol screening and brief interventions for offenders in the probation setting (SIPS Trial): a pragmatic multicentre cluster randomized controlled trial.

Wed, 05/13/2015 - 6:00am
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Alcohol screening and brief interventions for offenders in the probation setting (SIPS Trial): a pragmatic multicentre cluster randomized controlled trial.

Alcohol Alcohol. 2014 Sep-Oct;49(5):540-8

Authors: Newbury-Birch D, Coulton S, Bland M, Cassidy P, Dale V, Deluca P, Gilvarry E, Godfrey C, Heather N, Kaner E, McGovern R, Myles J, Oyefeso A, Parrott S, Patton R, Perryman K, Phillips T, Shepherd J, Drummond C

Abstract
AIM: To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in the probation setting. Offender managers were randomized to three interventions, each of which built on the previous one: feedback on screening outcome and a client information leaflet control group, 5 min of structured brief advice and 20 min of brief lifestyle counselling.
METHODS: A pragmatic multicentre factorial cluster randomized controlled trial. The primary outcome was self-reported hazardous or harmful drinking status measured by Alcohol Use Disorders Identification Test (AUDIT) at 6 months (negative status was a score of <8). Secondary outcomes were AUDIT status at 12 months, experience of alcohol-related problems, health utility, service utilization, readiness to change and reduction in conviction rates.
RESULTS: Follow-up rates were 68% at 6 months and 60% at 12 months. At both time points, there was no significant advantage of more intensive interventions compared with the control group in terms of AUDIT status. Those in the brief advice and brief lifestyle counselling intervention groups were statistically significantly less likely to reoffend (36 and 38%, respectively) than those in the client information leaflet group (50%) in the year following intervention.
CONCLUSION: Brief advice or brief lifestyle counselling provided no additional benefit in reducing hazardous or harmful drinking compared with feedback on screening outcome and a client information leaflet. The impact of more intensive brief intervention on reoffending warrants further research.

PMID: 25063992 [PubMed - indexed for MEDLINE]

Impact of a Multi-Component SBIRT Training Curriculum on a Medical Residency Program.

Tue, 05/12/2015 - 6:00am

Impact of a Multi-Component SBIRT Training Curriculum on a Medical Residency Program.

Subst Abus. 2015 May 11;:0

Authors: Kalu N, Cain G, McLaurin-Jones T, Scott D, Kwagyan J, Fassassi C, Greene W, Taylor RE

Abstract
BACKGROUND: Substance-related disorders are a growing problem in the United States. The patient-provider setting can serve as a crucial environment to detect and prevent at-risk substance use. Screening, brief intervention, and referral to treatment (SBIRT) is an integrated approach to deliver early intervention and treatment services for persons who have or are at-risk for substance related disorders. SBIRT training components can include online modules, in-person instruction, practical experience, and clinical skills assessment. This paper will evaluate the impact of multiple modes of training on acquisition of SBIRT skills as observed in a clinical skills assessment.
METHODS: Residents were part of an SBIRT training program, from 2009 through 2013, consisting of lecture, role play, online modules, patient encounters, and clinical skills assessment (CSA). Differences were assessed across satisfactory and unsatisfactory CSA performance.
RESULTS: 70% of the residents satisfactorily completed CSA. Demographics, type of components completed, and number of components completed were similar among residents that demonstrated satisfactory clinical skills compared to those that did not. All components of the training program were accepted equally across specialties and resident matriculation cohorts.
CONCLUSION: The authors conclude that the components employed in SBIRT training do not have to be numerous, or of a particular mode of training, in order to see observable demonstration of SBIRT skills among medical residents. Thus residency educators who have limited time or resources may utilize as few as one mode of training to effectually disseminate SBIRT skills among healthcare providers. As SBIRT continues to evolve as a promising tool to address at-risk substance-related disorders it is critical to train medical residents and other health professionals.

