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Punia K, Scott W, Manuja K, Sabbineni M, Campbell K, Balodis IM, MacKillop J. SAEM GRACE: Anti-craving medications for alcohol use disorder treatment in the emergency department: A systematic review of direct evidence. Acad Emerg Med 2024; 31:504-514. [PMID: 37735346 DOI: 10.1111/acem.14806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES Alcohol-related concerns commonly present to the emergency department (ED), with a subset of individuals experiencing the symptoms of an alcohol use disorder (AUD). As such, examining the efficacy of pharmacological anti-craving treatment for AUD in the ED is of increasing interest. The objective of this systematic review was to evaluate the direct evidence assessing the efficacy of providing anti-craving medications for AUD treatment in the ED. METHODS A systematic search was conducted according to the patient-intervention-control-outcome question: (P) adults (≥18 years old) presenting to the ED with an AUD (including suspected AUD); (I) anti-craving medications (i.e., naltrexone, acamprosate, gabapentin); (C) no prescription or placebo; (O) reduction of repeat ED visits, engagement in addiction services, reductions in heavy drinking days, reductions in any drinking and amount consumed (or abstinence), and in relapse. Two reviewers independently assessed articles for inclusion and conducted risk of bias assessments for included studies. RESULTS From 143 potentially relevant articles, 6 met inclusion criteria: 3 clinical trials, and 3 case studies. The clinical trials identified evaluated oral versus extended-release naltrexone, monthly extended-release naltrexone injections, and disulfiram. Both oral and extended-release naltrexone resulted in decreased alcohol consumption. Monthly extended-release naltrexone injections resulted in significant improvements in drinking and quality of life. Although out of scope, the disulfiram studies identified did not result in an improvement in drinking in comparison to no medication. CONCLUSIONS Overall, there are few studies directly examining the efficacy of anti-craving medications for AUD in the ED, although the limited evidence that exists is supportive of naltrexone pharmacotherapy, particularly extended-release injection formulation. Additional randomized controlled trials are necessary for substantive direct evidence on anti-craving medication initiation in the ED.
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Affiliation(s)
- Kiran Punia
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - William Scott
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kriti Manuja
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - Monica Sabbineni
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Iris M Balodis
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Pavalur R, Nattala P, Kandasamy A, Shukla DP. A randomized controlled trial of nurse-led Brief Focused Intervention for patients with alcohol use-related mild traumatic brain injury in the emergency and casualty services of a tertiary hospital. J Neurosci Rural Pract 2024; 15:103-110. [PMID: 38476409 PMCID: PMC10927034 DOI: 10.25259/jnrp_381_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/16/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives Driving under the influence of alcohol is one of the leading causes of road traffic accidents in India. Individuals with acute injuries often present to emergency hospital services. Carrying out brief interventions in the emergency can prevent further injury and even progression to severe patterns of drinking. However, there are no known studies from India examining the effectiveness of such interventions in emergency settings. Against this background, the objective of this randomized controlled trial was to evaluate the effectiveness of a nurse-led Brief Focused Intervention (BFI) in comparison with the minimal intervention for patients with mild Traumatic Brain Injury (TBI) reporting to the emergency and casualty services of a tertiary hospital in Bengaluru, South India, who screened positive for alcohol use. Materials and Methods The BFI comprised a video portraying the effects of alcohol on the brain and muscles and brief advice on how to reduce or avoid alcohol use. Subjects (N = 90) were randomly allocated to two groups: BFI (n = 45) or Minimal Intervention Group (MIG) (n = 45). Standardized tools were used to assess both groups on specific outcomes for up to six months following discharge from the emergency and casualty services. At the end of six months, complete data wasavailable for 73 patients. Results Participants' (N = 73) mean age was 35 years (standard deviation [SD]-11). Over the six-month follow-up, the BFI group reported significantly lesser quantity of alcohol consumption (Alcohol Use Disorder Identification Test [AUDIT] Score - 5.03, SD 4.09, 95% confidence interval [CI] = 3.70, 6.35) compared to MIG (AUDIT Score - 9.76, SD 2.96, 95% CI = 8.73, 10.80), and fewer alcohol use-related problems in BFI group (Mean - 4.18, SD 3.21, 95% CI = 3.14, 5.22) compared to MIG (Mean - 5.88, SD 2.59, 95% CI = 4.98, 6.79). Results of logistic regression showed that being in MIG as well as baseline hazardous use of alcohol were associated with unfavorable outcomes at the end of six months follow-up. Conclusion Findings provide the first known evidence from India for the effectiveness of nurse-led BFI in the emergency and casualty services in improving post-discharge outcomes for patients with alcohol use-related mild TBI. While the findings of the study are statistically significant, these findings also have significant clinical relevance, as they have shown that the BFI improved clinical outcomes. Thus, brief interventions should be implemented for these patients whenever possible in the Emergency setting.
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Affiliation(s)
- Rajitha Pavalur
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Prasanthi Nattala
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Arun Kandasamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Dhaval P. Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Assessment of substance use among injured persons seeking emergency care in Nairobi, Kenya. Afr J Emerg Med 2022; 12:321-326. [PMID: 35892006 PMCID: PMC9307445 DOI: 10.1016/j.afjem.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/24/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Trauma is a leading cause of morbidity and mortality in Kenya. In many countries, substance use is common among patients presenting with injuries to an emergency center (EC). Objective To describe the epidemiology of self-reported substance use among adult injured patients seeking ED care in Nairobi, Kenya. Methods This prospective cross-sectional study, assessed patients presenting with injuries to the Kenyatta National Hospital ED in Nairobi, Kenya from March through June of 2021. Data on substance use, injury characteristics and ED disposition were collected. Substances of interest were alcohol, stimulants, marijuana, and opiates. The Alcohol Use Disorders Identification Test-Concise (AUDIT-C) tool was used to characterize hazardous alcohol use. Results A total of 1,282 patients were screened for participation, of which 646 were enrolled. Among participants, 322 (49.8%) reported substance use in the past month (AUDIT-C positive, stimulants, opiates, and/or marijuana). Hazardous alcohol use was reported by 271 (42.0%) patients who screened positive with AUDIT-C. Polysubstance use, (≥2 substances) was reported by 87 participants in the past month. Median time from injury to ED arrival was 13.1 h for all enrolees, and this number was significantly higher among substance users (median 15.4 h, IQR 5.5 - 25.5; p = 0.029). Conclusions In the population studied, reported substance use was common with a substantial proportion of injured persons screening positive for hazardous alcohol use. Those with substance use had later presentations for injury care. These data suggest that ED programming for substance use disorder screening and care linkage could be impactful in the study setting.
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Verheij C, Haagsma JA, Koch BCP, Segers AEM, Schuit SCE, Rood PPM. Screening for hazardous alcohol use in the Emergency Department: Comparison of phosphatidylethanol with the Alcohol Use Disorders Identification Test and the Timeline Follow-back. Alcohol Clin Exp Res 2022; 46:2225-2235. [PMID: 36520053 PMCID: PMC10107187 DOI: 10.1111/acer.14958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/10/2022] [Accepted: 10/07/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Up to 15% of all visits to the Emergency Department (ED) are alcohol related. Identification of problematic alcohol use is important in this setting because it allows for intervention and prevention efforts. This study investigated the correlation between the objective phosphatidylethanol (PEth) marker and the subjective Alcohol Use Disorders Identification Test (AUDIT) and Timeline Followback Questionnaire (TLFB) as screening methods for hazardous alcohol use in the general ED population. METHODS This prospective cohort study included 301 ED patients (57% male) who were seen in the ED and required to give a blood sample. The correlation between the values of PEth (PEth 16:0/18:1 and PEth 16:0/18:2) and the scores on the AUDIT and TLFB were analyzed using Spearman's rank correlation coefficient. Differences between risk categories of PEth and AUDIT were also examined. RESULTS The Spearman correlation coefficients between PEth 16:0/18:1|PEth 16:0/18:2 values and the AUDIT scores were moderate (PEth 16:0/18:1: 0.67, p < 0.001; PEth 16:0/18:2: 0.67, p < 0.001). Of the patients who scored 'low risk drinking/abstinence' according to the AUDIT questionnaire, respectively 1% and 4% had PEth 16:0/18:1|PEth 16:0/18:2 values indicating excessive alcohol use, and another 10% and 12% had PEth 16:0/18:1|PEth 16:0/18:2 values indicating moderate alcohol consumption. Of the 12 (PEth 16:0/18:1) and 25 (PEth 16:0/18:2) patients with high-risk values, respectively 25% and 40% scored in the lowest risk category on the AUDIT questionnaire. Spearman correlation coefficients between PEth 16:0/18:1|PEth 16:0/18:2 values and TLFB two-week scores were high (PEth 16:0/18:1: 0.74, p < 0.001; PEth 16:0/18:2: 0.82, p < 0.001). CONCLUSIONS AUDIT scores were moderately correlated with PEth values in the general ED population. In almost all cases where there was not a good correlation, patients had high PEth values with low AUDIT scores. We conclude that PEth identifies patients with problematic alcohol use who are missed by the AUDIT questionnaire and therefore PEth could be used as an additional screening method for hazardous alcohol use in this population.
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Affiliation(s)
- Carolien Verheij
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Juanita A Haagsma
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Birgit C P Koch
- Department of Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anne E M Segers
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Stephanie C E Schuit
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Board of Directors, University Medical Center Groningen, Groningen, The Netherlands
| | - Pleunie P M Rood
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Bonar EE, Kidwell KM, Bohnert ASB, Bourque CA, Carter PM, Clark SJ, Glantz MD, King CA, Losman ED, McCabe SE, Philyaw-Kotov ML, Prosser LA, Voepel-Lewis T, Zheng K, Walton MA. Optimizing scalable, technology-supported behavioral interventions to prevent opioid misuse among adolescents and young adults in the emergency department: A randomized controlled trial protocol. Contemp Clin Trials 2021; 108:106523. [PMID: 34352386 PMCID: PMC8453131 DOI: 10.1016/j.cct.2021.106523] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 12/29/2022]
Abstract
Preventing opioid misuse and opioid use disorder is critical among at-risk adolescents and young adults (AYAs). An Emergency Department (ED) visit provides an opportunity for delivering interventions during a rapidly changing opioid landscape. This paper describes pilot data and the protocol for a 2 × 2 factorial randomized controlled trial testing efficacy of early interventions to reduce escalation of opioid (prescription or illicit) misuse among at-risk AYAs. Interventions are delivered using technology by health coaches. AYAs ages 16-30 in the ED screening positive for prescription opioid use (+ ≥ 1 risk factor) or opioid misuse will be stratified by risk severity, sex, and age group. Participants will be randomly assigned to a condition at intake, either a live video health coach-delivered single session or a control condition of an enhanced usual care (EUC) community resource brochure. They are also randomly assigned to one of two post-intake conditions: health coach-delivered portal-like messaging via web portal over 30 days or EUC delivered at 30 days post-intake. Thus, the trial has four groups: health coach-delivered session+portal, health coach-delivered session+EUC, EUC + portal, and EUC + EUC. Outcomes will be measured at 3-, 6-, and 12-months. The primary outcome is opioid misuse based on a modified Alcohol Smoking and Substance Involvement Screening Test. Secondary outcomes include other opioid outcomes (e.g., days of opioid misuse, overdose risk behaviors), other substance misuse and consequences, and impaired driving. This study is innovative by testing the efficacy of feasible and scalable technology-enabled interventions to reduce and prevent opioid misuse and opioid use disorder. Trial Registration:ClinicalTrials.gov University of Michigan HUM00177625 NCT Registration: NCT04550715.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA.
| | - Kelley M Kidwell
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Amy S B Bohnert
- Veterans Health Administration, Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109, USA; Department of Anesthesiology, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Carrie A Bourque
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Patrick M Carter
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Sarah J Clark
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, 300 N. Ingalls Street, Room 6D04, Ann Arbor, MI 48109, USA
| | - Meyer D Glantz
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, 3WFN BG 11601 RM 08C79 MSC 6020, 301 North Stonestreet Ave., Bethesda, MD 20892, USA
| | - Cheryl A King
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Eve D Losman
- Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109, USA
| | - Sean Esteban McCabe
- Department of Health Behavior and Biological Sciences and Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor 48109, USA
| | - Meredith L Philyaw-Kotov
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Lisa A Prosser
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, 300 N. Ingalls Street, Room 6D04, Ann Arbor, MI 48109, USA
| | - Terri Voepel-Lewis
- Department of Anesthesiology, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Department of Health Behavior and Biological Sciences and Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, Ann Arbor 48109, USA
| | - Kai Zheng
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA 92697, USA; Department of Emergency Medicine, School of Medicine, University of California, Irvine, CA 92697, USA
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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Brief alcohol interventions in U.S. medical settings: A systematic review of the implementation literature. J Subst Abuse Treat 2021; 131:108456. [PMID: 34098287 DOI: 10.1016/j.jsat.2021.108456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/20/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022]
Abstract
This systematic review provides a synthesis of the literature on brief alcohol intervention (BAI) implementation in medical settings. We utilized the Proctor et al. (2011) taxonomy of eight implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability) to organize and describe the qualitative and quantitative literature regarding BAI implementation. An electronic search of the PubMed database identified 25 articles that met inclusion criteria. The study team independently assessed all articles for methodological quality, with the majority of studies rated as weak to moderate. Descriptive and narrative review of the included articles identified penetration and acceptability as the two most commonly reported implementation outcomes. Studies rarely reported other outcomes (e.g., fidelity, cost, sustainability, adoption). On average, studies utilized approximately six implementation strategies to facilitate implementation, with education (96%), quality management (64%), and planning (56%) strategies the most frequently reported. Promising evidence exists that patients and providers are accepting of BAI implementation efforts and implementation efforts are helpful in expanding the reach of BAIs. A theory-informed approach to selecting implementation strategies may enhance implementation success in future work. When reporting on implementation, all studies should provide detailed BAI descriptions and strategies to enhance replication efforts. We suggest study designs that balance practical outcomes with methodological rigor to maximize the quality of future studies and better inform implementation efforts.
