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Biswal B, Bora S, Anand R, Bhatia U, Fernandes A, Joshi M, Nadkarni A. A systematic review of interventions to enhance initiation of and adherence to treatment for alcohol use disorders. Drug Alcohol Depend 2024; 263:112429. [PMID: 39232484 DOI: 10.1016/j.drugalcdep.2024.112429] [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: 07/05/2024] [Revised: 08/24/2024] [Accepted: 08/24/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Alcohol use disorders (AUDs) contribute significantly to the global disease burden in terms of morbidity and mortality. While effective treatment options exist, engagement with care remains a challenge, impacting treatment outcomes and resource allocation, particularly in resource-constrained settings. In this review, we aim to systematically examine and synthesize the evidence on interventions targeting initiation of and adherence to treatment for AUDs. METHODS A search was conducted on six electronic databases (MEDLINE, PsycINFO, Embase, Global Health, CINAHL and CENTRAL) using search terms under the following concepts: alcohol use disorders, initiation/adherence, treatments, and controlled trial study design. Due to the heterogeneity in intervention content and outcomes among the included studies, a narrative synthesis was conducted. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. RESULTS The search yielded 32 distinct studies testing eleven categories of interventions. 23 out of 32 studies reported effectiveness of interventions in improving at least one initiation or adherence outcome, with 11 studies reporting an improvement in at least one outcome related to drinking, and four studies reporting improvements in at least one measure of well-being or disability. Community Reinforcement Approach and Family Training (CRAFT) emerged as a prominent approach for treatment initiation, contingency management for adherence, and motivational interviewing (MI) for both treatment initiation and adherence. CONCLUSION Integrating initiation and adherence interventions into AUD treatment services holds immense potential for optimizing client outcomes and fostering overall well-being. However, generalizability of these strategies remains uncertain owing to the lack of studies conducted in low- and middle-income countries. Addressing this gap is crucial for enhancing global access to effective treatments for AUDs.
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Affiliation(s)
| | - Shruti Bora
- Addictions and related-Research Group, Sangath, Goa, India
| | - Radhika Anand
- Addictions and related-Research Group, Sangath, Goa, India
| | - Urvita Bhatia
- Addictions and related-Research Group, Sangath, Goa, India
| | | | - Manjita Joshi
- Addictions and related-Research Group, Sangath, Goa, India
| | - Abhijit Nadkarni
- Addictions and related-Research Group, Sangath, Goa, India; Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Lim N, Devuni D, German M, Guy J, Rabiee A, Sharma P, Shingina A, Shroff H, Pillai A. The rise of multidisciplinary clinics in hepatology: A practical, how-to-guide, and review of the literature. Hepatology 2024:01515467-990000000-00982. [PMID: 39212328 DOI: 10.1097/hep.0000000000001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/12/2024] [Indexed: 09/04/2024]
Abstract
Multidisciplinary clinics (MDCs) are gaining momentum throughout the medical field, having initially been pioneered in oncology clinics due to their inherent ability to streamline complex care and improve both patient outcomes and the patient care experience. Liver transplant and hepatobiliary tumor clinics are examples of established MDCs in hepatology. With the changing landscape of liver disease in regard to etiology and patient complexity and acuity, there is a clear need for efficient, highly coordinated care. These changes highlight opportunities for hepatology MDCs in alcohol-associated liver disease, metabolic dysfunction-associated steatotic liver disease, and palliative care. This review provides practical advice in navigating the complex logistics of establishing and maintaining a hepatology MDC while also reviewing the emerging evidence on clinical outcomes for patients seen in these MDCs. As hepatology looks to the future, establishment of MDCs in key clinical areas will be the cornerstone of patient care.
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Affiliation(s)
- Nicholas Lim
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Deepika Devuni
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Massachusetts, Worcester, Massachusetts, USA
| | - Margarita German
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jennifer Guy
- Department of Transplantation, California Pacific Medical Center, San Francisco, California, USA
| | - Atoosa Rabiee
- Division of Gastroenterology and Hepatology, Department of Medicine, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Pratima Sharma
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandra Shingina
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hersh Shroff
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
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Hutchison M, Szafranski S, Titus C, Abar B, Conner KR, Maisto S, Stecker T. An assessment of beliefs about mental health care among community-based adults with severe, untreated alcohol use disorder. Alcohol Alcohol 2024; 59:agae037. [PMID: 38832908 PMCID: PMC11149557 DOI: 10.1093/alcalc/agae037] [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: 09/05/2023] [Revised: 04/24/2024] [Accepted: 05/15/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE Alcohol use disorder (AUD) is among the most prevalent substance use disorders in the USA. Despite availability of effective interventions, treatment initiation and engagement remain low. Existing interventions target motivation and practical barriers to accessing treatment among individuals established within treatment systems. In contrast, Cognitive Behavioral Therapy for Treatment-Seeking (CBT-TS) aims to elicit and modify treatment-seeking beliefs to increase treatment-seeking behaviors among treatment-naïve samples. We aim to understand which beliefs were endorsed by those who did/did not initiate treatment, including changes in number of drinking days. METHOD We examined treatment seeking beliefs elicited during CBT-TS among community-based adults with moderate-severe AUD with no treatment history. In this study, we discuss which beliefs were modifiable (i.e. those discussed during the intervention among individuals who subsequently attended treatment and may be associated with treatment-seeking behaviors). RESULTS Of the 194 participants who received the intervention, 16 categories of beliefs were endorsed. Of the 38 participants (19.6%) who attended treatment, the most frequently endorsed belief was 'Not wanting specific types of substance use treatment or supports' (50%), a belief that may inhibit treatment seeking. The idea 'Treatment is positive' (47%) was also frequently cited, a belief that may facilitate treatment seeking. CONCLUSIONS This study describes the beliefs that were more frequently endorsed among adults with moderate-severe, but untreated AUD who reported attending treatment following CBT-TS. Findings point to the potential of discussing and modifying treatment-seeking beliefs among treatment-naïve adults with severe AUD to increase treatment-seeking behaviors.
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Affiliation(s)
- Morica Hutchison
- Department of Public Health Sciences, University of Connecticut School of Medicine, 195 Farmington Avenue, Farmington, CT 06032, United States
- Departmentof Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, United States
| | - Sarah Szafranski
- Department of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Room 431, Charleston, SC 29425, United States
| | - Caitlin Titus
- Canandaigua VA Medical Center, 400 Fort Hill Avenue, Canandaigua, NY 14424, United States
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, United States
| | - Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655C, Rochester, NY 14642, United States
| | - Stephen Maisto
- Department of Psychology, Syracuse University, 900 S Crouse Avenue, Syracuse, NY 13210, United States
| | - Tracy Stecker
- Department of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Room 431, Charleston, SC 29425, United States
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Blalock DV, Berlin SA, Berkowitz T, Smith VA, Wright C, Bachrach RL, Grubber JM. Associations Between a Primary Care-Delivered Alcohol-Related Brief Intervention and Subsequent Opioid-Related Outcomes. Am J Psychiatry 2024; 181:434-444. [PMID: 38706328 PMCID: PMC11076009 DOI: 10.1176/appi.ajp.20230683] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVE The co-occurrence of unhealthy alcohol use and opioid misuse is high and associated with increased rates of overdose, emergency health care utilization, and death. The current study examined whether receipt of an alcohol-related brief intervention is associated with reduced risk of negative downstream opioid-related outcomes. METHODS This retrospective cohort study included all VISN-6 Veterans Affairs (VA) patients with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening results (N=492,748) from 2014 to 2019. Logistic regression was used to examine the association between documentation of an alcohol-related brief intervention and probability of a new 1) opioid prescription, 2) opioid use disorder (OUD) diagnosis, or 3) opioid-related hospitalization in the following year, controlling for demographic and clinical covariates. RESULTS Of the veterans, 13% (N=63,804) had "positive" AUDIT-C screen results. Of those, 72% (N=46,216) had a documented alcohol-related brief intervention. Within 1 year, 8.5% (N=5,430) had a new opioid prescription, 1.1% (N=698) had a new OUD diagnosis, and 0.8% (N=499) had a new opioid-related hospitalization. In adjusted models, veterans with positive AUDIT-C screen results who did not receive an alcohol-related brief intervention had higher odds of new opioid prescriptions (adjusted odds ratio [OR]=1.10, 95% CI=1.03-1.17) and new OUD diagnoses (adjusted OR=1.19, 95% CI=1.02-1.40), while new opioid-related hospitalizations (adjusted OR=1.19, 95% CI=0.99-1.44) were higher although not statistically significant. Removal of medications for OUD (MOUD) did not impact associations. All outcomes were significantly associated with an alcohol-related brief intervention in unadjusted models. CONCLUSIONS The VA's standard alcohol-related brief intervention is associated with subsequent lower odds of a new opioid prescription or a new OUD diagnosis. Results suggest a reduction in a cascade of new opioid-related outcomes from prescriptions through hospitalizations.
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Affiliation(s)
- Dan V. Blalock
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham NC
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham NC
| | - Sophia A. Berlin
- Institute for Medical Research, Durham NC
- Durham Veterans Affairs Health Care System, Durham NC
| | - Theodore Berkowitz
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham NC
| | - Valerie A. Smith
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham NC
- Department of Population Health Sciences, Duke University, Durham NC
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham NC
| | | | - Rachel L. Bachrach
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Janet M. Grubber
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham NC
- Cooperative Studies Program Coordinating Center, Veterans Affairs Boston Health Care System, Boston MA
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Incze MA, Kelley AT, James H, Nolan S, Stofko A, Fordham C, Gordon AJ. Post-hospitalization Care Transition Strategies for Patients with Substance Use Disorders: A Narrative Review and Taxonomy. J Gen Intern Med 2024; 39:837-846. [PMID: 38413539 PMCID: PMC11043281 DOI: 10.1007/s11606-024-08670-5] [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: 11/22/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024]
Abstract
Hospitalizations represent important opportunities to engage individuals with substance use disorders (SUD) in treatment. For those who engage with SUD treatment in the hospital setting, tailored supports during post-discharge transitions to longitudinal care settings may improve care linkages, retention, and treatment outcomes. We updated a recent systematic review search on post-hospitalization SUD care transitions through a structured review of published literature from January 2020 through June 2023. We then added novel sources including a gray literature search and key informant interviews to develop a taxonomy of post-hospitalization care transition models for patients with SUD. Our updated literature search generated 956 abstracts not included in the original systematic review. We selected and reviewed 89 full-text articles, which yielded six new references added to 26 relevant articles from the original review. Our search of five gray literature sources yielded four additional references. Using a thematic analysis approach, we extracted themes from semi-structured interviews with 10 key informants. From these results, we constructed a taxonomy consisting of 10 unique SUD care transition models in three overarching domains (inpatient-focused, transitional, outpatient-focused). These models include (1) training and protocol implementation; (2) screening, brief intervention, and referral to treatment; (3) hospital-based interdisciplinary consult team; (4) continuity-enhanced interdisciplinary consult team; (5) peer navigation; (6) transitional care management; (7) outpatient in-reach; (8) post-discharge outreach; (9) incentivizing follow-up; and (10) bridge clinic. For each model, we describe design, scope, approach, and implementation strategies. Our taxonomy highlights emerging models of post-hospitalization care transitions for patients with SUD. An established taxonomy provides a framework for future research, implementation efforts, and policy in this understudied, but critically important, aspect of SUD care.
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Affiliation(s)
- Michael A Incze
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), , Salt Lake City, UT, USA.
| | - A Taylor Kelley
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), , Salt Lake City, UT, USA
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Vulnerable Veteran Patient-Aligned Care Team, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Hannah James
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Seonaid Nolan
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Stofko
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), , Salt Lake City, UT, USA
| | - Cole Fordham
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), , Salt Lake City, UT, USA
| | - Adam J Gordon
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), , Salt Lake City, UT, USA
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Vulnerable Veteran Patient-Aligned Care Team, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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Garrison YL, Luo Y, Sahker E. Integration of substance use disorder treatment in traditional mental health facilities: Timeseries and cross-sectional evaluations. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104312. [PMID: 38176176 DOI: 10.1016/j.drugpo.2023.104312] [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] [Received: 09/05/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Despite efforts to increase substance use disorder (SUD) treatment provision in the United States (US), the extent to which traditional mental health (MH) facilities offer SUD treatment remains unclear. In the present study, we analyzed the trend in SUD treatment integration among traditional MH facilities in the US from 2014 to 2020 and identified facility-level factors associated with SUD treatment provision. METHODS Data were extracted from the National Mental Health Services Survey (N-MHSS). A timeseries logit trend analysis for the multi-year dataset (2014-2020) was conducted to assess a yearly change in odds of SUD treatment provision. With the 2020 survey data, analyses were conducted to identify the differences between facilities offering SUD treatment and facilities not offering such treatment. Finally, exploratory multivariable logistic regression was conducted to estimate odds of SUD treatment provision by facility variables. RESULTS US MH facility SUD treatment provision went from 51.7 % (2014) to 57.9 % (2020). A mean sample of 12,312 US MH facilities over seven years, demonstrated a significant but small yearly increase in SUD treatment provision (OR = 1.04, 95 % CI = 1.03, 1.04). Important facility characteristics related to SUD treatment provision for facilities without a core SUD focus were MH diagnostics offered (OR = 2.03), dual-diagnosis program offered (OR = 3.65), state drug/alcohol license maintained (OR = 6.66), and VA setting (OR = 7.94). CONCLUSIONS Despite incremental progress in integrating SUD treatment services into US MH facilities, the SUD treatment gap remains large. Training and service development incentives for identified characteristics could help further reduce the treatment gap.
