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Boumans J, van de Mheen D, Crutzen R, Dupont H, Bovens R, Rozema A. Understanding How and Why Alcohol Interventions Prevent and Reduce Problematic Alcohol Consumption among Older Adults: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063188. [PMID: 35328875 PMCID: PMC8953167 DOI: 10.3390/ijerph19063188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
Problematic alcohol use has been increasing in older adults (55+) in recent decades. Many of the effective interventions that are available to prevent or reduce the negative effects of alcohol consumption are aimed at adults in general. It is unclear whether these interventions also work for older adults. The objective of this review was to understand how (i.e., which elements), in which context, and why (which mechanisms) interventions are successful in preventing or reducing (problematic) alcohol consumption among older adults. A systematic review of articles published between 2000 and 2022 was performed using PubMed, PsycINFO, Web of Science and CHINAHL. Realist evaluation was used to analyze the data. We found 61 studies on interventions aimed at preventing or reducing problematic alcohol use. Most of the interventions were not specifically designed for older adults but also included older adults. The findings of the current study highlight three major effective elements of interventions: (1) providing information on the consequences of alcohol consumption; (2) being in contact with others and communicating with them about (alcohol) problems; and (3) personalized feedback about drinking behavior. Two of these elements were also used in the interventions especially designed for older adults. Being in contact with others and communicating with them about (alcohol) problems is an important element to pay attention to for developers of alcohol interventions for older adults because loneliness is a problem for this age group and there is a relationship between the use of alcohol and loneliness.
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Affiliation(s)
- Jogé Boumans
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (D.v.d.M.); (R.B.); (A.R.)
- Correspondence:
| | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (D.v.d.M.); (R.B.); (A.R.)
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands; (R.C.); (H.D.)
| | - Hans Dupont
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands; (R.C.); (H.D.)
| | - Rob Bovens
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (D.v.d.M.); (R.B.); (A.R.)
| | - Andrea Rozema
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (D.v.d.M.); (R.B.); (A.R.)
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Sellinger JJ, Martino S, Lazar C, Mattocks K, Rando K, Serowik K, Ablondi K, Fenton B, Gilstad-Hayden K, Brummett B, Holtzheimer PE, Higgins D, Reznik TE, Semiatin AM, Stapley T, Ngo T, Rosen MI. The acceptability and feasibility of screening, brief intervention, and referral to treatment for pain management among new England veterans with chronic pain: A pilot study. Pain Pract 2022; 22:28-38. [PMID: 33934499 PMCID: PMC9084457 DOI: 10.1111/papr.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/09/2021] [Accepted: 04/23/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Musculoskeletal disorders often lead to chronic pain in Veterans. Chronic pain puts sufferers at risk for substance misuse, and early intervention is needed for both conditions. This pilot study tested the feasibility and acceptability of a Screening, Brief Intervention, and Referral to Treatment for Pain Management intervention (SBIRT-PM) to help engage Veterans seeking disability compensation for painful musculoskeletal disorders in multimodal pain treatment and to reduce risky substance use, when indicated. METHODS This pilot study enrolled 40 Veterans from 8 medical centers across New England in up to 4 sessions of telephone-based counseling using a motivational interviewing framework. Counseling provided education about, and facilitated engagement in, multimodal pain treatments. Study eligibility required Veterans be engaged in no more than 2 Veteran Affairs (VA) pain treatment modalities, and study participation involved a 12-week postassessment and semistructured interview about the counseling process. RESULTS Majorities of enrolled Veterans screened positive for comorbid depression and problematic substance use. Regarding the offered counseling, 80% of participants engaged in at least one session, with a mean of 3 sessions completed. Ninety percent of participants completed the postassessment. Numerically, most measures improved slightly from baseline to week 12. In semistructured interviews, participants described satisfaction with learning about new pain care services, obtaining assistance connecting to services, and receiving support from their counselors. DISCUSSION It was feasible to deliver SBIRT-PM to Veterans across New England to promote engagement in multimodal pain treatment and to track study outcomes over 12 weeks. Preliminary results suggest SBIRT-PM was well-received and has promise for the targeted outcomes.
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Affiliation(s)
- John J Sellinger
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christina Lazar
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kristin Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kenneth Rando
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kristin Serowik
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Karen Ablondi
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brenda Fenton
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Bradley Brummett
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
| | - Paul E Holtzheimer
- White River Junction VA Medical Center, White River Junction, Vermont, USA
- Dartmouth School of Medicine, Hanover, New Hampshire, USA
| | - Diana Higgins
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thomas E Reznik
- Providence VA Medical Center, Providence, Rhode Island, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | | | - Tu Ngo
- Bedford VA Medical Center, Bedford, Massachusetts, USA
| | - Marc I Rosen
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
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Kalichman SC, Katner H, Eaton LA, Hill M, Ewing W, Kalichman MO. Randomized Community Trial Comparing Telephone versus Clinic-Based Behavioral Health Counseling for People Living with HIV in a Rural Setting. J Rural Health 2021; 38:728-739. [PMID: 34494681 DOI: 10.1111/jrh.12618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To test the efficacy of a theory-based behavioral intervention delivered via telephone versus clinic-based counseling to improve HIV outcomes and reduce alcohol consumption for people at-risk for treatment failure in a rural setting. METHODS Patients receiving HIV care (N = 240) were randomized using a computer-generated scheme to one of three conditions: (a) telephone behavioral health counseling, (b) clinic-based behavioral health counseling, or (c) attention control nutrition education. Behavioral counseling was delivered by either a community nurse or a paraprofessional patient navigator, with differences examined. Participants were followed for 12 months to assess medication adherence using unannounced pill counts and alcohol use measured by electronic daily text message assessments, and 18 months for HIV viral load and retention in care extracted from medical records. FINDINGS There was evidence for telephone and office-based counseling demonstrating greater medication adherence than the control condition but only in the short term. Clinic-based behavioral counseling significantly reduced alcohol use to a greater degree than telephone counseling and the control condition. There were no other differences between conditions. There were also no discernable differences between counseling delivered by the community nurse and the patient navigator. CONCLUSIONS Telephone and clinic-based counseling demonstrated improved medication adherence in the short term, while clinic-based counseling demonstrated reductions in alcohol use. The modest outcomes suggest that intensive intervention strategies are needed for patients that clinicians identify as at-risk for treatment discontinuation and treatment failure.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Harold Katner
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Wendy Ewing
- Department of Medicine, Mercer University Medical School, Macon, Georgia, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
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Kalichman SC, Katner H, Eaton LA, Banas E, Hill M, Kalichman MO. Comparative effects of telephone versus in-office behavioral counseling to improve HIV treatment outcomes among people living with HIV in a rural setting. Transl Behav Med 2021; 11:852-862. [PMID: 33200772 DOI: 10.1093/tbm/ibaa109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
With the expansion of telehealth services, there is a need for evidence-based treatment adherence interventions that can be delivered remotely to people living with HIV. Evidence-based behavioral health counseling can be delivered via telephone, as well as in-office services. However, there is limited research on counseling delivery formats and their differential outcomes. The purpose of this study was to conduct a head-to-head comparison of behavioral self-regulation counseling delivered by telephone versus behavioral self-regulation counseling delivered by in-office sessions to improve HIV treatment outcomes. Patients (N = 251) deemed at risk for discontinuing care and treatment failure living in a rural area of the southeastern USA were referred by their care provider. The trial implemented a Wennberg Randomized Preferential Design to rigorously test: (a) patient preference and (b) comparative effects on patient retention in care and treatment adherence. There was a clear patient preference for telephone-delivered counseling (69%) over in-office-delivered counseling (31%) and participants who received telephone counseling completed a greater number of sessions. There were few differences between the two intervention delivery formats on clinical appointment attendance, antiretroviral adherence, and HIV viral load. Overall improvements in health outcomes were not observed across delivery formats. Telephone-delivered counseling did show somewhat greater benefit for improving depression symptoms, whereas in-office services demonstrated greater benefits for reducing alcohol use. These results encourage offering most patients the choice of telephone and in-office behavioral health counseling and suggest that more intensive interventions may be needed to improve clinical outcomes for people living with HIV who may be at risk for discontinuing care or experiencing HIV treatment failure.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Harold Katner
- Department of Medicine, Mercer University Medical School, Macon, GA, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Ellen Banas
- Department of Medicine, Mercer University Medical School, Macon, GA, USA
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School, Macon, GA, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
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Barticevic NA, Poblete F, Zuzulich SM, Rodriguez V, Bradshaw L. Brief motivational therapy versus enhanced usual care for alcohol use disorders in primary care in Chile: study protocol for an exploratory randomized trial. Trials 2020; 21:692. [PMID: 32736578 PMCID: PMC7393703 DOI: 10.1186/s13063-020-04589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Harmful alcohol use is a leading cause of global disability and death. However, increased detection and brief intervention capacity of more severe alcohol use disorders has not been accompanied by increased availability of treatment services. Incorporating treatment for such disorders into primary care is of paramount importance for improving access and health outcomes. This study aims to estimate the effectiveness of a Brief Motivational Treatment (BMT) applied in primary care for treatment of these disorders. METHODS A parallel-group, single-blinded, severity-stratified, randomized clinical trial will test the superiority of BMT over enhanced usual care. Eligible participants will be those seeking treatment and who fulfill DSM-V criteria for alcohol use disorder and criteria for harmful alcohol use. With an estimated a loss to follow-up of 20%, a total of 182 participants will be recruited and equally randomized to each treatment group. The intervention group will receive an adaptation of the motivational enhancement therapy, as manualized in Project MATCH. This treatment consists of four 45-min sessions provided by a general psychologist with at least 3 years of primary care experience. The primary outcome is the change from baseline in the drinks per drinking day during the last 90 days, which will be captured using the Timeline Follow Back method. Secondary outcomes will describe the changes in alcohol use pattern, motivational status, and severity of the disorder. All participants will be analyzed according to the group they were allocated, regardless of the treatment actually received. Mean differences (MD) will be computed for continuous outcomes and relative risks (RR) and RR reductions (RRR) for dichotomous results. Linear models will deliver the subgroup analyses. Missingness is assumed to be associated with the baseline alcohol use pattern and severity, so a multiple imputation method will be used to handle missing data. DISCUSSION This trial aims to test the superiority of BMT over enhanced usual care with a reasonable superiority margin, over which the BMT could be further considered for incorporation into PC in Chile. Its pragmatic approach ultimately aims to inform policymakers about the benefit of including a brief psychosocial treatment into PC. TRIAL REGISTRATION ClinicalTrials.gov NCT04345302 . Registered on 28 April 2020.
