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Tezuka Y, So R, Fukuda T. The effectiveness of an ultra-brief intervention in 1 min for hazardous drinking in a general hospital setting: A quasi-randomized pilot trial. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e216. [PMID: 38904063 PMCID: PMC11187907 DOI: 10.1002/pcn5.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/02/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
Objective We investigated the effectiveness of an ultra-brief intervention (Ultra-BI) for patients with hazardous drinking behaviors admitted to a general hospital. Method In a quasi-randomized controlled trial at a general hospital in Japan, we assigned participants to intervention or control groups based on the last digit of their patient ID (odd for intervention, even for control). The study included inpatients with Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) scores of ≥5 for men and ≥4 for women. The intervention involved providing advice and feedback within 1 min, accompanied by a leaflet on alcohol-related issues (Ultra-BI). The control group did not receive any intervention. The primary outcome was average weekly alcohol consumption at 3 months postintervention. Results The study included 68 participants. The intervention group showed a reduction in average weekly alcohol consumption by -69.7 g/week compared to the control group (95% confidence interval [CI] -145.7 to 6.3 g/week, p = 0.07). Post-hoc analysis, adjusting for baseline values, indicated a between-group difference of -78.7 g/week (95% CI -135.2 to -22.2 g/week, p = 0.007). Conclusion This pilot trial suggests the potential effectiveness of the Ultra-BI in general hospital wards. Further large-scale studies are required to confirm these findings.
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Affiliation(s)
- Yukio Tezuka
- Okinawa Rehabilitation Center Hospital
- Okinawa Chubu Hospital
| | - Ryuhei So
- Okayama Psychiatric Medical CenterOkayamaJapan
- CureApp Inc.
- Scientific Research WorkS Peer Support Group (SRWS‐PSG)
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2
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Jain B, Christopher Dee E, Jain U, Chaturvedi P, Murthy V. The implications of rising alcohol-associated cancer burden: Considerations for the Indian context. Asia Pac J Clin Oncol 2023; 19:275-276. [PMID: 35098671 DOI: 10.1111/ajco.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/03/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Bhav Jain
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Urvish Jain
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery and Center for Cancer Epidemiology, Tata Memorial Center, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
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3
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Romero-Rodríguez E, Chen CA, Dukes KA, Hartlage K, Palfai TP, Magane KM, Samet JH, Saitz R. Cannabis and cocaine use, drinking outcomes, and quality of life in general hospital inpatients with alcohol use disorder. Subst Abus 2022; 43:1225-1230. [PMID: 35670771 DOI: 10.1080/08897077.2022.2074592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: While associations between cannabis and cocaine use, and heavy drinking and quality of life (QOL), are well-established in the general population, it is unclear whether they are present in hospital inpatients with alcohol use disorder (AUD). The aim of the study was to assess associations between cannabis and cocaine use and two outcomes [heavy drinking days (HDDs) and QOL] among hospital inpatients with AUD. Methods: Hospitalized patients with AUD and at least one past-month HDD participated in this cross-sectional study. Cannabis and cocaine use were assessed using the Alcohol, Smoking, and Substance Involvement Screening Test. HDDs were assessed using the Timeline Followback. QOL was assessed by the WHOQOL-BREF instrument. Multivariable regression models assessed associations. Results: Of 248 participants, 225 (91%) had severe AUD. There were no statistically significant associations between: recent cannabis use and HDDs [Incidence Rate Ratio (IRR) = 0.95; 95% Confidence Interval (95% CI): 0.80, 1.14], cocaine use and HDDs [IRR = 0.88; 95% CI: 0.66, 1.18], or both cannabis and cocaine use and HDDs [IRR = 0.87; 95%CI: 0.70, 1.09], as compared to use of neither cannabis nor cocaine. Use of cannabis, cocaine, and both, were not associated with QOL [(odds ratio (OR) = 0.98; 95% CI:0.55, 1.74), (OR = 0.76; 95% CI:0.30, 1.93), (OR = 1.00; 95%CI: 0.49, 2.03), respectively]. Conclusions: Among hospital inpatients with AUD, there were no significant associations between cannabis and cocaine use, heavy drinking, or QOL. Our findings raise questions regarding how drug use affects AUD and whether similar results would be found among those with milder AUD and in prospective studies.
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Affiliation(s)
- Esperanza Romero-Rodríguez
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Section of General Internal Medicine, Department of Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Clara A Chen
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Kimberly A Dukes
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Kaitlin Hartlage
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Kara M Magane
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Jeffrey H Samet
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Section of General Internal Medicine, Department of Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Section of General Internal Medicine, Department of Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
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4
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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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Hai AH, Lee CS, Abbas BT, Bo A, Morgan H, Delva J. Culturally adapted evidence-based treatments for adults with substance use problems: A systematic review and meta-analysis. Drug Alcohol Depend 2021; 226:108856. [PMID: 34274617 DOI: 10.1016/j.drugalcdep.2021.108856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This systematic review/meta-analysis aimed to synthesize empirical evidence from randomized controlled trials on the efficacy of culturally adapted interventions (CAIs) for substance use and related consequences for adults of color. METHODS Six electronic databases were searched to identify eligible studies. Two reviewers independently screened studies, extracted data, and assessed risks of bias. We used robust variance estimation in meta-regression to synthesize effect size estimates and conduct moderator analyses. RESULTS Twenty-two studies met the inclusion criteria and were included in the review. The overall effect size was 0.23 (95 % Confidence Interval [CI] = 0.12, 0.35). The subgroup effect sizes for comparing CAIs with inactive controls and with active controls were 0.31 (CI = 0.14, 0.48) and 0.14 (CI=-0.02, 0.29), respectively. The effect sizes for alcohol use, illicit drug use, unspecified substance use outcomes, and substance use related consequences were 0.25 (CI = 0.08, 0.43), 0.35 (CI =-0.30, 1.00), 0.22 (CI=-0.17, 0.62), and 0.02 (CI=-0.11, 0.16), respectively. Moderator analysis showed that CAIs' effects might not vary significantly by treatment model, dose, country, follow-up assessment timing, participant age, or gender/sex. CONCLUSIONS Research on substance use interventions that are culturally adapted for people of color is growing, and more high-quality studies are needed to draw definitive conclusions about CAIs' treatment effects. Our study found CAIs to be a promising approach for reducing substance use and related consequences. We call for more efficacy/effectiveness and implementation research to further advance the development and testing of evidence-based CAIs that meet the unique needs and sociocultural preferences of diverse populations.
