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Moe J, Koh J, Ma JA, Pei LX, MacLean E, Keech J, Maguire K, Ronsley C, Doyle-Waters MM, Brubacher JR. Screening for harmful substance use in emergency departments: a systematic review. Int J Emerg Med 2024; 17:52. [PMID: 38584266 PMCID: PMC11000386 DOI: 10.1186/s12245-024-00616-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Substance use-related emergency department (ED) visits have increased substantially in North America. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthesizes evidence on diagnostic accuracy of ED screening tools to detect harmful substance use. METHODS We included derivation or validation studies, with or without comparator, that included adult (≥ 18 years) ED patients and evaluated screening tools to identify general or specific substance use disorders or harmful use. Our search strategy combined concepts Emergency Department AND Screening AND Substance Use. Trained reviewers assessed title/abstracts and full-text articles for inclusion, extracted data, and assessed risk of bias (QUADAS-2) independently and in duplicate. Reviewers resolved disagreements by discussion. Primary investigators adjudicated if necessary. Heterogeneity precluded meta-analysis. We descriptively summarized results. RESULTS Our search strategy yielded 2696 studies; we included 33. Twenty-one (64%) evaluated a North American population. Fourteen (42%) applied screening among general ED patients. Screening tools were administered by research staff (n = 21), self-administered by patients (n = 10), or non-research healthcare providers (n = 1). Most studies evaluated alcohol use screens (n = 26), most commonly the Alcohol Use Disorders Identification Test (AUDIT; n = 14), Cut down/Annoyed/Guilty/Eye-opener (CAGE; n = 13), and Rapid Alcohol Problems Screen (RAPS/RAPS4/RAPS4-QF; n = 12). Four studies assessing six tools and screening thresholds for alcohol abuse/dependence in North American patients (AUDIT ≥ 8; CAGE ≥ 2; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-2] ≥ 1; RAPS ≥ 1; National Institute on Alcohol Abuse and Alcoholism [NIAAA]; Tolerance/Worry/Eye-opener/Amnesia/K-Cut down [TWEAK] ≥ 3) reported both sensitivities and specificities ≥ 83%. Two studies evaluating a single alcohol screening question (SASQ) (When was the last time you had more than X drinks in 1 day?, X = 4 for women; X = 5 for men) reported sensitivities 82-85% and specificities 70-77%. Five evaluated screening tools for general substance abuse/dependence (Relax/Alone/Friends/Family/Trouble [RAFFT] ≥ 3, Drug Abuse Screening Test [DAST] ≥ 4, single drug screening question, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST] ≥ 42/18), reporting sensitivities 64%-90% and specificities 61%-100%. Studies' risk of bias were mostly high or uncertain. CONCLUSIONS Six screening tools demonstrated both sensitivities and specificities ≥ 83% for detecting alcohol abuse/dependence in EDs. Tools with the highest sensitivities (AUDIT ≥ 8; RAPS ≥ 1) and that prioritize simplicity and efficiency (SASQ) should be prioritized.
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Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Justin Koh
- Department of Emergency Medicine, Queen's University, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Jennifer A Ma
- Department of Emergency Medicine, University of Manitoba, S203 Medical Sciences Building, 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W2, Canada
| | - Lulu X Pei
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Eleanor MacLean
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - James Keech
- School of Medicine, Queen's University, 15 Arch Street, Kingston, ON, K7L 3N6, Canada
| | - Kaitlyn Maguire
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Claire Ronsley
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Pinedo M, Rivera JR. 'I like to protect my protector': How US-born Latinos safeguard the livelihood of their immigrant communities from immigration enforcement encounters. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5979-e5987. [PMID: 36124655 PMCID: PMC10246879 DOI: 10.1111/hsc.14030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/09/2022] [Accepted: 09/12/2022] [Indexed: 06/09/2023]
Abstract
Using a qualitative phenomenological design, the objective of this study was to explore in-depth how US-born Latinos provide social support to their immigrant counterparts during a time of heightened anti-immigrant rhetoric. A sample of 22 US-born Latino adult was recruited in 2019 for qualitative interviews, following a period of intense immigration raids. Eligible participants were adults who reported experiencing an immigration-related stressor and screened positive for a mental health concern or substance misuse. Open-ended questions focused on topics of immigration and health. Using a thematic analysis approach, interview transcripts were coded to identify common themes within the domains of social support: instrumental; informational; emotional; and appraisal. We found that US-born Latinos provide diverse forms of social support to immigrants with the intention of protecting them from immigration enforcement encounters (e.g. deportation), thereby safeguarding the livelihoods of their communities. US-born Latinos are integral pillars of support and resiliency for immigrant communities, and the domains identified within this study suggest important implications for immigrant health.
