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Frequency and Risk of Marijuana Use among Substance-Using Health Care Patients in Colorado with and without Access to State Legalized Medical Marijuana.

Thu, 02/26/2015 - 6:00am

Frequency and Risk of Marijuana Use among Substance-Using Health Care Patients in Colorado with and without Access to State Legalized Medical Marijuana.

J Psychoactive Drugs. 2015 January-March;47(1):1-9

Authors: Richmond MK, Pampel FC, Rivera LS, Broderick KB, Reimann B, Fischer L

Abstract
With increasing use of state legalized medical marijuana across the country, health care providers need accurate information on patterns of marijuana and other substance use for patients with access to medical marijuana. This study compared frequency and severity of marijuana use, and use of other substances, for patients with and without state legal access to medical marijuana. Data were collected from 2,030 patients who screened positive for marijuana use when seeking health care services in a large, urban safety-net medical center. Patients were screened as part of a federally funded screening, brief intervention, and referral to treatment (SBIRT) initiative. Patients were asked at screening whether they had a state-issued medical marijuana card and about risky use of tobacco, alcohol, and other illicit substances. A total of 17.4% of marijuana users had a medical marijuana card. Patients with cards had higher frequency of marijuana use and were more likely to screen at moderate than low or high risk from marijuana use. Patients with cards also had lower use of other substances than patients without cards. Findings can inform health care providers of both the specific risks of frequent, long-term use and the more limited risks of other substance use faced by legal medical marijuana users.

PMID: 25715066 [PubMed - as supplied by publisher]

Using process indicators to optimize service completion of an ED drug and alcohol brief intervention program.

Wed, 02/18/2015 - 6:00am
Related Articles

Using process indicators to optimize service completion of an ED drug and alcohol brief intervention program.

Am J Emerg Med. 2015 Jan;33(1):37-42

Authors: Akin J, Johnson JA, Seale JP, Kuperminc GP

Abstract
OBJECTIVE: The strongest evidence for effectiveness of screening, brief intervention, and referral to treatment (SBIRT) programs is in primary care settings. Emergency department (ED) studies have shown mixed results. Implementation of SBIRT into ED settings is complicated by the type of patients seen and the fast-paced, high-throughput nature of the ED environment that makes it difficult to reach patients flagged for SBIRT services. This study uses data from an ED-based SBIRT program to examine the relationship between screen-positive rate, ED patient flow, and SBIRT service delivery.
METHODS: Data for the study (N = 67137) were derived from weekly reports extracted directly from one hospital's electronic health record. Measures included time and day of patient entry, drug/alcohol screen result (positive or negative), and whether the patient was reached by SBIRT specialists. Factorial analysis of variance compared variations in screen-positive rates by day and time and the percentage of patients reached by SBIRT specialists during these periods.
RESULTS: Overall, 56% of screen-positive patients received SBIRT services. Only 5% of patients offered SBIRT services refused. Day and time of entry had a significant interaction effect on the reached rate (F12,14166 =3.48, P < .001). Although patient volume was lowest between 11 pm and 7 am, screen-positive rates were highest during this period, particularly on weekends; and patients were least likely to be reached during these periods.
CONCLUSIONS: When implementing an ED-based SBIRT program, thoughtful consideration should be given to patient flow and staffing to maximize program impact and increase the likelihood of sustainability.

PMID: 25455051 [PubMed - indexed for MEDLINE]

Reducing substance involvement in college students: A three-arm parallel-group randomized controlled trial of a computer-based intervention.

Sat, 02/14/2015 - 6:00am

Reducing substance involvement in college students: A three-arm parallel-group randomized controlled trial of a computer-based intervention.

