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A randomised controlled pilot trial evaluating feasibility and acceptability of a computer-based tool to identify and reduce harmful and hazardous drinking among adolescents with alcohol-related presentations in Canadian pediatric emergency departments.

Sun, 08/13/2017 - 6:10am
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A randomised controlled pilot trial evaluating feasibility and acceptability of a computer-based tool to identify and reduce harmful and hazardous drinking among adolescents with alcohol-related presentations in Canadian pediatric emergency departments.

BMJ Open. 2017 Aug 11;7(8):e015423

Authors: Newton AS, Dow N, Dong K, Fitzpatrick E, Cameron Wild T, Johnson DW, Ali S, Colman I, Rosychuk RJ, Pediatric Emergency Research Canada

Abstract
OBJECTIVE: This study piloted procedures and obtained data on intervention acceptability to determine the feasibility of a definitive randomised controlled trial (RCT) of the effectiveness of a computer-based brief intervention in the emergency department (ED).
DESIGN: Two-arm, multi-site, pilot RCT.
SETTING AND PARTICIPANTS: Adolescents aged 12-17 years presenting to three Canadian pediatric EDs from July 2010 to January 2013 for an alcohol-related complaint.
INTERVENTIONS: Standard medical care plus computer-based screening and personalised assessment feedback (experimental group) or standard care plus computer-based sham (control group). ED and research staff, and adolescents were blinded to allocation.
OUTCOMES: Main: change in alcohol consumption from baseline to 1- and 3 months post-intervention. Secondary: recruitment and retention rates, intervention acceptability and feasibility, perception of group allocation among ED and research staff, and change in health and social services utilisation.
RESULTS: Of the 340 adolescents screened, 117 adolescents were eligible and 44 participated in the study (37.6% recruitment rate). Adolescents allocated to the intervention found it easy, quick and informative, but were divided on the credibility of the feedback provided (agreed it was credible: 44.4%, disagreed: 16.7%, unsure: 16.7%, no response: 22.2%). We found no evidence of a statistically significant relationship between which interventions adolescents were allocated to and which interventions staff thought they received. Alcohol consumption, and health and social services data were largely incomplete due to modest study retention rates of 47.7% and 40.9% at 1- and 3 months post-intervention, respectively.
CONCLUSIONS: A computer-based intervention was acceptable to adolescents and delivery was feasible in the ED in terms of time to use and ease of use. However, adjustments are needed to the intervention to improve its credibility. A definitive RCT will be feasible if protocol adjustments are made to improve recruitment and retention rates; and increase the number of study sites and research staff.
TRIAL REGISTRATION: clinicaltrials.gov NCT01146665.

PMID: 28801399 [PubMed - in process]

Country-wide distance training for delivery of screening and brief intervention for problematic substance use: a pilot evaluation of participant experiences and patient outcomes.

Sat, 08/12/2017 - 6:09am

Country-wide distance training for delivery of screening and brief intervention for problematic substance use: a pilot evaluation of participant experiences and patient outcomes.

Subst Abus. 2017 Aug 11;:0

Authors: Carneiro APL, Souza-Formigoni MLO

Abstract
BACKGROUND: In this study, we evaluated if the 120-hour distance-learning (DL) course SUPERA (an acronym in Portuguese meaning: System for detection of excessive use or dependence on psychoactive substances: brief Intervention, social reinsertion and follow-up) was an effective way to train health professionals and social workers to apply screening and brief intervention (SBI) for patients with substance use disorders.
METHODS: In the first phase, 2,420 health professionals or social workers, who had completed the course, answered an online survey about their use of the SBI. In the second phase, 25 out of those professionals applied the ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) followed by a Brief Intervention (BI) to patients with substance use disorders. Three months after the SBI delivery, independent researchers followed-up 79 patients who had received SBI, re-applying the ASSIST and a questionnaire to evaluate the patients'/clients' satisfaction with the intervention they received.
RESULTS: In the first phase, it was found that most health professionals and social workers who completed the course applied the SBI in their work and felt very motivated to do it. In the second phase of the study, at a 3-month follow-up, most patients had significantly reduced their ASSIST scores in respect of alcohol and cocaine/crack in relation to their baseline levels. Those patients classified by their ASSIST score as "suggestive of dependence" presented a significant reduction in their scores regarding alcohol, tobacco and cocaine/crack, while those classified as "at-risk" presented a reduction in respect of alcohol problems only. Patients associated changes in their substance use with the SBI received.
CONCLUSIONS: A reduction in substance use related-problems was associated with the SBI applied by the health professionals or social workers trained by the DL course SUPERA. Two significant limitations of this study were the small number of participants (professionals and patients in the follow-up) and the absence of a control group in the second phase of the study.

PMID: 28799890 [PubMed - as supplied by publisher]

Screening, treatment initiation, and referral for substance use disorders.

