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Design of the NIDA clinical trials network validation study of tobacco, alcohol, prescription medications, and substance use/misuse (TAPS) tool.

Mon, 07/25/2016 - 1:10pm
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Design of the NIDA clinical trials network validation study of tobacco, alcohol, prescription medications, and substance use/misuse (TAPS) tool.

Contemp Clin Trials. 2016 Jul 18;

Authors: Wu LT, McNeely J, Subramaniam GA, Sharma G, VanVeldhuisen P, Schwartz RP

Abstract
BACKGROUND: Substance use and its associated use disorders are under-detected and under-treated in primary care. There is a need for a clinically useful brief screening and assessment instrument to identify primary care patients with substance use, sub-threshold substance use disorder (SUD), and SUD to facilitate brief intervention and treatment.
METHODS: We describe the design of the recently completed National Drug Abuse Treatment Clinical Trials Network's tobacco, alcohol, prescription medications, and substance use/misuse screen and brief assessment tool validation study. Study aims included to: develop a 2-stage screening and brief assessment tool (TAPS Tool) to detect substance use, problem use, and SUD among adult primary care patients; examine the validity of both the screen component and the TAPS Tool by comparing them to reference standard screening and assessment measures of no use, problem use, and SUD; and determine the feasibility and acceptability of the self-administration and interviewer-administration of the tool. The design included a pilot testing phase (n=30) and the main study of 2000 adult primary care participants who were randomly assigned in counter-balanced order to have the interviewer-administration or the self-administration of the TAPS Tool followed by the other administration format. Participants' views of feasibility, acceptability and preference for format of self-administration versus interviewer-administration of the TAPS Tool were assessed. Criterion measures of use and DSM-5 SUDs were administered.
DISCUSSION: The TAPS Tool study builds on prior work to develop a 2-stage clinical tool for facilitating the adoption of screening, brief assessment and treatment for SUDs in primary care.

PMID: 27444426 [PubMed - as supplied by publisher]

A Novel Brief Therapy for Patients Who Attempt Suicide: A 24-months Follow-Up Randomized Controlled Study of the Attempted Suicide Short Intervention Program (ASSIP).

Mon, 07/18/2016 - 1:10pm
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A Novel Brief Therapy for Patients Who Attempt Suicide: A 24-months Follow-Up Randomized Controlled Study of the Attempted Suicide Short Intervention Program (ASSIP).

PLoS Med. 2016 Mar;13(3):e1001968

Authors: Gysin-Maillart A, Schwab S, Soravia L, Megert M, Michel K

Abstract
BACKGROUND: Attempted suicide is the main risk factor for suicide and repeated suicide attempts. However, the evidence for follow-up treatments reducing suicidal behavior in these patients is limited. The objective of the present study was to evaluate the efficacy of the Attempted Suicide Short Intervention Program (ASSIP) in reducing suicidal behavior. ASSIP is a novel brief therapy based on a patient-centered model of suicidal behavior, with an emphasis on early therapeutic alliance.
METHODS AND FINDINGS: Patients who had recently attempted suicide were randomly allocated to treatment as usual (n = 60) or treatment as usual plus ASSIP (n = 60). ASSIP participants received three therapy sessions followed by regular contact through personalized letters over 24 months. Participants considered to be at high risk of suicide were included, 63% were diagnosed with an affective disorder, and 50% had a history of prior suicide attempts. Clinical exclusion criteria were habitual self-harm, serious cognitive impairment, and psychotic disorder. Study participants completed a set of psychosocial and clinical questionnaires every 6 months over a 24-month follow-up period. The study represents a real-world clinical setting at an outpatient clinic of a university hospital of psychiatry. The primary outcome measure was repeat suicide attempts during the 24-month follow-up period. Secondary outcome measures were suicidal ideation, depression, and health-care utilization. Furthermore, effects of prior suicide attempts, depression at baseline, diagnosis, and therapeutic alliance on outcome were investigated. During the 24-month follow-up period, five repeat suicide attempts were recorded in the ASSIP group and 41 attempts in the control group. The rates of participants reattempting suicide at least once were 8.3% (n = 5) and 26.7% (n = 16). ASSIP was associated with an approximately 80% reduced risk of participants making at least one repeat suicide attempt (Wald χ21 = 13.1, 95% CI 12.4-13.7, p < 0.001). ASSIP participants spent 72% fewer days in the hospital during follow-up (ASSIP: 29 d; control group: 105 d; W = 94.5, p = 0.038). Higher scores of patient-rated therapeutic alliance in the ASSIP group were associated with a lower rate of repeat suicide attempts. Prior suicide attempts, depression, and a diagnosis of personality disorder at baseline did not significantly affect outcome. Participants with a diagnosis of borderline personality disorder (n = 20) had more previous suicide attempts and a higher number of reattempts. Key study limitations were missing data and dropout rates. Although both were generally low, they increased during follow-up. At 24 months, the group difference in dropout rate was significant: ASSIP, 7% (n = 4); control, 22% (n = 13). A further limitation is that we do not have detailed information of the co-active follow-up treatment apart from participant self-reports every 6 months on the setting and the duration of the co-active treatment.
CONCLUSIONS: ASSIP, a manual-based brief therapy for patients who have recently attempted suicide, administered in addition to the usual clinical treatment, was efficacious in reducing suicidal behavior in a real-world clinical setting. ASSIP fulfills the need for an easy-to-administer low-cost intervention. Large pragmatic trials will be needed to conclusively establish the efficacy of ASSIP and replicate our findings in other clinical settings.
TRIAL REGISTRATION: ClinicalTrials.gov NCT02505373.