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Affiliation(s)
- Miguel Pinedo
- Department of Kinesiology & Health Education, College of Education, University of Texas, Austin, Austin, Texas, USA
| | - Jazmin R Rivera
- Department of Kinesiology & Health Education, College of Education, University of Texas, Austin, Austin, Texas, USA
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3
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Hernandez M, von Sternberg K, Velasquez MM. Alcohol use and problems among Latinas at risk of an alcohol-exposed pregnancy: The role of acculturation and interpersonal factors. J Ethn Subst Abuse 2020; 21:425-438. [PMID: 32538710 DOI: 10.1080/15332640.2020.1777609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Path analysis was used to examine the role of acculturation, helping relationships, partner status, age, and education on heavy drinking and alcohol problems among 119 Latina adults at risk of an alcohol-exposed pregnancy (AEP). Greater acculturation was positively related to more helping relationships and heavy drinking, and there was an indirect positive relationship between acculturation and alcohol problems. There was also a positive relationship between helping relationships and alcohol problems, and a negative relationship between helping relationships and being partnered. Knowledge of the mechanisms by which acculturation and interpersonal factors influence behavior change can inform potential targets for intervention among Latinas with AEP risk.
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Affiliation(s)
- Mercedes Hernandez
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Kirk von Sternberg
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Mary M Velasquez
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
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Hernandez M, von Sternberg KL, Castro Y, Velasquez MM. The Role of Acculturation and Alcohol Problems on Frequency of Cannabis Use Among Latinas at Risk of an Alcohol-Exposed Pregnancy. Subst Use Misuse 2019; 54:1980-1990. [PMID: 31220980 PMCID: PMC9728806 DOI: 10.1080/10826084.2019.1625399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Along with alcohol, cannabis is one of the most commonly used substances among women of childbearing age. Recent studies indicate detrimental effects of prenatal cannabis use. Because many women use these substances before realizing they are pregnant, these serious health consequences for women and their offspring are of great concern. Despite the recent upsurge in cannabis use, little is known about individual and sociocultural factors that may contribute to risk of a cannabis-exposed pregnancy, particularly among Latinas of child-bearing age also at risk of an alcohol-exposed pregnancy (AEP). Objectives: Examine the relationships of acculturation, alcohol use, alcohol problems, and psychological distress with frequency of cannabis use among adult Latinas at risk of an AEP. Methods: The hypothesized model included 76 Latinas and was analyzed using path analysis. The study used baseline data from a randomized controlled trial of an intervention targeting risky drinking and tobacco use among women at risk of an AEP in primary care clinics. Results: Greater acculturation was associated with more frequent cannabis use and greater psychological distress. There was a positive indirect relationship between acculturation and alcohol use and alcohol problems through psychological distress. Greater alcohol problems were associated with more frequent cannabis use. Greater psychological distress and alcohol use were indirectly related to more frequent cannabis use through alcohol problems. Conclusions: Findings underscore the critical role of acculturation and alcohol-related problems in cannabis use frequency and have relevant implications for preventive efforts addressing cannabis use among Latinas at risk of an AEP.
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Affiliation(s)
- Mercedes Hernandez
- Steve Hicks School of Social Work, University of Texas at Austin , Austin , Texas , USA.,Health Behavior Research and Training Institute, University of Texas at Austin , Austin , Texas , USA
| | - Kirk L von Sternberg
- Steve Hicks School of Social Work, University of Texas at Austin , Austin , Texas , USA.,Health Behavior Research and Training Institute, University of Texas at Austin , Austin , Texas , USA
| | - Yessenia Castro
- Steve Hicks School of Social Work, University of Texas at Austin , Austin , Texas , USA.,Health Behavior Research and Training Institute, University of Texas at Austin , Austin , Texas , USA
| | - Mary M Velasquez
- Steve Hicks School of Social Work, University of Texas at Austin , Austin , Texas , USA.,Health Behavior Research and Training Institute, University of Texas at Austin , Austin , Texas , USA
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Cherpitel CJ, Ye Y, Poznyak V. Single episode of alcohol use resulting in injury: a cross-sectional study in 21 countries. Bull World Health Organ 2018; 96:335-342. [PMID: 29875518 PMCID: PMC5985422 DOI: 10.2471/blt.17.202093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the empirical basis for including the diagnostic category of "a single episode of harmful substance use" in the 11th revision of the International statistical classification of diseases and related health problems (ICD-11). METHODS We used data on patients admitted to emergency departments in 21 countries with alcohol-related injuries (i.e. with drinking within the preceding six hours) who had no sign of alcohol intoxication or withdrawal, no alcohol in blood and no sign of alcohol dependence or harmful drinking as described in the ICD-10. We obtained data on alcohol-related injuries, the patient's causal attribution of injury to drinking, the alcohol amount consumed, blood alcohol concentration and usual drinking pattern. Patients with and without alcohol dependence or harmful drinking were compared. FINDINGS We included a representative sample of 18 369 patients. After adjustment for unequal sampling, 18.8% reported drinking in the six hours before injury and 47.1% of these attributed their injury to drinking; 16.3% of those reporting drinking and 10.3% of those attributing their injury to drinking were not alcohol dependent or harmful drinkers. The majority of these last two groups reported never having had five or more drinks on one occasion during the last year and had a blood alcohol concentration less than 0.05%. CONCLUSION Some individuals attending emergency departments had alcohol-attributable injuries due to a single episode of drinking but had no history of harmful use or dependence. These findings highlight the public health relevance of including the new diagnostic category in the ICD-11.
