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Lavilla‐Gracia M, Pueyo‐Garrigues M, Pueyo‐Garrigues S, Pardavila‐Belio MI, Canga‐Armayor A, Esandi N, Alfaro‐Díaz C, Canga‐Armayor N. Peer-led interventions to reduce alcohol consumption in college students: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3562-e3578. [PMID: 36057959 PMCID: PMC10087199 DOI: 10.1111/hsc.13990] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/06/2022] [Accepted: 08/20/2022] [Indexed: 05/04/2023]
Abstract
Risky alcohol consumption among college students is a significant public health issue. In the college setting, students can collaborate in the implementation of peer-led interventions. To date, evidence of peer-led programmes in reducing harmful alcohol consumption in this population is inconclusive. The aim of the current scoping review is to provide a broad overview by systematically examining and mapping the literature on peer-led interventions for preventing risky alcohol consumption by college students. The specific aims were to (1) identify the underlying focus of the interventions and assess their (2) effectiveness and (3) feasibility. A comprehensive search was conducted in PubMed, PsycINFO, CINAHL, Cochrane Library, Web of Science, DART-Europe, RCAAP, Trove and ProQuest. The inclusion criteria were peer-led interventions that exclusively addressed alcohol consumption, college students as the target population and interventional studies (randomised controlled trials, quasi-experimental studies, systematic reviews and meta-analyses of interventions). The methodological quality of the articles was evaluated. From 6654 potential studies, 13 were included. Nine interventions were described within these studies: Voice of Reason programme, Brief Advice sessions, Peer Theatre, Alcohol Education programme, Perceptions of Alcohol Norms intervention, Motivational Intervention, Alcohol Skills Training programme, Lifestyle Management Class and the Brief Alcohol Screening and Intervention for College Students. Only the last showed significant reductions in three of the four outcome measures: quantity and frequency of drinking, estimated peak blood alcohol concentration and alcohol-related consequences. It did not significantly decrease the number of heavy-drinking episodes. Peer interventions may be effective in preventing alcohol use among college students, although the evidence is weak and scarce. Further research is needed to strengthen the findings about peer-led interventions.
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Affiliation(s)
- María Lavilla‐Gracia
- School of Nursing, Community, Maternity and Pediatric NursingUniversity of NavarraPamplonaSpain
| | - María Pueyo‐Garrigues
- School of Nursing, Community, Maternity and Pediatric NursingUniversity of NavarraPamplonaSpain
- IdiSNA, Navarra Institute for Health ResearchPamplonaSpain
| | | | - Miren Idoia Pardavila‐Belio
- School of Nursing, Community, Maternity and Pediatric NursingUniversity of NavarraPamplonaSpain
- IdiSNA, Navarra Institute for Health ResearchPamplonaSpain
| | - Ana Canga‐Armayor
- IdiSNA, Navarra Institute for Health ResearchPamplonaSpain
- School of Nursing, Nursing Care for Adult Patients DepartmentUniversity of NavarraPamplonaSpain
| | - Nuria Esandi
- IdiSNA, Navarra Institute for Health ResearchPamplonaSpain
- School of Nursing, Nursing Care for Adult Patients DepartmentUniversity of NavarraPamplonaSpain
| | - Cristina Alfaro‐Díaz
- IdiSNA, Navarra Institute for Health ResearchPamplonaSpain
- School of Nursing, Nursing Care for Adult Patients DepartmentUniversity of NavarraPamplonaSpain
| | - Navidad Canga‐Armayor
- School of Nursing, Community, Maternity and Pediatric NursingUniversity of NavarraPamplonaSpain
- IdiSNA, Navarra Institute for Health ResearchPamplonaSpain
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2
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Smith-Bernardin SM, Suen LW, Barr-Walker J, Cuervo IA, Handley MA. Scoping review of managed alcohol programs. Harm Reduct J 2022; 19:82. [PMID: 35879719 PMCID: PMC9311344 DOI: 10.1186/s12954-022-00646-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internationally, strategies focusing on reducing alcohol-related harms in homeless populations with severe alcohol use disorder (AUD) continue to gain acceptance, especially when conventional modalities focused on alcohol abstinence have been unsuccessful. One such strategy is the managed alcohol program (MAP), an alcohol harm reduction program managing consumption by providing eligible individuals with regular doses of alcohol as a part of a structured program, and often providing resources such as housing and other social services. Evidence to the role of MAPs for individuals with AUD, including how MAPs are developed and implemented, is growing. Yet there has been limited collective review of literature findings. METHODS We conducted a scoping review to answer, "What is being evaluated in studies of MAPs? What factors are associated with a successful MAP, from the perspective of client outcomes? What are the factors perceived as making them a good fit for clients and for communities?" We first conducted a systematic search in PubMed, Embase, PsycINFO, CINAHL, Sociological Abstracts, Social Services Abstracts, and Google Scholar. Next, we searched the gray literature (through focused Google and Ecosia searches) and references of included articles to identify additional studies. We also contacted experts to ensure relevant studies were not missed. All articles were independently screened and extracted. RESULTS We included 32 studies with four categories of findings related to: (1) client outcomes resulting from MAP participation, (2) client experience within a MAP; (3) feasibility and fit considerations in MAP development within a community; and (4) recommendations for implementation and evaluation. There were 38 established MAPs found, of which 9 were featured in the literature. The majority were located in Canada; additional research works out of Australia, Poland, the USA, and the UK evaluate potential feasibility and fit of a MAP. CONCLUSIONS The growing literature showcases several outcomes of interest, with increasing efforts aimed at systematic measures by which to determine the effectiveness and potential risks of MAP. Based on a harm reduction approach, MAPs offer a promising, targeted intervention for individuals with severe AUD and experiencing homelessness. Research designs that allow for longitudinal follow-up and evaluation of health- and housing-sensitive outcomes are recommended.