PMID: 26930055 [PubMed - indexed for MEDLINE]

Cultural Adaptation of Screening, Brief Intervention and Referral to Treatment Using Motivational Interviewing.

Mon, 07/18/2016 - 1:10pm
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Cultural Adaptation of Screening, Brief Intervention and Referral to Treatment Using Motivational Interviewing.

J Addict Med. 2015 Sep-Oct;9(5):352-7

Authors: Satre DD, Manuel JK, Larios S, Steiger S, Satterfield J

Abstract
This clinical case presentation and discussion illustrates a culturally adapted alcohol and drug use intervention using the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach, incorporating motivational interviewing skills. This case conference serves to complement the accompanying review article on SBIRT with diverse cultural groups, placing information from the review in the context of a typical clinical setting. In this example, SBIRT is provided in a primary care clinic to a Latino patient who reports hazardous drinking, depression, chronic pain and use of prescription opioids.

PMID: 26428360 [PubMed - indexed for MEDLINE]

Usability Testing of a National Substance Use Screening Tool Embedded in Electronic Health Records.

Mon, 07/11/2016 - 1:09pm

Usability Testing of a National Substance Use Screening Tool Embedded in Electronic Health Records.

JMIR Hum Factors. 2016;3(2):e18

Authors: Press A, DeStio C, McCullagh L, Kapoor S, Morley J, SBIRT NY-II Team, Conigliaro J

Abstract
BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) is currently being implemented into health systems nationally via paper and electronic methods.
OBJECTIVE: The purpose of this study was to evaluate the integration of an electronic SBIRT tool into an existing paper-based SBIRT clinical workflow in a patient-centered medical home.
METHODS: Usability testing was conducted in an academic ambulatory clinic. Two rounds of usability testing were done with medical office assistants (MOAs) using a paper and electronic version of the SBIRT tool, with two and four participants, respectively. Qualitative and quantitative data was analyzed to determine the impact of both tools on clinical workflow. A second round of usability testing was done with the revised electronic version and compared with the first version.
RESULTS: Personal workflow barriers cited in the first round of testing were that the electronic health record (EHR) tool was disruptive to patient's visits. In Round 2 of testing, MOAs reported favoring the electronic version due to improved layout and the inclusion of an alert system embedded in the EHR. For example, using the system usability scale (SUS), MOAs reported a grade "1" for the statement, "I would like to use this system frequently" during the first round of testing but a "5" during the second round of analysis.
CONCLUSIONS: The importance of testing usability of various mediums of tools used in health care screening is highlighted by the findings of this study. In the first round of testing, the electronic tool was reported as less user friendly, being difficult to navigate, and time consuming. Many issues faced in the first generation of the tool were improved in the second generation after usability was evaluated. This study demonstrates how usability testing of an electronic SBRIT tool can help to identify challenges that can impact clinical workflow. However, a limitation of this study was the small sample size of MOAs that participated. The results may have been biased to Northwell Health workers' perceptions of the SBIRT tool and their specific clinical workflow.

PMID: 27393643 [PubMed]

Interprofessional Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education for Registered Nurses and Behavioral Health Professionals.

Mon, 07/11/2016 - 1:09pm

Interprofessional Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education for Registered Nurses and Behavioral Health Professionals.