Mon, 08/07/2017 - 1:39pm
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Screening, treatment initiation, and referral for substance use disorders.

Addict Sci Clin Pract. 2017 Aug 07;12(1):18

Authors: Bernstein SL, D'Onofrio G

Abstract
Substance use remains a leading cause of preventable death globally. A model of intervention known as screening, brief intervention, and referral to treatment (SBIRT) was developed decades ago to facilitate time- and resource-sensitive interventions in acute care and outpatient settings. SBIRT, which includes a psychosocial intervention incorporating the principles of motivational interviewing, has been shown to be effective in reducing alcohol consumption and consequences in unhealthy drinkers both in primary care and emergency department settings. Subsequently, SBIRT for unhealthy alcohol use has been endorsed by governmental agencies and professional societies in multiple countries. Although most trials support the efficacy of SBIRT for unhealthy alcohol use (McQueen et al. in Cochrane Database Syst Rev 8, 2011; Kaner et al. in Cochrane Database Syst Rev 2, 2007; O'Donnell et al. in Alcohol Alcohol 49(1):66-78, 2014), results are heterogenous; negative studies exist. A newer approach to screening and intervention for substance use can incorporate initiation of medication management at the index visit, for individuals willing to do so, and for providers and healthcare systems that are appropriately trained and resourced. Our group has conducted two successful trials of an approach we call screening, treatment initiation, and referral (STIR). In one trial, initiation of nicotine pharmacotherapy coupled with screening and brief counseling in adult smokers resulted in sustained biochemically confirmed abstinence. In a second trial, initiation of buprenorphine for opioid dependent individuals resulted in greater engagement in treatment at 30 days and greater self-reported abstinence. STIR may offer a new, clinically effective approach to the treatment of substance use in clinical care settings.

PMID: 28780906 [PubMed - in process]

Ten Years of Implementing SBIRT: Lessons Learned.

Wed, 08/02/2017 - 6:10am

Ten Years of Implementing SBIRT: Lessons Learned.

Subst Abus. 2017 Aug 01;:0

Authors: Nunes AP, Richmond MK, Marzano K, Swenson C, Lockhart J

Abstract
The US Surgeon General recently issued a comprehensive report indicating that substance use is a major public health concern that must be addressed using a number of strategies. Screening, brief intervention, and referral to treatment (SBIRT) is one such strategy. SBIRT Colorado funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), has implemented a state-wide initiative for the past ten years which has provided ample opportunities to identify key components for successful implementation. Successful implementation requires: 1) strong clinical and management advocates, 2) full integration of services into practices' workflow utilizing technology whenever possible, 3) inter-professional team approaches, 4) appropriate options for the small proportion of patients screening positive for a possible substance use disorder, 5) Cannabis screening that accounts for legalization, and interventions that acknowledge differences between alcohol and cannabis use, 6) incorporating SBIRT into standard healthcare professionals' training, and 7) addressing the significant issues regarding reimbursement through private and public payers for SBIRT services. Implementing and sustaining SBI as a standard of integrated care is essential to reduce the burden of substance use. Interdisciplinary approaches, technology, and training to increase practitioner confidence and skill are fundamental.

PMID: 28762888 [PubMed - as supplied by publisher]

Effectiveness of a computerized motivational intervention on treatment initiation and substance use: Results from a randomized trial.

Tue, 08/01/2017 - 4:09pm
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Effectiveness of a computerized motivational intervention on treatment initiation and substance use: Results from a randomized trial.

J Subst Abuse Treat. 2017 Sep;80:59-66

Authors: Lerch J, Walters ST, Tang L, Taxman FS

Abstract
As many as 80% of the nearly five million adults under community supervision (i.e., probation, parole) are substance involved; however, treatment utilization is low. Using a multi-site randomized controlled trial, we tested the efficacy of in-person motivational interviewing (MI), a motivational computer intervention (MAPIT), or standard probation intake (SAU) to encourage treatment initiation among 316 substance-involved probationers in Dallas, Texas and Baltimore City, Maryland. Ninety-three percent (n=295) of participants completed the 2-month follow-up and 90% (n=285) completed the 6-month follow-up. At 2-months, individuals in the MAPIT condition were more likely to report treatment initiation compared to the SAU condition (OR=2.40, 95% CI=1.06, 5.47) via intent-to-treat analysis, especially among those completing both sessions (RE=0.50, 95% CI=0.05, 0.95) via instrumental variable analysis. At 6-months, MAPIT approached significance for treatment initiation in both analyses. MI did not achieve significance in any model. We did not find any differential impact on substance use. The success of MAPIT suggests that an integrated health-justice computerized intervention as part of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) can be used to address public safety and health issues.

