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Alderson H, McGovern R, Brown R, Howel D, Becker F, Carr L, Copello A, Fouweather T, Kaner E, McArdle P, McColl E, Shucksmith J, Steele A, Vale L, Lingam R. Supporting Looked After Children and Care Leavers In Decreasing Drugs, and alcohol (SOLID): protocol for a pilot feasibility randomised controlled trial of interventions to decrease risky substance use (drugs and alcohol) and improve mental health of looked after children and care leavers aged 12-20 years. Pilot Feasibility Stud 2017; 3:25. [PMID: 28536655 PMCID: PMC5439153 DOI: 10.1186/s40814-017-0138-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Looked after children (LAC) and care leavers are young people who have been placed under the legal care of local authorities, in many instances due to a history of abuse and/or neglect. These young people have a significantly increased risk of substance use and mental disorder compared to their peers. The aim of the SOLID study is to assess the feasibility and acceptability of a definitive three-arm multi-centre randomised controlled trial (RCT) that compares the effectiveness of two interventions that aim to reduce risky drug and alcohol use and improve mental health among LAC aged 12 to 20 years with usual care. METHODS All LAC aged 12 to 20 years residing in four local authorities in North East England will be screened by their social worker for risky drug and alcohol use using the CRAFFT (Car, Relax, Alone, Forget, Friends and Trouble) screening tool. Those who score ≥2 will be invited to take part in the trial after further eligibility checks. Informed consent will be taken and baseline data collected. Participants will then be randomised into either (i) Motivational Enhancement Therapy, (ii) Social Behaviour and Network Therapy, or (iii) control-usual care. Follow-up data will be collected 12 months post-baseline. The baseline and follow-up questionnaires will measure self-reported drug and alcohol use, mental health and well-being and health-related quality of life. The follow-up will also collect data on placement stability and self-reported sexual, antisocial and criminal behaviour. Participants will also be asked about the use of health and social services. A detailed process evaluation, using both qualitative and quantitative methods, will be conducted and involve LAC, their carers, social workers and drug and alcohol practitioners. DISCUSSION Despite having an increased likelihood of risky substance misuse, there is a lack of evidence outlining specific interventions to decrease drug and alcohol use targeting LAC. This feasibility study will provide the information needed to develop a definitive trial. LAC will benefit from the results of this study and the further development of the interventions. TRIAL REGISTRATION ISRCTN80786829.
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Affiliation(s)
- Hayley Alderson
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Rebecca Brown
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Frauke Becker
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Louise Carr
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Alex Copello
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Tony Fouweather
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Paul McArdle
- Child and Adolescent Mental Health Services, Northumberland, Tyne and Wear NHS Foundation Trust, St Nicholas Hospital, Jubilee Road, Gosforth, Newcastle, NE3 3XT UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Janet Shucksmith
- Health and Social Care Institute, School of Health & Social Care, Teesside University, Middlesbrough, TS1 3BA UK
| | - Alison Steele
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne, NE7 7DN UK
| | - Luke Vale
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
| | - Raghu Lingam
- Institute of Health and Society, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle, NE2 4AX UK
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Schwartz RP, McNeely J, Wu LT, Sharma G, Wahle A, Cushing C, Nordeck CD, Sharma A, O'Grady KE, Gryczynski J, Mitchell SG, Ali RL, Marsden J, Subramaniam GA. Identifying substance misuse in primary care: TAPS Tool compared to the WHO ASSIST. J Subst Abuse Treat 2017; 76:69-76. [PMID: 28159441 PMCID: PMC5377907 DOI: 10.1016/j.jsat.2017.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST. METHODS Two thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses. RESULTS The interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications. CONCLUSIONS The TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months.
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Affiliation(s)
- R P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
| | - J McNeely
- New York University School of Medicine, Department of Population Health, 550 First Avenue, VZ30 6th floor, New York, NY 10016, USA.
| | - L T Wu
- Duke University, Department of Psychiatry and Behavioral Sciences and Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - G Sharma
- Emmes Corporation, 401 North Washington Street, Suite 700, Rockville, MD 20850, USA.
| | - A Wahle
- Emmes Corporation, 401 North Washington Street, Suite 700, Rockville, MD 20850, USA
| | - C Cushing
- National Institute on Drug Abuse, 6001 Executive Boulevard, Rockville, MD 20852, USA
| | - C D Nordeck
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - A Sharma
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - K E O'Grady
- University of Maryland, College Park, Department of Psychology, 4094 Campus Dr., College Park, MD 20742, USA
| | - J Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - S G Mitchell
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - R L Ali
- University of Adelaide, Department of Pharmacology, Frome Road, Level 5, Medical School North Bldg, The University of Adelaide, Adelaide, SA 5005, Australia.
| | - J Marsden
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addiction Sciences Building, 4 Windsor Walk, Denmark Hill, SE5 8BB London, United Kingdom.
| | - G A Subramaniam
- National Institute on Drug Abuse, 6001 Executive Boulevard, Rockville, MD 20852, USA.