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Affiliation(s)
- Cheryl J Cherpitel
- Alcohol Research Group, Public Health Institute, Suite 450, 6001 Shellmound Street, Emeryville, California, CA 94608, United States of America
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, Suite 450, 6001 Shellmound Street, Emeryville, California, CA 94608, United States of America
| | - Vladimir Poznyak
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Paulus DJ, Vujanovic AA, Schuhmann BB, Smith LJ, Tran J. Main and interactive effects of depression and posttraumatic stress in relation to alcohol dependence among urban male firefighters. Psychiatry Res 2017; 251:69-75. [PMID: 28189939 DOI: 10.1016/j.psychres.2017.02.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/31/2017] [Accepted: 02/05/2017] [Indexed: 11/24/2022]
Abstract
Depression, posttraumatic stress, and alcohol use are highly prevalent among firefighters. However, no study has evaluated the interactive effects of depression and posttraumatic stress with regard to alcohol use among firefighters. The current study examined main and interactive effects of depression and posttraumatic stress in terms of alcohol dependence symptoms, positive alcohol dependence screen, and drinks per occasion. Participants included 2707 male urban firefighters. There was a main effect of posttraumatic stress in relation to all alcohol-related outcomes and a main effect of depression only for alcohol dependence symptoms. There was a significant interaction of depression and posttraumatic stress with regard to symptoms of alcohol dependence, positive screen for alcohol dependence, and number of drinks per occasion. Interactions were evident above main effects and covariates (age, presence of a spouse/partner, tenure in the fire department, history of active duty in the U.S. armed forces, and racial/ethnic minority status). Overall, heightened depression was positively associated with alcohol-related outcomes for those with lower but not higher levels of posttraumatic stress in all models. Posttraumatic stress and depression may pose unique interactive risks for alcohol dependence in urban male firefighters. Implications for clinical intervention in firefighters are discussed.
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Affiliation(s)
- Daniel J Paulus
- University of Houston, Department of Psychology, Houston, TX, USA
| | - Anka A Vujanovic
- University of Houston, Department of Psychology, Houston, TX, USA
| | | | - Lia J Smith
- University of Houston, Department of Psychology, Houston, TX, USA
| | - Jana Tran
- Houston Fire Department, Houston, TX, USA
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Wall M, Casswell S. Drinker Types, Harm, and Policy-Related Variables: Results from the 2011 International Alcohol Control Study in New Zealand. Alcohol Clin Exp Res 2017; 41:1044-1053. [PMID: 28372021 DOI: 10.1111/acer.13372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/06/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim was to identify a typology of drinkers in New Zealand based on alcohol consumption, beverage choice, and public versus private drinking locations and investigate the relationship between drinker types, harms experienced, and policy-related variables. METHODS Model-based cluster analysis of male and female drinkers including volumes of alcohol consumed in the form of beer, wine, spirits, and ready-to-drinks (RTDs) in off- and on-premise settings. Cluster membership was then related to harm measures: alcohol dependence, self-rated health; and to 3 policy-relevant variables: liking for alcohol adverts, price paid for alcohol, and time of purchase. RESULTS Males and females were analyzed separately. Men fell into 4 and women into 14 clearly discriminated clusters. The male clusters consumed a relatively high proportion of alcohol in the form of beer. Women had a number of small extreme clusters and some consumed mainly spirits-based RTDs, while others drank mainly wine. Those in the higher consuming clusters were more likely to have signs of alcohol dependency, to report lower satisfaction with their health, to like alcohol ads, and to have purchased late at night. CONCLUSIONS Consumption patterns are sufficiently distinctive to identify typologies of male and female alcohol consumers. Women drinkers are more heterogeneous than men. The clusters relate differently to policy-related variables.
