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Punia K, Scott W, Manuja K, Sabbineni M, Campbell K, Balodis IM, MacKillop J. SAEM GRACE: Anti-craving medications for alcohol use disorder treatment in the emergency department: A systematic review of direct evidence. Acad Emerg Med 2024; 31:504-514. [PMID: 37735346 DOI: 10.1111/acem.14806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES Alcohol-related concerns commonly present to the emergency department (ED), with a subset of individuals experiencing the symptoms of an alcohol use disorder (AUD). As such, examining the efficacy of pharmacological anti-craving treatment for AUD in the ED is of increasing interest. The objective of this systematic review was to evaluate the direct evidence assessing the efficacy of providing anti-craving medications for AUD treatment in the ED. METHODS A systematic search was conducted according to the patient-intervention-control-outcome question: (P) adults (≥18 years old) presenting to the ED with an AUD (including suspected AUD); (I) anti-craving medications (i.e., naltrexone, acamprosate, gabapentin); (C) no prescription or placebo; (O) reduction of repeat ED visits, engagement in addiction services, reductions in heavy drinking days, reductions in any drinking and amount consumed (or abstinence), and in relapse. Two reviewers independently assessed articles for inclusion and conducted risk of bias assessments for included studies. RESULTS From 143 potentially relevant articles, 6 met inclusion criteria: 3 clinical trials, and 3 case studies. The clinical trials identified evaluated oral versus extended-release naltrexone, monthly extended-release naltrexone injections, and disulfiram. Both oral and extended-release naltrexone resulted in decreased alcohol consumption. Monthly extended-release naltrexone injections resulted in significant improvements in drinking and quality of life. Although out of scope, the disulfiram studies identified did not result in an improvement in drinking in comparison to no medication. CONCLUSIONS Overall, there are few studies directly examining the efficacy of anti-craving medications for AUD in the ED, although the limited evidence that exists is supportive of naltrexone pharmacotherapy, particularly extended-release injection formulation. Additional randomized controlled trials are necessary for substantive direct evidence on anti-craving medication initiation in the ED.
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Affiliation(s)
- Kiran Punia
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - William Scott
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kriti Manuja
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - Monica Sabbineni
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Iris M Balodis
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Syan SK, McIntyre-Wood C, Vandehei E, Vidal ML, Hargreaves T, Levitt EE, Scarfe M, Marsden E, MacKillop E, Sarles-Whittlesey H, Amlung M, Sweet L, MacKillop J. Resting state functional connectivity as a predictor of brief intervention response in adults with alcohol use disorder: A preliminary study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1590-1602. [PMID: 37572293 DOI: 10.1111/acer.15123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Brief interventions for alcohol use disorder (AUD) are generally efficacious, albeit with variability in response. Resting state functional connectivity (rsFC) may characterize neurobiological indicators that predict the response to brief interventions and is the focus of the current investigation. MATERIALS AND METHODS Forty-six individuals with AUD (65.2% female) completed a resting state functional magnetic resonance imaging (fMRI) scan immediately followed by a brief intervention aimed at reducing alcohol consumption. Positive clinical response was defined as a reduction in alcohol consumption by at least one World Health Organization (WHO) risk drinking level at 3-month follow-up. rsFC was analyzed using seed-to-voxel analysis with seed regions from four networks: salience network, reward network, frontoparietal network, and default mode network. RESULTS At baseline, responders had greater rsFC between the following seed regions in relation to voxel-based clusters than non-responders: (i) anterior cingulate cortex (ACC) in relation to left postcentral gyrus and right supramarginal gyrus (salience network); (ii) right posterior parietal cortex in relation to right ventral ACC (salience network); (iii) right interior frontal gyrus (IFG) pars opercularis in relation to right cerebellum and right occipital fusiform gyrus (frontoparietal); and (iv) right primary motor cortex in relation to left thalamus (default mode). Lower rsFC in responders vs. nonresponders was seen between the (i) right rostral prefrontal cortex in relation to left IFG pars triangularis (frontoparietal); (ii) right IFG pars triangularis in relation to right cerebellum (frontoparietal); (iii) right IFG pars triangularis in relation to right frontal eye fields and right angular gyrus (frontoparietal); and (iv) right nucleus accumbens in relation to right orbital frontal cortex and right insula (reward). CONCLUSIONS Resting state functional connectivity in the frontoparietal, salience, and reward networks predicts the response to a brief intervention in individuals with AUD and could reflect greater receptivity or motivation for behavior change.
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Affiliation(s)
- Sabrina K Syan
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Carly McIntyre-Wood
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Emily Vandehei
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Mae Linda Vidal
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Tegan Hargreaves
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Emily E Levitt
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Molly Scarfe
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Emma Marsden
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Emily MacKillop
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Michael Amlung
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, Kansas, USA
- Department of Applied Behavioral Science, University of Kansas, Lawrence, Kansas, USA
| | - Lawrence Sweet
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Shenvi CL, Wang Y, Revankar R, Phillips J, Bush M, Biese KJ, Aylward A, D'Onofrio G, Platts‐Mills TF. Use of a Brief Negotiation Interview in the emergency department to reduce high-risk alcohol use among older adults: A randomized trial. J Am Coll Emerg Physicians Open 2022; 3:e12651. [PMID: 35156089 PMCID: PMC8828696 DOI: 10.1002/emp2.12651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/19/2021] [Accepted: 12/28/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine whether a Brief Negotiation Interview (BNI) performed in the emergency department (ED) can reduce future rates of alcohol use among older adults who are high-risk drinkers. METHODS Adults aged 65 years and older in a single academic ED were screened for high-risk alcohol use based on the National Institute for Alcohol Abuse and Alcoholism definition of >7 drinks per week or >3 drinks per occasion. Eligible individuals who were high-risk drinkers who passed a cognitive impairment screener and who consented to enrollment were randomly assigned to receive the BNI versus usual care. Outcomes were assessed at 3, 6, and 12 months. The primary outcome was the rate of high-risk alcohol use at 6 months. RESULTS Of 2250 ED patients who were screened, 183 (8%) met the criteria for high-risk alcohol use. Of those, 98 (53%) patients met full criteria and consented to participation. Of the participants, 67% were men and 83% were non-Hispanic White. There was no significant difference in the primary outcome of high-risk alcohol use at 6 months between the BNI at 59.1% (95% confidence interval [CI], 45.5%-76.8%) and the control at 49.1% (95% CI, 36.9%-65.2%). However, there was a significant time-effect reduction in alcohol consumption and rates of high-risk alcohol use for both groups. CONCLUSION Among older adults who met the criteria for high-risk alcohol use, the BNI in the ED did not result in a reduction in high-risk alcohol use at 6 months, although both groups showed significant reductions after their ED visit. Further work is needed to determine the optimal setting and time to use the BNI to impact high-risk alcohol use in this population.
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Affiliation(s)
- Christina L. Shenvi
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Yushan Wang
- Wake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | | | | | - Montika Bush
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Kevin J. Biese
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Aileen Aylward
- Department of Emergency MedicineUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Gail D'Onofrio
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
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Sivertsen DM, Becker U, Andersen O, Kirk JW. An Ethnographic study of unhealthy alcohol use in a Danish Emergency Department. Addict Sci Clin Pract 2021; 16:60. [PMID: 34600564 PMCID: PMC8487327 DOI: 10.1186/s13722-021-00269-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Emergency Departments (EDs) are important arenas for the detection of unhealthy substance use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for unhealthy alcohol use has been used in some ED settings with funding support from external sources. However, widespread sustained implementation is uncommon, and research aimed at understanding culture as a determinant for implementation is lacking. This study aims to explore cultural practices concerning the handling of patients with unhealthy alcohol use admitted to an ED. Methods An ethnographic study was conducted in an ED in the Capital Region of Denmark. The data consists of participant observations of Health Care Professionals (HCPs) and semi-structured interviews with nurses. Data was collected from July 2018 to February 2020. A cultural analysis was performed by using Qualitative Content Analysis as an analytic tool. Results 150 h of observation and 11 interviews were conducted. Three themes emerged from the analysis: (1) Setting the scene describes how subthemes “flow,” “risky environment,” and “physical spaces and artefacts” are a part of the contextual environment of an ED, and their implications for patients with unhealthy alcohol use, such as placement in certain rooms; (2) The encounter presents how patients’ and HCPs’ encounters unfold in everyday practice. Subtheme “Professional differences” showcases how nurses and doctors address patients’ alcohol habits differently, and how they do not necessarily act on the information provided, due to several factors. These factors are shown in remaining sub-themes “gut-feeling vs. clinical parameters,” “ethical reasoning,” and “from compliance to zero-tolerance”; and (3) Collective repertoires shows how language shapes the perception of patients with unhealthy alcohol use, which may cause stigma and stereotyping. Subthemes are “occupiers” and “alcoholic or party animal?”. Conclusions Unhealthy alcohol use in the ED is entangled in complex cultural networks. Patients with severe and easily recognizable unhealthy alcohol use—characterized by an alcohol diagnosis in the electronic medical record, intoxication, or unwanted behavior—shape the general approach and attitude to unhealthy alcohol use. Consequently, from a prevention perspective, this means that patients with less apparent unhealthy alcohol use tend to be overlooked or neglected, which calls for a systematic screening approach. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00269-z.
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Affiliation(s)
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark.,Faculty of Health Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Public Health, Nursing, Aarhus University, Aarhus, Denmark
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Zatzick D, Moloney K, Palinkas L, Thomas P, Anderson K, Whiteside L, Nehra D, Bulger E. Catalyzing the Translation of Patient-Centered Research Into United States Trauma Care Systems: A Case Example. Med Care 2021; 59:S379-S386. [PMID: 34228020 PMCID: PMC8263139 DOI: 10.1097/mlr.0000000000001564] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The expedient translation of research findings into sustainable intervention procedures is a longstanding health care system priority. The Patient-Centered Outcomes Research Institute (PCORI) has facilitated the development of "research done differently," with a central tenet that key stakeholders can be productively engaged throughout the research process. Literature review revealed few examples of whether, as originally posited, PCORI's innovative stakeholder-driven approach could catalyze the expedient translation of research results into practice. OBJECTIVES This narrative review traces the historical development of an American College of Surgeons Committee on Trauma (ACS/COT) policy guidance, facilitated by evidence supplied by the PCORI-funded studies evaluating the delivery of patient-centered care transitions. Key elements catalyzing the guidance are reviewed, including the sustained engagement of ACS/COT policy stakeholders who have the capacity to invoke system-level implementation strategies, such as regulatory mandates linked to verification site visits. Other key elements, including the encouragement of patient stakeholder voice in policy decisions and the incorporation of end-of-study policy summits in pragmatic comparative effectiveness trial design, are discussed. CONCLUSIONS Informed by comparative effectiveness trials, ACS/COT policy has expedited introduction of the patient-centered care construct into US trauma care systems. A comparative health care systems conceptual framework for transitional care which incorporates Research Lifecycle, pragmatic clinical trial and implementation science models is articulated. When combined with Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE), employed as a targeted implementation strategy, this approach may accelerate the sustainable delivery of high-quality patient-centered care transitions for US trauma care systems.