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Affiliation(s)
- Audrey Hang Hai
- Center for Innovation in Social Work & Health, School of Social Work, Boston University, 264 Bay State Rd, Boston, MA, 02215, USA.
| | - Christina S Lee
- Center for Innovation in Social Work & Health, School of Social Work, Boston University, 264 Bay State Rd, Boston, MA, 02215, USA
| | - Bilal T Abbas
- Department of General Internal Medicine, Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
| | - Ai Bo
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, 2400 E. Hartford Avenue, Milwaukee, WI, 53211, USA
| | - Henry Morgan
- Sociology Department, Vassar College, 124 Raymond Avenue, Poughkeepsie, NY, 12604, USA
| | - Jorge Delva
- Center for Innovation in Social Work & Health, School of Social Work, Boston University, 264 Bay State Rd, Boston, MA, 02215, USA
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Ruben JP, Paul V, Nicholas AV, Devarbhavi H, Patil M, Selvam S, Mysore. V A. Nurse-conducted Brief Intervention for Alcohol Use Disorders in a Medical In-patient Setting in India - A Feasibility Study. ALCOHOLISM TREATMENT QUARTERLY 2021. [DOI: 10.1080/07347324.2021.1901633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Vanila Paul
- Department of Psychiatry, St. John’s Medical College, Bengaluru, India
| | | | - Harshad Devarbhavi
- Department of Gastroenterology, St. John’s Medical College, Bengaluru, India
| | - Mallikarjun Patil
- Department of Gastroenterology, St. John’s Medical College, Bengaluru, India
| | - Sumithra Selvam
- Division of Epidemiology, Biostatistics & Population Health, St. John’s Research Institute, St. John’s Medical College, Bengaluru, India
| | - Ashok Mysore. V
- Department of Psychiatry, St. John’s Medical College, Bengaluru, India
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7
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Kao CY, Bradshaw T, Mazarakis T. Gender differences in the association between social support and caregiver alcohol use in posttraumatic stress disorder of east Taiwan adolescents. Tzu Chi Med J 2021; 33:188-194. [PMID: 33912418 PMCID: PMC8059466 DOI: 10.4103/tcmj.tcmj_123_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/29/2020] [Accepted: 08/01/2020] [Indexed: 11/11/2022] Open
Abstract
Objectives: This study investigates traumatic experiences in a sample of high-risk Taiwanese adolescents in rural areas of Taiwan; correlation with psychosocial factors is assessed with focus on social support and caregiver alcohol use. Materials and Methods: This was a cross-sectional study using stratified cluster sampling. Structured questionnaires were used to collect demographic characteristics, social support (Taiwan Relationship Inventory for Children and Adolescents), and posttraumatic stress disorder (PTSD) symptoms (Chinese version of UCLA-PTSD Reaction Index) from a sample of 751 adolescents (54.6% females) with 61.2% response rate in high schools in Hualien County, Taiwan. Results: Girls with trauma experiences manifested significantly higher PTSD scores, concurrent with higher number of traumatic events (TE), while the likelihood of reporting trauma and subsequent PTSD symptoms was similar in both genders. Increased risk of reported trauma and PTSD in adolescent Taiwanese is strongly associated with caregiver alcohol use and lack of social support, particularly in girls. Conclusion: We found that girls reported higher numbers of TE which was concurrent with significantly higher PTSD scores. Early detection of alcohol use disorders among caregivers as well as assessment of quality of family interaction would benefit at risk adolescents through specifically tailored interventions to address these factors.
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Affiliation(s)
- Ching-Yi Kao
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Tyler Bradshaw
- Department of Counseling and Clinical Psychology, National Dong Hwa University, Hualien, Taiwan
| | - Theodoris Mazarakis
- Department of Counseling and Clinical Psychology, National Dong Hwa University, Hualien, Taiwan
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8
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Frost MC, Glass JE, Bradley KA, Williams EC. Documented brief intervention associated with reduced linkage to specialty addictions treatment in a national sample of VA patients with unhealthy alcohol use with and without alcohol use disorders. Addiction 2020; 115:668-678. [PMID: 31642124 PMCID: PMC7725424 DOI: 10.1111/add.14836] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/28/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Alcohol screening, brief intervention (BI) and referral to treatment is often considered stepped care, such that BI with referral links patients to treatment. A meta-analysis of randomized trials found no evidence that BI increases treatment for alcohol use disorder (AUD). This study aimed to determine whether BI is associated with receipt of treatment for AUD among patients receiving BI as part of routine care. DESIGN Regression analysis. SETTING US Veterans Health Administration (VA), in which BI is supported by performance measurement and electronic clinical reminders. PARTICIPANTS VA outpatients with positive Alcohol Use Disorders Identification Test Consumption screens (≥ 5) (n = 830,825) documented nationally from 1 October 2009 to 30 May 2013. MEASUREMENTS Regression models estimated the prevalence of receiving VA specialty addictions treatment within 0-365 days for patients with documented BI (advice to reduce/abstain within 0-14 days) compared to those without. Models clustered on patient and adjusted for demographics and mental health and substance use conditions were fit among all patients and stratified across documented past-year AUD diagnosis. Multiple secondary analyses assessed robustness of findings, including assessing repeated BI as a predictor. FINDINGS Among 830,825 VA outpatients with unhealthy alcohol use (1,172,606 positive screens), documented BI was associated with lower likelihood of receiving VA specialty addictions treatment [adjusted incidence rate ratio (aIRR) = 0.84, 95% confidence interval (CI) = 0.83-0.84]. Associations were similar for those with and without AUD (aIRR = 0.83, 95% CI = 0.82-0.84 and aIRR = 0.86, 95% CI = 0.83-0.88, respectively) and in most secondary analyses. However, among patients without AUD, documentation of more than one BI was associated with greater likelihood of treatment relative to no BI (aIRR = 1.75, 95% CI = 1.68-1.83). CONCLUSIONS In a national sample of US Veterans Health Administration patients with unhealthy alcohol use, documented brief intervention for alcohol use was associated with lower likelihood of receiving specialty addictions treatment regardless of alcohol use disorder diagnosis.