PMID: 28755774 [PubMed - in process]

Indicated school-based intervention to improve depressive symptoms among at risk Chilean adolescents: a randomized controlled trial.

Tue, 08/01/2017 - 4:09pm
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Indicated school-based intervention to improve depressive symptoms among at risk Chilean adolescents: a randomized controlled trial.

BMC Psychiatry. 2016 Aug 04;16:276

Authors: Gaete J, Martinez V, Fritsch R, Rojas G, Montgomery AA, Araya R

Abstract
BACKGROUND: Depression is a disabling condition affecting people of all ages, but generally starting during adolescence. Schools seem to be an excellent setting where preventive interventions may be delivered. This study aimed to test the effectiveness of an indicated school-based intervention to reduce depressive symptoms among at-risk adolescents from low-income families.
METHODS: A two-arm, parallel, randomized controlled trial was conducted in 11 secondary schools in vulnerable socioeconomic areas in Santiago, Chile. High-risk students in year 10 (2° Medio) were invited to a baseline assessment (n = 1048). Those who scored ≥10 (boys) and ≥15 (girls) in the BDI-II were invited to the trial (n = 376). A total of 342 students consented and were randomly allocated into an intervention or a control arm in a ratio of 2:1. The intervention consisted of 8 group sessions of 45 min each, based on cognitive-behavioural models and delivered by two trained psychologists in the schools. Primary (BDI-II) and secondary outcomes (measures of anxiety, automatic thoughts and problem-solving skills) were administered before and at 3 months post intervention. The primary outcome was the recovery rate, defined as the proportion of participants who scored in the BDI-II <10 (among boys) and <15 (among girls) at 3 months after completing the intervention.
RESULTS: There were 229 participants in the intervention group and 113 in the control group. At 3-month follow-up 81.4 % in the intervention and 81.7 % in the control group provided outcome data. The recovery rate was 10 % higher in the intervention (50.3 %) than in the control (40.2 %) group; with an adjusted OR = 1.62 (95 % CI: 0.95 to 2.77) (p = 0.08). No difference between groups was found in any of the secondary outcomes. Secondary analyses revealed an interaction between group and baseline BDI-II score.
CONCLUSIONS: We found no clear evidence of the effectiveness of a brief, indicated school-based intervention based on cognitive-behavioural models on reducing depressive symptoms among Chilean adolescents from low-income families. More research is needed in order to find better solutions to prevent depression among adolescents.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN33871591 . Retrospectively registered 29 June 2011.

PMID: 27488266 [PubMed - indexed for MEDLINE]

Using Virtual Patient Simulations to Prepare Primary Health Care Professionals to Conduct Substance Use and Mental Health Screening and Brief Intervention.

Sun, 07/30/2017 - 6:39am
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Using Virtual Patient Simulations to Prepare Primary Health Care Professionals to Conduct Substance Use and Mental Health Screening and Brief Intervention.

J Am Psychiatr Nurses Assoc. 2017 Jul 01;:1078390317719321

Authors: Albright G, Bryan C, Adam C, McMillan J, Shockley K

Abstract
BACKGROUND: Primary health care professionals are in an excellent position to identify, screen, and conduct brief interventions for patients with mental health and substance use disorders. However, discomfort in initiating conversations about behavioral health, time concerns, lack of knowledge about screening tools, and treatment resources are barriers.
OBJECTIVE: This study examines the impact of an online simulation where users practice role-playing with emotionally responsive virtual patients to learn motivational interviewing strategies to better manage screening, brief interventions, and referral conversations.
DESIGN: Baseline data were collected from 227 participants who were then randomly assigned into the treatment or wait-list control groups. Treatment group participants then completed the simulation, postsimulation survey, and 3-month follow-up survey.
RESULTS: Results showed significant increases in knowledge/skill to identify and engage in collaborative decision making with patients.
CONCLUSIONS: Results strongly suggest that role-play simulation experiences can be an effective means of teaching screening and brief intervention.

PMID: 28754067 [PubMed - as supplied by publisher]

Committee Opinion No. 711: Opioid Use and Opioid Use Disorder in Pregnancy.

Wed, 07/26/2017 - 6:11am

Committee Opinion No. 711: Opioid Use and Opioid Use Disorder in Pregnancy.