Addict Behav. 2015 Jan 21;45C:164-171

Authors: Christoff AO, Boerngen-Lacerda R

Abstract
The prevalence of alcohol and other drug use is high among college students. Reducing their consumption will likely be beneficial for society as a whole. Computer and web-based interventions are promising for providing behaviorally based information. The present study compared the efficacy of three interventions (computerized screening and motivational intervention [ASSIST/MBIc], non-computerized screening and motivational intervention [ASSIST/MBIi], and screening only [control]) in college students in Curitiba, Brazil. A convenience sample of 458 students scored moderate and high risk on the ASSIST. They were then randomized into the three arms of the randomized controlled trial (ASSIST/MBIc, ASSIST/MBIi [interview], and assessment-only [control]) and assessed at baseline and 3months later. The ASSIST involvement scores decreased at follow-up compared with baseline in the three groups, suggesting that any intervention is better than no intervention. For alcohol, the specific involvement scores decreased to a low level of risk in the three groups and the MBIc group showed a positive outcome compared with control, and the scores for each question were reduced in the two intervention groups compared to baseline. For tobacco, involvement scores decreased in the three groups, but they maintained moderate risk. For marijuana, a small positive effect was observed in the ASSIST/MBIi and control groups. The ASSIST/MBIc may be a good alternative to interview interventions because it is easy to administer, students frequently use such computer-based technologies, and individually tailored content can be delivered in the absence of a counselor.

PMID: 25679364 [PubMed - as supplied by publisher]

Integrating Screening, Brief Intervention and Referral to Treatment (SBIRT) into an Abortion Clinic: An Exploratory Study of Acceptability.

Sun, 01/18/2015 - 6:00am

Integrating Screening, Brief Intervention and Referral to Treatment (SBIRT) into an Abortion Clinic: An Exploratory Study of Acceptability.

Contraception. 2015 Jan 14;

Authors: Appel L, Ramanadhan S, Hladky K, Welsh C, Terplan M

Abstract
Screening, Brief Intervention, and Referral to treatment (SBIRT) is an effective means of identifying problematic substance use. We evaluated the acceptability of SBIRT in an abortion clinic via an anonymous survey of 100 participants. Clients were comfortable being asked about their substance use, receiving counseling, and treatment referral (mean Likert 1.1, 1.5, and 1.6 respectively) and were only minimally embarrassed when asked about substance use (mean Likert 3.6). These findings suggest that integrating SBIRT into an abortion clinic may be feasible. However, future studies are needed to assess the efficacy of abortion clinic SBIRT in reducing risky substance use.

PMID: 25596511 [PubMed - as supplied by publisher]

Symptom severity, social supports, coping styles, and quality of life among individuals' diagnosed with Ménierè's disease.

Sun, 01/18/2015 - 6:00am

Symptom severity, social supports, coping styles, and quality of life among individuals' diagnosed with Ménierè's disease.

Chronic Illn. 2015 Jan 16;

Authors: Porter M, Boothroyd RA

Abstract
OBJECTIVES: To (1) examine the quality of life of individuals with Ménierè's disease in relation to symptom severity, social supports, and coping styles and (2) develop a prediction model to identify factors most strongly associated with quality of life.
METHODS: Data were collected using a web-based survey that included previously developed and validated measures (i.e. SF-12, Dizziness Handicap Inventory, Hearing Handicap Inventory for Elderly Screening Version, Iowa Tinnitus Handicap Questionnaire, Interpersonal Support Evaluation List, Brief COPES, Lehman's Quality of Life). Ninety-five individuals with Ménierè's disease who were members of one of five online Ménierè's disease support groups responded to the survey.
RESULTS: The findings indicated that symptom severity was negatively associated with patients' quality of life, social supports were positively associated with quality of life, and the use of negative coping styles (e.g. substance use, blaming) was negatively associated with quality of life. Four predictors (i.e. SF-12 mental health, dizziness severity, self-esteem support, and negative coping styles) accounted for 62% of the variance in quality of life.
DISCUSSION: The findings suggest that the factors associated with the quality of life of patients with Ménierè's disease are similar to those reported in the literature among patients with other chronic illnesses. The results also suggested that emphasis on psychosocial factors may be an important aspect of a comprehensive treatment intervention for individuals with Ménierè's disease.

PMID: 25595277 [PubMed - as supplied by publisher]

The implementation of an integrated information system for substance use screening in general medical settings.

Fri, 01/16/2015 - 6:00am

The implementation of an integrated information system for substance use screening in general medical settings.