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Affiliation(s)
- Nicolas A Barticevic
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Alameda 340, PO 8331150, Santiago, Chile
| | - Fernando Poblete
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Alameda 340, PO 8331150, Santiago, Chile.
| | - Soledad M Zuzulich
- Nursing School, Pontificia Universidad Católica de Chile, Alameda 340, PO 8331150, Santiago, Chile
| | - Victoria Rodriguez
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Alameda 340, PO 8331150, Santiago, Chile
| | - Laura Bradshaw
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Alameda 340, PO 8331150, Santiago, Chile
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Client Experiences of a Telephone-Delivered Intervention for Alcohol Use: a Qualitative Study. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00381-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Frost MC, Glass JE, Bradley KA, Williams EC. Documented brief intervention associated with reduced linkage to specialty addictions treatment in a national sample of VA patients with unhealthy alcohol use with and without alcohol use disorders. Addiction 2020; 115:668-678. [PMID: 31642124 PMCID: PMC7725424 DOI: 10.1111/add.14836] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/28/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Alcohol screening, brief intervention (BI) and referral to treatment is often considered stepped care, such that BI with referral links patients to treatment. A meta-analysis of randomized trials found no evidence that BI increases treatment for alcohol use disorder (AUD). This study aimed to determine whether BI is associated with receipt of treatment for AUD among patients receiving BI as part of routine care. DESIGN Regression analysis. SETTING US Veterans Health Administration (VA), in which BI is supported by performance measurement and electronic clinical reminders. PARTICIPANTS VA outpatients with positive Alcohol Use Disorders Identification Test Consumption screens (≥ 5) (n = 830,825) documented nationally from 1 October 2009 to 30 May 2013. MEASUREMENTS Regression models estimated the prevalence of receiving VA specialty addictions treatment within 0-365 days for patients with documented BI (advice to reduce/abstain within 0-14 days) compared to those without. Models clustered on patient and adjusted for demographics and mental health and substance use conditions were fit among all patients and stratified across documented past-year AUD diagnosis. Multiple secondary analyses assessed robustness of findings, including assessing repeated BI as a predictor. FINDINGS Among 830,825 VA outpatients with unhealthy alcohol use (1,172,606 positive screens), documented BI was associated with lower likelihood of receiving VA specialty addictions treatment [adjusted incidence rate ratio (aIRR) = 0.84, 95% confidence interval (CI) = 0.83-0.84]. Associations were similar for those with and without AUD (aIRR = 0.83, 95% CI = 0.82-0.84 and aIRR = 0.86, 95% CI = 0.83-0.88, respectively) and in most secondary analyses. However, among patients without AUD, documentation of more than one BI was associated with greater likelihood of treatment relative to no BI (aIRR = 1.75, 95% CI = 1.68-1.83). CONCLUSIONS In a national sample of US Veterans Health Administration patients with unhealthy alcohol use, documented brief intervention for alcohol use was associated with lower likelihood of receiving specialty addictions treatment regardless of alcohol use disorder diagnosis.
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Affiliation(s)
- Madeline C. Frost
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
| | - Joseph E. Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101
| | - Katharine A. Bradley
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195,Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101,Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195
| | - Emily C. Williams
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108,Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
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Ramsey AT, Satterfield JM, Gerke DR, Proctor EK. Technology-Based Alcohol Interventions in Primary Care: Systematic Review. J Med Internet Res 2019; 21:e10859. [PMID: 30958270 PMCID: PMC6475823 DOI: 10.2196/10859] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/23/2022] Open
Abstract
Background Primary care settings are uniquely positioned to reach individuals at risk of alcohol use disorder through technology-delivered behavioral health interventions. Despite emerging effectiveness data, few efforts have been made to summarize the collective findings from these delivery approaches. Objective The aim of this study was to review recent literature on the use of technology to deliver, enhance, or support the implementation of alcohol-related interventions in primary care. We focused on addressing questions related to (1) categorization or target of the intervention, (2) descriptive characteristics and context of delivery, (3) reported efficacy, and (4) factors influencing efficacy. Methods We conducted a comprehensive search and systematic review of completed studies at the intersection of primary care, technology, and alcohol-related problems published from January 2000 to December 2018 within EBSCO databases, ProQuest Dissertations, and Cochrane Reviews. Of 2307 initial records, 42 were included and coded independently by 2 investigators. Results Compared with the years of 2000 to 2009, published studies on technology-based alcohol interventions in primary care nearly tripled during the years of 2010 to 2018. Of the 42 included studies, 28 (64%) were randomized controlled trials. Furthermore, studies were rated on risk of bias and found to be predominantly low risk (n=18), followed by moderate risk (n=16), and high risk (n=8). Of the 24 studies with primary or secondary efficacy outcomes related to drinking and drinking-related harms, 17 (71%) reported reduced drinking or harm in all primary and secondary efficacy outcomes. Furthermore, of the 31 studies with direct comparisons with treatment as usual (TAU), 13 (42%) reported that at least half of the primary and secondary efficacy outcomes of the technology-based interventions were superior to TAU. High efficacy was associated with provider involvement and the reported use of an implementation strategy to deliver the technology-based intervention. Conclusions Our systematic review has highlighted a pattern of growth in the number of studies evaluating technology-based alcohol interventions in primary care. Although these interventions appear to be largely beneficial in primary care, outcomes may be enhanced by provider involvement and implementation strategy use. This review enables better understanding of the typologies and efficacy of these interventions and informs recommendations for those developing and implementing technology-based alcohol interventions in primary care settings.
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Affiliation(s)
- Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Jason M Satterfield
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Donald R Gerke
- Graduate School of Social Work, University of Denver, Denver, CO, United States
| | - Enola K Proctor
- Brown School of Social Work, Washington University in St Louis, St Louis, MO, United States
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Rosen MI, Becker WC, Black AC, Martino S, Edens EL, Kerns RD. Brief Counseling for Veterans with Musculoskeletal Disorder, Risky Substance Use, and Service Connection Claims. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:528-542. [PMID: 29800338 PMCID: PMC6387983 DOI: 10.1093/pm/pny071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE High proportions of post-9/11 veterans have musculoskeletal disorders (MSDs), but engaging them in care early in their course of illness has been challenging. The service connection application is an ideal point of contact for referring veterans to early interventions for their conditions. DESIGN Among MSD claimants who reported risky substance use, we pilot-tested a counseling intervention targeting pain and risky substance use called Screening Brief Intervention and Referral to Treatment-Pain Module (SBIRT-PM). Veterans were randomly assigned in a 2:1:1 ratio to SBIRT-PM, Pain Module counseling only, or treatment as usual (TAU). METHODS Participants assigned to either counseling arm were offered a single meeting with a study therapist with two follow-up telephone calls as needed. Participants completed outcome assessments at four and 12 weeks after randomization. RESULTS Of 257 veterans evaluated, 101 reported risky substance use and were randomized. Counseling was attended by 75% of veterans offered it and was well received. VA pain-related services were used by 51% of participants in either of the pain-focused conditions but only by 27% in TAU (P < 0.04). Starting with average pain severity ratings of 5.1/10 at baseline, only minimal changes in mean pain severity were noted regardless of condition. Self-reported risky substance use was significantly lower over time in the SBIRT-PM condition relative to the two other conditions (P < 0.02). At week 12, proportions of veterans reporting risky substance use were 0.39, 0.69, and 0.71 for the SBIRT-PM, Pain Module counseling, and TAU conditions, respectively. CONCLUSIONS SBIRT-PM shows promise as a way to engage veterans in pain treatment and reduce substance use.
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Affiliation(s)
- Marc I Rosen
- Department of Psychiatry, Yale University, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - William C Becker
- VA Connecticut Healthcare System, West Haven, Connecticut
- Section of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Anne C Black
- Department of Psychiatry, Yale University, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Steve Martino
- Department of Psychiatry, Yale University, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Ellen L Edens
- Department of Psychiatry, Yale University, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Robert D Kerns
- Department of Psychiatry, Yale University, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
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Pradhan AM, Park L, Shaya FT, Finkelstein J. Consumer Health Information Technology in the Prevention of Substance Abuse: Scoping Review. J Med Internet Res 2019; 21:e11297. [PMID: 30698526 PMCID: PMC6372939 DOI: 10.2196/11297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/08/2018] [Accepted: 10/20/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Addiction is one of the most rapidly growing epidemics that currently plagues nations around the world. In the United States, it has cost the government more than US $700 billion a year in terms of health care and other associated costs and is also associated with serious social, physical, and mental consequences. Increasing efforts have been made to tackle this issue at different levels, from primary prevention to rehabilitation across the globe. With the use of digital technology rapidly increasing, an effort to leverage the consumer health information technologies (CHITs) to combat the rising substance abuse epidemic has been underway. CHITs are identified as patient-focused technological platforms aimed to improve patient engagement in health care and aid them in navigating the complex health care system. OBJECTIVE This review aimed to provide a holistic and overarching view of the breadth of research on primary prevention of substance abuse using CHIT conducted over nearly past five decades. It also aimed to map out the changing landscape of CHIT over this period. METHODS We conducted a scoping review using the Arksey and O'Malley's modified methodological framework. We searched 4 electronic databases (PubMed, Cochrane, Scopus, and EMBASE). Papers were included if the studies addressed the use of CHIT for primary prevention of substance abuse and were published in English between 1809 and 2018. Studies that did not focus solely on primary prevention or assessed additional comorbid conditions were eliminated. RESULTS Forty-two papers that met our inclusion criteria were included in the review. These studies were published between 1970 and 2018 and were not restricted by geography, age, race, or sex. The review mapped studies using the most commonly used CHIT platforms for substance abuse prevention from mass media in the 1970s to mobile and social media in 2018. Moreover, 191 studies that were exclusively focused on alcohol prevention were excluded and will be addressed in a separate paper. The studies included had diverse research designs although the majority were randomized controlled trials (RCT) or review papers. Many of the RCTs used interventions based on different behavioral theories such as family interactions, social cognitive theories, and harm-minimization framework. CONCLUSIONS This review found CHIT platforms to be efficacious and cost-effective in the real-world settings. We also observed a gradual shift in the types and use of CHIT platforms over the past few decades and mapped out their progression. In addition, the review detected a shift in consumer preferences and behaviors from face-to-face interactions to technology-based platforms. However, the studies included in this review only focused on the aspect of primary prevention. Future reviews could assess the effectiveness of platforms for secondary prevention and for prevention of substance abuse among comorbid populations.
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Affiliation(s)
- Apoorva Milind Pradhan
- Department of Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Leah Park
- Department of Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Fadia T Shaya
- Department of Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
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Timko C, Below M, Vittorio L, Taylor E, Chang G, Lash S, Festin FED, Brief D. Randomized controlled trial of enhanced telephone monitoring with detoxification patients: 3- and 6-month outcomes. J Subst Abuse Treat 2019; 99:24-31. [PMID: 30797391 DOI: 10.1016/j.jsat.2018.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/24/2018] [Accepted: 12/20/2018] [Indexed: 12/15/2022]
Abstract
Telehealth interventions have the potential to deter repeated detoxification episodes and improve outcomes. Using a sample of 298 detoxification inpatients, this randomized controlled trial compared Enhanced Telephone Monitoring (ETM) to usual care (UC) on the primary outcome of reducing subsequent detoxification, and secondary outcomes of linking patients to addiction treatment and mutual-help, and patients' experience of improved substance use and mental health outcomes. At the 3-month follow-up (i.e., at the end of the ETM intervention), compared to UC patients, ETM patients were significantly less likely to have received additional inpatient detoxification, but no more likely to have participated in 12-step groups or received outpatient addiction treatment. Even so, ETM patients had better alcohol, drug, and mental health outcomes. In contrast, at the 6-month follow-up, patients in ETM and UC generally did not differ on primary or secondary outcomes. Findings suggest that ETM deters additional detoxification episodes while the intervention is ongoing, but not after the intervention ends. Because telephone monitoring is low-intensity and low-cost, its extension over time may help reduce repeated detoxifications.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Maureen Below
- VA Boston Health Care System, 150 South Huntington Ave. (116b), Boston, MA 02130, USA; Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, USA.
| | - Lisa Vittorio
- VA Boston Health Care System, 150 South Huntington Ave. (116b), Boston, MA 02130, USA.
| | - Emmeline Taylor
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA 94304, USA.
| | - Grace Chang
- VA Boston Health Care System, 940 Belmont St., Brockton, MA 02301, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - Steven Lash
- VA Medical Center, 1970 Roanoke Blvd, Salem, VA 24153, USA; Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22094, USA; Virgina Tech Carillon School of Medicine and Research Institute, 2 Riverside Circle, Roanoke, VA 24016, USA.
| | - Fe Erlita D Festin
- VA Boston Health Care System, 940 Belmont St., Brockton, MA 02301, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - Deborah Brief
- VA Boston Health Care System, 150 South Huntington Ave. (116b), Boston, MA 02130, USA; Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, USA.