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Gaume J, Grazioli VS, Paroz S, Fortini C, Bertholet N, Daeppen JB. Developing a brief motivational intervention for young adults admitted with alcohol intoxication in the emergency department - Results from an iterative qualitative design. PLoS One 2021; 16:e0246652. [PMID: 33556153 PMCID: PMC7869998 DOI: 10.1371/journal.pone.0246652] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Unhealthy alcohol use among young adults is a major public health concern. Brief motivational interventions for young adults in the Emergency Department (ED) have shown promising but inconsistent results. METHODS Based on the literature on brief intervention and motivational interviewing efficacy and active ingredients, we developed a new motivational intervention model for young adults admitted in the ED with alcohol intoxication. Using an iterative qualitative design, we first pre-tested this model by conducting 4 experimental sessions and 8 related semi-structured interviews to evaluate clinicians' and patients' perceptions of the intervention's acceptability and feasibility. We then conducted a consultation meeting with 9 international experts using a nominal group technique. The intervention model was adjusted and finally re-tested by conducting 6 new experimental sessions and 12 related semi-structured interviews. At each round, data collected were analyzed and discussed, and the intervention model updated accordingly. RESULTS Based on the literature, we found 6 axes for developing a new model: High level of relational factors (e.g. empathy, alliance, avoidance of confrontation); Personalized feedback; Enhance discrepancy; Evoke change talk while softening sustain talk, strengthen ability and commitment to change; Completion of a change plan; Devote more time: longer sessions and follow-up options (face-to-face, telephone, or electronic boosters; referral to treatment). A qualitative analysis of the semi-structured interviews gave important insights regarding acceptability and feasibility of the model. Adjustments were made around which information to provide and how, as well as on how to deepen discussion about change with patients having low levels of self-exploration. The experts' consultation addressed numerous points, such as information and advice giving, and booster interventions. DISCUSSION This iterative, multi-component design resulted in the development of an intervention model embedded in recent research findings and theory advances, as well as feasible in a complex environment. The next step is a randomized controlled trial testing the efficacy of this model.
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Affiliation(s)
- Jacques Gaume
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Véronique S. Grazioli
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Sophie Paroz
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Cristiana Fortini
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicolas Bertholet
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Kenney A, Cox N, Bryan MA, Cochran G. Brief intervention medication therapy management: Establishment of an opioid misuse intervention model delivered in a community pharmacy. Am J Health Syst Pharm 2021; 78:310-319. [PMID: 33386733 PMCID: PMC7868881 DOI: 10.1093/ajhp/zxaa389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Medication expertise and close patient contact position community pharmacists to make significant contributions to combatting the opioid epidemic. This position facilitated the development and initial implementation of the Brief Intervention Medication Therapy Management (BIMTM) model to detect and address patient opioid misuse. BIMTM is an intervention consisting of 9 sessions. One medication management session is delivered by a pharmacist in a community pharmacy setting, and the remaining sessions are delivered telephonically by a patient navigator to follow up with goals established with the pharmacist and address concomitant health concerns that increase risk for misuse. METHODS We employed the Consolidated Framework for Implementation Research (CFIR) to summarize and present key findings from 4 distinct studies. CFIR domains addressed were (1) intervention characteristics, (2) outer setting, (3) inner setting, (4) process, and (5) characteristics of individuals. The study results show sequential development of evidence for BIMTM. RESULTS A multistate cross-sectional pharmacist survey (n = 739) demonstrated limited pharmacist training and/or resources to address misuse, suggesting the need for external intervention development. Our multistakeholder intervention planning project showed limitations of current evidence-based models of care and of intervention implementation, which resulted in construction of the BIMTM. A multisite cross-sectional screening survey of patients (n = 333) established an electronic misuse screening protocol within 4 community pharmacies and identified opioid misuse in 15% of screened patients; among those patients, 98% had concomitant health conditions that contribute to the risk of opioid misuse. Presentation of study results to pharmacy leaders produced commitment for intervention implementation and a partnership to develop a grant proposal supporting this action. Our small-scale randomized trial evinced success in recruitment and retention and BIMTM patient benefit. The small-scale randomized trial likewise showed high levels of satisfaction with BIMTM. CONCLUSION The establishment of BIMTM supports community pharmacist identification and intervention with patients engaged in misuse. Continued use of this research-based strategy may further empower pharmacists to address the opioid epidemic.
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Affiliation(s)
- Amy Kenney
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nicholas Cox
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - M Aryana Bryan
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Gerald Cochran
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Castro Y, Najera SN, Robles EH, Reddy SM, Holcomb BN, Field CA. Mechanisms of change in drinking following an alcohol-related injury: A qualitative examination of the sentinel event effect. Subst Abus 2020; 42:699-705. [PMID: 33284082 DOI: 10.1080/08897077.2020.1846150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sentinel events are negative health-related events that trigger change in risky health behaviors. Despite its presumed major role in behavior change, the sentinel event effect has received little empirical attention. Through analysis of qualitative interviews, we explored how sentinel events trigger behavior change. Methods: Thematic analysis and concept mapping were used to develop a preliminary model of the sentinel event effect among a sample of 24 adult heavy drinking Mexican-origin men previously admitted to a hospital due to injury. The model was checked against cases that did versus did not report change in alcohol use following an alcohol-related negative event. Results: Findings suggest that sentinel events may arouse negative emotional reactions, encourage reflection on the negative consequences of drinking, and cause reevaluation of the severity and significance of drinking. These processes may increase motivation to change. Conclusions: Findings support the concept of the sentinel event as a natural intervention, and identifies potential social-cognitive and motivational mechanisms through which it influences change. Findings stand to inform research on mechanisms underlying brief intervention effects, and research that seeks to identify treatment targets.
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Affiliation(s)
- Yessenia Castro
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Sarah N Najera
- Department of Psychology, University of Texas at El Paso, El Paso, Texas, USA
| | - Eden H Robles
- Department of Psychology, University of Texas at El Paso, El Paso, Texas, USA
| | - Swathi M Reddy
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Brianna N Holcomb
- Department of Psychology, University of Texas at El Paso, El Paso, Texas, USA
| | - Craig A Field
- Department of Psychology, University of Texas at El Paso, El Paso, Texas, USA
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Staton CA, Zhao D, Ginalis EE, Hirshon JM, Sakita F, Swahn MH, Mmbaga BT, Vissoci JRN. Alcohol Availability, Cost, Age of First Drink, and Its Association with At-Risk Alcohol Use in Moshi, Tanzania. Alcohol Clin Exp Res 2020; 44:2266-2274. [PMID: 32944986 PMCID: PMC7680393 DOI: 10.1111/acer.14457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Kilimanjaro region has one of the highest levels of reported alcohol intake per capita in Tanzania. Age at first drink has been found to be associated with alcohol problems in adulthood, but there is less information on the age of first drink in the Kilimanjaro region and its associations with alcohol-related consequences later in life. Furthermore, local alcohol cost and availability may influence the prevalence of alcohol use and alcohol use disorders. METHODS Data on the age of first drink, alcohol use disorder identification tool (AUDIT), number and type of alcohol consequences (DrInC), and perceived alcohol at low cost and high availability for children and adolescents were collected from an alcohol and health behavior survey of injury patients (N = 242) in Moshi, Tanzania. Generalized linear models were used to test age at first drink, perceived alcohol cost and availability, and their association with the AUDIT and DrInC scores, and current alcohol use, respectively. RESULTS Consuming alcohol before age 18 was significantly associated with higher AUDIT and DrInC scores, with odds ratios of 1.22 (CI: 1.004, 1.47) and 1.72 (CI: 1.11, 2.63), respectively. Female gender is strongly associated with less alcohol use and alcohol consequences, represented by an odds ratio of 3.70 (CI: 1.72, 8.33) for an AUDIT score above 8 and an odds ratio of 3.84 (CI: 2.13, 6.67) with the DrInC score. Perceived high availability of alcohol for children is significantly related to higher alcohol use quantity, with the odds ratio of 1.6 (CI: 1.17, 2.20). CONCLUSIONS The first use of alcohol before the age of 18 is associated with higher alcohol use and alcohol-related adverse consequences. In Tanzania, age at first drink is an important target for interventions aiming to prevent negative alcohol-related consequences later in life.
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Affiliation(s)
| | - Duan Zhao
- Duke Kunshan Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu China
| | | | - Jon Mark Hirshon
- University of Maryland School of Medicine, College Park, Maryland USA
| | | | | | - Blandina Theophil Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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11
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Gargaritano KL, Murphy C, Auyeung AB, Doyle F. Systematic Review of Clinician-Reported Barriers to Provision of Brief Advice for Alcohol Intake in Hospital Inpatient and Emergency Settings. Alcohol Clin Exp Res 2020; 44:2386-2400. [PMID: 33119905 DOI: 10.1111/acer.14491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
Abstract
Hospital inpatient and emergency care settings provide frequent opportunities for clinicians to screen and provide brief interventions to patients who engage in the harmful use of alcohol. However, these services are not always provided, with several reasons given in different studies. We aimed to systematically review clinician-reported barriers in the provision of brief alcohol screening, brief advice, and intervention specific to hospital inpatient and emergency department (ED) settings. A systematic literature review was conducted in MEDLINE, PsycINFO, and CINAHL to identify the barriers perceived by healthcare workers in the provision of alcohol screening and brief intervention. These barriers were then categorized according to the capability, opportunity, and motivation (COM-B) model of behavior change theory. Twenty-five articles were included in this study, which involved questionnaires, surveys, interviews, and conference call discussions. The most commonly cited barriers (i.e., greater than half of the studies) were related to capability (lack of knowledge cited in 60% of studies); opportunity (lack of time and resources, 76 and 52% of studies, respectively); and motivation (personal discomfort in 60% of studies). Twenty-two other barriers were reported but with lower frequency. Clinicians cite a multitude of factors that impede their delivery of alcohol screening and brief interventions in the hospital inpatient and ED settings. These barriers were explored further under the framework of the COM-B model, which allows for intervention design. As such, changes can be made at the policy, managerial, and educational levels to address these barriers and help improve the self-efficacy and knowledge of clinicians who counsel patients on alcohol use.
