1
|
Cucciare MA, Han X, Yousef S, Timko C. Predictors of concerned others' mental health and quality of life over 12 months following adults' entry into treatment for an alcohol use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209434. [PMID: 38866140 DOI: 10.1016/j.josat.2024.209434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 05/10/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION People in treatment for alcohol use disorders (AUDs) can negatively impact their Concerned Others (COs). This longitudinal study examined patient and CO characteristics associated with CO outcomes. METHOD Participants were 279 dyads of patients entering residential treatment and their CO. Outcomes were COs' mental health and quality of life. The study collected patient and CO predictors and CO outcomes at baseline and 3-, 6-, and 12-month follow-ups as part of a randomized controlled trial. In the first set of models, the analytic approach identified baseline patient predictors associated with COs' outcomes measured at baseline and follow-ups. In the second set of models, we examined whether those effects remained after adding baseline CO characteristics. RESULTS In the first set of models, COs of older age and whose patient reported less CO-patient relationship stress had better mental health. Also, married COs and those with higher income and whose patient reported no violence in the CO-patient relationship had better quality of life. In the second set of models, COs whose patient entered treatment due to criminal justice involvement, with more social support, less reported stigma, and less use of avoidance coping had better mental health. Also, married COs, those with higher income, and less reported discrimination stigma had better quality of life. CONCLUSIONS Understanding patient and CO characteristics that are associated with COs' outcomes may inform AUD treatment programs' efforts to help COs. Identifying modifiable determinants of CO outcomes is important to clinical practice regardless of whether the patient chooses to obtain treatment.
Collapse
Affiliation(s)
- Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205, USA.
| | - Xiaotong Han
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205, USA.
| | - Sara Yousef
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| |
Collapse
|
2
|
Cucciare MA, Benton C, Hildebrand D, Marchant K, Ghaus S, Han X, Williams JS, Thompson RG, Timko C. Adapting an Alcohol Care Linkage Intervention to US Military Veterans Presenting to Primary Care with Hazardous Drinking and PTSD and/or Depression Symptoms: A Qualitative Study. J Clin Psychol Med Settings 2024; 31:417-431. [PMID: 38100057 DOI: 10.1007/s10880-023-09986-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 02/04/2024]
Abstract
There is a critical need to improve linkage to alcohol care for veterans in primary care with hazardous drinking and PTSD and/or depression symptoms (A-MH). We adapted an alcohol care linkage intervention, "Connect to Care" (C2C), for this population. We conducted separate focus groups with veterans with A-MH, providers, and policy leaders. Feedback centered on how psychologists and other providers can optimally inform veterans about their care options and alcohol use, and how to ensure C2C is accessible. Participants reported that veterans with A-MH may not view alcohol use as their primary concern but rather as a symptom of a potential co-occurring mental health condition. Veterans have difficulty identifying and accessing existing alcohol care options within the Veterans Health Administration. C2C was modified to facilitate alcohol care linkage for this population specific to their locality, provide concrete support and education, and offer care options to preserve privacy.
Collapse
Affiliation(s)
- Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA.
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA.
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 West Markham Street (#755), Little Rock, AR, 72205, USA.
| | - Cristy Benton
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Deanna Hildebrand
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Kathy Marchant
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Sharfun Ghaus
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
| | - Xiaotong Han
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 West Markham Street (#755), Little Rock, AR, 72205, USA
| | - James S Williams
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Ronald G Thompson
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 West Markham Street (#755), Little Rock, AR, 72205, USA
| | - Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| |
Collapse
|
3
|
Zahr NM. Alcohol Use Disorder and Dementia: A Review. Alcohol Res 2024; 44:03. [PMID: 38812709 PMCID: PMC11135165 DOI: 10.35946/arcr.v44.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
PURPOSE By 2040, 21.6% of Americans will be over age 65, and the population of those older than age 85 is estimated to reach 14.4 million. Although not causative, older age is a risk factor for dementia: every 5 years beyond age 65, the risk doubles; approximately one-third of those older than age 85 are diagnosed with dementia. As current alcohol consumption among older adults is significantly higher compared to previous generations, a pressing question is whether drinking alcohol increases the risk for Alzheimer's disease or other forms of dementia. SEARCH METHODS Databases explored included PubMed, Web of Science, and ScienceDirect. To accomplish this narrative review on the effects of alcohol consumption on dementia risk, the literature covered included clinical diagnoses, epidemiology, neuropsychology, postmortem pathology, neuroimaging and other biomarkers, and translational studies. Searches conducted between January 12 and August 1, 2023, included the following terms and combinations: "aging," "alcoholism," "alcohol use disorder (AUD)," "brain," "CNS," "dementia," "Wernicke," "Korsakoff," "Alzheimer," "vascular," "frontotemporal," "Lewy body," "clinical," "diagnosis," "epidemiology," "pathology," "autopsy," "postmortem," "histology," "cognitive," "motor," "neuropsychological," "magnetic resonance," "imaging," "PET," "ligand," "degeneration," "atrophy," "translational," "rodent," "rat," "mouse," "model," "amyloid," "neurofibrillary tangles," "α-synuclein," or "presenilin." When relevant, "species" (i.e., "humans" or "other animals") was selected as an additional filter. Review articles were avoided when possible. SEARCH RESULTS The two terms "alcoholism" and "aging" retrieved about 1,350 papers; adding phrases-for example, "postmortem" or "magnetic resonance"-limited the number to fewer than 100 papers. Using the traditional term, "alcoholism" with "dementia" resulted in 876 citations, but using the currently accepted term "alcohol use disorder (AUD)" with "dementia" produced only 87 papers. Similarly, whereas the terms "Alzheimer's" and "alcoholism" yielded 318 results, "Alzheimer's" and "alcohol use disorder (AUD)" returned only 40 citations. As pertinent postmortem pathology papers were published in the 1950s and recent animal models of Alzheimer's disease were created in the early 2000s, articles referenced span the years 1957 to 2024. In total, more than 5,000 articles were considered; about 400 are herein referenced. DISCUSSION AND CONCLUSIONS Chronic alcohol misuse accelerates brain aging and contributes to cognitive impairments, including those in the mnemonic domain. The consensus among studies from multiple disciplines, however, is that alcohol misuse can increase the risk for dementia, but not necessarily Alzheimer's disease. Key issues to consider include the reversibility of brain damage following abstinence from chronic alcohol misuse compared to the degenerative and progressive course of Alzheimer's disease, and the characteristic presence of protein inclusions in the brains of people with Alzheimer's disease, which are absent in the brains of those with AUD.