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Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Lawrence Palinkas
- Department of Children, Youth and Families, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, CA
| | - Peter Thomas
- Powers Pyles Sutter and Verville PC, Washington, DC
| | - Kristina Anderson
- The Koshka Foundation and Department of Psychiatry and Behavioral Sciences
| | | | - Deepika Nehra
- Surgery, University of Washington School of Medicine, Seattle, WA
| | - Eileen Bulger
- Surgery, University of Washington School of Medicine, Seattle, WA
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Castro Y, Najera SN, Robles EH, Reddy SM, Holcomb BN, Field CA. Mechanisms of change in drinking following an alcohol-related injury: A qualitative examination of the sentinel event effect. Subst Abus 2020; 42:699-705. [PMID: 33284082 DOI: 10.1080/08897077.2020.1846150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sentinel events are negative health-related events that trigger change in risky health behaviors. Despite its presumed major role in behavior change, the sentinel event effect has received little empirical attention. Through analysis of qualitative interviews, we explored how sentinel events trigger behavior change. Methods: Thematic analysis and concept mapping were used to develop a preliminary model of the sentinel event effect among a sample of 24 adult heavy drinking Mexican-origin men previously admitted to a hospital due to injury. The model was checked against cases that did versus did not report change in alcohol use following an alcohol-related negative event. Results: Findings suggest that sentinel events may arouse negative emotional reactions, encourage reflection on the negative consequences of drinking, and cause reevaluation of the severity and significance of drinking. These processes may increase motivation to change. Conclusions: Findings support the concept of the sentinel event as a natural intervention, and identifies potential social-cognitive and motivational mechanisms through which it influences change. Findings stand to inform research on mechanisms underlying brief intervention effects, and research that seeks to identify treatment targets.
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Affiliation(s)
- Yessenia Castro
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Sarah N Najera
- Department of Psychology, University of Texas at El Paso, El Paso, Texas, USA
| | - Eden H Robles
- Department of Psychology, University of Texas at El Paso, El Paso, Texas, USA
| | - Swathi M Reddy
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Brianna N Holcomb
- Department of Psychology, University of Texas at El Paso, El Paso, Texas, USA
| | - Craig A Field
- Department of Psychology, University of Texas at El Paso, El Paso, Texas, USA
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Gargaritano KL, Murphy C, Auyeung AB, Doyle F. Systematic Review of Clinician-Reported Barriers to Provision of Brief Advice for Alcohol Intake in Hospital Inpatient and Emergency Settings. Alcohol Clin Exp Res 2020; 44:2386-2400. [PMID: 33119905 DOI: 10.1111/acer.14491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
Abstract
Hospital inpatient and emergency care settings provide frequent opportunities for clinicians to screen and provide brief interventions to patients who engage in the harmful use of alcohol. However, these services are not always provided, with several reasons given in different studies. We aimed to systematically review clinician-reported barriers in the provision of brief alcohol screening, brief advice, and intervention specific to hospital inpatient and emergency department (ED) settings. A systematic literature review was conducted in MEDLINE, PsycINFO, and CINAHL to identify the barriers perceived by healthcare workers in the provision of alcohol screening and brief intervention. These barriers were then categorized according to the capability, opportunity, and motivation (COM-B) model of behavior change theory. Twenty-five articles were included in this study, which involved questionnaires, surveys, interviews, and conference call discussions. The most commonly cited barriers (i.e., greater than half of the studies) were related to capability (lack of knowledge cited in 60% of studies); opportunity (lack of time and resources, 76 and 52% of studies, respectively); and motivation (personal discomfort in 60% of studies). Twenty-two other barriers were reported but with lower frequency. Clinicians cite a multitude of factors that impede their delivery of alcohol screening and brief interventions in the hospital inpatient and ED settings. These barriers were explored further under the framework of the COM-B model, which allows for intervention design. As such, changes can be made at the policy, managerial, and educational levels to address these barriers and help improve the self-efficacy and knowledge of clinicians who counsel patients on alcohol use.
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Affiliation(s)
- Kristine Lou Gargaritano
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Caoimhe Murphy
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Austin B Auyeung
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Frank Doyle
- From the, Division of Population Health Sciences (Health Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
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8
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Field CA, Richards DK, Castro Y, Alonso Cabriales J, Wagler A, von Sternberg K. The Effects of a Brief Motivational Intervention for Alcohol Use through Stages of Change among Nontreatment Seeking Injured Patients. Alcohol Clin Exp Res 2020; 44:2361-2372. [PMID: 32981123 DOI: 10.1111/acer.14466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the mechanisms of change underlying brief interventions and the patient characteristics that may affect them. The present study tested whether the stages of change mediate the effects of a BMI with and without a telephone booster relative to brief advice (i.e., multiple mediation). Further, the present study tested whether the effects of the BMI conditions on the stages of change were contingent on patients' alcohol use severity (i.e., moderated mediation). METHODS The present study is a secondary analysis using data from injured adult patients at 3 trauma centers who were screened for inclusion in the study and randomly assigned to brief advice (n = 200), BMI (n = 203), or BMI with a telephone booster (n = 193) (Field et al., 2014). Participants completed a baseline assessment and 3-, 6-, and 12-month follow-up assessments that included self-report measures of the stages of change, alcohol use, and alcohol-related problems, as well as other variables of interest. RESULTS The results demonstrated significant and consistent mediation at p < 0.05 wherein BMI with a telephone booster increased action at 3-month follow-up leading to reduced likelihood of at-risk drinking, less alcohol use, and fewer alcohol problems at both 6- and 12-month follow-up. However, moderated mediation analyses suggested that the effects of the BMI conditions on the stages of change were not contingent on patients' alcohol use severity. CONCLUSIONS This study contributes to the understanding of stages of change as potential mechanisms of change in BMI. Directions for future research are discussed.
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Affiliation(s)
- Craig A Field
- From the, Department of Psychology, (CAF), Latino Alcohol and Health Disparities Research and Training Center, University of Texas at El Paso, El Paso, Texas, USA
| | - Dylan K Richards
- Center on Alcohol, Substance use, And Addictions, (DKR), University of New Mexico, Albuquerque, New Mexico, USA
| | - Yessenia Castro
- Steve Hicks School of Social Work, (YC, KS), University of Texas at Austin, Texas, USA
| | - José Alonso Cabriales
- Arts and Sciences Division, (JAC), University of New Mexico-Gallup, Gallup, New Mexico, USA
| | - Amy Wagler
- Department of Mathematical Science, (AW), University of Texas at El Paso El Paso, Texas, USA
| | - Kirk von Sternberg
- Steve Hicks School of Social Work, (YC, KS), University of Texas at Austin, Texas, USA
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9
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Bonar EE, Schneeberger DM, Bourque C, Bauermeister JA, Young SD, Blow FC, Cunningham RM, Bohnert AS, Zimmerman MA, Walton MA. Social Media Interventions for Risky Drinking Among Adolescents and Emerging Adults: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e16688. [PMID: 32401225 PMCID: PMC7254293 DOI: 10.2196/16688] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/30/2020] [Accepted: 02/16/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Despite intervention efforts to date, the prevalence of risky drinking among adolescents and emerging adults remains high, increasing the risk for health consequences and the development of alcohol use disorders. Peer influences are particularly salient among this age group, including via social media. Thus, the development of efficacious early interventions for youth, delivered with a broad reach via trained peers on social media, could have an important role in addressing risky drinking and concomitant drug use. OBJECTIVE This paper describes the protocol of a randomized controlled trial (RCT) testing the efficacy of a social media intervention among adolescents and emerging adults who meet the criteria for risky drinking (using the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]), delivered with and without financial incentives for participation, compared with an attention placebo control condition (ie, entertaining social media content), on alcohol consumption and consequences. METHODS This RCT involved recruiting 955 youths (aged 16-24 years) via advertisements on Facebook and Instagram to self-administer a brief web-based screening survey. Those screening positive for past 3-month risky drinking (AUDIT-C positive: ages 16-17 years: ≥3 females and ≥4 males; and ages 18-24 years: ≥4 females and ≥5 males) were eligible for the RCT. After providing consent (a waiver of parental consent was obtained for minors), participants completed a web-based baseline survey and several verification procedures, including a selfie photo matched to Facebook profile photos. Participants were then randomized to join invitation-only secret Facebook groups, which were not searchable or viewable by parents, friends, or anyone not recruited by the study. The 3 conditions were social media intervention with incentives, social media intervention without incentives (SMI), and attention placebo control. Each condition lasted 8 weeks and consisted of bachelor's-level and master's-level therapist electronic coaches posting relevant content and responding to participants' posts in a manner consistent with Motivational Interviewing. Participants in the control condition and SMI condition did not receive payments but were blind to condition assignment between these 2 conditions. Follow-ups are ongoing and occur at 3, 6, and 12 months poststart of the groups. RESULTS We enrolled 955 participants over 10 waves of recruitment who screened positive for risky drinking into the RCT. CONCLUSIONS The findings of this study will provide the critical next step in delivering early alcohol interventions to the youth, capitalizing on social media platforms, which could have significant public health impact by altering alcohol use trajectories of adolescents and emerging adults engaged in risky drinking. TRIAL REGISTRATION ClinicalTrials.gov NCT02809586; https://clinicaltrials.gov/ct2/show/NCT02809586. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16688.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Diane M Schneeberger
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
| | - Jose A Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Sean D Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA, United States
- Department of Emergency Medicine, University of California Irvine, Irvine, CA, United States
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
- Center for Clinical Management Research, Veterans Health Administration, Ann Arbor, MI, United States
| | - Rebecca M Cunningham
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
- Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Amy Sb Bohnert
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- Center for Clinical Management Research, Veterans Health Administration, Ann Arbor, MI, United States
| | - Marc A Zimmerman
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Maureen A Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
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10
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Randomized Trial of Screening and Brief Intervention to Reduce Injury and Substance Abuse in an urban Level I Trauma Center. Drug Alcohol Depend 2020; 208:107792. [PMID: 32028253 DOI: 10.1016/j.drugalcdep.2019.107792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/26/2019] [Accepted: 11/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The TIP (Traumatic Injury Prevention) Project evaluated the impact on post-injury drug use of two brief motivational interventions compared to brief advice (BA) among injured patients who use drugs. METHOD Three-group, single blind, randomized controlled trial in a Level 1Trauma Center enrolled 395 admitted patients with drug positive toxicology screen or verbal report of drug use in the previous 30 days. 34% were Hispanic, 45% non-Hispanic White, 16% non-Hispanic Black. 88% smoked marijuana, 28% used cocaine and 11% prescription opioids. Brief Advice (BA) provided advice to abstain from drugs, educational materials and referral to community resources. Brief Motivational Intervention (BMI) additionally included a 30-45 minute session, with assessment feedback, based on motivational interviewing. BMI + B included a telephone booster 4-weeks post-intervention. Drug use as measured by percent days abstinent and total abstinence, derived from the Timeline Follow back was the primary outcome. RESULTS A significant reduction from baseline was observed at 3, 6, and 12 months in the primary outcomes of any drug use (excluding alcohol); cannabis and cocaine, the most frequently used drugs, were analyzed individually. There were no between group differences or group X time interactions. Similarly, there were no between groups differences on secondary outcomes including perceived health status, re-injury, arrest, incarceration, alcohol and drug treatment, employment, AA attendance, homelessness, physical abuse, and problems associated with alcohol and drug use. CONCLUSIONS The study does not support use of these enhanced motivational interventions over brief advice for trauma patients with a positive screen for drug use.