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Affiliation(s)
- Kristine Lou Gargaritano
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Caoimhe Murphy
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Austin B Auyeung
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Frank Doyle
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
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12
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Field CA, Richards DK, Castro Y, Alonso Cabriales J, Wagler A, von Sternberg K. The Effects of a Brief Motivational Intervention for Alcohol Use through Stages of Change among Nontreatment Seeking Injured Patients. Alcohol Clin Exp Res 2020; 44:2361-2372. [PMID: 32981123 DOI: 10.1111/acer.14466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the mechanisms of change underlying brief interventions and the patient characteristics that may affect them. The present study tested whether the stages of change mediate the effects of a BMI with and without a telephone booster relative to brief advice (i.e., multiple mediation). Further, the present study tested whether the effects of the BMI conditions on the stages of change were contingent on patients' alcohol use severity (i.e., moderated mediation). METHODS The present study is a secondary analysis using data from injured adult patients at 3 trauma centers who were screened for inclusion in the study and randomly assigned to brief advice (n = 200), BMI (n = 203), or BMI with a telephone booster (n = 193) (Field et al., 2014). Participants completed a baseline assessment and 3-, 6-, and 12-month follow-up assessments that included self-report measures of the stages of change, alcohol use, and alcohol-related problems, as well as other variables of interest. RESULTS The results demonstrated significant and consistent mediation at p < 0.05 wherein BMI with a telephone booster increased action at 3-month follow-up leading to reduced likelihood of at-risk drinking, less alcohol use, and fewer alcohol problems at both 6- and 12-month follow-up. However, moderated mediation analyses suggested that the effects of the BMI conditions on the stages of change were not contingent on patients' alcohol use severity. CONCLUSIONS This study contributes to the understanding of stages of change as potential mechanisms of change in BMI. Directions for future research are discussed.
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Affiliation(s)
- Craig A Field
- From the, Department of Psychology, (CAF), Latino Alcohol and Health Disparities Research and Training Center, University of Texas at El Paso, El Paso, Texas, USA
| | - Dylan K Richards
- Center on Alcohol, Substance use, And Addictions, (DKR), University of New Mexico, Albuquerque, New Mexico, USA
| | - Yessenia Castro
- Steve Hicks School of Social Work, (YC, KS), University of Texas at Austin, Texas, USA
| | - José Alonso Cabriales
- Arts and Sciences Division, (JAC), University of New Mexico-Gallup, Gallup, New Mexico, USA
| | - Amy Wagler
- Department of Mathematical Science, (AW), University of Texas at El Paso El Paso, Texas, USA
| | - Kirk von Sternberg
- Steve Hicks School of Social Work, (YC, KS), University of Texas at Austin, Texas, USA
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13
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Ahn S, Mello M, Baird J, Strezsak V, Choo EK. Emergency Department Patients are Receptive to Prayer-Based Interventions to Reduce Alcohol Use. JOURNAL OF RELIGION AND HEALTH 2020; 59:1913-1924. [PMID: 30771141 DOI: 10.1007/s10943-019-00779-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Previous studies show that elements of spirituality, including prayer and religious services, may contribute to reductions in harmful alcohol use. The objective of this study was to assess the acceptability of prayer as a component of emergency department (ED) interventions for risky alcohol use. A 12-question multiple-choice questionnaire was developed, piloted, and refined by the study team. The questionnaire included questions about current beliefs and attitudes toward prayer and assessed interest in various means of delivering prayer or prayer support for reducing alcohol use. The questionnaire was administered to a consecutive sample of 111 patients recruited from the 12-month follow-up of a parent RCT study on reducing alcohol use among injured ED patients (ReDIAL). To qualify for the parent study, participants needed an ASSIST v3.0 alcohol score ≥ 11. 90 participants (81%) consented to answer questions about prayer. The participating sample was 38% female and 29% nonwhite; mean age was 36 years. Of these participants, 64% reported that they currently pray; of those, 88% reported praying daily or weekly; 79% agreed that prayer helps with coping in difficult times; 68% agreed that prayer could assist in achieving difficult goals; and 48% agreed that prayer helps reduce alcohol use. Interest in various means of utilizing prayer to reduce alcohol use was assessed in all participants (regardless of whether they currently prayed or not): 45% were interested in having others pray for them to reduce alcohol use; 40% were interested in receiving text reminders to pray; 42% were interested in receiving text messages with specific prayers to use; and 47% were interested in receiving text messages that someone was praying for them. 33.3% of the entire sample stated that they would attend services if provided information on spiritual or religious groups in the community. The incorporation of prayer in alcohol interventions was considered acceptable by a proportion of our sample of risky alcohol users, even those who do not currently use prayer as a resource in their lives. Given the promising data on ED patients' perceptions of the significance and acceptability of spiritual practices in reducing alcohol use, prayer may emerge as a useful adjunctive tool in future ED interventions for alcohol use disorders.
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Affiliation(s)
- Susie Ahn
- Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Michael Mello
- Injury Prevention Center, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Janette Baird
- Injury Prevention Center, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Valerie Strezsak
- Injury Prevention Center, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Esther K Choo
- Center for Policy & Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.
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14
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Psychological morbidity and functional impairment following traumatic pelvic injury. Injury 2020; 51:978-983. [PMID: 32081393 DOI: 10.1016/j.injury.2020.02.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 02/04/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
Pelvic injuries often result from high-energy trauma and lead to significant functional impairment. While the physical outcomes of these injuries have been widely studied, the psychological consequences remain largely unexplored. The purpose of this study was to examine psychosocial and functional outcomes of patients with pelvic trauma in the year after injury. The sample (N = 32) consisted of adult patients with traumatic pelvic injures, as defined by ICD-9 codes, who were admitted to a Level I Trauma Center for at least 24 h. Participants were primarily female (53%) with a mean age of 48.7 years (SD = 17.9). Demographic, injury-related, and psychosocial data (e.g., posttraumatic stress disorder (PTSD), depression, alcohol use, quality of life, pain, return to work) were gathered at the time of hospitalization as well as at 3-, 6-, and 12 month follow-ups. Mixed regression models were used to examine the outcome variables over time. There were significant decreases in pain and alcohol use at each follow-up compared to baseline. However, despite the decrease, the levels of pain and alcohol use remained high. Physical and mental health also decreased significantly, indicating worsened functioning and lowered quality of life. Neither PTSD nor depression changed significantly over time, indicating that participants' symptoms were not likely to improve. These data suggest that sustaining a traumatic pelvic injury increases the risk of diminished quality of life, both mentally and physically. Even one-year post-injury, participants experienced moderate physical pain and higher levels of PTSD, depression, and problematic alcohol use than would be expected in the general population. These findings highlight the need for an interdisciplinary approach to treating patients with pelvic injuries, including psychological screening and intervention in acute care and throughout recovery.
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15
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Snowden C, Lynch E, Avery L, Haighton C, Howel D, Mamasoula V, Gilvarry E, McColl E, Prentis J, Gerrand C, Steel A, Goudie N, Howe N, Kaner E. Preoperative behavioural intervention to reduce drinking before elective orthopaedic surgery: the PRE-OP BIRDS feasibility RCT. Health Technol Assess 2020; 24:1-176. [PMID: 32131964 DOI: 10.3310/hta24120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Heavy alcohol consumption is associated with an increased risk of postoperative complications and extended hospital stay. Alcohol consumption therefore represents a modifiable risk factor for surgical outcomes. Brief behavioural interventions have been shown to be effective in reducing alcohol consumption among increased risk and risky drinkers in other health-care settings and may offer a method of addressing preoperative alcohol consumption. OBJECTIVES To investigate the feasibility of introducing a screening process to assess adult preoperative drinking levels and to deliver a brief behavioural intervention adapted for the target population group. To conduct a two-arm (brief behavioural intervention plus standard preoperative care vs. standard preoperative care alone), multicentre, pilot randomised controlled trial to assess the feasibility of proceeding to a definitive trial. To conduct focus groups and a national web-based survey to establish current treatment as usual for alcohol screening and intervention in preoperative assessment. DESIGN A single-centre, qualitative, feasibility study was followed by a multicentre, two-arm (brief behavioural intervention vs. treatment as usual), individually randomised controlled pilot trial with an embedded qualitative process evaluation. Focus groups and a quantitative survey were employed to characterise treatment as usual in preoperative assessment. SETTING The feasibility study took place at a secondary care hospital in the north-east of England. The pilot trial was conducted at three large secondary care centres in the north-east of England. PARTICIPANTS Nine health-care professionals and 15 patients (mean age 70.5 years, 86.7% male) participated in the feasibility study. Eleven health-care professionals and 68 patients (mean age 66.2 years, 80.9% male) participated in the pilot randomised trial. An additional 19 health-care professionals were recruited to one of three focus groups, while 62 completed an electronic survey to characterise treatment as usual. INTERVENTIONS The brief behavioural intervention comprised two sessions. The first session, delivered face to face in the preoperative assessment clinic, involved 5 minutes of structured brief advice followed by 15-20 minutes of behaviour change counselling, including goal-setting, problem-solving and identifying sources of social support. The second session, an optional booster, took place approximately 1 week before surgery and offered the opportunity to assess progress and boost self-efficacy. MAIN OUTCOME MEASURES Feasibility was assessed using rates of eligibility, recruitment and retention. The progression criteria for a definitive trial were recruitment of ≥ 40% of eligible patients and retention of ≥ 70% at 6-month follow-up. Acceptability was assessed using themes identified in qualitative data. RESULTS The initial recruitment of eligible patients was low but improved with the optimisation of recruitment processes. The recruitment of eligible participants to the pilot trial (34%) fell short of the progression criteria but was mitigated by very high retention (96%) at the 6-month follow-up. Multimethod analyses identified the methods as acceptable to the patients and professionals involved and offers recommendations of ways to further improve recruitment. CONCLUSIONS The evidence supports the feasibility of a definitive trial to assess the effectiveness of brief behavioural intervention in reducing preoperative alcohol consumption and for secondary outcomes of surgical complications if recommendations for further improvements are adopted. TRIAL REGISTRATION Current Controlled Trials ISRCTN36257982. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 12. See the National Institute for Health Research Journals Library website for further project information.
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Affiliation(s)
- Christopher Snowden
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Ellen Lynch
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Leah Avery
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Catherine Haighton
- Department of Social Work, Education & Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Denise Howel
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Valentina Mamasoula
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eilish Gilvarry
- Newcastle Addictions Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elaine McColl
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - James Prentis
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Alison Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Goudie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Howe
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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16
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Drislane LE, Waller R, Martz ME, Bonar EE, Walton MA, Chermack ST, Blow FC. Therapist and computer-based brief interventions for drug use within a randomized controlled trial: effects on parallel trajectories of alcohol use, cannabis use and anxiety symptoms. Addiction 2020; 115:158-169. [PMID: 31400240 PMCID: PMC6933089 DOI: 10.1111/add.14781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/11/2019] [Accepted: 08/02/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS Despite their high comorbidity, the effects of brief interventions (BI) to reduce cannabis use, alcohol use and anxiety symptoms have received little empirical attention. The aims of this study were to examine whether a therapist-delivered BI (TBI) or computer-guided BI (CBI) to address drug use, alcohol consumption (when relevant) and HIV risk behaviors, relative to enhanced usual care (EUC), was associated with reductions in parallel trajectories of alcohol use, cannabis use and anxiety symptoms, and whether demographic characteristics moderated reductions over time. DESIGN Latent growth curve modeling was used to examine joint trajectories of alcohol use, cannabis use and anxiety symptoms assessed at 3, 6 and 12 months after baseline enrollment. SETTING Hurley Medical Center Emergency Department (ED) in Flint, MI, USA. PARTICIPANTS The sample was 780 drug-using adults (aged 18-60 years; 44% male; 52% black) randomly assigned to receive either a TBI, CBI or EUC through the HealthiER You study. INTERVENTIONS AND COMPARATOR ED-delivered TBI and CBIs involved touchscreen-delivered and audio-assisted content. The TBI was administered by a Master's-level therapist, whereas the CBI was self-administered using a virtual health counselor. EUC included a review of health resources brochures in the ED. MEASUREMENTS Assessments of alcohol use (10-item Alcohol Use Disorders Identification Test), cannabis use (past 30-day frequency) and anxiety symptoms (Brief Symptom Inventory-18) occurred at baseline and 3-, 6- and 12-month follow-up. FINDINGS TBI, relative to EUC, was associated with significant reductions in cannabis use [B = -0.49, standard error (SE) = 0.20, P < 0.05) and anxiety (B = -0.04, SE = 0.02, P < 0.05), but no main effect for alcohol use. Two of 18 moderation tests were significant: TBI significantly reduced alcohol use among males (B = -0.60, SE = 0.19, P < 0.01) and patients aged 18-25 years in the TBI condition showed significantly greater reductions in cannabis use relative to older patients (B = -0.78, SE = 0.31, P < 0.05). Results for CBI were non-significant. CONCLUSIONS Emergency department-based therapist-delivered brief interventions to address drug use, alcohol consumption (when relevant) and HIV risk behaviors may also reduce alcohol use, cannabis use and anxiety over time, accounting for the overlap of these processes.