Appl Clin Inform. 2014;5(4):878-94

Authors: Shanahan CW, Sorensen-Alawad A, Carney BL, Persand I, Cruz A, Botticelli M, Pressman K, Adams WG, Brolin M, Alford DP

Abstract
UNLABELLED: The Massachusetts Screening, Brief Intervention and Referral to Treatment (MASBIRT) Program, a substance use screening program in general medical settings, created a web-based, point-of-care (POC), application - the MASBIRT Portal (the "Portal") to meet program goals.
OBJECTIVES: We report on development and implementation of the Portal.
METHODS: Five year program process outcomes recorded by an independent evaluator and an anonymous survey of Health Educator's (HEs) adoption, perceptions and Portal use with a modified version of the Technology Readiness Index are described. [8] Specific management team members, selected based on their roles in program leadership, development and implementation of the Portal and supervision of HEs, participated in semi-structured, qualitative interviews.
RESULTS: At the conclusion of the program 73% (24/33) of the HEs completed a survey on their experience using the Portal. HEs reported that the Portal made recording screening information easy (96%); improved planning their workday (83%); facilitated POC data collection (84%); decreased time dedicated to data entry (100%); and improved job satisfaction (59%). The top two barriers to use were "no or limited wireless connectivity" (46%) and "the tablet was too heavy/bulky to carry" (29%). Qualitative management team interviews identified strategies for successful HIT implementation: importance of engaging HEs in outlining specifications and workflow needs, collaborative testing prior to implementation and clear agreement on data collection purpose, quality requirements and staff roles.
DISCUSSION: Overall, HEs perceived the Portal favorably with regard to time saving ability and improved workflow. Lessons learned included identifying core requirements early during system development and need for managers to institute and enforce consistent behavioral work norms.
CONCLUSION: Barriers and HEs' views of technology impacted the utilization of the MASBIRT Portal. Further research is needed to determine best approaches for HIT system implementation in general medical settings.

PMID: 25589904 [PubMed - in process]

South Texas Residency SBIRT Training: 12-Month Outcomes.

Tue, 01/13/2015 - 6:00am

South Texas Residency SBIRT Training: 12-Month Outcomes.

Subst Abus. 2015 Jan 12;:0

Authors: Malone GP, Vale S, Schneegans S, Amodei N, Burge SK, Wathen PI, Conde MV, Palmer R, Williams JF

Abstract
ABSTRACT Background: Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious and cost-effective skill set when implemented in primary care settings regarding hazardous alcohol use. This study assesses the impact of medical resident SBIRT training across three specialties, and identifies predictors of change in trainee behavior, attitudes and knowledge over 12 months. Methods: Our program's substance use SBIRT training was developed and tailored to fit diverse curricular objectives and settings across an array of medical residency programs in South Texas. The 329 residents training in Pediatrics, Family Medicine and Internal Medicine during 2009-2012 comprised the trainee group reported in this analysis. Surveys assessing SBIRT-related knowledge, current practice, confidence, role responsibility, attitudes, beliefs, and readiness to change were completed by 234 (71%) trainees at three time points: pre-training, then 30-days and 12-months post-initial training. Results: SBIRT-related knowledge, confidence, and practice increased from pre-training to 12-months follow-up. Residents who reported the least amount of pre-training clinical and/or prior academic exposure to substance use reported the greatest SBIRT practice increases. When controlling for demographic and prior exposure variables, the largest contributor to variance in SBIRT practice was attributed to residents' confidence in their SBIRT skills. Conclusions: SBIRT training that employs diverse educational methodologies as part of customizing the training to residency specialties can similarly enhance SBIRT-related knowledge, confidence and practice. Trainee report of limited prior clinical or academic exposure to substance use and/or low confidence regarding SBIRT skills and their professional role responsibilities related to substance use predicted trainee success and sustained SBIRT strategy application. When customizing SBIRT training, curriculum developers should consider leveraging and capacity building related to those factors predicting continued use of SBIRT practices.

PMID: 25581553 [PubMed - as supplied by publisher]

Identifying and Intervening with Substance-Using Women Exposed to Intimate Partner Violence: Phenomenology, Comorbidities, and Integrated Approaches Within Primary Care and Other Agency Settings.

Sat, 01/03/2015 - 6:00am

Identifying and Intervening with Substance-Using Women Exposed to Intimate Partner Violence: Phenomenology, Comorbidities, and Integrated Approaches Within Primary Care and Other Agency Settings.