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Crombie IK, Irvine L, Williams B, Sniehotta FF, Petrie DJ, Jones C, Norrie J, Evans JMM, Emslie C, Rice PM, Slane PW, Humphris G, Ricketts IW, Melson AJ, Donnan PT, McKenzie A, Huang L, Achison M. Text message intervention to reduce frequency of binge drinking among disadvantaged men: the TRAM RCT. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Socially disadvantaged men are more likely to binge drink frequently and to experience high levels of alcohol-related harm.
Objectives
To test the effectiveness and cost-effectiveness of a text message intervention in reducing the frequency of binge drinking among disadvantaged men.
Study design
A four-centre, parallel-group, pragmatic, individually randomised controlled trial was conducted. Randomisation was carried out using a secure remote web-based system. It was stratified by participating centre and recruitment method and restricted using block sizes of randomly varying lengths.
Setting
The study was conducted in the community. Members of the public helped to develop the study methods.
Participants
Participants were men aged 25–44 years who had ≥ 2 episodes of binge drinking (> 8 units of alcohol in a single session) in the preceding 28 days. Men were recruited from areas of high deprivation.
Interventions
An empirically and theoretically based text message intervention was delivered by 112 interactive text messages over a 12-week period. The control group received an attentional control comprising 89 text messages on general health.
Primary outcome measure
The primary outcome measure was the proportion of men consuming > 8 units of alcohol on ≥ 3 occasions (in the previous 28 days) at 12 months post intervention.
Results
The recruitment target of 798 was exceeded and 825 men were randomised. Retention was high and similar in the intervention (84.9%) and control (86.5%) groups. Most men in the intervention group engaged enthusiastically with the text messages: almost all (92%) replied to text messages and over two-thirds (67%) replied more than 10 times. The intervention was estimated to have had a modest, statistically non-significant effect on the primary outcome at the 12-month follow-up [odds ratio 0.79, 95% confidence interval (CI) 0.57 to 1.08]. This corresponds to a net reduction of 5.7% in regular binge drinking. Five secondary outcomes showed small non-significant and inconsistent effects on alcohol consumption, with one suggesting a positive effect and four suggesting an adverse effect. Both the short- and the long-term cost per quality-adjusted life-year (QALY) analysis suggested that the brief intervention was dominated by a ‘do-nothing’ option. The intervention’s impacts on patterns of alcohol consumption, QALYs and downstream costs were inconsistent and uncertain.
Limitations
The study used an active control that, combined with the recruitment procedures and baseline assessments, could have biased the treatment effect towards the null. The measurement of alcohol consumption relied on self-reported drinking.
Conclusions
The trial has demonstrated that it is possible to recruit and retain large numbers of socially disadvantaged men in a research study. The text messages delivered a complex theoretically and empirically based intervention that fostered enthusiastic engagement with the key components of the behaviour change sequence. The intervention produced a modest, statistically non-significant effect on the primary outcome, with wide CIs. Further research is needed to reduce uncertainty about the treatment effect. The methods developed for this study provide a platform for the design and testing of interventions to reduce inequalities in health.
Future work
A future trial could reduce the uncertainty around the treatment effect of the intervention.
Trial registration
Current Controlled Trials ISRCTN07695192.
Funding
This study was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 6, No. 6. See NIHR Journals Library website for further information.
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Affiliation(s)
- Iain K Crombie
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Linda Irvine
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Falko F Sniehotta
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Dennis J Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Dundee, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Josie MM Evans
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Carol Emslie
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Peter M Rice
- Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Peter W Slane
- Erskine Practice, Arthurstone Medical Centre, Dundee, UK
| | - Gerry Humphris
- School of Medicine, Medical and Biological Sciences, University of St Andrews, St Andrews, UK
| | | | - Ambrose J Melson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter T Donnan
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Andrew McKenzie
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
| | - Li Huang
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Marcus Achison
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
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Stephenson R, Bonar EE, Carrico A, Hunter A, Connochie D, Himmelstein R, Bauermeister J. Intervention to Increase HIV Testing Among Substance-Using Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e114. [PMID: 29712625 PMCID: PMC5952122 DOI: 10.2196/resprot.9414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/24/2018] [Accepted: 03/09/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Young men who have sex with men (YMSM) and transgender people in the Detroit Metro Area are the only risk group for whom the incidence of HIV and sexually transmitted infections (STI) has increased since 2000, with HIV incidence nearly doubling among youth. Substance use (including alcohol), which is relatively frequent among YMSM and transgender people, creates barriers to the optimal delivery of HIV prevention and care services. Standard HIV counseling, testing, and referral (CTR) is limited in providing strategies to identify and address substance use. Hence, in its current form, CTR may not be serving the prevention needs of substance-using YMSM and transgender people. Brief counseling interventions, grounded in principles of motivational interviewing, may offer a mechanism to meet the HIV prevention and care needs of substance-using YMSM and transgender people. OBJECTIVE This prospective, 4-arm, factorial randomized controlled trial aims to examine the efficacy of an motivational interviewing-based substance use brief intervention (SUBI) on participants' substance use and engagement in HIV prevention. METHODS The research implements a prospective randomized controlled trial (Project Swerve) of 600 YMSM and transgender people recruited both online and in person. Eligibility criteria include participants who (1) are between the ages of 15 to 29 years, (2) live in the Detroit Metro Area, (3) self-identify as a man or transgender man or woman, (4) have had sexual contact with a man in the 6 months before enrollment, (5) self-report binge drinking or any substance use in the 3 months before enrollment, and (6) self-report an unknown or negative HIV status upon enrollment. Participants are randomized to receive, 3-months apart starting at baseline, 2 individual sessions. Sessions are CTR-only, SUBI-only, CTR followed by SUBI, or SUBI followed by CTR. RESULTS Project Swerve was launched in April 2017 and enrollment is ongoing. CONCLUSIONS Incorporating a SUBI that utilizes the principles of motivational interviewing into HIV CTR provides an opportunity to tailor counseling services for YMSM and transgender people to address additional client barriers to HIV and STI testing. TRIAL REGISTRATION ClinicalTrials.gov NCT02945436; http://clinicaltrials.gov/ct2/show/NCT02945436 (Archived by WebCite at http://www.webcitation.org/6yFyOK57w).
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Affiliation(s)
- Rob Stephenson
- Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Adam Carrico
- School of Public Health, University of Miami, Miami, FL, United States
| | - Alexis Hunter
- Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Daniel Connochie
- Program on Sexuality, Technology & Action Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Himmelstein
- Center for Sexuality & Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Jose Bauermeister
- Program on Sexuality, Technology & Action Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
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13
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Lappin JM, Ayub MH, Rogers D, Morgan M, Kanyamibwa JY, Shakeshaft A. Routine screening and related interventions significantly improve the effectiveness of emergency department detection and management of alcohol withdrawal syndrome. Emerg Med Australas 2018. [DOI: 10.1111/1742-6723.12959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Julia M Lappin
- National Drug and Alcohol Research Centre; The University of New South Wales; Sydney New South Wales Australia
- School of Psychiatry; The University of New South Wales; Sydney New South Wales Australia
| | - Muhammad H Ayub
- National Drug and Alcohol Research Centre; The University of New South Wales; Sydney New South Wales Australia
| | - David Rogers
- Drug and Alcohol Services; Mid North Coast Local Health District; Port Macquarie New South Wales Australia
| | - Madeleine Morgan
- Drug and Alcohol Services; Kempsey District Hospital; Kempsey New South Wales Australia
| | - Jean-Yves Kanyamibwa
- Drug and Alcohol Services; Kempsey District Hospital; Kempsey New South Wales Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre; The University of New South Wales; Sydney New South Wales Australia
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14
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Baumann S, Gaertner B, Haberecht K, Bischof G, John U, Freyer-Adam J. How alcohol use problem severity affects the outcome of brief intervention delivered in-person versus through computer-generated feedback letters. Drug Alcohol Depend 2018; 183:82-88. [PMID: 29241105 DOI: 10.1016/j.drugalcdep.2017.10.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/15/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim was to test if people with different alcohol use problem severity benefitted differentially from brief alcohol interventions delivered in-person versus through computer-generated feedback letters. METHODS Nine hundred sixty-one 18-64year old general hospital inpatients with at-risk alcohol use (mean age=40.9years [standard deviation=14.1], 75% men) were randomized to a) in-person counseling, b) computer-generated individualized feedback letters, or c) assessment only. Both interventions were delivered on the ward and 1 and 3 months later. Outcome was the change in the self-reported alcohol use per day at 6-, 12-, 18-, and 24-month follow-up. The Alcohol Use Disorder Identification Test (AUDIT) score was tested as a moderator of the effect of in-person counseling and computer-generated feedback letters, with higher AUDIT scores indicating more severe alcohol problems. RESULTS Compared to assessment only, computer-generated feedback letters more strongly reduced alcohol use over 24 months among persons with AUDIT scores of about 8 and lower (ps <0.05). In-person counseling tended to be superior over assessment only among persons scoring high on the AUDIT, but differences were not statistically significant. Six-, 12-, and 18-month differences between in-person counseling and computer-generated feedback letters were significant (ps<0.05) for persons with AUDIT scores below 7.1-7.7. The differences between both interventions attenuated at 24-month follow-up. CONCLUSIONS Computer-based intervention delivery may be superior over in-person delivery for people with low levels of alcohol use problem severity, whereas those with more severe alcohol problems may require more intensive care.