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Affiliation(s)
- Martin Wall
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Sally Casswell
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
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Martin CE, Vujanovic AA, Paulus DJ, Bartlett B, Gallagher MW, Tran JK. Alcohol use and suicidality in firefighters: Associations with depressive symptoms and posttraumatic stress. Compr Psychiatry 2017; 74:44-52. [PMID: 28092775 DOI: 10.1016/j.comppsych.2017.01.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/07/2016] [Accepted: 01/04/2017] [Indexed: 11/19/2022] Open
Abstract
Both suicidality and alcohol use disorders are significant public health concerns among firefighters, and alcohol use is associated with increased suicide risk. In addition, firefighters endorse high rates of symptoms of depression and posttraumatic stress disorder (PTSD). Thus, the current investigation examined associations between alcohol dependence and suicide risk among a large sample of firefighters. Specifically, this study examined the indirect effects of alcohol dependence on suicidality outcomes via both depression and posttraumatic stress, using structural equation modeling. A total of 2883 male firefighters completed a self-report survey, containing measures of alcohol use, suicidality, PTSD, and depressive symptoms. Results indicated good model fit. The latent alcohol dependence variable was directly related to the latent suicide risk variable. However, when depression and posttraumatic stress latent variables were added into the model, alcohol dependence was no longer associated with suicide risk. Furthermore, alcohol dependence was indirectly related to suicide risk via latent depression and posttraumatic stress variables. Indirect effects were established after controlling for relevant covariates. Clinical implications are discussed.
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Affiliation(s)
| | | | | | | | - Matthew W Gallagher
- University of Houston, Texas Institute of Measurement Evaluation and Statistics (TIMES)
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Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations. J Addict Med 2016; 9:343-51. [PMID: 26428359 DOI: 10.1097/adm.0000000000000150] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To review the literature on the screening, brief intervention, and referral to treatment (SBIRT) approach to alcohol and drug use with racial and ethnic subgroups in the United States and to develop recommendations for culturally competent SBIRT practice. METHODS Articles reporting on the use of SBIRT components (screening, brief intervention, referral to treatment) for alcohol and drug use were identified through a comprehensive literature search of PubMed from 1995 to 2015. RESULTS A synthesis of the published literature on racial and ethnic considerations regarding SBIRT components (including motivational interviewing techniques) was created using evidence-based findings. Recommendations on culturally competent use of SBIRT with specific ethnic groups are also described. CONCLUSIONS On the basis of the literature reviewed, SBIRT offers a useful set of tools to help reduce risky or problematic substance use. Special attention to validated screeners, appropriate use of language/literacy, trust building, and incorporation of patient and community health care preferences may enhance SBIRT acceptability and effectiveness. PRACTICE IMPLICATIONS Providers should consider the implications of previous research when adapting SBIRT for diverse populations, and use validated screening and brief intervention methods. The accompanying case illustration provides additional information relevant to clinical practice.
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Lee CS, Almeida J, Colby SM, Tavares T, Rohsenow DJ. Acculturation, hazardous drinking and depressive symptomatology among Hispanics enrolled in a clinical trial. ADDICTION RESEARCH & THEORY 2016; 24:69-79. [PMID: 26819573 PMCID: PMC4724423 DOI: 10.3109/16066359.2015.1072517] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Among Hispanics in the U.S., lower acculturation level has been found to be protective against alcohol abuse and depression. However, this relationship may not hold within at-risk samples. The prevalence and co-occurrence of hazardous drinking and depressive symptoms and their relationship to acculturation were examined among Hispanics enrolled in a study to reduce heavy drinking. At enrollment, all participants reported past-month heavy drinking (one or more occasions of >4/5 drinks for females/males, and average weekly consumption >7/14 drinks per week). We explored whether gender moderated the effects of acculturation on hazardous drinking and depressive symptoms. METHODS Participants (N = 100) completed measures at baseline. RESULTS Eighty-nine percent of participants met criteria for hazardous alcohol use as assessed by the AUDIT and of those, 55% (n=49) also reported elevated depressive symptoms. Of those who reported elevated depressive symptoms, nearly all (94%) met AUDIT criteria for hazardous drinking. Acculturation was not related to hazardous drinking or depressive symptoms in the full sample. Highly acculturated women reported more hazardous drinking than less acculturated women. Acculturation was not associated with hazardous drinking in men, but less acculturated men reported higher levels of depression than highly acculturated men. DISCUSSION Depression should be assessed in alcohol interventions for Hispanics. Alcohol interventions should be tailored for acculturation level and gender to improve relevance and efficacy. Clinical Trial Registration #NCT01996280.
