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Gourlan M, Ricupero S, Carayol M, Cousson-Gélie F. Efficacy of theory-based interventions aimed at reducing binge drinking in adolescents: A systematic review and meta-analysis of randomised controlled trials. Soc Sci Med 2023; 317:115571. [PMID: 36455407 DOI: 10.1016/j.socscimed.2022.115571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Binge drinking is a widespread practice among adolescents worldwide and is associated with various harmful consequences. Theory-based interventions are a promising approach to prevent this drinking behaviour in this population. The aim of the present review was to determine: (1) the characteristics of theory-based interventions targeting binge drinking in adolescents, (2) the impact of such interventions on binge drinking, and (3) the quality of theoretical implementation. METHODS For this systematic review, randomised controlled trials were eligible for inclusion if the binge drinking-targeting intervention was based at least on one theoretical framework, and if the population's mean age was between 10 and 18 years. Two authors extracted relevant data. A meta-analysis was conducted to evaluate the effect of interventions on binge drinking. Effect sizes were calculated with the Hedges's g. Binge drinking was measured as a continuous or dichotomous outcome. The quality of theoretical implementation of interventions was measured using an existing "theory coding scheme". RESULTS Sixteen studies were identified. Ten were based on a single theory, and six on a combination of theories. The number and type of behaviour change techniques used in each intervention varied greatly. Theory-based interventions led to a small but significant decrease in binge drinking (Hedges's g = 0.10; 95% confidence interval = 0.04, 0.16). The quality of theoretical implementation was globally low, and the reciprocal link between behaviour change techniques and theoretical constructs was unclear for most studies. CONCLUSIONS Theory-based interventions have a small but significant beneficial impact on decreasing binge drinking in adolescents. Future research should try to be more effective in matching theoretical determinants of behaviour with the content of the intervention.
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Affiliation(s)
- Mathieu Gourlan
- Epidaure-Prevention Department of the Montpellier Cancer Institute, France; Univ. Paul Valéry Montpellier 3 -EPSYLON EA 4556, F34000, Montpellier, France.
| | - Sarah Ricupero
- Epidaure-Prevention Department of the Montpellier Cancer Institute, France; Univ. Paul Valéry Montpellier 3 -EPSYLON EA 4556, F34000, Montpellier, France
| | - Marion Carayol
- Epidaure-Prevention Department of the Montpellier Cancer Institute, France; Univ. Paul Valéry Montpellier 3 -EPSYLON EA 4556, F34000, Montpellier, France; IAPS Laboratory "Impact of Physical Activity on Health", University of Toulon, France
| | - Florence Cousson-Gélie
- Epidaure-Prevention Department of the Montpellier Cancer Institute, France; Univ. Paul Valéry Montpellier 3 -EPSYLON EA 4556, F34000, Montpellier, France
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Martin J, Liddell M, Roberts S, Greenwood E. Effective therapeutic interventions for Australian adolescents using alcohol and/or other drugs: a scoping review. Int J Ment Health Syst 2020; 14:91. [PMID: 33372620 PMCID: PMC7720628 DOI: 10.1186/s13033-020-00425-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/29/2020] [Indexed: 11/14/2022] Open
Abstract
Background There are a variety of residential and community service models of therapeutic interventions for people using substances. The focus of much of the currently available research is on adult populations with relatively little known about effective therapeutic interventions for adolescents. The aim of this paper is to identify the most effective therapeutic interventions for Australian adolescents using substances by conducting a systematic scoping literature review. Methods We followed the PRISMA guidelines to conduct a systematic scoping review that included searches of nine electronic databases (EMBASE, MEDLINE, EBSCO Host, APA PsycNet, SocIndex, Social Science Abstracts, Proquest Central Informit) and grey literature searches of government department and alcohol and other drugs peak body and service provider websites, Google Scholar and the Cochrane library. Results A total of 21 studies were identified. These studies included biological, psychological, social and technological therapeutic interventions targeted at different population groups and different substances. The review findings are limited and should considered with caution due to the inability to disaggregate the combinations of interventions provided and the low quality of most of the studies included. Conclusions This scoping review highlights the paucity of quality research on effective therapeutic interventions for Australian adolescents using substances. This is primarily due to the available studies not controlling for all of the therapeutic interventions provided. While there is an evidence-base for some of these interventions, others such as encounter groups and journaling require further and more substantive research for use with adolescents. This is necessary to enable informed service design and delivery decision-making and fiscal accountability.
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Affiliation(s)
- Jennifer Martin
- Social Innovation Research Institute, Faculty of Health Arts and Design, Swinburne University, Swinburne University of Technology, Office AS430 L Internal Mail H31, PO Box 218, Hawthorn, VIC, 3122, Australia.
| | - Marg Liddell
- Social and Global Studies Centre, RMIT University, GPO Box 2476, Melbourne, VIC, 3001, Australia
| | - Susan Roberts
- Swinburne University of Technology, Swinburne Library C/-AS430 L Internal Mail H31, PO Box 218, Hawthorn, VIC, 3122, Australia
| | - Emily Greenwood
- Swinburne University of Technology, Office: c/-AS430 l Internal Mail H31, PO Box 218, Hawthorn, VIC, 3122, Australia
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Smith L, Disler R, Watson K. Physical activity and dietary habits of first year nursing students: An Australian dual-method study. Collegian 2020. [DOI: 10.1016/j.colegn.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Deluca P, Coulton S, Alam MF, Boniface S, Donoghue K, Gilvarry E, Kaner E, Lynch E, Maconochie I, McArdle P, McGovern R, Newbury-Birch D, Patton R, Pellatt-Higgins T, Phillips C, Phillips T, Pockett R, Russell IT, Strang J, Drummond C. Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Alcohol consumption and related harm increase steeply from the ages of 12–20 years. Adolescents in the UK are among the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected or regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most clinically effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (EDs).
Objectives
To estimate the distribution of alcohol consumption, alcohol-related problems and alcohol use disorders in adolescents attending EDs; to develop age-appropriate alcohol screening and brief intervention tools; and to evaluate the clinical effectiveness and cost-effectiveness of these interventions.
Design
The research has been conducted in three linked stages: (1) a prevalence study, (2) intervention development and (3) two linked randomised controlled trials (RCTs).
Setting
Twelve EDs in England (London, North East, and Yorkshire and The Humber).
Participants
A total of 5376 participants in the prevalence study [mean age 13.0 years, standard deviation (SD) 2.0 years; 46.2% female] and 1640 participants in the two linked RCTs (mean age 15.6 years, SD 1.0 years; 50.7% female).
Interventions
Personalised feedback and brief advice (PFBA) and personalised feedback plus electronic brief intervention (eBI), compared with alcohol screening alone. These age-appropriate alcohol interventions were developed in collaboration with the target audience through a series of focus groups and evaluations during stage 2 of the research programme and following two literature reviews.
Main outcome measures
Total alcohol consumed in standard UK units (1 unit = 8 g of ethanol) over the previous 3 months at 12-month follow-up, assessed using the Alcohol Use Disorders Identification Test, Consumption (3 items) (AUDIT-C).
Results
In the prevalence study, 2112 participants (39.5%) reported having had a drink of alcohol that was more than a sip in their lifetime, with prevalence increasing steadily with age and reaching 89.5% at the age of 17 years. The prevalence of at-risk alcohol consumption was 15% [95% confidence interval (CI) 14% to 16%] and the optimum cut-off point of the AUDIT-C in identifying at-risk drinking was ≥ 3. Associations of alcohol consumption and early onset of drinking with poorer health and social functioning were also found. In the RCT, the analysis of the primary outcome (average weekly alcohol consumption at month 12) identified no significant differences in effect between the three groups in both trials. In the high-risk drinking trial, the mean difference compared with control was 0.57 (95% CI –0.36 to 1.70) for PFBA and 0.19 (95% CI –0.71 to 1.30) for eBI. In the low-risk drinking trial, the mean difference compared with control was 0.03 (95% CI –0.07 to 0.13) for PFBA and 0.01 (95% CI –0.10 to 0.11) for eBI. The health economic analysis showed that eBI and PFBA were not more cost-effective than screening alone.
Conclusions
The ED can offer an opportunity for the identification of at-risk alcohol use in adolescents. A simple, short, self-completed screening instrument, the AUDIT-C, is an effective tool for identifying adolescents who are at risk of alcohol-related problems. Associations of alcohol consumption and earlier onset of drinking with poorer health and social functioning were observed in the prevalence study. The trials were feasible to implement and exceeded the recruitment target and minimum follow-up rates. However, PFBA and eBI were not found to be more effective than screening alone in reducing or preventing alcohol consumption in 14- to 17-year-olds attending EDs.
Limitations and future work
Only one-third of participants engaged with the application program; this is likely to have limited the effect of the intervention. We recommend that future research should focus on methods to maximise engagement with digital interventions and evaluate the effect of such engagement on clinical outcomes.