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Affiliation(s)
- Shannon M Smith-Bernardin
- School of Nursing, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA. .,UCSF Benioff Homelessness and Housing Initiative at ZSFG Hospital and Trauma Center, San Francisco, CA, USA.
| | - Leslie W Suen
- National Clinician Scholars Program, Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Jill Barr-Walker
- ZSFG Library, University of California, San Francisco, San Francisco, CA, USA
| | | | - Margaret A Handley
- UCSF Benioff Homelessness and Housing Initiative at ZSFG Hospital and Trauma Center, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,PRISE Center: Partnerships for Research in Implementation Science for Equity, University of California, San Francisco, CA, USA
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3
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Stapinski L, Routledge K, Snijder M, Doyle M, Champion K, Chapman C, Ward J, Baumgart A, Lee KSK, Teesson M, Newton N. A Web-Based Alcohol and Other Drug Prevention Program (Strong & Deadly Futures) for Aboriginal and Torres Strait Islander School Students: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e34530. [PMID: 34994696 PMCID: PMC8783274 DOI: 10.2196/34530] [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: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background There are no available school-based alcohol and drug prevention programs with evidence of effectiveness among Aboriginal and Torres Strait Islander youth. To address this, we codeveloped the Strong & Deadly Futures well-being and alcohol and drug prevention program in partnership with an Indigenous creative design agency and 4 Australian schools. Objective This paper presents the protocol to evaluate the effectiveness of Strong & Deadly Futures in reducing alcohol and other drug use and improving well-being among Aboriginal and Torres Strait Islander youth. Methods The target sample will be 960 year 7 and 8 students from 24 secondary schools in Australia, of which approximately 40% (384/960) will identify as Aboriginal or Torres Strait Islander. The study design is a 2-group, parallel cluster randomized controlled trial with allocation concealment. Recruited schools will be block randomized (ratio 1:1), stratified by geographical remoteness, by an independent statistician. Schools will be randomized to receive Strong & Deadly Futures, a web-based alcohol and drug prevention and social and emotional well-being program that delivers curriculum-aligned content over 6 lessons via an illustrated story, or health education as usual (control). Control schools will be supported to implement Strong & Deadly Futures following trial completion. Surveys will be administered at baseline, 6 weeks, 12 months, and 24 months (primary end point) post baseline. Primary outcomes are alcohol use (adapted from the National Drug Strategy Household Survey), tobacco use (Standard High School Youth Risk Behavior Survey), and psychological distress (Kessler-5 Psychological Distress Scale). Secondary outcomes are alcohol and drug knowledge and intentions, alcohol-related harms, binge drinking, cannabis use, well-being, empowerment, appreciation of cultural diversity, and truancy. Results The trial was funded by the National Health and Medical Research Council in January 2019, approved by the Human Research Ethics Committee of the University of Sydney (2020/039, April 2020), the Aboriginal Health and Medical Research Council of New South Wales (1620/19, February 2020), the Western Australian Aboriginal Health Ethics Committee (998, October 2021), and the ethics committees of each participating school, including the New South Wales Department of Education (2020170, June 2020), Catholic Education Western Australia (RP2020/39, November 2020), and the Queensland Department of Education (550/27/2390, August 2021). Projected dates of data collection are 2022-2024, and we expect to publish the results in 2025. A total of 24 schools have been recruited as of submission of the manuscript. Conclusions This will be the first cluster randomized controlled trial of a culturally inclusive, school-based alcohol and drug prevention program for Aboriginal and Torres Strait Islander youth; therefore, it has significant potential to address alcohol and other drug harms among Aboriginal and Torres Strait Islander youth. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620001038987; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380038&isReview=true International Registered Report Identifier (IRRID) PRR1-10.2196/34530
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Affiliation(s)
- Lexine Stapinski
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Darlington, Australia
| | - Kylie Routledge
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Darlington, Australia
| | - Mieke Snijder
- Institute of Development Studies, The University of Sussex, Brighton, United Kingdom
| | - Michael Doyle
- National Health and Medical Research Council Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Camperdown, Australia
| | - Katrina Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Darlington, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Darlington, Australia