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Affiliation(s)
- Laura E. Drislane
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109
| | - Rebecca Waller
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109,University of Pennsylvania, Department of Psychology, Stephen A. Levin Building, 425 S University Ave, Philadelphia, PA 19104
| | - Meghan E. Martz
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109
| | - Erin E. Bonar
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109
| | - Maureen A. Walton
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109
| | - Stephen T. Chermack
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109,Veterans Health Administration, Center for Clinical Management Research, Health Services Research & Development, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800,Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, 2215 Fuller Rd, Ann Arbor, MI 48105
| | - Frederic C. Blow
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109,Veterans Health Administration, Center for Clinical Management Research, Health Services Research & Development, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800
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17
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Gerber E, Gelberg L, Rotrosen J, Castelblanco D, Mijanovich T, Doran KM. Health-related material needs and substance use among emergency department patients. Subst Abus 2019; 41:196-202. [PMID: 31368863 DOI: 10.1080/08897077.2019.1635960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Emergency department (ED) visits related to substance use are common. ED patients also have high levels of health-related material needs (HRMNs), such as homelessness and food insecurity. However, little research has examined the intersection between ED patient HRMNs and substance use. Methods: We surveyed a random sample of public hospital ED patients. Surveys included validated single-item screeners for unhealthy alcohol and any drug use and questions on self-reported past-year material needs. We compared individual HRMNs and cumulative number of HRMNs by substance use screening status using bivariate and multivariable analyses. Results: A total of 2312 surveys were completed. Nearly one third of patients (32.3%, n = 747) screened positive for unhealthy alcohol use, and 21.8% (n = 503) screened positive for drug use. Prevalence of HRMNs for all patients-including food insecurity (50.8%), inability to meet essential expenses (40.8%), cost barriers to medical care (24.6%), employment issues (23.8%), and homelessness (21.4%)-was high and was significantly higher for patients with unhealthy alcohol use or drug use. In multivariable analyses, homelessness was independently associated with unhealthy alcohol use (adjusted odds ratio [aOR]: 1.61, 95% confidence interval [CI]: 1.24-2.09) and drug use (aOR: 2.30, 95% CI: 1.74-3.05). There was a significant stepwise increase in the odds of patient unhealthy alcohol or drug use as number of HRMNs increased. Conclusions: ED patients with unhealthy alcohol or drug use have higher prevalence of HRMNs than those without. Our findings suggest that HRMNs may act additively and that homelessness is particularly salient. Patients' comorbid HRMNs may affect the success of ED-based substance use interventions.
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Affiliation(s)
- Evan Gerber
- NYU School of Medicine, New York, New York, USA
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.,Office of Healthcare Transformation and Innovation, VA Greater Los Angeles, Healthcare System, Los Angeles, California, USA
| | - John Rotrosen
- Department of Psychiatry, NYU School of Medicine, New York, New York, USA
| | - Donna Castelblanco
- Department of Emergency Medicine, NYU School of Medicine, New York, New York, USA
| | - Tod Mijanovich
- Department of Applied Statistics, Social Science, and Humanities, NYU Steinhardt School of Culture, Education and Human Development, New York, New York, USA
| | - Kelly M Doran
- Department of Emergency Medicine, NYU School of Medicine, New York, New York, USA.,Department of Population Health, NYU School of Medicine, New York, New York, USA
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18
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Sharpe S, Kool B, Whittaker R, Lee AC, Reid P, Civil I, Ameratunga S. Effect of a text message intervention on alcohol-related harms and behaviours: secondary outcomes of a randomised controlled trial. BMC Res Notes 2019; 12:267. [PMID: 31088559 PMCID: PMC6518739 DOI: 10.1186/s13104-019-4308-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/08/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Mobile Health approaches show promise as a delivery mode for alcohol screening and brief intervention. The 'YourCall' trial evaluated the effect of a low-intensity mobile phone text message brief intervention compared with usual care on hazardous drinking and alcohol-related harms among injured adults. This paper extends our previously published primary outcome analysis which revealed a significant reduction in hazardous drinking associated with the intervention at 3 months, with the effect maintained across 12 months follow-up. The objective of the current study was to evaluate the effect of the intervention on alcohol-related harms and troubles and help-seeking behaviours (secondary outcomes) at 12-months follow-up. RESULTS A parallel two-group, single-blind, randomised controlled trial was conducted in 598 injured inpatients aged 16-69 years identified as having medium-risk hazardous drinking. Logistic regression models applied to 12-month follow-up data showed no significant differences between intervention and control groups in self-reported alcohol-related harms and troubles and help-seeking behaviours. Although this text message intervention led to a significant reduction in hazardous alcohol consumption (previously published primary outcome), changes in self-reported alcohol-related harms and troubles and help seeking behaviours at 12-months follow up (secondary outcomes) were small and non-significant. TRIAL REGISTRATION ACTRN12612001220853. Retrospectively registered 19 November 2012.
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Affiliation(s)
- Sarah Sharpe
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, and Waitemata District Health Board, Auckland, New Zealand
| | - Arier C. Lee
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ian Civil
- Trauma Service, Auckland City Hospital, Auckland, New Zealand
| | - Shanthi Ameratunga
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
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19
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Erdogan M, Kureshi N, Karim SA, Tallon JM, Asbridge M, Green RS. Retrospective analysis of alcohol testing in trauma team activation patients at a Canadian tertiary trauma centre. BMJ Open 2018; 8:e024190. [PMID: 30429147 PMCID: PMC6252682 DOI: 10.1136/bmjopen-2018-024190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Although alcohol screening is an essential requirement of level I trauma centre accreditation, actual rates of compliance with mandatory alcohol testing in trauma patients are seldom reported. Our objective was to determine the prevalence of blood alcohol concentration (BAC) testing in patients requiring trauma team activation (TTA) for whom blood alcohol testing was mandatory, and to elucidate patient-level, injury-level and system-level factors associated with BAC testing. DESIGN Retrospective cohort study. SETTING Tertiary trauma centre in Halifax, Canada. PARTICIPANTS 2306 trauma patients who required activation of the trauma team. PRIMARY OUTCOME MEASURE The primary outcome was the rate of BAC testing among TTA patients. Trends in BAC testing over time and across patient and injury characteristics were described. Multivariable logistic regression examined patient-level, injury-level and system-level factors associated with testing. RESULTS Overall, 61% of TTA patients received BAC testing despite existence of a mandatory testing protocol. Rates of BAC testing rose steadily over the study period from 33% in 2000 to 85% in 2010. Testing varied considerably across patient-level, injury-level and system-level characteristics. Key factors associated with testing were male gender, younger age, lower Injury Severity Score, scene Glasgow Coma Scale score <9, direct transport to hospital and presentation between midnight and 09:00 hours, or on the weekend. CONCLUSIONS At this tertiary trauma centre with a policy of empirical alcohol testing for TTA patients, BAC testing rates varied significantly over the 11-year study period and distinct factors were associated with alcohol testing in TTA patients.
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Affiliation(s)
- Mete Erdogan
- Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Nelofar Kureshi
- Departments of Critical Care, Emergency Medicine, and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Saleema A Karim
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - John M Tallon
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Asbridge
- Departments of Community Health and Epidemiology and Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert S Green
- Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
- Departments of Critical Care, Emergency Medicine, and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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20
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Culp BL, Roden-Foreman JW, Thomas EV, McShan EE, Bennett MM, Martin KR, Powers MB, Foreman ML, Petrey LB, Warren AM. Better with age? A comparison of geriatric and non-geriatric trauma patients' psychological outcomes 6 months post-injury. Cogn Behav Ther 2018; 48:406-418. [PMID: 30392449 DOI: 10.1080/16506073.2018.1533578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This is the first study to compare both physical and psychological outcomes in geriatric and non-geriatric patients (n = 268) at baseline and 6 months post-trauma. Demographic, clinical, and psychological data, including screens for alcohol use, depressive symptoms, and post-traumatic stress symptoms (PTSS) were collected from 67 geriatric patients (70.7 ± 8.0 years) and 201 non-geriatric patients (40.2 ± 12.8 years) admitted to a Level I trauma center for ≥ 24 h. Geriatric patients were significantly less likely to screen positive for alcohol use at baseline, and depression, PTSS, and alcohol use at follow-up. When not controlling for discharge to rehabilitation or nursing facility, geriatric patients had significantly lower odds of alcohol use at follow-up. There was no significant difference in injury severity, resilience, or pre-trauma psychological status between the two groups. Results indicate that geriatric trauma patients fare better than their younger counterparts at 6 months post-trauma on measures of alcohol use, depression, and PTSS. Screenings and interventions for both age groups could improve psychological health post-trauma, but younger patients may require additional attention.
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Affiliation(s)
- Brittney L Culp
- a Department of Surgery, Baylor Scott & White - Grapevine , Grapevine , TX , USA
| | - Jacob W Roden-Foreman
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Estrella V Thomas
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Evan Elizabeth McShan
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Monica M Bennett
- c Baylor Scott & White Health, Center for Clinical Effectiveness , Dallas , TX , USA
| | - Katherine Riley Martin
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Mark B Powers
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Michael L Foreman
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Laura B Petrey
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Ann Marie Warren
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
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21
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Rogers JL, Bernard JM, Veach LJ, Moro RR, Ivers NN, Reboussin BA, Miller P, O'Brien MC. Brief Counseling for Alcohol Misuse Among Trauma Patients: Two Interventions and Influence of Baseline Use. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2018. [DOI: 10.1002/jaoc.12049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | | | - Beth A. Reboussin
- Wake Forest University Health Sciences, all at Wake Forest University
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Baldacchino A, O'Rourke L, Humphris G. Investigating the effect of Alcohol Brief Interventions within accident and emergency departments using a data informatics methodology. Drug Alcohol Depend 2018; 188:47-52. [PMID: 29747037 DOI: 10.1016/j.drugalcdep.2018.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 03/10/2018] [Accepted: 03/12/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alcohol Brief Interventions (ABI) have been implemented throughout Scotland since 2008 and aim to reduce hazardous drinking through a Scottish Government funded initiative delivered in a range of settings, including Accident and Emergency (A and E) departments. PURPOSE To study the extent to which Alcohol Brief Interventions (ABI) are associated with later health service use. METHOD An opportunistic informatics approach was applied. A unique patient identifier was used to link patient data with core datasets spanning two years previous and two years post ABI. Variables included inpatient attendance, outpatient attendance, psychiatric admissions, and A and E attendance and prescribing. Patients (N = 1704) who presented at A and E departments who reported an average alcohol consumption of more than 8 units daily received the ABI. Fast Alcohol Screening Test (FAST) was used to assess patients for hazardous alcohol consumption. Multilevel linear modelling was employed to predict post-intervention utilisation using pre-ABI variables and controlling for person characteristics and venue. RESULTS Significant decrease in A and E usage was found at one and two years following the ABI intervention. Previous health service use was predictive of later service use. A single question (Item 4) on the FAST was predictive of A and E attendance at one and two years. CONCLUSIONS This investigation and methodology used provide support for the delivery of the ABI. However, it cannot be ascertained whether this is due to the ABI or simply is a result of making contact with a specialist in the addiction field.
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Affiliation(s)
- Alex Baldacchino
- St Andrews Medical School, Division of Population and Behavioural Science, University of St Andrews, North Haugh, St Andrews, Fife, KY16 9TF Scotland, United Kingdom.
| | - Louise O'Rourke
- St Andrews Medical School, Division of Population and Behavioural Science, University of St Andrews, North Haugh, St Andrews, Fife, KY16 9TF Scotland, United Kingdom.
| | - Gerry Humphris
- St Andrews Medical School, Division of Population and Behavioural Science, University of St Andrews, North Haugh, St Andrews, Fife, KY16 9TF Scotland, United Kingdom.