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Affiliation(s)
- Christina S. Lee
- Department of Applied Psychology, Northeastern University, Boston, MA, USA
| | | | - Suzanne M. Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Tonya Tavares
- Department of Applied Psychology, Northeastern University, Boston, MA, USA
| | - Damaris J. Rohsenow
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
- Providence Veterans Affairs Medical Center, Providence, RI, USA
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Abstract
Little is known about alcohol misuse and depression among Latino day laborers despite the fact that they encounter multiple stressors (e.g., job instability, unsafe work environments). A structural equation model tested the relationships among laborer stress, social support, health status, current alcohol misuse, and depression. A sample of 89 male, urban Latino day laborers completed measures assessing these constructs in 2011. Stress was negatively related to physical health status, which was associated with depression. Findings suggest that stressors specific to being a day laborer resulting from their work and living conditions generate and maintain health disparities in this vulnerable population.
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Affiliation(s)
- Guadalupe Bacio
- 1Department of Psychology, University of California, Los Angeles, California, USA
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12
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Nöthling J, Martin CL, Laughton B, Cotton MF, Seedat S. Maternal post-traumatic stress disorder, depression and alcohol dependence and child behaviour outcomes in mother-child dyads infected with HIV: a longitudinal study. BMJ Open 2013; 3:e003638. [PMID: 24334155 PMCID: PMC3863126 DOI: 10.1136/bmjopen-2013-003638] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 11/11/2013] [Accepted: 11/14/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES HIV and psychiatric disorders are prevalent and often concurrent. Childbearing women are at an increased risk for both HIV and psychiatric disorders, specifically depression and post-traumatic stress disorder (PTSD). Poor mental health in the peripartum period has adverse effects on infant development and behaviour. Few studies have investigated the relationship between maternal PTSD and child behaviour outcomes in an HIV vertically infected sample. The aim of this study was to investigate whether maternal postpartum trauma exposure and PTSD were risk factors for child behaviour problems. In addition, maternal depression, alcohol abuse and functional disability were explored as cofactors. SETTING The study was conducted in Cape Town, South Africa. PARTICIPANTS 70 mother-child dyads infected with HIV were selected from a group of participants recruited from community health centres. DESIGN The study followed a longitudinal design. Five measures were used to assess maternal trauma exposure, PTSD, depression, alcohol abuse and functional disability at 12 months postpartum: Life Events Checklist (LEC), Harvard Trauma Scale (HTS), Alcohol Use Disorders Identification Test (AUDIT), Center for Epidemiological Studies Depression (CESD) Scale and the Sheehan Disability Scale (SDS). Child behaviour was assessed at 42 months with the Child Behaviour Checklist (CBCL). RESULTS The rate of maternal disorder was high with 50% scoring above the cut-off for depression, 22.9% for PTSD and 7% for alcohol abuse. Half of the children scored within the clinical range for problematic behaviour. Children of mothers with depression were significantly more likely to display total behaviour problems than children of mothers without depression. Maternal PTSD had the greatest explanatory power for child behaviour problems, although it did not significantly predict child outcomes. CONCLUSIONS This study highlights the importance of identifying and managing maternal PTSD and depression in mothers of children infected with HIV. The relationship between maternal PTSD and child behaviour warrants further investigation.
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Affiliation(s)
- Jani Nöthling
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Cherie L Martin
- School of International Development and Global Studies, University of Ottawa, Ontario, Canada
| | - Barbara Laughton
- Department of Paediatrics and Child Health, The Children's Infectious Diseases Clinical Research Unit (KID-CRU), Stellenbosch University, Cape Town, South Africa
| | - Mark F Cotton
- Department of Paediatrics and Child Health, The Children's Infectious Diseases Clinical Research Unit (KID-CRU), Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Woolard R, Cherpitel C, Kathleen T. Brief Intervention for Emergency Department Patients with Alcohol Misuse: Implications for Current Practice. ALCOHOLISM TREATMENT QUARTERLY 2011; 29:146-157. [PMID: 21886943 DOI: 10.1080/07347324.2011.557978] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article reviews studies and current practices of brief motivational intervention in the emergency department and identifies factors related to the effectiveness of brief intervention. Studies of brief intervention in the emergency department have had mixed results with most studies showing improvements in both intervention and control groups. Most report brief intervention reducing alcohol's negative consequences without reducing consumption. Clinical practice is incorporating brief intervention as part of emergency treatment and further research is needed to determine the factors most responsible for the improvements noted in most studies.