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Affiliation(s)
- Madeline C. Frost
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
| | - Joseph E. Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101
| | - Katharine A. Bradley
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195,Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101,Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195
| | - Emily C. Williams
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
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Baby S, Singh H, Singh R, Dixit S, Chail A, Dubey A. Outcome of a "modified brief intervention" program delivered at work place for a population with hazardous alcohol use. Ind Psychiatry J 2019; 28:294-300. [PMID: 33223725 PMCID: PMC7660012 DOI: 10.4103/ipj.ipj_95_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/19/2020] [Accepted: 07/04/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION At the population level, screening and brief intervention (BI) is the most cost-effective method to reduce the burden of disease due to hazardous alcohol use. In delivering BI at individual level, trained workforce as well as time is a limiting factor. Hence, a study was conducted to assess the outcome of a "modified brief intervention" program delivered at workplace in a group setting for the participants identified with hazardous alcohol use pattern, as a secondary prevention measure. MATERIALS AND METHODS Study was a pre- and post-intervention study without a control group. Following an educational lecture, conducted by a mental health team including a psychiatrist, participants were screened using the WHO ASSIST questionnaire, V3.0 version. Those screened positive for hazardous alcohol use were given "modified brief intervention" in a group setting at their workplace which consisted of two semi-structured sessions of 1-h duration each. The sessions were spaced in a month. First session was based on motivation enhancement measures along with gathering of current alcohol use details and second session focused on relapse prevention. Three months later, the outcomes were assessed using a semistructured questionnaire and ASSIST was reapplied. The analysis was done using the R-commander from R-software. RESULTS No significant difficulty was experienced in conducting the interventions. Fifty (55.6%) participants stayed alcohol abstinent following second session and another 22 (24.44%) had reduced both the quantity and frequency of use. Paired t-tests revealed statistically significant reduction in all secondary outcome parameters (ASSIST scores, usual dose in one sitting, maximum dose, and number of days of use in month). Eighty (88.89%) participants reported the program to be effective. Only 3 months of observation is a limitation. CONCLUSION The study provides an efficient secondary prevention model to reduce hazardous drinking at the population level needing less workforce, cost, and time.
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Affiliation(s)
- Sojan Baby
- Department of Psychiatry, Base Hospital Barrackpore, West Bengal, India
| | - Harpreet Singh
- Department of Psychiatry, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Ranveer Singh
- Department of Psychiatry, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Siddharth Dixit
- Department of Psychiatry, Military Hospital, Pathankot, Punjab, India
| | - Amit Chail
- Department of Psychiatry, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Amresh Dubey
- Department of Psychiatry, Command Hospital (Southern Command), Pune, Maharashtra, India
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10
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Rumpf HJ, Bischof A, Bischof G, Besser B, Brand D, Rehbein F. Early Intervention in Gaming Disorder: What Can We Learn from Findings in the Substance Abuse Field? CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0229-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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L’addictologie de liaison : outils et spécificités. Encephale 2018; 44:354-362. [DOI: 10.1016/j.encep.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
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12
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Johnson NA, Kypri K, Latter J, Dunlop A, Brown A, Saitz R, Saunders JB, Attia J, Wolfenden L, Doran C, McCambridge J. Effect of electronic brief intervention on uptake of specialty treatment in hospital outpatients with likely alcohol dependence: Pilot randomized trial and qualitative interviews. Drug Alcohol Depend 2018; 183:253-260. [PMID: 29306817 DOI: 10.1016/j.drugalcdep.2017.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/25/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A large proportion of hospital outpatients are alcohol dependent (AD) but few are engaged in treatment for their drinking. Brief intervention, designed to raise patients' awareness of their drinking, might encourage uptake of referral to specialty treatment. We assessed the feasibility of conducting a randomized trial evaluating the effectiveness of electronic brief intervention on the uptake of specialty treatment in hospital outpatients with likely AD. METHODS This study was conducted in the outpatient department of a large public hospital in Newcastle, Australia. We randomly assigned adults who scored ≥10 on the AUDIT-C and were not currently receiving treatment for their drinking to electronic brief intervention (comprising an assessment of their drinking and personalized feedback) and referral (n = 59), or to referral alone (n = 64). We pre-specified two co-primary outcomes as the proportions of patients who (1) accepted and (2) attended a Drug and Alcohol outpatient clinic appointment. We interviewed 15 study participants to investigate why they had declined the appointment and what sort of help they might prefer to receive. RESULTS Ten patients (five in each group) accepted an appointment, and one patient (control) attended. Most interviewees' did not see their drinking as a problem or were confident they could manage it by themselves. Those who identified a preferred source of help expressed a preference for treatment by a GP. CONCLUSION Uptake of specialty treatment in hospital outpatients with likely AD was low regardless of whether they received brief intervention. Accordingly, a large randomized trial does not appear to be feasible.
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Affiliation(s)
- Natalie A Johnson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Kypros Kypri
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Joanna Latter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Local Health District Drug and Alcohol Clinical Services, Newcastle, NSW, 2300, Australia
| | - Amanda Brown
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Local Health District Drug and Alcohol Clinical Services, Newcastle, NSW, 2300, Australia
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and the Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - John B Saunders
- Centre for Youth Substance Abuse Research, University of Queensland, Herston, 4006, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Department of General Medicine, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Local Health District Population Health, Wallsend, NSW, 2287, Australia
| | - Christopher Doran
- Centre for Indigenous Health Equity Research, Central Queensland University, Brisbane, 4000, Australia
| | - Jim McCambridge
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
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13
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Charlet K, Heinz A. Harm reduction-a systematic review on effects of alcohol reduction on physical and mental symptoms. Addict Biol 2017; 22:1119-1159. [PMID: 27353220 DOI: 10.1111/adb.12414] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 03/31/2016] [Accepted: 04/28/2016] [Indexed: 12/20/2022]
Abstract
Based on the knowledge that alcohol misuse causes a multitude of diseases and increased mortality, this systematic review examines whether a reduction of the individual alcohol consumption can contribute to a minimization of health risks within a harm reduction approach. In fact, the reviewed 63 studies indicate that interventions aiming at alcohol reduction (including total abstinence as one possible therapeutic aim) indeed resulted in or were associated with positive effects in harmful, hazardous or alcohol-dependent drinkers. Major benefits were observed for reducing alcohol-associated injuries, recovery of ventricular heart function in alcoholic cardiomyopathy, blood pressure lowering, normalization of biochemical parameter, body weight reduction, histological improvement in pre-cirrhotic alcohol-related liver disease and slowed progression of an already existing alcohol-attributable liver fibrosis. Furthermore, reduced withdrawal symptoms, prevalence of psychiatric episodes and duration of in-patient hospital days, improvement of anxiety and depression symptoms, self-confidence, physical and mental quality of life, fewer alcohol-related adverse consequences as well as lower psychosocial stress levels and better social functioning can result from reduced alcohol intake. The reviewed literature demonstrated remarkable socioeconomic cost benefits in areas such as the medical health-care system or workforce productivity. Individuals with heightened vulnerability further benefit significantly from alcohol reduction (e.g. hypertension, hepatitis C, psychiatric co-morbidities, pregnancy, but also among adolescents and young adults). Concluding, the reviewed studies strongly support and emphasize the importance and benefits of early initial screening for problematic alcohol use followed by brief and other interventions in first contact medical health-care facilities to reduce alcohol intake.