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Corrigendum. Addiction 2016; 111:2263. [PMID: 28075533 DOI: 10.1111/add.13615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McNeely J, Wu LT, Subramaniam G, Sharma G, Cathers LA, Svikis D, Sleiter L, Russell L, Nordeck C, Sharma A, O'Grady KE, Bouk LB, Cushing C, King J, Wahle A, Schwartz RP. Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care Patients. Ann Intern Med 2016; 165:690-699. [PMID: 27595276 PMCID: PMC5291717 DOI: 10.7326/m16-0317] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Substance use, a leading cause of illness and death, is underidentified in medical practice. OBJECTIVE The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool was developed to address the need for a brief screening and assessment instrument that includes all commonly used substances and fits into clinical workflows. The goal of this study was to assess the performance of the TAPS tool in primary care patients. DESIGN Multisite study, conducted within the National Drug Abuse Treatment Clinical Trials Network, comparing the TAPS tool with a reference standard measure. (ClinicalTrials.gov: NCT02110693). SETTING 5 adult primary care clinics. PARTICIPANTS 2000 adult patients consecutively recruited from clinic waiting areas. MEASUREMENTS Interviewer- and self-administered versions of the TAPS tool were compared with a reference standard, the modified World Mental Health Composite International Diagnostic Interview (CIDI), which measures problem use and substance use disorder (SUD). RESULTS Interviewer- and self-administered versions of the TAPS tool had similar diagnostic characteristics. For identifying problem use (at a cutoff of 1+), the TAPS tool had a sensitivity of 0.93 (95% CI, 0.90 to 0.95) and specificity of 0.87 (CI, 0.85 to 0.89) for tobacco and a sensitivity of 0.74 (CI, 0.70 to 0.78) and specificity of 0.79 (CI, 0.76 to 0.81) for alcohol. For problem use of illicit and prescription drugs, sensitivity ranged from 0.82 (CI, 0.76 to 0.87) for marijuana to 0.63 (CI, 0.47 to 0.78) for sedatives; specificity was 0.93 or higher. For identifying any SUD (at a cutoff of 2+), sensitivity was lower. LIMITATIONS The low prevalence of some drug classes led to poor precision in some estimates. Research assistants were not blinded to participants' TAPS tool responses when they administered the CIDI. CONCLUSION In a diverse population of adult primary care patients, the TAPS tool detected clinically relevant problem substance use. Although it also may detect tobacco, alcohol, and marijuana use disorders, further refinement is needed before it can be recommended broadly for SUD screening. PRIMARY FUNDING SOURCE National Institute on Drug Abuse.
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Affiliation(s)
- Jennifer McNeely
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Li-Tzy Wu
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Geetha Subramaniam
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Gaurav Sharma
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Lauretta A Cathers
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Dace Svikis
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Luke Sleiter
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Linnea Russell
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Courtney Nordeck
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Anjalee Sharma
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Kevin E O'Grady
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Leah B Bouk
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Carol Cushing
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Jacqueline King
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Aimee Wahle
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Robert P Schwartz
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
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Howells FM, Donald KA, Roos A, Woods RP, Zar HJ, Narr KL, Stein DJ. Reduced glutamate in white matter of male neonates exposed to alcohol in utero: a (1)H-magnetic resonance spectroscopy study. Metab Brain Dis 2016; 31:1105-12. [PMID: 27311608 PMCID: PMC6465962 DOI: 10.1007/s11011-016-9850-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
In utero exposure to alcohol leads to a spectrum of fetal alcohol related disorders (FASD). However, few studies used have used proton magnetic resonance spectroscopy ((1)H-MRS) to understand how neurochemical disturbances relate to the pathophysiology of FASD. Further, no studies to date have assessed brain metabolites in infants exposed to alcohol in utero. We hypothesize that neonates exposed to alcohol in utero will show decreased glutamatergic activity, pre-emptive of their clinical diagnosis or behavioural phenotype. Single voxel (1)H-MRS data, sampled in parietal white and gray matter, were acquired from 36 neonates exposed to alcohol in utero, and 31 control unexposed healthy neonates, in their 2nd-4th week of life. Metabolites relative to creatine with phosophocreatine and metabolites absolute concentrations using a water reference are reported. Male infants exposed to alcohol in utero were found to have reduced concentration of glutamate with glutamine (Glx) in their parietal white matter (PWM), compared to healthy male infants (p = 0.02). Further, male infants exposed to alcohol in utero had reduced concentration and ratio for glutamate (Glu) in their PWM (p = 0.02), compared to healthy male infants and female infants exposed to alcohol in utero. Female infants showed higher relative Glx and Glu ratios for parietal gray matter (PGM, p < 0.01), compared to male infants. We speculate that the decreased Glx and Glu concentrations in PWM are a result of delayed oligodendrocyte maturation, which may be a result of dysfunctional thyroid hormone activity in males exposed to alcohol in utero. Further study is required to elucidate the relationship between Glx and Glu, thyroid hormone activity, and oligodendrocyte maturation in infants exposure to alcohol in utero.