Trial registration
Current Controlled Trials ISRCTN45300218.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paolo Deluca
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Sadie Boniface
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kim Donoghue
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Eilish Gilvarry
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ellen Lynch
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College London, London, UK
| | - Paul McArdle
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Robert Patton
- School of Psychology, University of Surrey, Guildford, UK
| | | | - Ceri Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Thomas Phillips
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Rhys Pockett
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | - John Strang
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Colin Drummond
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Trefan L, Gartner A, Alcock A, Farewell D, Morgan J, Fone D, Paranjothy S. Epidemiology of alcohol-related emergency hospital admissions in children and adolescents: An e-cohort analysis in Wales in 2006-2011. PLoS One 2019; 14:e0217598. [PMID: 31163052 PMCID: PMC6548373 DOI: 10.1371/journal.pone.0217598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/14/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Harmful levels of alcohol consumption in young people are prevalent and of increasing public concern in the western world. Rates of alcohol-related emergency hospital admissions in children and young people between 10 to 17 years were described, and the reasons for these admissions and their association with socio-demographic factors were examined. METHODS E-cohort data were extracted from the Secure Anonymised Information Linkage Databank, which contained alcohol-related emergency hospital admissions (N = 2968) from 2006 to 2011 in children and adolescents aged 10 to 17 years in Wales. A generalised linear mixed model was fitted using a log-link with a population offset to the data to calculate incident rate ratios (IRRSs). RESULTS There was a general decreasing trend from 2006 to 2011 in the number and rate of alcohol-related emergency hospital admissions; the mean age of admission was 15.4 (standard deviation 1.4) years. In each of the four youngest age groups (10-13,14,15,16 years), females had higher IRRs than males. Males had slightly higher IRR compared to females only in the oldest age group (17 years). IRRs increased with increasing deprivation. The majority (92%) of the admissions lasted one day and most of the admissions (70%) occured during the last three days of the week with a peak on Saturday. The length of stay in hospital was longer in cases when self-harm were present. Multiple admissions showed high prevalance of serious self-harm cases in females. The number of admissions with injuries and falls were higher for males than females. CONCLUSION Female children and adolescents were more likely to be admitted to hospital for alcohol-related reasons. These data illustrate the significant burden of alcohol-related harm in young people and highlight the need for interventions and policies that promote safe drinking practices among young people to prevent future alcohol-related harm during the life-course.
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Affiliation(s)
- Laszlo Trefan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Andrea Gartner
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Amy Alcock
- Royal Gwent Hospital, Newport, United Kingdom
| | - Daniel Farewell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | - David Fone
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Shantini Paranjothy
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
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Foster S, Gmel G, Mohler-Kuo M. Light and heavy drinking in jurisdictions with different alcohol policy environments. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 65:86-96. [PMID: 30711804 DOI: 10.1016/j.drugpo.2019.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/14/2018] [Accepted: 01/06/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND A basic, yet untested tenet underlying alcohol control policies is that they should affect both light and heavy drinking, thereby shifting the entire population in a favourable direction. The aim of this study was to test this assumption in young Swiss men. METHODS Cross-sectional self-reported data - from 5755 young Swiss men participating in the Cohort Study on Substance Use Risk Factors (C-SURF), a large cohort study on young men living within 21 jurisdictions across Switzerland - were analysed via nested logistic regression. With this approach, a set of increasingly-heavy drinking patterns was broken down into a set of nested regression models, each one estimating the probability of heavier drinking, conditional on the lighter drinking pattern. Drinking patterns relating to heavy episodic drinking (HED), heavy volume drinking (HVD) on weekends, and workweek drinking, as well as alcohol use disorder (AUD) were examined. The explanatory variable was a previously-used alcohol policy environment index (APEI) reflecting the number of alcohol control policies implemented in each jurisdiction. Conventional and multilevel logistic regression models were tested, adjusted for age, education, linguistic region, urban/rural status, attention-deficit/hyperactivity disorder, depression, sensation seeking, antisocial personality disorder, and unobserved heterogeneity between jurisdictions. RESULTS For HED, weekend HVD, and AUD, negative relationships with the APEI were found, such that with a higher APEI the probability of lighter drinking patterns was increased while the probability of heavier patterns was reduced, including a reduced probability of the heaviest patterns. These relationships were non-linear, however, and tapered off towards the heavy end of the drinking spectrum. No relationship was identified between the APEI and workweek drinking patterns. CONCLUSION Among young Swiss men, stricter alcohol policy environments were associated with a global shift towards lighter drinking, consistent with the basic tenet behind the universal prevention approach.
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Affiliation(s)
- Simon Foster
- Department of Child and Adolescent Psychiatry and Psychotherapy (KJPP), University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland; Swiss Research Institute for Public Health and Addiction at the University of Zurich, Zurich, Switzerland.
| | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland; Addiction Switzerland, Lausanne, Switzerland; Centre for Addiction and Mental Health, Toronto, Ontario, Canada; University of the West of England, Bristol, United Kingdom
| | - Meichun Mohler-Kuo
- Department of Child and Adolescent Psychiatry and Psychotherapy (KJPP), University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland; Swiss Research Institute for Public Health and Addiction at the University of Zurich, Zurich, Switzerland; La Source, School of Nursing, University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
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7
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Newton AS, Mushquash C, Krank M, Wild TC, Dyson MP, Hartling L, Stewart SH. When and How Do Brief Alcohol Interventions in Primary Care Reduce Alcohol Use and Alcohol-Related Consequences among Adolescents? J Pediatr 2018; 197:221-232.e2. [PMID: 29656865 DOI: 10.1016/j.jpeds.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 12/20/2017] [Accepted: 02/01/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To systematically describe when and how brief alcohol interventions delivered to adolescents in primary care settings reduce alcohol use and alcohol-related consequences among adolescents, using realist review methodology. STUDY DESIGN Eleven electronic databases, gray literature, and reference screening were searched up to June 2016; 11 brief interventions published in 13 studies met inclusion criteria. Intervention design components (delivery context and intervention mechanisms) underlying brief alcohol interventions for adolescents were extracted and linked to alcohol use and related consequences. RESULTS Brief interventions had either an indicated context of delivery (provided to adolescent patients with low-to-moderate risk for alcohol problems) or universal context of delivery (provided to general adolescent patient population). Interventions that used motivational interviewing in an indicated delivery context had 2 potential mechanisms-eliciting and strengthening motivation to change and providing direction through interpretation. These interventions resulted in clinically significant reductions in alcohol use and associated consequences. Peer risk also was identified among universal and indicated brief interventions as a potential mechanism for changing alcohol-related outcomes among adolescents who received the intervention. None of the studies tested the processes by which interventions were expected to work. CONCLUSIONS The current evidence base suggests that both indicated and universal delivery of brief alcohol interventions to adolescents in primary care settings can result in clinically important changes in alcohol-related outcomes. Studies that test brief intervention processes are now necessary to better understand how brief interventions work with adolescents in primary care settings.