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Affiliation(s)
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Graduate School of Medicine / School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan; Population Health and Policy Research Unit, Medical Education Center, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behavior, Graduate School of Medicine / School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan; Population Health and Policy Research Unit, Medical Education Center, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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Conner KR, Maisto SA, Abar B, Szafranski S, Chiang A, Hutchison M, Aldalur A, Stecker T. Brief, cognitive-behavioral intervention to promote treatment seeking in adults with severe alcohol use disorder: A randomized controlled trial. Addiction 2023; 118:2342-2351. [PMID: 37488997 PMCID: PMC10805959 DOI: 10.1111/add.16300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND AND AIMS There is little RCT evidence that brief interventions improve treatment seeking in individuals with severe alcohol use disorder (AUD) or treatment seeking reduces alcohol use. The aim was to test the efficacy of a brief intervention to increase treatment seeking in treatment naïve adults with severe AUD and measure its effects on alcohol use. DESIGN Parallel group, non-pharmacologic RCT with intervention (n = 197) and active control (n = 203) conditions, with blinded assessors conducting follow-ups at 1, 3 and 6 months. SETTING Online recruitment in a 17-county region of upstate New York, USA. PARTICIPANTS Inclusion criteria consisted of ages ≥18 years, Alcohol Use Disorders Identification Test score ≥16, exceeds recommended limits for alcohol use and no history of AUD treatment. n = 400; 50% female; 79% white; mean age, 40.7; mean education, 14.6 years. INTERVENTION AND COMPARATOR One-session telephone-delivered interventions: Cognitive-Behavioral Therapy for Treatment Seeking (CBT-TS; intervention), review of a National Institute on Alcohol Abuse and Alcoholism pamphlet on AUD treatment (control). MEASUREMENTS Self-report of any AUD treatment use over 3 months (primary outcome) and two standard measures of alcohol use over 6 months (secondary outcomes). FINDINGS Intent-to-treat analyses were used. Assessment follow-up rates were ≥93%. Any alcohol-related treatment use over 3-month follow-up was obtained by 38 (19%) intervention participants and 36 (18%) control participants, a non-significant difference, χ2 [1] = 0.16, P = 0.689. Secondary analysis showed a significant interaction term between sex and intervention assignment (β = -1.197, P = 0.027). The interaction suggested CBT-TS was effective in men (22% vs 13%), although the evidence was somewhat weak (P = 0.071), and it was not effective in women (17% vs 24%). CONCLUSIONS A one-session cognitive-behavioral therapy intervention to increase treatment seeking in treatment naïve adults with severe alcohol use disorder did not increase treatment seeking.
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Affiliation(s)
- Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah Szafranski
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Morica Hutchison
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
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Krawczyk N, Rivera BD, Chang JE, Grivel M, Chen YH, Nagappala S, Englander H, McNeely J. Strategies to support substance use disorder care transitions from acute-care to community-based settings: a scoping review and typology. Addict Sci Clin Pract 2023; 18:67. [PMID: 37919755 PMCID: PMC10621088 DOI: 10.1186/s13722-023-00422-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] [Received: 04/03/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Acute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies. METHODS We searched Pubmed, Embase, CINAHL and PsychINFO for peer-reviewed articles published between 2000 and 2021 that studied interventions linking patients with SUD from ED or inpatient hospital settings to community-based SUD services. Eligible articles measured at least one post-discharge treatment outcome and included a description of the strategy used to promote linkage to community care. Detailed information was extracted on the components of the transition strategies and a thematic coding process was used to categorize strategies into a typology based on shared characteristics. Facilitators and barriers to transitions of care were synthesized using the Consolidated Framework for Implementation Research. RESULTS Forty-five articles met inclusion criteria. 62% included ED interventions and 44% inpatient interventions. The majority focused on patients with opioid (71%) or alcohol (31%) use disorder. The transition strategies reported across studies were heterogeneous and often not well described. An initial typology of ten transition strategies, including five pre- and five post-discharge transition strategies is proposed. The most common strategy was scheduling an appointment with a community-based treatment provider prior to discharge. A range of facilitators and barriers were described, which can inform efforts to improve hospital-to-community transitions of care. CONCLUSIONS Strategies to support transitions from acute-care to community-based SUD services, although critical for ensuring continuity of care, vary greatly across interventions and are inconsistently measured and described. More research is needed to classify SUD care transition strategies, understand their components, and explore which lead to the best patient outcomes.
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Affiliation(s)
- Noa Krawczyk
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10065, USA.
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, Room 5-53, New York, USA.
| | - Bianca D Rivera
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10065, USA
| | - Ji E Chang
- Department of Public Health Policy and Management, NYU School of Global Public Health, New York, NY, 10003, USA
| | - Margaux Grivel
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York, NY, 10003, USA
| | - Yu-Heng Chen
- Department of Criminal Justice, Temple University, Philadelphia, PA, 19102, USA
| | | | - Honora Englander
- Department of Medicine, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Jennifer McNeely
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10065, USA
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Bromberg DJ, Galvez de Leon SJ, Litz T, Azbel L, Liberman AR, Polonsky M, Dvoriak S, Saichuk N, Taxman F, Altice FL. Aligning public health and public safety: Probation as a touchpoint to identify and link patients with opioid use disorder to opioid agonist treatment. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002349. [PMID: 37910486 PMCID: PMC10619786 DOI: 10.1371/journal.pgph.0002349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/10/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND People in criminal justice settings (CJS) have high rates of opioid use disorder (OUD) and HIV. Probation is part of the CJS and congregates many individuals with high rates of mental health and substance use disorders relative to the general population; nevertheless, probation remains a major improvement to incarceration. As a steppingstone to full decarceration efforts, community supervision settings like probation can be leveraged as "touchpoints" to identify and link people with OUD (and other co-morbid conditions) to treatment and reduce criminal activity. METHODOLOGY To determine the feasibility of a modified screening, brief intervention and referral to treatment (SBIRT) strategy to link probationers to opioid agonist therapies (OAT) in the newly created probation system in Ukraine, we conducted a single-arm SBIRT intervention in eight probation centers in four Ukrainian administrative regions. For those screening positive for OUD, interest in OAT was assessed before and after a brief intervention. Those interested in OAT were referred to community OAT services. Participants with OUD also underwent HIV testing. PRINCIPAL FINDINGS Of the 1,298 consecutive individuals screened, 208 (16.0%) met criteria for opioid dependence. Of these, 122 (58.7%) enrolled in brief intervention, of which 54 (44.3%) had HIV and 14 (25.9%) of these were newly diagnosed. After the brief intervention, interest in starting OAT increased significantly from a median of 7.0 to 8.0 (P = <0.001) using a 10-point scale. Thirty (N = 30; 24.6%) of the enrolled participants initiated OAT and 21 of these (70%) were retained in treatment for 6 months. SIGNIFICANCE The prevalence of OUD (and HIV) is high among people in probation in Ukraine. SBIRT can identify a large number of people eligible for OAT, many of whom were willing to initiate and remain on OAT. Integrating SBIRT into probation can potentially assist with OAT scale-up and help address HIV prevention efforts.
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Affiliation(s)
- Daniel J. Bromberg
- Yale University School of Public Health, New Haven, Connecticut, United States of America
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, United States of America
| | - Samy J. Galvez de Leon
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, United States of America
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Taylor Litz
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Lyu Azbel
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Amanda R. Liberman
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Maxim Polonsky
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | | | - Faye Taxman
- George Mason University Schar School of Policy and Government, Arlington, Virginia, United States of America
| | - Frederick L. Altice
- Yale University School of Public Health, New Haven, Connecticut, United States of America
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut, United States of America
- Yale University School of Medicine, New Haven, Connecticut, United States of America
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Schweer-Collins ML, Parr NJ, Saitz R, Tanner-Smith EE. Investigating for Whom Brief Substance Use Interventions Are Most Effective: An Individual Participant Data Meta-analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1459-1482. [PMID: 37133684 PMCID: PMC10678844 DOI: 10.1007/s11121-023-01525-1] [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: 03/07/2023] [Indexed: 05/04/2023]
Abstract
Prior research suggests that brief interventions (BIs) for alcohol and other drug use may vary in effectiveness across patient sociodemographic factors. The objective of this individual participant data (IPD) meta-analysis was to explore for whom BIs delivered in general healthcare settings are more or less effective. We examined variability in BI effects by patient age, sex, employment, education, relationship status, and baseline severity of substance use using a two-stage IPD meta-analysis approach. All trials included in a parent aggregate data meta-analysis (k = 116) were invited to contribute IPD, and 29 trials provided patient-level data (12,074 participants). Among females, BIs led to significant reductions in binge alcohol consumption ([Formula: see text] = 0.09, 95% CI [0.03, 0.14]), frequency of alcohol consumption ([Formula: see text] = 0.10, 95% CI [0.03, 0.17]), and alcohol-related consequences ([Formula: see text] = 0.16, 95% CI [0.08, 0.25]), as well as greater substance use treatment utilization ([Formula: see text] = 0.25, 95% CI [0.21, 0.30]). BIs yielded larger reductions in frequency of alcohol consumption at 3-month follow-up for individuals with less than a high school level education ([Formula: see text] = 0.16, 95% CI [0.09, 0.22]). Given evidence demonstrating modest BI effects on alcohol use and mixed or null findings for BI effects on other drug use, BI research should continue to investigate potential drivers of effect magnitude and variation. PROTOCOL REGISTRATION DETAILS: The protocol for this review was pre-registered in PROSPERO #CRD42018086832 and the analysis plan was pre-registered in OSF: osf.io/m48g6.
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Affiliation(s)
- Maria L Schweer-Collins
- Prevention Science Institute, University of Oregon, University of Oregon, 97403-6217, Eugene, OR, USA.
- HEDCO Institute for Evidence-Based Educational Practice, University of Oregon, University of Oregon, 1215, 97403-1215, Eugene, OR, USA.
| | - Nicholas J Parr
- U.S. Department of Veterans Affairs Evidence Synthesis Program Coordinating Center, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd, 97239, Portland, OR, USA
| | - Richard Saitz
- Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Ave, 4th Floor, 02118, Boston, MA, USA
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, USA
| | - Emily E Tanner-Smith
- Prevention Science Institute, University of Oregon, University of Oregon, 97403-6217, Eugene, OR, USA
- HEDCO Institute for Evidence-Based Educational Practice, University of Oregon, University of Oregon, 1215, 97403-1215, Eugene, OR, USA
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11
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Scott CK, Dennis ML, Grella CE, Watson DP, Davis JP, Hart MK. A randomized controlled trial of recovery management checkups for primary care patients: Twelve-month results. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1964-1977. [PMID: 37864532 PMCID: PMC10605959 DOI: 10.1111/acer.15172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/05/2023] [Accepted: 08/06/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Primary care settings like federally qualified health centers (FQHC) are optimal locations to identify individuals with substance use disorders (SUD) and link them to SUD treatment, yet successful linkage has proven difficult. Recovery management checkups for primary care (RMC-PC) is a promising method for increasing linkage to care, engagement in treatment, and reducing substance use. METHODS Participants (n = 266) who received screening, brief intervention, and referral to treatment (SBIRT) at four FQHC sites and needed SUD treatment were randomized to receive SBIRT only or SBIRT+RMC-PC. All participants received SBIRT prior to randomization as part of usual care while those in the experimental group also received quarterly checkups. All participants completed research interviews at enrollment and 3, 6, 9, and 12 months post-enrollment. The primary outcome was whether participants received any days of SUD treatment. Key secondary outcomes were days of SUD treatment (total and by SUD level of care), days of alcohol or drug abstinence, and a reduction in days of specific substance use, all based on self-report. RESULTS Relative to participants receiving SBIRT only, participants assigned to SBIRT+RMC-PC were significantly more likely to have received any SUD treatment over 12 months (adjusted odds ratio [AOR] = 3.85) and more days of SUD treatment over 12 months (Cohen's effect size d = +0.41). The SBIRT+RMC-PC group also reported significantly more days of abstinence over 12 months (d = +0.30), fewer days of alcohol use (d = -0.20) and cannabis use (d = -0.20), and lower combined substance use frequency (d = -0.25). Days of treatment were found to positively mediate the direct effect of SBIRT+RMC-PC on days of abstinence. CONCLUSION This study provides further evidence of the effectiveness of the "referral to treatment" component of SBIRT when combined with RMC for patients in primary care settings, including those with drug use problems. Moreover, results demonstrate the value of repeated checkups on longer-term treatment and substance use outcomes.
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Affiliation(s)
| | | | | | | | - Jordan P Davis
- Suzanne Dworak-Peck, School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - M Kate Hart
- Chestnut Health Systems, Normal, Illinois, USA
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12
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Mellinger JL, Medley S, Kidwell KM, Asefah H, Winder GS, Fernandez AC, Lok ASF, Blow F. Improving alcohol treatment engagement using integrated behavioral interventions in alcohol-associated liver disease: A randomized pilot trial. Hepatol Commun 2023; 7:e0181. [PMID: 37708435 PMCID: PMC10503679 DOI: 10.1097/hc9.0000000000000181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/24/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Alcohol cessation improves mortality in alcohol-associated liver disease (ALD), but few ALD patients will engage in treatment. We aimed to demonstrate the feasibility and acceptability of a mobile health intervention to increase alcohol use disorder (AUD) treatment among ALD patients. METHODS We conducted a pilot randomized controlled trial (September 2020 to June 2022) at a single tertiary care center in adults with any stage of ALD, past 6-month drinking, and no past-month AUD treatment. Sixty participants were randomized 1:1 to a mobile health application designed to increase AUD treatment engagement through preference elicitation and matching to treatment and misconception correction. Controls received enhanced usual care. The primary outcomes were feasibility (recruitment and retention rates) and acceptability. Exploratory outcomes were AUD treatment engagement and alcohol use, measured by Timeline Followback. Outcomes were measured at 3 and 6 months. RESULTS Baseline characteristics were balanced. The recruitment rate was 46%. Retention was 65% at 6 months. The intervention was highly acceptable to participants (91% were mostly/very satisfied; 95% felt that the intervention matched them well to AUD treatment). Secondary outcomes showed increased AUD treatment at 6 months in the intervention group (intent-to-treat: 27.3% vs. 13.3%, OR 2.3, 95% CI, 0.61-8.76). There was a trend toward a 1-level or greater reduction in World Health Organization (WHO) drinking risk levels in the intervention group (OR 2.25, 95% CI, 0.51-9.97). CONCLUSIONS A mobile health intervention for AUD treatment engagement was highly feasible, acceptable, and produced promising early outcomes, with improved AUD treatment engagement and alcohol reduction in ALD patients.