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Affiliation(s)
- F M Howells
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - K A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - A Roos
- Medical Research Council Anxiety and Stress Disorders Unit, University of Stellenbosch, Stellenbosch, South Africa
| | - R P Woods
- Departments of Neurology and of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - H J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - K L Narr
- Departments of Neurology and of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - D J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Wu LT, McNeely J, Subramaniam GA, Sharma G, VanVeldhuisen P, Schwartz RP. Design of the NIDA clinical trials network validation study of tobacco, alcohol, prescription medications, and substance use/misuse (TAPS) tool. Contemp Clin Trials 2016; 50:90-7. [PMID: 27444426 PMCID: PMC5035619 DOI: 10.1016/j.cct.2016.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 07/14/2016] [Accepted: 07/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substance use and its associated use disorders are under-detected and under-treated in primary care. There is a need for a clinically useful brief screening and assessment instrument to identify primary care patients with substance use, sub-threshold substance use disorder (SUD), and SUD to facilitate brief intervention and treatment. METHODS We describe the design of the recently completed National Drug Abuse Treatment Clinical Trials Network's tobacco, alcohol, prescription medications, and substance use/misuse screen and brief assessment tool validation study. Study aims included to: develop a 2-stage screening and brief assessment tool (TAPS Tool) to detect substance use, problem use, and SUD among adult primary care patients; examine the validity of both the screen component and the TAPS Tool by comparing them to reference standard screening and assessment measures of no use, problem use, and SUD; and determine the feasibility and acceptability of the self-administration and interviewer-administration of the tool. The design included a pilot testing phase (n=30) and the main study of 2000 adult primary care participants who were randomly assigned in counter-balanced order to have the interviewer-administration or the self-administration of the TAPS Tool followed by the other administration format. Participants' views of feasibility, acceptability and preference for format of self-administration versus interviewer-administration of the TAPS Tool were assessed. Criterion measures of use and DSM-5 SUDs were administered. DISCUSSION The TAPS Tool study builds on prior work to develop a 2-stage clinical tool for facilitating the adoption of screening, brief assessment and treatment for SUDs in primary care.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Center for Child and Family Policy, Duke University, Durham, NC, USA.
| | - Jennifer McNeely
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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Kane JC, Murray LK, Bass JK, Johnson RM, Bolton P. Validation of a substance and alcohol use assessment instrument among orphans and vulnerable children in Zambia using Audio Computer Assisted Self-Interviewing (ACASI). Drug Alcohol Depend 2016; 166:85-92. [PMID: 27402551 PMCID: PMC4983530 DOI: 10.1016/j.drugalcdep.2016.06.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/02/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Substance and alcohol misuse is a global problem that increases the risk of HIV infection. This is a concern among orphans and vulnerable children (OVC) in sub-Saharan Africa who may have elevated substance use rates. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is a reliable and valid instrument of substance use among adults in primary care high-income settings. This study examined psychometric properties of the ASSIST among OVC in Zambia using Audio Computer Assisted Self-Interviewing (ACASI). METHODS Baseline data from an ongoing randomized trial of interventions to reduce HIV risk behaviors were analyzed. The analysis included 502 OVC ages 13-17 living in low-income, high-density neighborhoods in Lusaka, Zambia. Internal consistency of the ASSIST was assessed and discriminant validity was measured using items from the Youth Self Report as criterion variables. RESULTS Internal reliability was strong with a Cronbach's alpha of ≥0.80 for each of the specific substance scales and total substance involvement. For all substances except tobacco and sedatives, discriminant validity was demonstrated in distinguishing between low risk use and moderate use. Sensitivity and specificity analysis indicated adequate area under the curve across substance types (AUC range: 0.68-0.80). Discrimination between moderate and high risk was demonstrated for alcohol and total substance involvement. CONCLUSIONS ASSIST administered via ACASI is a reliable instrument and an appropriate tool for distinguishing between low and hazardous substance use among adolescent OVC populations in sub-Saharan Africa. Additional examination is warranted to determine its ability to measure gradations of severity within hazardous use.
