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Intimate Partner Violence During Pregnancy: Maternal and Neonatal Outcomes.

11 hours 53 min ago

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
Related Articles

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]

Facilitators and Barriers to Implementing SBIRT in Primary Care in Integrated Health Care Settings.

Sat, 08/16/2014 - 6:00am

Facilitators and Barriers to Implementing SBIRT in Primary Care in Integrated Health Care Settings.

Subst Abus. 2014 Aug 15;:0

Authors: Rahm AK, Boggs JM, Martin C, Price DW, Beck A, Backer TE, Dearing JW

Abstract
ABSTRACT Background: Substance abuse in the United States is a serious public health concern impacting morbidity and mortality. However, systematic screening and intervention has not been widely adopted into routine practice by health care organizations and routine screening and intervention is not currently in place for primary care at Kaiser Permanente Colorado. Therefore, a formative evaluation was conducted to explore and enhance implementation of the Substance Abuse and Mental Health Services Administration (SAMHSA) Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach in the organization. Methods: Key clinical stakeholders, including internal and family medicine physicians, primary care nurses, mental health therapists, chemical dependency clinicians, and clinic-based psychologists provided feedback. Two focus groups were also conducted with patient stakeholders; one in English and one in Spanish. Results: All clinical stakeholders promoted clinic-based psychologists to conduct brief intervention and determine referral to treatment as the optimal implementation program. Inclusion of the patient perspective also highlighted the importance of considering this perspective in implementation. Both patient groups were generally supportive of SBIRT, especially the educational value of screening questions defining healthy drinking limits, however, English-speaking patients noted privacy concerns and Spanish-speaking patients noted frequently being asked about drug or alcohol use. Organizationally, systems exist to facilitate drug and alcohol use screening, intervention, and referral to treatment. However, physician time, alignment with other priorities, and lack of consistent communication were noted potential barriers to SBIRT implementation. Conclusions: Clinicians expressed concerns about competing priorities and the need for organizational leadership involvement for successful SBIRT implementation. A unique suggestion for successful implementation is to utilize existing primary care clinic-based psychologists to conduct brief intervention and facilitate referral to treatment. Patient stakeholders supported universal screening but cultural differences in opinions and current experience were noted, indicating the importance of including this perspective when evaluating implementation potential.

PMID: 25127073 [PubMed - as supplied by publisher]

Brief Intervention to Increase Emergency Department Uptake of Combined Rapid Human Immunodeficiency Virus and Hepatitis C Screening Among a Drug Misusing Population.

Sat, 08/16/2014 - 6:00am

Brief Intervention to Increase Emergency Department Uptake of Combined Rapid Human Immunodeficiency Virus and Hepatitis C Screening Among a Drug Misusing Population.

Acad Emerg Med. 2014 Jul;21(7):752-767

Authors: Merchant RC, Baird JR, Liu T, Taylor LE, Montague BT, Nirenberg TD

Abstract
OBJECTIVES: In this study, Increasing Viral Testing in the Emergency Department (InVITED), the authors investigated if a brief intervention about human immunodeficiency virus (HIV) and hepatitis C virus (HCV) risk-taking behaviors and drug use and misuse in addition to a self-administered risk assessment, compared to a self-administered risk assessment alone, increased uptake of combined screening for HIV and HCV, self-perception of HIV/HCV risk, and impacted beliefs and opinions on HIV/HCV screening.
METHODS: InVITED was a randomized, controlled trial conducted at two urban emergency departments (EDs) from February 2011 to March 2012. ED patients who self-reported drug use within the past 3 months were invited to enroll. Drug misuse severity and need for a brief or more intensive intervention was assessed using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants were randomly assigned to one of two study arms: a self-administered HIV/HCV risk assessment alone (control arm) or the assessment plus a brief intervention about their drug misuse and screening for HIV/HCV (intervention arm). Beliefs on the value of combined HIV/HCV screening, self-perception of HIV/HCV risk, and opinions on HIV/HCV screening in the ED were measured in both study arms before the HIV/HCV risk assessment (pre), after the assessment in the control arm, and after the brief intervention in the intervention arm (post). Participants in both study arms were offered free combined rapid HIV/HCV screening. Uptake of screening was compared by study arm. Multivariable logistic regression models were used to evaluate factors related to uptake of screening.
RESULTS: Of the 395 participants in the study, the median age was 28 years (interquartile range [IQR] = 23 to 38 years), 44.8% were female, 82.3% had ever been tested for HIV, and 67.3% had ever been tested for HCV. Uptake of combined rapid HIV/HCV screening was nearly identical by study arm (64.5% vs. 65.2%; Δ = -0.7%; 95% confidence interval [CI] = -10.1% to 8.7%). Of the 256 screened, none had reactive HIV antibody tests, but seven (2.7%) had reactive HCV antibody tests. Multivariable logistic regression analysis results indicated that uptake of screening was not related to study arm assignment, total ASSIST drug scores, need for an intervention for drug misuse, or HIV/HCV sexual risk assessment scores. However, uptake of screening was greater among participants who indicated placing a higher value on combined rapid HIV/HCV screening for themselves and all ED patients and those with higher levels of perceived HIV/HCV risk. Uptake of combined rapid HIV/HCV screening was not related to changes in beliefs regarding the value of combined HIV/HCV screening or self-perceived HIV/HCV risk (post- vs. pre-risk assessment with or without a brief intervention). Opinions regarding the ED as a venue for combined rapid HIV/HCV screening were not related to uptake of screening.
CONCLUSIONS: Uptake of combined rapid HIV/HCV screening is high and considered valuable among drug using and misusing ED patients with little concern about the ED as a screening venue. The brief intervention investigated in this study does not appear to change beliefs regarding screening, self-perceived risk, or uptake of screening for HIV/HCV in this population. Initial beliefs regarding the value of screening and self-perceived risk for these infections predict uptake of screening.