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Affiliation(s)
- Robert Woolard
- Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso Department of Emergency Medicine
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Cremonte M, Ledesma RD, Cherpitel CJ, Borges G. Psychometric properties of alcohol screening tests in the emergency department in Argentina, Mexico and the United States. Addict Behav 2010; 35:818-25. [PMID: 20472341 DOI: 10.1016/j.addbeh.2010.03.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 03/02/2010] [Accepted: 03/31/2010] [Indexed: 10/19/2022]
Abstract
The objective of this article is to report psychometric characteristics of the AUDIT, CAGE, RAPS4, and TWEAK and to compare them across three countries: Argentina, Mexico, and the United States which used a similar protocol and methodology. Probability samples of patients 18 years and older were drawn from emergency departments in Mar del Plata, Argentina (n=780), Pachuca, Mexico (n=1624) and Santa Clara, U.S. (n=1220). Concurrent validity was assessed by comparing their performance against a diagnosis of alcohol dependence (DSM-IV) obtained through the Composite International Diagnostic Interview, and for the briefer measures, also by their correlation with the AUDIT. The internal consistency of the CAGE, RAPS4, and TWEAK scores was estimated by the KR-20 formula and by Cronbach's Alpha for the AUDIT. Corrected item-total correlation and D-values were used as item discrimination measures. In Argentina and Mexico the AUDIT and the RAPS4 showed the highest validity. Reliability of all instruments was higher in the US than in Argentina or Mexico. In all three countries, reliability of the TWEAK was lowest, while the AUDIT was highest. With a few exceptions, all items showed good discrimination powers.
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Cunningham RM, Bernstein SL, Walton M, Broderick K, Vaca FE, Woolard R, Bernstein E, Blow F, D'Onofrio G. Alcohol, tobacco, and other drugs: future directions for screening and intervention in the emergency department. Acad Emerg Med 2009; 16:1078-88. [PMID: 20053226 DOI: 10.1111/j.1553-2712.2009.00552.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on "Public Health in the ED: Screening, Surveillance, and Intervention." The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening--develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention--conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups--conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategies--a) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and follow-up; and d) examine alternatives to specialized treatment referral. 5) Translation--conduct translational and cost-effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice.
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Affiliation(s)
- Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, School of Public Health Injury Research Center, Ann Arbor, MI, USA.
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Cremonte M, Cherpitel CJ. Performance of screening instruments for alcohol use disorders in emergency department patients in Argentina. Subst Use Misuse 2008; 43:125-38. [PMID: 18189209 DOI: 10.1080/10826080701212337] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The performance of the Alcohol Use Disorders Identification Test (AUDIT), CAGE, Brief Michigan Alcohol Screening Test (Brief MAST), Rapid Alcohol Problems Screen (RAPS), Rapid Alcohol Problems Screen-Quantity and Frequency (RAPS4-QF), and TWEAK was evaluated against a diagnosis of alcohol dependence and harmful drinking or alcohol abuse from ICD-10 and DSM-IV criteria. Data were collected from a probability sample of 779 patients admitted to the emergency department of a public general hospital in Mar del Plata, Argentina, during the year 2001. The majority of the patients sampled were male. The age range was 18 to 89 years, with a mean value of 36 years and a median of 31 years. Almost half of the sample had an elementary school education or less. All instruments were more sensitive for alcohol dependence than for harmful drinking or abuse and more sensitive for men than for women. Findings suggest the RAPS4 and RAPS4-QF may be preferred when screening for alcohol use disorders in the emergency department in Argentina. The study's limitations are noted.
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Affiliation(s)
- Mariana Cremonte
- Universidad Nacional de Mar del Plata, Mar del Plata, Argentina.
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Reinert DF, Allen JP. The alcohol use disorders identification test: an update of research findings. Alcohol Clin Exp Res 2007; 31:185-99. [PMID: 17250609 DOI: 10.1111/j.1530-0277.2006.00295.x] [Citation(s) in RCA: 936] [Impact Index Per Article: 55.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Alcohol Use Disorders Identification Test (AUDIT) has been extensively researched to determine its capability to accurately and practically screen for alcohol problems. METHODS During the 5 years since our previous review of the literature, a large number of additional studies have been published on the AUDIT, abbreviated versions of it, its psychometric properties, and the applicability of the AUDIT for a diverse array of populations. The current article summarizes new findings and integrates them with results of previous research. It also suggests some issues that we believe are particularly in need of further study. RESULTS A growing body of research evidence supports the criterion validity of English version of the AUDIT as a screen for alcohol dependence as well as for less severe alcohol problems. Nevertheless, the cut-points for effective detection of hazardous drinking as well as identification of alcohol dependence or harmful use in women need to be lowered from the originally recommended value of 8 points. The AUDIT-C, the most popular short version of the AUDIT consisting solely of its 3 consumption items, is approximately equal in accuracy to the full AUDIT. Psychometric properties of the AUDIT, such as test-retest reliability and internal consistency, are quite favorable. Continued research is urged to establish the psychometric properties of non-English versions of the AUDIT, use of the AUDIT with adolescents and with older adults, and selective inclusion of alcohol biomarkers with the AUDIT in some instances. CONCLUSIONS Research continues to support use of the AUDIT as a means of screening for the spectrum of alcohol use disorders in various settings and with diverse populations.
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Affiliation(s)
- Duane F Reinert
- Counseling Services, Conception Seminary College, Conception, Missouri 64433-0502, USA.