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Affiliation(s)
- Amanda S Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Christopher Mushquash
- Department of Psychology, Lakehead University, and Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Marvin Krank
- Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Michele P Dyson
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sherry H Stewart
- Departments of Psychiatry and of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
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Mewton L, Visontay R, Chapman C, Newton N, Slade T, Kay-Lambkin F, Teesson M. Universal prevention of alcohol and drug use: An overview of reviews in an Australian context. Drug Alcohol Rev 2018; 37 Suppl 1:S435-S469. [DOI: 10.1111/dar.12694] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/17/2018] [Accepted: 02/14/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Louise Mewton
- Centre of Research Excellence in Mental Health and Substance Use; National Drug and Alcohol Research Centre, University of New South Wales; Sydney Australia
| | - Rachel Visontay
- Centre of Research Excellence in Mental Health and Substance Use; National Drug and Alcohol Research Centre, University of New South Wales; Sydney Australia
| | - Cath Chapman
- Centre of Research Excellence in Mental Health and Substance Use; National Drug and Alcohol Research Centre, University of New South Wales; Sydney Australia
| | - Nicola Newton
- Centre of Research Excellence in Mental Health and Substance Use; National Drug and Alcohol Research Centre, University of New South Wales; Sydney Australia
| | - Tim Slade
- Centre of Research Excellence in Mental Health and Substance Use; National Drug and Alcohol Research Centre, University of New South Wales; Sydney Australia
| | - Frances Kay-Lambkin
- Centre of Research Excellence in Mental Health and Substance Use; National Drug and Alcohol Research Centre, University of New South Wales; Sydney Australia
| | - Maree Teesson
- Centre of Research Excellence in Mental Health and Substance Use; National Drug and Alcohol Research Centre, University of New South Wales; Sydney Australia
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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: 95] [Impact Index Per Article: 13.6] [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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Arnaud N, Diestelkamp S, Wartberg L, Sack P, Daubmann A, Thomasius R. Short- to Midterm Effectiveness of a Brief Motivational Intervention to Reduce Alcohol Use and Related Problems for Alcohol Intoxicated Children and Adolescents in Pediatric Emergency Departments: A Randomized Controlled Trial. Acad Emerg Med 2017; 24:186-200. [PMID: 27801991 DOI: 10.1111/acem.13126] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/29/2016] [Accepted: 10/19/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The proportion of children and adolescents receiving emergency care for acute alcohol intoxication (AAI) in Germany has sharply increased over the past years. Despite this, no randomized controlled trials (RCTs) have studied guideline- and evidence-based interventions to prevent future alcohol misuse within this population. The objective of our investigation was to evaluate the effectiveness of a brief motivational intervention (b-MI) to reduce drinking and associated problems within pediatric emergency departments (PED) in Hamburg, Germany. METHODS This stratified cluster-RCT compared a widely established but modified targeted b-MI and treatment as usual (TAU) for patients recruited and treated on Fridays, Saturdays, or Sundays from July 2011 to January 2014 for AAI in EDs of six pediatric hospitals in Hamburg, Germany. Patients under the age of 18 years and their caregivers were included in the study. Intervention was delivered by trained hospital-external staff. The intervention group (n = 141) received a single-session b-MI with a telephone booster after 6 weeks and a brief consultation for caregivers. All intervention material was manual-based. The TAU control group (n = 175) received youth-specific written information on alcohol use and contact information for community resources. Primary outcomes were changes in binge drinking frequency, number of alcoholic drinks on a typical occasion, and alcohol-related problems using the brief Rutgers Alcohol Problem Index. Outcomes were measured by research assistants not involved in intervention delivery. Baseline data were collected in person at the PED, and follow-up data were collected via telephone 3 and 6 months after baseline. Secondary outcome was postenrollment health service utilization. Analyses were based on linear mixed models and intent to treat. RESULTS A total of 86.1% (87.5%) of patients in the b-MI group and 82.4% (86.9%) in the TAU group provided valid outcome data after 3 (6) months, respectively. The differences between groups for all outcomes were statistically nonsignificant at both follow-ups (p > 0.05). After 3 months the mean change in binge drinking frequency was -1.36 (95% confidence interval [CI] = -1.81 to -0.91), a reduction of 62.1% in the b-MI group, and -1.29 (95% CI = -1.77 to -0.95), a reduction of 49.0% in the TAU group. The mean change in number of alcoholic drinks on a typical occasion was -2.24 (95% CI = -3.18 to -1.29), a reduction of 37.5% in the b-MI group, and -1.34 (95% CI = -2.54 to -0.14), a reduction of 26.4% in the TAU group. The mean change of alcohol-related problems was -6.72 (95% CI = -7.68 to -5.76), a reduction of 60.5% in the b-MI group, and -6.43 (95% CI = -7.37 to -5.49), a reduction of 58.3% in the TAU group. The differences in mean changes between groups were similar after 6 months for all outcomes. CONCLUSION This study provides new information on the effectiveness of b-MIs delivered at discharge of young AAI patients in emergency care. Both trial groups reduced alcohol use and related problems but the b-MI was not associated with significant effects. Although the intervention approach appears feasible, further considerations of improving the outcomes for this relevant target group are required.
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Affiliation(s)
- Nicolas Arnaud
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Silke Diestelkamp
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Lutz Wartberg
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Peter‐Michael Sack
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Rainer Thomasius
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
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11
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Yeh MY, Tung TH, Horng FF, Sung SC. Effectiveness of a psychoeducational programme in enhancing motivation to change alcohol-addictive behaviour. J Clin Nurs 2017; 26:3724-3733. [PMID: 28122409 DOI: 10.1111/jocn.13744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of a psychoeducational programme in enhancing motivation to change alcohol-addictive behaviour. BACKGROUND The prevalence of alcohol abuse has increased over the past 10 years, and the age of initial alcohol use has decreased gradually in Taiwan. Alcohol dependence is one of the leading causes of disability and has led to increases in the incidence of crime and violence, with alcohol abuse identified as a problem in society. DESIGN A quasi-experimental design with nonequivalent pre/post-testing was used. METHODS Alcohol-dependent inpatients undergoing alcohol treatment were selected from the psychiatric ward of a teaching hospital in northern Taiwan. The effectiveness of the psychoeducational programme in enhancing motivation to change alcohol-addictive behaviour was evaluated with the Severity of Alcohol Dependence Data Questionnaire and the Stages of Change Readiness and Treatment Eagerness Scale. In total, 24 and 51 participants were recruited to the experimental and control groups, respectively, for the baseline survey, and 14 and 17 were in the final survey, respectively. RESULTS After adjustment for baseline survey scores, the experimental group showed significantly greater increases in recognition and ambivalence relative to those observed in the control group. CONCLUSIONS The results not only showed that the psychoeducational programme was effective in reinforcing addicted inpatients' motivation for changing their drinking behaviour but also provided clinical nurses with practical methods via which to enhance patient motivation. RELEVANCE TO CLINICAL PRACTICE The psychoeducational programme could assist clinical nurses in helping alcohol-dependent patients to recognise the nature of their problematic drinking; increase participants' ambivalence towards their drinking behaviour, leading to the contemplation of change; and strengthen the possibility that they will change their addictive behaviour.
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Affiliation(s)
- Mei-Yu Yeh
- Department of Nursing, School of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng-Hsin General Hospital, Pai-Tou, Taipei, Taiwan.,Department of Public Health, School of Medicine, Fu-Jen Catholic University, Xinzhuang Dist, New Taipei City, Taiwan
| | - Fen-Fang Horng
- Department of Nursing, Hiten Medical Corporation Hiten Mental Hospital, Zhuangwei, Yilan, Taiwan
| | - Su-Ching Sung
- Graduate Institute of Health Care, Chang Gung University of Science and Technology, Guishan Dist., Taoyuan City, Taiwan
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Dir AL, Bell RL, Adams ZW, Hulvershorn LA. Gender Differences in Risk Factors for Adolescent Binge Drinking and Implications for Intervention and Prevention. Front Psychiatry 2017; 8:289. [PMID: 29312017 PMCID: PMC5743668 DOI: 10.3389/fpsyt.2017.00289] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/04/2017] [Indexed: 11/26/2022] Open
Abstract
Alcohol use, particularly binge drinking (BD), is a major public health concern among adolescents. Recent national data show that the gender gap in alcohol use is lessening, and BD among girls is rising. Considering the increase in BD among adolescent girls, as well as females' increased risk of experiencing more severe biopsychosocial negative effects and consequences from BD, the current review sought to examine gender differences in risk factors for BD. The review highlights gender differences in (1) developmental-related neurobiological vulnerability to BD, (2) psychiatric comorbidity and risk phenotypes for BD, and (3) social-related risk factors for BD among adolescents, as well as considerations for BD prevention and intervention. Most of the information gleaned thus far has come from preclinical research. However, it is expected that, with recent advances in clinical imaging technology, neurobiological effects observed in lower mammals will be confirmed in humans and vice versa. A synthesis of the literature highlights that males and females experience unique neurobiological paths of development, and although there is debate regarding the specific nature of these differences, literature suggests that these differences in turn influence gender differences in psychiatric comorbidity and risk for BD. For one, girls are more susceptible to stress, depression, and other internalizing behaviors and, in turn, these symptoms contribute to their risk for BD. On the other hand, males, given gender differences across the lifespan as well as gender differences in development, are driven by an externalizing phenotype for risk of BD, in part, due to unique paths of neurobiological development that occur across adolescence. With respect to social domains, although social and peer influences are important for both adolescent males and females, there are gender differences. For example, girls may be more sensitive to pressure from peers to fit in and impress others, while male gender role stereotypes regarding BD may be more of a risk factor for boys. Given these unique differences in male and female risk for BD, further research exploring risk factors, as well as tailoring intervention and prevention, is necessary. Although recent research has tailored substance use intervention to target males and females, more literature on gender considerations in treatment for prevention and intervention of BD in particular is warranted.
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Affiliation(s)
- Allyson L Dir
- Department of Pediatric Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Richard L Bell
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Zachary W Adams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
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Thomasius R, Sack PM, Arnaud N, Hoch E. [Treatment of alcohol-related disorders in children and adolescents: Age-specific treatment recommendations from the new interdisciplinary S3-guideline]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 44:295-303; quiz 304-5. [PMID: 27434689 DOI: 10.1024/1422-4917/a000435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objective Alcohol-related disorders typically have an early onset. However, current treatment provisions often fail to address developmental aspects adequately. Recently, the new evidence- and interdisciplinary consensus-based German S3-guideline (National Clinical Practice Guideline) was established for the screening, diagnosis, and treatment of alcohol-related disorders in young patients. For the first time it includes population-specific recommendations. Method For this new S3-guideline, 23 source guidelines, 28 systematic reviews, and 2,213 study reports were analyzed. An interdisciplinary consensus conference devised 174 recommendations with 14 specific recommendations for children and adolescents. Depending on the quality of evidence, they issued “must,” “should,” and “can” recommendations or a “clinical consensus point (CCP).“ Results For the psychotherapeutic treatment of children and adolescents with alcohol-related disorders, a “must” recommendation was devised for motivational interviewing, cognitive behavior therapy, and inclusion of family members in treatment. Recommendations for family-based therapies are heterogeneous. For psychosocial therapies (psychoeducation, parent counseling, ergotherapy, also hospital schools) a CCP was devised. Concerning pharmacological treatment, the evidence base was insufficient; only for treating comorbid disorders (ADHS) could a CCP be derived. As to differential indications, elevated risks for suicide, for treatment dropout, and for delinquency influenced by copatients should be considered (CCP). Conclusions Numerous population-specific recommendations have been issued for the treatment of alcohol-related disorders in youths. However, urgent research requirements have been identified especially in medical drug treatment.