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12
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Zaheer S, Garofalo V, Rodie D, Perivolaris A, Chum J, Crawford A, Geist R, Levinson A, Mitchell B, Oslin D, Sunderji N, Mulsant BH. Computer-Aided Telephone Support for Primary Care Patients with Common Mental Health Conditions: Randomized Controlled Trial. JMIR Ment Health 2018; 5:e10224. [PMID: 30530461 PMCID: PMC6305875 DOI: 10.2196/10224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/15/2018] [Accepted: 09/05/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression, anxiety, and at-risk drinking are highly prevalent in primary care settings. Many jurisdictions experience geographical barriers to accessing mental health services, necessitating the development and validation of alternative models of care delivery. Existing evidence supports the acceptability and effectiveness of providing mental health care by telephone. OBJECTIVE This analysis assesses patient's acceptability of computer-aided telephone support delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking. METHODS The Primary care Assessment and Research of a Telephone intervention for Neuropsychiatric conditions with Education and Resources study is a randomized controlled trial comparing a computer-aided telephone-based intervention to usual care enhanced by periodic assessments in adult primary care patients referred for the treatment of depression, anxiety, or at-risk drinking; no part of the study involves in-person contact. For this analysis, the following data were obtained: reasons provided for declining consent; reasons provided for withdrawing from the study; study retention rate; and a thematic analysis of a satisfaction survey upon study completion. RESULTS During the consent process, 17.1% (114/667) patients referred to the study declined to participate and 57.0% of them (65/114) attributed their refusal to research-related factors (ie, randomization and time commitment); a further 16.7% (19/114) declined owing to the telephone delivery of the intervention. Among the 377 participants who were randomized to the 1-year intervention, the overall retention rate was 82.8% (312/377). Almost no participants who withdrew from the study identified the telephone components of the study as their reason for withdrawal. Analysis of a qualitative satisfaction survey revealed that 97% (38/39) of comments related to the telephone components were positive with key reported positive attributes being accessibility, convenience, and privacy. CONCLUSIONS Our results suggest that a computer-aided telephone support is highly acceptable to primary care patients with depression, anxiety, or at-risk drinking. In particular, these patients appreciate its accessibility, flexibility, and privacy. TRIAL REGISTRATION ClinicalTrials.gov NCT02345122; https://clinicaltrials.gov/ct2/show/NCT02345122 (Archived by WebCite at http://www.webcitation.org/73R9Q2cle).
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Affiliation(s)
- Salaha Zaheer
- Geriatric Mental Health Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Vanessa Garofalo
- Geriatric Mental Health Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Rodie
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, ON, Canada
| | | | - Jenny Chum
- Geriatric Mental Health Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, ON, Canada
| | - Rose Geist
- Department of Psychiatry, University of Toronto, Toronto, ON, ON, Canada.,Trillium Health Partners, Mississauga, ON, Canada
| | - Andrea Levinson
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, ON, Canada
| | | | - David Oslin
- University of Pennsylvania and the Department of Veteran Affairs, Philadelphia, PA, United States
| | - Nadiya Sunderji
- Department of Psychiatry, University of Toronto, Toronto, ON, ON, Canada.,St Michael's Hospital, Toronto, ON, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, ON, Canada
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- Centre for Addiction and Mental Health, Toronto, ON, Canada
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13
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Kalichman SC, Mathews C, Banas E, Kalichman MO. Stigma management intervention to improve antiretroviral therapy adherence: Phase-I test of concept trial, Cape Town South Africa. Glob Public Health 2018; 14:1059-1074. [PMID: 30500309 DOI: 10.1080/17441692.2018.1552307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Combination antiretroviral therapy (cART) has transformed HIV infection from a universally fatal disease to a medically manageable chronic illness. We conducted a Phase-I test of concept intervention trial to examine feasibility and potential efficacy of behavioural self-regulation counselling designed to improve care retention and cART adherence. The intervention was culturally adapted from client-centered evidence-based interventions that are grounded in behavioural self-regulation theory and available in the US. The intervention adaptation included enhancements to directly address HIV stigma and alcohol-related sources of nonadherence. Fifty patients receiving cART in Cape Town, South Africa were randomised to receive either: (a) five weekly cellphone-delivered sessions of stigma and alcohol-enhanced behavioural self-regulation counselling or (b) a contact matched control condition. Participants were baseline assessed and followed for two weeks post-intervention, with 94% of participants retained throughout the study. Participants receiving the intervention significantly improved cART adherence from baseline-to-follow up and improvement was significantly greater than the control condition. Behaviours related to stigma and alcohol use that impede cART adherence were significantly reduced, and there was uptake of adherence improvement strategies. The current study supports the potential efficacy of relatively brief behavioural self-regulation counselling delivered by cellphone in a context of differentiated care in South Africa.
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Affiliation(s)
- Seth C Kalichman
- a Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut , Storrs, CT , USA
| | - Catherine Mathews
- b Health Systems Research Unit, South African Medical Research Council , Cape Town , South Africa
| | - Ellen Banas
- b Health Systems Research Unit, South African Medical Research Council , Cape Town , South Africa
| | - Moira O Kalichman
- a Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut , Storrs, CT , USA
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14
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Harris BR, Yu J, Wolff M, Rogers M, Blank S. Optimizing the impact of alcohol and drug screening and early intervention in a high-risk population receiving services in New York City sexual health clinics: A process and outcome evaluation of Project Renew. Prev Med 2018; 112:160-167. [PMID: 29673885 DOI: 10.1016/j.ypmed.2018.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/03/2018] [Accepted: 04/15/2018] [Indexed: 10/17/2022]
Abstract
Unhealthy substance use is associated with increased rates of STDs, including HIV. Within three high-risk New York City (NYC) sexual health clinics between 2008 and 2012 (n = 146,657), 17% of patients screened positive for a current SUD but only 5.3% ever received prior treatment. The goal of Project Renew was to expand the reach of substance use early intervention services within and across sexual health clinics citywide and decrease substance use, poor mental health, and risky sexual behavior. To accomplish this goal, Screening, Brief Intervention, and Referral to Treatment (SBIRT), an evidence-based substance use early intervention model, was implemented in all eight NYC sexual health clinics February 2012-January 2015. Clinic patients were screened for substance misuse using the AUDIT/DAST-10, and those who screened positive were eligible for on-site brief intervention. Overall, 130,597 substance misuse screenings were conducted (66,989, or 51%, positive), and 17,474 on-site brief interventions and 1238 referrals were provided (not unique to individual patients). A 10% sample of 14,709 unique patients who screened positive were interviewed using a federal data collection tool at baseline and six months later to assess changes in substance use, sexual risk behaviors, mental health, and health status (n = 1328). At six-month follow-up, patients reported reduced substance use, less sexual activity, improved overall health, and fewer days of depression and anxiety compared to measures at baseline (p < 0.05). Based on positive results, Project Renew SBIRT services have been sustained, ensuring essential care which may help prevent acquisition of HIV/STDs among a large population of high-risk New Yorkers.
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Affiliation(s)
- B R Harris
- University at Albany School of Public Health, One University Place, Rensselaer, NY, USA.
| | - J Yu
- University at Albany School of Social Welfare, 135 Western Ave., Albany, NY, USA.
| | - M Wolff
- Mount Sinai Icahn School of Medicine, 1 Gustave L. Levy Place, New York, NY, USA
| | - M Rogers
- New York City Department of Health and Mental Hygiene Bureau of STD Control and Prevention, 42-09 28th St., Long Island City, NY, USA
| | - S Blank
- New York City Department of Health and Mental Hygiene Bureau of STD Control and Prevention, 42-09 28th St., Long Island City, NY, USA; Centers for Disease Control and Prevention, Division of STD Prevention, 1600 Clifton Road, Atlanta, GA, USA.
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15
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Abughosh S, Wang X, Serna O, Esse T, Mann A, Masilamani S, Holstad MM, Essien EJ, Fleming M. A Motivational Interviewing Intervention by Pharmacy Students to Improve Medication Adherence. J Manag Care Spec Pharm 2018; 23:549-560. [PMID: 28448784 PMCID: PMC10398180 DOI: 10.18553/jmcp.2017.23.5.549] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) patients with comorbid hypertension (HTN) are at a higher risk of developing microvascular and macrovascular DM complications. Through guideline-driven recommendations, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are highly recommended for these patients. Unfortunately, medication adherence to these products, though crucial to achieving therapeutic benefit, is frequently suboptimal. Motivational interviewing (MI) is a patient-centered collaborative communication style that is used to strengthen internal motivation for change that may prove effective in enhancing adherence. OBJECTIVE To examine the effect of an MI telephone intervention conducted by pharmacy students in improving adherence to ACEIs/ARBs among Medicare Advantage Plan (MAP) patients with both DM and HTN. METHODS A prospective study was conducted among patients enrolled in a Texas MAP. Medical claims data were used to identify patients with DM and HTN, and pharmacy claims were observed to recognize those who filled either an ACEI or an ARB during June 2014. Patients with a 6-month proportion of days covered (PDC) < 0.80 in the previous 6 months were determined nonadherent, and 75% of those were randomly selected to serve as potential subjects for the intervention, while 25% were randomly selected to serve as potential subjects for the control group. The intervention was a telephone call by a pharmacy student on rotation at the health plan, and 5 monthly follow-up calls. Before implementing calls, participating students attended a 3-day MI training course, where their proficiency for MI skills was evaluated. Refill data during the 6-month postintervention were evaluated to examine the intervention effect measured on 3 outcomes: PDC; PDC ≥ 0.80 versus < 0.80; and discontinuation versus continuation. Multivariate linear and logistic regression models were constructed to adjust for any imbalances in baseline characteristics, including age, gender, number of other medications, regimen complexity, health low-income subsidy status, prescriber specialty, comorbidities, 6-month previous hospitalization, baseline 6-month PDC, and Centers for Medicare & Medicaid Services risk score. RESULTS A total of 11 students participated in the intervention implementation. Patients receiving calls were randomly selected from those potential subjects for the intervention arm until a target of 250 was reached; 500 controls were randomly selected from the potential subjects for the control arm. The final cohort included in multivariate models consisted of 743 patients. Patients completing the initial call and at least 2 follow-ups were less likely to discontinue (OR = 0.29; 95% CI = 0.15-0.54; P < 0.001) and more likely to be adherent in the linear regression model (β = 0.0604, P < 0.001) and the logistic regression model (OR = 1.53; 95% CI = 1.02-2.28; P = 0.009). Other factors significantly associated with better adherence included higher baseline PDC and number of medications. Depression status was significantly associated with lower adherence. CONCLUSIONS Patients receiving 2 or more calls had significantly better adherence and less discontinuation during the 6 months following initial calls compared with those who did not receive calls. This finding indicates that an MI-based telephone intervention by pharmacy students may be a promising intervention to improve adherence. Future research should examine the sustainability of the intervention effect for longer time periods and its influence on associated clinical outcomes. DISCLOSURES This project was supported by the Pharmaceutical Research and Manufacturers of America Foundation (PhRMA). The content is solely the responsibility of the authors and does not necessarily represent the official views of PhRMA. The funding agency was not involved in research design, analysis, or reporting results. Funding was obtained by Abughosh. Holstad provided a consultation regarding the MI guide and provided the MI training. Study concept and design were contributed by Abughosh and Fleming, along with Serna, Esse, and Holstad. Serna, Esse, Mann, Holstad, and Masilamani collected the data, and data interpretation was performed by Abughosh, Wong, and Esse. The manuscript was written by Abughosh, Wong, and Esse and revised by Masilamani and Holstad, along with the other authors.