| | - James Ward
- University of Queensland Poche Centre for Indigenous Health, University of Queensland, St Lucia, Australia
| | - Amanda Baumgart
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Darlington, Australia
| | - K S Kylie Lee
- National Health and Medical Research Council Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Camperdown, Australia.,National Drug Research Institute, Curtin University, Bentley, Australia.,Burnet Institute, Melbourne, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Darlington, Australia
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Darlington, Australia
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4
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Calverley HLM, Petrass LA, Blitvich JD. A systematic review of alcohol education programs for young people: do these programs change behavior? HEALTH EDUCATION RESEARCH 2021; 36:87-99. [PMID: 33306789 DOI: 10.1093/her/cyaa049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 11/05/2020] [Indexed: 06/12/2023]
Abstract
Numerous education programs have addressed young peoples' alcohol use. To date, no peer-reviewed publication has evaluated the effectiveness of such programs delivered across a range of contexts to change alcohol-related behaviors, attitudes and/or knowledge. This systematic review aimed to identify alcohol education programs addressing young people, and determine whether they changed alcohol-related behavior, knowledge and attitudes; and, ascertain components of successful programs. Studies were identified, guided by the PRISMA review process, from the earliest records until June 2020. Included studies (N = 70) comprised an alcohol education program which focused on young people (15-24 years). Forty programs reported behavior changes, and these programs were the highest quality. Others impacted attitudes and/or knowledge only (n = 12); or reported no impacts (n = 17). Recent programs were more likely than older programs to feature online delivery and report behavior changes. To enhance alcohol education, future programs should include the identified quality criteria, alongside process and long-term outcome evaluations, to better monitor effectiveness. Findings indicated some education programs have capacity to positively change alcohol-related behavior; however, outcome consistency varied even in high-quality programs. Alcohol education programs should be designed alongside health education/promotion models and best-practice recommendations, to improve the likelihood of desirable behavior-related outcomes.
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Affiliation(s)
- Hannah L M Calverley
- School of Education, Federation University Australia, University Drive, Mt Helen, Victoria, 3350, Australia
| | - Lauren A Petrass
- School of Education, Federation University Australia, University Drive, Mt Helen, Victoria, 3350, Australia
| | - Jennifer D Blitvich
- School of Science, Psychology and Sport, Federation University Australia, University Drive, Mt Helen, Victoria, 3350, Australia
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5
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Pedersen ER, Davis JP, Hummer JF, DiGuiseppi G, Sedano A, Rodriguez A, Clapp JD. Development of a Measure to Assess Protective Behavioral Strategies for Pregaming among Young Adults. Subst Use Misuse 2020; 55:534-545. [PMID: 31847662 PMCID: PMC7310598 DOI: 10.1080/10826084.2019.1686025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Although most young adults drink alcohol, there are specific drinking contexts that are associated with increased risk for alcohol-related consequences. One such drinking context is pregaming, which typically involves heavy drinking in brief periods of time and has consistently been linked to consequences within the pregaming event itself, on a night after pregaming, and in the long-term. Intervention efforts that specifically target this risky behavior are needed, but these efforts need to be informed by empirical work to better understand what behaviors young people engage in that can protect them from pregaming-related harms. Purpose: We designed this study to create a measure of protective behavioral strategies that young people use before, during, and after pregaming to inform future intervention work. Methods: We tested an item pool with 363 young adult college students who engaged in pregaming in the past year and conducted exploratory factor analysis to develop a 19-item Protective Behavioral Strategies for Pregaming (PBSP) scale, which featured four subscales of safety and familiarity, setting drink limits, pacing strategies, and minimizing intoxication. Results: Each subscale negatively and significantly correlated with measures of alcohol use and consequences, though subscales differed in their associations with specific pregaming outcomes and by sex. Conclusion: This initial exploratory examination of the PBSP scale's psychometric properties suggests that use of protective behavioral strategies used specifically during pregaming events may protect young people from heavy drinking and harms. More research with the PBSP scale is encouraged to determine its practical utility as a clinical and assessment tool with young people.