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Affiliation(s)
- Jessica L. Mellinger
- Michigan Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, United States
- Michigan Medicine, Department of Psychiatry, Ann Arbor, Michigan, United States
| | - Sarah Medley
- Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Michigan, United States
| | - Kelley M. Kidwell
- Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Michigan, United States
| | - Haila Asefah
- Michigan Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, United States
| | - G. Scott Winder
- Michigan Medicine, Department of Psychiatry, Ann Arbor, Michigan, United States
- Department of Surgery Michigan Medicine, Ann Arbor, Michigan, United States
- Department of Neurology Michigan Medicine, Ann Arbor, Michigan, United States
| | - Anne C. Fernandez
- Michigan Medicine, Department of Psychiatry, Ann Arbor, Michigan, United States
| | - Anna S. F. Lok
- Michigan Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, United States
| | - Fred Blow
- Michigan Medicine, Department of Psychiatry, Ann Arbor, Michigan, United States
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Goldschmidt L, Mncina B, Langa M, Rebello S, Budaza T, Tshabalala J, Kinfu Y, Achoki T. AUDIT-C as a possible source of referral during the COVID-19 pandemic for participants presenting patterns of high-risk alcohol consumption in a South African township. BMC Public Health 2023; 23:1890. [PMID: 37775803 PMCID: PMC10542669 DOI: 10.1186/s12889-023-16775-5] [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: 11/15/2022] [Accepted: 09/16/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Unhealthy alcohol use is a leading contributor to premature death and disability worldwide. The World Health Organization's Global Status Report on Alcohol and Health ranked South Africa as having one of the riskiest patterns of alcohol consumption, which calls for intervention. Recognising the need for effective primary care interventions, particularly in the absence of appropriate alcohol-related harm reduction policies at national and local levels, this paper highlights the opportunities and challenges associated with a two-pronged, community-centred approach to the identification of unhealthy alcohol use and interventions. METHODS This approach included the use of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) as a means of screening to identify individuals at moderate (score of 5-7) to high risk (score of 8 +) alcohol use, raising awareness, and investigating the potential utility of brief advice and referrals as a means of reducing risk. RESULTS Of the 54,187 participants, 43.0% reported engaging in moderate-risk alcohol consumption, with 22.1% reporting high-risk alcohol consumption. Resistance to brief advice was observed to increase with higher AUDIT-C scores. Similarly, participants engaging in high-risk alcohol consumption were resistant to accepting treatment referrals, with fewer than 10% open to receiving a referral. CONCLUSIONS While men were most likely to report patterns of high-risk alcohol consumption, they were more resistant to accepting referrals. Additionally, participants who were willing to receive brief advice were often resistant to taking active steps to alter their alcohol use. This study highlights the need to consider how to prevent harmful patterns of alcohol use effectively and holistically, especially in low socioeconomic settings through primary health care and community services.
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Affiliation(s)
- Lynne Goldschmidt
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa.
| | - Buyisile Mncina
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
| | - Malose Langa
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
- Centre for the Study of Violence and Reconciliation, Johannesburg, South Africa
| | | | | | | | - Yohannes Kinfu
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
- United Nations University, International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia
| | - Tom Achoki
- ABInBev Foundation, New York, NY, USA
- Africa Institute for Health Policy, Nairobi, Kenya
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Stecker T, Allan NP, Hoge C, Ashrafioun L, Conner KR. Efficacy of CBT for Treatment Seeking (CBT-TS) in Untreated Veterans and Service Members at Risk for Suicidal Behavior. J Gen Intern Med 2023; 38:2639-2646. [PMID: 36964422 PMCID: PMC10506992 DOI: 10.1007/s11606-023-08129-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 03/01/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE Military members and Veterans at-risk for suicide are often unlikely to seek behavioral health treatment. The primary aim of this study was to test the efficacy of brief CBT for Treatment Seeking (CBT-TS) to improve behavioral health treatment utilization among U.S. military service members and Veterans at-risk for suicide. METHODS A total of 841 participants who served in the U.S. military since 9/11 and who reported suicidality but were not in behavioral health treatment were recruited to participate in this trial. Participants were randomly assigned to either brief CBT-TS delivered by phone or an assessment-only control condition. Follow-up assessments were conducted at baseline and months 1, 3, 6, and 12 to track treatment utilization and symptoms. RESULTS CBT-TS resulted in significantly greater behavioral health treatment initiation within 1 month compared to the control condition (B = .93, p < .001); and the higher treatment initiation persisted for 12 months post intervention. CONCLUSIONS This study employed a low-cost, easily implementable one-session intervention administered by phone. The study provides evidence that CBT-TS is efficacious in promoting behavioral health treatment initiation in an adult population at risk for suicidal behavior and showed enduring benefits for 6-12 months. CBT-TS provides a unique strategy for treatment engagement for at-risk adults unlikely to seek treatment. TRIAL REGISTRATION Clinicaltrials.gov NCT05077514.
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Affiliation(s)
- Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA.
| | - Nicholas P Allan
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - Charles Hoge
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Lisham Ashrafioun
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA
- Departments of Emergency Medicine and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kenneth R Conner
- Departments of Emergency Medicine and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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15
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Mellinger JL, Fernandez AC, Winder GS. Management of alcohol use disorder in patients with chronic liver disease. Hepatol Commun 2023; 7:e00145. [PMID: 37314739 DOI: 10.1097/hc9.0000000000000145] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/15/2023] [Indexed: 06/15/2023] Open
Abstract
Alcohol use disorder (AUD) rates have risen dramatically in the United States, resulting in increasing rates of alcohol-associated liver disease (ALD), but many patients struggle to access alcohol use treatment. AUD treatment improves outcomes, including mortality, and represents the most urgent means by which care can be improved for those with liver disease (including ALD and others) and AUD. AUD care for those with liver disease involves 3 steps: detecting alcohol use, diagnosing AUD, and directing patients to alcohol treatment. Detecting alcohol use can involve questioning during the clinical interview, the use of standardized alcohol use surveys, and alcohol biomarkers. Identifying and diagnosing AUD are interview-based processes that should ideally be performed by a trained addiction professional, but nonaddiction clinicians can use surveys to determine the severity of hazardous drinking. Referral to formal AUD treatment should be made, especially where more severe AUD is suspected or identified. Therapeutic modalities are numerous and include different forms of one-on-one psychotherapy, such as motivational enhancement therapy or cognitive behavior therapy, group therapy, community mutual aid societies (such as Alcoholics Anonymous), inpatient addiction treatment, and relapse prevention medications. Finally, integrated care approaches that build strong relationships between addiction professionals and hepatologists or medical providers caring for those with liver disease are crucial to improving care for this population.
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Affiliation(s)
- Jessica L Mellinger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Anne C Fernandez
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| | - G Scott Winder
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Neurology, Michigan Medicine, Ann Arbor, Michigan, USA
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16
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Rao D, Mercy M, McAtee C, Ford JH, Shiyanbola OO. A scoping literature review of pharmacy-based opioid misuse screening and brief interventions. Res Social Adm Pharm 2023:S1551-7411(23)00253-X. [PMID: 37210240 PMCID: PMC10186861 DOI: 10.1016/j.sapharm.2023.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/04/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Although prescription opioid dispensing rates have continued to decrease, overdose deaths involving prescription opioids have increased during the COVID-19 pandemic. Screening and brief interventions (SBI) are an effective prevention strategy to identify and address opioid misuse and safety risks. Emerging literature on pharmacy-based SBI needs to be systematically appraised to develop robust interventions. OBJECTIVE Our objective was to conduct a scoping review of the literature regarding pharmacy-based opioid misuse SBI to identify relevant literature that explore the topic, evaluate the patient-centeredness of included studies, and explore the use of dissemination and implementation science in the literature. METHODS The review was conducted according to Preferred Reporting of Systematic Reviews and Meta-analyses -Scoping reviews (PRISMA-Sc) guidelines. We searched PubMed, CINHAL, PsychInfo, and Scopus for studies regarding pharmacy-based SBI, published in the last 20 years. We also conducted a separate grey literature search. Two of three total reviewers screened each abstract individually and identified eligible full-texts for inclusion. We critically appraised quality of included studies and qualitatively synthesized the relevant information. RESULTS The search resulted in 21 studies (categorized as intervention, descriptive, and observational research) and 3 grey literature reports. Of the recently published 21 studies, 11 were observational research, with six interventions in the pilot stages. Screening tools varied but naloxone was the brief intervention in 15 of the 24 results. Only eight studies had high validity, reliability, and applicability and only five were patient-centered. Implementation science principles were addressed in eight studies (mainly interventions). Overall, the findings suggest high potential for evidence-based SBI to be successful. CONCLUSIONS Overall, the review suggested a strong lack of a patient-centered and implementation science-focused approach to designing pharmacy-based opioid misuse SBI. Findings suggest that a patient-centered, implementation focused approach is needed for effective and sustained pharmacy-based opioid misuse SBI.
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Affiliation(s)
- Deepika Rao
- School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI, 53703, USA.
| | - Meg Mercy
- University of Wisconsin-Madison, Madison, WI, USA.
| | | | - James H Ford
- School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI, 53703, USA.
| | - Olayinka O Shiyanbola
- School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI, 53703, USA.
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Mogk JM, Matson TE, Caldeiro RM, Garza Mcwethy AM, Beatty T, Sevey BC, Hsu CW, Glass JE. Implementation and workflow strategies for integrating digital therapeutics for alcohol use disorders into primary care: a qualitative study. Addict Sci Clin Pract 2023; 18:27. [PMID: 37158931 PMCID: PMC10169300 DOI: 10.1186/s13722-023-00387-w] [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] [Received: 12/20/2022] [Accepted: 05/01/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Alcohol use disorders (AUD) are prevalent and often go untreated. Patients are commonly screened for AUD in primary care, but existing treatment programs are failing to meet demand. Digital therapeutics include novel mobile app-based treatment approaches which may be cost-effective treatment options to help fill treatment gaps. The goal of this study was to identify implementation needs and workflow design considerations for integrating digital therapeutics for AUD into primary care. METHODS We conducted qualitative interviews with clinicians, care delivery leaders, and implementation staff (n = 16) in an integrated healthcare delivery system in the United States. All participants had experience implementing digital therapeutics for depression or substance use disorders in primary care. Interviews were designed to gain insights into adaptations needed to optimize existing clinical processes, workflows, and implementation strategies for use with alcohol-focused digital therapeutics. Interviews were recorded and transcribed and then analyzed using a rapid analysis process and affinity diagramming. RESULTS Qualitative themes were well represented across health system staff roles. Participants were enthusiastic about digital therapeutics for AUD, anticipated high patient demand for such a resource, and made suggestions for successful implementation. Key insights regarding the implementation of digital therapeutics for AUD and unhealthy alcohol use from our data include: (1) implementation strategy selection must be driven by digital therapeutic design and target population characteristics, (2) implementation strategies should seek to minimize burden on clinicians given the large numbers of patients with AUD who are likely to be interested in and eligible for digital therapeutics, and (3) digital therapeutics should be offered alongside many other treatment options to accommodate individual patients' AUD severity and treatment goals. Participants also expressed confidence that previous implementation strategies used with other digital therapeutics such as clinician training, electronic health record supports, health coaching, and practice facilitation would be effective for the implementation of digital therapeutics for AUD. CONCLUSIONS The implementation of digital therapeutics for AUD would benefit from careful consideration of the target population. Optimal integration requires tailoring workflows to meet anticipated patient volume and designing workflow and implementation strategies to meet the unique needs of patients with varying AUD severity.
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Affiliation(s)
- Jessica M Mogk
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA.
| | - Theresa E Matson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA
| | - Ryan M Caldeiro
- Kaiser Permanente Washington Mental Health & Wellness Services, Renton, WA, USA
| | | | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA
| | - Brandie C Sevey
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA
| | - Clarissa W Hsu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA
| | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA, 98101, USA
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18
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Lee AK, Bobb JF, Richards JE, Achtmeyer CE, Ludman E, Oliver M, Caldeiro RM, Parrish R, Lozano PM, Lapham GT, Williams EC, Glass JE, Bradley KA. Integrating Alcohol-Related Prevention and Treatment Into Primary Care: A Cluster Randomized Implementation Trial. JAMA Intern Med 2023; 183:319-328. [PMID: 36848119 PMCID: PMC9972247 DOI: 10.1001/jamainternmed.2022.7083] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/24/2022] [Indexed: 03/01/2023]
Abstract
Importance Unhealthy alcohol use is common and affects morbidity and mortality but is often neglected in medical settings, despite guidelines for both prevention and treatment. Objective To test an implementation intervention to increase (1) population-based alcohol-related prevention with brief interventions and (2) treatment of alcohol use disorder (AUD) in primary care implemented with a broader program of behavioral health integration. Design, Setting, and Participants The Sustained Patient-Centered Alcohol-Related Care (SPARC) trial was a stepped-wedge cluster randomized implementation trial, including 22 primary care practices in an integrated health system in Washington state. Participants consisted of all adult patients (aged ≥18 years) with primary care visits from January 2015 to July 2018. Data were analyzed from August 2018 to March 2021. Interventions The implementation intervention included 3 strategies: practice facilitation; electronic health record decision support; and performance feedback. Practices were randomly assigned launch dates, which placed them in 1 of 7 waves and defined the start of the practice's intervention period. Main Outcomes and Measures Coprimary outcomes for prevention and AUD treatment were (1) the proportion of patients who had unhealthy alcohol use and brief intervention documented in the electronic health record (brief intervention) for prevention and (2) the proportion of patients who had newly diagnosed AUD and engaged in AUD treatment (AUD treatment engagement). Analyses compared monthly rates of primary and intermediate outcomes (eg, screening, diagnosis, treatment initiation) among all patients who visited primary care during usual care and intervention periods using mixed-effects regression. Results A total of 333 596 patients visited primary care (mean [SD] age, 48 [18] years; 193 583 [58%] female; 234 764 [70%] White individuals). The proportion with brief intervention was higher during SPARC intervention than usual care periods (57 vs 11 per 10 000 patients per month; P < .001). The proportion with AUD treatment engagement did not differ during intervention and usual care (1.4 vs 1.8 per 10 000 patients; P = .30). The intervention increased intermediate outcomes: screening (83.2% vs 20.8%; P < .001), new AUD diagnosis (33.8 vs 28.8 per 10 000; P = .003), and treatment initiation (7.8 vs 6.2 per 10 000; P = .04). Conclusions and Relevance In this stepped-wedge cluster randomized implementation trial, the SPARC intervention resulted in modest increases in prevention (brief intervention) but not AUD treatment engagement in primary care, despite important increases in screening, new diagnoses, and treatment initiation. Trial Registration ClinicalTrials.gov Identifier: NCT02675777.