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Affiliation(s)
- Susan Abughosh
- 1 Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Xin Wang
- 1 Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | | | - Tara Esse
- 2 Cigna-HealthSpring, Houston, Texas
| | | | - Santhi Masilamani
- 3 Nell Hodgson Woodruff School of Nursing and Clinical and Social Science Integration, Emory Center for AIDS Research, Emory University, Atlanta, Georgia
| | - Marcia McDonnell Holstad
- 3 Nell Hodgson Woodruff School of Nursing and Clinical and Social Science Integration, Emory Center for AIDS Research, Emory University, Atlanta, Georgia
| | - Ekere James Essien
- 1 Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Marc Fleming
- 1 Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
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16
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Kramer Schmidt L, Bojesen AB, Nielsen AS, Andersen K. Duration of therapy - Does it matter?: A systematic review and meta-regression of the duration of psychosocial treatments for alcohol use disorder. J Subst Abuse Treat 2017; 84:57-67. [PMID: 29195594 DOI: 10.1016/j.jsat.2017.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/26/2017] [Accepted: 11/06/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The recommendations in clinical guidelines for duration of therapy for alcohol use disorder (AUD) are based on consensus decisions. In reality, we do not know the optimal duration of an alcohol treatment course. METHODS A systematic review and meta-regression of randomized controlled trials of psychosocial treatment in alcohol outpatient treatment centers. The population consisted of adults suffering from AUD, treated in an outpatient facility with at least two sessions of therapy. Meta-regression analysis was performed with treatment outcome as a function of duration of therapy across studies. Treatment outcome was defined as long-term alcohol use measured in percentage of days abstinent (PDA), percentage of heavy days drinking (PHD), and/or proportion of participants abstinent (ABS). RESULTS 48 studies encompassing 8984 participants. Mean planned duration of therapy: 18 (8-82) weeks and 14 (2-36) sessions. Mean actual attended sessions: 9 (1-26). Mean follow-up time: 43 (8-104) weeks with a mean of 6 (2-18) research assessments. Neither planned weeks, duration of sessions, frequency of sessions per week, nor actual attended sessions were associated with long-term alcohol use outcomes. However, frequency of research assessments was positively associated with PDA and PHD. CONCLUSION No associations between long-term alcohol use outcomes and planned or actual attended duration of psychosocial treatment in outpatient care. Research assessments and, accordingly, the research project in itself may influence outcome in studies of psychosocial treatment for alcohol use disorder.
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Affiliation(s)
- Lotte Kramer Schmidt
- Unit of Clinical Alcohol Research, University of Southern Denmark, J.B. Winsløwsvej 20, entrance 220B, 5000 Odense C, Denmark.
| | - Anders Bo Bojesen
- Unit of Clinical Alcohol Research, University of Southern Denmark, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, University of Southern Denmark, Denmark; OPEN Odense Patient data Explorative Network, Denmark
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research, University of Southern Denmark, Denmark; Department of Mental Health, Region of Southern Denmark, Denmark
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17
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Andersson C, Öjehagen A, Olsson MO, Brådvik L, Håkansson A. Interactive Voice Response with Feedback Intervention in Outpatient Treatment of Substance Use Problems in Adolescents and Young Adults: A Randomized Controlled Trial. Int J Behav Med 2017; 24:789-797. [PMID: 28028732 PMCID: PMC5608891 DOI: 10.1007/s12529-016-9625-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Substance use disorders and problematic substance use are common problems in adolescence and young adulthood. Brief personalized feedback has been suggested for treatment of alcohol and drug problems and poor mental health. This repeated measurement randomized controlled trial examines the effect of an interactive voice response (IVR) system for assessing stress, depression, anxiety and substance use. METHODS The IVR system was used twice weekly over 3 months after treatment initiation, with or without addition of a personalized feedback intervention on stress and mental health symptoms. Both IVR assessment only (control group) and IVR assessment including feedback (intervention group) were provided as an add-on to treatment-as-usual procedures (TAU) in outpatient treatment of substance use problems in adolescents and young adults (N = 73). RESULTS By using a mixed models approach, differences in change scores were analyzed over the three-month assessment period. Compared to the control group, the intervention group demonstrated significantly greater improvement in the Arnetz and Hasson stress score (AHSS, p = 0.019), the total Symptoms Checklist 8 score (SCL-8D, p = 0.037), the SCL-8D anxiety sub-score (p = 0.017), and on a summarized feedback score (p = 0.026), but not on the depression subscale. There were no differences in global substance use scores between the intervention group (feedback on mental health symptoms) and the control group. CONCLUSION In conclusion, IVR may be useful for follow-up and repeated interventions as an add-on to regular treatment, and personalized feedback could potentially improve mental health in adolescents and young adults with problematic substance use.
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Affiliation(s)
- Claes Andersson
- Faculty of Health and Society, Department of Criminology, Malmö University, -205 06, Malmö, SE, Sweden.
| | - Agneta Öjehagen
- Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
| | - Martin O Olsson
- Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
| | - Louise Brådvik
- Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
| | - Anders Håkansson
- Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
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18
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Beyond face-to-face individual counseling: A systematic review on alternative modes of motivational interviewing in substance abuse treatment and prevention. Addict Behav 2017; 73:216-235. [PMID: 28554033 DOI: 10.1016/j.addbeh.2017.05.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/17/2017] [Accepted: 05/19/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This systematic review aimed to synthesize the evidence on the effectiveness of motivational interviewing (MI), delivered in modes other than face-to-face individual counseling, in preventing and treating substance abuse related behaviors. METHODS Four databases (PubMed/MEDLINE, PsycINFO, ISI Web of Science and Cochrane Library) were searched for randomised clinical trials (RCTs) that evaluated the effectiveness of alternative modes of MI (other than face-to-face individual counseling) in preventing and treating substance abuse. Eligible studies were rated on methodological quality and their findings were qualitatively synthesized. RESULTS A total of 25 articles (on 22 RCTs) were eligible for this review. Beyond face-to-face counseling, telephone was the most frequently used medium for delivering MI (11 studies), followed by Internet communication (4 studies) and short message service (SMS) (2 studies). Mail was incorporated as a supplement in one of the studies for telephone MI. In contrast to one-to-one individual counseling, group MI was adopted in 5 studies. The effectiveness of telephone MI in treating substance abuse was supported by all of the published RCTs we located. Internet-based MI was effective in preventing and treating alcoholism, but its outcome appeared to be inconsistent for smoking cessation and poor for abstinence from illicit drugs. SMS-based MI appeared to be useful for controlling tobacco and drinking. Group MI was attempted for quitting alcohol and drugs, with mixed findings on its outcomes. CONCLUSIONS Collectively, the studies reviewed indicate that telephone MI is a promising mode of intervention in treating and preventing substance abuse. The effectiveness of other alternative modes (SMS-based MI, Internet-based MI and group MI) remains inconclusive given the controversial findings and a limited number of studies. By synthesizing the currently available evidence, this systematic review suggested that telephone MI might be considered as an alternative to face-to-face MI for treating and preventing substance abuse. Further research is needed to investigate the effectiveness of SMS-based MI, Internet MI, group MI and other alternative modes. Studies with methodological rigor and incorporating MI fidelity measures have great potential to advance the understanding in this field.
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19
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Bradley KA, Ludman EJ, Chavez LJ, Bobb JF, Ruedebusch SJ, Achtmeyer CE, Merrill JO, Saxon AJ, Caldeiro RM, Greenberg DM, Lee AK, Richards JE, Thomas RM, Matson TE, Williams EC, Hawkins E, Lapham G, Kivlahan DR. Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial. Addict Sci Clin Pract 2017; 12:15. [PMID: 28514963 PMCID: PMC5436432 DOI: 10.1186/s13722-017-0080-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 04/28/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Most patients with alcohol use disorders (AUDs) never receive alcohol treatment, and experts have recommended management of AUDs in primary care. The Choosing Healthier Drinking Options In primary CarE (CHOICE) trial was a randomized controlled effectiveness trial of a novel intervention for primary care patients at high risk for AUDs. This report describes the conceptual and scientific foundation of the CHOICE model of care, critical elements of the CHOICE trial design consistent with the Template for Intervention Description and Replication (TIDieR), results of recruitment, and baseline characteristics of the enrolled sample. METHODS The CHOICE intervention is a multi-contact, extended counseling intervention, based on the Chronic Care Model, shared decision-making, motivational interviewing, and evidence-based options for managing AUDs, designed to be practical in primary care. Outpatients who received care at 3 Veterans Affairs primary care sites in the Pacific Northwest and reported frequent heavy drinking (≥4 drinks/day for women; ≥5 for men) were recruited (2011-2014) into a trial in which half of the participants would be offered additional alcohol-related care from a nurse. CHOICE nurses offered 12 months of patient-centered care, including proactive outreach and engagement, repeated brief motivational interventions, monitoring with and without alcohol biomarkers, medications for AUDs, and/or specialty alcohol treatment as appropriate and per patient preference. A CHOICE nurse practitioner was available to prescribe medications for AUDs. RESULTS A total of 304 patients consented to participate in the CHOICE trial. Among consenting participants, 90% were men, the mean age was 51 (range 22-75), and most met DSM-IV criteria for alcohol abuse (14%) or dependence (59%). Many participants also screened positive for tobacco use (44%), depression (45%), anxiety disorders (30-41%) and non-tobacco drug use disorders (19%). At baseline, participants had a median AUDIT score of 18 [Interquartile range (IQR) 14-24] and a median readiness to change drinking score of 5 (IQR 2.75-6.25) on a 1-10 Likert scale. CONCLUSION The CHOICE trial tested a patient-centered intervention for AUDs and recruited primary care patients at high risk for AUDs, with a spectrum of severity, co-morbidity, and readiness to change drinking. Trial registration The trial is registered at clinicaltrial.gov (NCT01400581).
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Affiliation(s)
- Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Health Services, University of Washington, Seattle, WA USA
- Department of Medicine, University of Washington, Seattle, WA USA
| | - Evette Joy Ludman
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Laura J. Chavez
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH USA
- Center for Innovation in Pediatric Practice, Nationwide Children’s Hospital, Columbus, OH USA
| | - Jennifer F. Bobb
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Susan J. Ruedebusch
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
| | - Carol E. Achtmeyer
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
| | | | - Andrew J. Saxon
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | - Ryan M. Caldeiro
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Diane M. Greenberg
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
| | - Amy K. Lee
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Julie E. Richards
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Rachel M. Thomas
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
| | - Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Emily C. Williams
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Eric Hawkins
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | - Gwen Lapham
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Daniel R. Kivlahan
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
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Glass JE, Andréasson S, Bradley KA, Finn SW, Williams EC, Bakshi AS, Gual A, Heather N, Sainz MT, Benegal V, Saitz R. Rethinking alcohol interventions in health care: a thematic meeting of the International Network on Brief Interventions for Alcohol & Other Drugs (INEBRIA). Addict Sci Clin Pract 2017; 12:14. [PMID: 28490342 PMCID: PMC5425968 DOI: 10.1186/s13722-017-0079-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/14/2017] [Indexed: 11/29/2022] Open
Abstract
In 2016, the International Network on Brief Interventions for Alcohol & Other Drugs convened a meeting titled “Rethinking alcohol interventions in health care”. The aims of the meeting were to synthesize recent evidence about screening and brief intervention and to set directions for research, practice, and policy in light of this evidence. Screening and brief intervention is efficacious in reducing self-reported alcohol consumption for some with unhealthy alcohol use, but there are gaps in evidence for its effectiveness. Because screening and brief intervention is not known to be efficacious for individuals with more severe unhealthy alcohol use, recent data showing the lack of evidence for referral to treatment as part of screening and brief intervention are alarming. While screening and brief intervention was designed to be a population-based approach, its reach is limited. Implementation in real world care also remains a challenge. This report summarizes practice, research, and policy recommendations and key research developments from our meeting. In order to move the field forward, a research agenda was proposed to (1) address evidence gaps in screening, brief intervention, and referral to treatment, (2) develop innovations to address severe unhealthy alcohol use within primary care, (3) describe the stigma of unhealthy alcohol use, which obstructs progress in prevention and treatment, (4) reconsider existing conceptualizations of unhealthy alcohol use that may influence health care, and (5) identify efforts needed to improve the capacity for addressing unhealthy alcohol consumption in all world regions.