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Cherpitel C, Bond J, Ye Y, Room R, Poznyak V, Rehm J, Peden M. Clinical assessment compared with breathalyser readings in the emergency room: concordance of ICD-10 Y90 and Y91 codes. Emerg Med J 2006; 22:689-95. [PMID: 16189028 PMCID: PMC1726581 DOI: 10.1136/emj.2004.016865] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The purpose of this study was to analyse the validity of clinical assessment of alcohol intoxication (ICD-10 Y91) compared with estimated blood alcohol concentration (BAC) using a breath analyser (ICD-10 Y90) among patients in the emergency room (ER). METHODS Representative samples of ER patients reporting within six hours of injury (n = 4798) from 12 countries comprising the WHO Collaborative Study on Alcohol and Injuries were breath analysed and assessed blindly for alcohol intoxication at the time of ER admission. Data were analysed using Kendall's Tau-B to measure concordance of clinical assessment and BAC, and meta analysis to determine heterogeneity of effect size. RESULTS Raw agreement between the two measures was 86% (Tau-B 0.68), but was lower among those reporting drinking in the six hours prior to injury (raw agreement 39%; Tau-B 0.32). No difference was found by gender or for timing of clinical assessment in relation to breath analysis. Patients positive for tolerance or dependence were more likely to be assessed as intoxicated at low levels of BAC. Estimates were homogeneous across countries only for females and for those negative for alcohol dependence. CONCLUSIONS Clinical assessment is moderately concordant with level of BAC, but in those patients who have actually been drinking within the last six hours the concordance was much less, possibly because, in part, of a tendency on the part of clinicians to assign some level of intoxication to anyone who appeared to have been drinking.
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Affiliation(s)
- C Cherpitel
- Alcohol Research Group, Berkeley, CA 94709, USA.
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Selin KH. Alcohol Use Disorder Identification Test (AUDIT): what does it screen? Performance of the AUDIT against four different criteria in a Swedish population sample. Subst Use Misuse 2006; 41:1881-99. [PMID: 17162595 DOI: 10.1080/10826080601025532] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this article was to examine the kinds of alcohol use disorder the AUDIT most accurately screens for since the literature is inconsistent in the use of the AUDIT. Sometimes it is viewed as a measure of hazardous or harmful drinking and sometimes as a measure of dependence. The performance of its subsets (consumption items, AUDIT-C; and problem items, AUDIT-P) and of the full AUDIT (AUDIT-10) was tested against four criteria: high-volume drinking, alcohol-related social problems, alcohol-related health problems, and alcohol dependence. A general population sample of 600 Swedish subjects was interviewed during the winter 2000-01. The results document that, at the recommended cutoff score of 8+, the AUDIT-10 performed well against all four criteria, even if less well against the alcohol-related health problems. The AUDIT-C also performed well against all the problem criteria, showing high areas under the ROC curve, even though significantly lower than the full scale. When measuring high-volume drinking, the AUDIT-C outperformed the full instrument. Scoring at least 1 on the AUDIT-P improved sensitivity of the instrument when screening for social problems and dependence and made it a satisfactory measure of health problems. It is suggested that, when using the full AUDIT to screen for problems more severe than high-volume drinking, the criterion of scoring at least 1 on the AUDIT-P should be applied in combination with a cutoff score on the AUDIT-C.
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Affiliation(s)
- Klara Hradilova Selin
- Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.
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Cherpitel CJ, Ye Y, Moskalewicz J, Swiatkiewicz G. Screening for alcohol problems in two emergency service samples in Poland: comparison of the RAPS4, CAGE and AUDIT. Drug Alcohol Depend 2005; 80:201-7. [PMID: 15896929 DOI: 10.1016/j.drugalcdep.2005.03.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2004] [Revised: 03/29/2005] [Accepted: 03/29/2005] [Indexed: 11/16/2022]
Abstract
Prior research on alcohol-related problems among emergency service patients in Poland found substantial alcohol involvement on the part of injured males, suggesting emergency services may be a productive venue for identifying patients who could benefit from a brief intervention or referral for treatment. Performance of the RAPS4, CAGE and AUDIT against ICD-10 and DSM-IV criteria for alcohol dependence and for alcohol abuse/harmful drinking was compared in probability samples of emergency service patients from two regions of Poland. Sensitivity of the RAPS4 and AUDIT was significantly better than the CAGE for alcohol dependence among males in Warsaw, but specificity was poorer. Among females, although numbers were small, sensitivity for alcohol abuse/harmful drinking and for alcohol dependence or abuse/harmful drinking was significantly better for the RAPS4-QF than for the CAGE or AUDIT at a cut point of 8 across both sites. Performance of the AUDIT at a cut point of 3 was similar to the RAPS4-QF for females. Among males, sensitivity was higher but specificity considerably lower for the RAPS4-QF compared to the CAGE at a cut point of 1 or for the AUDIT at a cut point of 8. Alternate cut points for the AUDIT optimized performance. Findings suggest some regional and gender differences in performance of screening instruments in these Polish samples, but no instrument or cut point is optimal in identifying those with alcohol use disorders. Additional cross-cultural research is needed to evaluate the performance of instruments, especially among females with alcohol use disorders.