J Womens Health (Larchmt). 2015 Jan 2;

Authors: Weaver TL, Gilbert L, El-Bassel N, Resnick HS, Noursi S

Abstract
Abstract Substance use and/or disorders (SUDs) have been identified as a significant correlate of intimate partner violence (IPV) exposure and present complex issues that intersect with the topography of IPV, attendant mental health, and physical co-morbidities and may pose barriers to primary care- and other agency-based screening and intervention efforts. Despite substantial research indicating significantly higher rates of all types and severity of IPV victimization among women with SUDs and bidirectional associations between partner or self-use of drugs or alcohol and IPV victimization, effective screening, brief interventions, coordinated systems of care, and treatment approaches to address these co-occurring problems remain very limited. We integrated select research examining the intersection of IPV victimization and SUDs and several comorbidities that have significant public health impact and provided recommendations for scaling up targeted interventions to redress these co-occurring problems among women in primary, emergency, and other care settings.

PMID: 25554915 [PubMed - as supplied by publisher]

A randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website (EFAR Spain): the study protocol.

Fri, 01/02/2015 - 6:00am

A randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website (EFAR Spain): the study protocol.

BMJ Open. 2014;4(12):e007130

Authors: López-Pelayo H, Wallace P, Segura L, Miquel L, Díaz E, Teixidó L, Baena B, Struzzo P, Palacio-Vieira J, Casajuana C, Colom J, Gual A

Abstract
INTRODUCTION: Early identification (EI) and brief interventions (BIs) for risky drinkers are effective tools in primary care. Lack of time in daily practice has been identified as one of the main barriers to implementation of BI. There is growing evidence that facilitated access by primary healthcare professionals (PHCPs) to a web-based BI can be a time-saving alternative to standard face-to-face BIs, but there is as yet no evidence about the effectiveness of this approach relative to conventional BI. The main aim of this study is to test non-inferiority of facilitation to a web-based BI for risky drinkers delivered by PHCP against face-to-face BI.
METHOD AND ANALYSIS: A randomised controlled non-inferiority trial comparing both interventions will be performed in primary care health centres in Catalonia, Spain. Unselected adult patients attending participating centres will be given a leaflet inviting them to log on to a website to complete the Alcohol Use Disorders Identification Test (AUDIT-C) alcohol screening questionnaire. Participants with positive results will be requested online to complete a trial module including consent, baseline assessment and randomisation to either face-to-face BI by the practitioner or BI via the alcohol reduction website. Follow-up assessment of risky drinking will be undertaken online at 3 months and 1 year using the full AUDIT and D5-EQD5 scale. Proportions of risky drinkers in each group will be calculated and non-inferiority assessed against a specified margin of 10%. Assuming reduction of 30% of risky drinkers receiving standard intervention, 1000 patients will be required to give 90% power to reject the null hypothesis.
ETHICS AND DISSEMINATION: The protocol was approved by the Ethics Commmittee of IDIAP Jordi Gol i Gurina P14/028. The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations.
TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02082990.

PMID: 25552616 [PubMed - as supplied by publisher]

A Longitudinal Study of State Strategies and Policies to Accelerate Evidence-Based Practices in the Context of Systems Transformation.

Wed, 12/24/2014 - 6:00am

A Longitudinal Study of State Strategies and Policies to Accelerate Evidence-Based Practices in the Context of Systems Transformation.

Health Serv Res. 2014 Dec 23;

Authors: Rieckmann T, Abraham A, Zwick J, Rasplica C, McCarty D

Abstract
OBJECTIVE: To profile state agency efforts to promote implementation of three evidence-based practices (EBPs): screening and brief intervention (SBIRT), psychosocial interventions, and medication-assisted treatment (MAT).
DATA SOURCES/STUDY SETTING: Primary data collected from representatives of 50 states and the District of Columbia's Single State Authorities from 2007 to 2009.
STUDY DESIGN/DATA COLLECTION: The study used mixed methods, in-depth, semistructured interviews and quantitative surveys. Interviews assessed state and provider strategies to accelerate implementation of EBPs.
PRINCIPAL FINDINGS: Statewide implementation of psychosocial interventions and MAT increased significantly over 3 years. In the first two assessments, states that contracted directly with providers were more likely to link use of EBPs to reimbursement, and states with indirect contract, through counties and other entities, increased recommendations, and some requirements for provision of specific EBPs. The number of states using legislation as a policy lever to promote EBPs was unchanged.
CONCLUSIONS: Health care reform and implementation of parity in coverage increases access to treatment for alcohol and drug use. Science-based substance abuse treatment will become even more crucial as payers seek consistent quality of care. This study provides baseline data on service delivery, contracting, and financing as state agencies and treatment providers prepare for implementation of the Affordable Care Act.