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Affiliation(s)
- Sophie Baumann
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Walther-Rathenau-Str. 48, D-17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, D-17475 Greifswald, Germany.
| | - Beate Gaertner
- Robert Koch Institute Berlin, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62-66, D-12101 Berlin, Germany
| | - Katja Haberecht
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Walther-Rathenau-Str. 48, D-17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, D-17475 Greifswald, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, Medical University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Ulrich John
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Walther-Rathenau-Str. 48, D-17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, D-17475 Greifswald, Germany
| | - Jennis Freyer-Adam
- Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Walther-Rathenau-Str. 48, D-17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Fleischmannstr. 42-44, D-17475 Greifswald, Germany; Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, D-17475 Greifswald, Germany
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15
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Shorter GW, Heather N, Bray JW, Giles EL, Holloway A, Barbosa C, Berman AH, O'Donnell AJ, Clarke M, Stockdale KJ, Newbury-Birch D. The 'Outcome Reporting in Brief Intervention Trials: Alcohol' (ORBITAL) framework: protocol to determine a core outcome set for efficacy and effectiveness trials of alcohol screening and brief intervention. Trials 2017; 18:611. [PMID: 29273070 PMCID: PMC5741954 DOI: 10.1186/s13063-017-2335-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/31/2017] [Indexed: 11/12/2022] Open
Abstract
Background The evidence base to assess the efficacy and effectiveness of alcohol brief interventions (ABI) is weakened by variation in the outcomes measured and by inconsistent reporting. The ‘Outcome Reporting in Brief Intervention Trials: Alcohol’ (ORBITAL) project aims to develop a core outcome set (COS) and reporting guidance for its use in future trials of ABI in a range of settings. Methods/design An international Special Interest Group was convened through INEBRIA (International Network on Brief Interventions for Alcohol and Other Drugs) to inform the development of a COS for trials of ABI. ORBITAL will incorporate a systematic review to map outcomes used in efficacy and effectiveness trials of ABI and their measurement properties, using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. This will support a multi-round Delphi study to prioritise outcomes. Delphi panellists will be drawn from a range of settings and stakeholder groups, and the Delphi study will also be used to determine if a single COS is relevant for all settings. A consensus meeting with key stakeholder representation will determine the final COS and associated guidance for its use in trials of ABI. Discussion ORBITAL will develop a COS for alcohol screening and brief intervention trials, with outcomes stratified into domains and guidance on outcome measurement instruments. The standardisation of ABI outcomes and their measurement will support the ongoing development of ABI studies and a systematic synthesis of emerging research findings. We will track the extent to which the COS delivers on this promise through an exploration of the use of the guidance in the decade following COS publication.
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Affiliation(s)
- G W Shorter
- Alcohol and Public Health Research Team, School of Health and Social Care, Teesside University, Middlesbrough, UK.,Psychotraumatology, Mental Health & Suicidal Behaviour Research Group, Psychology Research Institute, Ulster University, Coleraine, UK.,Inspire, Belfast, UK.,College of Medicine, Biology and Environment, Australian National University, Canberra, ACT, Australia
| | - N Heather
- Faculty of Health and Life Science, Northumbria University, Newcastle upon Tyne, UK
| | - Jeremy W Bray
- Department of Economics, Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, NC, USA.
| | - E L Giles
- Alcohol and Public Health Research Team, School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - A Holloway
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - C Barbosa
- Behavioral Health Economics Program, RTI International, Chicago, IL, USA
| | - A H Berman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - A J O'Donnell
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - M Clarke
- Northern Ireland Methodology Hub, Queen's University of Belfast, Belfast, UK
| | - K J Stockdale
- Alcohol and Public Health Research Team, School of Health and Social Care, Teesside University, Middlesbrough, UK.,School of Psychological and Social Sciences, York St. John University, York, UK
| | - D Newbury-Birch
- Alcohol and Public Health Research Team, School of Health and Social Care, Teesside University, Middlesbrough, UK
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16
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Poblete F, Barticevic NA, Zuzulich MS, Portilla R, Castillo-Carniglia A, Sapag JC, Villarroel L, Sena BF, Galarce M. A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile. Addiction 2017; 112:1462-1469. [PMID: 28239995 DOI: 10.1111/add.13808] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/11/2016] [Accepted: 02/20/2017] [Indexed: 11/28/2022]
Abstract
AIM To study the effectiveness of a brief intervention (BI) associated with the ASSIST (Alcohol Smoking and Substance Involvement Screening Test) for alcohol and illicit drug use as part of a systematic screening program implemented in primary care. DESIGN A multi-center randomized open-label trial stratified using the ASSIST-specific substance involvement score (for alcohol, scores ranged from 11 to 15 and 16 to 20; and for the other substances from 4 to 12 and 13 to 20). SETTING A total of 19 primary care centers (n = 520), eight emergency rooms (n = 195) and five police stations (n = 91) were evaluated. PARTICIPANTS A total of 12 217 people aged between 19 and 55 years were screened for moderate alcohol and drug use risk as defined by the ASSIST Chilean version. A total of 806 non-treatment-seekers were randomized. INTERVENTION AND COMPARISON ASSIST-linked BI (n = 400) compared with an informational pamphlet on risk associated with substance use (n = 406). MEASUREMENTS Total ASSIST alcohol and illicit involvement score (ASSIST-AI), and ASSIST-specific score for alcohol, cannabis and cocaine at baseline and at 3-month follow-up. FINDINGS Sixty-two per cent of participants completed follow-up. An intention-to-treat analysis showed no difference between the two groups for the ASSIST-AI score [mean difference (MD) = - 0.17, confidence interval (CI) = -1.87, 2.20], either for specific scores alcohol (MD = 0.18, CI = -1.45, 1.10), cannabis (MD = -0.62, CI = -0.89, 2.14) or cocaine (MD = -0.79, CI = -2.89, 4.47). CONCLUSION It is not clear whether a brief intervention associated with the Alcohol Smoking and Substance Involvement Screening Test is more effective than an informational pamphlet in reducing alcohol and illicit substance consumption in non-treatment-seeking, primary care users with moderate risk.
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Affiliation(s)
- Fernando Poblete
- School of Medicine, Department of Public Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolas A Barticevic
- School of Medicine, Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria Soledad Zuzulich
- School of Medicine, Nursing School, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Portilla
- Research Department, National Service for Prevention and Rehabilitation of Drug and Alcohol Consumption, Santiago, Chile
| | - Alvaro Castillo-Carniglia
- Department of Emergency Medicine, UC Davis School of Medicine, Violence Prevention Research Program, Sacramento, CA, USA
| | - Jaime C Sapag
- School of Medicine, Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- School of Medicine, Department of Public Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Brena F Sena
- Columbia University School of Public Health, New York, NY, USA
| | - Magdalena Galarce
- School of Medicine, Center for Study of Addiction, Pontificia Universidad Catolica de Chile, Santiago, Chile
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17
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Haskins BL, Davis-Martin R, Abar B, Baumann BM, Harralson T, Boudreaux ED. Health Evaluation and Referral Assistant: A Randomized Controlled Trial of a Web-Based Screening, Brief Intervention, and Referral to Treatment System to Reduce Risky Alcohol Use Among Emergency Department Patients. J Med Internet Res 2017; 19:e119. [PMID: 28461283 PMCID: PMC5432666 DOI: 10.2196/jmir.6812] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 11/17/2022] Open
Abstract
Background Computer technologies hold promise for implementing alcohol screening, brief intervention, and referral to treatment (SBIRT). Questions concerning the most effective and appropriate SBIRT model remain. Objective The aim of this study was to evaluate the impact of a computerized SBIRT system called the Health Evaluation and Referral Assistant (HERA) on risky alcohol use treatment initiation. Methods Alcohol users (N=319) presenting to an emergency department (ED) were considered for enrollment. Those enrolled (n=212) were randomly assigned to the HERA, to complete a patient-administered assessment using a tablet computer, or a minimal-treatment control, and were followed for 3 months. Analyses compared alcohol treatment provider contact, treatment initiation, treatment completion, and alcohol use across condition using univariate comparisons, generalized estimating equations (GEEs), and post hoc chi-square analyses. Results HERA participants (n=212; control=115; intervention=97) did not differ between conditions on initial contact with an alcohol treatment provider, treatment initiation, treatment completion, or change in risky alcohol use behavior. Subanalyses indicated that HERA participants, who accepted a faxed referral, were more likely to initiate contact with a treatment provider and initiate treatment for risky alcohol use, but were not more likely to continue engaging in treatment, or to complete treatment and change risky alcohol use behavior over the 3-month period following the ED visit. Conclusions The HERA promoted initial contact with an alcohol treatment provider and initiation of treatment for those who accepted the faxed referral, but it did not lead to reduced risky alcohol use behavior. Factors which may have limited the HERA’s impact include lack of support for the intervention by clinical staff, the low intensity of the brief and stand-alone design of the intervention, and barriers related to patient follow-through, (eg, a lack of transportation or childcare, fees for services, or schedule conflicts). Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): NCT01153373; https://clinicaltrials.gov/ct2/show/NCT01153373 (Archived by WebCite at http://www.webcitation.org/6pHQEpuIF)
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Affiliation(s)
- Brianna L Haskins
- University of Massachusetts Medical School, Worcester, MA, United States
| | | | - Beau Abar
- University of Rochester Medical Center, Rochester, NY, United States
| | | | - Tina Harralson
- Polaris Health Directions, Inc, Wayne, PA, United States
| | - Edwin D Boudreaux
- University of Massachusetts Medical School, Worcester, MA, United States
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18
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Arnaud N, Diestelkamp S, Wartberg L, Sack P, Daubmann A, Thomasius R. Short- to Midterm Effectiveness of a Brief Motivational Intervention to Reduce Alcohol Use and Related Problems for Alcohol Intoxicated Children and Adolescents in Pediatric Emergency Departments: A Randomized Controlled Trial. Acad Emerg Med 2017; 24:186-200. [PMID: 27801991 DOI: 10.1111/acem.13126] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/29/2016] [Accepted: 10/19/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The proportion of children and adolescents receiving emergency care for acute alcohol intoxication (AAI) in Germany has sharply increased over the past years. Despite this, no randomized controlled trials (RCTs) have studied guideline- and evidence-based interventions to prevent future alcohol misuse within this population. The objective of our investigation was to evaluate the effectiveness of a brief motivational intervention (b-MI) to reduce drinking and associated problems within pediatric emergency departments (PED) in Hamburg, Germany. METHODS This stratified cluster-RCT compared a widely established but modified targeted b-MI and treatment as usual (TAU) for patients recruited and treated on Fridays, Saturdays, or Sundays from July 2011 to January 2014 for AAI in EDs of six pediatric hospitals in Hamburg, Germany. Patients under the age of 18 years and their caregivers were included in the study. Intervention was delivered by trained hospital-external staff. The intervention group (n = 141) received a single-session b-MI with a telephone booster after 6 weeks and a brief consultation for caregivers. All intervention material was manual-based. The TAU control group (n = 175) received youth-specific written information on alcohol use and contact information for community resources. Primary outcomes were changes in binge drinking frequency, number of alcoholic drinks on a typical occasion, and alcohol-related problems using the brief Rutgers Alcohol Problem Index. Outcomes were measured by research assistants not involved in intervention delivery. Baseline data were collected in person at the PED, and follow-up data were collected via telephone 3 and 6 months after baseline. Secondary outcome was postenrollment health service utilization. Analyses were based on linear mixed models and intent to treat. RESULTS A total of 86.1% (87.5%) of patients in the b-MI group and 82.4% (86.9%) in the TAU group provided valid outcome data after 3 (6) months, respectively. The differences between groups for all outcomes were statistically nonsignificant at both follow-ups (p > 0.05). After 3 months the mean change in binge drinking frequency was -1.36 (95% confidence interval [CI] = -1.81 to -0.91), a reduction of 62.1% in the b-MI group, and -1.29 (95% CI = -1.77 to -0.95), a reduction of 49.0% in the TAU group. The mean change in number of alcoholic drinks on a typical occasion was -2.24 (95% CI = -3.18 to -1.29), a reduction of 37.5% in the b-MI group, and -1.34 (95% CI = -2.54 to -0.14), a reduction of 26.4% in the TAU group. The mean change of alcohol-related problems was -6.72 (95% CI = -7.68 to -5.76), a reduction of 60.5% in the b-MI group, and -6.43 (95% CI = -7.37 to -5.49), a reduction of 58.3% in the TAU group. The differences in mean changes between groups were similar after 6 months for all outcomes. CONCLUSION This study provides new information on the effectiveness of b-MIs delivered at discharge of young AAI patients in emergency care. Both trial groups reduced alcohol use and related problems but the b-MI was not associated with significant effects. Although the intervention approach appears feasible, further considerations of improving the outcomes for this relevant target group are required.