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23
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Falvo F, Schmid A. Bridging the Gap: Drug and Alcohol Screening in Adolescent Trauma Patients. J Emerg Nurs 2018; 44:325-330. [DOI: 10.1016/j.jen.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/23/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022]
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24
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Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training and Implementation: Perspectives from 4 Health Professions. J Addict Med 2018; 12:262-272. [DOI: 10.1097/adm.0000000000000410] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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McGovern R, Stamp E, Javanbakht M, McColl E, Hickman M, Kaner E. Promoting Alcohol Reduction in Non-Treatment Seeking parents (PAReNTS): a protocol for a pilot feasibility cluster randomised controlled trial of alcohol screening and brief interventions to reduce parental alcohol use disorders in vulnerable families. Pilot Feasibility Stud 2018; 4:111. [PMID: 29930865 PMCID: PMC5994069 DOI: 10.1186/s40814-018-0305-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/25/2018] [Indexed: 11/20/2022] Open
Abstract
Background Research estimates that 30% of children under the age of 16 years in the UK live with at least one parent with an alcohol use disorder (AUD). Parental AUDs are associated with adverse childhood experiences and poorer outcomes for children. The PAReNTS (Promoting Alcohol Reduction in Non-Treatment Seeking parents) trial aims to examine the feasibility and acceptability of a randomised controlled trial of brief alcohol interventions to reduce parental alcohol misuse. Methods The cluster randomised controlled trial will be conducted within early help family support and children’s social care services in three local authorities in the North East of England: Newcastle, Durham and North Tyneside. All eligible parents the caseloads of participating practitioners will be screened for an AUD using the Alcohol Use Disorder Identification Test – Consumption (AUDIT-C) screening tool by the social care practitioners within routine appointments. All parents who score 5 or more on the AUDIT-C will be invited to participate in the trial. Consenting participants will complete a baseline questionnaire before receiving one of three randomised interventions: (i) healthy lifestyle leaflet (control intervention); (ii) a brief alcohol advice intervention delivered by the social care practitioner plus healthy lifestyle leaflet; (iii) a brief alcohol advice intervention delivered by the social care practitioner, healthy lifestyle leaflet plus a 40-min behaviour change intervention with an optional review session delivered by the local alcohol service. Follow-up data will be collected 6 and 12 months post recruitment. A linked qualitative study will explore participating parent and practitioner views on the acceptability of trial processes and interventions. Discussion The PAReNTS trial will provide a robust estimate of recruitment, retention and consent rates in order to inform the design of a future definitive study examining the effectiveness and cost-effectiveness of alcohol screening and brief interventions to reduce parental AUDs within vulnerable families. Trial registration ISRCTN registry ISRCTN60291091; protocol version 2; 17.10.2016 Electronic supplementary material The online version of this article (10.1186/s40814-018-0305-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruth McGovern
- 1Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine Stamp
- 1Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mehdi Javanbakht
- 1Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- 1Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Hickman
- 2School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Eileen Kaner
- 1Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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26
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Dwommoh R, Sorsdahl K, Myers B, Asante KP, Naledi T, Stein DJ, Cleary S. Brief interventions to address substance use among patients presenting to emergency departments in resource poor settings: a cost-effectiveness analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:24. [PMID: 29946229 PMCID: PMC6006568 DOI: 10.1186/s12962-018-0109-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 06/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background There are limited data describing the cost-effectiveness of brief interventions for substance use in resource-poor settings. Using a patient and provider perspective, this study investigates the cost-effectiveness of a brief motivational interviewing (MI) intervention versus a combined intervention of MI and problem solving therapy (MI-PST) for reducing substance use among patients presenting to emergency departments, in comparison to a control group. Methods Effectiveness data were extracted from Project STRIVE (Substance use and Trauma InterVention) conducted in South Africa. Patients were randomised to either receive 1 session of MI (n = 113) or MI in addition to four sessions of PST (n = 109) or no intervention [control (n = 110)]. Costs included the direct health care costs associated with the interventions. Patient costs included out of pocket payments incurred accessing the MI-PST intervention. Outcome measures were patients’ scores on the Alcohol, Smoking and Substance Use Involvement Screening Test (ASSIST) and the Centre for Epidemiological Studies Depression Scale (CES-D). Results Cost per patient was low in all three groups; US$16, US$33 and US$11, and for MI, MI-PST and control respectively. Outcomes were 0.92 (MI), 1.06 (MI-PST) and 0.88 (control) for ASSIST scores; and 0.74 (MI), 1.27 (MI-PST) and 0.53 (control) for CES-D scores. In comparison to the control group, the MI intervention costs an additional US$119 per unit reduction in ASSIST score, (US$20 for CES-D); MI-PST in comparison to MI costs US$131 or US$33 per unit reduction in ASSIST or CES-D scores respectively. The sensitivity analyses showed that increasing the number of patients who screened positive and thus received the intervention could improve the effectiveness and cost-effectiveness of the interventions. Conclusion MI or MI-PST interventions delivered by lay counsellors have the potential to be cost-effective strategies for the reduction of substance use disorder and depressive symptoms among patients presenting at emergency departments in resource poor settings. Given the high economic, social and health care cost of substance use disorders in South Africa, these results suggest that these interventions should be carefully considered for future implementation. Trial registration This study is part of a trial registered with the Pan African Clinical Trial Registry (PACTR201308000591418)
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Affiliation(s)
- Rebecca Dwommoh
- 1Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925 South Africa.,2Kintampo Health Research Centre, P.O. Box 200, Kintampo, Ghana
| | - Katherine Sorsdahl
- 3Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, 7925 South Africa
| | - Bronwyn Myers
- 4Department of Psychiatry & Mental Health, Groote Schuur Hospital, University of Cape Town, Cape Town, 7925 South Africa.,5Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Tygerberg, 7505 South Africa
| | | | - Tracey Naledi
- 6Western Cape Department of Health, 8 Riebeeck Street, Cape Town, 8001 South Africa
| | - Dan J Stein
- 4Department of Psychiatry & Mental Health, Groote Schuur Hospital, University of Cape Town, Cape Town, 7925 South Africa.,7South African MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, 7925 South Africa
| | - Susan Cleary
- 1Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925 South Africa
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Effect of a text message intervention to reduce hazardous drinking among injured patients discharged from a trauma ward: a randomized controlled trial. NPJ Digit Med 2018; 1:13. [PMID: 31304298 PMCID: PMC6550138 DOI: 10.1038/s41746-018-0019-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 02/04/2018] [Accepted: 02/08/2018] [Indexed: 02/03/2023] Open
Abstract
Screening and brief intervention for hazardous alcohol use in trauma care settings is known to reduce alcohol intake and injury recidivism, but is often not implemented due to resource constraints. Brief interventions delivered by mobile phone could overcome this challenge. This study aimed to evaluate the effect of a mobile phone text message intervention (YourCallTM) on hazardous drinkers admitted for an injury. The parallel two-group, single-blind, randomised controlled trial enrolled 598 injured patients aged 16–69 years identified as medium-risk drinkers at recruitment. The intervention group (n = 299) received 16 text messages incorporating brief intervention principles in the 4 weeks following discharge from hospital. Controls (n = 299) received usual care and one text message acknowledging participation in the trial. The primary outcome was the difference in hazardous alcohol use (assessed using AUDIT-C) between study groups at 3 months, with the maintenance of effect examined at 6 and 12 months’ follow-up. Data were analysed using a mixed-effects model for repeated measures. Both groups had similar baseline features. Compared to controls, hazardous drinking was significantly lower in the intervention group at 3 months and maintained over the 12-month follow-up period (least squares mean difference in AUDIT-C scores: −0.322; 95% CI: −0.636, −0.008; p = 0.04). The intervention effect was similar among Māori (New Zealand’s indigenous population) and non-Māori (interaction p = 0.59), and among younger (16–29 years) and older (30–69 years) patients (p = 0.77). The effectiveness of this intervention reflects the potential of low cost, scalable mobile health technologies to overcome common barriers in implementing alcohol harm reduction strategies following injury. Mobile phone text messages reduce dangerous patterns of alcohol consumption and could help prevent alcohol-related injuries. A trial carried out in New Zealand led by Sarah Sharpe at the University of Auckland examined the effect of sending 16 automated text messages over a four-week period to 299 adults discharged from hospital following an injury and identified as moderate risk hazardous drinkers. The messages, which encouraged patients to reduce their alcohol consumption and offered information on how to do so in an easy-to-understand and non-judgemental manner, reduced hazardous drinking throughout the 12-month follow-up period compared with a control group that received usual care. These findings suggest that text message interventions are an effective, low cost and easily scalable solution to curb harmful alcohol consumption.
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Kool B, Buller S, Kuriyan R, Jones-Todd CM, Newcombe D, Jones P. Alcohol and injury among attendees at a busy inner city New Zealand emergency department. Injury 2018. [PMID: 29519635 DOI: 10.1016/j.injury.2018.02.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We present a study that provides a contemporary view of alcohol-related injury prevalence amongst patients presenting to a New Zealand (NZ) emergency department (ED). METHODS Adult injury patients presenting to Auckland City Hospital ED within 6 h of injury were invited to participate during three recruitment periods (2015-2016). An interviewer-administered questionnaire obtained information on demographic, injury, general health, and lifestyle factors. Breath alcohol samples were obtained. Descriptive and logistic regression analyses were conducted. RESULTS 501 patients participated (71% response rate), 21% had consumed alcohol within 6 h of their injury. The majority were male, and overall falls were the most common mechanism of injury among all patients. Alcohol-related injuries most commonly occurred at home, and were significantly more likely to occur during the weekend (Friday-Sunday) and night hours (23:00-06:59). After controlling for the effects of confounding; 'poor' general health, engaging in leisure activities at the time of injury, and injuries resulting from assaults were associated with increasing the odds of alcohol-related injury. CONCLUSIONS Acute alcohol use continues to play a considerable role in ED injury presentations in NZ. Continued policy, health promotion, and injury prevention efforts are required to reduce the harms associated with alcohol use.
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Affiliation(s)
- Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Centre for Addiction Research, University of Auckland, Auckland, New Zealand.
| | - Sarah Buller
- Auckland City Hospital Emergency Department, Auckland, New Zealand
| | - Ron Kuriyan
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charlotte M Jones-Todd
- Centre for Research into Ecological and Environmental Statistics, School of Mathematics and Statistics, University of St Andrews, St Andrews, Scotland, UK
| | - David Newcombe
- Centre for Addiction Research, University of Auckland, Auckland, New Zealand; Section of Social and Community Health, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Peter Jones
- Auckland City Hospital Emergency Department, Auckland, New Zealand
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Bonar EE, Walton MA, Barry KL, Bohnert AS, Chermack ST, Cunningham RM, Massey LS, Ignacio RV, Blow FC. Sexual HIV risk behavior outcomes of brief interventions for drug use in an inner-city emergency department: Secondary outcomes from a randomized controlled trial. Drug Alcohol Depend 2018; 183:217-224. [PMID: 29291549 PMCID: PMC5803438 DOI: 10.1016/j.drugalcdep.2017.10.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Drug use is an established risk factor for HIV. Brief Interventions (BIs) targeting reductions in both drug use and HIV risk behaviors may help curtail these related epidemics. The present study evaluates the impact of BIs for drug use and HIV risk reduction on sexual HIV risk behaviors among a primarily marijuana-using sample during a 12-month post-intervention follow-up period. METHODS We conducted a randomized controlled trial of 780 adult patients in an Emergency Department (ED) with past 3-month drug use (primarily non-injecting). This study used a 3 × 2 factorial design (3 ED-based conditions: computer-delivered brief intervention [Computer BI], therapist-delivered, computer-guided BI [Therapist BI], or enhanced usual care (EUC-ED) for drug-using adults; 2 follow-up conditions at 3 months: booster or control). This analysis examines the outcomes of the BIs on sexual HIV risk behaviors at 3-, 6-, and 12-months. RESULTS Compared to the enhanced usual care control, the combined Therapist BI with booster resulted in significant reductions in scores on the sexual risk subscale of the HIV Risk Taking Behaviour Scale over 12-months, when controlling for baseline sexual risk, gender, and drug dependency status. The baseline interventions alone, booster alone, and Computer BI plus booster did not differ from the comparison group (EUC plus control). CONCLUSIONS A therapist-delivered BI for drug use and HIV risk behaviors, combined with a follow-up therapist-delivered booster, shows promise for reducing sexual HIV risk behaviors among a primarily marijuana using, non-injecting sample.