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Affiliation(s)
- Katrin Charlet
- Department of Psychiatry and Psychotherapy, Campus Mitte; Charité - Universitätsmedizin Berlin; Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Mitte; Charité - Universitätsmedizin Berlin; Germany
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Grønkjær M, Søndergaard LN, Klit MØ, Mariegaard K, Kusk KH. Alcohol screening in North Denmark Region hospitals: Frequency of screening and experiences of health professionals. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017; 34:230-242. [PMID: 32934487 PMCID: PMC7450869 DOI: 10.1177/1455072517691057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/09/2017] [Indexed: 11/15/2022] Open
Abstract
Background: Alcohol consumption is a risk factor for disease, disability and death. Approximately 20% of all hospital admissions are alcohol related. In Denmark, hospitalised patients undergo systematic health risk screenings to establish preventive initiatives if the screening detects a risk. The frequency and usability of alcohol screening and health professionals’ experiences of the screening is unknown. Aim: To examine the frequency and usability of alcohol screening at North Denmark Region hospitals, as well as health professionals’ experiences of screening for alcohol. Methods: This study consisted of an initial audit of 120 patient records from medical and surgical units at four hospitals assessing information on alcohol screening. This was followed by six focus-group interviews with health professionals (n = 20) regarding their experiences of conducting alcohol screening. Results: Among overall health screenings, screening for alcohol and tobacco smoking was performed most frequently (81.8% and 85%). Alcohol screening scored the lowest percentage for usability (67.7%). Hospital-based alcohol screening was perceived ambiguously leading to a schism between standardised alcohol screening and the individual needs of the patient. Health professionals described different patient types, each with their perceived needs, and screening was associated with taboo and reluctance to engage in alcohol screening of some patient groups. Conclusion: This study revealed factors that influence health professionals working with hospital-based alcohol screening. The variation in and complexity of alcohol screening suggests that screening practice is an ambiguous task that needs continuous reflection and development to ensure that health professionals are prepared for the task.
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Affiliation(s)
- Mette Grønkjær
- Aalborg University & Aalborg University Hospital, Denmark
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Glass JE, Andréasson S, Bradley KA, Finn SW, Williams EC, Bakshi AS, Gual A, Heather N, Sainz MT, Benegal V, Saitz R. Rethinking alcohol interventions in health care: a thematic meeting of the International Network on Brief Interventions for Alcohol & Other Drugs (INEBRIA). Addict Sci Clin Pract 2017; 12:14. [PMID: 28490342 PMCID: PMC5425968 DOI: 10.1186/s13722-017-0079-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/14/2017] [Indexed: 11/29/2022] Open
Abstract
In 2016, the International Network on Brief Interventions for Alcohol & Other Drugs convened a meeting titled “Rethinking alcohol interventions in health care”. The aims of the meeting were to synthesize recent evidence about screening and brief intervention and to set directions for research, practice, and policy in light of this evidence. Screening and brief intervention is efficacious in reducing self-reported alcohol consumption for some with unhealthy alcohol use, but there are gaps in evidence for its effectiveness. Because screening and brief intervention is not known to be efficacious for individuals with more severe unhealthy alcohol use, recent data showing the lack of evidence for referral to treatment as part of screening and brief intervention are alarming. While screening and brief intervention was designed to be a population-based approach, its reach is limited. Implementation in real world care also remains a challenge. This report summarizes practice, research, and policy recommendations and key research developments from our meeting. In order to move the field forward, a research agenda was proposed to (1) address evidence gaps in screening, brief intervention, and referral to treatment, (2) develop innovations to address severe unhealthy alcohol use within primary care, (3) describe the stigma of unhealthy alcohol use, which obstructs progress in prevention and treatment, (4) reconsider existing conceptualizations of unhealthy alcohol use that may influence health care, and (5) identify efforts needed to improve the capacity for addressing unhealthy alcohol consumption in all world regions.
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Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
| | - Sven Andréasson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Sara Wallhed Finn
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Emily C Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ann-Sofie Bakshi
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, ICN, Hospital Clínic, IDIBAPS, RTA, Barcelona, Spain
| | - Nick Heather
- Department of Psychology, Faculty of Health & Social Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Marcela Tiburcio Sainz
- Department of Social Sciences in Health, Ramón de la Fuente Muñiz, National Institute of Psychiatry, Mexico City, Mexico
| | - Vivek Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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Platt L, Melendez-Torres GJ, O'Donnell A, Bradley J, Newbury-Birch D, Kaner E, Ashton C. How effective are brief interventions in reducing alcohol consumption: do the setting, practitioner group and content matter? Findings from a systematic review and metaregression analysis. BMJ Open 2016; 6:e011473. [PMID: 27515753 PMCID: PMC4985973 DOI: 10.1136/bmjopen-2016-011473] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/15/2016] [Accepted: 07/14/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND While the efficacy and effectiveness of brief interventions for alcohol (ABI) have been demonstrated in primary care, there is weaker evidence in other settings and reviews do not consider differences in content. We conducted a systematic review to measure the effect of ABIs on alcohol consumption and how it differs by the setting, practitioner group and content of intervention. METHODS We searched MEDLINE, EMBASE, PsycINFO; CINAHL, Social Science Citation Index, Cochrane Library and Global Health up to January 2015 for randomised controlled trials that measured effectiveness of ABIs on alcohol consumption. We grouped outcomes into measures of quantity and frequency indices. We used multilevel meta-analysis to estimate pooled effect sizes and tested for the effect of moderators through a multiparameter Wald test. Stratified analysis of a subset of quantity and frequency outcomes was conducted as a sensitivity check. RESULTS 52 trials were included contributing data on 29 891 individuals. ABIs reduced the quantity of alcohol consumed by 0.15 SDs. While neither the setting nor content appeared to significantly moderate intervention effectiveness, the provider did in some analyses. Interventions delivered by nurses had the most effect in reducing quantity (d=-0.23, 95% CI (-0.33 to -0.13)) but not frequency of alcohol consumption. All content groups had statistically significant mean effects, brief advice was the most effective in reducing quantity consumed (d=-0.20, 95% CI (-0.30 to -0.09)). Effects were maintained in the stratified sensitivity analysis at the first and last assessment time. CONCLUSIONS ABIs play a small but significant role in reducing alcohol consumption. Findings show the positive role of nurses in delivering interventions. The lack of evidence on the impact of content of intervention reinforces advice that services should select the ABI tool that best suits their needs.