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Affiliation(s)
- Jeremy C. Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205
| | - Laura K. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205
| | - Judith K. Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205
| | - Renee M. Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205
| | - Paul Bolton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, United States.
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Webb MJ, Kauer SD, Ozer EM, Haller DM, Sanci LA. Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? A systematic review. BMC FAMILY PRACTICE 2016; 17:104. [PMID: 27488823 PMCID: PMC4973106 DOI: 10.1186/s12875-016-0504-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 07/28/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Adolescence and young adulthood are important developmental periods. Screening for health compromising behaviours and mental health disorders during routine primary care visits has the potential to assist clinicians to identify areas of concern and provide appropriate interventions. The objective of this systematic review is to investigate whether screening and subsequent interventions for multiple health compromising behaviours and mental health disorders in primary care settings improves the health outcomes of young people. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in Medline, PsycINFO, Scopus and Cochrane Library databases (Prospero registration number CRD42013005828) using search terms representing four thematic concepts: primary care, young people, screening, and mental health and health compromising behaviour. To be eligible for inclusion, studies had to: include a measure of health outcome; include at least 75 % of participants aged under 25 years; use a screening tool that assessed more than one health domain; and be conducted within a primary care setting. Risk of bias was assessed using the Quality Rating Scale. RESULTS From 5051 articles identified, nine studies fulfilled the inclusion criteria and were reviewed: two randomised controlled trials (RCTs), one pilot RCT, two clustered RCTs, one randomised study with multiple intervention groups and no control group, one cluster RCT with two active arms, one longitudinal study and one pre-post study. Seven studies, including two RCTs and one clustered RCT, found positive changes in substance use, diet, sexual health or risky sexual behaviour, alcohol-related risky behaviour, social stress, stress management, helmet use, sleep and exercise. Of only two studies reporting on harms, one reported a negative health outcome of increased alcohol use. CONCLUSIONS There is some evidence that the use of screening and intervention with young people for mental health disorder or health compromising behaviours in clinical settings improves health outcomes. Along with other evidence that young people value discussions of health risks with their providers, these discussions should be part of the routine primary care of young people. Further quality studies are needed to strengthen this evidence.
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Affiliation(s)
- Marianne J. Webb
- Department of General Practice, University of Melbourne, 200 Berkeley Street, Carlton, 3053 Australia
| | - Sylvia D. Kauer
- Department of General Practice, University of Melbourne, 200 Berkeley Street, Carlton, 3053 Australia
| | - Elizabeth M. Ozer
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California San Francisco, San Francisco, 94118 USA
- UCSF Office of Diversity and Outreach, University of California San Francisco, San Francisco, 94118 USA
| | - Dagmar M. Haller
- Department of General Practice, University of Melbourne, 200 Berkeley Street, Carlton, 3053 Australia
- Primary Care Unit, Faculty of Medicine, University of Geneva, 9 av de Champel, 1211 Geneva 4, Switzerland
- Adolescent and Young Adult Program, Department of Community, Primary Care and Emergency Medicine and Department of Pediatrics, Geneva University Hospitals, 87 bvd de la Cluse, Geneva, 1205 Switzerland
| | - Lena A. Sanci
- Department of General Practice, University of Melbourne, 200 Berkeley Street, Carlton, 3053 Australia
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The future of screening, brief intervention and referral to treatment in adolescent primary care: research directions and dissemination challenges. Curr Opin Pediatr 2016; 28:434-40. [PMID: 27152620 DOI: 10.1097/mop.0000000000000371] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW Screening, brief intervention and referral to treatment (SBIRT) offers a practical, integrated model for addressing substance use in primary care settings. This review provides an update of the research on SBIRT for adolescents in primary care, examines current dissemination challenges and suggests future research directions. RECENT FINDINGS A number of brief screening tools for adolescents have been developed and tested relative to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) substance use disorders. Computerized previsit screening promotes standardization and is a more time-efficient alternative to provider interview. The adolescent brief intervention literature is growing, particularly with respect to technology-based tools, but is still limited, with evidence greatest for alcohol, and for motivational enhancement therapy interventions. Increasing SBIRT implementation in pediatric primary care remains a challenge. Using nonphysician behavioral health providers to deliver SBIRT, and embedding a screener and decision support tool in electronic medical record systems are strategies being investigated to promote SBIRT implementation. SUMMARY Substance use begins in adolescence, and pediatric SBIRT could help to achieve a population-level reduction of substance use-related harms. With a growing number of available tools, adolescent SBIRT effectiveness and feasibility are increasing, but more studies are needed to grow its evidence base, and elucidate strategies to increase implementation.