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Affiliation(s)
| | - Jordan P Davis
- University of Southern California, Suzanne Dworak-Peck School of Social Work; USC Institute for Addiction Science, Los Angeles, California, USA
| | | | - Graham DiGuiseppi
- University of Southern California, Suzanne Dworak-Peck School of Social Work; USC Institute for Addiction Science, Los Angeles, California, USA
| | - Angeles Sedano
- University of Southern California, Suzanne Dworak-Peck School of Social Work; USC Institute for Addiction Science, Los Angeles, California, USA
| | | | - John D Clapp
- University of Southern California, Suzanne Dworak-Peck School of Social Work; Department of Preventive Medicine, Keck School of Medicine; USC Institute for Addiction Science, Los Angeles, California, USA
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6
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Alfred L. Routine health checks can provide opportunities for alcohol health promotion in older adults who identify as responsible drinkers. Evid Based Nurs 2019; 22:91. [PMID: 30975692 DOI: 10.1136/ebnurs-2019-103082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Lolita Alfred
- Faculty of Health Sciences, School of Health and Social Work, University of Hull, Hull, UK
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7
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Harm-reduction and zero-tolerance maternal messages about college alcohol use. Addict Behav 2019; 89:136-142. [PMID: 30296649 DOI: 10.1016/j.addbeh.2018.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/23/2018] [Accepted: 09/21/2018] [Indexed: 11/22/2022]
Abstract
Past cross-sectional research suggests that zero-tolerance messaging by parents of college students may be more effective than harm-reduction communication at reducing student alcohol risk. The current study employs longitudinal data to examine whether communication type interacts with student alcohol use to predict subsequent drinking outcomes. U.S. college students reported on their own exposure to zero-tolerance and harm-reduction maternal communication. Approximately seven months later, students completed measures of maternal alcohol approval and their own alcohol behaviors. The relationship between communication and subsequent alcohol behaviors depended on students' baseline drinking. For heavy drinkers, harm-reduction communication was associated with less alcohol use and consequences. For those who drank less than two drinks a week, zero-tolerance communication was associated with fewer negative consequences. Zero-tolerance communication was associated with perceiving mothers as less approving, while harm reduction communication was associated with perceiving mothers as more approving. There were indirect effects of communication on drinking through perceived maternal approval. While overall harm-reduction communication may lead students to perceive mothers as more approving of alcohol use, there may be contexts in which this type of communication is beneficial.
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8
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Ehman AC, Gross AM. Acceptance and Commitment Therapy and Motivational Interviewing in the Treatment of Alcohol Use Disorder in a College Woman: A Case Study. Clin Case Stud 2018. [DOI: 10.1177/1534650118804886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alcohol abuse is common among college students. Acceptance and commitment therapy (ACT) is widely supported as a treatment of alcohol abuse. However, little research has examined how ACT may be paired with other techniques traditionally applied to treat substance abuse, such as motivational interviewing (MI). This clinical case study describes the use of ACT and MI to facilitate treatment of a 20-year-old woman who was referred for treatment for alcohol abuse. The client remained in treatment in spite of her initial self-reported belief that treatment was unnecessary. At follow-up, the client reported increased present moment awareness, particularly of her drinking habits, and demonstrated the ability to behave in ways consistent with her values. At the completion of treatment, the client reported fewer episodes of alcohol consumption and less severe drinking. Implications of these findings are discussed, with an emphasis on the potential benefits of pairing MI techniques with ACT.
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Wilson MN, Langille DB, Ogilvie R, Asbridge M. When parents supply alcohol to their children: Exploring associations with drinking frequency, alcohol-related harms, and the role of parental monitoring. Drug Alcohol Depend 2018; 183:141-149. [PMID: 29248692 DOI: 10.1016/j.drugalcdep.2017.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Youth obtain alcohol from many sources, including friends, siblings, parents and other adults. Whether parental supply, relative to other sources, is associated with experiencing a negative alcohol-related outcome is an area of considerable debate. Less well understood is whether the observed association is further contextualized by level of parental monitoring of the child. OBJECTIVES This study has two main objectives: 1) determine if there is a relationship between parental supply, drinking frequency, and alcohol-related harms among youth; and 2) assess whether parental monitoring moderates this relationship. METHODS Participants were drawn from the 2012 Student Drug Use Survey in Canada's Atlantic Provinces, an anonymous cross-sectional survey of high school students (ages 15-19 years). Adjusted regression models assessed the association between drinking frequency, experiencing alcohol-related harms, and four different sources of supply. Additional analyses stratified on levels of parental monitoring. RESULTS Relative to receiving alcohol from friends, parental supply was associated with lower odds of experiencing any alcohol-related harm (AOR 0.42; 95% CI 0.28-0.61) and loss of control (AOR = 0.42; 95% CI 0.29-0.62). Drinking frequency did not differ by source of supply. Associations between parental supply and harm were absent among youth reporting low levels of parental monitoring. CONCLUSIONS Youth who receive alcohol from parents' report fewer alcohol-related harms relative to those who obtain their alcohol from friends, despite no observed differences in drinking frequency. Understanding how parents may help to minimize experiences of alcohol-related harm among youth beyond the simple promotion of abstinence from drinking is warranted.
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Affiliation(s)
- Maria N Wilson
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, NS, Canada, B3H 1V7, Canada
| | - Donald B Langille
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, NS, Canada, B3H 1V7, Canada
| | - Rachel Ogilvie
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, NS, Canada, B3H 1V7, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, NS, Canada, B3H 1V7, Canada.