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Affiliation(s)
- Cheryl J Cherpitel
- Public Health Institute, Alcohol Research Group, 2000 Hearst Avenue, Berkeley, CA 94709, USA.
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Cherpitel CJ, Borges G. Screening for drug use disorders in the emergency department: performance of the rapid drug problems screen (RDPS). Drug Alcohol Depend 2004; 74:171-5. [PMID: 15099660 DOI: 10.1016/j.drugalcdep.2003.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Revised: 12/02/2003] [Accepted: 12/04/2003] [Indexed: 11/30/2022]
Abstract
Little research is available on brief screening instruments for identify those meeting diagnostic criteria for drug dependence or abuse. A brief, four-item screening instrument, called the rapid drug problems screen (RDPS), was developed from a similar instrument for alcohol use disorders, the rapid alcohol problems screen (RAPS). Performance of the RDPS was evaluated against DSM-IV and ICD-10 criteria for drug dependence and for dependence or abuse in a sample of 703 emergency department patients in Mexico City. Among males, sensitivity and specificity were 91 and 96%, respectively, for dependence and 93 and 96%, respectively, for dependence or abuse. Neither of the two females meeting diagnostic criteria for dependence or abuse were identified by the RDPS. Area under the receiver-operating characteristic curve indicates an optimum cut point of 1. The data suggest that the RDPS may hold promise as a brief screening instrument for substance use among males, but should be tested in larger populations of females meeting diagnostic criteria for drug use disorders, and across ethnic subgroups in other geographic locales.
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Affiliation(s)
- Cheryl J Cherpitel
- Alcohol Research Group, Public Health Institute, 2000 Hearst Avenue, Berkeley, CA 94709, USA.
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Barnett NP, Monti PM, Cherpitel C, Bendtsen P, Borges G, Colby SM, Nordqvist C, Johansson K. Identification and brief treatment of alcohol problems with medical patients: an international perspective. Alcohol Clin Exp Res 2003; 27:262-70. [PMID: 12605075 DOI: 10.1097/01.alc.0000057123.36127.8b] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article summarizes the proceedings of a symposium at the 2002 RSA meeting in San Francisco, California. The chair was Peter Monti and co-chair was Nancy Barnett. The aim of the symposium was to bring together researchers from the United States, Sweden, and Mexico to present current findings on the development and implementation of screening and intervention research in Emergency Departments (ED). Cheryl Cherpitel presented findings on the performance of the Rapid Alcohol Problems Screen (RAPS4), a 4-item instrument used for screening for alcohol dependence and harmful drinking in the ED. Dr. Cherpitel also presented for her collaborator, Guilherme Borges, their research on the performance of a number of screening measures including the RAPS among Mexicans and Mexican-Americans with alcohol-related disorders in the ED. Preben Bendtsen described the implementation of an alcohol screening and intervention procedure delivered by ordinary ED staff in Sweden. Nancy Barnett presented data on characteristics related to readiness to change alcohol use in a sample of young adults who were treated in an ED for injury or intoxication.
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Affiliation(s)
- Nancy P Barnett
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island 02912, USA.
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Zlotnick C, Robertson MJ, Tam T. Substance use and labor force participation among homeless adults. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2002; 28:37-53. [PMID: 11853134 DOI: 10.1081/ada-120001280] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We measured the proportion of homeless adults in the labor force and examined the impact of substance use on labor force participation. METHODS A county-wide probability sample of 397 homeless adults was interviewed three times in a 15-month period. RESULTS Almost 80% of homeless adults were employed or looking for work at one point in time; however, only 47.7% remained in the labor force over the 15-month study period. Recent drug users were only 5% as likely as other homeless adults to be in the labor force; and consistent public entitlement recipients were only 18% as likely as other homeless adults to be in the labor force. CONCLUSIONS Recent illicit drug use posed a deterrent to labor force participation among homeless adults, but heavy alcohol use did not. Most homeless adults were not consistently in the labor force and those who were, did not receive public entitlement benefits. This finding poses an interesting dilemma since previous studies indicated that homeless adults, who are consistent public entitlement recipients, were more likely to get housed than those who are not.
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Affiliation(s)
- Cheryl Zlotnick
- Alcohol Research Group-Public Health Institute, Berkeley, CA 94709, USA.
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