PMID: 25532616 [PubMed - as supplied by publisher]

Community-based HCV screening: knowledge and attitudes in a high risk urban population.

Fri, 12/19/2014 - 6:00am
Related Articles

Community-based HCV screening: knowledge and attitudes in a high risk urban population.

BMC Infect Dis. 2014;14:74

Authors: Norton BL, Voils CI, Timberlake SH, Hecker EJ, Goswami ND, Huffman KM, Landgraf A, Naggie S, Stout JE

Abstract
BACKGROUND: In an attempt to curtail the rising morbidity and mortality from undiagnosed HCV (hepatitis C virus) in the United States, screening guidelines have been expanded to high-risk individuals and persons born 1945-1965. Community-based screening may be one strategy in which to reach such persons; however, the acceptance of HCV testing, when many high-risk individuals may not have access to HCV specific medications, remains unknown.
METHODS: We set out to assess attitudes about HCV screening and knowledge about HCV disease at several community-based testing sites that serve high-risk populations. This assessment was paired with a brief HCV educational intervention, followed by post-education evaluation.
RESULTS: Participants (n = 140) were surveyed at five sites; two homeless shelters, two drug rehabilitation centers, and a women's "drop-in" center. Personal acceptance of HCV testing was almost unanimous, and 90% of participants reported that they would still want to be tested even if they were unable to receive HCV treatment. Baseline hepatitis C knowledge was poor; however, the brief educational intervention significantly improved knowledge and increased acceptability of testing when medical access issues were explicitly stated.
CONCLUSIONS: Despite inconsistencies in access to care and treatment, high-risk communities want to know their HCV status. Though baseline HCV knowledge was poor in this population, a brief on-site educational intervention improved both knowledge and acceptability of HCV testing and care. These data support the establishment of programs that utilize community-based screening, and also provide initial evidence for acceptance of the implementation of the recently expanded screening guidelines among marginalized communities.

PMID: 24512462 [PubMed - indexed for MEDLINE]

Comparing the motivational interviewing integrity in two prevalent models of brief intervention service delivery for primary care settings.

Thu, 12/18/2014 - 6:00am

Comparing the motivational interviewing integrity in two prevalent models of brief intervention service delivery for primary care settings.

J Subst Abuse Treat. 2014 Nov 5;

Authors: Dunn C, Darnell D, Carmel A, Atkins DC, Bumgardner K, Roy-Byrne P

Abstract
This quasi experimental study compared the motivational interviewing (MI) integrity in two prevalent brief intervention (BI) service delivery models for drug abuse. Routine primary care providers (RCPs) and non-routine care providers (NRCPs) performed BIs using an MI style within the same medical setting, patient population, and Screening, Brief Intervention, and Referral for Treatment (SBIRT) protocol. Interventionists (9 RCPs and 6 NRCPs) underwent similar MI training and performed a total of 423 audiorecorded BIs. We compared the MI integrity scores for all audio recorded sessions from these two SBIRT models for up to 40months post MI training. Both groups met the lower standard (beginning proficiency in MI) on 4 of 5 MI integrity scores, but NRCPs met more of the higher standards (competency in MI) than RCPs. There may be limitations with regards to MI fidelity when using RCPs to conduct BIs in some primary care settings. Further experimental investigation is warranted to replicate this finding and identify casual factors of observed differences in MI fidelity.

PMID: 25515624 [PubMed - as supplied by publisher]

[The addiction patient in the family physicians' practice: tools and skills for a successful performance].

Wed, 12/17/2014 - 6:00am
Related Articles

[The addiction patient in the family physicians' practice: tools and skills for a successful performance].