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Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
| | - Sven Andréasson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Sara Wallhed Finn
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Emily C Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ann-Sofie Bakshi
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, ICN, Hospital Clínic, IDIBAPS, RTA, Barcelona, Spain
| | - Nick Heather
- Department of Psychology, Faculty of Health & Social Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Marcela Tiburcio Sainz
- Department of Social Sciences in Health, Ramón de la Fuente Muñiz, National Institute of Psychiatry, Mexico City, Mexico
| | - Vivek Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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Posadzki P, Mastellos N, Ryan R, Gunn LH, Felix LM, Pappas Y, Gagnon M, Julious SA, Xiang L, Oldenburg B, Car J. Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database Syst Rev 2016; 12:CD009921. [PMID: 27960229 PMCID: PMC6463821 DOI: 10.1002/14651858.cd009921.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients using either their telephone's touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention. OBJECTIVES To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes. SEARCH METHODS We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL; Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses, Australasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published between 1980 and June 2015. SELECTION CRITERIA Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any preventive healthcare or long term condition management role were eligible. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods to select and extract data and to appraise eligible studies. MAIN RESULTS We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for managing long-term conditions, and seven studies for appointment reminders. We downgraded our certainty in the evidence primarily because of the risk of bias for many outcomes. We judged the risk of bias arising from allocation processes to be low for just over half the studies and unclear for the remainder. We considered most studies to be at unclear risk of performance or detection bias due to blinding, while only 16% of studies were at low risk. We generally judged the risk of bias due to missing data and selective outcome reporting to be unclear.For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). The effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).For screening, multimodal ATCS increase uptake of screening for breast cancer (RR 2.17, 95% CI 1.55 to 3.04; 2 studies, N = 462; high certainty) and colorectal cancer (CRC) (RR 2.19, 95% CI 1.88 to 2.55; 3 studies, N = 1013; high certainty) versus usual care. It may also increase osteoporosis screening. ATCS Plus interventions probably slightly increase cervical cancer screening (moderate certainty), but effects on osteoporosis screening are uncertain. IVR systems probably increase CRC screening at 6 months (RR 1.36, 95% CI 1.25 to 1.48; 2 studies, N = 16,915; moderate certainty) but not at 9 to 12 months, with probably little or no effect of IVR (RR 1.05, 95% CI 0.99, 1.11; 2 studies, 2599 participants; moderate certainty) or unidirectional ATCS on breast cancer screening.Appointment reminders delivered through IVR or unidirectional ATCS may improve attendance rates compared with no calls (low certainty). For long-term management, medication or laboratory test adherence provided the most general evidence across conditions (25 studies, data not combined). Multimodal ATCS versus usual care showed conflicting effects (positive and uncertain) on medication adherence. ATCS Plus probably slightly (versus control; moderate certainty) or probably (versus usual care; moderate certainty) improves medication adherence but may have little effect on adherence to tests (versus control). IVR probably slightly improves medication adherence versus control (moderate certainty). Compared with usual care, IVR probably improves test adherence and slightly increases medication adherence up to six months but has little or no effect at longer time points (moderate certainty). Unidirectional ATCS, compared with control, may have little effect or slightly improve medication adherence (low certainty). The evidence suggested little or no consistent effect of any ATCS type on clinical outcomes (blood pressure control, blood lipids, asthma control, therapeutic coverage) related to adherence, but only a small number of studies contributed clinical outcome data.The above results focus on areas with the most general findings across conditions. In condition-specific areas, the effects of ATCS varied, including by the type of ATCS intervention in use.Multimodal ATCS probably decrease both cancer pain and chronic pain as well as depression (moderate certainty), but other ATCS types were less effective. Depending on the type of intervention, ATCS may have small effects on outcomes for physical activity, weight management, alcohol consumption, and diabetes mellitus. ATCS have little or no effect on outcomes related to heart failure, hypertension, mental health or smoking cessation, and there is insufficient evidence to determine their effects for preventing alcohol/substance misuse or managing illicit drug addiction, asthma, chronic obstructive pulmonary disease, HIV/AIDS, hypercholesterolaemia, obstructive sleep apnoea, spinal cord dysfunction or psychological stress in carers.Only four trials (3%) reported adverse events, and it was unclear whether these were related to the interventions. AUTHORS' CONCLUSIONS ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost-effective.
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Affiliation(s)
- Pawel Posadzki
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
| | - Nikolaos Mastellos
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt Dunstans RoadLondonHammersmithUKW6 8RP
| | - Rebecca Ryan
- La Trobe UniversityCentre for Health Communication and Participation, School of Psychology and Public HealthBundooraVICAustralia3086
| | - Laura H Gunn
- Stetson UniversityPublic Health Program421 N Woodland BlvdDeLandFloridaUSA32723
| | - Lambert M Felix
- Edge Hill UniversityFaculty of Health and Social CareSt Helens RoadOrmskirkLancashireUKL39 4QP
| | - Yannis Pappas
- University of BedfordshireInstitute for Health ResearchPark SquareLutonBedfordUKLU1 3JU
| | - Marie‐Pierre Gagnon
- Traumatologie – Urgence – Soins IntensifsCentre de recherche du CHU de Québec, Axe Santé des populations ‐ Pratiques optimales en santé10 Rue de l'Espinay, D6‐727QuébecQCCanadaG1L 3L5
| | - Steven A Julious
- University of SheffieldMedical Statistics Group, School of Health and Related ResearchRegent Court, 30 Regent StreetSheffieldUKS1 4DA
| | - Liming Xiang
- Nanyang Technological UniversityDivision of Mathematical Sciences, School of Physical and Mathematical Sciences21 Nanyang LinkSingaporeSingapore
| | - Brian Oldenburg
- University of MelbourneMelbourne School of Population and Global HealthMelbourneVictoriaAustralia
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)3 Fusionopolis Link, #06‐13Nexus@one‐northSingaporeSingapore138543
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt Dunstans RoadLondonHammersmithUKW6 8RP
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicineLjubljanaSlovenia
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Harris B, Yu J. Attitudes, perceptions and practice of alcohol and drug screening, brief intervention and referral to treatment: a case study of New York State primary care physicians and non-physician providers. Public Health 2016; 139:70-78. [DOI: 10.1016/j.puhe.2016.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/14/2016] [Accepted: 05/11/2016] [Indexed: 01/02/2023]
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Bradley KA, Lapham GT. Is it time for a more ambitious research agenda for decreasing alcohol-related harm among young adults? Addiction 2016; 111:1531-2. [PMID: 26948421 PMCID: PMC5667540 DOI: 10.1111/add.13235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 11/10/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Katharine A. Bradley
- Group Health Research Institute; 1730 Minor Avenue Ste. 1500 Seattle WA 98101 USA
| | - Gwen T. Lapham
- Group Health Research Institute; 1730 Minor Avenue Ste. 1500 Seattle WA 98101 USA
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Chan YF, Lu SE, Howe B, Tieben H, Hoeft T, Unützer J. Screening and Follow-Up Monitoring for Substance Use in Primary Care: An Exploration of Rural-Urban Variations. J Gen Intern Med 2016; 31:215-222. [PMID: 26269130 PMCID: PMC4720630 DOI: 10.1007/s11606-015-3488-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/16/2015] [Accepted: 07/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rates of substance use in rural areas are close to those of urban areas. While recent efforts have emphasized integrated care as a promising model for addressing workforce shortages in providing behavioral health services to those living in medically underserved regions, little is known on how substance use problems are addressed in rural primary care settings. OBJECTIVE To examine rural-urban variations in screening and monitoring primary care- based patients for substance use problems in a state-wide mental health integration program. DESIGN This was an observational study using patient registry. SUBJECTS The study included adult enrollees (n = 15,843) with a mental disorder from 133 participating community health clinics. MAIN OUTCOMES We measured whether a standardized substance use instrument was used to screen patients at treatment entry and to monitor symptoms at follow-up visits. KEY RESULTS While on average 73.6 % of patients were screened for substance use, follow-up on substance use problems after initial screening was low (41.4 %); clinics in small/isolated rural settings appeared to be the lowest (13.6 %). Patients who were treated for a mental disorder or substance abuse in the past and who showed greater psychiatric complexities were more likely to receive a screening, whereas patients of small, isolated rural clinics and those traveling longer distances to the care facility were least likely to receive follow-up monitoring for their substance use problems. CONCLUSIONS Despite the prevalent substance misuse among patients with mental disorders, opportunities to screen this high-risk population for substance use and provide a timely follow-up for those identified as at risk remained overlooked in both rural and urban areas. Rural residents continue to bear a disproportionate burden of substance use problems, with rural-urban disparities found to be most salient in providing the continuum of services for patients with substance use problems in primary care.
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Affiliation(s)
- Ya-Fen Chan
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Shou-En Lu
- Department of Biostatistics, School of Public Health, Rutgers University, Newark, NJ, USA
| | - Bill Howe
- Department of Computer Science & Engineering, University of Washington, Seattle, WA, USA
| | - Hendrik Tieben
- School of Architecture, Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Theresa Hoeft
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jürgen Unützer
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
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Barrio P, Gual A. Patient-centered care interventions for the management of alcohol use disorders: a systematic review of randomized controlled trials. Patient Prefer Adherence 2016; 10:1823-1845. [PMID: 27695301 PMCID: PMC5029836 DOI: 10.2147/ppa.s109641] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
ISSUES Patient-centered care (PCC) is increasingly accepted as an integral component of good health care, including addiction medicine. However, its implementation has been controversial in people with alcohol use disorders. APPROACH A systematic search strategy was devised to find completed randomized controlled trials enrolling adults (>18 years) with alcohol use disorders. Studies had to use a PCC approach such that they should have been individualized, respectful to the patients' own goals, and empowering. Studies until September 2015 were searched using PubMed, Scopus, the Cochrane Library, PsychINFO, and Web of Knowledge. KEY FINDINGS In total, 40 studies enrolling 16,020 patients met the inclusion criteria. Assessment revealed two main categories of study: psychosocial (n=35 based on motivational interviewing) and pharmacological (n=5 based on an as needed dosing regimen). Psychosocial interventions were further classified according to the presence or absence of an active comparator. When no active comparator was present, studies were classified according to the number of sessions (≥1). Results from single sessions of motivational interviewing showed no clear benefit on alcohol consumption outcomes, with few studies indicating benefit of PCC versus control. Although the results for studies of multiple sessions of counseling were also mixed, many did show a significant benefit of the PCC intervention. By contrast, studies consistently demonstrated a benefit of pharmacologically supported PCC interventions, with most of the differences reaching statistical significance. IMPLICATIONS PCC-based interventions may be beneficial for reducing alcohol consumption in people with alcohol use disorders.