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Affiliation(s)
- Nicolas Arnaud
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Silke Diestelkamp
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Lutz Wartberg
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Peter‐Michael Sack
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Rainer Thomasius
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
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Oh H, Lee C. Culture and motivational interviewing. PATIENT EDUCATION AND COUNSELING 2016; 99:1914-1919. [PMID: 27401829 PMCID: PMC6698383 DOI: 10.1016/j.pec.2016.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 05/12/2023]
Affiliation(s)
- Hans Oh
- University of California Berkeley, Berkeley, USA; Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue Suite 1200, Oakland, CA 94612, USA.
| | - Christina Lee
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University 360 Huntington Avenue 432, International Village Boston, MA 02115, USA
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Borsari B, Apodaca TR, Yurasek A, Monti PM. Does mental status impact therapist and patient communication in emergency department brief interventions addressing alcohol use? J Subst Abuse Treat 2016; 73:1-8. [PMID: 28017179 DOI: 10.1016/j.jsat.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/18/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
Motivational interviewing (MI) is often incorporated into screening, brief intervention, and referral to treatment (SBIRT) interventions in critical care settings to address alcohol and other drug use. However, cognitive status has been linked to differential response to MI sessions in emergency department (ED) settings. The current study examined one possible explanation for this differential response: whether higher versus lower mental status impacts patient response to clinician statements during MI sessions conducted in an ED. Participants were 126 patients receiving an MI-based single-session alcohol brief intervention, and 13 therapists who provided treatment. Participants completed a mental status exam (MSE) as part of the screening process. Intervention sessions were audio-taped, and transcribed and coded using the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003). The MISC 2.0 coded therapist behaviors that are related to the use of motivational interviewing, and patient language reflecting movement toward (change talk) or away from (sustain talk) changing personal alcohol use. Overall, patients responded in a similar manner to therapist MI behaviors regardless of high versus low level of mental functioning at the time of the intervention. Group differences emerged on patient response to only three specific therapist skills: giving information, open questions, and complex reflection. Thus, the differential effects of SBIRT in critical care settings do not appear to be a result of differences in the therapist and patient communication process.
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Affiliation(s)
- Brian Borsari
- Mental Health Service (116B), San Francisco VA Medical Center, 4150 Clement St., San Francisco, CA 94121; Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912; Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143.
| | - Timothy R Apodaca
- Children's Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO, 64108; University of Missouri-Kansas City School of Medicine, 3901 Rainbow Blvd, Kansas City, KS 66103
| | - Ali Yurasek
- Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912
| | - Peter M Monti
- Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912
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Cochran G, Field C, Foreman M, Ylioja T, Brown CVR. Effects of brief intervention on subgroups of injured patients who drink at risk levels. Inj Prev 2016; 22:221-5. [PMID: 26124071 PMCID: PMC4726485 DOI: 10.1136/injuryprev-2015-041596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/12/2015] [Indexed: 11/04/2022]
Abstract
Alcohol-related injuries are a major source of admission for trauma care. Screening and brief intervention (SBI) for injured patients can result in decreased drinking and risk behaviors. It is not clear SBI is equally beneficial for all injured patients. A secondary data analysis of 553 patients admitted to two Level-1 trauma centers was conducted. Latent class analysis was used to identify patient subgroups based on injury-related risks and consequences of alcohol use. Intervention effects on drinking were examined among subgroups. Five subgroups were identified. Drinking improved in patients reporting multiple risks and injuries/accidents and drinking and driving. Patients that reported drinking and driving and taking foolish risks or fighting while drinking and taking foolish risks did not show improvements. Trauma centers may benefit from targeting interventions based on injury-related risks and consequences of alcohol use. Further research is needed to test bedside approaches for tailored interventions.
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Affiliation(s)
- Gerald Cochran
- University of Pittsburgh, Assistant Professor, School of Social Work, School of Medicine, Department of Psychiatry, 4200 Forbes Ave. #2006, Pittsburgh PA, 15260, Phone: (412) 624-2325, Fax: (412) 624-6323
| | - Craig Field
- University of Texas, El Paso, Department of Psychology, El Paso TX, USA
| | | | - Thomas Ylioja
- University of Pittsburgh, School of Social Work, Pittsburgh PA, USA
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Schmidt CS, Schulte B, Seo HN, Kuhn S, O'Donnell A, Kriston L, Verthein U, Reimer J. Meta-analysis on the effectiveness of alcohol screening with brief interventions for patients in emergency care settings. Addiction 2016; 111:783-94. [PMID: 26637990 DOI: 10.1111/add.13263] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/17/2015] [Accepted: 11/27/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Despite ambiguous evidence for the effectiveness of alcohol screening with brief interventions (BI) in emergency departments (ED), ambition for their widespread implementation continues to grow. To clarify whether such an application of BI is justifiable, we conducted a systematic review and meta-analysis on studies testing the impact of BI on alcohol consumption. METHODS We included peer-reviewed, randomized controlled studies investigating the effects of BI on alcohol consumption in injured and/or intoxicated patients, published January 2002-September 2015. Changes from baseline in consumption quantity, intensity and number of heavy drinking episodes were assessed at 3-, 6- and 12-month follow-up, resulting in nine separate random-effects meta-analyses of standardized mean differences (SMD). Moderation effects of intervention mode, length, type of interventionist, intensity of control intervention and study quality were assessed using subgroup comparisons and meta-regression. RESULTS We considered 33 publications (28 separate studies) including 14 456 patients. Six of nine comparisons revealed small significant effects in favour of BI, with the highest SMD at 0.19 [95% confidence interval (CI) = 0.08-0.31]. No significant moderators could be identified, and statistical heterogeneity (I(2) ) was below 40%. CONCLUSIONS In a large meta-analysis of randomized controlled trials in emergency care settings, there was evidence for very small effects of brief interventions on alcohol consumption reductions. More intensive interventions showed no benefit over shorter approaches. Non-face-to-face interventions appear to be comparably effective, but this finding remains tentative due to the low number of non-face-to-face studies.
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Affiliation(s)
- Christiane Sybille Schmidt
- Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ha-Na Seo
- Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Kuhn
- Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amy O'Donnell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Reimer
- Center for Interdisciplinary Addiction Research of Hamburg University (CIAR), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Schwarz AS, Bilberg R, Bjerregaard L, Nielsen B, Søgaard J, Nielsen AS. Relay model for recruiting alcohol dependent patients in general hospitals--a single-blind pragmatic randomized trial. BMC Health Serv Res 2016; 16:132. [PMID: 27080865 PMCID: PMC4832463 DOI: 10.1186/s12913-016-1376-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/21/2016] [Indexed: 12/03/2022] Open
Abstract
Background A large proportion of the Danish population consumes more than the officially recommended weekly amount of alcohol. Untreated alcohol use disorders lead to frequent contacts with the health care system and can be associated with considerable human and societal costs. However, only a small share of those with alcohol use disorders receives treatment. A referral model to ensure treatment for alcohol dependent patients after discharge is needed. This study evaluates the i) cost-effectiveness ii) efficacy and iii) overall impact on societal costs of the proposed referral model - The Relay Model. Method/Design The study is a single-blind pragmatic randomized controlled trial including patients admitted to the hospital. The study group (n = 500) will receive an intervention, and the control group (n = 500) will be referred to treatment by usual procedures. All patients complete a lifestyle questionnaire with the Alcohol Use Disorders Identification Test embedded as a case identification strategy. The primary outcome of the study will be health care expenditures 12 months after discharge. The secondary outcome will be the percentage of the target group, who 30 days after discharge, reports at the alcohol treatment clinics. In order to analyse both outcomes, difference-in-difference models will be used. Discussion We expect to establish evidence as to whether The Relay Model is either cost-neutral or cost-effective, compared to referral by usual procedures. Trial registration https://register.clinicaltrials.gov/by identifier: RESCueH_Relay NCT02188043 Project Relay Model for Recruiting Alcohol Dependent Patients in General Hospitals (TRN Registration: 07/09/2014)
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Affiliation(s)
- Anne-Sophie Schwarz
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Randi Bilberg
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lene Bjerregaard
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Bent Nielsen
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jes Søgaard
- The Danish Cancer Society and Aarhus University, Faculty of Health Science, Institute of Clinical Medicine, Department of Clinical Epidemiology, Copenhagen, Denmark
| | - Anette Søgaard Nielsen
- RESCueH studies, Unit of Clinical Alcohol Research, Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Nunn J, Erdogan M, Green RS. The prevalence of alcohol-related trauma recidivism: A systematic review. Injury 2016; 47:551-8. [PMID: 26830122 DOI: 10.1016/j.injury.2016.01.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/06/2016] [Accepted: 01/09/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Recurrent admission to a hospital or trauma centre for separate incidents of traumatic injury is known as trauma recidivism. Although use of alcohol is a known risk factor for injury and associated with trauma recidivism, the scale of alcohol-related trauma recidivism has not been well described. The purpose of this review was to search the published literature for studies that evaluated the prevalence of alcohol use among trauma recidivists. Our primary objective was to determine the proportion of trauma recidivism related to alcohol use. The association between alcohol and trauma recidivism was evaluated as a secondary objective. METHODS Four electronic databases (MEDLINE, Embase, CINAHL, Web of Science) were searched from inception until December 2015 for all articles that might provide evidence on the proportion of trauma recidivism related to use of alcohol. After removal of duplicates, the search strategy yielded 2470 records for screening. Only primary studies that reported on repeated admissions to a hospital or trauma centre for traumatic injuries specifically related to alcohol use were included. Descriptive statistics were used to assess study characteristics and the prevalence of trauma recidivism related to alcohol use. An aggregate weighted estimate of alcohol-related trauma recidivism was calculated. RESULTS A total of 12 studies met all inclusion criteria. Studies were published between 1989 and 2014. Overall, there were 3386 trauma recidivists among included studies. The proportion of trauma recidivists with evidence of alcohol use on admission ranged from 26.7% to 76.9% (median 46.4%). The aggregated sample produced a weighted estimate of 41.0% (1388/3386) for alcohol-related trauma recidivism. In four studies, the association between alcohol and trauma recidivism was examined; all four found a positive association between alcohol use and repeated admission for traumatic injury. Studies varied considerably in design, trauma populations, periods for evaluating recidivism, definitions for positive alcohol on admission, and methods used to determine alcohol use. CONCLUSION Evidence from current literature suggests that 41.0% of trauma recidivism is related to use of alcohol. Due to methodological limitations among the studies included for review, this may underestimate the actual prevalence of alcohol-related trauma recidivism.