Issues Ment Health Nurs. 2016 Jul 7;:1-6

Authors: Puskar K, Kane I, Lee H, Mitchell AM, Albrecht S, Frank L, Hagle H, Lindsay D, Houze MP

Abstract
Although substance use is prevalent in the United States, the majority of people who misuse substances do not receive appropriate treatment. This paper describes, (1) an interprofessional education (IPE) program for health professionals to provide Screening Brief Intervention and Referral to Treatment to rural substance use patients, and (2) compares registered nurses' [RNs] and behavioral health professionals' [BHPs] attitudes to work with those patients and their perceptions on IPE. A data analysis of 62 RNs and 36 BHPs shows statistically significant increases in both attitudes and perceptions. This paper discusses the implications of the IPE program vis-á-vis substance use treatment.

PMID: 27387524 [PubMed - as supplied by publisher]

Predictive Validity of Clinical AUDIT-C Alcohol Screening Scores and Changes in Scores for Three Objective Alcohol-related Outcomes in a Veterans Affairs (VA) Population.

Mon, 07/04/2016 - 1:09pm
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Predictive Validity of Clinical AUDIT-C Alcohol Screening Scores and Changes in Scores for Three Objective Alcohol-related Outcomes in a Veterans Affairs (VA) Population.

Addiction. 2016 Jun 27;

Authors: Bradley KA, Rubinsky AD, Lapham GT, Berger D, Bryson C, Achtmeyer C, Hawkins EJ, Chavez LJ, Williams EC, Kivlahan DR

Abstract
AIMS: To evaluate the association between AUDIT-C alcohol screening scores, collected as part of routine clinical care, and three outcomes in the following year (Aim 1), and the association between changes in AUDIT-C risk group at one year follow-up and the same outcomes in the subsequent year (Aim 2).
DESIGN: Cohort study SETTING: Twenty-four US Veterans Affairs (VA) healthcare systems (2004-2007), before systematic implementation of brief intervention PARTICIPANTS: 486,115 outpatients with AUDIT-Cs documented in their electronic health records (EHRs) on two occasions ≥12 months apart ("baseline" and "follow-up") MEASUREMENTS: Independent measures were baseline AUDIT-C scores and change in standard AUDIT-C risk groups (no use, low risk use, and mild, moderate, severe misuse) from baseline to follow-up. Outcome measures were 1) high density lipoprotein cholesterol (HDL), 2) alcohol-related gastrointestinal hospitalizations ("GI hospitalizations") and 3) physical trauma, each in the years after baseline and follow-up.
FINDINGS: Baseline AUDIT-C scores had a positive association with outcomes in the following year. Across AUDIT-C scores 0 to 12, mean HDL ranged from 41.4 (95% Cl 41.3-41.5) to 53.5 (51.4-55.6) mg/L, and probabilities of GI hospitalizations from 0.49% (0.48-0.51%) to 1.8% (1.3-2.3%), and trauma from 3.0% (2.95-3.06%) to 6.0% (5.2-6.8%). At follow-up, patients who increased to moderate or severe alcohol misuse had consistently higher mean HDL and probabilities of subsequent GI hospitalizations or trauma compared with those who did not (p-values all < 0.05). For example, among those with baseline low-risk use, in those with persistent low-risk use vs. severe misuse at follow-up, the probabilities of subsequent trauma were 2.65% (2.54-2.75%) vs. 5.15% (3.86-6.45%), respectively. However, for patients who decreased to lower AUDIT-C risk groups at follow-up, findings were inconsistent across outcomes, with only mean HDL decreasing in most groups that decreased use (p-values all < 0.05).
CONCLUSIONS: When AUDIT-C screening is conducted in clinical settings, baseline AUDIT-C scores and score increases to moderate-severe alcohol misuse at follow-up screening appear to have predictive validity for HDL cholesterol, alcohol-related gastrointestinal hospitalizations, and physical trauma. Decreasing AUDIT-C scores collected in clinical settings appear to have predictive validity for only HDL.

PMID: 27349855 [PubMed - as supplied by publisher]

Substance Use Screening, Brief Intervention, and Referral to Treatment.

Mon, 06/27/2016 - 1:09pm
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Substance Use Screening, Brief Intervention, and Referral to Treatment.

Pediatrics. 2016 Jun 20;

Authors: COMMITTEE ON SUBSTANCE USE AND PREVENTION

Abstract
The enormous public health impact of adolescent substance use and its preventable morbidity and mortality show the need for the health care sector, including pediatricians and the medical home, to increase its capacity related to substance use prevention, detection, assessment, and intervention. The American Academy of Pediatrics published its policy statement "Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians" in 2011 to introduce the concepts and terminology of screening, brief intervention, and referral to treatment (SBIRT) and to offer clinical guidance about available substance use screening tools and intervention procedures. This policy statement is a revision of the 2011 SBIRT statement. An accompanying clinical report updates clinical guidance for adolescent SBIRT.