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Affiliation(s)
- Rainer Thomasius
- 1 Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ), Universitätsklinikum Hamburg-Eppendorf
| | - Peter-Michael Sack
- 1 Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ), Universitätsklinikum Hamburg-Eppendorf
| | - Nicolas Arnaud
- 1 Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ), Universitätsklinikum Hamburg-Eppendorf
| | - Eva Hoch
- 2 Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit (ZI), Mannheim
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14
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[Influence of Counsellor- and Intervention Variables on Motivation to Change Following a Brief Motivational Intervention to Reduce Risky Alcohol Use]. Prax Kinderpsychol Kinderpsychiatr 2016; 65:534-49. [PMID: 27595811 DOI: 10.13109/prkk.2016.65.7.534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Influence of Counsellor- and Intervention Variables on Motivation to Change Following a Brief Motivational Intervention to Reduce Risky Alcohol Use Brief interventions are recommended for prevention and early intervention of risky alcohol use. However, evidence of their effectiveness, in particular for children and adolescents, is heterogeneous. Analysis of counsellor and intervention variables may provide insights into mechanisms of action in brief interventions and thereby contribute to an enhanced effectiveness. We analyzed data of N = 141 children and adolescents who were treated for acute alcohol intoxication in the emergency department. Study participants received a brief motivational intervention to reduce risky alcohol use during hospitalization. We applied multiple regression analysis to examine counsellor variables (empathy, affirmation, competence, congruence) and intervention variables (readiness and confidence ruler, decisional balance, goal agreement) as predictors of motivation to change. Higher scores on the basic therapeutic skill "positive affirmation" (R2 = 7.1 %; p < .01), finishing the intervention with a written goal agreement (R2 = 2.9 %; p < .05) and younger age were associated with greater readiness to change (R2 = 10.2 %; p < .01). Therefore, a special focus should be put on the counsellor skill "positive affirmation" when training new counsellors. Results also indicate that younger patients respond stronger to a brief intervention in this context.
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15
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Tait RJ, Teoh L, Kelty E, Geelhoed E, Mountain D, Hulse GK. Emergency department based intervention with adolescent substance users: 10year economic and health outcomes. Drug Alcohol Depend 2016; 165:168-74. [PMID: 27317044 DOI: 10.1016/j.drugalcdep.2016.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alcohol and other drug (AOD) use are significant cause of disease burden and costs among adolescents. METHODS We conducted a randomized trial in hospital emergency departments (ED) following an AOD-related presentation, comparing usual care with brief advice and referral to link adolescents aged 12-19 years with external AOD services. Subsequently, we used health data linkage to assemble data on mortality, hospital admissions, ED attendances, out-patient mental health and use of opiate pharmacotherapies in the next 10 years. From these, treatment costs and rates of events were estimated and compared using generalized linear models. RESULTS Those who received the intervention had lower costs ($22 versus $227: z=3.16, p=0.002) and rates (0.03 versus 0.25: z=2.57, p=0.010) of ED mental health AOD presentations. However, the intervention did not significantly reduce overall mean health costs per patient (intervention $58746 versus control $64833, p=0.800). Similarly, there was no significant difference in the costs associated with hospitalizations ($48920 versus $50911 p=0.924), overall ED presentations ($4266 versus $4150, p=0.916), out-patient mental health services ($4494 versus $7717, p=0.282), or opiate pharmacotherapies ($1013 versus $2054, p=0.209). Injecting drug use was a significant baseline predictor of subsequent costs in the cohort (z=2.64, p=0.008). CONCLUSIONS An ED delivered intervention may reduce direct ED costs and subsequent ED AOD attendances. There was also some indication that overall costs may be impacted, with economically large but non-significant differences between the groups. The high costs and morbidity incurred by some of this cohort illustrate the importance of targeting high-risk adolescents.
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Affiliation(s)
- Robert J Tait
- National Drug Research Institute, Faculty Health Science, Curtin University, Australia.
| | - Lucinda Teoh
- School of Psychiatry and Clinical Neurosciences, the University of Western Australia, Australia; School of Population Health, the University of Western Australia, Australia
| | - Erin Kelty
- School of Psychiatry and Clinical Neurosciences, the University of Western Australia, Australia
| | - Elizabeth Geelhoed
- School of Population Health, the University of Western Australia, Australia
| | - David Mountain
- School of Primary, Aboriginal & Rural Health Care, the University of Western Australia, Australia; Department of Emergency Medicine Sir Charles Gairdner Hospital, Perth, Australia
| | - Gary K Hulse
- School of Psychiatry and Clinical Neurosciences, the University of Western Australia, Australia
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Carney T, Myers B, Louw J. Reliability of the GAIN-SS, CRAFTT and PESQ screening instruments for substance use among South African adolescents. S Afr J Psychiatr 2016; 22:932. [PMID: 30263165 PMCID: PMC6138113 DOI: 10.4102/sajpsychiatry.v22i1.932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 05/23/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction Screening for adolescent substance use can assist with the early identification of substance-related problems and guide the provision of appropriate services. As such, psychometrically sound screening tools are needed. The aim of this study was to compare the reliability of the CRAFFT, Global Appraisal of Individual Needs-Short Screener (GAIN-SS) substance use subscale and Personal Experience Screening Questionnaire (PESQ) among adolescents from disadvantaged communities in Cape Town, South Africa. Methods Adolescents aged 12–19 years (n = 231) completed the three screeners at two points in time. Results Findings show that all three of the screeners had adequate internal consistency (Cronbach α ≥ 0.8). Test-retest reliability was similar for all three screeners, with intraclass correlation coefficient values slightly higher for the PESQ (0.82, 95% CI: 0.77–0.86) than for the GAIN-SS substance use subscale (0.79, 95% CI: 0.73–0.84) and CRAFFT (0.76; 95% CI: 0.66–0.83). Kappa values indicated that the GAIN-SS substance use subscale and CRAFFT had moderate levels of agreement, while the PESQ had substantial levels of agreement for identifying those who had moderate or higher substance use risks at Time 1 and Time 2. Conclusion The findings indicate that all of these short screeners seem to have acceptable reliability when used in this population. All of the three screeners are appropriately reliable when used with adolescents from disadvantaged communities in Cape Town, but the PESQ performed slightly better. Future studies should also include the assessment of validity of these screeners in this context.
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Affiliation(s)
- Tara Carney
- Alcohol, Tobacco and Other Drug Use Research Unit, South African Medical Research Council, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Use Research Unit, South African Medical Research Council, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Johann Louw
- Department of Psychology, University of Cape Town, South Africa
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Humeniuk R, Holmwood C, Beshara M, Kambala A. ASSIST-Y V1.0: First-Stage Development of the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and Linked Brief Intervention for Young People. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2016. [DOI: 10.1080/1067828x.2015.1049395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Carney T, Myers BJ, Louw J, Okwundu CI. Brief school-based interventions and behavioural outcomes for substance-using adolescents. Cochrane Database Syst Rev 2016; 2016:CD008969. [PMID: 26787125 PMCID: PMC7119449 DOI: 10.1002/14651858.cd008969.pub3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Adolescent substance use is a major problem in and of itself, and because it acts as a risk factor for other problem behaviours. As substance use during adolescence can lead to adverse and often long-term health and social consequences, it is important to intervene early in order to prevent progression to more severe problems. Brief interventions have been shown to reduce problematic substance use among adolescents and are especially useful for individuals who have moderately risky patterns of substance use. Such interventions can be conducted in school settings. This review set out to evaluate the effectiveness of brief school-based interventions for adolescent substance use. OBJECTIVES To evaluate the effectiveness of brief school-based interventions in reducing substance use and other behavioural outcomes among adolescents compared to another intervention or assessment-only conditions. SEARCH METHODS We conducted the original literature search in March 2013 and performed the search update to February 2015. For both review stages (original and update), we searched 10 electronic databases and six websites on evidence-based interventions, and the reference lists of included studies and reviews, from 1966 to February 2015. We also contacted authors and organisations to identify any additional studies. SELECTION CRITERIA We included randomised controlled trials that evaluated the effects of brief school-based interventions for substance-using adolescents.The primary outcomes were reduction or cessation of substance use. The secondary outcomes were engagement in criminal activity and engagement in delinquent or problem behaviours related to substance use. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures outlined by The Cochrane Collaboration, including the GRADE approach for evaluating the quality of evidence. MAIN RESULTS We included six trials with 1176 adolescents that measured outcomes at different follow-up periods in this review. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. We generally found moderate-quality evidence that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short-, medium-, or long-term follow-up. They also did not have a significant effect on delinquent-type behaviour outcomes among adolescents. When compared to assessment-only controls, we found low- or very low-quality evidence that BIs reduced cannabis frequency at short-term follow-up in one study (standardised mean difference (SMD) -0.83; 95% confidence interval (CI) -1.14 to -0.53, n = 269). BIs also significantly reduced frequency of alcohol use (SMD -0.91; 95% CI -1.21 to -0.61, n = 242), alcohol abuse (SMD -0.38; 95% CI -0.7 to -0.07, n = 190) and dependence (SMD -0.58; 95% CI -0.9 to -0.26, n = 190), and cannabis abuse (SMD -0.34; 95% CI -0.65 to -0.02, n = 190) at medium-term follow-up in one study. At long-term follow-up, BIs also reduced alcohol abuse (SMD -0.72; 95% CI -1.05 to -0.40, n = 181), cannabis frequency (SMD -0.56; 95% CI -0.75 to -0.36, n = 181), abuse (SMD -0.62; 95% CI -0.95 to -0.29, n = 181), and dependence (SMD -0.96; 95% CI -1.30 to -0.63, n = 181) in one study. However, the evidence from studies that compared brief interventions to assessment-only conditions was generally of low quality. Brief interventions also had mixed effects on adolescents' delinquent or problem behaviours, although the effect at long-term follow-up on these outcomes in the assessment-only comparison was significant (SMD -0.78; 95% CI -1.11 to -0.45). AUTHORS' CONCLUSIONS We found low- or very low-quality evidence that brief school-based interventions may be more effective in reducing alcohol and cannabis use than the assessment-only condition and that these reductions were sustained at long-term follow-up. We found moderate-quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. It is premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use. Further high-quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low- and middle-income countries.