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Affiliation(s)
- Erin E. Bonar
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA
| | - Maureen A. Walton
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA
| | - Kristen L. Barry
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA
| | - Amy S.B. Bohnert
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Stephen T. Chermack
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Mental Health Service, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Rebecca M. Cunningham
- Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA,Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109, USA,Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Place, Flint, MI 48503, USA,Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Lynn S. Massey
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA
| | - Rosalinda V. Ignacio
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Frederic C. Blow
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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Anderson P, Jané-Llopis E, Hasan OSM, Rehm J. City-based action to reduce harmful alcohol use: review of reviews. F1000Res 2018; 7:120. [PMID: 29862017 PMCID: PMC5843824 DOI: 10.12688/f1000research.13783.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 02/03/2023] Open
Abstract
Background: The World Health Organization global strategy on alcohol called for municipal policies to reduce the harmful use of alcohol. Yet, there is limited evidence that documents the impact of city-level alcohol policies. Methods: Review of reviews for all years to July 2017. Searches on OVID Medline, Healthstar, Embase, PsycINFO, AMED, Social Work Abstracts, CAB Abstracts, Mental Measurements Yearbook, Health and Psychosocial Instruments, International Pharmaceutical Abstracts, International Political Science Abstracts, NASW Clinical Register, and Epub Ahead of Print databases. All reviews that address adults, without language or date restrictions resulting from combining the terms ("review" or "literature review" or "review literature" or "data pooling" or "comparative study" or "systematic review" or "meta-analysis" or "pooled analysis"), and "alcohol", and "intervention" and ("municipal" or "city" or "community"). Results: Five relevant reviews were identified. Studies in the reviews were all from high income countries and focussed on the acute consequences of drinking, usually with one target intervention, commonly bars, media, or drink-driving. No studies in the reviews reported the impact of comprehensive city-based action. One community cluster randomized controlled trial in Australia, published after the reviews, failed to find convincing evidence of an impact of community-based interventions in reducing adult harmful use of alcohol. Conclusions: To date, with one exception, the impact of adult-oriented comprehensive community and municipal action to reduce the harmful use of alcohol has not been studied. The one exception failed to find a convincing effect. We conclude with recommendations for closing this evidence gap.
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Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne , NE2 4AX, UK
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, Maastricht, 6221 HA , Netherlands
| | - Eva Jané-Llopis
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- ESADE Business School, Ramon Llull University, Av. Esplugues 92-96, Barcelona, 08034, Spain
| | - Omer Syed Muhammad Hasan
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON M5T 1R8, Canada
- Institute of Medical Science (IMS) , University of Toronto, Medical Sciences Building,1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, Dresden, 01187 , Germany
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Anderson P, Jané-Llopis E, Hasan OSM, Rehm J. City-based action to reduce harmful alcohol use: review of reviews. F1000Res 2018; 7:120. [PMID: 29862017 PMCID: PMC5843824 DOI: 10.12688/f1000research.13783.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2018] [Indexed: 11/20/2022] Open
Abstract
Background: The World Health Organization global strategy on alcohol called for municipal policies to reduce the harmful use of alcohol. Yet, there is limited evidence that documents the impact of city-level alcohol policies. Methods: Review of reviews for all years to July 2017. Searches on OVID Medline, Healthstar, Embase, PsycINFO, AMED, Social Work Abstracts, CAB Abstracts, Mental Measurements Yearbook, Health and Psychosocial Instruments, International Pharmaceutical Abstracts, International Political Science Abstracts, NASW Clinical Register, and Epub Ahead of Print databases. All reviews that address adults, without language or date restrictions resulting from combining the terms ("review" or "literature review" or "review literature" or "data pooling" or "comparative study" or "systematic review" or "meta-analysis" or "pooled analysis"), and "alcohol", and "intervention" and ("municipal" or "city" or "community"). Results: Five relevant reviews were identified. Studies in the reviews were all from high income countries and focussed on the acute consequences of drinking, usually with one target intervention, commonly bars, media, or drink-driving. No studies in the reviews reported the impact of comprehensive city-based action. One community cluster randomized controlled trial in Australia, published after the reviews, failed to find convincing evidence of an impact of community-based interventions in reducing adult harmful use of alcohol. Conclusions: To date, with one exception, the impact of adult-oriented comprehensive community and municipal action to reduce the harmful use of alcohol has not been studied. The one exception failed to find a convincing effect. We conclude with recommendations for closing this evidence gap.
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Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne , NE2 4AX, UK
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, Maastricht, 6221 HA , Netherlands
| | - Eva Jané-Llopis
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- ESADE Business School, Ramon Llull University, Av. Esplugues 92-96, Barcelona, 08034, Spain
| | - Omer Syed Muhammad Hasan
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON M5T 1R8, Canada
- Institute of Medical Science (IMS) , University of Toronto, Medical Sciences Building,1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, Dresden, 01187 , Germany
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Merchant RC, Romanoff J, Zhang Z, Liu T, Baird JR. Impact of a brief intervention on reducing alcohol use and increasing alcohol treatment services utilization among alcohol- and drug-using adult emergency department patients. Alcohol 2017; 65:71-80. [PMID: 29084632 PMCID: PMC5681406 DOI: 10.1016/j.alcohol.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 05/30/2017] [Accepted: 07/13/2017] [Indexed: 11/22/2022]
Abstract
Most previous brief intervention (BI) studies have focused on alcohol or drug use, instead of both substances. Our primary aim was to determine if an alcohol- and drug-use BI reduced alcohol use and increased alcohol treatment services utilization among adult emergency department (ED) patients who drink alcohol and require an intervention for their drug use. Our secondary aims were to assess when the greatest relative reductions in alcohol use occurred, and which patients (stratified by need for an alcohol use intervention) reduced their alcohol use the most. In this secondary analysis, we studied a sub-sample of participants from the Brief Intervention for Drug Misuse in the Emergency Department (BIDMED) randomized, controlled trial of a BI vs. no BI, whose responses to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) indicated a need for a BI for any drug use, and who also reported alcohol use. Participants were stratified by their ASSIST alcohol subscore: 1) no BI needed, 2) a BI needed, or 3) an intensive intervention needed for alcohol use. Alcohol use and alcohol treatment services utilization were measured every 3 months for 12 months post-enrollment. Of these 833 participants, median age was 29 years-old, 46% were female; 55% were white/non-Hispanic, 27% black/non-Hispanic, and 15% Hispanic. Although any alcohol use, alcohol use frequency, days of alcohol use, typical drinks consumed/day, and most drinks consumed/day decreased in both the BI and no BI arms, there were no differences between study arms. Few patients sought alcohol use treatment services in follow-up, and utilization also did not differ by study arm. Compared to baseline, alcohol use reduced the most during the first 3 months after enrollment, yet reduced little afterward. Participants whose ASSIST alcohol subscores indicated a need for an intensive intervention generally had the greatest relative decreases in alcohol use. These results indicate that the BI was not efficacious in reducing alcohol use among alcohol- and drug-using adult ED patients than the self-assessments alone, but suggest that self-assessments with or without a BI may confer reductions in alcohol use.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
| | - Justin Romanoff
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Zihao Zhang
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Janette R Baird
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
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Variance in the Efficacy of Brief Interventions to Reduce Hazardous and Harmful Alcohol Consumption Between Injury and Noninjury Patients in Emergency Departments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ann Emerg Med 2017; 70:714-723.e13. [DOI: 10.1016/j.annemergmed.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/19/2017] [Accepted: 05/02/2017] [Indexed: 01/03/2023]
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The Acceptability and Feasibility of Screening for Alcohol and Drug Misuse in a Hospital Emergency Department. ADDICTIVE DISORDERS & THEIR TREATMENT 2017; 16:111-120. [PMID: 28883782 PMCID: PMC5566165 DOI: 10.1097/adt.0000000000000108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Objectives: Screening and brief intervention (SBI) is an evidence-based technique for reducing harmful consumption of alcohol and other drugs, which has been shown to be effective in Emergency Departments (EDs). The feasibility of SBI in the ED, however, remains contentious and no studies have been conducted on this topic in a New Zealand ED. Materials and Methods: This study recruited 8 experienced ED nurses who attempted to provide SBI, using the ASSIST-Lite tool, to as many of their patients as possible over one calendar month. All nurses participated in a comprehensive 1-day training workshop on the administration and interpretation of the ASSIST-Lite and linked brief intervention. Results: Only 46 (11.79%) of the 390 eligible patients were given the opportunity to participate over the data collection period. Analysis of the data showed there was a significant, negative correlation between the number of patients in the ED and the average number of screens that were performed by the nurses, and that the number of screens waned immediately after SBI training. Following the data collection period, the nurse participants were interviewed about their experience. These interviews revealed 3 main themes that contextualized the willingness to, but inherent difficulty of, administering the SBI within the ED environment. Conclusions: High patient-to-nurse ratios in the ED currently preclude nurses from providing consistent SBI to all eligible patients; however, there are several practical considerations highlighted here that might help nurses increase the participation rate.
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Cordovilla-Guardia S, Fernández-Mondéjar E, Vilar-López R, Navas JF, Portillo-Santamaría M, Rico-Martín S, Lardelli-Claret P. Effect of a brief intervention for alcohol and illicit drug use on trauma recidivism in a cohort of trauma patients. PLoS One 2017; 12:e0182441. [PMID: 28813444 PMCID: PMC5559089 DOI: 10.1371/journal.pone.0182441] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/18/2017] [Indexed: 11/19/2022] Open
Abstract
Objective Estimate the effectiveness of brief interventions in reducing trauma recidivism in hospitalized trauma patients who screened positive for alcohol and/or illicit drug use. Methods Dynamic cohort study based on registry data from 1818 patients included in a screening and brief intervention program for alcohol and illicit drug use for hospitalized trauma patients. Three subcohorts emerged from the data analysis: patients who screened negative, those who screened positive and were offered brief intervention, and those who screened positive and were not offered brief intervention. Follow-up lasted from 10 to 52 months. Trauma-free survival, adjusted hazard rate ratios (aHRR) and adjusted incidence rate ratios (aIRR) were calculated, and complier average causal effect (CACE) analysis was used. Results We found a higher cumulative risk of trauma recidivism in the subcohort who screened positive. In this subcohort, an aHRR of 0.63 (95% CI: 0.41–0.95) was obtained for the group offered brief intervention compared to the group not offered intervention. CACE analysis yielded an estimated 52% reduction in trauma recidivism associated with the brief intervention. Conclusion The brief intervention offered during hospitalization in trauma patients positive for alcohol and/or illicit drug use can halve the incidence of trauma recidivism.
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Affiliation(s)
- Sergio Cordovilla-Guardia
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
- * E-mail:
| | - Enrique Fernández-Mondéjar
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Raquel Vilar-López
- Department of Personality, Evaluation and Psychological Treatment. University of Granada, Granada, Spain
- Addictive Disorders Network, RTA Instituto de Salud Carlos III, Spanish Ministry, Spain
- Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
| | - Juan F. Navas
- Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
- Department of Experimental Psychology. University of Granada, Granada, Spain
| | | | - Sergio Rico-Martín
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Pablo Lardelli-Claret
- Instituto de Investigación Biosanitaria IBS, Granada, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain. CIBER of Epidemiology and Public Health. Spain
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Milward J, Deluca P, Drummond C, Watson R, Dunne J, Kimergård A. Usability Testing of the BRANCH Smartphone App Designed to Reduce Harmful Drinking in Young Adults. JMIR Mhealth Uhealth 2017; 5:e109. [PMID: 28790022 PMCID: PMC5566629 DOI: 10.2196/mhealth.7836] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/30/2017] [Accepted: 06/02/2017] [Indexed: 12/02/2022] Open
Abstract
Background Electronic screening and brief intervention (eSBI) apps demonstrate potential to reduce harmful drinking. However, low user engagement rates with eSBI reduce overall effectiveness of interventions. As “Digital Natives,” young adults have high expectations of app quality. Ensuring that the design, content, and functionality of an eSBI app are acceptable to young adults is an integral stage to the development process. Objective The objective of this study was to identify usability barriers and enablers for an app, BRANCH, targeting harmful drinking in young adults. Methods The BRANCH app contains a drinking diary, alcohol reduction goal setting functions, normative drinking feedback, and information on risks and advice for cutting down. The app includes a social feature personalized to motivate cutting down and to promote engagement with a point-based system for usage. Three focus groups were conducted with 20 users who had tested the app for 1 week. A detailed thematic analysis was undertaken. Results The first theme, “Functionality” referred to how users wanted an easy-to-use interface, with minimum required user-input. Poor functionality was considered a major usability barrier. The second theme, “Design” described how an aesthetic with minimum text, clearly distinguishable tabs and buttons and appealing infographics was integral to the level of usability. The final theme, “Content” described how participants wanted all aspects of the app to be automatically personalized to them, as well as providing them with opportunities to personalize the app themselves, with increased options for social connectivity. Conclusions There are high demands for apps such as BRANCH that target skilled technology users including young adults. Key areas to optimize eSBI app development that emerged from testing BRANCH with representative users include high-quality functionality, appealing aesthetics, and improved personalization.