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10
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Krank M, Robinson J. Automatic Cognitive Processes and Youth Substance Use: Risks and Prevention. CURRENT ADDICTION REPORTS 2017. [DOI: 10.1007/s40429-017-0168-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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11
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Mangot AG. Ethical aspects of surreptitious use of disulfiram. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1208775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Percy A, McKay M. The stability of alcohol consumption between age 16 and 26: Evidence from a National Birth Cohort Study. J Adolesc 2015. [PMID: 26218601 DOI: 10.1016/j.adolescence.2015.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examined the association between moderate drinking at age 16 (adolescence) and alcohol consumption at age 26 (young adulthood), whilst controlling for possible confounding effects at the individual and family level (assessed at birth and age 10). Using the British Cohort Study (BCS70), 6515 respondents provided data on their adolescent alcohol consumption and other behaviours. Of these, 4392 also completed the survey at age 26. Consumption patterns established in adolescence persisted, to a large degree, into early adulthood. Those adolescents who drank moderately in adolescence drank significantly less in adulthood than those adolescents who drank to heavy or hazardous levels. Implications for health promotion strategies and guidance are discussed.
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Affiliation(s)
- Andrew Percy
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, UK.
| | - Michael McKay
- Centre for Public Health, Liverpool John Moore's University, UK
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13
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Pfefferbaum A, Zahr NM, Mayer D, Rohlfing T, Sullivan EV. Dynamic responses of selective brain white matter fiber tracts to binge alcohol and recovery in the rat. PLoS One 2015; 10:e0124885. [PMID: 25894968 PMCID: PMC4403879 DOI: 10.1371/journal.pone.0124885] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 03/18/2015] [Indexed: 01/08/2023] Open
Abstract
To determine the dynamics of white matter vulnerability to excessive alcohol consumption, diffusion tensor imaging (DTI) was used in an animal model of alcohol exposure. Quantitative, in vivo fiber tracking results are presented from rats with DTI conducted at 3 time points: baseline; after 4 days of intragastric alcohol to blood alcohol levels of ~250mg/dL; and after one week of recovery. Binge alcohol followed by a week of sobriety resulted in rapidly reversible decreases in fractional anisotropy (FA), a measure of the coherence of fiber tracts, in callosal genu and fimbria-fornix but not splenium; and increases in mean diffusivity (MD), an index of freely diffusing water in tissue, selective to the fimbria-fornix. These effects were confirmed with tract-based spatial statistics (TBSS). The directionality of changes in DTI metrics reproduce those observed in human alcoholism. That a single exposure to binge alcohol can cause substantial transient changes detectable in DTI metrics demonstrates the potential for rapid neuroplasticity.
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Affiliation(s)
- Adolf Pfefferbaum
- Neuroscience Program, SRI International, Menlo Park, CA, United States of America
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Natalie M. Zahr
- Neuroscience Program, SRI International, Menlo Park, CA, United States of America
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States of America
- * E-mail:
| | - Dirk Mayer
- Neuroscience Program, SRI International, Menlo Park, CA, United States of America
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Torsten Rohlfing
- Neuroscience Program, SRI International, Menlo Park, CA, United States of America
| | - Edith V. Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States of America
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14
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Strunz E, Jungerman J, Kinyua J, Frew PM. Evaluation of an Assertive Continuing Care Program for Hispanic Adolescents. Glob J Health Sci 2015; 7:106-16. [PMID: 26156933 PMCID: PMC4803868 DOI: 10.5539/gjhs.v7n5p106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 12/04/2022] Open
Abstract
Purpose: This study evaluated an Adolescent Community Reinforcement Approach (A-CRA) and Assertive Continuing Care (ACC) program targeting Hispanic adolescents at risk for substance abuse. Method: The Clinic for Education, Treatment, and Prevention of Addiction (CETPA, Inc.), a behavioral health provider offering culturally appropriate substance use and mental health services, carried out the intervention. We examined longitudinal substance use data in relation to time spent in the program and possible confounders. Results: We analyzed data from 72 adolescent clients collected between 2010 and 2012. Self-reported data were evaluated to determine if time spent in the program was associated with substance use reduction. The data were correlated, zero-inflated, and overdispersed; consequently, we employed a mixed-effects zero-inflated negative-binomial model. Time spent in CETPA’s program was significantly associated with reductions in the number of days of substance use (p = .039), but not with the likelihood of fully abstaining from use (p = .290). For non-abstinent participants who spend a year in the program, our models revealed an average decline of 46% in reported days of substance use. Conclusions: A culturally tailored and age-appropriate substance abuse program for Hispanic adolescents resulted in a significant reduction of the numbers of days using alcohol, drugs, or other illicit substances. The A-CRA/ACC approach can yield successful results in culturally diverse settings.