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Affiliation(s)
- Amy K. Lee
- Kaiser Permanente Washington Health Research Institute, Seattle
- Mental Health and Wellness Department, Kaiser Permanente Washington, Seattle
| | | | - Julie E. Richards
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle
| | - Carol E. Achtmeyer
- Veterans Affairs Puget Sound Health Care System, Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | - Evette Ludman
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Ryan M. Caldeiro
- Mental Health and Wellness Department, Kaiser Permanente Washington, Seattle
| | - Rebecca Parrish
- Mental Health and Wellness Department, Kaiser Permanente Washington, Seattle
| | - Paula M. Lozano
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Gwen T. Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle
| | - Emily C. Williams
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle
- Veterans Affairs Puget Sound Health Care System, Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | - Joseph E. Glass
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle
- Department of Medicine, School of Medicine, University of Washington, Seattle
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19
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Reilly J, Meurk C, Heffernan E, Sara G. Substance use disorder screening and brief intervention in routine clinical practice in specialist adult mental health services: A systematic review. Aust N Z J Psychiatry 2023; 57:793-810. [PMID: 36632829 DOI: 10.1177/00048674221148394] [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: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Substance use disorders co-occurring with other mental health disorders are common and harmful. Clinical guidelines often recommend substance use screening and brief intervention though evidence about screening practice in mental health services is limited. This systematic review of routine clinical practice in adult mental health services aims to identify (a) proportions of screening and brief intervention, (b) how they are practised and (c) their outcomes. METHODS We searched MEDLINE, PsycINFO and Embase and relevant Cochrane databases for articles until 31 July 2021 reporting on adults in English, regardless of geographical location. Backward snowball methods were used to locate additional articles. Screening, brief intervention and mental health services were defined. Data were extracted and variables compared related to setting, period, patient cohort, substances routine substance use disorder care pathways, and study quality was assessed. RESULTS We identified 17 articles reporting routine screening within adult mental health services. Studies in community settings mainly reported on screening for alcohol and other substance use disorders, while studies from inpatient settings reported mainly on tobacco. There was marked variation in methods and screening proportions. Only two studies reported on brief intervention. CONCLUSION This systematic review shows marked variation in mental health services routine screening practices with early focus on alcohol but more recently tobacco screening. We suggest approaches to enhancing implementation of screening and brief intervention in routine care, particularly using electronic health records.
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Affiliation(s)
- John Reilly
- Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Carla Meurk
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Brisbane, QLD, Australia
| | - Ed Heffernan
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Brisbane, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Grant Sara
- NSW Ministry of Health, St Leonards, NSW, Australia
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Abstract
INTRODUCTION The opioid epidemic has evolved into a combined stimulant epidemic, with escalating stimulant and fentanyl-related overdose deaths. Primary care providers are on the frontlines grappling with patients' methamphetamine use. Although effective models exist for treating opioid use disorder in primary care, little is known about current clinical practices for methamphetamine use. METHODS Six semistructured group interviews were conducted with 38 primary care providers. Interviews focused on provider perceptions of patients with methamphetamine use problems and their care. Data were analyzed using inductive and thematic analysis and summarized along the following dimensions: (1) problem identification, (2) clinical management, (3) barriers and facilitators to care, and (4) perceived needs to improve services. RESULTS Primary care providers varied in their approach to identifying and treating patient methamphetamine use. Unlike opioid use disorders, providers reported lacking standardized screening measures and evidence-based treatments, particularly medications, to address methamphetamine use. They seek more standardized screening tools, Food and Drug Administration-approved medications, reliable connections to addiction medicine specialists, and more training. Interest in novel behavioral health interventions suitable for primary care settings was also noteworthy. CONCLUSIONS The findings from this qualitative analysis revealed that primary care providers are using a wide range of tools to screen and treat methamphetamine use, but with little perceived effectiveness. Primary care faces multiple challenges in effectively addressing methamphetamine use among patients singularly or comorbid with opioid use disorders, including the lack of Food and Drug Administration-approved medications, limited patient retention, referral opportunities, funding, and training for methamphetamine use. Focusing on patients' medical issues using a harm reduction, motivational interviewing approach, and linkage with addiction medicine specialists may be the most reasonable options to support primary care in compassionately and effectively managing patients who use methamphetamines.
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Abstract
Alcohol is one of the most widely consumed psychoactive drugs globally. Hazardous drinking, defined by quantity and frequency of consumption, is associated with acute and chronic morbidity. Alcohol use disorders (AUDs) are psychiatric syndromes characterized by impaired control over drinking and other symptoms. Contemporary aetiological perspectives on AUDs apply a biopsychosocial framework that emphasizes the interplay of genetics, neurobiology, psychology, and an individual's social and societal context. There is strong evidence that AUDs are genetically influenced, but with a complex polygenic architecture. Likewise, there is robust evidence for environmental influences, such as adverse childhood exposures and maladaptive developmental trajectories. Well-established biological and psychological determinants of AUDs include neuroadaptive changes following persistent use, differences in brain structure and function, and motivational determinants including overvaluation of alcohol reinforcement, acute effects of environmental triggers and stress, elevations in multiple facets of impulsivity, and lack of alternative reinforcers. Social factors include bidirectional roles of social networks and sociocultural influences, such as public health control strategies and social determinants of health. An array of evidence-based approaches for reducing alcohol harms are available, including screening, pharmacotherapies, psychological interventions and policy strategies, but are substantially underused. Priorities for the field include translating advances in basic biobehavioural research into novel clinical applications and, in turn, promoting widespread implementation of evidence-based clinical approaches in practice and health-care systems.
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22
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Metz VE, Leibowitz A, Satre DD, Parthasarathy S, Jackson-Morris M, Cocohoba J, Sterling SA. Effectiveness of a pharmacist-delivered primary care telemedicine intervention to increase access to pharmacotherapy and specialty treatment for alcohol use problems: Protocol for the alcohol telemedicine consult cluster-randomized pragmatic trial. Contemp Clin Trials 2022; 123:107004. [PMID: 36379437 PMCID: PMC9729439 DOI: 10.1016/j.cct.2022.107004] [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: 07/18/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Alcohol use problems are associated with serious medical, mental health and socio-economic consequences. Yet even when patients are identified in healthcare settings, most do not receive treatment, and use of pharmacotherapy is rare. This study will test the effectiveness of the Alcohol Telemedicine Consult (ATC) Service, a novel, personalized telehealth intervention approach for primary care patients with alcohol use problems. METHODS This cluster-randomized pragmatic trial, supplemented by qualitative interviews, will include adults with a primary care visit between 9/10/21-3/10/23 from 16 primary care clinics at two large urban medical centers within Kaiser Permanente Northern California, a large, integrated healthcare system. Clinics are randomized to the ATC Service (intervention), including alcohol pharmacotherapy and SBIRT (screening, MI (Motivational Interviewing)-based brief intervention and referral to addiction treatment) delivered by clinical pharmacists, or the Usual Care (UC) arm that provides systematic alcohol SBIRT. Primary outcomes include a comparison of the ATC and UC arms on 1) implementation outcomes (alcohol pharmacotherapy prescription rates, specialty addiction treatment referrals); and 2) patient outcomes (medication fills, addiction treatment initiation, alcohol use, healthcare services utilization) over 1.5 years. A general modeling approach will consider clustering of patients/providers, and a random effects model will account for intra-class correlations across patients within providers and across clinics. Qualitative interviews with providers will examine barriers and facilitators to implementation. DISCUSSION The ATC study examines the effectiveness of a pharmacist-provided telehealth intervention that combines pharmacotherapy and MI-based consultation. If effective, the ATC study could affect treatment models across the spectrum of alcohol use problems. CLINICAL TRIALS REGISTRATION This study has been registered on ClinicalTrials.gov (NCT05252221).
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Affiliation(s)
- Verena E Metz
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA.
| | - Amy Leibowitz
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA
| | - Derek D Satre
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th Street, San Francisco 94107, CA, USA
| | - Sujaya Parthasarathy
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA
| | - Melanie Jackson-Morris
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA
| | - Jennifer Cocohoba
- School of Pharmacy, University of California, San Francisco, 521 Parnassus Avenue, San Francisco 94117, CA, USA
| | - Stacy A Sterling
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th Street, San Francisco 94107, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 South Los Robles Avenue, Pasadena 91101, CA, USA.
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Liberman AR, Bromberg DJ, Litz T, Kurmanalieva A, Galvez S, Rozanova J, Azbel L, Meyer JP, Altice FL. Interest without uptake: A mixed-methods analysis of methadone utilization in Kyrgyz prisons. PLoS One 2022; 17:e0276723. [PMID: 36282864 PMCID: PMC9595522 DOI: 10.1371/journal.pone.0276723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
HIV incidence continues to increase in Eastern Europe and Central Asia (EECA), in large part due to non-sterile injection drug use, especially within prisons. Therefore, medication-assisted therapy with opioid agonists is an evidence-based HIV-prevention strategy. The Kyrgyz Republic offers methadone within its prison system, but uptake remains low. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a framework for identifying people who would potentially benefit from methadone, intervening to identify OUD as a problem and methadone as a potential solution, and providing referral to methadone treatment. Using an SBIRT framework, we screened for OUD in Kyrgyz prisons among people who were within six months of returning to the community (n = 1118). We enrolled 125 people with OUD in this study, 102 of whom were not already engaged in methadone treatment. We conducted a pre-release survey followed by a brief intervention (BI) to address barriers to methadone engagement. Follow-up surveys immediately after the intervention and at 1 month, 3 months, and 6 months after prison release assessed methadone attitudes and uptake. In-depth qualitative interviews with 12 participants explored factors influencing methadone utilization during and after incarceration. Nearly all participants indicated favorable attitudes toward methadone both before and after intervention in surveys; however, interest in initiating methadone treatment remained very low both before and after the BI. Qualitative findings identified five factors that negatively influence methadone uptake, despite expressed positive attitudes toward methadone: (1) interpersonal relationships, (2) interactions with the criminal justice system, (3) logistical concerns, (4) criminal subculture, and (5) health-related concerns.
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Affiliation(s)
- Amanda R. Liberman
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Daniel J. Bromberg
- Yale University School of Public Health, New Haven, CT, United States of America
- Yale Center for Interdisciplinary Research on AIDS, New Haven, CT, United States of America
| | - Taylor Litz
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Ainura Kurmanalieva
- AIDS Foundation East-West (AFEW) in the Kyrgyz Republic, Bishkek, Kyrgyz Republic
| | - Samy Galvez
- Yale University School of Medicine, New Haven, CT, United States of America
- Yale Center for Interdisciplinary Research on AIDS, New Haven, CT, United States of America
| | - Julia Rozanova
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Lyu Azbel
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Jaimie P. Meyer
- Yale University School of Medicine, New Haven, CT, United States of America
- Yale Center for Interdisciplinary Research on AIDS, New Haven, CT, United States of America
| | - Frederick L. Altice
- Yale University School of Medicine, New Haven, CT, United States of America
- Yale Center for Interdisciplinary Research on AIDS, New Haven, CT, United States of America
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Gaume J, Bertholet N, McCambridge J, Magill M, Adam A, Hugli O, Daeppen JB. Effect of a Novel Brief Motivational Intervention for Alcohol-Intoxicated Young Adults in the Emergency Department: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2237563. [PMID: 36269355 PMCID: PMC9587483 DOI: 10.1001/jamanetworkopen.2022.37563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Heavy drinking among young adults is a major public health concern. Brief motivational interventions in the emergency department have shown promising but inconsistent results. OBJECTIVE To test whether young adults receiving a newly developed brief motivational intervention reduce their number of heavy drinking days and alcohol-related problems over 1 year compared with participants receiving brief advice. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted at an emergency department of a tertiary care university hospital in Lausanne, Switzerland. Recruitment ran from December 2016 to August 2019. Follow-up was conducted after 1, 3, 6, and 12 months. All adults aged 18 to 35 years presenting for any cause and presenting with alcohol intoxication were eligible (N = 2108); 1764 were excluded or refused participation. Follow-up rate was 79% at 12 months and 89% of participants provided follow-up data at least once and were included in the primary analyses. Statistical analysis was performed from September 2020 to January 2021. INTERVENTIONS The novel intervention was based on motivational interviewing and comprised in-person discussion in the emergency department and up to 3 booster telephone calls. The control group received brief advice. MAIN OUTCOMES AND MEASURES Primary outcomes were the number of heavy drinking days (at least 60 g of ethanol) over the previous month and the total score on the Short Inventory of Problems (0-45, higher scores indicating more problems) over the previous 3 months. Hypotheses tested were formulated before data collection. RESULTS There were 344 young adults included (median [IQR] age: 23 [20-28] years; 84 women [24.4%]). Among the 306 participants providing at least 1 follow-up point, a statistically significant time × group interaction was observed (β = -0.03; 95% CI, -0.05 to 0.00; P = .02), and simple slopes indicated an increase of heavy drinking days over time in the control (β = 0.04; 95% CI, 0.02 to 0.05; P < .001) but not in the intervention group (β = 0.01; 95% CI, -0.01 to 0.03; P = .24). There was no effect on the Short Inventory of Problems score (β = -0.01; 95% CI, -0.03 to 0.02; P = .71). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that a brief motivational intervention implemented in the emergency department provided beneficial effects on heavy drinking, which accounts for a substantial portion of mortality and disease burden among young adults. TRIAL REGISTRATION ISRCTN registry: 13832949.