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Affiliation(s)
- Joanna Milward
- Addictions Department, King's College London, London, United Kingdom
| | - Paolo Deluca
- Addictions Department, King's College London, London, United Kingdom
| | - Colin Drummond
- Addictions Department, King's College London, London, United Kingdom
| | - Rod Watson
- Health Innovation Network, London, United Kingdom
| | - Jacklyn Dunne
- Addictions Department, King's College London, London, United Kingdom
| | - Andreas Kimergård
- Addictions Department, King's College London, London, United Kingdom
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Reid SD, Gentius J. Type and Context of Alcohol-Related Injury among Patients Presenting to Emergency Departments in a Caribbean Country. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080877. [PMID: 28777317 PMCID: PMC5580581 DOI: 10.3390/ijerph14080877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/30/2017] [Accepted: 08/02/2017] [Indexed: 12/05/2022]
Abstract
There is an association between alcohol consumption and injuries in Latin America and the Caribbean. This cross-sectional study explores the socio-contextual factors of alcohol-related injuries in Trinidad and Tobago. Data on drinking patterns, injury type, drinking context prior to injury, and demographics were collected from patients presenting with injuries to the Emergency Departments (ED) of four hospitals. Findings show that 20.6% of patients had consumed alcohol, mainly beer, in the 6 h before injury. More than half were drinking at home (27%), or someone else’s home (27%). Injury most commonly occurred outdoors (36%) while in transit. Alcohol-related injuries occurred mainly because of falling or tripping (31.7%); these patients recorded the highest mean alcohol consumption prior to injury. Most persons who fell (50%) did so at home. Findings highlight the previously unreported significant risk of non-drivers sustaining injures through falling and tripping because of heavy alcohol use. Current interventions to reduce alcohol-related injury have focused on drink driving but there is a need for interventions targeting pedestrians and those who drink at home. A comprehensive multi-component approach including secondary prevention interventions in the medical setting, community educational interventions, enforcement of current legislative policies concerning the sale of alcohol, and policy initiatives surrounding road safety and alcohol outlet density should be implemented.
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Affiliation(s)
- Sandra D Reid
- Department of Psychiatry, The University of the West Indies, St. Augustine, Trinidad and Tobago.
- Caribbean Institute on Addictive Disorders, Petit Bourg, Trinidad and Tobago.
| | - Jannel Gentius
- Department of Behavioural Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
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Blow FC, Walton MA, Bohnert ASB, Ignacio RV, Chermack S, Cunningham RM, Booth BM, Ilgen M, Barry KL. A randomized controlled trial of brief interventions to reduce drug use among adults in a low-income urban emergency department: the HealthiER You study. Addiction 2017; 112:1395-1405. [PMID: 28127808 DOI: 10.1111/add.13773] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/20/2016] [Accepted: 01/26/2017] [Indexed: 11/27/2022]
Abstract
AIMS To examine efficacy of drug brief interventions (BIs) among adults presenting to a low-income urban emergency department (ED). DESIGN Randomized controlled trial on drug use outcomes at 3, 6 and 12 months. Participants were assigned to (1) computer-delivered BI (Computer BI), (2) therapist-delivered, computer-guided BI (Therapist BI) or (3) enhanced usual care (EUC-ED) for drug-using adults. Participants were re-randomized after the 3-month assessment to either adapted motivational enhancement therapy (AMET) booster or enhanced usual care booster (EUC-B). SETTING Patients recruited from low-income urban emergency departments (ED) in Flint, Michigan, USA. PARTICIPANTS A total of 780 ED patients reporting recent drug use, 44% males, mean age = 31 years. INTERVENTIONS Computer BI consisted of an interactive program guided by a virtual health counselor. Therapist BI included computer guidance. The EUC-ED conditions included review of community health and HIV prevention resources. The BIs and boosters were based on motivational interviewing, focusing on reduction of drug use and HIV risk behaviors. MEASUREMENTS Primary outcome was past 90 days using drugs at 6 and 12 months and secondary outcomes were weighted drug-days and days of marijuana use. FINDINGS Percentage changes in mean days used any drug from baseline to 12 months were: Computer BI + EUC-B: -10.9%, P = 0.0844; Therapist BI + EUC-B: -26.7%, P = 0.0041, for EUC-ED + EUC-B: -20.9, P = 0.0011. In adjusted analyses, there was no significant interaction between ED intervention and booster AMET for primary and secondary outcomes. Compared with EUC-ED, Therapist BI reduced number of days using any drug [95% confidence interval (CI) = -0.41, -0.07, P = 0.0422] and weighted drug-days (95% CI = -0.41, -0.08, P = 0.0283). Both Therapist and Computer BI had significantly fewer number of days using marijuana compared to EUC-ED (Therapist BI: 95% CI = -0.42, -0.06, P = 0.0104, Computer BI: 95% CI = -0.34, -0.01, P = 0.0406). Booster effects were not significant. CONCLUSIONS An emergency department-based motivational brief intervention, delivered by a therapist and guided by computer, appears to reduce drug use among adults seeking emergency department care compared with enhanced usual care.
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Affiliation(s)
- Frederic C Blow
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Maureen A Walton
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA
| | - Amy S B Bohnert
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Rosalinda V Ignacio
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Stephen Chermack
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, USA
| | - Rebecca M Cunningham
- Injury Center, University of Michigan, Ann Arbor, MI, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, MI and Hurley Hospital, Flint, MI, USA.,School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Mark Ilgen
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Kristen L Barry
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA
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McCormack RP. Commentary on Blow et al. (2017): Leveraging technology may boost the effectiveness and adoption of interventions for drug use in emergency departments. Addiction 2017; 112:1406-1407. [PMID: 28691272 PMCID: PMC5691291 DOI: 10.1111/add.13872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 04/26/2017] [Accepted: 05/03/2017] [Indexed: 11/28/2022]
Abstract
The effect of brief interventions for drug use can depend upon the type and severity of substance use, as well as psychosocial stability and other variables. Innovative technology, such as the computer delivered or assisted approaches tested by Blow et al., should be used to support implementation of brief interventions by maintaining simplicity and enhancing efficiency.
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Affiliation(s)
- Ryan P. McCormack
- Department of Emergency Medicine; NYU School of Medicine; New York NY USA
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Implementing Interprofessional Alcohol Screening, Brief Intervention, and Referral to Treatment in the Emergency Department: An Evidence-Based Quality Improvement Initiative. Adv Emerg Nurs J 2017; 39:199-216. [PMID: 28759512 DOI: 10.1097/tme.0000000000000151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Alcohol misuse is one of the leading causes of illness, disease, injury, and death in the Unites States. For many patients, the emergency department (ED) visit may provide the only therapeutic opportunity to influence problematic drinking behavior. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach that may reduce alcohol-related morbidity and mortality and improve health outcomes and quality of life. Developing and implementing an alcohol SBIRT educational module for ED nurses and social workers is an efficient and effective mechanism to provide education about alcohol SBIRT, and revising the electronic health record to include an alcohol SBIRT protocol provides a standard mechanism for documentation by the interprofessional team of ED nurses and social workers. By integrating SBIRT knowledge as standard of practice in the ED setting, providers can positively impact the health and well-being of patients.
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Turner BJ, McCann BS, Dunn CW, Darnell DA, Beam CR, Kleiber B, Nelson KM, Fukunaga R. Examining the reach of a brief alcohol intervention service in routine practice at a level 1 trauma center. J Subst Abuse Treat 2017; 79:29-33. [PMID: 28673524 DOI: 10.1016/j.jsat.2017.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/15/2017] [Accepted: 05/19/2017] [Indexed: 01/20/2023]
Abstract
The American College of Surgeons requires Level I and II trauma centers to provide brief intervention services to traumatically injured patients who screen positive for alcohol. Despite evidence supporting substantial cost savings and reduced re-injury associated with these services, brief interventions may not be uniformly delivered owing to a variety of demographic, clinical and operational characteristics. To inform service adjustments that may improve the reach of such services, we compared trauma patients who did and did not receive brief alcohol intervention services during their hospitalizations. Electronic medical records of injured patients admitted to a Level I trauma center between September 27, 2013 and March 11, 2014 with a positive blood alcohol concentration (N=189) were coded for demographic and clinical variables. Records of those who did not receive a brief intervention during their admission were reviewed for possible reasons why interventions were not delivered. Of the total sample, 115 patients (60.8%) received brief interventions. Patients who did and did not receive brief interventions did not differ on age, sex, race, blood alcohol concentration at admission, or mechanism of injury, indicating that patient characteristics were unlikely to bias service delivery. Instead, common features of patients who were referred but did not receive SBIRT interventions included admissions lasting fewer than two working days (12.7%) and persistent cognitive impairment following injury (9.0%). These findings align with previous studies suggesting that service reach could be improved by promoting dedicated and flexible staffing and adapting services to allow for SBIRT delivery in follow-up care settings.
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Affiliation(s)
- Brianna J Turner
- Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 359896, 325 Ninth Ave, Seattle, WA 98104, USA
| | - Barbara S McCann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 359896, 325 Ninth Ave, Seattle, WA 98104, USA..
| | - Christopher W Dunn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 359896, 325 Ninth Ave, Seattle, WA 98104, USA
| | - Doyanne A Darnell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 359896, 325 Ninth Ave, Seattle, WA 98104, USA
| | - Christopher R Beam
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 359896, 325 Ninth Ave, Seattle, WA 98104, USA.; Department of Psychology, University of Southern California, 3620 South McClintock Ave, Seeley G. Mudd, Room 523, Los Angeles, CA 90089, USA
| | - Blair Kleiber
- Evidence Based Treatment Centers of Seattle, Suite 800, 1200 5(th) Avenue, Seattle, WA 98101, USA
| | - Kimberly M Nelson
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Box G-A1, Providence, RI 02912, USA; Department of Psychiatry, Rhode Island Hospital, 235 Plain St. #501, Providence, RI 02905, USA; Centers for Behavioral and Preventative Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA
| | - Rena Fukunaga
- Center for Depression, Anxiety and Stress Research, Anxiety and Traumatic Stress Disorders Laboratory, McLean Hospital, DeMarneffe, 2nd Floor, 115 Mill St., Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 2 West, Room 205, 401 Park Drive, Boston, MA 02215, USA
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Del Boca FK, McRee B, Vendetti J, Damon D. The SBIRT program matrix: a conceptual framework for program implementation and evaluation. Addiction 2017; 112 Suppl 2:12-22. [PMID: 28074572 DOI: 10.1111/add.13656] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/11/2015] [Accepted: 09/28/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Screening, Brief Intervention and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of services to those at risk for the adverse consequences of alcohol and other drug use, and for those with probable substance use disorders. Research on successful SBIRT implementation has lagged behind studies of efficacy and effectiveness. This paper (1) outlines a conceptual framework, the SBIRT Program Matrix, to guide implementation research and program evaluation and (2) specifies potential implementation outcomes. METHODS Overview and narrative description of the SBIRT Program Matrix. RESULTS The SBIRT Program Matrix has five components, each of which includes multiple elements: SBIRT services; performance sites; provider attributes; patient/client populations; and management structure and activities. Implementation outcomes include program adoption, acceptability, appropriateness, feasibility, fidelity, costs, penetration, sustainability, service provision and grant compliance. CONCLUSIONS The Screening, Brief Intervention and Referral to Treatment Program Matrix provides a template for identifying, classifying and organizing the naturally occurring commonalities and variations within and across SBIRT programs, and for investigating which variables are associated with implementation success and, ultimately, with treatment outcomes and other impacts.