PMID: 25961140 [PubMed - as supplied by publisher]

Validation of the ASSIST for Detecting Unhealthy Alcohol Use and Alcohol Use Disorders in Urgent Care Patients.

Wed, 05/06/2015 - 6:00am

Validation of the ASSIST for Detecting Unhealthy Alcohol Use and Alcohol Use Disorders in Urgent Care Patients.

Alcohol Clin Exp Res. 2015 May 2;

Authors: Johnson JA, Bembry W, Peterson J, Lee A, Seale JP

Abstract
BACKGROUND: Screening and brief intervention (SBI) is effective in reducing alcohol use, particularly among moderate risk patients. Results of SBI are inconsistent among patients with alcohol use disorders (AUDs). The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is used as a screening tool in many existing SBI programs. ASSIST validation studies have identified risk level cutoff scores using criteria for AUD and have not included a criterion measure for at-risk drinking (ARD), the group for whom SBI is most effective. This study examines the ability of the ASSIST to identify unhealthy alcohol use (ARD or AUD) and AUD in patients presenting to urgent care.
METHODS: Data were obtained from interviews with 442 adult drinkers presenting to 1 of 3 urgent care clinics. Subjects completed the ASSIST, a 90-day timeline follow-back interview to detect ARD, and a modified Diagnostic Interview Schedule to identify AUD. Validity measures compared the specificity and sensitivity of cutoff scores for the ASSIST in detecting unhealthy alcohol use and AUDs.
RESULTS: The optimal ASSIST score for detecting unhealthy alcohol use is 6+ for males (sensitivity and specificity 68 and 66%, respectively) and 5+ for females (62%/70%). Sensitivity, specificity, and receiver operating characteristic values were lower than those previously reported for the Alcohol Use Disorders Identification Test (AUDIT). For AUD, the optimal ASSIST cutoff scores are 10+ for males (63%/85%) and 9+ for females (63%/85%). While higher scores provided increased specificity, thereby reducing the percentage of false positives, sensitivity dropped sharply as scores increased.
CONCLUSIONS: Optimal ASSIST cutoff scores for unhealthy alcohol use are lower than those commonly used in many SBI programs. Use of lower ASSIST cutoff scores may increase detection of unhealthy alcohol use and increase the numbers served by SBI programs.

PMID: 25939447 [PubMed - as supplied by publisher]

Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials.

Wed, 04/29/2015 - 6:00am
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Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials.

Addiction. 2015 Apr 24;

Authors: Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA

Abstract
BACKGROUND AND AIMS: Brief alcohol interventions in medical settings are efficacious in improving self-reported alcohol consumption among those with low-severity alcohol problems. Screening, Brief Intervention, and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral-specific component, in increasing the utilization of alcohol-related care.
METHODS: A systematic review of English language articles published in electronic databases through 2013. We included randomised controlled trials (RCTs) of brief alcohol interventions in general healthcare settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and independently conducted. The primary outcome was post-treatment alcohol services utilization assessed by self-report or administrative data, which we compared across intervention and control groups.
RESULTS: Thirteen RCTs met inclusion criteria and nine were meta-analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio was RR = 1.08 (95% CI = 0.92-1.28). Five studies compared referral-specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81-1.43). Other subgroup analyses of studies with common characteristics (e.g., age, setting, severity, risk of bias) yielded non-statistically significant results.
CONCLUSIONS: There is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol-related services.

PMID: 25913697 [PubMed - as supplied by publisher]

Expressive writing as a therapeutic process for drug-dependent women.

Tue, 04/14/2015 - 6:30am
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Expressive writing as a therapeutic process for drug-dependent women.