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Affiliation(s)
- James Nunn
- Dalhousie University Medical School, Halifax, Nova Scotia, Canada
| | - Mete Erdogan
- Trauma Nova Scotia, Halifax, Nova Scotia, Canada
| | - Robert S Green
- Trauma Nova Scotia, Halifax, Nova Scotia, Canada; Department of Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada.
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Readiness to change is a predictor of reduced substance use involvement: findings from a randomized controlled trial of patients attending South African emergency departments. BMC Psychiatry 2016; 16:35. [PMID: 26897614 PMCID: PMC4761196 DOI: 10.1186/s12888-016-0742-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study examines whether readiness to change is a predictor of substance use outcomes and explores factors associated with RTC substance use among patients at South African emergency departments. METHODS We use data from participants enrolled into a randomized controlled trial of a brief substance use intervention conducted in three emergency departments in Cape Town, South Africa. RESULTS In adjusted analyses, the SOCRATES "Recognition" (B = 11.6; 95 % CI = 6.2-17.0) and "Taking Steps" score (B = -9.5; 95 % CI = -15.5- -3.5) as well as alcohol problems (B = 4.4; 95 % CI = 0.9-7.9) predicted change in substance use involvement at 3 month follow-up. Severity of depression (B = 0.2; 95 % CI = 0.1-0.3), methamphetamine use (B = 3.4; 95 % CI = 0.5- 6.3) and substance-related injury (B = 1.9; 95 % CI = 0.6-3.2) were associated with greater recognition of the need for change. Depression (B = 0.1; 95 % CI = 0.04 -0.1) and methamphetamine use (B = 2.3; 95 % CI = 0.1 -4.2) were also associated with more ambivalence about whether to change. Participants who presented with an injury that was preceded by substance use were less likely to be taking steps to reduce their substance use compared to individuals who did not (B = -1.7; 95 % CI = -5.0- -0.6). CONCLUSION Findings suggest that brief interventions for this population should include a strong focus on building readiness to change substance use through motivational enhancement strategies. Findings also suggest that providing additional support to individuals with depression may enhance intervention outcomes. TRIAL REGISTRATION This trial registered with the Pan African Clinical Trial Registry (PACTR201308000591418) on 14/07/2013.
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26
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Mello MJ, Baird J, Lee C, Strezsak V, French MT, Longabaugh R. A Randomized Controlled Trial of a Telephone Intervention for Alcohol Misuse With Injured Emergency Department Patients. Ann Emerg Med 2016; 67:263-75. [PMID: 26585044 PMCID: PMC4724518 DOI: 10.1016/j.annemergmed.2015.09.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/02/2015] [Accepted: 09/17/2015] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE We conduct a randomized controlled trial to test efficacy of a telephone intervention for injured emergency department (ED) patients with alcohol misuse to decrease alcohol use, impaired driving, alcohol-related injuries, and alcohol-related negative consequences. METHODS ED patients screening positive for alcohol misuse were randomized to a 3-session telephone brief motivational intervention on alcohol, delivered by a counselor trained in motivational interviewing during 6 weeks, or a control intervention of a scripted home fire and burn safety education delivered in 3 calls. Patients were followed for 12 months and assessed for changes in alcohol use, impaired driving, alcohol-related injuries, and alcohol-related negative consequences. RESULTS Seven hundred thirty ED patients were randomized; 78% received their assigned intervention by telephone, and of those, 72% completed 12-month assessments. There were no differential benefits of telephone brief motivational intervention versus assessment and a control intervention in all 3 variables of alcohol use (frequency of binge alcohol use during the previous 30 days, maximum number of drinks at one time in the past 30 days, and typical alcohol use in the past 30 days), alcohol-impaired driving, alcohol-related injuries, and alcohol-related negative consequences. CONCLUSION Despite the potential advantage of delivering a telephone brief motivational intervention in not disrupting ED clinical care, our study found no efficacy for it over an assessment and control intervention. Potential causes for our finding include that injury itself, alcohol assessments, or the control intervention had active ingredients for alcohol change.
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Affiliation(s)
- Michael J Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI; Injury Prevention Center at Rhode Island Hospital, Providence, RI; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI.
| | - Janette Baird
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI; Injury Prevention Center at Rhode Island Hospital, Providence, RI
| | - Christina Lee
- Department of Counseling and Applied Educational Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | - Valerie Strezsak
- Injury Prevention Center at Rhode Island Hospital, Providence, RI; Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Michael T French
- Departments of Sociology, Economics, and Public Health Sciences, University of Miami, Miami, FL
| | - Richard Longabaugh
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
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Choi NG, Marti CNN, DiNitto DM, Choi BY. Alcohol Use as Risk Factors for Older Adults' Emergency Department Visits: A Latent Class Analysis. West J Emerg Med 2015; 16:1146-58. [PMID: 26759670 PMCID: PMC4703192 DOI: 10.5811/westjem.2015.9.27704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Late middle-aged and older adults' share of emergency department (ED) visits is increasing more than other age groups. ED visits by individuals with substance-related problems are also increasing. This paper was intended to identify subgroups of individuals aged 50+ by their risk for ED visits by examining their health/mental health status and alcohol use patterns. METHODS Data came from the 2013 National Health Interview Survey's Sample Adult file (n=15,713). Following descriptive analysis of sample characteristics by alcohol use patterns, latent class analysis (LCA) modeling was fit using alcohol use pattern (lifetime abstainers, ex-drinkers, current infrequent/light/moderate drinkers, and current heavy drinkers), chronic health and mental health status, and past-year ED visits as indicators. RESULTS LCA identified a four-class model. All members of Class 1 (35% of the sample; lowest-risk group) were infrequent/light/moderate drinkers and exhibited the lowest probabilities of chronic health/mental health problems; Class 2 (21%; low-risk group) consisted entirely of lifetime abstainers and, despite being the oldest group, exhibited low probabilities of health/mental health problems; Class 3 (37%; moderate-risk group) was evenly divided between ex-drinkers and heavy drinkers; and Class 4 (7%; high-risk group) included all four groups of drinkers but more ex-drinkers. In addition, Class 4 had the highest probabilities of chronic health/mental problems, unhealthy behaviors, and repeat ED visits, with the highest proportion of Blacks and the lowest proportions of college graduates and employed persons, indicating significant roles of these risk factors. CONCLUSION Alcohol nonuse/use (and quantity of use) and chronic health conditions are significant contributors to varying levels of ED visit risk. Clinicians need to help heavy-drinking older adults reduce unhealthy alcohol consumption and help both heavy drinkers and ex-drinkers improve chronic illnesses self-management.
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Affiliation(s)
- Namkee G. Choi
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | | | - Diana M. DiNitto
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | - Bryan Y. Choi
- Brown University, Department of Emergency Medicine, Providence, Rhode Island
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Sorsdahl K, Stein DJ, Corrigall J, Cuijpers P, Smits N, Naledi T, Myers B. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:46. [PMID: 26576946 PMCID: PMC4650345 DOI: 10.1186/s13011-015-0042-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/08/2015] [Indexed: 12/13/2022]
Abstract
Background The treatment of substance use disorders is a public health priority, particularly in South Africa where the prevalence of these disorders is high. We tested two peer-counsellor delivered brief interventions (BIs) for risky substance use among adults presenting to emergency departments (EDs) in South Africa. Methods In this randomised controlled trial, we enrolled patients presenting to one of three 24-hour EDs who screened at risk for substance use according to the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Eligible patients were randomly allocated to one of three conditions: Motivational Interviewing (MI), blended MI and Problem Solving Therapy (MI-PST) or a Psycho-educational Control Group (CG). The primary outcome was reduction in ASSIST scores at three months follow-up. Results Of the 2736 patients screened, 335 met inclusion criteria, were willing to participate in the intervention and were randomised to one of three conditions: 113 to MI, 112 to MI-PST and 110 to CG. ASSIST scores at three months were lower in the MI-PST group than they were in the MI and CG groups (adjusted mean difference of −1.72, 95 % CI −3.36 - -0.08). We recorded no significant difference in ASSIST scores between the CG and MI group (adjusted mean difference of −0.02, 95 % CI −2.01 - 1.96). Conclusion With the addition of minimal resources, BIs are feasible to conduct in EDs in a low resourced country. These preliminary findings report that MI-PST appears to be an effective BI for reducing substance use among at risk participants. Further research is required to replicate these findings with effort to limit attrition, to determine whether reductions in substance use are persistent at 6 and 12 month follow-up and whether parallel changes occur in other indications of treatment outcomes, such as injury rates and ED presentations. Trial registration This trial registered with the Pan African Clinical Trial Registry (PACTR201308000591418)
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Affiliation(s)
- K Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Groote Schuur Hospital, Cape Town, 7925, South Africa.
| | - D J Stein
- Department of Psychiatry & Mental Health, University of Cape Town, Groote Schuur Hospital, Cape Town, 7925, South Africa.
| | - J Corrigall
- Western Cape Department of Health, 8 Riebeeck Street, Cape Town, 8001, South Africa.
| | - P Cuijpers
- Department of Clinical Psychology, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands.
| | - N Smits
- Department of Clinical Psychology, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands.
| | - T Naledi
- Western Cape Department of Health, 8 Riebeeck Street, Cape Town, 8001, South Africa.
| | - B Myers
- Department of Psychiatry & Mental Health, University of Cape Town, Groote Schuur Hospital, Cape Town, 7925, South Africa. .,Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa.