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Affiliation(s)
- Jacques Gaume
- Department of Psychiatry—Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Bertholet
- Department of Psychiatry—Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jim McCambridge
- Department of Health Sciences, University of York, York, United Kingdom
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Angéline Adam
- Department of Psychiatry—Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Department of Psychiatry—Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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25
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Ryan ED, Chang YM, Oliver M, Bradley KA, Hallgren KA. An Alcohol Symptom Checklist identifies high rates of alcohol use disorder in primary care patients who screen positive for depression and high-risk drinking. BMC Health Serv Res 2022; 22:1123. [PMID: 36064354 PMCID: PMC9446862 DOI: 10.1186/s12913-022-08408-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022] Open
Abstract
Background Although alcohol use disorder can complicate depression management, there is no standard process for assessing AUD symptoms (i.e., AUD diagnostic criteria) in primary care for patients who screen positive for depression. This study characterizes the association between depressive symptoms and high-risk drinking reported by primary care patients on screening measures in routine care. Then, using data from a novel clinical program, this study characterizes the association between depressive symptoms and AUD symptoms reported by primary care patients with high-risk drinking via an Alcohol Symptom Checklist. Methods In this cross-sectional study, electronic health record data were obtained from patients who visited 33 Kaiser Permanente Washington primary care clinics between 03/2018 and 02/2020 and completed depression (PHQ-2) and alcohol consumption (AUDIT-C) screening measures as part of routine care (N = 369,943). Patients who reported high-risk drinking (AUDIT-C scores 7–12) also completed an Alcohol Symptom Checklist where they reported the presence or absence of 11 AUD criteria as defined by the DSM-5 (N = 8,184). Generalized linear models estimated and compared the prevalence of high-risk drinking (AUDIT-C scores 7–12) and probable AUD (2–11 AUD symptoms on Alcohol Symptom Checklists) for patients with and without positive depression screens. Results Patients who screened positive for depression had a 131% higher prevalence of high-risk drinking than those who screened negative (5.2% vs. 2.2%; p < 0.001). Among patients with high-risk drinking, positive depression screens were associated with a significantly higher prevalence of probable AUD (69.8% vs. 48.0%; p < 0.001), with large differences in the prevalence of probable AUD observed with increasing PHQ-2 scores (e.g., probable AUD prevalence of 37.6%, 55.3% and 65.2%, for PHQ-2 scores of 0, 1, and 2, respectively). Although the overall prevalence of high-risk drinking was higher for male patients, similar patterns of association between depression screens, high-risk drinking, and AUD symptoms were observed for male and female patients. Conclusions Patients with positive depression screens are more likely to have high-risk drinking. Large percentages of patients with positive depression screens and high-risk drinking report symptoms consistent with AUD to healthcare providers when given the opportunity to do so using an Alcohol Symptom Checklist. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08408-1.
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Affiliation(s)
- Emma D Ryan
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| | - Yanni M Chang
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.,Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.,Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
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Nadkarni A, Bhatia U, Bedendo A, de Paula TCS, de Andrade Tostes JG, Segura-Garcia L, Tiburcio M, Andréasson S. Brief interventions for alcohol use disorders in low- and middle-income countries: barriers and potential solutions. Int J Ment Health Syst 2022; 16:36. [PMID: 35934695 PMCID: PMC9358825 DOI: 10.1186/s13033-022-00548-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/29/2022] [Indexed: 12/05/2022] Open
Abstract
Global alcohol consumption and harmful use of alcohol is projected to increase in the coming decades, and most of the increase will occur in low- and middle-income countries (LMICs); which calls for cost-effective measures to reduce alcohol exposure in these countries. One such evidence based measure is screening and brief intervention (BI) for alcohol problems. Some of the characteristics of BI make them a particularly appealing choice of interventions in low-resource settings. However, despite evidence of effectiveness, implementation of BI in LMICs is rare. In this paper we discuss barriers to implementation of BI in LMICs, with examples from Latin America and India. Key barriers to implementation of BI in LMICs are the lack of financial and structural resources. Specialized services for alcohol use disorders are limited or non-existent. Hence primary care is often the only possible alternative to implement BI. However, health professionals in such settings generally lack training to deal with these disorders. In our review of BI research in these countries, we find some promising results, primarily in countries from Latin America, but so far there is limited research on effectiveness. Appropriate evaluation of efficacy and effectiveness of BI is undermined by lack of generalisability and methodological limitations. No systematic and scientific efforts to explore the implementation and evaluation of BI in primary and community platforms of care have been published in India. Innovative strategies need to be deployed to overcome supply side barriers related to specialist manpower shortages in LMICs. There is a growing evidence on the effectiveness of non-specialist health workers, including lay counsellors, in delivering frontline psychological interventions for a range of disorders including alcohol use disorders in LMICs. This paper is intended to stimulate discussion among researchers, practitioners and policy-makers in LMICs because increasing access to evidence based care for alcohol use disorders in LMICs would need a concerted effort from all these stakeholders.
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Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health (CGMH), Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK. .,Addictions Research Group, Sangath, Porvorim, Goa, India.
| | - Urvita Bhatia
- Addictions Research Group, Sangath, Porvorim, Goa, India.,Department of Psychology, Health and Professional Development at Oxford Brookes University, Oxford, UK
| | - Andre Bedendo
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil.,Department of Health Sciences, Faculty of Sciences, University of York, York, UK
| | | | - Joanna Gonçalves de Andrade Tostes
- Center for Research, Intervention and Evaluation on Alcohol & Drugs (CREPEIA), Department of Psychology, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Lidia Segura-Garcia
- Program on Substance Abuse, Public Health Agency of Catalonia, Barcelona, Spain.,Clincal Psychology and Health Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Marcela Tiburcio
- Department of Social Sciences in Health, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Sven Andréasson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Maisto SA, Aldalur A, Abar B, Stecker T, Chiang A, Conner K. Heterogeneity in Alcohol-Related Severity and Interests in Going to Treatment in Community Adults with Alcohol Use Disorder (AUD). Subst Use Misuse 2022; 57:1626-1632. [PMID: 35869665 PMCID: PMC10518904 DOI: 10.1080/10826084.2022.2102192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
RATIONALE Alcohol use disorder (AUD) is highly prevalent among adults in the US and is associated with substantial personal and societal costs. Yet only a small percentage of adults with AUD initiate treatment, including those with severe AUD symptoms who are most in need of treatment. In this paper we use latent profile analysis (LPA) to describe differences in symptoms of AUD severity and alcohol-related consequences among untreated adults with severe AUD symptoms who were recruited from the community. Identification of such differences will result in better understanding of this population and will improve methods of treatment outreach. METHOD The LPAs were conducted on the baseline data of 403 (50% male, 77% White, M age = 40.74 with severe AUD recruited from the community and enrolled in a trial of an intervention designed to encourage treatment initiation. Participants reported no prior AUD treatment history. The LPAs were based on indicators of AUD severity, alcohol-related negative consequences, and self-reported intention to initiate AUD treatment. RESULTS The LPAs revealed 4 profiles. Profile membership was predicted by baseline participant sex and whether they were living with a partner and was associated with baseline past 30-days alcohol consumption. CONCLUSIONS The findings characterize and describe the variability among adults in the community with untreated severe AUD on variables that tend to motivate such individuals to seek treatment, which could significantly advance treatment outreach efforts.
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Affiliation(s)
- Stephen A. Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- Department of Psychiatry, University of South Carolina, Columbia, South Carolina, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Kenneth Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Singh AN, Sanchez V, Kenzie ES, Sullivan E, McCormack JL, Hiebert Larson J, Robbins A, Weekley T, Hatch BA, Dickinson C, Elder NC, Muench JP, Davis MM. Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: Protocol of the ANTECEDENT study. PLoS One 2022; 17:e0269635. [PMID: 35763485 PMCID: PMC9239445 DOI: 10.1371/journal.pone.0269635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Unhealthy alcohol use (UAU) is a leading cause of morbidity and mortality in the United States, contributing to 95,000 deaths annually. When offered in primary care, screening, brief intervention, referral to treatment (SBIRT), and medication-assisted treatment for alcohol use disorder (MAUD) can effectively address UAU. However, these interventions are not yet routine in primary care clinics. Therefore, our study evaluates tailored implementation support to increase SBIRT and MAUD in primary care. Methods ANTECEDENT is a pragmatic implementation study designed to support 150 primary care clinics in Oregon adopting and optimizing SBIRT and MAUD workflows to address UAU. The study is a partnership between the Oregon Health Authority Transformation Center—state leaders in Medicaid health system transformation—SBIRT Oregon and the Oregon Rural Practice-based Research Network. We recruited clinics providing primary care in Oregon and prioritized reaching clinics that were small to medium in size (<10 providers). All participating clinics receive foundational support (i.e., a baseline assessment, exit assessment, and access to the online SBIRT Oregon materials) and may opt to receive tailored implementation support delivered by a practice facilitator over 12 months. Tailored implementation support is designed to address identified needs and may include health information technology support, peer-to-peer learning, workflow mapping, or expert consultation via academic detailing. The study aims are to 1) engage, recruit, and conduct needs assessments with 150 primary care clinics and their regional Medicaid health plans called Coordinated Care Organizations within the state of Oregon, 2) implement and evaluate the impact of foundational and supplemental implementation support on clinic change in SBIRT and MAUD, and 3) describe how practice facilitators tailor implementation support based on context and personal expertise. Our convergent parallel mixed-methods analysis uses RE-AIM (reach, effectiveness, adoption, implementation, maintenance). It is informed by a hybrid of the i-PARIHS (integrated Promoting Action on Research Implementation in Health Services) and the Dynamic Sustainability Framework. Discussion This study will explore how primary care clinics implement SBIRT and MAUD in routine practice and how practice facilitators vary implementation support across diverse clinic settings. Findings will inform how to effectively align implementation support to context, advance our understanding of practice facilitator skill development over time, and ultimately improve detection and treatment of UAU across diverse primary care clinics.
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Affiliation(s)
- Amrita N. Singh
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Victoria Sanchez
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Erin S. Kenzie
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Eliana Sullivan
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - James L. McCormack
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Jean Hiebert Larson
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Alissa Robbins
- Oregon Health Authority Transformation Center, Portland, Oregon, United States of America
| | - Tiffany Weekley
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Brigit A. Hatch
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Caitlin Dickinson
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Nancy C. Elder
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - John P. Muench
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Melinda M. Davis
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
- Community Health, OHSU-PSU School of Public Health, Portland, Oregon, United States of America
- * E-mail:
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Sahker E, Luo Y, Sakata M, Toyomoto R, Hwang C, Yoshida K, Watanabe N, Furukawa TA. Efficacy of Brief Intervention for Unhealthy Drug Use in Outpatient Medical Care: a Systematic Review and Meta-analysis. J Gen Intern Med 2022; 37:2041-2049. [PMID: 35419744 PMCID: PMC9198157 DOI: 10.1007/s11606-022-07543-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The efficacy of brief intervention (BI) for unhealthy drug use in outpatient medical care has not been sufficiently substantiated through meta-analysis despite its ongoing global delivery. This study aims to determine the efficacy of BI for unhealthy drug use and the expected length of effects, and describe subgroup analyses by outpatient setting. METHODS Trials comparing BI with usual care controls were retrieved through four databases up to January 13, 2021. Two reviewers independently screened, selected, and extracted data. Primary outcomes included drug use frequency (days used) and severity on validated scales at 4-8 months and were analyzed using random-effects model meta-analysis. RESULTS In total, 20 studies with 9182 randomized patients were included. There was insufficient evidence to support the efficacy of BI for unhealthy drug use among all outpatient medical care settings for use frequency (SMD = -0.07, 95% CI = -0.17, 0.02, p = 0.12, I2 = 37%, high certainty of evidence) and severity (SMD = -0.27, 95% CI = -0.78, 0.24, p = 0.30, I2 = 98%, low certainty of evidence). However, post hoc subgroup analyses uncovered significant effects for use frequency by setting (interaction p = 0.02), with significant small effects only in emergency departments (SMD = -0.15, 95% CI = -0.25, -0.04, p < 0.01). Primary care, student health, women's health, and HIV primary care subgroups were nonsignificant. Primary care BI revealed nonsignificant greater average use in the treatment group compared to usual care. DISCUSSION BI for unhealthy drug use lacks evidence of efficacy among all outpatient medical settings. However, small effects found in emergency departments may indicate incremental benefits for some patients. Clinical decisions for SBI or specialty treatment program referrals should be carefully considered accounting for these small effects in emergency departments. REGISTRATION PROSPERO (CRD42020157733).
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Affiliation(s)
- Ethan Sahker
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan. .,Population Health and Policy Research Unit, Medical Education Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Chiyoung Hwang
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
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Chi FW, Parthasarathy S, Palzes VA, Kline-Simon AH, Metz VE, Weisner C, Satre DD, Campbell CI, Elson J, Ross TB, Lu Y, Sterling SA. Alcohol brief intervention, specialty treatment and drinking outcomes at 12 months: Results from a systematic alcohol screening and brief intervention initiative in adult primary care. Drug Alcohol Depend 2022; 235:109458. [PMID: 35453082 PMCID: PMC10122418 DOI: 10.1016/j.drugalcdep.2022.109458] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Alcohol screening, brief intervention and referral to treatment (SBIRT) in adult primary care is an evidence-based, public health strategy to address unhealthy alcohol use, but evidence of effectiveness of alcohol brief intervention (ABI) in real-world implementation is lacking. METHODS We fit marginal structural models with inverse probability weighting to estimate the causal effects of ABI on 12-month drinking outcomes using longitudinal electronic health records data for 312,056 adults with a positive screening result for unhealthy drinking between 2014 and 2017 in a large healthcare system that implemented systematic primary care-based SBIRT. We examined effects of ABI with and without adjusting for receipt of specialty alcohol use disorder (AUD) treatment, and whether effects varied by patient demographic characteristics and alcohol use patterns. RESULTS Receiving ABI resulted in significantly greater reductions in heavy drinking days (mean difference [95% CI] = -0.26 [-0.45, -0.08]), drinking days per week (-0.04 [-0.07, -0.01]), drinks per drinking day (-0.05 [-0.08, -0.02]) and drinks per week (-0.16 [-0.27, -0.04]). Effects of ABI on 12-month drinking outcomes varied by baseline consumption level, age group and whether patients already had an AUD, with better improvement in those who were drinking at levels exceeding only daily limits, younger, and without an AUD. CONCLUSIONS Systematic ABI in adult primary care has the potential to reduce drinking among people with unhealthy drinking considerably on both an individual and population level. More research is needed to help optimize ABI, in particular tailoring it to diverse sub-populations, and studying its long-term public health impact.