Ther Umsch. 2014 Oct;71(10):585-91

Authors: Neuner-Jehle S

Abstract
Addiction patients are usually perceived as problematic patients in primary care practices: Encounters often are time-consuming and the approach to the patient is difficult. Moreover, patients sometimes are hiding their addictive behaviour and behave shameful. Other barriers are a lack of experience in communication skills among physicians or their own addictive behaviour. Nevertheless, to diagnose and treat addiction as early as possible is an important task for family doctors, as patients' confidence in them is an important factor to induce a behaviour change. We present four screening tests for the early diagnosis of addiction to alcohol (AUDIT, AUDIT-C, CAGE, SMAST-G) and discuss their strengths and shortcomings. The family doctor's practice is also a useful setting for brief interventions based on motivational interviewing (MI) techniques and the transtheoretical model of behaviour change (TTM). We shortly introduce to these techniques and attitudes using addiction to alcohol and nicotine as examples, and we present innovative methods as "defined drinking" and new quit smoking methods. A respectful attitude towards the patient and communication skills seem to be key factors for family physicians to successfully approach their addiction patients.

PMID: 25257112 [PubMed - indexed for MEDLINE]

SBIRT goes to college: interdisciplinary screening for alcohol use.

Mon, 12/15/2014 - 1:30pm
Related Articles

SBIRT goes to college: interdisciplinary screening for alcohol use.

J Addict Nurs. 2013 Jan-Mar;24(1):45-50

Authors: Naegle M, Himmel J, Ellis P

Abstract
Although risky/harmful drinking, in the form of binge drinking, remains a national problem, only recently have health services in universities systematically screened for drinking, drug use, and smoking. This article recounts "lessons learned" in two nurse-directed, interdisciplinary health services, which adapted the National College Depression Partnership model to include screening and brief intervention (SBIRT) for risky/harmful alcohol use in the form of binge drinking. Using a planned change model, nurse leaders worked with university administrators, providers, and health service staff to screen all students seeking health services for risky drinking. The outcomes suggest that this process may increase staff and student awareness of the importance of alcohol consumption to health, show the ease of using SBIRT screening along with standard screening tools, and yield information on the normalization of high-risk drinking in collegiate settings. Project findings indicate that common perceptions in college students minimize negative outcomes and stress the importance of additional quality assurance initiatives that review the efficacy of combinations of standardized screening tools.

PMID: 24622529 [PubMed - indexed for MEDLINE]

Evaluation of a pilot training program in alcohol screening, brief intervention, and referral to treatment for nurses in inpatient settings.

Mon, 12/15/2014 - 1:30pm
Related Articles

Evaluation of a pilot training program in alcohol screening, brief intervention, and referral to treatment for nurses in inpatient settings.

J Addict Nurs. 2013 Jan-Mar;24(1):8-19

Authors: Broyles LM, Gordon AJ, Rodriguez KL, Hanusa BH, Kengor C, Kraemer KL

Abstract
Alcohol screening, brief intervention, and referral to treatment (SBIRT) is a set of clinical strategies for reducing the burden of alcohol-related injury, disease, and disability. SBIRT is typically considered a physician responsibility but calls for interdisciplinary involvement requiring basic SBIRT knowledge and skills training for all healthcare disciplines. The purpose of this pilot study was to design, implement, and evaluate a theory-driven SBIRT training program for nurses in inpatient settings (RN-SBIRT) that was developed through an interdisciplinary collaboration of nursing, medical, and public health professionals and tailored for registered nurses in the inpatient setting. In this three-phase study, we evaluated (1) RN-SBIRT's effectiveness for changing nurses' alcohol-related knowledge, clinical practice, and attitudes and (2) the feasibility of implementing the inpatient curriculum. In a quasi-experimental design, two general medical units at our facility were randomized to receive RN-SBIRT or a self-directed Web site on alcohol-related care. We performed a formative evaluation of RN-SBIRT, guided by the RE-AIM implementation framework. After training, nurses in the experimental condition had significant increases in Role Adequacy for working with drinkers and reported increased performance and increased competence for a greater number of SBIRT care tasks. Despite some scheduling challenges for the nurses to attend RN-SBIRT, nurse stakeholders were highly satisfied with RN-SBIRT. Results suggest that with adequate training and ongoing role support, nurses in inpatient settings could play active roles in interdisciplinary initiatives to address unhealthy alcohol use among hospitalized patients.

PMID: 24622525 [PubMed - indexed for MEDLINE]

A Randomized Control Trial of a Chronic Care Intervention for Homeless Women With Alcohol Use Problems.

Wed, 12/10/2014 - 6:00am
Related Articles

A Randomized Control Trial of a Chronic Care Intervention for Homeless Women With Alcohol Use Problems.