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Collins SE, Duncan MH, Smart BF, Saxon AJ, Malone DK, Jackson TR, Ries RK. Extended-Release Naltrexone and Harm Reduction Counseling for Chronically Homeless People With Alcohol Dependence. Subst Abus 2015; 36:21-33. [DOI: 10.1080/08897077.2014.904838] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Collins SE, Saxon AJ, Duncan MH, Smart BF, Merrill JO, Malone DK, Jackson TR, Clifasefi SL, Joesch J, Ries RK. Harm reduction with pharmacotherapy for homeless people with alcohol dependence: protocol for a randomized controlled trial. Contemp Clin Trials 2014; 38:221-34. [PMID: 24846619 PMCID: PMC4104260 DOI: 10.1016/j.cct.2014.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/05/2014] [Accepted: 05/10/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Interventions requiring abstinence from alcohol are neither preferred by nor shown to be highly effective with many homeless individuals with alcohol dependence. It is therefore important to develop lower-threshold, patient-centered interventions for this multimorbid and high-utilizing population. Harm-reduction counseling requires neither abstinence nor use reduction and pairs a compassionate style with patient-driven goal-setting. Extended-release naltrexone (XR-NTX), a monthly injectable formulation of an opioid receptor antagonist, reduces craving and may support achievement of harm-reduction goals. Together, harm-reduction counseling and XR-NTX may support alcohol harm reduction and quality-of-life improvement. AIMS Study aims include testing: a) the relative efficacy of XR-NTX and harm-reduction counseling compared to a community-based, supportive-services-as-usual control, b) theory-based mediators of treatment effects, and c) treatment effects on publicly funded service costs. METHODS This RCT involves four arms: a) XR-NTX+harm-reduction counseling, b) placebo+harm-reduction counseling, c) harm-reduction counseling only, and d) community-based, supportive-services-as-usual control conditions. Participants are currently/formerly homeless, alcohol dependent individuals (N=300). Outcomes include alcohol variables (i.e., craving, quantity/frequency, problems and biomarkers), health-related quality of life, and publicly funded service utilization and associated costs. Mediators include 10-point motivation rulers and the Penn Alcohol Craving Scale. XR-NTX and harm-reduction counseling are administered every 4weeks over the 12-week treatment course. Follow-up assessments are conducted at weeks 24 and 36. DISCUSSION If found efficacious, XR-NTX and harm-reduction counseling will be well-positioned to support reductions in alcohol-related harm, decreases in costs associated with publicly funded service utilization, and increases in quality of life among homeless, alcohol-dependent individuals.
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Affiliation(s)
- Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
| | - Andrew J Saxon
- VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 45th St. Box 354944, Seattle, WA 98195, USA.
| | - Mark H Duncan
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
| | - Brian F Smart
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
| | - Joseph O Merrill
- Department of Medicine, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359780, Seattle, WA 98195, USA.
| | - Daniel K Malone
- Downtown Emergency Service Center (DESC), 515 Third Ave, Seattle, WA 98104, USA.
| | - T Ron Jackson
- Evergreen Treatment Services - REACH, 1700 Airport Way S, Seattle, WA 98134, USA.
| | - Seema L Clifasefi
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 45th St. Box 354944, Seattle, WA 98195, USA.
| | - Jutta Joesch
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
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Overton TL, Rives TE, Hecht C, Shafi S, Gandhi RR. Distracted driving: prevalence, problems, and prevention. Int J Inj Contr Saf Promot 2014; 22:187-92. [PMID: 24499372 DOI: 10.1080/17457300.2013.879482] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
While the number of motor vehicle crashes has declined over the years, crashes resulting from distracted driving are increasing in the United States resulting in significant morbidity and mortality. The national public seems to be aware of the dangers associated with using technology while driving, but continues to engage in this dangerous behaviour, and may be unaware of or underestimate the impact of cell phone use on their own driving performance. Problems associated with distracted driving are not limited to novice or teenage drivers; multifaceted universal prevention efforts aimed at impacting large segments of the population may have the greatest impact. Legislation limiting drivers' cell phone use has had little impact, possibly due to low regulation and enforcement. Behaviour change programmes, improved vehicle safety, and public awareness campaigns have been developed as potential preventive efforts to reduce accidents caused by distracted drivers.
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Talley AE, Sher KJ, Steinley D, Wood PK, Littlefield AK. Patterns of alcohol use and consequences among empirically derived sexual minority subgroups. J Stud Alcohol Drugs 2012; 73:290-302. [PMID: 22333337 DOI: 10.15288/jsad.2012.73.290] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The current study develops an empirically determined classification of sexual orientation developmental patterns based on participants' annual reports of self-identifications, sexual attractions, and sexual behaviors during the first 4 years of college. A secondary aim of the current work was to examine trajectories of alcohol involvement among identified subgroups. METHOD Data were drawn from a subsample of a longitudinal study of incoming first-time college students at a large, public university (n = 2,068). Longitudinal latent class analysis was used to classify sexual minority participants into empirically derived subgroups based on three self-reported facets of sexual orientation. Multivariate repeated-measures analyses were conducted to examine how trajectories of alcohol involvement varied by sexual orientation class membership. RESULTS Four unique subclasses of sexual orientation developmental patterns were identified for males and females: one consistently exclusively heterosexual group and three sexual minority groups. Despite generally similar alcohol use patterns among subclasses, certain sexual minority subgroups reported elevated levels of alcohol-related negative consequences and maladaptive motivations for use throughout college compared with their exclusively heterosexual counterparts. CONCLUSIONS Elevations in coping and conformity motivations for alcohol use were seen among those subgroups that also evidenced heightened negative alcohol-related consequences. Implications and limitations of the current work are discussed.