Obstet Gynecol. 2017 Aug;130(2):e81-e94

Authors:

Abstract
Opioid use in pregnancy has escalated dramatically in recent years, paralleling the epidemic observed in the general population. To combat the opioid epidemic, all health care providers need to take an active role. Pregnancy provides an important opportunity to identify and treat women with substance use disorders. Substance use disorders affect women across all racial and ethnic groups and all socioeconomic groups, and affect women in rural, urban, and suburban populations. Therefore, it is essential that screening be universal. Screening for substance use should be a part of comprehensive obstetric care and should be done at the first prenatal visit in partnership with the pregnant woman. Patients who use opioids during pregnancy represent a diverse group, and it is important to recognize and differentiate between opioid use in the context of medical care, opioid misuse, and untreated opioid use disorder. Multidisciplinary long-term follow-up should include medical, developmental, and social support. Infants born to women who used opioids during pregnancy should be monitored for neonatal abstinence syndrome by a pediatric care provider. Early universal screening, brief intervention (such as engaging a patient in a short conversation, providing feedback and advice), and referral for treatment of pregnant women with opioid use and opioid use disorder improve maternal and infant outcomes. In general, a coordinated multidisciplinary approach without criminal sanctions has the best chance of helping infants and families.

PMID: 28742676 [PubMed - in process]

Committee Opinion No. 711 Summary: Opioid Use and Opioid Use Disorder in Pregnancy.

Wed, 07/26/2017 - 6:11am

Committee Opinion No. 711 Summary: Opioid Use and Opioid Use Disorder in Pregnancy.

Obstet Gynecol. 2017 Aug;130(2):488-489

Authors:

Abstract
Opioid use in pregnancy has escalated dramatically in recent years, paralleling the epidemic observed in the general population. To combat the opioid epidemic, all health care providers need to take an active role. Pregnancy provides an important opportunity to identify and treat women with substance use disorders. Substance use disorders affect women across all racial and ethnic groups and all socioeconomic groups, and affect women in rural, urban, and suburban populations. Therefore, it is essential that screening be universal. Screening for substance use should be a part of comprehensive obstetric care and should be done at the first prenatal visit in partnership with the pregnant woman. Patients who use opioids during pregnancy represent a diverse group, and it is important to recognize and differentiate between opioid use in the context of medical care, opioid misuse, and untreated opioid use disorder. Multidisciplinary long-term follow-up should include medical, developmental, and social support. Infants born to women who used opioids during pregnancy should be monitored for neonatal abstinence syndrome by a pediatric care provider. Early universal screening, brief intervention (such as engaging a patient in a short conversation, providing feedback and advice), and referral for treatment of pregnant women with opioid use and opioid use disorder improve maternal and infant outcomes. In general, a coordinated multidisciplinary approach without criminal sanctions has the best chance of helping infants and families.

PMID: 28742670 [PubMed - in process]

Screening Adolescents for Alcohol Use: Tracking Practice Trends of Massachusetts Pediatricians.

Sat, 07/22/2017 - 6:09am

Screening Adolescents for Alcohol Use: Tracking Practice Trends of Massachusetts Pediatricians.

J Addict Med. 2017 Jul 20;:

Authors: Levy S, Ziemnik RE, Harris SK, Rabinow L, Breen L, Fluet C, Strother H, Straus JH

Abstract
OBJECTIVES: Substance use screening is a recommended component of routine healthcare for adolescents. A 2008 survey of Massachusetts primary care physicians found high rates of screening, but low rates of validated tool use, leading to the concern that physicians may be missing substance use-related problems and disorders. In an effort to improve practice, a cross-disciplinary group developed and distributed an adolescent screening, brief intervention, and referral to treatment toolkit in 2009. A new survey of Massachusetts primary care physicians was conducted in 2014; this report describes its findings, and compares them to those from 2008.
METHODS: A survey was mailed to a randomly selected sample of Massachusetts primary care physicians listed in the state Board of Registration in Medicine database. Item response frequencies were computed. Multiple logistic regression modeling was used to compare 2008 and 2014 responses, while controlling for any demographic differences between samples.
RESULTS: Pediatrician respondents in 2014 (analysis N = 130) reported a high rate of annually screening patients for alcohol use (96.2%), but only 56.2% reported using a validated screening tool. Rates of screening and validated tool use were higher in 2014 than 2008. Insufficient knowledge as a reported barrier to screening decreased from 2008 to 2014. However, lack of time or staff resources remained key perceived barriers to screening.
CONCLUSIONS: Our findings suggest that adolescent alcohol use screening practices among Massachusetts pediatricians have improved in recent years, during a time of national and statewide efforts to educate physicians. However, opportunities for practice improvement remain.

PMID: 28731863 [PubMed - as supplied by publisher]

Trends of Youth Marijuana Treatment Admissions: Increasing Admissions Contrasted with Decreasing Drug Involvement.

Fri, 07/14/2017 - 6:09am

Trends of Youth Marijuana Treatment Admissions: Increasing Admissions Contrasted with Decreasing Drug Involvement.