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Affiliation(s)
- Pablo Barrio
- Neurosciences Institute, Hospital Clinic, Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain
- Correspondence: Pablo Barrio, Neurosciences Institute, Hospital Clinic, IDIBAPS, Carrer de Villlarroel 170, 08036 Barcelona, Spain, Tel +34 932 275 400 ext 3167, Email
| | - Antoni Gual
- Neurosciences Institute, Hospital Clinic, Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain
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26
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Keurhorst M, van de Glind I, Bitarello do Amaral-Sabadini M, Anderson P, Kaner E, Newbury-Birch D, Braspenning J, Wensing M, Heinen M, Laurant M. Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis. Addiction 2015; 110:1877-900. [PMID: 26234486 DOI: 10.1111/add.13088] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 01/15/2015] [Accepted: 07/28/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Screening and brief interventions (SBI) delivered in primary health care (PHC) are cost-effective in decreasing alcohol consumption; however, they are underused. This study aims to identify implementation strategies that focus on SBI uptake and measure impact on: (1) heavy drinking and (2) delivery of SBI in PHC. METHODS Meta-analysis was conducted of controlled trials of SBI implementation strategies in PHC to reduce heavy drinking. Key outcomes included alcohol consumption, screening, brief interventions and costs in PHC. Predictor measures concerned single versus multiple strategies, type of strategy, duration and physician-only input versus that including mid-level professionals. Standardized mean differences (SMD) were calculated to indicate the impact of implementation strategies on key outcomes. Effect sizes were aggregated using meta-regression models. RESULTS The 29 included studies were of moderate methodological quality. Strategies had no overall impact on patients' reported alcohol consumption [SMD=0.07; 95% confidence interval (CI)=-0.02 to 0.16], despite improving screening (SMD=0.53; 95% CI=0.28-0.78) and brief intervention delivery (SMD=0.64;95% CI=0.27-1.02). Multi-faceted strategies, i.e. professional and/or organizational and/or patient-orientated strategies, seemed to have strongest effects on patients' alcohol consumption (P<0.05, compared with professional-orientated strategies alone). Regarding SBI delivery, combining professional with patient-orientated implementation strategies had the highest impact (P<0.05). Involving other staff besides physicians was beneficial for screening (P<0.05). CONCLUSIONS To increase delivery of alcohol screening and brief interventions and decrease patients' alcohol consumption, implementation strategies should include a combination of patient-, professional- and organizational-orientated approaches and involve mid-level health professionals as well as physicians.
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Affiliation(s)
- Myrna Keurhorst
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.,Saxion University of Applied Sciences, Centre for Nursing Research, Deventer/Enschede, Sao Paulo, the Netherlands
| | - Irene van de Glind
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | | | - Peter Anderson
- Newcastle University, Institute of Health and Society, Newcastle, UK.,Maastricht University, School Caphri, Department of Family Medicine, Maastricht, the Netherlands
| | - Eileen Kaner
- Newcastle University, Institute of Health and Society, Newcastle, UK
| | | | - Jozé Braspenning
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Michel Wensing
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Maud Heinen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Miranda Laurant
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.,HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
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Gates P, Albertella L. The effectiveness of telephone counselling in the treatment of illicit drug and alcohol use concerns. J Telemed Telecare 2015; 22:67-85. [PMID: 26026185 DOI: 10.1177/1357633x15587406] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 03/20/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Technology-assisted substance use interventions such as 'high-tech' internet-based treatments are thought to be effective; however, the relatively 'low-tech' use of telephone counselling does not yet have an established evidence base. This paper reviews the literature including articles with information on the use of telephone counselling for the treatment of illicit drug or alcohol use. METHODS A systematic literature search using a set of telephone counselling and substance-related terms was conducted across four electronic databases. English studies prior to June 2014 that involved the use of telephone counselling with the treatment of illicit drug or alcohol use as a primary or secondary outcome were included. Review papers, opinion pieces, letters or editorials, case studies, published abstracts, and posters were excluded. In all, 94 publications were included in the review. RESULTS AND DISCUSSION The literature was supportive of telephone counselling for the treatment of alcohol use in the short term; however, literature regarding illicit drug use was particularly scarce. The generalisability of findings was limited by evident methodological issues in the included studies.
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Affiliation(s)
- Peter Gates
- National Cannabis Prevention and Information Centre, Randwick NSW, Australia
| | - Lucy Albertella
- National Cannabis Prevention and Information Centre, Randwick NSW, Australia
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28
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Best D, Hall K, Guthrie A, Abbatangelo M, Hunter B, Lubman D. Development and Implementation of a Structured Intervention for Alcohol Use Disorders for Telephone Helpline Services. ALCOHOLISM TREATMENT QUARTERLY 2015. [DOI: 10.1080/07347324.2015.986424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Danielsson AK, Eriksson AK, Allebeck P. Technology-based support via telephone or web: a systematic review of the effects on smoking, alcohol use and gambling. Addict Behav 2014; 39:1846-68. [PMID: 25128637 DOI: 10.1016/j.addbeh.2014.06.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/03/2014] [Accepted: 06/13/2014] [Indexed: 11/27/2022]
Abstract
A systematic review of the literature on telephone or internet-based support for smoking, alcohol use or gambling was performed. Studies were included if they met the following criteria: The design being a randomized control trail (RCT), focused on effects of telephone or web based interventions, focused on pure telephone or internet-based self-help, provided information on alcohol or tobacco consumption, or gambling behavior, as an outcome, had a follow-up period of at least 3months, and included adults. Seventy-four relevant studies were found; 36 addressed the effect of internet interventions on alcohol consumption, 21 on smoking and 1 on gambling, 12 the effect of helplines on smoking, 2 on alcohol consumption, and 2 on gambling. Telephone helplines can have an effect on tobacco smoking, but there is no evidence of the effects for alcohol use or gambling. There are some positive findings regarding internet-based support for heavy alcohol use among U.S. college students. However, evidence on the effects of internet-based support for smoking, alcohol use or gambling are to a large extent inconsistent.
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Larsen M, Krogstad A, Aas E, Moum T, Wahl A. A telephone-based motivational interviewing intervention has positive effects on psoriasis severity and self-management: a randomized controlled trial. Br J Dermatol 2014; 171:1458-69. [DOI: 10.1111/bjd.13363] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2014] [Indexed: 11/27/2022]
Affiliation(s)
- M.H. Larsen
- Department of Health Sciences; Institute of Health and Society; The Medical Faculty; University of Oslo; P.O. Box 1089 Blindern N-0317 Oslo Norway
- Section for Climate Therapy; Oslo University Hospital; Oslo Norway
| | - A.L. Krogstad
- Section for Climate Therapy; Oslo University Hospital; Oslo Norway
- The Department of Dermatology; Oslo University Hospital; Oslo Norway
| | - E. Aas
- The Department of Health Management and Health Economics; Institute of Health and Society; The Medical Faculty; University of Oslo; P.O. Box 1089 Blindern N-0317 Oslo Norway
| | - T. Moum
- Department of Behavioural Sciences in Medicine; The Medical Faculty; University of Oslo; Oslo Norway
| | - A.K. Wahl
- Department of Health Sciences; Institute of Health and Society; The Medical Faculty; University of Oslo; P.O. Box 1089 Blindern N-0317 Oslo Norway
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31
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Kalapatapu RK, Ho J, Cai X, Vinogradov S, Batki SL, Mohr DC. Cognitive-behavioral therapy in depressed primary care patients with co-occurring problematic alcohol use: effect of telephone-administered vs. face-to-face treatment-a secondary analysis. J Psychoactive Drugs 2014; 46:85-92. [PMID: 25052784 DOI: 10.1080/02791072.2013.876521] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This secondary analysis of a larger study compared adherence to telephone-administered cognitive-behavioral therapy (T-CBT) vs. face-to-face CBT and depression outcomes in depressed primary care patients with co-occurring problematic alcohol use. To our knowledge, T-CBT has never been directly compared to face-to-face CBT in such a sample of primary care patients. Participants were randomized in a 1:1 ratio to face-to-face CBT or T-CBT for depression. Participants receiving T-CBT (n = 50) and face-to-face CBT (n = 53) were compared at baseline, end of treatment (week 18), and three-month and six-month follow-ups. Face-to-face CBT and T-CBT groups did not significantly differ in age, sex, ethnicity, marital status, educational level, severity of depression, antidepressant use, and total score on the Alcohol Use Disorders Identification Test. Face-to-face CBT and T-CBT groups were similar on all treatment adherence outcomes and depression outcomes at all time points. T-CBT and face-to-face CBT had similar treatment adherence and efficacy for the treatment of depression in depressed primary care patients with co-occurring problematic alcohol use. When targeting patients who might have difficulties in accessing care, primary care clinicians may consider both types of CBT delivery when treating depression in patients with co-occurring problematic alcohol use.
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Affiliation(s)
- Raj K Kalapatapu
- a Department of Psychiatry , University of California , San Francisco , CA
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VanBuskirk KA, Wetherell JL. Motivational interviewing with primary care populations: a systematic review and meta-analysis. J Behav Med 2014; 37:768-80. [PMID: 23934180 PMCID: PMC4118674 DOI: 10.1007/s10865-013-9527-4] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/20/2013] [Indexed: 12/18/2022]
Abstract
This meta-analysis synthesized the findings from randomized controlled trials (RCTs) of motivational interviewing (MI) for health behavior outcomes within primary care populations. Published and unpublished RCTs were identified using databases and online listservs. Studies were synthesized by outcome subgroup and meta-regression analyses were conducted to determine potential moderators accounting for heterogeneity within samples. Mean effect sizes ranged from .07 to .47; significant effect sizes were found for the adherence subgroup of studies (p = .04) and all outcomes combined (p = .02). Professional credentials of intervention deliverer were found to significantly moderate the association between MI and effect size in substance use subgroup (p = .0005) and all outcomes combined (p = .004). Mean effect sizes were largest in outcomes related to weight loss, blood pressure, and substance use. MI appears to be useful in clinical settings and as few as 1 MI session may be effective in enhancing readiness to change and action directed towards reaching health behavior-change goals.
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Ahacic K, Nederfeldt L, Helgason ÁR. The national alcohol helpline in Sweden: an evaluation of its first year. Subst Abuse Treat Prev Policy 2014; 9:28. [PMID: 25015403 PMCID: PMC4100057 DOI: 10.1186/1747-597x-9-28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 06/27/2014] [Indexed: 11/28/2022] Open
Abstract
Background Telephone helplines are easily available and can offer anonymity. Alcohol helplines may be a potential gateway to a more advanced support protocol, and they may function as a primary support option for some. However, although telephone helplines (quitlines) make up an established evidence-based support arena for smoking cessation, few studies have described such telephone-based alcohol counseling. Methods This study describes the basic characteristics of callers (n = 480) to the Swedish Alcohol Helpline during its first year of operation, and assesses aspects of change in alcohol behavior in a selected cohort of clients (n = 40) willing to abstain from anonymity and enter a proactive support protocol. Results During the study period, 50% of callers called for consultation regarding their own alcohol use (clients), a third called about relatives with alcohol problems, and the others called for information. The clients’ average age was 49 years, and half were females. The clients’ average AUDIT score at baseline was 21 (std. dev. =7.2). Approximately a quarter had scores indicating hazardous alcohol use at baseline, while the others had higher scores. In a follow-up pilot study, the average AUDIT score had decreased from 21 to 14. While clients reporting more severe alcohol use showed a significant decrease at follow-up, hazardous users exhibited no change during the study period. Conclusion The study indicates that telephone helplines addressing the general public can be a primary-care option to reduce risky alcohol use. A randomized controlled study is needed to control for the effect of spontaneous recovery.
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Affiliation(s)
- Kozma Ahacic
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden.
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Signor L, Pierozan PS, Ferigolo M, Fernandes S, Moreira TCD, Mazoni CG, Barros HMT. Efficacy of the telephone-based Brief Motivational Intervention for alcohol problems in Brazil. BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 35:254-61. [PMID: 24142086 DOI: 10.1590/1516-4446-2011-0724] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 07/10/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Brief Motivational Intervention (BMI) is an effective treatment for alcohol misuse but has not been adequately tested for use in helplines for alcoholics. The main objective of this study was to evaluate the efficacy of a telephone-based BMI for Brazilians seeking help with alcohol use cessation. METHODS A randomized, controlled trial was performed with Brazilian subjects. Participants were randomly assigned to either the minimal intervention group (i.e., given reference materials) or the BMI group. Alcohol abstinence was evaluated in a 6-month follow-up telephone counseling session. The analysis was based on the intention to treat (ITT). RESULTS Of the 5,896 drug users who called the helpline, 700 (12%) used alcohol, 637 of whom enrolled in this study. At 6-month follow-up, 70% of the BMI group had stopped consuming alcohol compared to 41% in the control group (odds ratio = 1.5; 95% confidence interval = 1.2-1.9; p = 0.001). CONCLUSIONS A helpline-based BMI helps alcohol users achieve abstinence.