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Affiliation(s)
- Frances K Del Boca
- Department of Community Medicine and Health Care, UConn Health, Farmington, CT, USA
| | - Bonnie McRee
- Department of Community Medicine and Health Care, UConn Health, Farmington, CT, USA
| | - Janice Vendetti
- Department of Community Medicine and Health Care, UConn Health, Farmington, CT, USA
| | - Donna Damon
- Department of Community Medicine and Health Care, UConn Health, Farmington, CT, USA
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Joseph J, Basu D. Efficacy of Brief Interventions in Reducing Hazardous or Harmful Alcohol Use in Middle-Income Countries: Systematic Review of Randomized Controlled Trials. Alcohol Alcohol 2017; 52:56-64. [DOI: 10.1093/alcalc/agw054] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Bernstein J, Bernstein E, Hudson D, Belanoff C, Cabral HJ, Cherpitel CJ, Bond J, Ye Y, Woolard R, Villalobos S, Ramos R. Differences by gender at twelve months in a brief intervention trial among Mexican-origin young adults in the emergency department. J Ethn Subst Abuse 2017; 16:91-108. [PMID: 26821181 PMCID: PMC4733888 DOI: 10.1080/15332640.2015.1095667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this study, we investigate the role of gender in prevalence and consequences of binge drinking and brief intervention outcomes among Mexican-origin young adults aged 18-30 years at the U.S.-Mexico border. We conducted a secondary analysis, stratified by gender, from a randomized controlled trial of a brief motivational intervention in a hospital emergency department. Intervention effects for males included reductions in drinking frequency, binge drinking, and alcohol-related consequences. For females the intervention was associated with reduction in drinking frequency and binge drinking but did not have a significant effect on alcohol-related consequences. Results suggest a new direction for tailoring interventions to gender.
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Affiliation(s)
- Judith Bernstein
- a Boston University School of Public Health , Boston , Massachusetts
| | - Edward Bernstein
- a Boston University School of Public Health , Boston , Massachusetts
| | - Dantia Hudson
- a Boston University School of Public Health , Boston , Massachusetts
| | - Candice Belanoff
- a Boston University School of Public Health , Boston , Massachusetts
| | - Howard J Cabral
- a Boston University School of Public Health , Boston , Massachusetts
| | - Cheryl J Cherpitel
- b Public Health Institute , Alcohol Research Group , Emeryville , California
| | - Jason Bond
- b Public Health Institute , Alcohol Research Group , Emeryville , California
| | - Yu Ye
- b Public Health Institute , Alcohol Research Group , Emeryville , California
| | - Robert Woolard
- c Texas Tech University Health Science Center , El Paso , Texas
| | | | - Rebeca Ramos
- d Alliance for Border Collaboratives , El Paso , Texas
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Brereton R, Gerdtz M. Alcohol and Other Drug (AOD) Education for Hospital Staff: An Integrative Literature Review. Issues Ment Health Nurs 2017; 38:42-60. [PMID: 27960576 DOI: 10.1080/01612840.2016.1248876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Alcohol and Other Drug (AOD) education amongst hospital staff is often inadequate. This leads to suboptimal care of patients and is a missed opportunity for early identification and treatment. This integrative review evaluates the core features of current education for hospital-based doctors and nurses in AOD, including country of origin, content, duration, and pedagogy. The majority of included studies were conducted in the USA (72%), target alcohol rather than AOD in general (72%), adopted a purely medical model of treatment (94%), and utilised a Screening, Brief Intervention, and Referral to Treatment (SBIRT) model (94%). The overall quality of the studies was weak-moderate, which led to small effect sizes in most studies and limits the generalizability of any conclusions. More high quality research trials are needed to establish the core features of effective AOD education for hospital staff. Future research should include a focus on the psychosocial context of addiction, other drug use and the impact of negative attitudes on care delivery.
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Affiliation(s)
| | - Marie Gerdtz
- b School of Nursing, University of Melbourne , Melbourne , Australia
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Cochran G, Field C, Caetano R. Changes in Classes of Injury-Related Risks and Consequences of Risk-Level Drinking: a Latent Transition Analysis. J Behav Health Serv Res 2016; 42:355-66. [PMID: 24259197 DOI: 10.1007/s11414-013-9378-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Risk-level drinking, drinking and driving, and alcohol-related violence are risk factors that result in injuries. The current study sought to identify which subgroups of patients experience the most behavioral change following a brief intervention. A secondary analysis of data from a brief alcohol intervention study was conducted. The sample (N = 664) includes at-risk drinkers who experienced an injury and were admitted for care to a Level 1 trauma center. Injury-related items from the Short Inventory of Problems+6 were used to perform a latent transition analysis to describe class transitions participants experienced following discharge. Four classes emerged for the year before and after the current injury. Most individuals transitioned from higher-risk classes into those with lower risk. Some participants maintained risky profiles, and others increased risks and consequences. Drinking and driving remained a persistent problem among the study participants. Although a large portion of intervention recipients improved risks and consequences of alcohol use following discharge, more intensive intervention services may be needed for a subset of patients who showed little or no improvement.
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Affiliation(s)
- Gerald Cochran
- School of Work, University of Pittsburgh, 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA, 15260, USA,
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Borsari B, Apodaca TR, Yurasek A, Monti PM. Does mental status impact therapist and patient communication in emergency department brief interventions addressing alcohol use? J Subst Abuse Treat 2016; 73:1-8. [PMID: 28017179 DOI: 10.1016/j.jsat.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/18/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
Motivational interviewing (MI) is often incorporated into screening, brief intervention, and referral to treatment (SBIRT) interventions in critical care settings to address alcohol and other drug use. However, cognitive status has been linked to differential response to MI sessions in emergency department (ED) settings. The current study examined one possible explanation for this differential response: whether higher versus lower mental status impacts patient response to clinician statements during MI sessions conducted in an ED. Participants were 126 patients receiving an MI-based single-session alcohol brief intervention, and 13 therapists who provided treatment. Participants completed a mental status exam (MSE) as part of the screening process. Intervention sessions were audio-taped, and transcribed and coded using the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003). The MISC 2.0 coded therapist behaviors that are related to the use of motivational interviewing, and patient language reflecting movement toward (change talk) or away from (sustain talk) changing personal alcohol use. Overall, patients responded in a similar manner to therapist MI behaviors regardless of high versus low level of mental functioning at the time of the intervention. Group differences emerged on patient response to only three specific therapist skills: giving information, open questions, and complex reflection. Thus, the differential effects of SBIRT in critical care settings do not appear to be a result of differences in the therapist and patient communication process.
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Affiliation(s)
- Brian Borsari
- Mental Health Service (116B), San Francisco VA Medical Center, 4150 Clement St., San Francisco, CA 94121; Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912; Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143.
| | - Timothy R Apodaca
- Children's Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO, 64108; University of Missouri-Kansas City School of Medicine, 3901 Rainbow Blvd, Kansas City, KS 66103
| | - Ali Yurasek
- Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912
| | - Peter M Monti
- Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912
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48
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[Influence of Counsellor- and Intervention Variables on Motivation to Change Following a Brief Motivational Intervention to Reduce Risky Alcohol Use]. Prax Kinderpsychol Kinderpsychiatr 2016; 65:534-49. [PMID: 27595811 DOI: 10.13109/prkk.2016.65.7.534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Influence of Counsellor- and Intervention Variables on Motivation to Change Following a Brief Motivational Intervention to Reduce Risky Alcohol Use Brief interventions are recommended for prevention and early intervention of risky alcohol use. However, evidence of their effectiveness, in particular for children and adolescents, is heterogeneous. Analysis of counsellor and intervention variables may provide insights into mechanisms of action in brief interventions and thereby contribute to an enhanced effectiveness. We analyzed data of N = 141 children and adolescents who were treated for acute alcohol intoxication in the emergency department. Study participants received a brief motivational intervention to reduce risky alcohol use during hospitalization. We applied multiple regression analysis to examine counsellor variables (empathy, affirmation, competence, congruence) and intervention variables (readiness and confidence ruler, decisional balance, goal agreement) as predictors of motivation to change. Higher scores on the basic therapeutic skill "positive affirmation" (R2 = 7.1 %; p < .01), finishing the intervention with a written goal agreement (R2 = 2.9 %; p < .05) and younger age were associated with greater readiness to change (R2 = 10.2 %; p < .01). Therefore, a special focus should be put on the counsellor skill "positive affirmation" when training new counsellors. Results also indicate that younger patients respond stronger to a brief intervention in this context.
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Tait RJ, Teoh L, Kelty E, Geelhoed E, Mountain D, Hulse GK. Emergency department based intervention with adolescent substance users: 10year economic and health outcomes. Drug Alcohol Depend 2016; 165:168-74. [PMID: 27317044 DOI: 10.1016/j.drugalcdep.2016.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alcohol and other drug (AOD) use are significant cause of disease burden and costs among adolescents. METHODS We conducted a randomized trial in hospital emergency departments (ED) following an AOD-related presentation, comparing usual care with brief advice and referral to link adolescents aged 12-19 years with external AOD services. Subsequently, we used health data linkage to assemble data on mortality, hospital admissions, ED attendances, out-patient mental health and use of opiate pharmacotherapies in the next 10 years. From these, treatment costs and rates of events were estimated and compared using generalized linear models. RESULTS Those who received the intervention had lower costs ($22 versus $227: z=3.16, p=0.002) and rates (0.03 versus 0.25: z=2.57, p=0.010) of ED mental health AOD presentations. However, the intervention did not significantly reduce overall mean health costs per patient (intervention $58746 versus control $64833, p=0.800). Similarly, there was no significant difference in the costs associated with hospitalizations ($48920 versus $50911 p=0.924), overall ED presentations ($4266 versus $4150, p=0.916), out-patient mental health services ($4494 versus $7717, p=0.282), or opiate pharmacotherapies ($1013 versus $2054, p=0.209). Injecting drug use was a significant baseline predictor of subsequent costs in the cohort (z=2.64, p=0.008). CONCLUSIONS An ED delivered intervention may reduce direct ED costs and subsequent ED AOD attendances. There was also some indication that overall costs may be impacted, with economically large but non-significant differences between the groups. The high costs and morbidity incurred by some of this cohort illustrate the importance of targeting high-risk adolescents.
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Affiliation(s)
- Robert J Tait
- National Drug Research Institute, Faculty Health Science, Curtin University, Australia.
| | - Lucinda Teoh
- School of Psychiatry and Clinical Neurosciences, the University of Western Australia, Australia; School of Population Health, the University of Western Australia, Australia
| | - Erin Kelty
- School of Psychiatry and Clinical Neurosciences, the University of Western Australia, Australia
| | - Elizabeth Geelhoed
- School of Population Health, the University of Western Australia, Australia
| | - David Mountain
- School of Primary, Aboriginal & Rural Health Care, the University of Western Australia, Australia; Department of Emergency Medicine Sir Charles Gairdner Hospital, Perth, Australia
| | - Gary K Hulse
- School of Psychiatry and Clinical Neurosciences, the University of Western Australia, Australia
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McGinnes RA, Hutton JE, Weiland TJ, Fatovich DM, Egerton-Warburton D. Review article: Effectiveness of ultra-brief interventions in the emergency department to reduce alcohol consumption: A systematic review. Emerg Med Australas 2016; 28:629-640. [PMID: 27459669 DOI: 10.1111/1742-6723.12624] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 04/13/2016] [Accepted: 05/03/2016] [Indexed: 11/28/2022]
Abstract
To assess the effectiveness of ultra-brief interventions (ultra-BI) or technology-involved preventive measures in the ED to reduce alcohol harm and risky drinking. Medline, Embase, PsycINFO, CINAHL and EBM reviews were searched for articles published between 1996 and 2015. Randomised controlled trials and quasi-randomised trials, which compared an ultra-BI with screening, standard care or minimal intervention for adults and adolescents at risk for alcohol-related harm presenting to an ED, were included. Outcomes of interest were frequency of alcohol consumption, quantity of alcohol consumed, binge drinking and ED representation. Thirteen studies (nine single centre and four multicentre) were included. Six studies showed a significant reduction in the quantity consumed with intermediate effect size at 3 months (d = -0.40) and small effect size at 12 months (d = -0.15). Two studies showed a significant reduction in binge drinking with small effect size at 3 months (d = -0.12) and 12 months (d = -0.09). No studies showed an effect on frequency of alcohol consumption or ED representation. Heterogeneity in study design, definition of risky, harmful or hazardous alcohol use, intervention types, outcomes, outcome timeframes and outcome measures prevented the performance of quantitative meta-analysis. Despite its limited effectiveness in reducing alcohol use in the short-term, with the large number of people attending EDs with risky drinking, the use of an effective ultra-BI would have the potential to have a measurable population effect.
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Affiliation(s)
- Rosemary A McGinnes
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Jennie E Hutton
- Emergency Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Tracey J Weiland
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel M Fatovich
- Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Diana Egerton-Warburton
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Monash Medical Centre Emergency Department, Monash Health, Melbourne, Victoria, Australia
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