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Affiliation(s)
- Tara Carney
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitFrancie van Zyl Drive, Tygerberg, 7505, ParowCape TownWestern CapeSouth Africa7505
| | - Bronwyn J Myers
- South African Medical Research CouncilAlcohol Tobacco and Other Drug Research UnitFrancie van Zyl Drive, Tygerberg, 7505, ParowCape TownWestern CapeSouth Africa7505
- University of Cape TownDepartment of Psychiatry and Mental HealthCape TownSouth Africa
| | - Johann Louw
- University of Cape TownDepartment of PsychologyRondeboschCape TownWestern CapeSouth Africa7701
| | - Charles I Okwundu
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesFrancie van Zijl DriveTygerbergCape TownSouth Africa7505
- South African Medical Research CouncilSouth African Cochrane CentrePO Box 19070TygerbergWestern CapeSouth Africa7505
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Prevention trial in the Cherokee Nation: design of a randomized community trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 16:291-300. [PMID: 24615546 PMCID: PMC4308639 DOI: 10.1007/s11121-014-0478-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite advances in prevention science and practice in recent decades, the U.S. continues to struggle with significant alcohol-related risks and consequences among youth, especially among vulnerable rural and Native American youth. The Prevention Trial in the Cherokee Nation is a partnership between prevention scientists and Cherokee Nation Behavioral Health to create, implement, and evaluate a new, integrated community-level intervention designed to prevent underage drinking and associated negative consequences among Native American and other youth living in rural high-risk underserved communities. The intervention builds directly on results of multiple previous trials of two conceptually distinct approaches. The first is an updated version of CMCA, an established community environmental change intervention, and the second is CONNECT, our newly developed population-wide intervention based on screening, brief intervention, and referral to treatment (SBIRT) research. CMCA direct-action community organizing is used to engage local citizens to address community norms and practices related to alcohol use and commercial and social access to alcohol among adolescents. The new CONNECT intervention expands traditional SBIRT to be implemented universally within schools. Six key research design elements optimize causal inference and experimental evaluation of intervention effects, including a controlled interrupted time-series design, purposive selection of towns, random assignment to study condition, nested cohorts as well as repeated cross-sectional observations, a factorial design crossing two conceptually distinct interventions, and multiple comparison groups. The purpose of this paper is to describe the strong partnership between prevention scientists and behavioral health leaders within the Cherokee Nation, and the intervention and research design of this new community trial.
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Adams-Guppy JR, Guppy A. A systematic review of interventions for homeless alcohol-abusing adults. DRUGS: EDUCATION, PREVENTION AND POLICY 2016. [DOI: 10.3109/09687637.2015.1044499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abar CC, Hernandez L, Rodriguez AM, Spirito A. Trajectories of Adolescent Alcohol Use in the Year Following a Brief Alcohol Intervention. J Stud Alcohol Drugs 2015; 76:710-20. [PMID: 26402351 DOI: 10.15288/jsad.2015.76.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Brief interventions have become increasingly popular for youth who engage in problematic drinking behavior. The purpose of this study was to examine the alcohol use trajectories of adolescents over a 12-month period following the receipt of a brief intervention. METHOD The current sample came from two independent studies and consisted of 206 adolescents (ages 13-19; 52% male) recruited through an emergency department or community institution (e.g., courts, schools). Timeline followback methods were used at four points over 1 year to obtain daily estimates of alcohol use behaviors, with daily data then aggregated at the monthly level to examine trajectories of total drinks consumed and maximum drinks on one occasion. Using latent growth curve analysis, we expected a general pattern of increasing use over time, with lower use during the month immediately following completion of the intervention. RESULTS Models with random intercepts, random linear slopes, and fixed quadratic trends provided good fit to the data for both total drinks and maximum drinks. For each outcome, there was an immediate decrease and then a gradual increase up to the 3- and 6-month assessments, with decreases seen in the months following assessments. Older age, White race, non-Hispanic ethnicity, and greater prior substance use were associated with greater initial levels of use and growth over time. CONCLUSIONS Interindividual differences were observed in alcohol use trajectories over time for high-risk adolescents following an alcohol use intervention. Subsequent research may demonstrate more uniform and permanent modification of trajectories by incorporating intervention-related materials into follow-up contacts.
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Affiliation(s)
- Caitlin C Abar
- Department of Psychology, The College at Brockport, Brockport, New York
| | - Lynn Hernandez
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ana Maria Rodriguez
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Anthony Spirito
- Department of Psychology, The College at Brockport, Brockport, New York.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
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Piehler TF, Winters KC. Parental involvement in brief interventions for adolescent marijuana use. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2015; 29:512-21. [PMID: 26415058 PMCID: PMC4588068 DOI: 10.1037/adb0000106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adolescents (aged 12-18 years) identified in a school setting as abusing marijuana and other drugs were randomly assigned to complete 1 of 2 brief interventions (BIs). Adolescents and their parent (N = 259) were randomly assigned to receive either a 2-session adolescent only (BI-A) or a 2-session adolescent and additional parent session (BI-AP). Interventions were manualized and delivered in a school setting by trained counselors. Adolescents were assessed at intake and at 6 months following the completion of the intervention. Using a latent construct representing 6-month marijuana use outcomes, current findings supported previous research that BI-AP resulted in superior outcomes when compared to BI-A. The presence of a marijuana dependence diagnosis at baseline predicted poorer outcomes when compared to youth without a diagnosis. Both baseline diagnostic status and co-occurring conduct problems interacted with intervention condition in predicting marijuana use outcomes. A marijuana dependence diagnosis resulted in poorer marijuana use outcomes within the BI-A condition when compared to BI-AP. Co-occurring conduct problems were associated with poorer marijuana use outcomes within the BI-AP intervention when compared to BI-A. Implications for implementing BIs given diagnostic status, parent involvement, and co-occurring conduct problems are discussed.