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Egerton-Warburton D, Gosbell A, Moore K, Jelinek GA. Public health in Australasian emergency departments: Attitudes, barriers and current practices. Emerg Med Australas 2015; 27:522-528. [DOI: 10.1111/1742-6723.12475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Diana Egerton-Warburton
- Department of Emergency Medicine; Monash Medical Centre; Melbourne Victoria Australia
- School of Clinical Sciences at Monash Health; Monash University; Melbourne Victoria Australia
| | - Andrew Gosbell
- Policy and Research; Australasian College for Emergency Medicine; Melbourne Victoria Australia
| | - Katie Moore
- Policy and Research; Australasian College for Emergency Medicine; Melbourne Victoria Australia
| | - George A Jelinek
- Neuroepidemiology Unit; Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
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The Impact of a Mandated Trauma Center Alcohol Intervention on Readmission and Cost per Readmission in Arizona. Med Care 2015; 53:639-45. [PMID: 26067886 DOI: 10.1097/mlr.0000000000000381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Persons appearing in trauma centers have a higher prevalence of unhealthy alcohol use than the general population. Screening and brief intervention (SBI) is designed to moderate drinking levels and avoid costly future readmissions, but few studies have examined the impact of SBI on hospital readmissions and health care costs in a trauma population. RESEARCH DESIGN This study uses comparative interrupted time-series and the Arizona State Inpatient Database to estimate the effect of the American College of Surgeons Committee on Trauma SBI mandate on the probability of readmission and cost per readmission in Arizona trauma centers. We compare individuals with and without an alcohol diagnosis code before and after the mandate was implemented. RESULTS The mandate resulted in a 2.2 percentage point reduction (44%) in the probability of readmission. Total health care and readmission costs were not affected by the mandate. CONCLUSIONS The estimates are consistent with a differential effect of SBI: SBI reduces readmissions among those who present with a less serious alcohol-related problem. Persons with more serious alcohol problems are less likely to respond to SBI. These higher risk individuals likely have a higher cost, which may explain the lack of change in readmission costs. Our study is a macrolevel intent-to-treat analysis of SBI's impact that corroborates the potential of SBI implied by efficacy studies in trauma centers and other settings. This study provides a framework for future research involving more states and health systems and evaluating other SBI policies.
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Affiliation(s)
- Christopher Morrison
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia.
| | - Peter Cameron
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia
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Darnell D, Dunn C, Atkins D, Ingraham L, Zatzick D. A Randomized Evaluation of Motivational Interviewing Training for Mandated Implementation of Alcohol Screening and Brief Intervention in Trauma Centers. J Subst Abuse Treat 2015; 60:36-44. [PMID: 26117081 DOI: 10.1016/j.jsat.2015.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/21/2015] [Accepted: 05/28/2015] [Indexed: 11/19/2022]
Abstract
The American College of Surgeons has mandated that level I and level II trauma centers implement universal alcohol screening and brief intervention (SBI) for injured patients. This study was a secondary analysis of a national, 20-hospital, cluster-randomized implementation trial focusing on practical issues of training and supervising alcohol SBI providers in motivational interviewing (MI). The purpose of this study was to examine whether real-world trauma center providers can be trained to provide higher quality counseling using MI as part of brief interventions for alcohol and whether MI skills can be maintained over time. Sites were randomly assigned to receive a 1day workshop training in MI for alcohol SBI or not, and all providers regardless of training completed up to seven standardized patient assessments of MI fidelity over 27months. Six domains on the Motivational Interviewing Treatment Integrity (MITI) coding system were assessed and compared to proficiency criteria. Providers in the intervention training group showed substantially improved MITI scores over the course of the 27-month time period. Domains that had particularly strong improvement were MI spirit and empathy; however, despite the overall improvement in the intervention group scores, expert-derived proficiency criteria were attained only for the global scores. Routine trauma center providers who receive MI training can deliver higher quality counseling in alcohol brief interventions, but may not, however, attain previously derived proficiency standards. Future implementation efforts in real-world acute care medical settings could further elucidate provider characteristics that predict training response and also strive to demonstrate that higher quality alcohol SBI implementation is associated with improved patient-level outcomes.
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Affiliation(s)
- Doyanne Darnell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - Christopher Dunn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - David Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Leah Ingraham
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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Havard A, Shakeshaft AP, Conigrave KM. Randomized Controlled Trial of Mailed Personalized Feedback for Risky Drinkers in the Emergency Department: The Impact on Alcohol Consumption, Alcohol-Related Injuries, and Repeat Emergency Department Presentations. Alcohol Clin Exp Res 2015; 39:1260-6. [PMID: 26031313 DOI: 10.1111/acer.12760] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 04/22/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Due to the difficulty encountered in disseminating resource-intensive emergency department (ED)-based brief alcohol interventions into real-world settings, this study evaluated the effect of a mailed personalized feedback intervention for problem drinking ED patients. At 6-week follow-up, this intervention was associated with a statistically significant reduction in alcohol consumption among patients with alcohol-involved ED presentations. This study aimed to evaluate the effects of this intervention over time. METHODS A randomized controlled trial was conducted among problem drinking ED patients, defined as those scoring 8 or more on the Alcohol Use Disorders Identification Test. Participants in the intervention group received mailed personalized feedback regarding their alcohol consumption. The control group received no feedback. Follow-up interviews were conducted over the phone, postal survey, or email survey 6 weeks and 6 months after baseline screening, and repeat ED presentations over 12-month follow-up were ascertained via linked ED records. RESULTS Six-month follow-up interviews were completed with 210 participants (69%), and linked ED records were obtained for 286 participants (94%). The intervention had no effect on alcohol consumption, while findings regarding alcohol-related injuries and repeat ED presentations remain inconclusive. CONCLUSIONS Further research in which the receipt of feedback is improved and a booster intervention is provided is recommended.
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Affiliation(s)
- Alys Havard
- Centre for Big Data Research in Health, UNSW Australia, Sydney, New South Wales, Australia.,Centre for Health Research, University of Western Sydney, Sydney, New South Wales, Australia.,National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Anthony P Shakeshaft
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Katherine M Conigrave
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.,Drug Health Service, Royal Prince Alfred Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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34
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Hansen MB, Kloster S, Danquah IH, Nielsen AS, Becker U, Tjørnhøj-Thomsen T, Tolstrup JS. "A welfare recipient may be drinking, but as long as he does as told--he may drink himself to death": a qualitative analysis of project implementation barriers among Danish job consultants. BMC Public Health 2015; 15:264. [PMID: 25886200 PMCID: PMC4379594 DOI: 10.1186/s12889-015-1620-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 03/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper is embedded in a randomised controlled trial (Alcohol and Employment) that investigated whether welfare-to-work schemes combined with alcohol treatment were more effective than welfare-to-work schemes alone for helping unemployed welfare recipients with alcohol problems get back to employment and reduce their alcohol problems. The implementation of Alcohol and Employment turned out to be challenging, and fewer welfare recipients than expected were enrolled. The aim of this paper was to identify and investigate obstacles to the implementation of Alcohol and Employment. Our main objective was to study the job consultants' role in the implementation process as they were key personnel in conducting the trial. METHODS The process evaluation was conducted in four Danish municipalities in 2011-2012. Data for identifying factors important for the implementation were collected through observations and focus group interviews with job consultants. Data were analysed thematically and thoroughly discussed among members of the project team; emerging themes were then grouped and read again repeatedly until the themes were consistent. RESULTS Three themes emerged as the main factors influencing the degree of implementation of Alcohol and Employment: (1) The job consultants' personal attitudes toward alcohol were an important factor. The job consultants generally did not consider a high alcohol intake to be an impediment to employment, or they thought that alcohol problems were only symptoms of more profound problems. (2) The job consultants' perception of their own roles and responsibilities in relation to the welfare recipients was a barrier: they felt that addressing alcohol problems and at the same time sustaining trust with the welfare recipient was difficult. Also, they did not consider alcohol problems to be their responsibility. (3) Shortage of time and resources among the job consultants was determined to be an influential factor. CONCLUSIONS We identified important factors at the individual level among the job consultants who threatened the implementation of Alcohol and Employment. Future studies in similar settings can take advantage of these findings when preparing interventions that are implemented by job consultants or similar professionals. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT01416103.
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Affiliation(s)
- Maja Bæksgaard Hansen
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, DK-1353, Denmark.
| | - Stine Kloster
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, DK-1353, Denmark.
| | - Ida Høgstedt Danquah
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, DK-1353, Denmark.
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, JB Winsløwsvej 20, Entrance 220B, 1st floor, Odense, C DK-5000, Denmark.
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, DK-1353, Denmark.
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, DK-1353, Denmark.
| | - Janne Schurmann Tolstrup
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, DK-1353, Denmark.
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Cochran G, Field C, DiClemente C, Caetano R. Latent Classes Among Recipients of a Brief Alcohol Intervention: A Replication Analysis. Behav Med 2014; 42:29-38. [PMID: 25105898 PMCID: PMC4736504 DOI: 10.1080/08964289.2014.951305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to identify differential improvement in alcohol use among injured patients following brief intervention. Latent class analysis was conducted to identify patient profiles based on alcohol-related risk from two clinical trials (Texas: N = 737; Maryland: N = 250) conducted in Level-1 trauma centers. Drinking was analyzed to detect improvements at 6 and 12 months. The four classes that emerged from Maryland participants were similar to four of the five classes from Texas. Increases in both studies for days abstinent were reported by classes characterized by multiple risks and minimal risks. Decreases in volume consumed for both studies were also reported by classes characterized by multiple risks and minimal risks. By classifying patients according to alcohol-related risk, providers may be able to build on positive prognoses for drinking improvements or adapt interventions to better serve those likely to improve less.
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Affiliation(s)
- Gerald Cochran
- University of Pittsburgh, School of Work, Fax: (412) 624-6323
| | - Craig Field
- University of Texas, El Paso, Department of Psychology, Fax: 915-747-6553
| | - Carlo DiClemente
- University of Maryland Baltimore County, Department of Psychology, Fax: 410-455-1055
| | - Raul Caetano
- UT School of Public Health, UT Southwestern Medical Center, Fax: 214-648-1081
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Vaca FE, Romano E, Fell JC. Female drivers increasingly involved in impaired driving crashes: actions to ameliorate the risk. Acad Emerg Med 2014; 21:1485-92. [PMID: 25491711 DOI: 10.1111/acem.12542] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 05/25/2014] [Accepted: 07/02/2014] [Indexed: 01/24/2023]
Abstract
Emergency physicians are confronted daily with the care of traumatically injured patients. A considerable proportion of blunt trauma cases are due to motor vehicle crashes. While men have historically been overrepresented in crash-related injuries and deaths, unfavorable trends for women in alcohol-impaired driving crashes have emerged. This extended commentary with in-depth review presents an examination of the evolving role of sex and gender in alcohol-impaired driving and its outcomes.