Subst Use Misuse. 2017 Jul 13;:1-6

Authors: Marzell M, Sahker E, Arndt S

Abstract
BACKGROUND: Recent changes in marijuana policies and their potential negative effects on youth development are a public health concern. Identifying the most appropriate treatment approaches for problematic marijuana use is important.
OBJECTIVES: The aim of this study was to track marijuana use among young people by examining national changes from 1995 to 2012 in the demographics, referral sources, and the substance use patterns related to youth admissions to substance abuse treatment programs.
METHODS: We examined first-time substance abuse treatment admissions among youth, utilizing the Treatment Episode Data Set - Admissions (TEDS-A) of the Substance Abuse Mental Health Services Administration (N = 12,025,787). Chi-squared analysis was used to examine differences between admission years and binomial logistic regression was used to examine trends over the 18 years.
RESULTS: We found increasing numbers of youth in dependent living situations (e.g. with parents) admitted to substance use disorder treatment for marijuana. We also found a dramatic drop in the degree of drug involvement for those admissions over nearly two decades of data. Conclusions/Importance: While availability and changing perceptions of marijuana might have caused an increase in admissions to substance abuse treatment, our findings indicate that the severity of drug use involved in those admissions has decreased. This study highlights the importance of identifying youth in actual need of treatment services and not overlooking tools such as screening, brief intervention, and motivational interviewing as effective for varying levels of marijuana use by youth.

PMID: 28704115 [PubMed - as supplied by publisher]

Efficacy of a universal smoking cessation intervention initiated in inpatient psychiatry and continued post-discharge: A randomised controlled trial.

Fri, 07/14/2017 - 6:09am
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Efficacy of a universal smoking cessation intervention initiated in inpatient psychiatry and continued post-discharge: A randomised controlled trial.

Aust N Z J Psychiatry. 2017 Apr;51(4):366-381

Authors: Metse AP, Wiggers J, Wye P, Wolfenden L, Freund M, Clancy R, Stockings E, Terry M, Allan J, Colyvas K, Prochaska JJ, Bowman JA

Abstract
OBJECTIVE: Interventions are required to redress the disproportionate tobacco-related health burden experienced by persons with a mental illness. This study aimed to assess the efficacy of a universal smoking cessation intervention initiated within an acute psychiatric inpatient setting and continued post-discharge in reducing smoking prevalence and increasing quitting behaviours.
METHOD: A randomised controlled trial was undertaken across four psychiatric inpatient facilities in Australia. Participants ( N = 754) were randomised to receive either usual care ( n = 375) or an intervention comprising a brief motivational interview and self-help material while in hospital, followed by a 4-month pharmacological and psychosocial intervention ( n = 379) upon discharge. Primary outcomes assessed at 6 and 12 months post-discharge were 7-day point prevalence and 1-month prolonged smoking abstinence. A number of secondary smoking-related outcomes were also assessed. Subgroup analyses were conducted based on psychiatric diagnosis, baseline readiness to quit and nicotine dependence.
RESULTS: Seven-day point prevalence abstinence was higher for intervention participants (15.8%) than controls (9.3%) at 6 months post-discharge (odds ratio = 1.07, p = 0.04), but not at 12 months (13.4% and 10.0%, respectively; odds ratio = 1.03, p = 0.25). Significant intervention effects were not found on measures of prolonged abstinence at either 6 or 12 months post-discharge. Differential intervention effects for the primary outcomes were not detected for any subgroups. At both 6 and 12 months post-discharge, intervention group participants were significantly more likely to smoke fewer cigarettes per day, have reduced cigarette consumption by ⩾50% and to have made at least one quit attempt, relative to controls.
CONCLUSIONS: Universal smoking cessation treatment initiated in inpatient psychiatry and continued post-discharge was efficacious in increasing 7-day point prevalence smoking cessation rates and related quitting behaviours at 6 months post-discharge, with sustained effects on quitting behaviour at 12 months. Further research is required to identify strategies for achieving longer term smoking cessation.

PMID: 28195010 [PubMed - indexed for MEDLINE]

Improved recovery of repeat intoxicated drivers using fingernails and blood spots to monitor alcohol and other substance abuse.

Fri, 07/14/2017 - 6:09am
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Improved recovery of repeat intoxicated drivers using fingernails and blood spots to monitor alcohol and other substance abuse.