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O'Grady KE, Gryczynski J, Mitchell SG, Ondersma SJ, Schwartz RP. Confirmatory factor analysis of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in community health center patients. Am J Addict 2016; 25:259-63. [PMID: 27037633 DOI: 10.1111/ajad.12360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/17/2016] [Accepted: 02/27/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the factor structure of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). METHODS Secondary analysis on an adult primary care sample (N = 2,599). RESULTS AND DISCUSSION Factor analysis of the tobacco, alcohol, and cannabis items did not yield an acceptable oblique, three-factor solution, due in part to floor effects and limited variability. A short form comprises three items (past-3-month frequency of use, urge to use, and whether others have expressed concern for use), that showed good psychometrics. SCIENTIFIC SIGNIFICANCE Supports the need for further investigation of the ASSIST factor structure and a short form. (Am J Addict 2016;25:259-263).
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Affiliation(s)
- Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, Maryland
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Haller DM, Meynard A, Lefebvre D, Hasselgård-Rowe J, Broers B, Narring F. Excessive substance use among young people consulting family doctors: a cross-sectional study. Fam Pract 2015; 32:500-4. [PMID: 26251025 DOI: 10.1093/fampra/cmv058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family doctors can only play a role in the prevention of excessive substance use in young people if those affected are seen in the practice. OBJECTIVE To describe the prevalence of excessive substance use among young people consulting family doctors in a European context. METHODS As part of a trial of an intervention addressing substance use we collected data from young people consulting 32 family doctors in the French-speaking part of Switzerland. Before the consultation, consecutive patients aged 15-24 years completed a self-administered questionnaire on their general health and substance use. Outcomes were excessive alcohol (defined as ≥1 episode of binge drinking), excessive cannabis (use ≥1/week), regular tobacco (≥1 cigarettes a day) and/or any other substance use in the past 30 days. Prevalence data were computed with 95% confidence intervals (CIs) adjusted for clustering within practices, stratified by age and gender. RESULTS Between February 2009 and November 2010, 636 patients were eligible. Participation rate was 93.4% (n=594, 53% female). The prevalence of excessive use in the past 30 days was alcohol 44.9% (95% CI: 37.8-52.1), cannabis 11.1% (95% CI: 8.0-14.1), tobacco 23.4% (95% CI: 19.0-28.1) and any other drug 2.6 (95% CI: 1.4-4.2). Excessive use was higher in males than in females. Except for tobacco prevalence of excessive use was only slightly higher in young adults compared to adolescents. CONCLUSION Excessive substance use is frequent among young people consulting family doctors in a European context. Future research should provide guidance about how to best seize this window of opportunity for prevention and early intervention.
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Affiliation(s)
- Dagmar M Haller
- Adolescent and Young Adult Program, Department of Community, Primary Care and Emergency Medicine and Department of Child and Adolescent Health, Geneva University Hospitals, Geneva, Switzerland, Department of community health and medicine, Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland, Department of General Practice, The University of Melbourne, Parkville, Australia,
| | - Anne Meynard
- Adolescent and Young Adult Program, Department of Community, Primary Care and Emergency Medicine and Department of Child and Adolescent Health, Geneva University Hospitals, Geneva, Switzerland
| | | | - Jennifer Hasselgård-Rowe
- Department of community health and medicine, Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Barbara Broers
- Dependencies Unit, Division of Primary Care, Department of Community Medicine, Primary Care and Emergency, Geneva University Hospitals, Geneva, Switzerland
| | - Françoise Narring
- Adolescent and Young Adult Program, Department of Community, Primary Care and Emergency Medicine and Department of Child and Adolescent Health, Geneva University Hospitals, Geneva, Switzerland
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