PMID: 27325638 [PubMed - as supplied by publisher]

Substance Use Screening, Brief Intervention, and Referral to Treatment.

Mon, 06/27/2016 - 1:09pm
Related Articles

Substance Use Screening, Brief Intervention, and Referral to Treatment.

Pediatrics. 2016 Jun 20;

Authors: Levy SJ, Williams JF, COMMITTEE ON SUBSTANCE USE AND PREVENTION

Abstract
The enormous public health impact of adolescent substance use and its preventable morbidity and mortality highlight the need for the health care sector, including pediatricians and the medical home, to increase its capacity regarding adolescent substance use screening, brief intervention, and referral to treatment (SBIRT). The American Academy of Pediatrics first published a policy statement on SBIRT and adolescents in 2011 to introduce SBIRT concepts and terminology and to offer clinical guidance about available substance use screening tools and intervention procedures. This clinical report provides a simplified adolescent SBIRT clinical approach that, in combination with the accompanying updated policy statement, guides pediatricians in implementing substance use prevention, detection, assessment, and intervention practices across the varied clinical settings in which adolescents receive health care.

PMID: 27325634 [PubMed - as supplied by publisher]

Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial.

Mon, 06/20/2016 - 1:07pm

Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial.

BMJ Open. 2016;6(6):e010271

Authors: Bendtsen P, Müssener U, Karlsson N, López-Pelayo H, Palacio-Vieira J, Colom J, Gual A, Reynolds J, Wallace P, Segura L, Anderson P

Abstract
OBJECTIVES: The objective of the present study was to explore whether the possibility of offering facilitated access to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increased the proportion of consulting adults who were screened and given brief advice.
DESIGN: The study was a 12-week implementation study. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands, Poland and Sweden) were asked to screen adults who attended the PHCU for risky drinking.
SETTING: A total of 120 primary healthcare centres from 5 jurisdictions in Europe.
PARTICIPANTS: 746 individual providers (general practitioners, nurses or other professionals) participated in the study.
PRIMARY OUTCOME: Change in the proportion of patients screened and referred to eBI comparing a baseline 4-week preimplementation period with a 12-week implementation period.
RESULTS: The possibility of referring patients to the eBI was not found to be associated with any increase in the proportion of patients screened. However, it was associated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole (p<0.05), mainly driven by a significant increase in brief intervention rates in England from 87% to 96% (p<0.01). The study indicated that staff displayed a low level of engagement in this new technology. Staff continued to offer face-to-face advice to a larger proportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among the referred patients; on average, 18% of the patients logged on to the website with a mean log-on rate across the different countries between 0.58% and 36.95%.
CONCLUSIONS: Referral to eBI takes nearly as much time as brief oral advice and might require more introduction and training before staff are comfortable with referring to eBI.
TRIAL REGISTRATION NUMBER: NCT01501552; Post-results.

PMID: 27311902 [PubMed - in process]

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

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

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

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

Authors: Fornili KS

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

PMID: 27272992 [PubMed - as supplied by publisher]

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

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

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

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

Authors: Fornili KS

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

PMID: 27272991 [PubMed - as supplied by publisher]

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

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

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

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

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

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

PMID: 27267887 [PubMed - as supplied by publisher]

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

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

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

Addiction. 2016 May 30;

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

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

PMID: 27237081 [PubMed - as supplied by publisher]

Dual Diagnosis: Coexisting Substance Use Disorders and Psychiatric Disorders.

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

Dual Diagnosis: Coexisting Substance Use Disorders and Psychiatric Disorders.

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

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

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

PMID: 27229278 [PubMed - in process]

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

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

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

J Behav Health Serv Res. 2016 May 24;

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

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

PMID: 27221694 [PubMed - as supplied by publisher]

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

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

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

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

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

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

PMID: 27220276 [PubMed - in process]

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

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

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

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

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

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

PMID: 25623412 [PubMed - indexed for MEDLINE]

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

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

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

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

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

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

PMID: 27191587 [PubMed - as supplied by publisher]

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

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

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

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

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

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

PMID: 27158853 [PubMed - as supplied by publisher]

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

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

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

Curr Opin Pediatr. 2016 May 5;

Authors: DʼSouza-Li L, Harris SK

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

PMID: 27152620 [PubMed - as supplied by publisher]

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