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Affiliation(s)
- Luciana Signor
- Universidade Federal de Ciências da Saúde de Porto Alegre, Pharmacology Department, Porto AlegreRS, Brazil
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Burraston BO, Bahr SJ, Cherrington DJ. Reducing juvenile delinquency with automated cell phone calls. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2014; 58:522-536. [PMID: 23486755 DOI: 10.1177/0306624x13480947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Using a sample of 70 juvenile probationers (39 treatment and 31 controls), we evaluated the effectiveness of a rehabilitation program that combined cognitive-behavioral training and automated phone calls. The cognitive-behavioral training contained six 90-min sessions, one per week, and the phone calls occurred twice per day for the year following treatment. Recidivism was measured by whether they were rearrested and the total number of rearrests during the 1st year. To test the impact of the phone calls, those who received phone calls were divided into high and low groups depending on whether they answered more or less than half of their phone calls. Those who completed the class and answered at least half of their phone calls were less likely to have been arrested and had fewer total arrests.
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Williams EC, Rubinsky AD, Lapham GT, Chavez LJ, Rittmueller SE, Hawkins EJ, Grossbard JR, Kivlahan DR, Bradley KA. Prevalence of clinically recognized alcohol and other substance use disorders among VA outpatients with unhealthy alcohol use identified by routine alcohol screening. Drug Alcohol Depend 2014; 135:95-103. [PMID: 24360928 DOI: 10.1016/j.drugalcdep.2013.11.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/11/2013] [Accepted: 11/16/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of routine alcohol screening is to identify patients who may benefit from brief intervention, but patients who also have alcohol and other substance use disorders (AUD/SUD) likely require more intensive interventions. This study sought to determine the prevalence of clinically documented AUD/SUD among VA outpatients with unhealthy alcohol use identified by routine screening. METHODS VA patients 18-90 years who screened positive for unhealthy alcohol use (AUDIT-C ≥3 women; ≥4 men) and were randomly selected for quality improvement standardized medical record review (6/06-6/10) were included. Gender-stratified prevalences of clinically documented AUD/SUD (diagnosis of AUD, SUD, or alcohol-specific medical conditions, or VA specialty addictions treatment on the date of or 365 days prior to screening) were estimated and compared across AUDIT-C risk groups, and then repeated across groups further stratified by age. RESULTS Among 63,397 eligible patients with unhealthy alcohol use, 25% (n=2109) women and 28% (n=15,199) men had documented AUD/SUD (p<0.001). The prevalence of AUD/SUD increased with increasing AUDIT-C risk, ranging from 13% (95% CI 13-14%) to 82% (79-85%) for women and 12% (11-12%) to 69% (68-71%) for men in the lowest and highest AUDIT-C risk groups, respectively. Patterns were similar across age groups. CONCLUSIONS One-quarter of all patients with unhealthy alcohol use, and a majority of those with the highest alcohol screening scores, had clinically recognized AUD/SUD. Healthcare systems implementing evidence-based alcohol-related care should be prepared to offer more intensive interventions and/or effective pharmacotherapies for these patients.
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Affiliation(s)
- Emily C Williams
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States.
| | - Anna D Rubinsky
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Excellence for Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States
| | - Gwen T Lapham
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Group Health Research Institute, Seattle, WA, United States
| | - Laura J Chavez
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States
| | - Stacey E Rittmueller
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States
| | - Eric J Hawkins
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Excellence for Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Joel R Grossbard
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Excellence for Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States
| | - Daniel R Kivlahan
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Excellence for Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Katharine A Bradley
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Excellence for Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States; Group Health Research Institute, Seattle, WA, United States
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Referral for substance abuse treatment and depression improvement among patients with co-occurring disorders seeking behavioral health services in primary care. J Subst Abuse Treat 2014; 46:106-12. [DOI: 10.1016/j.jsat.2013.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 08/05/2013] [Accepted: 08/14/2013] [Indexed: 11/20/2022]
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Gebara CFDP, Bhona FMDC, Ronzani TM, Lourenço LM, Noto AR. Brief intervention and decrease of alcohol consumption among women: a systematic review. Subst Abuse Treat Prev Policy 2013; 8:31. [PMID: 24016074 PMCID: PMC3847063 DOI: 10.1186/1747-597x-8-31] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 09/05/2013] [Indexed: 12/05/2022] Open
Abstract
Problems related to alcohol consumption are priority public health issues worldwide and may compromise women's health. The early detection of risky alcohol consumption combined with a brief intervention (BI) has shown promising results in prevention for different populations. The aim of this study was to examine data from recent scientific publications on the use of BI toward reducing alcohol consumption among women through a systematic review. Electronic searches were conducted using Web of Science, PubMed(Medline) and PsycInfo databases. In all databases, the term "brief intervention" was associated with the words "alcohol" and "women", and studies published between the years 2006 and 2011 were selected. Out of the 133 publications found, the 36 scientific articles whose central theme was performing and/or evaluating the effectiveness of BI were included. The full texts were reviewed by content analysis technique. This review identified promising results of BI for women, especially pregnant women and female college students, in different forms of application (face-to-face, by computer or telephone) despite a substantial heterogeneity in the clinical trials analyzed. In primary care, which is a setting involving quite different characteristics, the results among women were rather unclear. In general, the results indicated a decrease in alcohol consumption among women following BI, both in the number of days of consumption and the number of doses, suggesting that the impact on the woman's reproductive health and the lower social acceptance of female consumption can be aspects favorable for the effectiveness of BI in this population.
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Affiliation(s)
- Carla Ferreira de Paula Gebara
- Department of Psychobiology, Research Center on Health and Substance Use (NEPSIS), Universidade Federal de São Paulo (UNIFESP), Rua Botucatu, 862 – 1° andar, 04023-062 São Paulo - SP, Brazil
| | - Fernanda Monteiro de Castro Bhona
- Department of Psychology, Center for Studies on Violence and Social Anxiety (NEVAS), Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora - MG, Brazil
| | - Telmo Mota Ronzani
- Department of Psychology, Center for Research, Intervention and Evaluation for Alcohol & Drugs (CREPEIA), Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora - MG, Brazil
| | - Lelio Moura Lourenço
- Department of Psychology, Center for Studies on Violence and Social Anxiety (NEVAS), Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora - MG, Brazil
| | - Ana Regina Noto
- Department of Psychobiology, Research Center on Health and Substance Use (NEPSIS), Universidade Federal de São Paulo (UNIFESP), Rua Botucatu, 862 – 1° andar, 04023-062 São Paulo - SP, Brazil
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Bradley KA, Rubinsky AD. Why not add consumption measures to current definitions of substance use disorders? Commentary on Rehm et al.: 'Defining substance use disorders: do we really need more than heavy use?'. Alcohol Alcohol 2013; 48:642-3. [PMID: 23955834 DOI: 10.1093/alcalc/agt132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The article by Rehm and colleagues in this issue of the Journal argues that diagnoses of substance use disorders should be based solely on measures of consumption. Although the authors provide convincing arguments for inclusion of consumption measures in the diagnostic criteria for substance use disorders, we do not agree that diagnostic criteria should be restricted to measures of consumption alone. Our clinical and research experience with alcohol use disorders suggests that use of consumption measures alone would fail to identify many patients whose alcohol or drug use is adversely impacting their health. Instead, we advocate-as others have done-that measures of consumption be added to current diagnostic criteria.
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Affiliation(s)
- Katharine A Bradley
- Correspondence author: Group Health Research Institute, Metropolitan Park East, 1730 Minor Avenue, Ste. 1600, Seattle, WA 98101, USA.
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Grossbard JR, Hawkins EJ, Lapham GT, Williams EC, Rubinsky AD, Simpson TL, Seal KH, Kivlahan DR, Bradley KA. Follow-up care for alcohol misuse among OEF/OIF veterans with and without alcohol use disorders and posttraumatic stress disorder. J Subst Abuse Treat 2013; 45:409-15. [PMID: 23906670 DOI: 10.1016/j.jsat.2013.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 04/11/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
Abstract
Little is known about follow-up care for alcohol misuse in the Veterans Affairs (VA) health care system among Operations Enduring and Iraqi Freedom (OEF/OIF) veterans with and without alcohol use disorders (AUD) and/or posttraumatic stress disorder (PTSD). Using data from 4725 OEF/OIF VA outpatients with alcohol screening (2006-2010), we compared the prevalence of follow-up for alcohol misuse--brief intervention (BI) or referral to treatment--among patients with and without AUD and/or PTSD. Among 933 (19.7%) patients with alcohol misuse (AUDIT-C ≥5), 77.0% had AUD and/or PTSD. Rates of BI or referral for alcohol misuse were higher among patients with AUD (76.9%) and both AUD and PTSD (70.1%) compared to those with PTSD only (53.1%) and neither AUD nor PTSD (52.3%). Among OEF/OIF VA outpatients with alcohol misuse, those with AUD had higher rates of follow-up for alcohol misuse than those without, but PTSD was not associated with differential follow-up.
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Affiliation(s)
- Joel R Grossbard
- Health Services Research & Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98101, USA; Health Services, University of Washington, Seattle, WA, USA.
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Pereira MO, Anginoni BM, Ferreira NDC, Oliveira MAFD, Vargas DD, Colvero LDA. Efetividade da intervenção breve para o uso abusivo de álcool na atenção primária: revisão sistemática. Rev Bras Enferm 2013; 66:420-8. [PMID: 23887793 DOI: 10.1590/s0034-71672013000300018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 04/09/2013] [Indexed: 11/21/2022] Open
Abstract
A pesquisa identificou estudos clínicos acerca das intervenções breves para o uso abusivo de álcool e analisou a eficácia dos aconselhamentos para os consumidores. Estudo bibliográfico sistemático que utilizou artigos publicados no período de 1997 a 2010. Os achados mostraram que a estratégia de intervenção breve é efetiva na redução da frequência e quantidade de álcool, com melhores resultados quando aplicada na atenção primária. Todos os profissionais da área da saúde obtêm bons resultados com o manejo dessa terapia. Não foi possível definir se a estratégia é mais eficaz se aplicada em bebedores de uso nocivo ou em crônicos, uma vez que a intervenção depende da mobilização de recursos motivacionais do paciente e de mudanças de atitude relacionadas ao consumo de álcool.
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Affiliation(s)
- Peter D Friedmann
- Research Service, Veterans Affairs Medical Center, and Division of General Internal Medicine, Rhode Island Hospital, Providence, RI 02903, USA.
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McKellar J, Austin J, Moos R. Building the first step: a review of low-intensity interventions for stepped care. Addict Sci Clin Pract 2012; 7:26. [PMID: 23227807 PMCID: PMC3554471 DOI: 10.1186/1940-0640-7-26] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 12/02/2012] [Indexed: 11/30/2022] Open
Abstract
Within the last 30 years, a substantial number of interventions for alcohol use disorders (AUDs) have received empirical support. Nevertheless, fewer than 25% of individuals with alcohol-related problems access these interventions. If several intensive psychosocial treatments are relatively effective, but most individuals in need do not access them, it seems logical to place a priority on developing more engaging interventions. Accordingly, after briefly describing findings about barriers to help-seeking, we focus on identifying an array of innovative and effective low-intensity intervention strategies, including telephone, computer-based, and Internet-based interventions, that surmount these barriers and are suitable for use within a stepped-care model. We conclude that these interventions attract individuals who would otherwise not seek help, that they can benefit individuals who misuse alcohol and those with more severe AUDs, and that they can facilitate subsequent help-seeking when needed. We note that these types of low-intensity interventions are flexible and can be tailored to address many of the perceived barriers that hinder individuals with alcohol misuse or AUDs from obtaining timely help. We also describe key areas of further research, such as identifying the mechanisms that underlie stepped-care interventions and finding out how to structure these interventions to best initiate a program of stepped care.