Collapse
Affiliation(s)
- Natalie M Zahr
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. Center for Health Sciences, SRI International, Menlo Park, California
| |
Collapse
|
4
|
Punia K, Scott W, Manuja K, Sabbineni M, Campbell K, Balodis IM, MacKillop J. SAEM GRACE: Anti-craving medications for alcohol use disorder treatment in the emergency department: A systematic review of direct evidence. Acad Emerg Med 2024; 31:504-514. [PMID: 37735346 DOI: 10.1111/acem.14806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES Alcohol-related concerns commonly present to the emergency department (ED), with a subset of individuals experiencing the symptoms of an alcohol use disorder (AUD). As such, examining the efficacy of pharmacological anti-craving treatment for AUD in the ED is of increasing interest. The objective of this systematic review was to evaluate the direct evidence assessing the efficacy of providing anti-craving medications for AUD treatment in the ED. METHODS A systematic search was conducted according to the patient-intervention-control-outcome question: (P) adults (≥18 years old) presenting to the ED with an AUD (including suspected AUD); (I) anti-craving medications (i.e., naltrexone, acamprosate, gabapentin); (C) no prescription or placebo; (O) reduction of repeat ED visits, engagement in addiction services, reductions in heavy drinking days, reductions in any drinking and amount consumed (or abstinence), and in relapse. Two reviewers independently assessed articles for inclusion and conducted risk of bias assessments for included studies. RESULTS From 143 potentially relevant articles, 6 met inclusion criteria: 3 clinical trials, and 3 case studies. The clinical trials identified evaluated oral versus extended-release naltrexone, monthly extended-release naltrexone injections, and disulfiram. Both oral and extended-release naltrexone resulted in decreased alcohol consumption. Monthly extended-release naltrexone injections resulted in significant improvements in drinking and quality of life. Although out of scope, the disulfiram studies identified did not result in an improvement in drinking in comparison to no medication. CONCLUSIONS Overall, there are few studies directly examining the efficacy of anti-craving medications for AUD in the ED, although the limited evidence that exists is supportive of naltrexone pharmacotherapy, particularly extended-release injection formulation. Additional randomized controlled trials are necessary for substantive direct evidence on anti-craving medication initiation in the ED.
Collapse
Affiliation(s)
- Kiran Punia
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - William Scott
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kriti Manuja
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - Monica Sabbineni
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Iris M Balodis
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| |
Collapse
|
5
|
Anderson ES, Frazee BW. The Intersection of Substance Use Disorders and Infectious Diseases in the Emergency Department. Emerg Med Clin North Am 2024; 42:391-413. [PMID: 38641396 DOI: 10.1016/j.emc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Substance use disorders (SUDs) intersect clinically with many infectious diseases, leading to significant morbidity and mortality if either condition is inadequately treated. In this article, we will describe commonly seen SUDs in the emergency department (ED) as well as their associated infectious diseases, discuss social drivers of patient outcomes, and introduce novel ED-based interventions for co-occurring conditions. Clinicians should come away from this article with prescriptions for both antimicrobial medications and pharmacotherapy for SUDs, as well as an appreciation for social barriers, to care for these patients.
Collapse
Affiliation(s)
- Erik S Anderson
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA; Division of Addiction Medicine, Highland Hospital, Alameda Health System, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Bradley W Frazee
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA
| |
Collapse
|
6
|
De Monnin KS, Terian E, Yeary J, Bathon E, Asaro P, Mintz CM, Baumgartner K. Emergency department initiation of pharmacotherapy for alcohol use disorder: A retrospective cohort study. Acad Emerg Med 2024; 31:525-528. [PMID: 37822078 PMCID: PMC11006820 DOI: 10.1111/acem.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Karlee S De Monnin
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Emily Terian
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Julianne Yeary
- Barnes-Jewish Hospital, Charles F. Knight Emergency and Trauma Center, St. Louis, Missouri, USA
| | - Elizabeth Bathon
- Barnes-Jewish Hospital, Charles F. Knight Emergency and Trauma Center, St. Louis, Missouri, USA
| | - Phillip Asaro
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Carrie M Mintz
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Kevin Baumgartner
- Department of Emergency Medicine, Division of Medical Toxicology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| |
Collapse
|
7
|
Timko C, Lewis M, Lor MC, Aldaco-Revilla L, Blonigen D, Ilgen M. Hazardous Drinking Interventions Delivered During Medical-Surgical Care: Patient and Provider Views. J Clin Psychol Med Settings 2024; 31:224-235. [PMID: 36959430 PMCID: PMC10035972 DOI: 10.1007/s10880-023-09954-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/25/2023]
Abstract
Addressing hazardous drinking during medical-surgical care improves patients' health. This formative evaluation examined patients' consideration of options to change drinking and engage in treatment. It explored whether interventions such as "DO-MoST" overcome treatment barriers. We interviewed 20 medical-surgical patients with hazardous drinking in a trial of DO-MoST, and 16 providers. Analyses used a directed content approach. Patients were receptive to and comfortable discussing drinking during medical-surgical care. Interventions like DO-MoST (patient-centered, motivational approach to shared decision making) addressed some treatment barriers. Patients and providers viewed such interventions as helpful by building a relationship with a psychologist who facilitated self-awareness of drinking behaviors, and discussing connections between alcohol- and physical health-related problems and potential strategies to address drinking. However, both groups expressed concerns about individual and system-level barriers to long-term change. Interventions like DO-MoST bridge the gap between the patient's medical treatment episode and transition to other health care settings. TRIAL REGISTRATION: The study is registered on ClinicalTrials.gov (ID: NCT03258632).
Collapse
Affiliation(s)
- Christine Timko
- Department of Veterans Affairs, Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd. (152-MPD), Menlo Park, CA, 94025, USA.
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA.