J Subst Abuse Treat. 2014 Nov 21;

Authors: Upshur C, Weinreb L, Bharel M, Reed G, Frisard C

Abstract
A clinician-randomized trial was conducted using the chronic care model for disease management for alcohol use problems among n=82 women served in a health care for the homeless clinic. Women with problem alcohol use received either usual care or an intervention consisting of a primary care provider (PCP) brief intervention, referral to addiction services, and on-going support from a care manager (CM) for 6months. Both groups significantly reduced their alcohol consumption, with a small effect size favoring intervention at 3months, but there were no significant differences between groups in reductions in drinking or in housing stability, or mental or physical health. However, intervention women had significantly more frequent participation in substance use treatment services. Baseline differences and small sample size limit generalizability, although substantial reductions in drinking for both groups suggest that screening and PCP brief treatment are promising interventions for homeless women with alcohol use problems.

PMID: 25488504 [PubMed - as supplied by publisher]

Effects of a Brief Intervention for Substance Use on Tobacco Smoking and Family Relationship Functioning in Schizophrenia and Related Psychoses: A Randomised Controlled Trial.

Thu, 12/04/2014 - 6:00am

Effects of a Brief Intervention for Substance Use on Tobacco Smoking and Family Relationship Functioning in Schizophrenia and Related Psychoses: A Randomised Controlled Trial.

J Subst Abuse Treat. 2014 Nov 5;

Authors: Tantirangsee N, Assanangkornchai S, Marsden J

Abstract
Surveys indicate that substance use is prevalent in populations with schizophrenia. Family members may be able to support brief interventions (BI). We conducted a randomised controlled trial with 6-month follow-up among adult patients with schizophrenia and related psychoses who were referred to two hospitals in southern Thailand. Patients with psychosis were screened using the Alcohol Smoking and Substance Involvement Screening Test (ASSIST). 169 participants (all at moderate substance risk on the ASSIST) were randomised to receive simple advice (the clinics' treatment-as-usual, TAU condition), or single-session brief intervention (BI), or a single-session BI with family support (BI-FS). Given observed substance use, the primary outcome was the ASSIST tobacco smoking involvement score (SIS). Secondary outcomes were cigarettes smoked per day, change motivation (Taking Steps from the Stages of Change and Treatment Eagerness Scale), and DSM-IV Axis V Global Assessment of Relational Functioning (GARF). At follow-up, BI-FS participants reported a lower SIS (mean difference, -2.82, 95% confidence interval [CI] -4.84 to -0.81; Glass' effect size [Δ]=0.57, 95% CI 0.19 to 0.95), smoked fewer cigarettes per day (mean difference -3.10, 95% CI -5.45 to -0.74; Δ=0.56, 95% CI 0.18 to 0.94), had greater change motivation (mean difference 3.05, 95% CI 0.54 to 5.57; Δ=0.41, 95% CI 0.03 to 0.79) and GARF (mean difference 6.75, 95% CI 1.57 to 11.93; Δ=0.54, 95% CI 0.16 to 0.92). The BI-FS group also had better relational functioning in comparison to those receiving BI only (mean difference 5.44, 95% CI 0.20 to 10.67; Δ=0.46, 95% CI 0.08 to 0.84). In schizophrenia and related psychoses, a brief intervention supported by a family member reduces smoking involvement, cigarette smoking intensity, and increases change motivation and relational functioning.

PMID: 25468004 [PubMed - as supplied by publisher]

Brief Interventions Implementation on Alcohol from the European Health Systems Perspective.

Thu, 11/27/2014 - 6:00am

Brief Interventions Implementation on Alcohol from the European Health Systems Perspective.