Subst Abus. 2014;35(1):80-8

Authors: Meshberg-Cohen S, Svikis D, McMahon TJ

Abstract
BACKGROUND: Although women with substance use disorders (SUDs) have high rates of trauma and posttraumatic stress, many addiction programs do not offer trauma-specific treatments. One promising intervention is Pennebaker's expressive writing, which involves daily, 20-minute writing sessions to facilitate disclosure of stressful experiences.
METHODS: Women (N = 149) in residential treatment completed a randomized clinical trial comparing expressive writing with control writing. Repeated-measures analysis of variance was used to document change in psychological and physical distress from baseline to 2-week and 1-month follow-ups. Analyses also examined immediate levels of negative affect following expressive writing.
RESULTS: Expressive writing participants showed greater reductions in posttraumatic symptom severity, depression, and anxiety scores, when compared with control writing participants at the 2-week follow-up. No group differences were found at the 1-month follow-up. Safety data were encouraging: although expressive writing participants showed increased negative affect immediately after each writing session, there were no differences in pre-writing negative affect scores between conditions the following day. By the final writing session, participants were able to write about traumatic/stressful events without having a spike in negative affect.
CONCLUSIONS: Results suggest that expressive writing may be a brief, safe, low-cost, adjunct to SUD treatment that warrants further study as a strategy for addressing posttraumatic distress in substance-abusing women.

PMID: 24588298 [PubMed - indexed for MEDLINE]

Kiosk versus In-person Screening for Alcohol and Drug Use in the Emergency Department: Patient Preferences and Disclosure.

Fri, 04/03/2015 - 6:00am

Kiosk versus In-person Screening for Alcohol and Drug Use in the Emergency Department: Patient Preferences and Disclosure.

West J Emerg Med. 2015 Mar;16(2):220-228

Authors: Hankin A, Haley L, Baugher A, Colbert K, Houry D

Abstract
INTRODUCTION: Annually eight million emergency department (ED) visits are attributable to alcohol use. Screening ED patients for at-risk alcohol and substance use is an integral component of screening, brief intervention, and referral to treatment programs, shown to be effective at reducing substance use. The objective is to evaluate ED patients' acceptance of and willingness to disclose alcohol/substance use via a computer kiosk versus an in-person interview.
METHODS: This was a cross-sectional, survey-based study. Eligible participants included those who presented to walk-in triage, were English-speaking, ≥18 years, were clinically stable and able to consent. Patients had the opportunity to access the kiosk in the ED waiting room, and were approached for an in-person survey by a research assistant (9am-5pm weekdays). Both surveys used validated assessment tools to assess drug and alcohol use. Disclosure statistics and preferences were calculated using chi-square tests and McNemar's test.
RESULTS: A total of 1,207 patients were screened: 229 in person only, 824 by kiosk, and 154 by both in person and kiosk. Single-modality participants were more likely to disclose hazardous drinking (p=0.003) and high-risk drug use (OR=22.3 [12.3-42.2]; p<0.0001) via kiosk. Participants who had participated in screening via both modalities were more likely to reveal high-risk drug use on the kiosk (p=0.003). When asked about screening preferences, 73.6% reported a preference for an in-person survey, which patients rated higher on privacy and comfort.
CONCLUSION: ED patients were significantly more likely to disclose at-risk alcohol and substance use to a computer kiosk than an interviewer. Paradoxically patients stated a preference for in-person screening, despite reduced disclosure to a human screener.

PMID: 25834660 [PubMed - as supplied by publisher]

Implementing outside the box: Community-based social service provider experiences with using an alcohol screening and intervention.

Tue, 03/24/2015 - 6:00am

Implementing outside the box: Community-based social service provider experiences with using an alcohol screening and intervention.