| | - Mandy Lewis
- VA Center for Clinical Management Research (CCMR), North Campus Research Complex, 2800 Plymouth Rd., Building 16, Ann Arbor, MI, 48109, USA
- Department of Psychiatry, North Campus Research Complex, University of Michigan, 2800 Plymouth Rd., Building 16, Ann Arbor, MI, 48109, USA
| | - Mai Chee Lor
- Department of Veterans Affairs, Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd. (152-MPD), Menlo Park, CA, 94025, USA
| | - Laura Aldaco-Revilla
- VA Center for Clinical Management Research (CCMR), North Campus Research Complex, 2800 Plymouth Rd., Building 16, Ann Arbor, MI, 48109, USA
- Department of Psychiatry, North Campus Research Complex, University of Michigan, 2800 Plymouth Rd., Building 16, Ann Arbor, MI, 48109, USA
| | - Daniel Blonigen
- Department of Veterans Affairs, Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd. (152-MPD), Menlo Park, CA, 94025, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA
| | - Mark Ilgen
- VA Center for Clinical Management Research (CCMR), North Campus Research Complex, 2800 Plymouth Rd., Building 16, Ann Arbor, MI, 48109, USA
- Department of Psychiatry, North Campus Research Complex, University of Michigan, 2800 Plymouth Rd., Building 16, Ann Arbor, MI, 48109, USA
| |
Collapse
|
8
|
Leung J, Yimer TM, Chiu V, Hall WD, Connor JP, Chan GCK. Participation in Australian drug treatment programs for individuals engaging in high-risk substance use: Data from a nationally representative sample. Drug Alcohol Rev 2024; 43:688-693. [PMID: 38087847 DOI: 10.1111/dar.13792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Substance use, including drugs, alcohol and smoking have a significant health, social and economic impact. We aim to assess the rate and factors associated with treatment access among individuals with high-risk substance use. METHOD This study is a cross-sectional analysis of the 2019 Australian National Drug Strategy Household Survey (N = 22,015). Participants were persons with high-risk substance use based on the Alcohol, Smoking and Substance Involvement Screening Test-Lite (ASSIST-Lite) and current smokers. We measured self-reports of past 12-month engagement in a tobacco, alcohol or other drugs treatment program. RESULTS Overall, 0.4% had high-risk drug use (0.3% cannabis, 0.1% meth/amphetamine or 0.1% opioids), 7.4% had high-risk alcohol use, and 14.0% currently smoked. Among high-risk users, past 12-month treatment access rates were 50.6% [22.3-78.9%] for opioids, 27.1% [8.1-46.1%] for meth/amphetamine, 14.5% [4.3-24.7%] for cannabis, 9.6% [8.1-11.0%] for alcohol and 11.7% [10.6-12.9%] for current smoking. The primary source of treatment support was information and education (12.7% drugs, 4.6% alcohol, 4.0% smoking), followed by counselling (6.7% drugs, 4.5% alcohol, 3.0% smoking). Online or internet support was accessed by 5.9% (drug) and 1.6% (alcohol) people with high-risk use. Psychological distress was associated with treatment access (drugs: odds ratio 3.03 [0.77-11.95], p = 0.111; alcohol: odds ratio 3.16 [2.20-4.56], p ≤ 0.001; smoking: odds ratio 1.95 [1.52-2.49], p ≤ 0.001). DISCUSSION AND CONCLUSIONS The proportion of people engaging in risky substance use who had used treatment programs remains low, especially for alcohol. Public health strategies to scale up treatment access are warranted.
Collapse
Affiliation(s)
- Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Tesfa Mekonen Yimer
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Vivian Chiu
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Gary Chung Kai Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| |
Collapse
|
9
|
Koob GF. Alcohol Use Disorder Treatment: Problems and Solutions. Annu Rev Pharmacol Toxicol 2024; 64:255-275. [PMID: 38261428 DOI: 10.1146/annurev-pharmtox-031323-115847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Alcohol use disorder (AUD) afflicts over 29 million individuals and causes more than 140,000 deaths annually in the United States. A heuristic framework for AUD includes a three-stage cycle-binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation-that provides a starting point for exploring the heterogeneity of AUD with regard to treatment. Effective behavioral health treatments and US Food and Drug Administration-approved medications are available but greatly underutilized, creating a major treatment gap. This review outlines challenges that face the alcohol field in closing this treatment gap and offers solutions, including broadening end points for the approval of medications for the treatment of AUD; increasing the uptake of screening, brief intervention, and referral to treatment; addressing stigma; implementing a heuristic definition of recovery; engaging early treatment; and educating health-care professionals and the public about challenges that are associated with alcohol misuse. Additionally, this review focuses on broadening potential targets for the development of medications for AUD by utilizing the three-stage heuristic model of addiction that outlines domains of dysfunction in AUD and the mediating neurobiology of AUD.
Collapse
Affiliation(s)
- George F Koob
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA;
| |
Collapse
|
10
|
Sengupta S, Anand A, Lopez R, Weleff J, Wang PR, Bellar A, Attaway A, Welch N, Dasarathy S. Emergency services utilization by patients with alcohol-associated hepatitis: An analysis of national trends. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:98-109. [PMID: 38193831 PMCID: PMC10783841 DOI: 10.1111/acer.15223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/10/2023] [Accepted: 11/03/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Hospitalization and mortality in patients with alcohol-associated hepatitis (AH), a severe form of liver disease, continue to increase over time. Given the severity of the illness, most hospitalized patients with AH are admitted from the emergency department (ED). However, there are no data on ED utilization by patients with AH. Thus, the Nationwide Emergency Department Sample (NEDS) dataset was analyzed to determine the ED utilization for AH. METHODS Temporal trends (2016-2019) and outcomes of ED visits for AH were determined. Primary or secondary AH diagnoses were based on coding priority. Numbers of patients evaluated in the ED, severity of disease, complications of liver disease, and discharge disposition were analyzed. Crude and adjusted rates were examined, and temporal trends evaluated using logistic regression with orthogonal polynomial contrasts for each year. RESULTS There were 466,014,370 ED visits during 2016-2019, of which 448,984 (0.096%) were for AH, 85.0% of which required hospitalization. The rate of visits for AH (primary and secondary) between 2016 and 2019 increased from 85 to 106.8/100,000 ED visits. The rate of secondary AH increased more than the rate of primary AH (from 68.6 to 86.5 vs. from 16.4 to 20.3/100,000 ED visits). Patients aged 45-64 years had the highest rate of ED visits for AH, which decreased during the study period, while the rate of ED visits for AH increased in those aged 25-44 years (from 38.5% to 42.9%). The severity of disease (ascites, hepatic encephalopathy, and acute kidney injury) also increased over time. Medicaid and private insurance were the most common payors for patients seeking care in the ED for AH. CONCLUSIONS Temporal trends show an overall increase in ED utilization rates for AH, more patients requiring hospitalization, and an increase in the proportion of younger patients presenting to the ED with AH.
Collapse
Affiliation(s)
- Shreya Sengupta
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Akhil Anand
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, OH, USA
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Rocio Lopez
- Center for Populations Health Research, Cleveland Clinic, Cleveland, OH, USA
| | - Jeremy Weleff
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, OH, USA
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT, 06511, USA
| | - Philip R Wang
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Annette Bellar
- Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, USA
| | - Amy Attaway
- Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Nicole Welch
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
- Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, USA
| | - Srinivasan Dasarathy
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
- Inflammation and Immunity, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
11
|
Levine EA, Sugarman DE, Rockas M, McHugh RK, Jordan C, Greenfield SF. Alcohol Treatment Access and Engagement Among Women in the USA: a Targeted Review of the Literature 2012-2022. CURRENT ADDICTION REPORTS 2023; 10:638-648. [PMID: 38505370 PMCID: PMC10948108 DOI: 10.1007/s40429-023-00515-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 03/21/2024]
Abstract
Purpose of Review The purpose of this review is to examine recent literature (2012-2022) on alcohol treatment access and engagement in women in the U.S. and propose future directions for research and clinical practice. Recent Findings A targeted literature review resulted in 27 studies encompassing screening and brief intervention (SBIRT), treatment utilization, treatment engagement, and barriers to treatment. Recent literature demonstrates overall low rates of screening and brief interventions and treatment utilization in the population with women less likely to be screened and utilize alcohol treatment. The magnitude of these gender differences varies with race/ethnicity. Extensive barriers to care include provider knowledge, structural barriers, and attitudinal barriers and these vary with service setting, gender, and race/ethnicity. Summary There is an increasing prevalence of alcohol use and Alcohol Use Disorder (AUD) in women with low rates of screening, brief treatment, treatment, and engagement which have resulted from extensive barriers to care. Possible areas of further inquiry include the impact of race/ethnicity on gender differences, improving provider and system level policies to promote SBIRT and treatment engagement and utilization, further developing digital interventions, and implementation research to investigate factors associated with optimizing effectiveness of gender-responsive and culturally tailored interventions that address the unique needs of women.