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Affiliation(s)
| | - Ken C Winters
- Department of Psychiatry, University of Minnesota Medical School
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Mitchell SG, Schwartz RP, Kirk AS, Dusek K, Oros M, Hosler C, Gryczynski J, Barbosa C, Dunlap L, Lounsbury D, O'Grady KE, Brown BS. SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers. J Subst Abuse Treat 2015; 60:81-90. [PMID: 26297321 DOI: 10.1016/j.jsat.2015.06.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/11/2015] [Accepted: 06/17/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Evidence from clinical trials and meta-analyses supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse but primary care providers have been slow to adopt this evidence-based approach. The purpose of this paper is to describe the theoretically informed methodology of an on-going implementation study. METHODS This study protocol is a multi-site, cluster randomized trial (N=7) guided by Proctor's conceptual model of implementation research and comparing two principal approaches to SBIRT delivery within adolescent medicine: Generalist vs. Specialist. In the Generalist Approach, the primary care provider delivers brief intervention (BI) for substance misuse. In the Specialist Approach, BIs are delivered by behavioral health counselors. The study will also examine the effectiveness of integrating HIV risk screening within an SBIRT model. Implementation Strategies employed include: integrated team development of the service delivery model, modifications to the electronic medical record, regular performance feedback and supervision. Implementation outcomes, include: Acceptability, Appropriateness, Adoption, Feasibility, Fidelity, Costs/Cost-Effectiveness, Penetration, and Sustainability. DISCUSSION The study will fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It will also provide novel data to inform the expansion of the SBIRT model to address HIV risk behaviors among adolescents. Finally, the study will generate important cost data that offer guidance to policymakers and clinic directors about the adoption of SBIRT in adolescent health care.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Laura Dunlap
- RTI International, Research Triangle Park, NC USA
| | | | - Kevin E O'Grady
- University of Maryland, College Park, Department of Psychology, College Park, MD USA
| | - Barry S Brown
- Friends Research Institute, Baltimore, MD USA; University of North Carolina at Wilmington, Wilmington, NC USA
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Newbury-Birch D, Scott S, O’Donnell A, Coulton S, Howel D, McColl E, Stamp E, Graybill E, Gilvarry E, Laing K, McGovern R, Deluca P, Drummond C, Harle C, McArdle P, Tate L, Kaner E. A pilot feasibility cluster randomised controlled trial of screening and brief alcohol intervention to prevent hazardous drinking in young people aged 14–15 years in a high school setting (SIPS JR-HIGH). PUBLIC HEALTH RESEARCH 2014. [DOI: 10.3310/phr02060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BackgroundApproximately 33% of 15- to 16-year-olds in England report alcohol intoxication in the past month. This present work builds on the evidence base by focusing on Alcohol Screening and Brief Intervention (ASBI) to reduce hazardous drinking in younger adolescents.ObjectivesTo explore the feasibility and acceptability of a future definitive cluster randomised controlled trial (cRCT) of ASBI in a school setting to staff, young people and parents; to explore the fidelity of the interventions as delivered by school learning mentors; to estimate the parameters for the design of a definitive cRCT of brief alcohol intervention, including rates of eligibility, consent, participation and retention at 12 months; and to pilot the collection of cost and resource-use data to inform the cost-effectiveness/utility analysis in a definitive trial.SettingSeven schools across one geographical area in North East England.MethodsFeasibility of trial processes, recruitment and retention and a qualitative evaluation examined facilitators and barriers to the use of ASBI approaches in the school setting in this age group. A three-arm pilot cRCT (with randomisation at the school level) with qualitative evaluation to assess the feasibility of a future definitive cRCT of the effectiveness and cost-effectiveness of ASBI in a school setting, with an integrated qualitative component. The trial ran in parallel with a repeated cross-sectional survey, which facilitated screening for the trial.ParticipantsYear 10 school pupils (aged 14–15 years).InterventionsYoung people who screened positive on a single alcohol screening question, and consented to take part, were randomised to one of three groups: (1) feedback that their drinking habits may be risky and provision of an advice leaflet (control condition,n = two schools); (2) feedback as for the control condition plus a 30-minute brief interactive session, which combined structured advice and motivational interviewing techniques, delivered by the school learning mentor (intervention 1,n = two schools); or (3) feedback as for the control condition plus a 30-minute brief interactive session as for intervention 1 plus a 60-minute session involving family members delivered by the school learning mentor (intervention 2,n = three schools). Young people were followed up at 12 months.Main outcome measuresFeasibility and acceptability.RandomisationRandomisation was carried out at the school level. Randomisation achieved balance on two school-level variables (numbers of pupils in school year and proportion receiving free school meals).BlindingSchool staff, young people and researchers were not blind to the intervention allocated.ResultsA total of 229 young people were eligible for the trial; 182 (79.5%) were randomised (control,n = 53; intervention 1,n = 54; intervention 2,n = 75). Of the 75 randomised to intervention 2, 67 received intervention 1 (89%). Eight received both intervention 1 and intervention 2 (11%). In total, 160 out of 182 were successfully followed up at 12 months (88%). Interviews were carried out with six school lead liaisons, 13 learning mentors, 27 young people and seven parents (n = 53). Analysis shows that the school setting is a feasible and acceptable place to carry out ASBI, with learning mentors seen as suitable people to do this. Intervention 2 was not seen as feasible or acceptable by school staff, parents or young people.Outcomes/conclusionsIt is feasible and acceptable to carry out a trial of the effectiveness and cost-effectiveness of single-session ASBI with young people in the school setting, with learning mentors delivering the intervention. Future work should include a definitive study that does not include a parental arm.Trial registrationCurrent Controlled Trials ISRCTN07073105.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Dorothy Newbury-Birch
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Stephanie Scott
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Amy O’Donnell
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Simon Coulton
- Centre for Health Services Research, University of Kent, Canterbury, UK
| | - Denise Howel
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Newcastle Clinical Trials Unit, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine Stamp
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Erin Graybill
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Eilish Gilvarry
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kirsty Laing
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth McGovern
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Paolo Deluca
- Institute of Psychiatry, King’s College London, London, UK
| | - Colin Drummond
- Institute of Psychiatry, King’s College London, London, UK
| | - Christine Harle
- Newcastle Clinical Trials Unit, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Paul McArdle
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Les Tate
- Young People’s Drug and Alcohol Department, North Tyneside Council, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
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Mertens JR, Ward CL, Bresick GF, Broder T, Weisner CM. Effectiveness of nurse-practitioner-delivered brief motivational intervention for young adult alcohol and drug use in primary care in South Africa: a randomized clinical trial. Alcohol Alcohol 2014; 49:430-8. [PMID: 24899076 DOI: 10.1093/alcalc/agu030] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIMS To assess the effectiveness of brief motivational intervention for alcohol and drug use in young adult primary care patients in a low-income population and country. METHODS A randomized controlled trial in a public-sector clinic in Delft, a township in the Western Cape, South Africa recruited 403 patients who were randomized to either single-session, nurse practitioner-delivered Brief Motivational Intervention plus referral list or usual care plus referral list, and followed up at 3 months. RESULTS Although rates of at-risk alcohol use and drug use did not differ by treatment arm at follow-up, patients assigned to the Brief Motivational Intervention had significantly reduced scores on ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) for alcohol-the most prevalent substance. CONCLUSION Brief Motivational Intervention may be effective at reducing at-risk alcohol use in the short term among low-income young adult primary care patients; additional research is needed to examine long-term outcomes.
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Affiliation(s)
| | - Catherine L Ward
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Graham F Bresick
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tina Broder
- National Viral Hepatitis Roundtable, San Francisco, CA, USA
| | - Constance M Weisner
- Langley Porter Psychiatric Institute, University of California San Francisco, San Francisco, CA, USA Division of Research, Kaiser Permanente, Oakland, CA, USA
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Winters KC, Lee S, Botzet A, Fahnhorst T, Nicholson A. One-year outcomes and mediators of a brief intervention for drug abusing adolescents. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:464-474. [PMID: 24955669 PMCID: PMC4075470 DOI: 10.1037/a0035041] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Two manually guided brief interventions were evaluated with a randomized, controlled trial. Adolescents (aged 13-17 years) suspected of abusing alcohol and other drugs and their parent were randomly assigned to receive either a 2-session adolescent only (BI-A), 2-session adolescent and additional parent session (BI-AP), or assessment only control condition (CON). Adolescents were identified in a school setting, and the intervention was delivered by trained counselors. Outcome analyses (N = 284; 90% of those enrolled) of relative change (from intake to 12 months) and absolute status (at 12 months) revealed a general pattern of reductions in drug use behaviors, particularly with the cannabis outcome measures, in both active conditions (BI-A and BI-AP). Students in the control condition showed worse outcome compared with the BI-A and BI-AP groups. Among the 4 mediating variables measured at 6 months, use of additional services, motivation to change, and parenting practices had significant influences on 12-month outcome; problem-solving skills approached significance as a mediator. The potential value of a brief intervention for drug abusing adolescents is discussed.
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Affiliation(s)
- Ken C Winters
- Department of Psychiatry, University of Minnesota Medical School
| | - Susanne Lee
- Department of Psychiatry, University of Minnesota Medical School
| | - Andria Botzet
- Department of Psychiatry, University of Minnesota Medical School
| | - Tamara Fahnhorst
- Department of Psychiatry, University of Minnesota Medical School
| | - Ali Nicholson
- Department of Psychiatry, University of Minnesota Medical School
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Haller DM, Meynard A, Lefebvre D, Ukoumunne OC, Narring F, Broers B. Effectiveness of training family physicians to deliver a brief intervention to address excessive substance use among young patients: a cluster randomized controlled trial. CMAJ 2014; 186:E263-72. [PMID: 24616136 DOI: 10.1503/cmaj.131301] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Brief interventions delivered by family physicians to address excessive alcohol use among adult patients are effective. We conducted a study to determine whether such an intervention would be similarly effective in reducing binge drinking and excessive cannabis use among young people. METHODS We conducted a cluster randomized controlled trial involving 33 family physicians in Switzerland. Physicians in the intervention group received training in delivering a brief intervention to young people during the consultation in addition to usual care. Physicians in the control group delivered usual care only. Consecutive patients aged 15-24 years were recruited from each practice and, before the consultation, completed a confidential questionnaire about their general health and substance use. Patients were followed up at 3, 6 and 12 months after the consultation. The primary outcome measure was self-reported excessive substance use (≥ 1 episode of binge drinking, or ≥ 1 joint of cannabis per week, or both) in the past 30 days. RESULTS Of the 33 participating physicians, 17 were randomly allocated to the intervention group and 16 to the control group. Of the 594 participating patients, 279 (47.0%) identified themselves as binge drinkers or excessive cannabis users, or both, at baseline. Excessive substance use did not differ significantly between patients whose physicians were in the intervention group and those whose physicians were in the control group at any of the follow-up points (odds ratio [OR] and 95% confidence interval [CI] at 3 months: 0.9 [0.6-1.4]; at 6 mo: 1.0 [0.6-1.6]; and at 12 mo: 1.1 [0.7-1.8]). The differences between groups were also nonsignificant after we restricted the analysis to patients who reported excessive substance use at baseline (OR 1.6, 95% CI 0.9-2.8, at 3 mo; OR 1.7, 95% CI 0.9-3.2, at 6 mo; and OR 1.9, 95% CI 0.9-4.0, at 12 mo). INTERPRETATION Training family physicians to use a brief intervention to address excessive substance use among young people was not effective in reducing binge drinking and excessive cannabis use in this patient population. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, no. ACTRN12608000432314.