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Affiliation(s)
- John McKellar
- Center for Healthcare Evaluation, Health Services Research and Development Service, Department of Veterans Affairs Health Care System and Stanford University School of Medicine, Palo Alto, CA, USA.
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Screening and brief intervention for unhealthy drug use in primary care settings: randomized clinical trials are needed. J Addict Med 2012; 4:123-30. [PMID: 20936079 DOI: 10.1097/adm.0b013e3181db6b67] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The efficacy of screening and brief intervention (SBI) for drug use in primary care patients is largely unknown. Because of this lack of evidence, US professional organizations do not recommend it. Yet, a strong theoretical case can be made for drug SBI. Drug use is common and associated with numerous health consequences, patients usually do not seek help for drug abuse and dependence, and SBI has proven efficacy for unhealthy alcohol use. On the other hand, the diversity of drugs of abuse and the high prevalence of abuse and dependence among those who use them raise concerns that drug SBI may have limited or no efficacy. Federal efforts to disseminate SBI for drug use are underway, and reimbursement codes to compensate clinicians for these activities have been developed. However, the discrepancies between science and policy developments underscore the need for evidence-based research regarding the efficacy of SBI for drug use. This article discusses the rationale for drug SBI and existing research on its potential to improve drug-use outcomes and makes the argument that randomized controlled trials to determine its efficacy are urgently needed to bridge the gap between research, policy, and clinical practice.
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Kwon B, Kim JS, Kim SS, Jung JG, Kim MY, Song IG, Youn KM. Effects of Brief Advice from Family Physicians on the Readiness to Change of Korean Male At-risk Drinkers. Korean J Fam Med 2012; 33:157-65. [PMID: 22787538 PMCID: PMC3391641 DOI: 10.4082/kjfm.2012.33.3.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 04/17/2012] [Indexed: 11/27/2022] Open
Abstract
Background This study examined the effects of the method of delivery of brief advice on the readiness to change in at-risk drinkers. Methods The participants were 103 at-risk male drinkers who visited Chungnam National University Hospital for general health examinations. Baseline data on drinking behavior, readiness to change drinking behavior, and sociodemographic characteristics were obtained from a questionnaire. Family physicians gave two minutes of advice by telephone or in-person. The brief advice comprised a simple statement that the patient's drinking exceeded the recommended limits and could lead to alcohol-related problems. It also included advice to moderate one's drinking. One month later, the readiness to change was assessed again by telephone. The improvement in the readiness to change according to each method of delivery was investigated. Results Initially, among the 58-patient in-person advice group, 12 patients were in the precontemplation stage, 38 in the contemplation stage, and 8 in the action stage. One month after the advice was given to the patients, the distribution had changed significantly (P < 0.001) to 1, 21, and 36 patients, respectively. Among the 45-patient telephone advice group, 7 patients were in the precontemplation stage, 32 patients were in the contemplation stage, and 6 patients were in the action stage before the advice. The distribution had changed significantly (P < 0.001) to 1, 17, and 27 patients, respectively, 1 month after the advice. Conclusion These results suggest that brief advice by family physicians is effective in improving the readiness to change of at-risk drinkers, regardless of the delivery method.
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Affiliation(s)
- Bora Kwon
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
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Sullivan LE, Tetrault JM, Braithwaite RS, Turner BJ, Fiellin DA. A meta-analysis of the efficacy of nonphysician brief interventions for unhealthy alcohol use: implications for the patient-centered medical home. Am J Addict 2011; 20:343-56. [PMID: 21679266 DOI: 10.1111/j.1521-0391.2011.00143.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Brief physician interventions can reduce alcohol consumption. Physicians may not have the time to provide brief interventions, and it is unclear whether nonphysicians can do so effectively. We conducted a systematic review and meta-analysis to examine the efficacy of brief interventions by nonphysician clinicians for unhealthy alcohol use. We searched the English-language literature in MEDLINE and other databases covering the domains of alcohol problems, primary care, nonphysician, and brief interventions. Studies of brief interventions delivered at least in part by nonphysicians in primary care and examining drinking outcomes were included. Sensitivity analyses examined the effect of excluding studies that contributed disproportionately to the heterogeneity of results. Thirteen studies, conducted 1996-2008, met our criteria. Seven studies with a total of 2,633 patients were included in the meta-analysis. Nonphysician interventions were associated with 1.7 (95% confidence interval [CI]=-.03 to -3.5) fewer standard drinks per week than control conditions (p = .054). Excluding the one study that increased heterogeneity, the effect was smaller but reached statistical significance; nonphysician counseling was associated with 1.4 (95% CI = .3- 2.4) fewer standard drinks per week compared to control (p = .012). Nonphysician brief interventions are modestly effective at reducing drinking in primary care patients with unhealthy alcohol use.
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Affiliation(s)
- Lynn E Sullivan
- Yale University School of Medicine, New Haven, Connecticut 06520–8093, USA.
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Smedslund G, Berg RC, Hammerstrøm KT, Steiro A, Leiknes KA, Dahl HM, Karlsen K. Motivational interviewing for substance abuse. Cochrane Database Syst Rev 2011; 2011:CD008063. [PMID: 21563163 PMCID: PMC8939890 DOI: 10.1002/14651858.cd008063.pub2] [Citation(s) in RCA: 158] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are 76.3 million people with alcohol use disorders worldwide and 15.3 million with drug use disorders. Motivational interviewing (MI) is a client-centred, semi-directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The intervention is used widely, and therefore it is important to find out whether it helps, harms or is ineffective. OBJECTIVES To assess the effectiveness of motivational interviewing for substance abuse on drug use, retention in treatment, readiness to change, and number of repeat convictions. SEARCH STRATEGY We searched 18 electronic databases, 5 web sites, 4 mailing lists, and reference lists from included studies and reviews. Search dates were November 30, 2010 for Cochrane Library, Medline, Embase and PsychINFO. SELECTION CRITERIA Randomized controlled trials with persons dependent or abusing substance. Interventions were MI or motivational enhancement therapy. The outcomes were extent of substance abuse, retention in treatment, motivation for change, repeat conviction. DATA COLLECTION AND ANALYSIS Three authors independently assessed studies for inclusion, and two authors extracted data. Results were categorized into (1) MI versus no-treatment control, (2) MI versus treatment as usual, (3) MI versus assessment and feedback, and (4) MI versus other active treatment. Within each category, we computed meta-analyses separately for post-intervention, short, medium and long follow-ups. MAIN RESULTS We included 59 studies with a total of 13,342 participants. Compared to no treatment control MI showed a significant effect on substance use which was strongest at post-intervention SMD 0.79, (95% CI 0.48 to 1.09) and weaker at short SMD 0.17 (95% CI 0.09 to 0.26], and medium follow-up SMD 0.15 (95% CI 0.04 to 0.25]). For long follow-up, the effect was not significant SMD 0.06 (95% CI-0.16 to 0.28). There were no significant differences between MI and treatment as usual for either follow-up post-intervention, short and medium follow up. MI did better than assessment and feedback for medium follow-up SMD 0.38 (95% CI 0.10 to 0.66). For short follow-up, there was no significant effect . For other active intervention there were no significant effects for either follow-up.There was not enough data to conclude about effects of MI on the secondary outcomes. AUTHORS' CONCLUSIONS MI can reduce the extent of substance abuse compared to no intervention. The evidence is mostly of low quality, so further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
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Affiliation(s)
- Geir Smedslund
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Rigmor C Berg
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Karianne T Hammerstrøm
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Asbjørn Steiro
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Kari A Leiknes
- Norwegian Knowledge Centre for the Health ServicesPostboks 7004St. Olavs plassOsloN‐0130Norway
| | - Helene M Dahl
- Institute of Clinical MedicineDepartment of Clinical PsychiatryUniversity of Tromsø, Asgard,TromsøNorway9291
| | - Kjetil Karlsen
- Institute of Clinical MedicineDepartment of Clinical PsychiatryUniversity of Tromsø, Asgard,TromsøNorway9291
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Progress in HIV reduction and prevention among injection and noninjection drug users. J Acquir Immune Defic Syndr 2011; 55 Suppl 2:S84-7. [PMID: 21406993 DOI: 10.1097/qai.0b013e3181fbca5a] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Substantial progress has been made in reducing HIV among injection drug users (IDUs) in the United States, despite political and social resistance that reduced resources and restricted access to services. The record for HIV prevention among noninjecting drug users is less developed, although they are more numerous than IDUs. Newer treatments for opiate and alcohol abuse can now be integrated into primary HIV care; treatment for stimulant abuse is less developed. All drug users present challenges for newer HIV prevention strategies (eg, "test and treat," nonoccupational postexposure prophylaxis and preexposure prophylaxis, contingency management, and conditional cash transfer). A comprehensive HIV prevention program that includes multicomponent multilevel approaches (ie, individual, network, structural) has been effective in HIV prevention among IDUs. Expanding these approaches to noninjecting drug users, especially those at highest risk (eg, minority men who have sex with men) and incorporating these newer approaches is a public health priority.
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Bradley KA, Lapham GT, Hawkins EJ, Achtmeyer CE, Williams EC, Thomas RM, Kivlahan DR. Quality concerns with routine alcohol screening in VA clinical settings. J Gen Intern Med 2011; 26:299-306. [PMID: 20859699 PMCID: PMC3043188 DOI: 10.1007/s11606-010-1509-4] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 07/26/2010] [Accepted: 08/30/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND Alcohol screening questionnaires have typically been validated when self- or researcher-administered. Little is known about the performance of alcohol screening questionnaires administered in clinical settings. OBJECTIVE The purpose of this study was to compare the results of alcohol screening conducted as part of routine outpatient clinical care in the Veterans Affairs (VA) Health Care System to the results on the same alcohol screening questionnaire completed on a mailed survey within 90 days and identify factors associated with discordant screening results. DESIGN Cross sectional. PARTICIPANTS A national sample of 6,861 VA outpatients (fiscal years 2007-2008) who completed the AUDIT-C alcohol screening questionnaire on mailed surveys (survey screen) within 90 days of having clinical AUDIT-C screening documented in their medical records (clinical screen). MAIN MEASURES Alcohol screening results were considered discordant if patients screened positive (AUDIT-C ≥ 5) on either the clinical or survey screen but not both. Multivariable logistic regression was used to estimate the prevalence of discordance in different patient subgroups based on demographic and clinical characteristics, VA network and temporal factors (e.g. the order of screens). KEY RESULTS Whereas 11.1% (95% CI 10.4-11.9%) of patients screened positive for unhealthy alcohol use on the survey screen, 5.7% (5.1- 6.2%) screened positive on the clinical screen. Of 765 patients who screened positive on the survey screen, 61.2% (57.7-64.6%) had discordant results on the clinical screen, contrasted with 1.5% (1.2-1.8%) of 6096 patients who screened negative on the survey screen. In multivariable analyses, discordance was significantly increased among Black patients compared with White, and among patients who had a positive survey AUDIT-C screen or who received care at 4 of 21 VA networks. CONCLUSION Use of a validated alcohol screening questionnaire does not-by itself-ensure the quality of alcohol screening. This study suggests that the quality of clinical alcohol screening should be monitored, even when well-validated screening questionnaires are used.
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Affiliation(s)
- Katharine A Bradley
- Health Services Research & Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA.
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What can general medical providers do for hospitalized patients with alcohol dependence after discharge? J Gen Intern Med 2010; 25:1000-2. [PMID: 20632122 PMCID: PMC2955484 DOI: 10.1007/s11606-010-1441-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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