Collapse
Affiliation(s)
| | | | - Mary Rockas
- McLean Hospital
- Department of Psychiatry, Harvard Medical School
| | | | - Chloe Jordan
- McLean Hospital
- Department of Psychiatry, Harvard Medical School
| | | |
Collapse
|
12
|
Donato S, Ray LA. Neurobiology and the Treatment of Alcohol Use Disorder: A Review of the Evidence Base. Subst Abuse Rehabil 2023; 14:157-166. [PMID: 38026786 PMCID: PMC10657770 DOI: 10.2147/sar.s409943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Alcohol use disorder (AUD) is a significant public health concern, accounting for a majority of substance use disorder cases in the United States. Treatment for AUD is complex, with multiple intervention points that may be further complicated by genotype and phenotype, resulting in diverse outcomes. In order to better understand the current landscape of AUD treatment, the present review considers different etiological models of AUD and assesses the evidence base of current treatment options. The first section of this review summarizes various etiological models of AUD and presents different approaches to classifying the disorder. Various theories, including neurobiological models, are discussed. The second section presents a comprehensive analysis of available treatment options for AUD, encompassing behavioral and pharmacological interventions and their current evidence base. Finally, this review discusses the ongoing treatment gap and significant factors contributing to low treatment utilization. Together, this review provides an overview of different etiological processes and mechanisms of AUD, as well as summarizes the literature on key treatment approaches. By integrating historical, theoretical, and empirical data, this review aims to inform both researchers and providers with valuable insights to advance AUD treatment approaches and narrow the treatment gap.
Collapse
Affiliation(s)
- Suzanna Donato
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Brain Research Institute, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| |
Collapse
|
13
|
Colditz JB, Chu KH, Hsiao L, Barrett E, Kraemer KL, Pedersen SL. Characterizing online social support for alcohol use disorder: A mixed-methods approach. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2110-2120. [PMID: 38226760 PMCID: PMC11218862 DOI: 10.1111/acer.15187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Online social media communities are increasingly popular venues for discussing alcohol use disorder (AUD) and recovery. Little is known about distinct contexts of social support that are exchanged in this milieu, which are critical to understanding the social dynamics of online recovery support. METHODS We randomly selected one post per day over the span of a year from the StopDrinking recovery forum. Direct responses to posts were double coded within an established theoretical framework of social support. Within a mixed-methods research framework, we quantified the linguistic characteristics of 1386 responses (i.e., text length, complexity, and sentiment) and qualitatively explored themes within and among different types of social support. RESULTS Emotional support was most prevalent (74% of responses) and appeared as the sole form of support in 38% of responses. Emotionally supportive responses were significantly shorter, less complex, and more positively valenced than other support types. Appraisal support was also common in 55% of responses, while informational support was identified in only 17%. There was substantial overlap among support types, with 40% of responses including two or more types. Salient themes included the common use of community-specific acronyms in emotional support. Appraisal support conveyed feedback about attitudes and behaviors that are perceived as (un-) favorable for AUD recovery. Informational support responses were composed primarily of recommendations for self-help literature, clinical treatment approaches, and peer recovery programs. CONCLUSIONS Social support in this sample was primarily emotional in nature, with other types of support included to provide feedback and guidance (i.e., appraisal support) and supplemental recovery resources (i.e., informational support). The provided social support framework can be helpful in characterizing community dynamics among heterogeneous online AUD recovery support forums. This framework could also be helpful in considering changes in support approaches that correspond to progress in recovery.
Collapse
Affiliation(s)
- Jason B Colditz
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kar-Hai Chu
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lily Hsiao
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Erica Barrett
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kevin L Kraemer
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah L Pedersen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
14
|
Socias ME, Scheuermeyer FX, Cui Z, Mok WY, Crabtree A, Fairbairn N, Nolan S, Slaunwhite A, Ti L. Using a cascade of care framework to identify gaps in access to medications for alcohol use disorder in British Columbia, Canada. Addiction 2023; 118:2128-2138. [PMID: 37488683 DOI: 10.1111/add.16273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 05/22/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND AND AIMS Despite the significant burden of alcohol use disorder (AUD) and availability of safe and effective medications for AUD (MAUD), population-level estimates of access and engagement in AUD-related care are limited. The aims of this study were to generate a cascade of care for AUD in British Columbia (BC), Canada, and to estimate the impacts of MAUD on health outcomes. DESIGN This was a retrospective population-based cohort study using linked administrative health data. SETTING British Columbia, Canada, 2015-2019. PARTICIPANTS Using a 20% random sample of BC residents, we identified 7231 people with moderate-to-severe alcohol use disorder (PWAUD; overall prevalence = 0.7%). MEASUREMENTS We developed a six-stage AUD cascade (from diagnosis to ≥6 months retention in MAUD) among PWAUD. We evaluated trends over time and estimated the impacts of access to MAUD on AUD-related hospitalizations, emergency department visits and death. FINDINGS Between 2015 and 2019, linkage to AUD-related care decreased (from 80.4% to 46.5%). However, rates of MAUD initiation (11.4% to 24.1%) and retention for ≥1 (7.0% to 18.2%), ≥3 (1.2% to 4.3%) or ≥6 months (0.2% to 1.6%) increased significantly. In adjusted analyses, access to MAUD was associated with reduced odds of experiencing any AUD-related adverse outcomes, with longer retention in MAUD showing a trend to greater odds reduction: adjusted odds ratio (95% CI) ranging from 0.59 (0.48-0.71) for MAUD retention <1 month to 0.37 (0.21-0.67) for ≥6 months retention. CONCLUSIONS Access to medications for alcohol use disorder among people with moderate-to-severe alcohol use disorder in British Colombia, Canada increased between 2015 and 2019; however, initiation and retention remained low. There was a trend between longer retention in medications for alcohol use disorder and greater reductions in the odds of experiencing alcohol use disorder-related adverse outcomes.