Traffic Inj Prev. 2017 Jan 02;18(1):9-18

Authors: Bean P, Brown G, Hallinan P, Becerra S, Lewis D

Abstract
OBJECTIVES: This study reports the results of a pilot program in Kenosha County that used a combination of direct biomarkers extracted from blood spots and nails to monitor repeat intoxicated drivers for their use of alcohol and drugs with a detection window spanning from 3 weeks to several months. The objectives were to test whether the direct biomarkers phosphatidylethanol (PEth), ethylglucuronide (EtG), and 5 drug metabolites would (1) help assessors obtain a more objective evaluation of repeat offenders during the assessment interview, (2) allow for timely identification of relapses and improve classification of drivers into risk categories, and (3) predict recidivism by identifying offenders most likely to obtain a subsequent operating while intoxicated (OWI) offense within 4 years of enrollment in the program.
METHODS: All (N = 261) repeat offenders were tested using PEth obtained from blood spots and EtG obtained from fingernails; 159 participants were also tested for a 5 drugs of abuse nail panel. Drivers were tested immediately after the assessment interview (baseline) and at 3, 6, 9, and 12 months after baseline. Based on biomarker results and self-reports of abstinence, offenders were classified into different risk categories and required to follow specific testing timelines based on the program's decision tree.
RESULTS: The baseline analysis shows that 60% of drivers tested positive for alcohol biomarkers (EtG, PEth, or both) at the assessment interview, with lower detection rates (0-11%) for the 5 drug metabolites. The comparison of biomarkers results to self-reports of abstinence identified 28% of all offenders as high risk and assigned them to more frequent testing and more intense monitoring. The longitudinal analysis shows that 56% (completers) of participants completed the program successfully and the remaining 44% (noncompliant) terminated prematurely. Two thirds (68%) of the completers were able to reduce or control their drinking and one third relapsed at least one time during their mandated monitoring periods. After a brief intervention by the assessors, 79% of relapsers tested negative for biomarkers in their repeat tests. The rearrest analysis showed that offenders classified in the noncompliant and relapsers groups were 7 times more likely to receive a new OWI 4 years after enrollment compared to drivers classified as abstainers or controllers. Refractory drivers were monitored the longest and reported no subsequent rearrests.
CONCLUSION: These findings demonstrate the benefits of more individualized interventions with repeat OWI offenders and calls for further development of multimodal approaches in traffic medicine including those that use direct alcohol biomarkers as evidence-based practices to reduce recidivism.

PMID: 27285956 [PubMed - indexed for MEDLINE]

Screening, brief intervention, and referral to treatment for opioid and other substance use during infertility treatment.

Thu, 07/13/2017 - 6:56am
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Screening, brief intervention, and referral to treatment for opioid and other substance use during infertility treatment.

Fertil Steril. 2017 Jul 08;:

Authors: Wright TE

Abstract
Opioid use and misuse have reached epidemic proportions in the United States, especially in women of childbearing age, some of whom seek infertility treatments. Substance use is much more common than many of the conditions routinely screened for during the preconception period, and it can have devastating consequences for the woman and her family. Substance use can worsen infertility, complicate pregnancy, increase medical problems, and lead to psychosocial difficulties for the woman and her family. The reproductive endocrinologist thus has an ethical and medical duty to screen for substance use, provide initial counseling, and refer to specialized treatment as needed. This article provides an overview of screening, brief intervention, and referral to treatment (SBIRT), a public health approach shown to be effective in ameliorating the harms of substance use.

PMID: 28697912 [PubMed - as supplied by publisher]

Delivery of Brief Interventions for Heavy Drinking in Primary Care: Outcomes of the ODHIN 5-Country Cluster Randomized Trial.

Wed, 07/12/2017 - 6:26am
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Delivery of Brief Interventions for Heavy Drinking in Primary Care: Outcomes of the ODHIN 5-Country Cluster Randomized Trial.

Ann Fam Med. 2017 Jul;15(4):335-340

Authors: Anderson P, Coulton S, Kaner E, Bendtsen P, Kłoda K, Reynolds J, Segura L, Wojnar M, Mierzecki A, Deluca P, Newbury-Birch D, Parkinson K, Okulicz-Kozaryn K, Drummond C, Gual A

Abstract
PURPOSE: We aimed to test whether 3 strategies-training and support, financial reimbursement, and an option to direct screen-positive patients to an Internet-based method of giving brief advice-have a longer-term effect on primary care clinicians' delivery of screening and advice to heavy drinkers operationalized with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) tool.
METHODS: We undertook a cluster randomized factorial trial with a 12-week implementation period in 120 primary health care units throughout Catalonia, England, Netherlands, Poland, and Sweden. Units were randomized to 8 groups: care as usual (control); training and support alone; financial reimbursement alone; electronic brief advice alone; paired combinations of these conditions; and all 3 combined. The primary outcome was the proportion of consulting adult patients (aged 18 years and older) receiving intervention-screening and, if screen-positive, advice-at 9 months.
RESULTS: Based on the factorial design, the ratio of the log of the proportion of patients given intervention at the 9-month follow-up was 1.39 (95% CI, 1.03-1.88) in units that received training and support as compared with units that did not. Neither financial reimbursement nor directing screen-positive patients to electronic brief advice led to a higher proportion of patients receiving intervention.
CONCLUSIONS: Training and support of primary health care units has a lasting, albeit small, impact on the proportion of adult patients given an alcohol intervention at 9 months.