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Affiliation(s)
- Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Verena E Metz
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA; Department of Psychiatry, Weill Institute of Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Joseph Elson
- The Permanente Medical Group, 1600 Owens Street, San Francisco, CA 94158, USA
| | - Thekla B Ross
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Yun Lu
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
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Tarp K, Sari S, Nielsen AS. Why treatment is not an option: Treatment naïve individuals, suffering from alcohol use disorders’ narratives about alcohol use and treatment seeking. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:437-452. [PMID: 36003123 PMCID: PMC9379291 DOI: 10.1177/14550725221082512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims: To investigate the narratives of in- and outpatients at mental health and somatic hospitals, who suffer from alcohol use disorders (AUD) but have never sought AUD treatment. More specifically, to understand how the individuals view their alcohol use and explore their reasons for not seeking treatment. Methods: Individuals suffering from AUD were recruited at somatic and mental health hospitals. The study was qualitative, based on semi-structured individual interviews. A narrative analysis was performed. A total of six patients participated: three recruited at a mental health hospital, three from a somatic hospital. Results: The individuals described how heavy alcohol use had always characterised their lives; it was part of their surroundings and it added to their quality of life. Two narrative forms within the individuals’ stories were identified, in which treatment was considered either as a positive option for others but not relevant for themselves, or as representing a threat to the individuals’ autonomy. The participants expressed that they did not believe treatment was relevant for them, and if necessary, they preferred to deal with their heavy drinking themselves. Conclusions: Our findings indicate that a broad focus is needed if relatively more individuals suffering from AUD should seek treatment, since they – in spite of clearly suffering from AUD – nevertheless see themselves as heavy drinkers and have not even thought of seeking treatment. Thus, it is not (only) a question about the attractiveness of the treatment offer or due to lack of knowledge about treatment options that patients suffering from AUD do not seek treatment.
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Affiliation(s)
- Kristine Tarp
- Centre for Telepsychiatry, Region of Southern Denmark, Odense, Denmark; and University of Southern Denmark, Odense, Denmark
| | - Sengül Sari
- University of Southern Denmark, Odense, Denmark
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Philippine T, Forsgren E, DeWitt C, Carter I, McCollough M, Taira BR. Provider perspectives on emergency department initiation of medication assisted treatment for alcohol use disorder. BMC Health Serv Res 2022; 22:456. [PMID: 35392901 PMCID: PMC8988541 DOI: 10.1186/s12913-022-07862-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Alcohol use disorder (AUD) is ubiquitous and its sequelae contribute to high levels of healthcare utilization, yet AUD remains undertreated. The ED encounter represents a missed opportunity to initiate medication assisted treatment (MAT) for patients with AUD. The aims of this study are to identify barriers and facilitators to the treatment of AUD in the ED, and to design interventions to address identified barriers. Methods Using an implementation science approach based on the Behavior Change Wheel framework, we conducted qualitative interviews with staff to interrogate their perspectives on ED initiation of AUD treatment. Subjects included physicians, nurses, nurse practitioners, clinical social workers, and pharmacists. Interviews were thematically coded using both inductive and deductive approaches and constant comparative analysis. Themes were further categorized as relating to providers’ capabilities, opportunities, or motivations. Barriers were then mapped to corresponding intervention functions. Results Facilitators at our institution included time allotted for continuing education, the availability of clinical social workers, and favorable opinions of MAT based on previous experiences implementing buprenorphine for opioid use disorder. Capability barriers included limited familiarity with naltrexone and difficulty determining which patients are candidates for therapy. Opportunity barriers included the limited supply of naltrexone and a lack of clarity as to who should introduce naltrexone and assess readiness for change. Motivation barriers included a sense of futility in treating patients with AUD and stigmas associated with alcohol use. Evidence-based interventions included multi-modal provider education, a standardized treatment algorithm and order set, selection of clinical champions, and clarification of roles among providers on the team. Conclusions A large evidence-practice gap exists for the treatment of AUD with Naltrexone, and the ED visit is a missed opportunity for intervention. ED providers are optimistic about implementing AUD treatment in the ED but described many barriers, especially related to knowledge, clarification of roles, and stigma associated with AUD. Applying a formal implementation science approach guided by the Behavior Change Wheel allowed us to transform qualitative interview data into evidence-based interventions for the implementation of an ED-based program for the treatment of AUD. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07862-1.
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Affiliation(s)
| | - Ethan Forsgren
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
| | | | - Inanna Carter
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Maureen McCollough
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Breena R Taira
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA
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McNeely J, Mazumdar M, Appleton N, Bunting AM, Polyn A, Floyd S, Sharma A, Shelley D, Cleland CM. Leveraging technology to address unhealthy drug use in primary care: Effectiveness of the Substance use Screening and Intervention Tool (SUSIT). Subst Abus 2022; 43:564-572. [PMID: 34586976 PMCID: PMC9968463 DOI: 10.1080/08897077.2021.1975868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Screening for unhealthy drug use is now recommended for adult primary care patients, but primary care providers (PCPs) generally lack the time and knowledge required to screen and deliver an intervention during the medical visit. To address these barriers, we developed a tablet computer-based 'Substance Use Screening and Intervention Tool (SUSIT)'. Using the SUSIT, patients self-administer screening questionnaires prior to the medical visit, and results are presented to the PCP at the point of care, paired with clinical decision support (CDS) that guides them in providing a brief intervention (BI) for unhealthy drug use. Methods: PCPs and their patients with moderate-risk drug use were recruited from primary care and HIV clinics. A pre-post design compared a control 'screening only' (SO) period to an intervention 'SUSIT' period. Unique patients were enrolled in each period. In both conditions, patients completed screening and identified their drug of most concern (DOMC) before the visit, and completed a questionnaire about BI delivery by the PCP after the visit. In the SUSIT condition only, PCPs received the tablet with the patient's screening results and CDS. Multilevel models with random intercepts and patients nested within PCPs examined the effect of the SUSIT intervention on PCP delivery of BI. Results: 20 PCPs and 79 patients (42 SO, 37 SUSIT) participated. Most patients had moderate-risk marijuana use (92.4%), and selected marijuana as the DOMC (68.4%). Moderate-risk use of drugs other than marijuana included cocaine (15.2%), hallucinogens (12.7%), and sedatives (12.7%). Compared to the SO condition, patients in SUSIT had higher odds of receiving any BI for drug use, with an adjusted odds ratio of 11.59 (95% confidence interval: 3.39, 39.25), and received more elements of BI for drug use. Conclusions: The SUSIT significantly increased delivery of BI for drug use by PCPs during routine primary care encounters.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Noa Appleton
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Amanda M. Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Antonia Polyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Steven Floyd
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Akarsh Sharma
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Donna Shelley
- Department of Public Health Policy and Management, New York University Global School of Public Health
| | - Charles M. Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Moberg DP, Paltzer J. Clinical Recognition of Substance Use Disorders in Medicaid Primary Care Associated With Universal Screening, Brief Intervention and Referral to Treatment (SBIRT). J Stud Alcohol Drugs 2021; 82:700-709. [PMID: 34762029 PMCID: PMC8819617 DOI: 10.15288/jsad.2021.82.700] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/28/2021] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE Screening, Brief Intervention and Referral to Treatment (SBIRT) programs have been effective for moderate reductions of alcohol use among participants in universal settings. However, there has been limited evidence of effectiveness in referring individuals to specialty care, and the literature now often refers to screening and brief intervention (SBI). This study examines documentation of substance use disorder (SUD) diagnoses in a low-income Medicaid population to evaluate the effect of universal SBIRT on healthcare system recognition of SUDs, a first step to obtaining a referral to treatment (RT) for individuals with SUDs. METHOD SBI patient data from Wisconsin's Initiative to Promote Healthy Lifestyles (WIPHL) were linked to Wisconsin Medicaid claims data. A comparison group of Medicaid beneficiaries was identified from a matched sample of non-SBIRT clinics (total study N = 14,856). Hierarchical generalized linear modeling was used to assess rates of SUD diagnosis in the 12 months following receipt of SBIRT in WIPHL clinics compared with rates in non-SBIRT clinics. Analysis controlled for clinic, individual patient's health status, demographics, and baseline substance use diagnoses. RESULTS SBIRT was associated with greater odds of being diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), alcohol abuse or dependence as well as drug abuse or dependence over the 12 months subsequent to receipt of the screen. The overall diagnostic rate for any DSM-IV substance abuse or dependence was 9.9% at baseline and 12.2% during the follow-up year. SBIRT patients had 42% (p = .003) greater odds of being diagnosed with a substance use disorder within 12 months relative to comparison clinic patients. However, there were very few claims for specialty SUD services. CONCLUSIONS The presence of SBIRT in a primary care clinic appears to increase the awareness and recognition of patients with SUDs and a greater willingness of healthcare providers to diagnose patients with an alcohol or drug use disorder on Medicaid claims. Further research is needed to determine if this increase in diagnosis reflects integrated care for SUDs or if it leads to improved access to specialty care, in which case abandonment of the RT component of SBIRT may be premature.
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Affiliation(s)
- D. Paul Moberg
- University of Wisconsin–Madison Population Health Institute, Madison, Wisconsin
| | - Jason Paltzer
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
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35
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Moberg DP, Paltzer J. Clinical Recognition of Substance Use Disorders in Medicaid Primary Care Associated With Universal Screening, Brief Intervention and Referral to Treatment (SBIRT). J Stud Alcohol Drugs 2021; 82:700-709. [PMID: 34762029 PMCID: PMC8819617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/28/2021] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE Screening, Brief Intervention and Referral to Treatment (SBIRT) programs have been effective for moderate reductions of alcohol use among participants in universal settings. However, there has been limited evidence of effectiveness in referring individuals to specialty care, and the literature now often refers to screening and brief intervention (SBI). This study examines documentation of substance use disorder (SUD) diagnoses in a low-income Medicaid population to evaluate the effect of universal SBIRT on healthcare system recognition of SUDs, a first step to obtaining a referral to treatment (RT) for individuals with SUDs. METHOD SBI patient data from Wisconsin's Initiative to Promote Healthy Lifestyles (WIPHL) were linked to Wisconsin Medicaid claims data. A comparison group of Medicaid beneficiaries was identified from a matched sample of non-SBIRT clinics (total study N = 14,856). Hierarchical generalized linear modeling was used to assess rates of SUD diagnosis in the 12 months following receipt of SBIRT in WIPHL clinics compared with rates in non-SBIRT clinics. Analysis controlled for clinic, individual patient's health status, demographics, and baseline substance use diagnoses. RESULTS SBIRT was associated with greater odds of being diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), alcohol abuse or dependence as well as drug abuse or dependence over the 12 months subsequent to receipt of the screen. The overall diagnostic rate for any DSM-IV substance abuse or dependence was 9.9% at baseline and 12.2% during the follow-up year. SBIRT patients had 42% (p = .003) greater odds of being diagnosed with a substance use disorder within 12 months relative to comparison clinic patients. However, there were very few claims for specialty SUD services. CONCLUSIONS The presence of SBIRT in a primary care clinic appears to increase the awareness and recognition of patients with SUDs and a greater willingness of healthcare providers to diagnose patients with an alcohol or drug use disorder on Medicaid claims. Further research is needed to determine if this increase in diagnosis reflects integrated care for SUDs or if it leads to improved access to specialty care, in which case abandonment of the RT component of SBIRT may be premature.
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Affiliation(s)
- D. Paul Moberg
- University of Wisconsin–Madison Population Health Institute, Madison, Wisconsin
| | - Jason Paltzer
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
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Watson DP, Staton MD, Dennis ML, Grella CE, Scott CK. Variation in brief treatment for substance use disorder: a qualitative investigation of four federally qualified health centers with SBIRT services. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:58. [PMID: 34261499 PMCID: PMC8278761 DOI: 10.1186/s13011-021-00381-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/18/2022]
Abstract
Background Brief treatment (BT) can be an effective, short-term, and low-cost treatment option for many people who misuse alcohol and drugs. However, inconsistent implementation is suggested to result in BT that often looks and potentially costs similar to regular outpatient care. Prior research is also rife with inconsistent operationalizations regarding the measurement of BT received by patients. As such, there is a need to more explicitly identify and document variations in BT practice. Methods A qualitative investigation of BT in four Federally Qualified Health Centers (FQHC) was undertaken as a sub study of a larger clinical trial. Researchers interviewed 12 staff (administrators and clinicians) involved in BT oversight, referral, or delivery within the four FQHCs. Data were analyzed following an inductive approach guided by the primary research questions. Results Findings demonstrate considerable differences in how BT was conceptualized and implemented within the FQHCs. This included a variety of ways in which BT was presented and described to patients that likely impacts how they perceive the BT they receive, including potentially not understanding they received substance use disorder treatment at all. Conclusions The findings raise questions regarding the validity of prior research, demonstrating more objective definitions of BT and fidelity checklists are needed to ensure integrity of results. Future work in this area should seek to understand BT as practiced among a larger sample of providers and the direct experiences and perspectives of patients. There is also a need for more consistent implementation, quality assurance guidelines, and standardized stage of change assessments to aid practitioners.
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Affiliation(s)
- Dennis P Watson
- Chestnut Health Systems, 221 W Walton St, 60610, Chicago, IL, United States.
| | - Monte D Staton
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, 818 S. Wolcott, 60612, Chicago, IL, United States
| | - Michael L Dennis
- Chestnut Health Systems, 448 Wylie Dr, 61761, Normal, IL, United States
| | - Christine E Grella
- Chestnut Health Systems, 221 W Walton St, 60610, Chicago, IL, United States
| | - Christy K Scott
- Chestnut Health Systems, 221 W Walton St, 60610, Chicago, IL, United States
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Robins JE, Morley KI, Hayes RD, Ross KR, Pritchard M, Curtis V, Kalk NJ. Alcohol dependence and heavy episodic drinking are associated with different levels of risk of death or repeat emergency service attendance after a suicide attempt. Drug Alcohol Depend 2021; 224:108725. [PMID: 33940325 DOI: 10.1016/j.drugalcdep.2021.108725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Alcohol use is a multidimensional risk factor for suicidal behaviour. However, suicide prevention strategies often take 'one-size-fits-all' approaches to alcohol use, reflecting an evidence base built on unidimensional measures. Latent Class Analysis can use a range of measures to differentiate distinct patterns of alcohol using behaviour and their associated risks. METHODS We analysed Electronic Health Record data from 650 suicidal adults detained for up to 36 h using police powers (Section 136 of the Mental Health Act 1983, amended 2007) to facilitate psychiatric assessment at a Health-Based Place of Safety, a dedicated emergency psychiatric care centre in London, UK. We conducted a Latent Class Analysis of alcohol using behaviours at first detention, and used multivariable logistic regression to estimate the association of each identified latent class with subsequent death or recontact with emergency psychiatric care over a median follow-up of 490 days, adjusting for sex, age and past-year psychiatric diagnosis. RESULTS Three classes of alcohol use were identified: low risk drinkers, heavy episodic drinkers and dependent drinkers. The dependent drinking class had twice the odds of death or recontact with emergency psychiatric care as the low risk drinking class (OR 2.32, 95 %CI 1.62-3.32, p < 0.001). Conversely, the heavy episodic drinking class was associated with lower odds of death or recontact than the low risk drinking class (OR 0.66, 95 %CI 0.53-0.81, p < 0.001). CONCLUSIONS The risk of adverse outcomes after a suicide attempt are not uniform for different alcohol use classes. Clinical assessment and suicide prevention efforts should be tailored accordingly.