Collapse
Affiliation(s)
- Maria Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frank Xavier Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zizhan Cui
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wing Yin Mok
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Alexis Crabtree
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda Slaunwhite
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
15
|
Mintz CM, Knox J, Hartz SM, Hasin DS, Martins SS, Kranzler HR, Greene E, Geng EH, Grucza RA, Bierut LJ. Demographic differences in the cascade of care for unhealthy alcohol use: A cross-sectional analysis of data from the 2015-2019 National Survey on Drug Use and Health. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1890-1903. [PMID: 37864538 PMCID: PMC10590988 DOI: 10.1111/acer.15176] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/07/2023] [Accepted: 08/15/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND The screening, brief intervention, and referral to treatment (SBIRT) model is recommended by the U.S. Preventive Services Task Force to improve recognition of and intervention for unhealthy alcohol use. How SBIRT implementation differs by demographic characteristics is poorly understood. METHODS We analyzed data from the 2015-2019 National Survey on Drug Use and Health from respondents ≥18 years old who used an outpatient clinic and had at least one alcoholic drink within the past year. Respondents were grouped into one of three mutually exclusive groups: "no binge drinking or alcohol use disorder (AUD)," "binge drinking without AUD," or "AUD." Outcome variables were likelihood of screening, brief intervention (BI), referral to treatment (RT), and AUD treatment. The demographic predictors on which outcomes were regressed included gender, age, race and ethnicity, sexual orientation, insurance status, and history of military involvement. Consistent with SBIRT guidelines, the entire sample was included in the screening model; screened persons with either binge drinking without AUD or with AUD were included in the BI model; screened persons with AUD were included in the RT model, and persons referred to treatment with AUD were included in the AUD treatment model. RESULTS Analyses included 120,804 respondents. Women were more likely than men to be screened, but less likely to receive BI or RT. When referred to treatment, women were more likely than men to receive it. Persons aged ≥50 were least likely to be screened about alcohol, but most likely to receive BI, while persons aged 18-25 were least likely to receive BI or AUD treatment. Racial and ethnic minorities were less likely than White persons to be screened; Asians were less likely to receive RT, and Black persons were less likely to receive treatment than White persons. Persons identifying as gay, lesbian, or bisexual were equally as likely or more likely to receive SBIRT or AUD treatment as those identifying as heterosexual. Persons without insurance were less likely to be screened than those with insurance. Persons with a history of military involvement were more likely to be screened and receive BI and RT than persons who had not served in the military. CONCLUSIONS Demographic disparities in SBIRT implementation exist. Addressing the sources of these disparities and minimizing attrition from care could improve outcomes for persons with unhealthy alcohol use.
Collapse
Affiliation(s)
- Carrie M. Mintz
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Sarah M. Hartz
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Silvia S. Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, and Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Emily Greene
- Physician Assistant Program, The City College of New York School of Medicine, New York, New York, USA
| | - Elvin H. Geng
- Department of Medicine, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Richard A. Grucza
- Department of Family Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Laura J. Bierut
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| |
Collapse
|
16
|
Iorfino F, Varidel M, Marchant R, Cripps S, Crouse J, Prodan A, Oliveria R, Carpenter JS, Hermens DF, Guastella A, Scott E, Shah J, Merikangas K, Scott J, Hickie IB. The temporal dependencies between social, emotional and physical health factors in young people receiving mental healthcare: a dynamic Bayesian network analysis. Epidemiol Psychiatr Sci 2023; 32:e56. [PMID: 37680185 PMCID: PMC10539737 DOI: 10.1017/s2045796023000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 09/09/2023] Open
Abstract
AIMS The needs of young people attending mental healthcare can be complex and often span multiple domains (e.g., social, emotional and physical health factors). These factors often complicate treatment approaches and contribute to poorer outcomes in youth mental health. We aimed to identify how these factors interact over time by modelling the temporal dependencies between these transdiagnostic social, emotional and physical health factors among young people presenting for youth mental healthcare. METHODS Dynamic Bayesian networks were used to examine the relationship between mental health factors across multiple domains (social and occupational function, self-harm and suicidality, alcohol and substance use, physical health and psychiatric syndromes) in a longitudinal cohort of 2663 young people accessing youth mental health services. Two networks were developed: (1) 'initial network', that shows the conditional dependencies between factors at first presentation, and a (2) 'transition network', how factors are dependent longitudinally. RESULTS The 'initial network' identified that childhood disorders tend to precede adolescent depression which itself was associated with three distinct pathways or illness trajectories; (1) anxiety disorder; (2) bipolar disorder, manic-like experiences, circadian disturbances and psychosis-like experiences; (3) self-harm and suicidality to alcohol and substance use or functioning. The 'transition network' identified that over time social and occupational function had the largest effect on self-harm and suicidality, with direct effects on ideation (relative risk [RR], 1.79; CI, 1.59-1.99) and self-harm (RR, 1.32; CI, 1.22-1.41), and an indirect effect on attempts (RR, 2.10; CI, 1.69-2.50). Suicide ideation had a direct effect on future suicide attempts (RR, 4.37; CI, 3.28-5.43) and self-harm (RR, 2.78; CI, 2.55-3.01). Alcohol and substance use, physical health and psychiatric syndromes (e.g., depression and anxiety, at-risk mental states) were independent domains whereby all direct effects remained within each domain over time. CONCLUSIONS This study identified probable temporal dependencies between domains, which has causal interpretations, and therefore can provide insight into their differential role over the course of illness. This work identified social, emotional and physical health factors that may be important early intervention and prevention targets. Improving social and occupational function may be a critical target due to its impacts longitudinally on self-harm and suicidality. The conditional independence of alcohol and substance use supports the need for specific interventions to target these comorbidities.
Collapse
Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Mathew Varidel
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Roman Marchant
- Human Technology Institute, University of Technology, Sydney, NSW, Australia
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Sally Cripps
- Human Technology Institute, University of Technology, Sydney, NSW, Australia
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Jacob Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ante Prodan
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Rafael Oliveria
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- School of Computer Science, The University of Sydney, Sydney, NSW, Australia
| | | | - Daniel F. Hermens
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Adam Guastella
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Scott
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Kathleen Merikangas
- Genetic Epidemiology Research Branch, Division of Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Ian B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
17
|
Cucciare MA, Marchant K, Benton C, Hildebrand D, Ghaus S, Han X, Thompson RG, Timko C. Connect To Care (C2C): protocol for two-site randomized controlled pilot trial to improve outcomes for patients with hazardous drinking and PTSD and/or depression symptoms. Addict Sci Clin Pract 2023; 18:50. [PMID: 37592359 PMCID: PMC10433540 DOI: 10.1186/s13722-023-00403-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/31/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND In studies of the general population and of military veterans, many primary care patients with hazardous drinking and PTSD and/or depression (abbreviated here as HD +) do not initiate or engage with alcohol-related care. To address this gap in care, we identified and will pilot test a promising evidence-based intervention, Connect To Care (C2C). C2C is a strengths-based approach, delivered by a Care Coach by telephone and/or video, with four components: (1) identifying and leveraging patient strengths to facilitate care initiation, (2) collaborative decision-making around a menu of care options, (3) identifying and resolving barriers to care, and (4) monitoring and facilitating progress toward care initiation by, for example, checking on barriers, identifying solutions, and revisiting care options. METHODS/DESIGN Aim 1 will involve adapting C2C for use in Veterans Affairs' (VA) primary care. We will use an iterative process that includes focus groups and semi-structured interviews with key stakeholders (patients, primary care providers, and VA national policy leaders). In Aim 2, we will conduct a two-site, pilot randomized controlled trial to determine the feasibility of conducting a larger scale trial to test C2C's effectiveness, ascertain the acceptability of C2C among primary care patients with HD + , and explore the efficacy of C2C to improve veteran patients' initiation of and engagement in alcohol care, and their alcohol and mental health (PTSD, depression) outcomes, at 3-month follow-up. We will explore explanatory mechanisms by which C2C is effective. DISCUSSION Study findings are likely to have implications for clinical practice to enhance current approaches to linking patients with HD + to alcohol care by applying a practical intervention such as C2C. The results may improve treatment outcomes for people with HD + by drawing on patients' strengths to problem-solve barriers to care following a process of shared decision-making with a coach. In addition to possibly accelerating the translation of C2C into practice, study findings will also support additional research in terms of a planned effectiveness-implementation hybrid trial, adding to this study's potential for high impact. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05023317.