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Patton R, Deluca P, Kaner E, Newbury-Birch D, Phillips T, Drummond C. Alcohol screening and brief intervention for adolescents: the how, what and where of reducing alcohol consumption and related harm among young people. Alcohol Alcohol 2014; 49:207-12. [PMID: 24232178 PMCID: PMC3932830 DOI: 10.1093/alcalc/agt165] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIM The aim of the study was to explore the evidence base on alcohol screening and brief intervention for adolescents to determine age appropriate screening tools, effective brief interventions and appropriate locations to undertake these activities. METHODS A review of existing reviews (2003-2013) and a systematic review of recent research not included in earlier reviews. RESULTS The CRAFFT and AUDIT tools are recommended for identification of 'at risk' adolescents. Motivational interventions delivered over one or more sessions and based in health care or educational settings are effective at reducing levels of consumption and alcohol-related harm. CONCLUSION Further research to develop age appropriate screening tools needs to be undertaken. Screening and brief intervention activity should be undertaken in settings where young people are likely to present; further assessment at such venues as paediatric emergency departments, sexual health clinics and youth offending teams should be evaluated. The use of electronic (web/smart-phone based) screening and intervention shows promise and should also be the focus of future research.
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Affiliation(s)
- Robert Patton
- Corresponding author: Addictions Department, National Addiction Centre, Institute of Psychiatry, King's College London, 4 Windsor Walk, London SE5 8BB, UK
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Carney T, Myers BJ, Louw J, Okwundu CI. Brief school-based interventions and behavioural outcomes for substance-using adolescents. Cochrane Database Syst Rev 2014:CD008969. [PMID: 24563456 DOI: 10.1002/14651858.cd008969.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adolescent substance use is a major problem, in and of itself and because it acts as a risk factor for other problem behaviours. As substance use during adolescence can lead to adverse and often long-term health and social consequences, it is important to intervene early on in order to prevent progression to more severe problems. Brief interventions have been shown to reduce problematic substance use among adolescents and are especially useful for individuals who have moderately risky patterns of substance use. Such interventions can be conducted in school settings. This review set out to evaluate the effectiveness of brief school-based interventions for adolescent substance use. OBJECTIVES To evaluate the effectiveness of brief school-based interventions on reducing substance use and other behavioural outcomes among adolescents compared to another intervention or assessment-only conditions. SEARCH METHODS We searched 10 electronic databases and six websites on evidence-based interventions, and the reference lists of included studies and reviews, from 1966 to March 2013. We also contacted authors and organisations to identify any additional studies. SELECTION CRITERIA We included randomised controlled trials that evaluated the effects of brief school-based interventions for substance-using adolescents.The primary outcomes were reduction or cessation of substance use. The secondary outcomes were engagement in criminal activity and engagement in delinquent or problem behaviours related to substance use. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures outlined by The Cochrane Collaboration, including the GRADE approach for evaluating the quality of evidence. MAIN RESULTS Six studies involving 1139 participants were included in this review. Overall the quality of evidence was moderate in the information provision comparison, and low or very low in the assessment only comparison. Reasons for downgrading the quality included risk of bias of the included studies, imprecision and inconsistency. Our findings suggested that compared to information provision only, brief interventions (BIs) did not have a significant effect on any substance use (three studies, 732 participants, standardised mean difference (SMD) -0.06; 95% confidence interval (CI) -0.20 to 0.09) or delinquent-type behaviour outcomes among adolescents (two studies, 531 participants, SMD -0.26; 95% CI -0.54 to 0.02). When compared to assessment-only controls, BIs had some significant effects on substance use and delinquent-type or problem behaviours, but high levels of heterogeneity existed between studies and it was not always possible to pool the results. When the comparison was with assessment-only conditions, studies of individual interventions that measured BI effectiveness reported significantly reduced substance use in general and in two studies reduced frequency of alcohol use specifically. When the data were pooled, BIs reduced cannabis frequency (SMD -0.22; 95% CI -0.45 to -0.02) across three studies (n = 407). Cannabis quantity was also reduced by BIs in comparison to assessment only (SMD -60.27; 95% CI -66.59 to -53.95) in one study (n = 179). However, the evidence for studies that compared brief interventions to assessment-only conditions was generally of low quality. Brief interventions also had mixed effects on participants' delinquent or problem behaviours. AUTHORS' CONCLUSIONS There was limited quality evidence that brief school-based interventions were more effective in reducing substance use than the assessment-only condition, but were similar to information provision. There is some evidence for the effectiveness of BI in reducing adolescent substance use, particularly cannabis, when compared to assessment only. However, it is premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use. Further high quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low- and middle-income countries.
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Affiliation(s)
- Tara Carney
- Alcohol and Drug Abuse Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg, 7505, Parow, Cape Town, Western Cape, South Africa, 7505
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Healey C, Rahman A, Faizal M, Kinderman P. Underage drinking in the UK: Changing trends, impact and interventions. A rapid evidence synthesis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:124-32. [DOI: 10.1016/j.drugpo.2013.07.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/03/2013] [Accepted: 07/08/2013] [Indexed: 12/21/2022]
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Chen X, Li R, Liang T, Zhang K, Gao Y, Xu L. Puerarin improves metabolic function leading to hepatoprotective effects in chronic alcohol-induced liver injury in rats. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2013; 20:849-852. [PMID: 23669266 DOI: 10.1016/j.phymed.2013.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 02/28/2013] [Accepted: 04/09/2013] [Indexed: 06/02/2023]
Abstract
Puerarin (PR), an active component extracted from the kudzu root, has been widely used as an ethno-medicine to treat hepatopathy in China. Therefore, the aim of the present study was to investigate the hepatoprotective action of PR in chronic alcohol-induced liver injury in rats. Data showed that the serum levels of alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) were elevated following PR administration. In addition, the levels of endogenous CYP2E1, CYP1A2, and CYP3A proteins in liver tissue were also gradually decreased following PR treatment. Histopathological examinations suggested that alcohol-induced hepatocellular lesions were mitigated by PR treatment. Collectively, these data indicate that PR contributes to cytoprotection against alcohol-induced liver lesions through improving metabolic function.
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Affiliation(s)
- Xu Chen
- Guilin Medical University, Guilin, Guangxi 541004, PR China
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Brief emergency department interventions for youth who use alcohol and other drugs: a systematic review. Pediatr Emerg Care 2013; 29:673-84. [PMID: 23640153 DOI: 10.1097/pec.0b013e31828ed325] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Brief intervention (BI) is recommended for use with youth who use alcohol and other drugs. Emergency departments (EDs) can provide BIs at a time directly linked to harmful and hazardous use. The objective of this systematic review was to determine the effectiveness of ED-based BIs. METHODS We searched 14 electronic databases, a clinical trial registry, conference proceedings, and study references. We included randomized controlled trials with youth 21 years or younger. Two reviewers independently selected studies and assessed methodological quality. One reviewer extracted and a second verified data. We summarized findings qualitatively. RESULTS Two trials with low risk of bias, 2 trials with unclear risk of bias, and 5 trials with high risk of bias were included. Trials evaluated targeted BIs for alcohol-positive (n = 3) and alcohol/other drug-positive youth (n = 1) and universal BIs for youth reporting recent alcohol (n = 4) or cannabis use (n = 1). Few differences were found in favor of ED-based BIs, and variation in outcome measurement and poor study quality precluded firm conclusions for many comparisons. Universal and targeted BIs did not significantly reduce alcohol use more than other care. In one targeted BI trial with high risk of bias, motivational interviewing (MI) that involved parents reduced drinking quantity per occasion and high-volume alcohol use compared with MI that was delivered to youth only. Another trial with high risk of bias reported an increase in abstinence and reduction in physical altercations when youth received peer-delivered universal MI for cannabis use. In 2 trials with unclear risk of bias, MI reduced drinking and driving and alcohol-related injuries after the ED visit. Computer-based MI delivered universally in 1 trial with low risk of bias reduced alcohol-related consequences 6 months after the ED visit. CONCLUSIONS Clear benefits of using ED-based BI to reduce alcohol and other drug use and associated injuries or high-risk behaviours remain inconclusive because of variation in assessing outcomes and poor study quality.