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Affiliation(s)
- Lucy Platt
- Department of Social and Environmental Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - G J Melendez-Torres
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Amy O'Donnell
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Jennifer Bradley
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | | | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Charlotte Ashton
- Camden & Islington Public Health, London Boroughs of Islington and Camden, London, UK
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Simioni N, Rolland B, Cottencin O. Is there really no evidence of the efficacy of brief alcohol interventions for increasing subsequent utilization of alcohol-related services? Commentary on the paper by Glass et al. (2015). Addiction 2016; 111:180-1. [PMID: 26464266 DOI: 10.1111/add.13145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Nicolas Simioni
- Service d'Addictologie, CHRU Lille, Lille, France.,Centre de Soins et d'Accompagnement et de Prévention en Addictologie, EPSM Val de Lys-Artois, Béthune, France
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An Examination of the Workflow Processes of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) Program in Health Care Settings. J Subst Abuse Treat 2016; 60:21-6. [DOI: 10.1016/j.jsat.2015.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 07/30/2015] [Accepted: 08/03/2015] [Indexed: 11/23/2022]
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Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA. Revisiting our review of Screening, Brief Intervention and Referral to Treatment (SBIRT): meta-analytical results still point to no efficacy in increasing the use of substance use disorder services. Addiction 2016; 111:181-3. [PMID: 26464318 DOI: 10.1111/add.13146] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Joseph E Glass
- School of Social Work, University of Wisconsin-Madison, Madison, WI, USA.
| | | | - Byron J Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian E Perron
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Randall T Brown
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Mark A Ilgen
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System and the Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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Martino S, Zimbrean P, Forray A, Kaufman J, Desan P, Olmstead TA, Gueorguieva R, Howell H, McCaherty A, Yonkers KA. See One, Do One, Order One: a study protocol for cluster randomized controlled trial testing three strategies for implementing motivational interviewing on medical inpatient units. Implement Sci 2015; 10:138. [PMID: 26420671 PMCID: PMC4589113 DOI: 10.1186/s13012-015-0327-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background General medical hospitals provide care for a disproportionate share of patients who abuse or are dependent upon substances. This group is among the most costly to treat and has the poorest medical and addiction recovery outcomes. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance use problems in that patients are accessible, have time for an intervention, and are often admitted for complications related to substance use that renders hospitalization a “teachable moment.” Methods/Design This randomized controlled trial will examine the effectiveness of three different strategies for integrating motivational interviewing (MI) into the practice of providers working within a general medical inpatient hospitalist service: (1) a continuing medical education workshop that provides background and “shows” providers how to conduct MI (See One); (2) an apprenticeship model involving workshop training plus live supervision of bedside practice (Do One); and (3) ordering MI from the psychiatry consultation-liaison (CL) service after learning about it in a workshop (Order One). Thirty providers (physicians, physician assistants, nurses) will be randomized to conditions and then assessed for their provision of MI to 40 study-eligible inpatients. The primary aims of the study are to assess (1) the utilization of MI in each condition; (2) the integrity of MI when providers use it on the medical units; and (3) the relative costs and cost-effectiveness of the three different implementation strategies. Discussion If implementation of Do One and Order One is successful, the field will have two alternative strategies for supporting medical providers’ proficient use of brief behavioral interventions, such as MI, for medical inpatients who use substances problematically. Trial registration Clinical Trials.gov (NCT01825057)
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Affiliation(s)
- Steve Martino
- Psychology Service, VA Connecticut Healthcare System, 950 Campbell Avenue (116B), West Haven, CT, 06516, USA. .,Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Paula Zimbrean
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Ariadna Forray
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Joy Kaufman
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Paul Desan
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Todd A Olmstead
- Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin, 2300 Red River St., Stop E2700, Sid Richardson Hall, Unit 3, Austin, TX, 78712, USA. .,Seton/UT Clinical Research Institute, 1400 North IH 35, Austin, TX, 78701, USA.
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale University School of Medicine, 60 College Street, New Haven, CT, 06510, USA.
| | - Heather Howell
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Ashley McCaherty
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Kimberly A Yonkers
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
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Broyles LM, Wieland ME, Confer AL, DiNardo MM, Kraemer KL, Hanusa BH, Youk AO, Gordon AJ, Sevick MA. Alcohol brief intervention for hospitalized veterans with hazardous drinking: protocol for a 3-arm randomized controlled efficacy trial. Addict Sci Clin Pract 2015; 10:13. [PMID: 25968121 PMCID: PMC4480647 DOI: 10.1186/s13722-015-0033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various hospital accreditation and quality assurance entities in the United States have approved and endorsed performance measures promoting alcohol brief intervention (BI) for hospitalized individuals who screen positive for unhealthy alcohol use, the spectrum of use ranging from hazardous use to alcohol use disorders. These performance measures have been controversial due to the limited and equivocal evidence for the efficacy of BI among hospitalized individuals. The few BI trials conducted with hospital inpatients vary widely in methodological quality. While the majority of these studies indicate limited to no effects of BI in this population, none have been designed to account for the most pervasive methodological issue in BI studies presumed to drive study findings towards the null: assessment reactivity (AR). METHODS/DESIGN This is a three-arm, single-site, randomized controlled trial of BI for hospitalized patients at a large academic medical center affiliated with the U.S. Department of Veterans Affairs who use alcohol at hazardous levels but do not have an alcohol use disorder. Participants are randomized to one of three study conditions. Study Arm 1 receives a three-part alcohol BI. Study Arm 2 receives attention control. To account for potential AR, Study Arm 3 receives AC with limited assessment. Primary outcomes will include the number of standard drinks/week and binge drinking episodes reported in the 30-day period prior to a final measurement visit obtained 6 months after hospital discharge. Additional outcomes will include readiness to change drinking behavior and number of adverse consequences of alcohol use. To assess differences in primary outcomes across the three arms, we will use mixed-effects regression models that account for a patient's repeated measures over the timepoints and clustering within medical units. Intervention implementation will be assessed by: a) review of intervention audio recordings to characterize barriers to intervention fidelity; and b) feasibility of participant recruitment, enrollment, and follow-up. DISCUSSION The results of this methodologically rigorous trial will provide greater justification for or against the use of BI performance measures in the inpatient setting and inform organizational responses to BI-related hospital accreditation and performance measures. TRIAL REGISTRATION NCT01602172.
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Affiliation(s)
- Lauren M Broyles
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA.
- Veterans Integrated Service Network 4 (VISN4) Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
| | - Melissa E Wieland
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
| | - Andrea L Confer
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
| | - Monica M DiNardo
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
| | - Kevin L Kraemer
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA.
| | - Barbara H Hanusa
- Veterans Integrated Service Network 4 (VISN4) Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
| | - Ada O Youk
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Adam J Gordon
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA.
- Veterans Integrated Service Network 4 (VISN4) Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University Drive C (151C), Pittsburgh, PA, 15240, USA.
| | - Mary Ann Sevick
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA.