PMID: 28694269 [PubMed - in process]

Benefit-cost analysis of SBIRT interventions for substance using patients in emergency departments.

Fri, 07/07/2017 - 3:33pm

Benefit-cost analysis of SBIRT interventions for substance using patients in emergency departments.

J Subst Abuse Treat. 2017 Aug;79:6-11

Authors: Horn BP, Crandall C, Forcehimes A, French MT, Bogenschutz M

Abstract
Screening, brief intervention, and referral to treatment (SBIRT) has been widely implemented as a method to address substance use disorders in general medical settings, and some evidence suggests that its use is associated with decreased societal costs. In this paper, we investigated the economic impact of SBIRT using data from Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED), a multisite, randomized controlled trial. Utilizing self-reported information on medical status, health services utilization, employment, and crime, we conduct a benefit-cost analysis. Findings indicate that neither of the SMART-ED interventions resulted in any significant changes to the main economic outcomes, nor had any significant impact on total economic benefit. Thus, while SBIRT interventions for substance abuse in Emergency Departments may be appealing from a clinical perspective, evidence from this economic study suggests resources could be better utilized supporting other health interventions.

PMID: 28673528 [PubMed - in process]

Interprofessional collaborative practice incorporating training for alcohol and drug use screening for healthcare providers in rural areas.

Thu, 06/22/2017 - 6:24am
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Interprofessional collaborative practice incorporating training for alcohol and drug use screening for healthcare providers in rural areas.

J Interprof Care. 2016 Jul;30(4):542-4

Authors: Puskar K, Mitchell AM, Albrecht SA, Frank LR, Kane I, Hagle H, Lindsay D, Lee H, Fioravanti M, Talcott KS

Abstract
Interprofessional collaborative practice expands resources in rural and underserved communities. This article explores the impact of an online education programme on the perceptions of healthcare providers about interprofessional care within alcohol and drug use screening for rural residents. Nurses, behavioural health counsellors, and public health professionals participated in an evidence-based practice (screening, brief intervention, and referral to treatment-SBIRT) model that targets individuals who use alcohol and other drugs in a risky manner. SBIRT is recommended by the United States Preventive Services Task Force as a universal, evidence-based screening tool. Online modules, case simulation practice, and interprofessional dialogues are used to deliver practice-based learning experiences. A quasi-experimental method with pre-tests and post-tests was utilised. Results indicate increased perceptions of professional competence, need for cooperation, actual cooperation, and role values pre-to-post training. Implications suggest that online interprofessional education is useful but the added component of professional dialogues regarding patient cases offers promise in promoting collaborative practice.

PMID: 27295396 [PubMed - indexed for MEDLINE]

Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Randomized Clinical Trial.

Tue, 06/20/2017 - 6:24am
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Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Randomized Clinical Trial.

JAMA Psychiatry. 2017 Jun 01;74(6):571-578

Authors: Weersing VR, Brent DA, Rozenman MS, Gonzalez A, Jeffreys M, Dickerson JF, Lynch FL, Porta G, Iyengar S

Abstract
Importance: Anxiety and depression affect 30% of youth but are markedly undertreated compared with other mental disorders, especially in Hispanic populations.
Objective: To examine whether a pediatrics-based behavioral intervention targeting anxiety and depression improves clinical outcome compared with referral to outpatient community mental health care.
Design, Setting, and Participants: This 2-center randomized clinical trial with masked outcome assessment conducted between brief behavioral therapy (BBT) and assisted referral to care (ARC) studied 185 youths (aged 8.0-16.9 years) from 9 pediatric clinics in San Diego, California, and Pittsburgh, Pennsylvania, recruited from October 6, 2010, through December 5, 2014. Youths who met DSM-IV criteria for full or probable diagnoses of separation anxiety disorder, generalized anxiety disorder, social phobia, major depression, dysthymic disorder, and/or minor depression; lived with a consenting legal guardian for at least 6 months; and spoke English were included in the study. Exclusions included receipt of alternate treatment for anxiety or depression, presence of a suicidal plan, bipolar disorder, psychosis, posttraumatic stress disorder, substance dependence, current abuse, intellectual disability, or unstable serious physical illness.
Interventions: The BBT consisted of 8 to 12 weekly 45-minute sessions of behavioral therapy delivered in pediatric clinics by master's-level clinicians. The ARC families received personalized referrals to mental health care and check-in calls to support accessing care from master's-level coordinators.
Main Outcomes and Measures: The primary outcome was clinically significant improvement on the Clinical Global Impression-Improvement scale (score ≤2). Secondary outcomes included the Pediatric Anxiety Rating Scale, Children's Depression Rating Scale-Revised, and functioning.
Results: A total of 185 patients were enrolled in the study (mean [SD] age, 11.3 [2.6] years; 107 [57.8%] female; 144 [77.8%] white; and 38 [20.7%] Hispanic). Youths in the BBT group (n = 95), compared with those in the ARC group (n = 90), had significantly higher rates of clinical improvement (56.8% vs 28.2%; χ21 = 13.09, P < .001; number needed to treat, 4), greater reductions in symptoms (F2,146 = 5.72; P = .004; Cohen f = 0.28), and better functioning (mean [SD], 68.5 [10.7] vs 61.9 [11.9]; t156 = 3.64; P < .001; Cohen d = 0.58). Ethnicity moderated outcomes, with Hispanic youth having substantially stronger response to BBT (76.5%) than ARC (7.1%) (χ21 = 14.90; P < .001; number needed to treat, 2). Effects were robust across sites.
Conclusions and Relevance: A pediatric-based brief behavioral intervention for anxiety and depression is associated with benefits superior to those of assisted referral to outpatient mental health care. Effects were especially strong for Hispanic participants, suggesting that the protocol may be a useful tool in addressing ethnic disparities in care.
Trial Registration: clinicaltrials.gov Identifier: NCT01147614.