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Affiliation(s)
- Amelia E Talley
- University of Missouri and the Midwest Alcoholism Research Center, Columbia, Missouri 65211, USA.
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19
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Thompson RG, Auslander WF. Substance use and mental health problems as predictors of HIV sexual risk behaviors among adolescents in foster care. HEALTH & SOCIAL WORK 2011; 36:33-43. [PMID: 21446607 PMCID: PMC3785296 DOI: 10.1093/hsw/36.1.33] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This study examined the relationship between substance use, mental health problems, and HIV sexual risk behaviors among a sample of foster care adolescents. Data were collected through structured baseline interviews with 320 adolescents (ages 15 to 18 years) who resided in foster care placements and participated in a larger evaluation study of an HIV prevention program. Final logistic regression models indicated that delinquent behavior and marijuana use were the most significant predictors of engaging in any one HIV risk behavior. Adolescents who reported delinquent behaviors, alcohol use, and marijuana use and who were female were more likely than their counterparts to engage in vaginal sex without using a condom. Future research is needed to further identify risk and protective factors for substance use, mental health problems, and HIV sexual risk behaviors among adolescents in foster care. HIV prevention efforts for these vulnerable adolescents should target those with substance use and delinquent behaviors.
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, Columbia University, New York, NY 10032, USA.
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Abstract
Harm reduction is a pragmatic approach to reduce the harmful consequences of alcohol and drug use or other high-risk activities by incorporating several strategies that cut across the spectrum from safer use to managed use to abstinence. The primary goal of most harm-reduction approaches is to meet individuals "where they are at" and not to ignore or condemn the harmful behaviors but rather to work with the individual or community to minimize the harmful effects of a given behavior. The current review addresses some of the newest developments with respect to harm-reduction policy, prevention, and treatment. In particular, this review highlights policies and programs that have been evaluated in peer-reviewed journals and shown to be effective at reducing the harms associated with alcohol and drug use. The overall goal of this review is to present some of the most recent developments in the field of harm reduction.
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Affiliation(s)
- G Alan Marlatt
- The Addictive Behaviors Research Center, University of Washington, Seattle, Washington 98195-1629, USA.
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Abstract
Harm reduction is an umbrella term for interventions aiming to reduce the problematic effects of behaviors. Although harm reduction was originally and most frequently associated with substance use, it is increasingly being applied to a multitude of other behavioral disorders. This article reviews the state of empirical research on harm reduction practices including alcohol interventions for youth, college students, and a variety of other adult interventions. We also review nicotine replacement and opioid substitution, as well as needle exchanges and safe injection sites for intravenous drug users. Dozens of peer-reviewed controlled trial publications provide support for the effectiveness of harm reduction for a multitude of clients and disorders without indications of iatrogenic effects. Harm reduction interventions provide additional tools for clinicians working with clients who, for whatever reason, may not be ready, willing, or able to pursue full abstinence as a goal.
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Affiliation(s)
- Diane E Logan
- Department of Psychology, University of Washington, Box 351629, Seattle, WA 98195, USA.
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Whiteside U, Cronce JM, Pedersen ER, Larimer ME. Brief motivational feedback for college students and adolescents: a harm reduction approach. J Clin Psychol 2010; 66:150-63. [PMID: 20049906 DOI: 10.1002/jclp.20667] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Alcohol consumption and its attendant problems are prevalent among adolescents and young adult college students. Harm reduction has been found efficacious with heavy drinking adolescents and college students. These harm reduction approaches do not demand abstinence and are designed to meet the individual where he or she is in the change process. The authors present a case illustration of a harm reduction intervention, the Brief Alcohol Screening and Intervention for College Students (BASICS), with a heavy-drinking female college student experiencing significant problems as a result of her drinking. BASICS is conducted in a motivational interviewing style and includes cognitive-behavioral skills training and personalized feedback.
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Affiliation(s)
- Ursula Whiteside
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 354933, Seattle, WA 98195, USA.
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Vervaeke HKE, Benschop A, Korf DJ. Fear, rationality and opportunity: Reasons and motives for not trying ecstasy. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/09687630701444932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mun EY, White HR, Morgan TJ. Individual and situational factors that influence the efficacy of personalized feedback substance use interventions for mandated college students. J Consult Clin Psychol 2009; 77:88-102. [PMID: 19170456 PMCID: PMC2818838 DOI: 10.1037/a0014679] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Little is known about individual and situational factors that moderate the efficacy of personalized feedback interventions (PFIs). Mandated college students (N = 348) were randomly assigned either to a PFI delivered in the context of a brief motivational interview (BMI; n = 180) or to a written PFI only (WF) condition and were followed up at 4 months and 15 months postintervention. The authors empirically identified heterogeneous subgroups utilizing mixture modeling analysis based on heavy episodic drinking and alcohol-related problems. The 4 identified groups were dichotomized into an improved group (53.4%) and a nonimproved group (46.6%). Logistic regression results indicated that the BMI was no more efficacious than the WF across all mandated students. However, mandated students who experienced a serious incident requiring medical or police attention and those with higher levels of alcohol-related problems at baseline benefited more from the BMI than from the WF. It may be an efficacious and cost-effective approach to provide a written PFI for low-risk mandated students and an enhanced PFI with a BMI for those students who experience a serious incident or have higher baseline alcohol-related problems.