Collapse
Affiliation(s)
- Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
- Education and Clinical Center, Veterans Affairs South Central Mental Illness Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Kathy Marchant
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Cristy Benton
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Deanna Hildebrand
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
| | - Sharfun Ghaus
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
| | - Xiaotong Han
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
- Education and Clinical Center, Veterans Affairs South Central Mental Illness Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Ronald G Thompson
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Center for Innovation to Implementation, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.
| |
Collapse
|
18
|
Kilian C, Lemp JM, Probst C. Who benefits from alcohol screening and brief intervention? A mini-review on socioeconomic inequalities with a focus on evidence from the United States. Addict Behav 2023; 145:107765. [PMID: 37315509 DOI: 10.1016/j.addbeh.2023.107765] [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: 02/20/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
Alcohol-attributable mortality contributes to growing health inequalities. Addressing hazardous alcohol use and alcohol use disorders through alcohol screening and brief intervention is therefore a promising public health strategy to improve health equity. In this narrative mini-review, we discuss the extent to which socioeconomic differences exist in the alcohol screening and brief intervention cascade, highlighting the example of the United States. We have searched PubMed to identify and summarize relevant literature addressing socioeconomic inequalities in (a) accessing and affording healthcare, (b) receiving alcohol screenings, and/or (c) receiving brief interventions, focusing predominantly on literature from the Unites States. We found evidence for income-related inequalities in access to healthcare in the United States, partly due to inadequate health insurance coverage for individuals with low socioeconomic status. Alcohol screening coverage appears to be generally very low, as is the probability of receiving a brief intervention when indicated. However, research suggests that the latter is more likely to be provided to individuals with low socioeconomic status than those with high socioeconomic status. Individuals with low socioeconomic status also tend to benefit more from brief interventions, showing greater reductions in their alcohol use. Once access to and affordability of healthcare is ensured and high coverage of alcohol screening is achieved for all, alcohol screening and brief interventions have the potential to enhance health equity by reducing alcohol consumption and alcohol-related health harms.
Collapse
Affiliation(s)
- Carolin Kilian
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Julia M Lemp
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
19
|
Sistad RE, Enggasser J, Livingston NA, Brief D. Comparing substance use treatment initiation and retention between telehealth delivered during COVID-19 and in-person treatment pre-COVID-19. Am J Addict 2023; 32:301-308. [PMID: 36645267 DOI: 10.1111/ajad.13385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/19/2022] [Accepted: 12/24/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A large portion of veterans referred to substance use disorder (SUD) treatment do not attend their first appointment or leave treatment prematurely. Telehealth options may increase access to care and treatment attendance. This study compared treatment initiation and retention between in-person treatment pre-COVID-19 and telehealth treatment during COVID-19 in a VA hospital outpatient alcohol and drug treatment clinic. METHODS Electronic health record data were collected on 373 veterans out of 481 referrals. Mixed logistic and negative binomial regression models were used for estimating the effect of treatment modality on treatment initiation and retention, respectively. RESULTS The odds of initiating treatment were 2.6 times greater when referred to a telehealth appointment during COVID-19 compared to an in-person appointment pre-COVID-19. Months retained in treatment postinitiation was similar between treatment modalities. Each month in treatment corresponded to a subsequently lower rate of treatment session attendance and by the fourth month, the average number of sessions attended was significantly lower for those receiving in-person treatment compared to those receiving telehealth treatment. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE The odds of initiating SUD treatment and rate of treatment attendance over time was greater for services delivered via telehealth during COVID-19 compared to in-person pre-COVID-19. Extending telehealth services as an option for individual and group SUD treatment may promote treatment initiation and potentially higher rate of attendance over time. This study provides additional evidence for the feasibility and utility of rapidly expanding telehealth for veterans seeking outpatient substance use treatment.
Collapse
Affiliation(s)
- Rebecca E Sistad
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Massachusetts, Boston, USA
| | - Justin Enggasser
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Massachusetts, Boston, USA.,Pear Therapeutics, Boston, Massachusetts, USA
| | - Nicholas A Livingston
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Massachusetts, Boston, USA.,Behavioral Science Division, National Center for PTSD, Massachusetts, Boston, USA
| | - Deborah Brief
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Massachusetts, Boston, USA
| |
Collapse
|
20
|
Bachrach RL, Quinn DA. The role of gender and veteran status in healthcare access among a national sample of U.S. adults with unhealthy alcohol use. Subst Use Misuse 2023; 58:491-499. [PMID: 36722613 DOI: 10.1080/10826084.2023.2170182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background: Routine healthcare access is critical to reduce drinking and its effects, yet little is known about Veteran and gender differences in routine healthcare access among unhealthy drinkers. The current study examined differences in routine healthcare access, stratified by Veteran status and gender, among a national sample of adults endorsing unhealthy drinking. Method: Using data from the Centers for Disease Control and Prevention's 2019 Behavioral Risk Factor Surveillance System National Survey, we identified adults who endorsed unhealthy drinking over the past month (N = 58,816; 41.4% female; 2.7% female Veterans). Bivariate and multivariable analyses modeled associations between gender, Veteran status, and their interaction in predicting routine healthcare access. All multivariable models adjusted for sociodemographic characteristics. Results: Veterans with unhealthy alcohol use reported high rates of routine healthcare access (e.g., >86% sought care in the past 2 years) and were less likely to experience a cost barrier to care (aOR = 0.75, 95% CI = 0.62-0.92). Females were more likely than males to report better access to care but also to experience a cost barrier (aOR = 1.2, 95% CI = 1.10-1.37). The interaction between Veteran status and gender was non-significant. Conclusions: Overall, healthcare access was better for Veterans and females with unhealthy alcohol use compared to civilians and males with unhealthy alcohol use. However, given that females were more likely to report a cost barrier, future implementation research aiming to improve equity in care may want to explore reasons for cost barriers and develop strategies to help reduce these barriers in order to eliminate gender disparities in primary care-based alcohol-related care.