J Soc Serv Res. 2015;41(2):233-245

Authors: Patterson Silver Wolf Adelv Unegv Waya DA, Ramsey AT, van den Berk-Clark C

Abstract
OBJECTIVE: The aim of this study is better understand perceptions of front-line social service workers who are not addiction specialists, but have to address addiction-related issues during their standard services.
METHOD: Six social service organizations implemented a validated alcohol assessment and brief education intervention. After a 3-month trial implementation period, a convenience sample of 64 front-line providers participated in six focus groups to examine barriers and facilitators to the implementation of an alcohol screening and brief intervention.
RESULTS: Three themes emerged: (1) usefulness of the intervention, (2) intervention being an appropriate fit with the agency and client population, and (3) worker commitment and proper utilization during the implementation process.
CONCLUSIONS: A cross-cutting theme that emerged was the context in which the intervention was implemented, as this was central to each of the three primary themes identified from the focus groups (i.e., the usefulness and appropriateness of the intervention and the implementation process overall). Practitioner buy-in concerns also indicate the need for better addiction service training opportunities for those without addiction-specific educational backgrounds. Future research should assess whether targeted trainings increase addiction screening and education in social services settings.

PMID: 25798019 [PubMed - as supplied by publisher]

Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study.

Fri, 03/20/2015 - 6:00am

Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study.

Alcohol Alcohol. 2015 Mar 18;

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

Abstract
AIMS: To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals.
METHODS: Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment.
RESULTS: The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%.
CONCLUSION: The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation.

PMID: 25787012 [PubMed - as supplied by publisher]

Screening, Brief Intervention and Referral to Treatment for Adolescents: Attitudes, Perceptions and Practice of New York School-Based Health Center Providers.

Tue, 03/17/2015 - 6:00am

Screening, Brief Intervention and Referral to Treatment for Adolescents: Attitudes, Perceptions and Practice of New York School-Based Health Center Providers.

Subst Abus. 2015 Mar 16;:0

Authors: Harris BR, Shaw BA, Sherman BR, Lawson HA

Abstract
BACKGROUND: Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been endorsed by the American Academy of Pediatrics as an evidence-based strategy to address risky substance use among adolescents in primary care. However, less than half of pediatricians even screen adolescents for substance use. The purpose of this study was to identify variation in SBIRT practice and explore how program directors' and clinicians' attitudes and perceptions of effectiveness, role responsibility, and self-efficacy impact SBIRT adoption, implementation, and practice in school-based health centers (SBHCs).
METHODS: All 162 New York State SBHC program directors and clinicians serving middle and high school students were surveyed between May and June 2013 (40% response rate).
RESULTS: Only 22% of participants reported practicing the SBIRT model. Of the individual SBIRT model components, using a standardized tool to screen students for risky substance use, referring students with substance use problems to specialty treatment, and assessing students' readiness to change were practiced least frequently. Less than 30% of participants felt they could be effective at helping students reduce substance use, 63% did not believe it was their role to use a standardized screening tool, and 20-30% did not feel confident performing specific aspects of intervention and management. Each of these factors was correlated with SBIRT practice frequency (p<.05).
CONCLUSIONS: Findings from this study identify an important gap between an evidence-based SBIRT model and its adoption into practice within SBHCs, indicating a need for dissemination strategies targeting role responsibility, self-efficacy, and clinician perceptions of SBIRT effectiveness.

PMID: 25774987 [PubMed - as supplied by publisher]

The Role of Schools in Substance Use Prevention and Intervention.

Tue, 03/17/2015 - 6:00am

The Role of Schools in Substance Use Prevention and Intervention.

Child Adolesc Psychiatr Clin N Am. 2015 Apr;24(2):291-303

Authors: Benningfield MM, Riggs P, Stephan SH

Abstract
Schools provide an ideal setting for screening, brief interventions, and outpatient treatment for substance use disorders (SUD). Individual treatment for SUD is effective at decreasing substance use as well as substance-related harm. In some contexts, rather than being helpful, group interventions can result in harm to participants; therefore, individual treatment may be preferred. Early interventions for adolescents who are using alcohol and other drugs (AOD) are generally effective in decreasing frequency and quantity of AOD use as well as decreasing risky behaviors.

PMID: 25773325 [PubMed - as supplied by publisher]