Front Psychiatry. 2014;5:161

Authors: Colom J, Scafato E, Segura L, Gandin C, Struzzo P

Abstract
Alcohol-related health problems are important public health issues and alcohol remains one of the leading risk factors of chronic health conditions. In addition, only a small proportion of those who need treatment access it, with figures ranging from 1 in 25 to 1 in 7. In this context, screening and brief interventions (SBI) have proven to be effective in reducing alcohol consumption and alcohol-related problems in primary health care (PHC) and are very cost effective, or even cost-saving, in PHC. Even if the widespread implementation of SBI has been prioritized and encouraged by the World Health Organization, in the global alcohol strategy, the evidence on long term and population-level effects is still weak. This review study will summarize the SBI programs implemented by six European countries with different socio-economic contexts. Similar components at health professional level but differences at organizational level, especially on the measures to support clinical practice, incentives, and monitoring systems developed were adopted. In Italy, cost-effectiveness analyses and Internet trials shed new light on limits and facilitators of renewed, evidence-based approaches to better deal with brief intervention in PHC. The majority of the efforts were aimed at overcoming individual barriers and promoting health professionals' involvement. The population screened has been in general too low to be able to detect any population-level effect, with a negative impact on the acceptability of the program to all stakeholders. This paper will present a different point of view based on a strategic broadening of the implemented actions to real inter-sectoriality and a wider holistic approach. Effective alcohol policies should strive for quality provision of health services and the empowerment of the individuals in a health system approach.

PMID: 25426083 [PubMed - as supplied by publisher]

Brief overdose education can significantly increase accurate recognition of opioid overdose among heroin users.

Wed, 11/19/2014 - 6:00am
Related Articles

Brief overdose education can significantly increase accurate recognition of opioid overdose among heroin users.

Int J Drug Policy. 2014 Jan;25(1):166-70

Authors: Jones JD, Roux P, Stancliff S, Matthews W, Comer SD

Abstract
BACKGROUND: In an effort to increase effective intervention following opioid overdose, the New York State Department of Health (NYSDOH) has implemented programs where bystanders are given brief education in recognizing the signs of opioid overdose and how to provide intervention, including the use of naloxone. The current study sought to assess the ability of NYSDOH training to increase accurate identification of opioid and non-opioid overdose, and naloxone use among heroin users.
METHODS: Eighty-four participants completed a test on overdose knowledge comprised of 16 putative overdose scenarios. Forty-four individuals completed the questionnaire immediately prior to and following standard overdose prevention training. A control group (n=40), who opted out of training, completed the questionnaire just once.
RESULTS: Overdose training significantly increased participants' ability to accurately identify opioid overdose (p<0.05), and scenarios where naloxone administration was indicated (p<0.05). Training did not alter recognition of non-opioid overdose or non-overdose situations where naloxone should not be administered.
CONCLUSIONS: The data indicate that overdose prevention training improves participants' knowledge of opioid overdose and naloxone use, but naloxone may be administered in some situations where it is not warranted. Training curriculum could be improved by teaching individuals to recognize symptoms of non-opioid drug over-intoxication.

PMID: 23773683 [PubMed - indexed for MEDLINE]

Evaluating Training of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use: Reliability of the MD3 SBIRT Coding Scale.

Tue, 11/18/2014 - 6:00am

Evaluating Training of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use: Reliability of the MD3 SBIRT Coding Scale.

Psychol Addict Behav. 2014 Nov 17;

Authors: DiClemente CC, Crouch TB, Norwood AE, Delahanty J, Welsh C

Abstract
Screening, brief intervention, and referral to treatment (SBIRT) has become an empirically supported and widely implemented approach in primary and specialty care for addressing substance misuse. Accordingly, training of providers in SBIRT has increased exponentially in recent years. However, the quality and fidelity of training programs and subsequent interventions are largely unknown because of the lack of SBIRT-specific evaluation tools. The purpose of this study was to create a coding scale to assess quality and fidelity of SBIRT interactions addressing alcohol, tobacco, illicit drugs, and prescription medication misuse. The scale was developed to evaluate performance in an SBIRT residency training program. Scale development was based on training protocol and competencies with consultation from Motivational Interviewing coding experts. Trained medical residents practiced SBIRT with standardized patients during 10- to 15-min videotaped interactions. This study included 25 tapes from the Family Medicine program coded by 3 unique coder pairs with varying levels of coding experience. Interrater reliability was assessed for overall scale components and individual items via intraclass correlation coefficients. Coder pair-specific reliability was also assessed. Interrater reliability was excellent overall for the scale components (>.85) and nearly all items. Reliability was higher for more experienced coders, though still adequate for the trained coder pair. Descriptive data demonstrated a broad range of adherence and skills. Subscale correlations supported concurrent and discriminant validity. Data provide evidence that the MD3 SBIRT Coding Scale is a psychometrically reliable coding system for evaluating SBIRT interactions and can be used to evaluate implementation skills for fidelity, training, assessment, and research. Recommendations for refinement and further testing of the measure are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

PMID: 25402834 [PubMed - as supplied by publisher]

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