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Affiliation(s)
- John E Robins
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
| | - Katherine I Morley
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK; Innovation, Health, and Science, RAND Europe, Westbrook Centre/Milton Rd, Cambridge, CB4 1YG, UK; Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, 207 Bouverie Street, Victoria, 3010, Australia
| | - Richard D Hayes
- Department of Psychological Medicine and NIHR Maudsley Biomedical Research Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK
| | - Kezia R Ross
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK
| | - Megan Pritchard
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK; CRIS Training & Development Lead, NIHR Maudsley Biomedical Research Centre (BRC), UK; King's College London Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK
| | - Vivienne Curtis
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK; CRIS Training & Development Lead, NIHR Maudsley Biomedical Research Centre (BRC), UK; Health Education England, 4 Stewart House, 32 Russell Square, Bloomsbury, London, WC1B 5DN, UK
| | - Nicola J Kalk
- National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
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Hyland K, Hammarberg A, Andreasson S, Jirwe M. Treatment of alcohol dependence in Swedish primary care: perceptions among general practitioners. Scand J Prim Health Care 2021; 39:247-256. [PMID: 34151724 PMCID: PMC8293973 DOI: 10.1080/02813432.2021.1922834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To describe general practitioners' (GPs) attitudes to the management of patients with alcohol dependence in primary care and current treatment routines and their view on a new treatment approach; internet-based Cognitive Behavioral Therapy (iCBT). DESIGN A qualitative interview study with ten GPs participating in a randomized controlled trial. The interviews were analyzed using qualitative content analysis. SETTING The participating GPs were recruited via purposeful sampling from primary care clinics in Stockholm. SUBJECTS The GPs were participants in an RCT investigating if iCBT when added to treatment as usual (TAU) was more effective than TAU only when treating alcohol dependence in primary care. RESULTS The GPs found alcohol important to discuss in many consultations and perceived most patients open to discuss their alcohol habits. Lack of training and treatment options were expressed as limiting factors when working with alcohol dependence. According to the respondents, routines for treating alcohol dependence were rare. CONCLUSION GPs believed that iCBT might facilitate raising questions about alcohol use and thought iCBT may serve as an attractive treatment option to some patients. The iCBT program did not require GPs to acquire skills in behavioral treatment, which could make implementation more feasible.KEY POINTSAlcohol dependence is highly prevalent, has a large treatment gap and is relevant to discuss with patients in many consultations in primary care.This study is based on interviews with 10 GPs participating in a randomized controlled trial comparing internet-based Cognitive Behavioral Therapy (iCBT) for alcohol-dependent patients to treatment as usual.GPs viewed alcohol habits as important to discuss and they perceived most patients are open to discuss this.The access to iCBT seemed to increase GPs' willingness to ask questions about alcohol and was viewed as an attractive treatment for some patients.The iCBT program did not require GPs to acquire skills in behavioral treatment, which might be timesaving and make implementation more feasible.
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Affiliation(s)
- Karin Hyland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- CONTACT Karin Hyland Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Sven Andreasson
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Maria Jirwe
- Department of Health Sciences, Red Cross University College, Huddinge, Sweden
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McCall MH, Wester KL, Bray JW, Hanchate AD, Veach LJ, Smart BD, Wachter Morris C. SBIRT administered by mental health counselors for hospitalized adults with substance misuse or disordered use: Evaluating hospital utilization and costs. J Subst Abuse Treat 2021; 132:108510. [PMID: 34098211 DOI: 10.1016/j.jsat.2021.108510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We analyzed the association of Screening, Brief Intervention, and Referral to Treatment (SBIRT) with hospitalizations, emergency department (ED) visits, and related costs, when administered to inpatients with substance misuse or disordered use by professional mental health counselors. METHODS Our study used retrospective program and health records data and a difference-in-differences design with propensity score covariates. The study population consisted of hospital inpatients admitted to integrated care services staffed by physicians, nurses, and mental health counselors. The intervention group consisted of patients selected for intervention based on substance use history and receiving SBIRT (n = 1577). Patients selected for intervention but discharged before SBIRT administration (n = 618) formed the comparison group. The outcome variables were hospitalization and ED visits costs and counts. Costs of hospitalizations and ED visits were combined to allow sufficient data for analysis, with counts treated similarly. Patient-level variables were substance use type and substance use severity. A cluster variable was inpatient clinical service. Zero-censored and two-part logistic and generalized linear models with robust standard errors tested the association of SBIRT interventions with the outcomes. RESULTS For the full study population of patients using alcohol, illicit drugs, or both, SBIRT administered by mental health counselors was not associated with changes in hospitalizations and ED visits. For patients with alcohol misuse or disordered use, SBIRT by mental health counselors was associated an odds ratio of 0.32 (p < .001) of having subsequent hospitalizations or ED visits. For patients with alcohol use who did return as hospital inpatients or to the ED, SBIRT by counselors was associated with a reduction in costs of $2547 per patient (p < .001) and with an incidence rate ratio of 0.57 for counts (p = .003). CONCLUSION Our results suggest that professional mental health counselors on inpatient integrated care teams may provide SBIRT effectively for patients with misuse and disordered use of alcohol, reducing the likelihood of future healthcare utilization and costs.
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Affiliation(s)
- Marcia H McCall
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
| | - Kelly L Wester
- School of Education, The University of North Carolina at Greensboro, 1300 Spring Garden Street, Greensboro, NC 27412, United States of America.
| | - Jeremy W Bray
- Bryan School of Business, The University of North Carolina at Greensboro, 516 Stirling Street, Greensboro, NC 27412, United States of America.
| | - Amresh D Hanchate
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
| | - Laura J Veach
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
| | - Benjamin D Smart
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
| | - Carrie Wachter Morris
- School of Education, The University of North Carolina at Greensboro, 1300 Spring Garden Street, Greensboro, NC 27412, United States of America.
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Anders M, Kitzlerová E, Racková S, Ćapek V. A Real-World Study on the Use of the Alcohol Use Disorders Identification Test (AUDIT) in Men Admitted to a Psychiatric Hospital. Med Sci Monit 2021; 27:e929667. [PMID: 33776055 PMCID: PMC8018177 DOI: 10.12659/msm.929667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background This real-world study aimed to investigate the use of the Alcohol Use Disorders Identification Test (AUDIT) in men admitted to a psychiatric hospital. Material/Methods The AUDIT questionnaire (10 items) was consecutively administered for a period of 3 years to male patients admitted to a psychiatric hospital (n=636). Laboratory blood tests of biochemical parameters were measured as biomarkers of alcohol consumption. Data were evaluated using linear models with mixed effects in the case of continuous dependent variables and logistic regression models with mixed effects in the case of categorical dependent variables. Results We found that 45.3% of the patients had a high risk of alcohol consumption or alcohol dependence and 54.7% had a low risk of alcohol consumption. The ICD-10 diagnoses of alcohol-related disorders (F1x), psychotic disorders (F2x), affective disorders (F3x), neurotic and psychosomatic disorders (F4x) were statistically significantly associated with total AUDIT score (P<0.001). There was a statistically significant association between the total AUDIT score and length of hospitalization (P=0.004) and the incidence of suicidal thoughts (P=0.003). Plasma concentrations of alanine aminotransferase (P=0.005), aspartate aminotransferase (P<0.001), gamma glutamyltransferase (P=0.001), total cholesterol (P=0.027) and mean corpuscular value of erythrocytes (P<0.001) were statistically significantly increased with a higher AUDIT score. Conclusions This real-world study showed that the AUDIT questionnaire evaluated the severity of disorders caused by alcohol and their impact on comorbid mental disorders. These results may be helpful in improving targeted interventions in this group of patients.
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Affiliation(s)
- Martin Anders
- Department of Psychiatry, First Faculty of Medicine Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Kitzlerová
- Department of Psychiatry, First Faculty of Medicine Charles University and General University Hospital, Prague, Czech Republic
| | - Sylva Racková
- Psychiatric Outpatient Department, Plzeň, Czech Republic
| | - Václav Ćapek
- Department of Psychiatry, First Faculty of Medicine Charles University and General University Hospital, Prague, Czech Republic
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Wallhed Finn S, Hammarberg A, Andreasson S, Jirwe M. Treating alcohol use disorders in primary care - a qualitative evaluation of a new innovation: the 15-method. Scand J Prim Health Care 2021; 39:51-59. [PMID: 33586596 PMCID: PMC7971313 DOI: 10.1080/02813432.2021.1882079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 11/21/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE This study aims to explore how the characteristics of an innovation, the 15-method, a stepped care model for treatment of alcohol use disorders in primary care was perceived. METHODS/DESIGN/SETTING/SUBJECT General practitioners and heads of primary care units (n = 10) that delivered the 15-method in a randomized controlled trial participated in individual interviews at two occasions in Stockholm, Sweden. Data were analyzed with theoretical thematic analysis, using Diffusion of Innovation Theory. RESULTS The participants described that offering the 15-method met a need among their patients. Participants were positive towards the training and the manual for the method. They mentioned a previous lack of routines to work with alcohol use disorders. The 15-method was described as easy to use. It would however be more feasible to implement in a team of different professions, rather than among general practitioners only. Priorities made by regional health care managers were described as important for the implementation, as well as financial incentives. A barrier to implementation was that alcohol screening was perceived as difficult. While the 15-method was perceived as effective in reducing the patients' alcohol use and cost effective, participants expressed uncertainty about the long-term effects. CONCLUSIONS The 15-method provides structure for treatment of alcohol use disorders and is described by general practitioners and heads as a promising approach. Being able to offer treatment for alcohol dependence may increase the uptake of alcohol interventions in primary care.KEY POINTSLittle attention has been given to develop treatment models for alcohol use disorders that are adapted to primary care settings.This study describes how an innovation, the 15-method, a stepped care model for treatment of alcohol use disorders in primary care was perceived.The 15-method provides structure for treatment of alcohol use disorders in primary care and is described by general practitioners and heads as a promising approach.Being able to offer treatment for alcohol dependence may increase the uptake of alcohol interventions in primary care.
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Affiliation(s)
- Sara Wallhed Finn
- Department of Global Public Health, Karolinska Institutet, Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Anders Hammarberg
- Department of Clinical Neurosciences, Karolinska Institutet, Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Sven Andreasson
- Department of Global Public Health, Karolinska Institutet, Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Maria Jirwe
- Department of Health Science, Red Cross University College, Stockholm, Sweden
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Karno MP, Rawson R, Rogers B, Spear S, Grella C, Mooney LJ, Saitz R, Kagan B, Glasner S. Effect of screening, brief intervention and referral to treatment for unhealthy alcohol and other drug use in mental health treatment settings: a randomized controlled trial. Addiction 2021; 116:159-169. [PMID: 32415721 PMCID: PMC7666646 DOI: 10.1111/add.15114] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/24/2019] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Abstract
AIMS To test the efficacy of a brief intervention to reduce alcohol or drug use and to promote use of addiction services among patients seeking mental health treatment. DESIGN AND SETTING A multi-centre, longitudinal, two-group randomized controlled trial with randomization within each of two mental health treatment systems located in Ventura County and Los Angeles County in California, USA. PARTICIPANTS A total of 718 patients (49.2% female) aged 18 and older with a mental health diagnosis and either a heavy drinking day or any use of cannabis or stimulants in the past 90 days. INTERVENTION AND COMPARATOR A motivation-based brief intervention with personalized feedback (screening, brief intervention and referral to treatment (SBIRT) condition) (n = 354) or a health education session (control condition) (n = 364). MEASUREMENTS Primary outcomes included frequency of heavy drinking days, days of cannabis use and days of stimulant use at the primary end-point 3 months post-baseline. Secondary outcomes included frequency and abstinence from substance use out to a 12-month follow-up and the use of addiction treatment services. FINDINGS Participants in the SBIRT condition had fewer heavy drinking days [odds ratio (OR) = 0.53; 95% credible interval (CrI) = 0.48-0.6] and fewer days of stimulant use (OR = 0.58; 95% CrI = 0.50-0.66) at the 3-month follow-up compared with participants in the health education condition. Participants in the SBIRT condition did not comparatively reduce days of cannabis use at the 3-month follow-up (OR = 0.93; 95% CrI = 0.85-1.01). Secondary outcomes indicated sustained effects of SBIRT on reducing the frequency of heavy drinking days and days of stimulant use. No effects were observed on abstinence rates or use of addiction treatment services. CONCLUSIONS Screening and brief intervention for unhealthy alcohol and drug use in mental health treatment settings were effective at reducing the frequency of heavy drinking and stimulant use.
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Affiliation(s)
- Mitchell P Karno
- Department of Psychiatry and Biobehavioral Sciences, Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Richard Rawson
- Department of Psychiatry and Biobehavioral Sciences, Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
- Vermont Center for Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Benjamin Rogers
- Department of Biostatistics and School of Nursing, University of California, Los Angeles, CA, USA
| | - Suzanne Spear
- Department of Health Sciences, California State University, Northridge, CA, USA
| | - Christine Grella
- Department of Psychiatry and Biobehavioral Sciences, Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Bruce Kagan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Suzette Glasner
- Department of Psychiatry and Biobehavioral Sciences, Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
- Department of Family Medicine, University of California, Los Angeles, CA, USA
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Palfai TP. Integrating Videoconferencing into Primary Care to Address Alcohol Use Disorder. J Addict Med 2021; 15:8-9. [PMID: 32467416 DOI: 10.1097/adm.0000000000000665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This commentary on Leibowitz et al, "Video Consultation to Increase Treatment of Alcohol Use Disorder in Primary Care: A Pilot Feasibility Study" highlights the potential value of utilizing videoconferencing to address unhealthy drinking in primary care settings, the advantages of centralized expert consultants that may be accessed through technology, and the need for future implementation process and clinical care outcome research.