PMID: 25125271 [PubMed - as supplied by publisher]

Adolescent Substance Involvement Use and Abuse.

Sat, 08/16/2014 - 6:00am

Adolescent Substance Involvement Use and Abuse.

Prim Care. 2014 Sep;41(3):567-585

Authors: Monasterio EB

Abstract
Substance use in adolescence is common, but not all use indicates a substance use disorder. The primary care provider has an essential role in screening for substance involvement, assessing the level of substance use and its impact on function, and engaging in a brief intervention to encourage and support behavioral change related to substance use. This article summarizes the literature on adolescent vulnerability to substance use disorders and their impact on adolescent health and well-being. Practical concrete suggestions for approaches to screening, brief interventions, and referral to treatment provide a stepwise approach to adolescent substance use assessment and intervention.

PMID: 25124207 [PubMed - as supplied by publisher]

Web-based training for primary care providers on screening, brief intervention, and referral to treatment (SBIRT) for alcohol, tobacco, and other drugs.

Fri, 08/15/2014 - 6:00am

Web-based training for primary care providers on screening, brief intervention, and referral to treatment (SBIRT) for alcohol, tobacco, and other drugs.

J Subst Abuse Treat. 2014 Jul 12;

Authors: Stoner SA, Mikko AT, Carpenter KM

Abstract
This project evaluated a Web-based multimedia training for primary care providers in screening, brief intervention, and referral to treatment (SBIRT) for unhealthy use of alcohol, tobacco, and other drugs. Physicians (n=37), physician assistants (n=35), and nurse practitioners (n=20) were recruited nationally by email and randomly assigned to online access to either the multimedia training or comparable reading materials. At baseline, compared to non-physicians, physicians reported lower self-efficacy for counseling patients regarding substance use and doing so less frequently. All provider types in both conditions showed significant increases in SBIRT-related knowledge, self-efficacy, and clinical practices. Although the multimedia training was not superior to the reading materials with regard to these outcomes, the multimedia training was more likely to be completed and rated more favorably. Findings indicate that SBIRT training does not have to be elaborate to be effective. However, multimedia training may be more appealing to the target audiences.

PMID: 25115136 [PubMed - as supplied by publisher]

Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial.

Thu, 08/07/2014 - 6:00am

Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial.

JAMA. 2014 Aug 6;312(5):502-13

Authors: Saitz R, Palfai TP, Cheng DM, Alford DP, Bernstein JA, Lloyd-Travaglini CA, Meli SM, Chaisson CE, Samet JH

Abstract
IMPORTANCE: The United States has invested substantially in screening and brief intervention for illicit drug use and prescription drug misuse, based in part on evidence of efficacy for unhealthy alcohol use. However, it is not a recommended universal preventive service in primary care because of lack of evidence of efficacy.
OBJECTIVE: To test the efficacy of 2 brief counseling interventions for unhealthy drug use (any illicit drug use or prescription drug misuse)-a brief negotiated interview (BNI) and an adaptation of motivational interviewing (MOTIV)-compared with no brief intervention.
DESIGN, SETTING, AND PARTICIPANTS: This 3-group randomized trial took place at an urban hospital-based primary care internal medicine practice; 528 adult primary care patients with drug use (Alcohol, Smoking, and Substance Involvement Screening Test [ASSIST] substance-specific scores of ≥4) were identified by screening between June 2009 and January 2012 in Boston, Massachusetts.
INTERVENTIONS: Two interventions were tested: the BNI is a 10- to 15-minute structured interview conducted by health educators; the MOTIV is a 30- to 45-minute intervention based on motivational interviewing with a 20- to 30-minute booster conducted by master's-level counselors. All study participants received a written list of substance use disorder treatment and mutual help resources.
MAIN OUTCOMES AND MEASURES: Primary outcome was number of days of use in the past 30 days of the self-identified main drug as determined by a validated calendar method at 6 months. Secondary outcomes included other self-reported measures of drug use, drug use according to hair testing, ASSIST scores (severity), drug use consequences, unsafe sex, mutual help meeting attendance, and health care utilization.
RESULTS: At baseline, 63% of participants reported their main drug was marijuana, 19% cocaine, and 17% opioids. At 6 months, 98% completed follow-up. Mean adjusted number of days using the main drug at 6 months was 12 for no brief intervention vs 11 for the BNI group (incidence rate ratio [IRR], 0.97; 95% CI, 0.77-1.22) and 12 for the MOTIV group (IRR, 1.05; 95% CI, 0.84-1.32; P = .81 for both comparisons vs no brief intervention). There were also no significant effects of BNI or MOTIV on any other outcome or in analyses stratified by main drug or drug use severity.
CONCLUSIONS AND RELEVANCE: Brief intervention did not have efficacy for decreasing unhealthy drug use in primary care patients identified by screening. These results do not support widespread implementation of illicit drug use and prescription drug misuse screening and brief intervention.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00876941.

PMID: 25096690 [PubMed - in process]

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