Collapse
Affiliation(s)
- Rachel L Bachrach
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,Mental Illness Research, Education, and Clinical Center, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Deirdre A Quinn
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,Mental Illness Research, Education, and Clinical Center, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
21
|
Goldman-Mellor S, Kaplan MS, Qin P. Mortality Risk Following Nonfatal Injuries With Alcohol Use Disorder Involvement: A One-Year Follow-Up of Emergency Department Patients Using Linked Administrative Data. J Stud Alcohol Drugs 2022; 83:879-887. [PMID: 36484585 PMCID: PMC9756401 DOI: 10.15288/jsad.21-00444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/21/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Patient presentations to the emergency department (ED) for alcohol-involved injury represent a growing public health burden, but their characteristics and sequelae remain understudied. This study examined mortality rates among ED patients presenting with alcohol-involved injuries and assessed how mortality varied by injury intent and other characteristics. METHOD This retrospective cohort study used statewide, longitudinally linked ED patient record and mortality data from California. Participants comprised all residents presenting to a licensed ED in 2009-2012 with a nonfatal injury that involved comorbid diagnosis of alcohol use disorder (AUD; n = 261,222; 59.3% male). Injury intent was defined using International Classification of Diseases, 9th Revision, Clinical Modification external cause-of-injury codes. Cox regression was used to investigate factors associated with 12-month all-cause mortality rates. Age-, sex-, and race/ethnicity-adjusted standardized mortality ratios (SMRs) were calculated using statewide mortality data. RESULTS Most ED injury visits involving an AUD diagnosis were coded as unintentional (75.9%). Following the index ED visit, all-cause mortality among AUD-involved injury patients was 5,205 per 100,000 person-years, five times higher than the demographically matched population (SMR = 5.3; 95% confidence interval [5.2, 5.4]). Adjusted Cox regression models indicated that patients whose index injury was unintentional, and whose AUD was for acute intoxication, had significantly higher mortality. Most deaths among unintentionally injured patients were from natural causes, whereas external-cause deaths were relatively more common in the other patient groups. CONCLUSIONS AUD-involved injury presentations to the ED in California are common and associated with high patient mortality burden, which varies by injury intent. Interventions are needed to reduce excess mortality in these patients.
Collapse
Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, California
| | - Mark S. Kaplan
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
22
|
Alcohol Screening During US Primary Care Visits, 2014-2016. J Gen Intern Med 2022; 37:3848-3852. [PMID: 35048299 PMCID: PMC9640516 DOI: 10.1007/s11606-021-07369-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Unhealthy alcohol use is a significant health issue for the US population. The US Preventive Services Task Force (USPSTF) recommends screening adults 18 years or older for unhealthy alcohol use during primary care visits. OBJECTIVES To evaluate alcohol screening among ambulatory visits made by US adult primary care patients and identify characteristics predictive of alcohol screening. DESIGN A series of cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) data collected from 2014 to 2016 was used to examine US primary care providers' use of alcohol screening questionnaires and delivery of counseling on alcohol use. PARTICIPANTS A total of 19,213 visits made by patients aged 18 years or older to a US primary care physician trained in family medicine or internal medicine. MAIN MEASURES Administration of a validated alcohol screening questionnaire and counseling/education on alcohol use. Variation in alcohol screening by patient demographic characteristics, reason for office visit, length of office visit, chronic medical conditions, evaluation by assigned primary care physician, new patient to practice, and region. KEY RESULTS Alcohol screening with a validated questionnaire occurred during 2.6% (95% Cl: 0.9%, 4.3%) of visits. Alcohol counseling, provided either by the physician or by referral, was documented in 0.8% (95% Cl: 0.3%, 1.3%) of visits. Screening was significantly more likely if patients were seen by their assigned primary care physician (adjOR 4.38 (95% Cl: 1.41, 13.61)), a new patient to the practice (adjOR 4.18 (95% Cl: 2.30, 7.79)), or had several chronic medical conditions (adjOR 3.40 (95% Cl: 1.48, 7.78)). Patients' sex, race/ethnicity, age group, or length of appointment time was not associated with screening for unhealthy alcohol use. CONCLUSIONS Screening for unhealthy alcohol use using a validated questionnaire is uncommonly performed during US primary care visits. Interventions or incentives may be needed to increase uptake of USPSTF alcohol screening recommendations.
Collapse
|
23
|
Rathburn J. Destigmatizing alcohol use disorder among nurses. Nursing 2022; 52:23-29. [PMID: 35752904 PMCID: PMC9208743 DOI: 10.1097/01.nurse.0000832364.28141.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The use of alcohol to cope with work-related stress is an increasing problem among nurses. However, barriers to diagnosis and treatment keep nurses with alcohol use disorder (AUD) from getting the help they need. This article discusses the issues and treatment obstacles affecting AUD among nurses, and outlines compassionate, stigma-free paths forward.
Collapse
Affiliation(s)
- Jill Rathburn
- Jill Rathburn is a board-certified recovery coach and holistic health nurse
| |
Collapse
|
24
|
Hallgren KA, Matson TE, Oliver M, Caldeiro RM, Kivlahan D, Bradley KA. Practical assessment of DSM-5 alcohol use disorder criteria in routine care: High test-retest reliability of an Alcohol Symptom Checklist. Alcohol Clin Exp Res 2022; 46:458-467. [PMID: 35275415 PMCID: PMC8962965 DOI: 10.1111/acer.14778] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is underdiagnosed and undertreated in medical settings, in part due to a lack of AUD assessment instruments that are reliable and practical for use in routine care. This study evaluates the test-retest reliability of a patient-report Alcohol Symptom Checklist questionnaire when it is used in routine care, including primary care and mental health specialty settings. METHODS We performed a pragmatic test-retest reliability study using electronic health record (EHR) data from Kaiser Permanente Washington, an integrated health system in Washington state. The sample included 454 patients who reported high-risk drinking on a behavioral health screen and completed two Alcohol Symptom Checklists 1 to 21 days apart. Subgroups of these patients who completed both checklists in primary care (n = 271) or mental health settings (n = 79) were also examined. The primary measure was an Alcohol Symptom Checklist on which patients self-reported whether they experienced each of the 11 AUD criteria within the past year, as defined by the Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5). RESULTS Alcohol Symptom Checklists completed in routine care and documented in EHRs had excellent test-retest reliability for measuring AUD criterion counts (ICC = 0.79, 95% CI: 0.76 to 0.82). Test-retest reliability estimates were also high and not significantly different for the subsamples of patients who completed both checklists in primary care (ICC = 0.82, 95% CI: 0.77 to 0.85) or mental health settings (ICC = 0.74, 95% CI: 0.62 to 0.83). Test-retest reliability was not moderated by having a past two-year AUD diagnosis, nor by the age or sex of the patient completing it. CONCLUSIONS Alcohol Symptom Checklists can reliably and pragmatically assess AUD criteria in routine care among patients who screen positive for high-risk drinking. The Alcohol Symptom Checklist may be a valuable tool in supporting AUD-related care and monitoring AUD criteria longitudinally in routine primary care and mental health settings.