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Simioni N, Cottencin O, Rolland B. Interventions for Increasing Subsequent Alcohol Treatment Utilisation Among Patients with Alcohol Use Disorders from Somatic Inpatient Settings: A Systematic Review. Alcohol Alcohol 2015; 50:420-9. [DOI: 10.1093/alcalc/agv017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 02/17/2015] [Indexed: 11/13/2022] Open
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Li Q, Babor TF, Zeigler D, Xuan Z, Morisky D, Hovell MF, Nelson TF, Shen W, Li B. Health promotion interventions and policies addressing excessive alcohol use: a systematic review of national and global evidence as a guide to health-care reform in China. Addiction 2015; 110 Suppl 1:68-78. [PMID: 25533866 PMCID: PMC4350681 DOI: 10.1111/add.12784] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 12/20/2013] [Accepted: 03/17/2014] [Indexed: 12/26/2022]
Abstract
AIMS Steady increases in alcohol consumption and related problems are likely to accompany China's rapid epidemiological transition and profit-based marketing activities. We reviewed research on health promotion interventions and policies to address excessive drinking and to guide health-care reform. METHODS We searched Chinese- and English-language databases and included 21 studies in China published between 1980 and 2013 that covered each policy area from the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol. We evaluated and compared preventive interventions to the global alcohol literature for cross-national applicability. RESULTS In contrast with hundreds of studies in the global literature, 11 of 12 studies from mainland China were published in Chinese; six of 10 in English were on taxation from Taiwan or Hong Kong. Most studies demonstrated effectiveness in reducing excessive drinking, and some reported the reduction of health problems. Seven were randomized controlled trials. Studies targeted schools, drink-driving, work-places, the health sector and taxation. CONCLUSIONS China is the world's largest alcohol market, yet there has been little growth in alcohol policy research related to health promotion interventions over the past decade. Guided by a public health approach, the WHO Global Strategy and health reform experience in Russia, Australia, Mexico and the United States, China could improve its public health response through better coordination and implementation of surveillance and evidence-based research, and through programmatic and legal responses such as public health law research, screening and early intervention within health systems and the implementation of effective alcohol control strategies.
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Affiliation(s)
- Qing Li
- Michigan State University, Department of Epidemiology & Biostatistics, East Lansing, Michigan
- San Diego State University, Graduate School of Public Health, Center for Behavioral Epidemiology and Community Health, San Diego
| | - Thomas F. Babor
- University of Connecticut Health Center, Department of Community Medicine and Health Care, Farmington, Connecticut
| | - Donald Zeigler
- University of Illinois at Chicago, School of Public Health, Chicago
| | - Ziming Xuan
- Boston University, School of Public Health, Community Health Sciences, Boston
| | - Donald Morisky
- University of California, Los Angeles, Community Health Sciences, Los Angeles
| | - Melbourne F. Hovell
- San Diego State University, Graduate School of Public Health, Center for Behavioral Epidemiology and Community Health, San Diego
| | - Toben F. Nelson
- University of Minnesota, School of Public Health, Division of Epidemiology & Community Health, Minneapolis
| | - Weixing Shen
- Tsinghua University, School of Law, Center for Public Health Law Research, Beijing, China
| | - Bing Li
- Peking University, Sixth Hospital, Institute of Mental Health, Beijing, China
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Ito C, Yuzuriha T, Noda T, Ojima T, Hiro H, Higuchi S. Brief Intervention in the Workplace for Heavy Drinkers: A Randomized Clinical Trial in Japan. Alcohol Alcohol 2014; 50:157-63. [DOI: 10.1093/alcalc/agu090] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- Nick Heather
- Department of Psychology, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
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Patel V, Weobong B, Nadkarni A, Weiss HA, Anand A, Naik S, Bhat B, Pereira J, Araya R, Dimidjian S, Hollon SD, King M, McCambridge J, McDaid D, Murthy P, Velleman R, Fairburn CG, Kirkwood B. The effectiveness and cost-effectiveness of lay counsellor-delivered psychological treatments for harmful and dependent drinking and moderate to severe depression in primary care in India: PREMIUM study protocol for randomized controlled trials. Trials 2014; 15:101. [PMID: 24690184 PMCID: PMC4230277 DOI: 10.1186/1745-6215-15-101] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 03/19/2014] [Indexed: 05/16/2023] Open
Abstract
Background The leading mental health causes of the global burden of disease are depression in women and alcohol use disorders in men. A major hurdle to the implementation of evidence-based psychological treatments in primary care in developing countries is the non-availability of skilled human resources. The aim of these trials is to evaluate the effectiveness and cost-effectiveness of two psychological treatments developed for the treatment of depression and alcohol use disorders in primary care in India. Methods/design This study protocol is for parallel group, randomized controlled trials (Healthy Activity Program for moderate to severe depression, Counselling for Alcohol Problems for harmful and dependent drinking) in eight primary health centres in Goa, India. Adult primary care attendees will be screened with the Patient Health Questionnaire for depression and, in men only, the Alcohol Use Disorders Identification Test for drinking problems. Screen-positive attendees will be invited to participate; men who screen positive for both disorders will be invited to participate in the Counselling for Alcohol Problems trial. Those who consent will be allocated in a 1:1 ratio to receive either the respective psychological treatment plus enhanced usual care or enhanced usual care only using a computer generated allocation sequence, stratified by primary health centre and, for depression, by sex. The enhanced usual care comprises providing primary health centre doctors with contextualized World Health Organization guidelines and screening results. Psychological treatments will be delivered by lay counsellors, over a maximum period of three months. Primary outcomes are severity of disorder and remission rates at three months post-enrolment and, for the Counselling for Alcohol Problems trial, drinking and the impact of drinking on daily lives. Secondary outcomes include severity of disorder and remission rates at 12 months, disability scores, suicidal behaviour and economic impact, and cost-effectiveness at three and 12 months. 500 participants with depression and 400 participants with harmful drinking will be recruited. Primary analyses will be intention-to-treat. Discussion These trials may offer a new approach for the treatment of moderate-severe depression and drinking problems in primary care that is potentially scalable as it relies on delivery by a single pool of lay counsellors. Trial registration Both trials are registered with the International Society for the Registration of Clinical Trials (Healthy Activity Programme registration number ISRCTN95149997; Counselling for Alcohol Problems registration number ISRCTN76465238).
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Affiliation(s)
- Vikram Patel
- Sangath Centre, Alto-Porvorim, 403521 Goa, India.