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Affiliation(s)
- Tibor P Palfai
- Department of Psychological and Brain SciencesBoston University, Boston, MA
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Bischof G, Lange N, Rumpf HJ, Preuss UW. Reduced drinking and harm reduction in the treatment of alcohol use disorders. DRUGS AND ALCOHOL TODAY 2020. [DOI: 10.1108/dat-10-2020-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to give an overview of the scientific evidence for reduced drinking in alcohol use disorders. While the aim of alcohol use disorders (AUD) treatment usually focuses on abstinence, only a minority of individuals with AUD enter treatment. Lack of alternative treatment goals, including reduced drinking instead of abstinence, have been identified as a potential barrier for treatment entry. Epidemiological and treatment outcome studies reveal that a large proportion of individuals with AUD are able to substantially reduce their alcohol intake for a prolonged duration of time.
Design/methodology/approach
A narrative review of the literature on prevalence rates and health effects as well as evidence-based approaches fostering reduced drinking in individuals with AUD is presented.
Findings
Reduced drinking is associated with improvements in both morbidity and mortality. Research has identified evidence-based psychosocial and pharmacological treatment approaches; however, implementation is still scarce.
Originality/value
Target groups for interventions fostering drinking reduction instead of abstinence are defined and desiderata for further research are outlined.
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Palzes VA, Kline-Simon AH, Satre DD, Sterling S, Weisner C, Chi FW. Remission From Unhealthy Drinking Among Patients With an Alcohol Use Disorder: A Longitudinal Study Using Systematic, Primary Care-Based Alcohol Screening Data. J Stud Alcohol Drugs 2020. [PMID: 32800079 DOI: 10.15288/jsad.2020.81.436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Using electronic health record (EHR) data from a systematic, primary care-based alcohol screening, brief intervention, and referral to treatment (SBIRT) initiative within a health system, we examined correlates of remission from unhealthy drinking among patients with an alcohol use disorder (AUD). METHOD We conducted a longitudinal study of 4,078 adults with AUD who screened positive for unhealthy drinking between October 1, 2015, and September 30, 2016. We extracted EHR data up to 3 years after screening until October 1, 2018. We used survival analysis to examine associations between remission (i.e., reporting abstinence or low-risk drinking at a subsequent screening) and patient characteristics, comorbidities, and treatment utilization. RESULTS The median time to remission from unhealthy drinking was 1.7 years. Factors significantly associated with greater odds of remitting from unhealthy drinking during follow-up were female gender; older age (50-64 years); Black or Latino/Hispanic race/ethnicity; having more medical comorbidities; not having a comorbid drug use disorder; lower alcohol consumption levels; and receiving addiction medicine treatment before the index screening. In the first follow-up year, individuals with mental health comorbidities were more likely to remit, but those in psychiatric treatment were less likely. Receiving addiction treatment during follow-up was not associated with remission. CONCLUSIONS Ethnic minorities and individuals with mental illness were more likely to remit, which is encouraging given the health disparities observed among these clinically important subgroups and warrants further research. Our findings may inform research on AUD recovery and clinical practice, as remission from unhealthy drinking is a crucial component of the early stages of recovery.
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Affiliation(s)
- Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California
| | - Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California
| | - Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Field CA, Richards DK, Castro Y, Alonso Cabriales J, Wagler A, von Sternberg K. The Effects of a Brief Motivational Intervention for Alcohol Use through Stages of Change among Nontreatment Seeking Injured Patients. Alcohol Clin Exp Res 2020; 44:2361-2372. [PMID: 32981123 DOI: 10.1111/acer.14466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the mechanisms of change underlying brief interventions and the patient characteristics that may affect them. The present study tested whether the stages of change mediate the effects of a BMI with and without a telephone booster relative to brief advice (i.e., multiple mediation). Further, the present study tested whether the effects of the BMI conditions on the stages of change were contingent on patients' alcohol use severity (i.e., moderated mediation). METHODS The present study is a secondary analysis using data from injured adult patients at 3 trauma centers who were screened for inclusion in the study and randomly assigned to brief advice (n = 200), BMI (n = 203), or BMI with a telephone booster (n = 193) (Field et al., 2014). Participants completed a baseline assessment and 3-, 6-, and 12-month follow-up assessments that included self-report measures of the stages of change, alcohol use, and alcohol-related problems, as well as other variables of interest. RESULTS The results demonstrated significant and consistent mediation at p < 0.05 wherein BMI with a telephone booster increased action at 3-month follow-up leading to reduced likelihood of at-risk drinking, less alcohol use, and fewer alcohol problems at both 6- and 12-month follow-up. However, moderated mediation analyses suggested that the effects of the BMI conditions on the stages of change were not contingent on patients' alcohol use severity. CONCLUSIONS This study contributes to the understanding of stages of change as potential mechanisms of change in BMI. Directions for future research are discussed.
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Affiliation(s)
- Craig A Field
- From the, Department of Psychology, (CAF), Latino Alcohol and Health Disparities Research and Training Center, University of Texas at El Paso, El Paso, Texas, USA
| | - Dylan K Richards
- Center on Alcohol, Substance use, And Addictions, (DKR), University of New Mexico, Albuquerque, New Mexico, USA
| | - Yessenia Castro
- Steve Hicks School of Social Work, (YC, KS), University of Texas at Austin, Texas, USA
| | - José Alonso Cabriales
- Arts and Sciences Division, (JAC), University of New Mexico-Gallup, Gallup, New Mexico, USA
| | - Amy Wagler
- Department of Mathematical Science, (AW), University of Texas at El Paso El Paso, Texas, USA
| | - Kirk von Sternberg
- Steve Hicks School of Social Work, (YC, KS), University of Texas at Austin, Texas, USA
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Sahker E, Sakata M, Toyomoto R, Hwang C, Yoshida K, Luo Y, Watanabe N, Furukawa TA. Efficacy of brief intervention for drug misuse in primary care facilities: systematic review and meta-analysis protocol. BMJ Open 2020; 10:e036633. [PMID: 32878757 PMCID: PMC7470504 DOI: 10.1136/bmjopen-2019-036633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Drug misuse is associated with significant global morbidity, mortality, economic costs and social costs. Many primary care facilities have integrated drug misuse screening and brief intervention (BI) into their usual care delivery. However, the efficacy of BI for drug misuse in primary care has not been substantiated through meta-analysis. The aim of this systematic review and meta-analysis is to determine the efficacy of BI for drug misuse in primary care settings. METHODS AND ANALYSIS We will include all randomised controlled trials comparing primary care-delivered BI for drug misuse with no intervention or minimal screening/assessment and usual care. Primary outcomes are (1) drug use frequency scores and (2) severity scores at intermediate follow-up (4-8 months). We will retrieve all studies through searches in CENTRAL, Embase, MEDLINE and PsycINFO until 31 May 2020. The reference list will be supplemented with searches in trial registries (eg, www.clinicaltrials.gov) and through relevant existing study reference lists identified in the literature. We will conduct a random-effect pairwise meta-analysis for primary and secondary outcomes. We will assess statistical heterogeneity though visual inspection of a forest plot and calculate I2 statistics. We will assess risk of bias using the Cochrane Risk of Bias Tool V.2 and evaluate the certainty of evidence through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Sensitivity analyses will account for studies with control group variations and studies with a high risk of bias. If heterogeneity is present, subgroup analyses will consider patient variables of age, sex/gender, race/ethnicity, per cent insured, baseline severity and primary drug misused. ETHICS AND DISSEMINATION This study will use published aggregate data and will not require ethical approval. Findings will be disseminated in a peer-reviewed journal.
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Affiliation(s)
- Ethan Sahker
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
- Japan Society for the Promotion of Science (JSPS), Overseas Fellowship Division, Kojimachi, Chiyoda-ku, Tokyo, Japan
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Chiyoung Hwang
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
- Japan Society for the Promotion of Science (JSPS), Research Fellowship Division, Kojimachi, Chiyoda-ku, Tokyo, Japan
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
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Hammock K, Velasquez MM, Alwan H, von Sternberg K. Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Girls and Women. Alcohol Res 2020; 40:07. [PMID: 34646716 PMCID: PMC8496756 DOI: 10.35946/arcr.v40.2.07] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Females ages 12 and older are the fastest growing segment of alcohol consumers in the United States, with the past decade showing a 16% increase in alcohol use per 12-month period and a 58% increase in high-risk drinking (i.e., > 3 drinks in a day and/or > 7 drinks in a week) per 12-month period. The increase in alcohol use and risk drinking poses unique and serious consequences for women. Women have a more rapid progression to alcohol-related problems and alcohol use disorders (AUD) than men, and if pregnant, women can potentially expose the fetus to alcohol. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based, integrated public health approach used to identify and address risky alcohol use among women in a variety of health and social service settings. This article presents the current status of SBIRT among girls ages 12 and older, women of childbearing age, and older women. Screening instruments, brief interventions, and implementation issues specific to women of all ages are described. Through this review of the current literature, care providers can determine best practices for the prevention and treatment of risk drinking in women of all ages presenting in health care settings.
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Affiliation(s)
- Kyndal Hammock
- Health Behavior Research and Training Institute, University of Texas at Austin, Austin, Texas
| | - Mary M Velasquez
- Health Behavior Research and Training Institute, University of Texas at Austin, Austin, Texas
| | - Hanan Alwan
- Health Behavior Research and Training Institute, University of Texas at Austin, Austin, Texas
| | - Kirk von Sternberg
- Health Behavior Research and Training Institute, University of Texas at Austin, Austin, Texas
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Chen IQ, Chokron Garneau H, Seay-Morrison T, Mahoney MR, Filipowicz H, McGovern MP. What constitutes "behavioral health"? Perceptions of substance-related problems and their treatment in primary care. Addict Sci Clin Pract 2020; 15:29. [PMID: 32727589 PMCID: PMC7388518 DOI: 10.1186/s13722-020-00202-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/18/2020] [Indexed: 11/15/2022] Open
Abstract
Background Integrating behavioral health in primary care is a widespread endeavor. Yet rampant variation exists in models and approaches. One significant question is whether frontline providers perceive that behavioral health includes substance use. The current study examined front line providers’: 1. definition of behavioral health, and 2. levels of comfort treating patients who use alcohol and other drugs. Frontline providers at two primary care clinics were surveyed using a 28-item instrument designed to assess their comfort and knowledge of behavioral health, including substance use. Two questions from the Integrated Behavioral Health Staff Perceptions Survey pertaining to confidence in clinics’ ability to care for patients’ behavioral health needs and comfort dealing with patients with behavioral health needs were used for the purposes of this report. Participants also self-reported their clinic role. Responses to these two items were assessed and then compared across roles. Chi square estimates and analysis of variance tests were used to examine relationships between clinic roles and comfort of substance use care delivery. Results Physicians, nurses/nurse practitioners, medical assistants, and other staff (N = 59) participated. Forty-nine participants included substance use in their definition of behavioral health. Participants reported the least comfort caring for patients who use substances (M = 3.5, SD = 1.0) compared to those with mental health concerns (M = 4.1, SD = 0.7), chronic medical conditions (M = 4.2, SD = 0.7), and general health concerns (M = 4.2, SD = 0.7) (p < 0.001). Physicians (M = 3.0, SD = 0.7) reported significantly lower levels of comfort than medical assistants (M = 4.2, SD = 0.9) (p < 0.001) caring for patients who use substances. Conclusions In a small sample of key stakeholders from two primary care clinics who participated in this survey, most considered substance use part of the broad umbrella of behavioral health. Compared to other conditions, primary care providers reported being less comfortable addressing patients’ substance use. Level of comfort varied by role, where physicians were least comfortable, and medical assistants most comfortable.
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Affiliation(s)
- Ida Q Chen
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1520 Page Mill Road, Palo Alto, CA, 94304, USA
| | - Helene Chokron Garneau
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1520 Page Mill Road, Palo Alto, CA, 94304, USA
| | - Timothy Seay-Morrison
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94305, USA
| | - Megan R Mahoney
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94305, USA
| | - Heather Filipowicz
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94305, USA
| | - Mark P McGovern
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1520 Page Mill Road, Palo Alto, CA, 94304, USA. .,Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94305, USA.
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Palzes VA, Kline-Simon AH, Satre DD, Sterling S, Weisner C, Chi FW. Remission From Unhealthy Drinking Among Patients With an Alcohol Use Disorder: A Longitudinal Study Using Systematic, Primary Care-Based Alcohol Screening Data. J Stud Alcohol Drugs 2020; 81:436-445. [PMID: 32800079 PMCID: PMC7437559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/07/2020] [Indexed: 03/30/2024] Open
Abstract
OBJECTIVE Using electronic health record (EHR) data from a systematic, primary care-based alcohol screening, brief intervention, and referral to treatment (SBIRT) initiative within a health system, we examined correlates of remission from unhealthy drinking among patients with an alcohol use disorder (AUD). METHOD We conducted a longitudinal study of 4,078 adults with AUD who screened positive for unhealthy drinking between October 1, 2015, and September 30, 2016. We extracted EHR data up to 3 years after screening until October 1, 2018. We used survival analysis to examine associations between remission (i.e., reporting abstinence or low-risk drinking at a subsequent screening) and patient characteristics, comorbidities, and treatment utilization. RESULTS The median time to remission from unhealthy drinking was 1.7 years. Factors significantly associated with greater odds of remitting from unhealthy drinking during follow-up were female gender; older age (50-64 years); Black or Latino/Hispanic race/ethnicity; having more medical comorbidities; not having a comorbid drug use disorder; lower alcohol consumption levels; and receiving addiction medicine treatment before the index screening. In the first follow-up year, individuals with mental health comorbidities were more likely to remit, but those in psychiatric treatment were less likely. Receiving addiction treatment during follow-up was not associated with remission. CONCLUSIONS Ethnic minorities and individuals with mental illness were more likely to remit, which is encouraging given the health disparities observed among these clinically important subgroups and warrants further research. Our findings may inform research on AUD recovery and clinical practice, as remission from unhealthy drinking is a crucial component of the early stages of recovery.
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Affiliation(s)
- Vanessa A. Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California
| | - Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California
| | - Felicia W. Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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