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Yarnell LM, Brown HS, Pasch KE, Perry CL, Komro KA. Influence of grade-level drinking norms on individual drinking behavior. Am J Health Behav 2013; 37:70-9. [PMID: 22943103 DOI: 10.5993/ajhb.37.1.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate which points of the middle-school drinking distribution are the most influential in the social contagion of drinking across the middle-school years, in order to identify potential social multipliers. METHODS We measured drinking intentions and behaviors by gender, school, and grade among urban middle-school students who participated in Project Northland Chicago in a longitudinal cohort design. RESULTS Individual drinking behaviors were consistently influenced by extreme (80(th) percentile) drinking intentions and behaviors. This effect was mediated through normal or average levels of drinking, over time. CONCLUSIONS Interventions can target extreme drinkers as the influential persons in middle-school grades.
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Affiliation(s)
- Lisa M Yarnell
- University of Southern California, Department of Psychology, Los Angeles, CA, USA
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Kiernan C, Ni Fhearail A, Coyne I. Nurses' role in managing alcohol misuse among adolescents. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2012; 21:474-478. [PMID: 22585075 DOI: 10.12968/bjon.2012.21.8.474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Over the past decade, there has been an increase in the amount of alcohol consumed by young people, aged 11-17 years, in the UK and Ireland, which has implications for all health professionals caring for adolescents. Alcohol misuse is increasingly common among adolescents and is a significant concern for families, communities and society. Health professionals need to be aware of the dangers involved with underage drinking, how to recognise the signs of alcohol misuse, and how to intervene appropriately. Over the past few years, there has been a noticeable increase in the number of adolescents presenting to emergency departments (EDs) owing to alcohol-related injuries. This increase means that all nurses and other health professionals are suitably placed to provide education and support to adolescents who are consuming excessive alcohol. Regular alcohol misuse can lead to adverse health outcomes, and therefore nurses need to take an active role in health promotion to ensure that adolescents are aware of the associated dangers. This article summarises the harmful effects of underage drinking, the influencing factors and outlines the current guidelines on alcohol misuse in young people. It discusses strategies that nurses can use in the ED setting, and all healthcare settings, to motivate adolescents to change health-damaging behaviours.
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Abstract
PURPOSE OF REVIEW Adolescent alcohol use is a considerable public health problem, contributing to the leading causes of adolescent morbidity and mortality. Additionally, adolescent alcohol use is a major risk factor for adult alcohol use disorders. Successful prevention of and interventions for adolescent alcohol use may thus have significant public health impact. This article reviews the current literature on adolescent alcohol prevention and intervention strategies. RECENT FINDINGS Systematic reviews and meta-analyses find that a variety of adolescent alcohol interventions are effective at reducing adolescents' alcohol use, as well as harmful behaviors associated with alcohol use. Long-term treatment is not necessarily superior, as brief interventions have been found to have a large effect size. Additionally, universal interventions (i.e., those that target all families within a group) may be more successful than selective interventions (i.e., those that target only certain families within a group). Intervention effects tend to wane 6-12 months after the cessation of treatment. The results of prevention interventions are more mixed. Many different intervention modalities have been shown to be effective, particularly family-based interventions, as have both universal and targeted interventions. SUMMARY A wide range of interventions are effective at reducing the harm of adolescent alcohol use. It is unclear which intervention(s) is/are optimal or most efficacious. Additionally, further research is needed on how to maintain long-term intervention effects. It is less clear which prevention strategies are most efficacious. Family-based interventions appear to be most promising.
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Bell RL, Rodd ZA, Smith RJ, Toalston JE, Franklin KM, McBride WJ. Modeling binge-like ethanol drinking by peri-adolescent and adult P rats. Pharmacol Biochem Behav 2011; 100:90-7. [PMID: 21824488 DOI: 10.1016/j.pbb.2011.07.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 07/18/2011] [Accepted: 07/23/2011] [Indexed: 01/27/2023]
Abstract
Alcohol binge-drinking, especially among adolescents and young adults, is a serious public health concern. The present study examined ethanol binge-like drinking by peri-adolescent [postnatal days (PNDs 30-72)] and adult (PNDs 90-132) alcohol-preferring (P) rats with a drinking-in-the-dark-multiple-scheduled-access (DID-MSA) procedure used by our laboratory. Male and female P rats were provided concurrent access to 15% and 30% ethanol for three 1-h sessions across the dark cycle 5 days/week. For the 1st week, adolescent and adult female P rats consumed 3.4 and 1.6g/kg of ethanol, respectively, during the 1st hour of access, whereas for male rats the values were 3.5 and 1.1g/kg of ethanol, respectively. Adult intakes increased to ~2.0 g/kg/h and adolescent intakes decreased to ~2.5 g/kg/h across the 6 weeks of ethanol access. The daily ethanol intake of adult DID-MSA rats approximated or modestly exceeded that seen in continuous access (CA) rats or the selection criterion for P rats (≥5 g/kg/day). However, in general, the daily ethanol intake of DID-MSA peri-adolescent rats significantly exceeded that of their CA counterparts. BELs were assessed at 15-min intervals across the 3rd hour of access during the 4th week. Ethanol intake was 1.7 g/kg vs. 2.7 g/kg and BELs were 57 mg% vs. 100mg% at 15- and 60-min, respectively. Intoxication induced by DID-MSA in female P rats was assessed during the 1st vs. 4th week of ethanol access. Level of impairment did not differ between the 2 weeks (106 vs. 97 s latency to fall, 120 s criterion) and was significant (vs. naïve controls) only during the 4th week. Overall, these findings support the use of the DID-MSA procedure in rats, and underscore the presence of age- and sex-dependent effects mediating ethanol binge-like drinking in P rats.
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Affiliation(s)
- Richard L Bell
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN 46202-4887, USA.
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Drumright LN, Hagan H, Thomas DL, Latka MH, Golub ET, Garfein RS, Clapp JD, Campbell JV, Bonner S, Kapadia F, Thiel TK, Strathdee SA. Predictors and effects of alcohol use on liver function among young HCV-infected injection drug users in a behavioral intervention. J Hepatol 2011; 55:45-52. [PMID: 21145862 PMCID: PMC3094600 DOI: 10.1016/j.jhep.2010.10.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 10/06/2010] [Accepted: 10/07/2010] [Indexed: 01/16/2023]
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) screening can provide opportunities to reduce disease progression through counseling against alcohol use, but empirical data on this issue are sparse. We determined the efficacy of a behavioral intervention in reducing alcohol use among young, HCV-infected injection drug users (IDUs) (n=355) and assessed whether changes in liver enzymes were associated with changes in alcohol consumption. METHODS Both the intervention and attention-control groups were counseled to avoid alcohol use, but the intervention group received enhanced counseling. Logistic regression, ANOVA, and continuous time Markov models were used to identify factors associated with alcohol use, changes in mean ALT and AST levels, and change in alcohol use post-intervention. RESULTS Six months post-intervention, alcohol abstinence increased 22.7% in both groups, with no difference by intervention arm. Transition from alcohol use to abstinence was associated with a decrease in liver enzymes, with a marginally greater decrease in the intervention group (p=0.05 for ALT; p=0.06 for AST). In multivariate Markov models, those who used marijuana transitioned from alcohol abstinence to consumption more rapidly than non-users (RR=3.11); those who were homeless transitioned more slowly to alcohol abstinence (RR=0.47); and those who had ever received a clinical diagnosis of liver disease transitioned more rapidly to abstinence (RR=1.88). CONCLUSIONS Although, behavioral counseling to reduce alcohol consumption among HCV-infected IDUs had a modest effect, reductions in alcohol consumption were associated with marked improvements in liver function. Interventions to reduce alcohol use among HCV-infected IDUs may benefit from being integrated into clinical care and monitoring of HCV infection.
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Affiliation(s)
- Lydia N. Drumright
- At the time of work on study: University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA; Current affiliation: Centre for Infection Prevention and Management, Division of Infectious Diseases and Immunology, Department of Medicine, Imperial College London, London, United Kingdom
| | - Holly Hagan
- National Development and Research Institute, Center for Drug Use and HIV Research, New York, NY
| | | | - Mary H. Latka
- At the time of the study: Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY; Current affiliation: The Aurum Institute, Johannesburg, South Africa
| | | | - Richard S. Garfein
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA
| | - John D. Clapp
- Center for Alcohol and Drug Studies, School of Social Work, San Diego State University, San Diego, CA
| | - Jennifer V. Campbell
- At the time of the study: Seattle-King County Department of Public Health, HIV/AIDS Prevention Program, Seattle, WA
| | - Sebastian Bonner
- Center for Urban Epidemiologic Studies, New York Academy of Medicine
| | - Farzana Kapadia
- At the time of the study: Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, Current affiliation: New York University, Community Public Health Program New York, NY
| | | | - Steffanie A. Strathdee
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA
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