PMID: 28423145 [PubMed - indexed for MEDLINE]

Attitudes and Learning through Practice Are Key to Delivering Brief Interventions for Heavy Drinking in Primary Health Care: Analyses from the ODHIN Five Country Cluster Randomized Factorial Trial.

Thu, 06/15/2017 - 10:39am
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Attitudes and Learning through Practice Are Key to Delivering Brief Interventions for Heavy Drinking in Primary Health Care: Analyses from the ODHIN Five Country Cluster Randomized Factorial Trial.

Int J Environ Res Public Health. 2017 Jan 26;14(2):

Authors: Anderson P, Kaner E, Keurhorst M, Bendtsen P, Steenkiste BV, Reynolds J, Segura L, Wojnar M, Kłoda K, Parkinson K, Drummond C, Okulicz-Kozaryn K, Mierzecki A, Laurant M, Newbury-Birch D, Gual A

Abstract
In this paper, we test path models that study the interrelations between primary health care provider attitudes towards working with drinkers, their screening and brief advice activity, and their receipt of training and support and financial reimbursement. Study participants were 756 primary health care providers from 120 primary health care units (PHCUs) in different locations throughout Catalonia, England, The Netherlands, Poland, and Sweden. Our interventions were training and support and financial reimbursement to providers. Our design was a randomized factorial trial with baseline measurement period, 12-week implementation period, and 9-month follow-up measurement period. Our outcome measures were: attitudes of individual providers in working with drinkers as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire; and the proportion of consulting adult patients (age 18+ years) who screened positive and were given advice to reduce their alcohol consumption (intervention activity). We found that more positive attitudes were associated with higher intervention activity, and higher intervention activity was then associated with more positive attitudes. Training and support was associated with both positive changes in attitudes and higher intervention activity. Financial reimbursement was associated with more positive attitudes through its impact on higher intervention activity. We conclude that improving primary health care providers' screening and brief advice activity for heavy drinking requires a combination of training and support and on-the-job experience of actually delivering screening and brief advice activity.

PMID: 28134783 [PubMed - indexed for MEDLINE]

Randomized Pilot of an Anxiety Sensitivity-Based Intervention for Individuals in a Substance Use Day Program.

Fri, 06/09/2017 - 6:08am

Randomized Pilot of an Anxiety Sensitivity-Based Intervention for Individuals in a Substance Use Day Program.

J Psychoactive Drugs. 2017 Jun 08;:1-11

Authors: Worden BL, Genova M, Tolin DF

Abstract
Anxiety sensitivity (AS), or the tendency to appraise physical symptoms as intolerable or dangerous, may maintain the cycle between co-occurring anxiety and substance use disorders. This study examined preliminary efficacy of a brief intervention targeting AS for individuals with heterogeneous substance use disorders. Forty-one patients with high AS entering an addictions day program were randomized to treatment as usual (TAU) or to TAU plus a nine-hour AS-focused intervention that consisted of interoceptive exposures, psychoeducation about the cycle of problematic substance use and anxiety, and a single session of cognitive challenging (e.g., reviewing common cognitive distortions and decatastrophizing anxiety symptoms). Mixed-effects intent-to-treat models suggested that participants in the AS condition showed greater decreases in AS at post-treatment, but this effect was lost at follow-up three months later. Intervention conditions did not differ in change in percent days abstinent or self-reported anxiety, with both conditions showing significant improvement at post-treatment. Results suggest that the nine-hour AS-focused intervention led to a short-term benefit over TAU alone, but this benefit was not sustained at three months' follow-up. Future AS interventions may need to target specific subconstructs of AS for selected populations, or target emotional distress tolerance more broadly.

PMID: 28594602 [PubMed - as supplied by publisher]

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