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Rehm J, Rehm M, Shield KD, Gmel G, Frick U, Mann K. Reduzierung alkoholbedingter Mortalität durch Behandlung der Alkoholabhängigkeit. SUCHT-ZEITSCHRIFT FUR WISSENSCHAFT UND PRAXIS 2014. [DOI: 10.1024/0939-5911.a000299] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fragestellung: Ziel dieser Studie ist es, die von riskantem Trinken und von Alkoholabhängigkeit in Deutschland verursachte Krankheitslast zu quantifizieren. Weiterhin sollen die erwartbaren Auswirkungen eines verbesserten Zugangs von Alkoholabhängigen zu effektiven Therapien auf die alkoholbedingte Sterblichkeit abgeschätzt werden. Methodik: Die Krankheitslast wurde anhand von „Attributable Fractions“ berechnet, die den durch die jeweilige Exposition bedingten Anteil an den Todesfällen einer umfassenden Liste von durch Alkohol verursachten Krankheiten beziffern. Mögliche Auswirkungen eines verbesserten Zugangs zu Behandlungen wurden berechnet durch modellgemäße Veränderungen in der Zusammensetzung der trinkenden Bevölkerung. Alle Modelle legten das Jahr 2004 und die Bevölkerung zwischen 15 und 64 Jahren zugrunde, d. h. ausschließlich vorzeitige Todesfälle wurden berücksichtigt. Ergebnisse: Riskantes Trinken ist bei Frauen für rund 58 % und bei Männern für rund 71 % aller vorzeitigen alkoholbedingten Todesfälle ursächlich. Die entsprechenden Anteile der mit riskantem Trinken stark überlappenden Kategorie der Alkoholabhängigkeit liegen bei 40 % (Frauen) und 68 % (Männer). Eine Erhöhung der gegenwärtigen Behandlungsquote auf 40 % aller Alkoholabhängigen zeitigte eine Verringerung um bis zu 13,1 % bei den männlichen und 10,7 % bei den weiblichen alkoholbedingten Todesfällen innerhalb eines Jahres, eine Erhöhung auf 20 % war mit einer Verringerung um bis zu 6.5 % bei den männlichen und 5.3 % bei den weiblichen alkoholbedingten Todesfällen verbunden. Schlussfolgerungen: Durch einen verbesserten Zugang besonders der abhängig Erkrankten zu effektiven therapeutischen Interventionen könnte ein bedeutsamer Teil der alkoholbedingten Krankheitslast vermindert werden.
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Affiliation(s)
- Jürgen Rehm
- Institut für Klinische Psychologie und Psychotherapie, TU Dresden, Deutschland
- Centre for Addiction and Mental Health (CAMH), Toronto, Kanada
- Institute of Medical Science, University of Toronto, Kanada
- Dalla Lana School of Public Health (DLSPH), University of Toronto, Kanada
- Department of Psychiatry, University of Toronto, Kanada
| | - Maximilien Rehm
- Faculty of Arts and Sciences/Politics and Governance, Ryerson University, Toronto, Kanada
| | - Kevin D. Shield
- Centre for Addiction and Mental Health (CAMH), Toronto, Kanada
- Institute of Medical Science, University of Toronto, Kanada
| | - Gerrit Gmel
- Centre for Addiction and Mental Health (CAMH), Toronto, Kanada
| | - Ulrich Frick
- Klinik & Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg, Deutschland
- Fachhochschule Kärnten, Bereich Gesundheit & Soziales, Österreich
| | - Karl Mann
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland
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Screening and brief interventions for hazardous and harmful alcohol use among hospital outpatients in South Africa: results from a randomized controlled trial. BMC Public Health 2013; 13:644. [PMID: 23844552 PMCID: PMC3849548 DOI: 10.1186/1471-2458-13-644] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 06/12/2013] [Indexed: 11/10/2022] Open
Abstract
Background High prevalence rates of hazardous and harmful alcohol use have been found in a hospital outpatient setting in South Africa. Hospital settings are a particularly valuable point of contact for the delivery of brief interventions because of the large access to patient populations each year. With this in mind, the primary purpose of this randomized controlled trial is to provide screening for alcohol misuse and to test the effectiveness of brief interventions in reducing alcohol intake among hospital outpatients in South Africa. Methods The study design for this effectiveness study is a randomized controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by hazardous or harmful drinkers in a hospital setting. Outpatients were screened for alcohol problems, and those identified as hazardous or harmful drinkers were randomized into an experimental or control group. The experimental group received one brief counselling session on alcohol risk reduction, while the control group received a health education leaflet. Results Of the 1419 screened for alcohol misuse who agreed to participate in the trial 392 (27.6%) screened positive for hazardous or harmful use on the Alcohol Use Disorder Identification Test (AUDIT) (score 7/8-19) and 51 (3.6%) had an AUDIT score of 20 or more. Among the 282 (72%) hospital outpatients who also attended the 12-month follow-up session, the time effects on the AUDIT scores were significant [F (1,195 = 7.72), P < 0.01] but the intervention effect on the AUDIT score was statistically not significant [F (1,194 = 0.06), P < 0.804]. Conclusion Given the lack of difference in outcome between control and intervention group, alcohol screening and the provision of an alcohol health education leaflet may in itself cause reduction in drinking. Trial registration PACTR201110000319392
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Mdege ND, Fayter D, Watson JM, Stirk L, Sowden A, Godfrey C. Interventions for reducing alcohol consumption among general hospital inpatient heavy alcohol users: a systematic review. Drug Alcohol Depend 2013; 131:1-22. [PMID: 23474201 DOI: 10.1016/j.drugalcdep.2013.01.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is growing interest in pro-active detection and provision of interventions for heavy alcohol use in the general hospital inpatient population. We aimed to determine, from the available evidence, the effectiveness of interventions in reducing alcohol consumption among general hospital inpatient heavy alcohol users. METHODS The following databases were searched for completed and on-going randomised and non-randomised controlled studies published up to November 2012: MEDLINE; C2-SPECTR; CINAHL; The Cochrane Library; Conference Proceedings Citation Index: Science; EMBASE; HMIC; PsycInfo; Public Health Interventions Cost Effectiveness Database (PHICED); and ClinicalTrials.gov. Studies were screened independently by two reviewers. Data extraction was performed by one reviewer and independently checked by a second. RESULTS Twenty-two studies which met the inclusion criteria enrolled 5307 participants in total. All interventions were non-pharmacological and alcohol focused. Results from single session brief interventions and self-help literature showed no clear benefit on alcohol consumption outcomes, with indications of benefit from some studies but not others. However, results suggest brief interventions of more than one session could be beneficial on reducing alcohol consumption, especially for non-dependent patients. No active intervention was found superior over another on alcohol consumption and other outcomes. CONCLUSIONS Brief interventions of more than one session could be beneficial on reducing alcohol consumption among hospital inpatients, especially for non-dependent patients. However, additional evidence is still needed before more definitive conclusions can be reached.