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Affiliation(s)
- Eun Young Mun
- Center of Alcohol Studies, Rutgers, The State University of New Jersey, 607 Allison Road, Piscataway, NJ 08854, USA.
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Percy A. Moderate adolescent drug use and the development of substance use self-regulation. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2008. [DOI: 10.1177/0165025408093664] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This article presents a re-conceptualization of moderate adolescent drug use. It is argued that experimentation with alcohol and other drugs during the teenage years may play an important role in the development of regulatory competency in relation to drug consumption in adulthood. When such regulatory skills fail to emerge in young people, during the transition to adulthood, the likelihood of serious alcohol- or drug-related harm is increased. The article reviews the empirical evidence of poor self-regulation as a predictor of long-term alcohol- and drug-related problems, places self-regulation within a broader theoretical framework, and considers the policy and practice implications of this conceptualization.
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Borsari B, Boyle KE, Hustad JTP, Barnett NP, O'Leary Tevyaw T, Kahler CW. Drinking before drinking: pregaming and drinking games in mandated students. Addict Behav 2007; 32:2694-705. [PMID: 17574344 PMCID: PMC2094391 DOI: 10.1016/j.addbeh.2007.05.003] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 05/09/2007] [Indexed: 11/20/2022]
Abstract
Pregaming, the practice of consuming alcohol before attending a social function, has not received as much research attention as drinking games among college students. This study investigated the prevalence of both pregaming and drinking game participation in a sample of mandated students (N=334) who had been referred for an alcohol violation. Approximately one-third (31%) of the sample reported pregaming on the night of their referral event. Pregaming was associated with higher estimated blood alcohol content on that night, along with a greater history of pregaming and taking greater responsibility for the incident. A higher proportion of the students (49%) reported playing drinking games on the event night and reported the event to be less aversive than non-players. Neither drinking games nor pregaming was consistently related to recent alcohol consumption or problems, nor did they frequently occur together on the event night. Pregaming was a unique predictor of intoxication on the night of the referral, and drinking games were not. Therefore, pregaming and drinking games appear to be distinct activities. This research suggests methods of prevention for both activities as well as promising research directions for future research.
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Affiliation(s)
- Brian Borsari
- Brown University, Center for Alcohol and Addiction Studies, Box G-S121, Providence, RI 02903, USA.
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Toumbourou JW, Stockwell T, Neighbors C, Marlatt GA, Sturge J, Rehm J. Interventions to reduce harm associated with adolescent substance use. Lancet 2007; 369:1391-1401. [PMID: 17448826 DOI: 10.1016/s0140-6736(07)60369-9] [Citation(s) in RCA: 278] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A major proportion of the disease burden and deaths for young people in developed nations is attributable to misuse of alcohol and illicit drugs. Patterns of substance use established in adolescence are quite stable and predict chronic patterns of use, mortality, and morbidity later in life. We integrated findings of systematic reviews to summarise evidence for interventions aimed at prevention and reduction of harms related to adolescent substance use. Evidence of efficacy was available for developmental prevention interventions that aim to prevent onset of harmful patterns in settings such as vulnerable families, schools, and communities, and universal strategies to reduce attractiveness of substance use. Regulatory interventions aim to increase perceived costs and reduce availability and accessibility of substances. Increasing price, restricting settings of use, and raising legal purchase age are effective in reducing use of alcohol and tobacco and related harms. Screening and brief intervention are efficacious, but efficacy of a range of treatment approaches has not been reliably established. Harm-reduction interventions are effective in young people involved in risky and injecting substance use.
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Affiliation(s)
- J W Toumbourou
- Centre for Adolescent Health, Murdoch Childrens Research Institute and School of Psychology, Deakin University, Victoria, Australia
| | - T Stockwell
- Centre for Addictions Research of British Colombia, University of Victoria, PO Box 1700 STN CSC Victoria, BC V8W 2Y2, Canada; National Drug Research Institute, Curtin University, Perth, Australia.
| | - C Neighbors
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, USA
| | - G A Marlatt
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, USA
| | - J Sturge
- Centre for Addictions Research of British Colombia, University of Victoria, PO Box 1700 STN CSC Victoria, BC V8W 2Y2, Canada
| | - J Rehm
- Centre for Addictions and Mental Health, Toronto, Ontario, Canada
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Witkiewitz K, Alan Marlatt G. Overview of harm reduction treatments for alcohol problems. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2006. [DOI: 10.1016/j.drugpo.2006.03.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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