Collapse
Affiliation(s)
- Kevin A. Hallgren
- Department of Psychiatry and Behavioral Sciences,
University of Washington, Seattle, WA, United States,Kaiser Permanente Washington Health Research Institute,
Seattle, WA, United States,University of Washington, Department of Health Systems and
Population Health, Seattle, WA, United States
| | - Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute,
Seattle, WA, United States,University of Washington, Department of Health Systems and
Population Health, Seattle, WA, United States
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute,
Seattle, WA, United States
| | - Ryan M. Caldeiro
- Mental Health and Wellness, Kaiser Permanente of
Washington, Renton, WA
| | - Daniel Kivlahan
- Center of Innovation for Veteran-Centered and Value-Driven
Care, Health Services Research and Development, Veteran Affairs Puget Sound
HealthCare System, Seattle, WA, United States
| | - Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute,
Seattle, WA, United States,University of Washington, Department of Health Systems and
Population Health, Seattle, WA, United States,Department of Medicine, University of Washington, Seattle,
WA, United States
| |
Collapse
|
25
|
Stanojlović M, Allen R, Valentine P, Davidson L, O’Connell M. Recovery Coaching In and Out of Emergency Departments: an Overview of the Connecticut Community for Addiction Recovery’s (CCAR) Emergency Department Recovery Coaching Program. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00772-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
26
|
Johnson E, Ghosh SM, Daniels VJ, Wild TC, Tandon P, Hyde A. Clinicians' perspectives and perceived barriers to caring for patients with alcohol use disorder and cirrhosis. Addict Sci Clin Pract 2022; 17:9. [PMID: 35139919 PMCID: PMC8827145 DOI: 10.1186/s13722-022-00292-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Alcohol use disorder (AUD) is one of the leading etiologies for liver cirrhosis and liver transplantation. Few individuals with AUD receive guideline-based care in the form of screening, brief intervention, referral to treatment, or prescription of pharmacotherapy for relapse prevention. We interviewed clinicians across Alberta to assess the current experience and perceived barriers to managing AUD in people who have cirrhosis. The aim of this paper is to summarize these findings to inform the development of an educational intervention. Methods We used a qualitative descriptive approach to explore the experiences of clinicians who care for patients with cirrhosis and AUD in Alberta. We conducted semi-structured interviews directed by an interview guide. Interviews were recorded and transcribed verbatim. We used an inductive thematic analysis approach whereby transcripts were coded, with codes grouped into larger categories, then themes. Results Sixteen clinicians participated in this study. Many participants acknowledged that they do not use a standardized approach to screening, brief intervention, and referral to treatment. Through thematic analysis we identified four themes surrounding barriers to managing AUD in patients with cirrhosis: (i) Practicing within knowledge constraints, (ii) Navigating limited resources and system challenges, (iii) Balancing the complexity of cirrhosis and AUD, and (iv) Acknowledging the influence of provider perceptions on care. Conclusion This article presents the perspectives of clinicians who care for people who have AUD and cirrhosis. Significant barriers exist, including limited knowledge and resources, systemic challenges, and patient complexity. The information gathered will be used to develop an educational intervention that will delve deeper into these issues in order to have the greatest impact on clinicians who routinely interface with this patient population.
Collapse
Affiliation(s)
- Emily Johnson
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sumantra Monty Ghosh
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Vijay John Daniels
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Ashley Hyde
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
27
|
Koob GF. NIAAA 50th Anniversary Festschrift: From the Editor. Alcohol Res 2022; 42:14. [PMID: 36420304 PMCID: PMC9678371 DOI: 10.35946/arcr.v42.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- George F Koob
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| |
Collapse
|
28
|
Lu Y, Chi FW, Parthasarathy S, Palzes VA, Kline-Simon AH, Metz VE, Weisner C, Satre DD, Campbell CI, Elson J, Ross TB, Awsare SV, Sterling SA. Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care. Alcohol Clin Exp Res 2021; 45:2179-2189. [PMID: 34486124 DOI: 10.1111/acer.14702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/06/2021] [Accepted: 08/15/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Unhealthy alcohol use is a serious and costly public health problem. Alcohol screening and brief interventions are effective in reducing unhealthy alcohol consumption. However, rates of receipt and delivery of brief interventions vary significantly across healthcare settings, and relatively little is known about the associated patient and provider factors. METHODS This study examines patient and provider factors associated with the receipt of brief interventions for unhealthy alcohol use in an integrated healthcare system, based on documented brief interventions in the electronic health record. Using multilevel logistic regression models, we retrospectively analyzed 287,551 adult primary care patients (and their 2952 providers) who screened positive for unhealthy drinking between 2014 and 2017. RESULTS We found lower odds of receiving a brief intervention among patients exceeding daily or weekly drinking limits (vs. exceeding both limits), females, older age groups, those with higher medical complexity, and those already diagnosed with alcohol use disorders. Patients with other unhealthy lifestyle activities (e.g., smoking, no/insufficient exercise) were more likely to receive a brief intervention. We also found that female providers and those with longer tenure in the health system were more likely to deliver brief interventions. CONCLUSIONS These findings point to characteristics that can be targeted to improve universal receipt of brief intervention.
Collapse
Affiliation(s)
- Yun Lu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Verena E Metz
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Joseph Elson
- The Permanente Medical Group, San Francisco, California, USA
| | - Thekla B Ross
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sameer V Awsare
- The Permanente Medical Group, TPMG Executive Offices, Oakland, California, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
29
|
Mekonen T, Leung J, Chan GCK, Hides L, Connor JP. Treatment trajectories for alcohol use disorder: Where is the gap? Alcohol Clin Exp Res 2021; 45:1560-1562. [PMID: 34342020 DOI: 10.1111/acer.14660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/16/2021] [Accepted: 06/19/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Tesfa Mekonen
- School of Psychology, The University of Queensland, St Lucia, Qld, Australia.,Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Janni Leung
- School of Psychology, The University of Queensland, St Lucia, Qld, Australia.,National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Qld, Australia
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Qld, Australia
| | - Leanne Hides
- School of Psychology, The University of Queensland, St Lucia, Qld, Australia.,National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Qld, Australia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Qld, Australia.,Discipline of Psychiatry, The University of Queensland, St Lucia, Qld, Australia
| |
Collapse
|