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Affiliation(s)
- Noreen D Mdege
- Department of Health Sciences, University of York, Heslington, York, UK.
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Rehm J, Roerecke M. Reduction of Drinking in Problem Drinkers and All-Cause Mortality. Alcohol Alcohol 2013; 48:509-13. [DOI: 10.1093/alcalc/agt021] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Mdege ND, Watson J. Predictors of study setting (primary care vs. hospital setting) among studies of the effectiveness of brief interventions among heavy alcohol users: A systematic review. Drug Alcohol Rev 2013; 32:368-80. [DOI: 10.1111/dar.12036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/05/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Noreen Dadirai Mdege
- Addiction Research Group; Department of Health Sciences; University of York; York; UK
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Tsai YF, Lin YP, Tsai MC, Weng CE, Chen CY. Hazardous alcohol-drinking problems among a Chinese hospital patient population. J Adv Nurs 2012; 69:1819-28. [PMID: 23157429 DOI: 10.1111/jan.12043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2012] [Indexed: 11/28/2022]
Abstract
AIM The aims of this study were to explore: (1) the prevalence and predictors for hazardous alcohol-drinking problems; and (2) previous assessments and interventions for alcohol-drinking problems in hospitalized Chinese patients. BACKGROUND Alcohol is legally accessible and widely used in Taiwan, but few studies have addressed alcohol-drinking problems in hospital settings. DESIGN A cross-sectional design was used. METHOD Self-report data were collected in 2009 from 484 patients at five randomly selected general teaching hospitals. FINDINGS The prevalence of hazardous alcohol-drinking problems was 19·2%. Logistic regression analysis revealed that predictors for hazardous drinking problems were being male, smoking, and chewing betel quid. Only 29·1% of participants had been assessed for drinking problems in the past year. Only 38·7% of participants with drinking problems had received a drinking intervention in the past year. CONCLUSION These findings suggest that alcohol problems in Taiwanese general teaching hospitals are insufficiently assessed and targeted with interventions. Targeting high-risk groups in general teaching hospitals is important to prevent patients' drinking problems.
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Affiliation(s)
- Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
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Wilson GB, Heather N, Kaner EFS. New developments in brief interventions to treat problem drinking in nonspecialty health care settings. Curr Psychiatry Rep 2011; 13:422-9. [PMID: 21744155 PMCID: PMC3166704 DOI: 10.1007/s11920-011-0219-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The delivery of brief interventions (BIs) in health care settings to reduce problematic alcohol consumption is a key preventive strategy for public health. However, evidence of effectiveness beyond primary care is inconsistent. Patient populations and intervention components are heterogeneous. Also, evidence for successful implementation strategies is limited. In this article, recent literature is reviewed covering BI effectiveness for patient populations and subgroups, and design and implementation of BIs. Support is evident for short-term effectiveness in hospital settings, but long-term effects may be confounded by changes in control groups. Limited evidence suggests effectiveness with young patients not admitted as a consequence of alcohol, dependent patients, and binge drinkers. Influential BI components include high-quality change plans and provider characteristics. Health professionals endorse BI and feel confident in delivering it, but training and support initiatives continue to show no significant effects on uptake, prompting calls for systematic approaches to implementing BI in health care.
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Affiliation(s)
- Graeme B. Wilson
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne, NE2 4AX UK
| | - Nick Heather
- Department of Psychology, School of Life Sciences, Northumbria University, Northumberland Building, Newcastle Upon Tyne, NE1 8ST UK
| | - Eileen F. S. Kaner
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne, NE2 4AX UK
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McQueen J, Howe TE, Allan L, Mains D, Hardy V. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev 2011; 2011:CD005191. [PMID: 21833953 PMCID: PMC10600352 DOI: 10.1002/14651858.cd005191.pub3] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Brief interventions involve a time-limited intervention focusing on changing behaviour. They are often motivational in nature using counselling skills to encourage a reduction in alcohol consumption. OBJECTIVES To determine whether brief interventions reduce alcohol consumption and improve outcomes for heavy alcohol users admitted to general hospital inpatient units. SEARCH STRATEGY We searched the Cochrane Drug and Alcohol Group Register of Trials (March 2011) the Cochrane Central Register of Controlled Trials (The Cochrane Library March 2011), MEDLINE January 1966-March 2011, CINAHL 1982-March 2011, EMBASE 1980-March 2011 and www.clinicaltrials.gov to April 2011 and performed some relevant handsearching. SELECTION CRITERIA All prospective randomised controlled trials and controlled clinical trials were eligible for inclusion. Participants were adults and adolescents (16 years or older) admitted to general inpatient hospital care for any reason other than specifically for alcohol treatment and received brief interventions (of up to 3 sessions) compared to no or usual care. DATA COLLECTION AND ANALYSIS Three reviewers independently selected the studies and extracted data. Where appropriate random effects meta-analysis and sensitivity analysis were performed. MAIN RESULTS Forteen studies involving 4041 mainly male participants were included. Our results demonstrate that patients receiving brief interventions have a greater reduction in alcohol consumption compared to those in control groups at six month, MD -69.43 (95% CI -128.14 to -10.72) and nine months follow up, MD -182.88 (95% CI -360.00 to -5.76) but this is not maintained at one year. Self reports of reduction of alcohol consumption at 1 year were found in favour of brief interventions, SMD -0.26 (95% CI -0.50 to -0.03). In addition there were significantly fewer deaths in the groups receiving brief interventions than in control groups at 6 months, RR 0.42 (95% CI 0.19 to 0.94) and one year follow up, RR 0.60 (95% CI 0.40 to 0.91). Furthermore screening, asking participants about their drinking patterns, may also have a positive impact on alcohol consumption levels and changes in drinking behaviour. AUTHORS' CONCLUSIONS The main results of this review indicate that there are benefits to delivering brief interventions to heavy alcohol users admitted to general hospital wards in terms of reduction in alcohol consumption and death rates. However, these findings are based on studies involving mainly male participants. Further research is required determine the optimal content and treatment exposure of brief interventions within general hospital settings and whether they are likely to be more successful in patients with certain characteristics.
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Affiliation(s)
- Jean McQueen
- University of GlasgowMRC/CSO Social and Public Health Sciences Unit200, Renfield StreetGlasgowUKG2 3QB
| | - Tracey E Howe
- Glasgow City of ScienceGlasgow Caledonian UniversityGlasgowScotlandUKG4 0BA
| | - Linda Allan
- Southern General HospitalTherapy centreGlasgowUKG51 4TF
| | - Diane Mains
- Victoria InfirmaryOccupational Therapy DepartmentGlasgowUKG42 9TY
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