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Affiliation(s)
- Federico E. Vaca
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Eduardo Romano
- Pacific Institute for Research and Evaluation (PIRE); The Calverton Center; Calverton MD
| | - James C. Fell
- Pacific Institute for Research and Evaluation (PIRE); The Calverton Center; Calverton MD
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Monti PM, Colby SM, Mastroleo NR, Barnett NP, Gwaltney CJ, Apodaca TR, Rohsenow DJ, Magill M, Gogineni A, Mello MJ, Biffl WL, Cioffi WG. Individual versus significant-other-enhanced brief motivational intervention for alcohol in emergency care. J Consult Clin Psychol 2014; 82:936-48. [PMID: 25111430 DOI: 10.1037/a0037658] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Effects of brief motivational interventions (BMIs) for heavy drinkers identified by alcohol-related emergency department (ED) visits are mixed. The successes of including significant others (SOs) in behavioral treatment suggest that involving SOs in ED-delivered BMI might prove beneficial. This study investigated the relative efficacy of an SO-enhanced motivational intervention (SOMI) compared with an individual motivational intervention (IMI) to address heavy drinking in emergency care settings. METHOD ED (n = 317) or trauma unit (n = 89) patients were randomly assigned to receive either an IMI or an SOMI and were reassessed at 6 and 12 months for alcohol consumption, alcohol-related consequences, and perceived alcohol-specific SO support. RESULTS Generalized estimating equation analyses showed consistent reductions over time for both alcohol consumption and consequences. At 1-year follow-up, the average reduction in total drinks consumed per week was greater for patients in the SOMI condition than the IMI condition. In SOMI, 9.4% more patients moved to within the national guidelines for weekly drinking than did IMI patients. Frequency of heavy drinking and negative alcohol consequences showed no differential effects of intervention. CONCLUSIONS Emergence of a modest treatment effect at 12 months suggests that SO involvement in the SOMI condition may have led to more sustained positive influence on patient drinking than in the IMI condition. Implications and limitations regarding SO involvement in brief treatment are discussed.
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38
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Drummond C, Deluca P, Coulton S, Bland M, Cassidy P, Crawford M, Dale V, Gilvarry E, Godfrey C, Heather N, McGovern R, Myles J, Newbury-Birch D, Oyefeso A, Parrott S, Patton R, Perryman K, Phillips T, Shepherd J, Touquet R, Kaner E. The effectiveness of alcohol screening and brief intervention in emergency departments: a multicentre pragmatic cluster randomized controlled trial. PLoS One 2014; 9:e99463. [PMID: 24963731 PMCID: PMC4070907 DOI: 10.1371/journal.pone.0099463] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/12/2014] [Indexed: 11/18/2022] Open
Abstract
Background Alcohol misuse is common in people attending emergency departments (EDs) and there is some evidence of efficacy of alcohol screening and brief interventions (SBI). This study investigated the effectiveness of SBI approaches of different intensities delivered by ED staff in nine typical EDs in England: the SIPS ED trial. Methods and Findings Pragmatic multicentre cluster randomized controlled trial of SBI for hazardous and harmful drinkers presenting to ED. Nine EDs were randomized to three conditions: a patient information leaflet (PIL), 5 minutes of brief advice (BA), and referral to an alcohol health worker who provided 20 minutes of brief lifestyle counseling (BLC). The primary outcome measure was the Alcohol Use Disorders Identification Test (AUDIT) status at 6 months. Of 5899 patients aged 18 or more presenting to EDs, 3737 (63·3%) were eligible to participate and 1497 (40·1%) screened positive for hazardous or harmful drinking, of whom 1204 (80·4%) gave consent to participate in the trial. Follow up rates were 72% (n = 863) at six, and 67% (n = 810) at 12 months. There was no evidence of any differences between intervention conditions for AUDIT status or any other outcome measures at months 6 or 12 in an intention to treat analysis. At month 6, compared to the PIL group, the odds ratio of being AUDIT negative for brief advice was 1·103 (95% CI 0·328 to 3·715). The odds ratio comparing BLC to PIL was 1·247 (95% CI 0·315 to 4·939). A per protocol analysis confirmed these findings. Conclusions SBI is difficult to implement in typical EDs. The results do not support widespread implementation of alcohol SBI in ED beyond screening followed by simple clinical feedback and alcohol information, which is likely to be easier and less expensive to implement than more complex interventions. Trial Registration Current Controlled Trials ISRCTN 93681536
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Affiliation(s)
- Colin Drummond
- Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Paolo Deluca
- Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom
- * E-mail:
| | - Simon Coulton
- Centre for Health Service Studies, University of Kent, Canterbury, United Kingdom
| | - Martin Bland
- Department of Health Sciences, University of York, York, United Kingdom
| | - Paul Cassidy
- Teams Family Practice, Gateshead, United Kingdom
| | - Mike Crawford
- Department of Psychological Medicine, Imperial College, London, United Kingdom
| | - Veronica Dale
- Department of Health Sciences, University of York, York, United Kingdom
| | - Eilish Gilvarry
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
- Northern Regional Drug and Alcohol Services, Newcastle, United Kingdom
| | - Christine Godfrey
- Department of Health Sciences, University of York, York, United Kingdom
| | - Nick Heather
- Faculty of Health and Life Sciences, Northumbria University, Newcastle, United Kingdom
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Judy Myles
- Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | | | - Adenekan Oyefeso
- Division of Population Health Sciences and Education, St George's, University of London, London, United Kingdom
- Jeesal Cawston Park Hospital, Norfolk, United Kingdom
| | - Steve Parrott
- Department of Health Sciences, University of York, York, United Kingdom
| | - Robert Patton
- Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Katherine Perryman
- Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Tom Phillips
- Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom
- Humber NHS Foundation Trust, Willerby, United Kingdom
| | - Jonathan Shepherd
- Violence Research Group, Cardiff University, Cardiff, United Kingdom
| | - Robin Touquet
- Emergency Department, Kingston Hospital, Kingston upon Thames, London, United Kingdom
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
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Sanjuan PM, Rice SL, Witkiewitz K, Mandler RN, Crandall C, Bogenschutz MP. Alcohol, tobacco, and drug use among emergency department patients. Drug Alcohol Depend 2014; 138:32-8. [PMID: 24594289 PMCID: PMC4030520 DOI: 10.1016/j.drugalcdep.2014.01.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The prevalence of alcohol, tobacco, and other drug (ATOD) use among emergency department (ED) patients is high and many of these patients have unrecognized and unmet substance use treatment needs. Identification of patients in the ED with problem substance use is not routine at this time. METHODS We examined screening data, including standardized measures of ATOD use (HSI, AUDIT-C, DAST-10), from 14,866 ED patients in six hospitals across the United States. We expected younger age, male gender, higher triage acuity, and other substance use severity (ATOD) to be associated both with use versus abstinence and with severity of each substance use type. We used negative binomial hurdle models to examine the association between covariates and (1) substance use versus abstinence (logistic submodel) and with (2) severity among those who used substances (count submodel). RESULTS Rates of use and problem use in our sample were similar to or higher than other ED samples. Younger patients and males were more likely to use ATOD, but the association of age and gender with severity varied across substances. Triage level was a poor predictor of substance use severity. Alcohol, tobacco, and drug use were significantly associated with using other substances and severity of other substance use. CONCLUSION Better understanding of the demographic correlates of ATOD use and severity and the patterns of comorbidity among classes of substance can inform the design of optimal screening and brief intervention procedures addressing ATOD use among ED patients. Tobacco may be an especially useful predictor.
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Affiliation(s)
- Pilar M Sanjuan
- The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Boulevard, SE, MSC11-6280, Albuquerque, NM, 87106, USA.
| | - Samara L Rice
- The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Boulevard, SE, MSC11-6280, Albuquerque, NM, 87106, USA; Research Institute on Addictions, State University of New York at Buffalo, 1021 Main Street, Buffalo, NY 14203, USA
| | - Katie Witkiewitz
- The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Boulevard, SE, MSC11-6280, Albuquerque, NM, 87106, USA
| | - Raul N Mandler
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard Room 3105, Bethesda, MD, 20892-9557, USA
| | - Cameron Crandall
- Department of Emergency Medicine, Health Sciences Center, University of New Mexico, MSC10 5560, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Michael P Bogenschutz
- The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Boulevard, SE, MSC11-6280, Albuquerque, NM, 87106, USA; Department of Psychiatry, Health Sciences Center, University of New Mexico, MSC 09 50301 University of New Mexico, Albuquerque, NM, 87131, USA
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40
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Zatzick D, Donovan DM, Jurkovich G, Gentilello L, Dunn C, Russo J, Wang J, Zatzick CD, Love J, McFadden C, Rivara FP. Disseminating alcohol screening and brief intervention at trauma centers: a policy-relevant cluster randomized effectiveness trial. Addiction 2014; 109:754-65. [PMID: 24450612 PMCID: PMC4014067 DOI: 10.1111/add.12492] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 11/04/2013] [Accepted: 01/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS In 2005 the American College of Surgeons passed a mandate requiring that level I trauma centers have mechanisms to identify and intervene with problem drinkers. The aim of this investigation was to determine if a multi-level trauma center intervention targeting both providers and patients would lead to higher-quality alcohol screening and brief intervention (SBI) when compared with trauma center mandate compliance without implementation enhancements. DESIGN Cluster randomized trial in which intervention site (site n = 10, patient n = 409) providers received 1-day workshop training on evidence-based motivational interviewing (MI) alcohol interventions and four 30-minute feedback and coaching sessions; control sites (site n = 10, patient n = 469) implemented the mandate without study team training enhancements. SETTING Trauma centers in the United States of America. PARTICIPANTS A total of 878 blood alcohol-positive in-patients with and without traumatic brain injury (TBI). MEASUREMENTS MI skills of providers were assessed with fidelity coded standardized patient interviews. All patients were interviewed at baseline and 6- and 12-months post-injury with the Alcohol Use Disorders Identification Test (AUDIT). FINDINGS Intervention site providers consistently demonstrated enhanced MI skills compared with control providers. Intervention patients demonstrated an 8% reduction in AUDIT hazardous drinking relative to controls over the course of the year after injury (relative risk = 0.88, 95%, confidence interval = 0.79, 0.98). Intervention patients were more likely to demonstrate improvements in alcohol use problems in the absence of traumatic brain injury (TBI) (P = 0.002). CONCLUSION Trauma center providers can be trained to deliver higher-quality alcohol screening and brief intervention (SBI) than untrained providers, which is associated with modest reductions in alcohol use problems, particularly among patients without TBI.
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Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Dennis M. Donovan
- Department of Psychiatry and Behavioral Sciences, Alcohol and Drug Abuse Institute, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Larry Gentilello
- Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Chris Dunn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Jeff Love
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Collin McFadden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Frederick P. Rivara
- Department of Pediatrics Harborview Injury Prevention and Research Center, University of Washington School of Medicine
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Gaume J, McCambridge J, Bertholet N, Daeppen JB. Mechanisms of action of brief alcohol interventions remain largely unknown - a narrative review. Front Psychiatry 2014; 5:108. [PMID: 25206342 PMCID: PMC4143721 DOI: 10.3389/fpsyt.2014.00108] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/06/2014] [Indexed: 11/13/2022] Open
Abstract
A growing body of evidence has shown the efficacy of brief intervention (BI) for hazardous and harmful alcohol use in primary health care settings. Evidence for efficacy in other settings and effectiveness when implemented at larger scale are disappointing. Indeed, BI comprises varying content; exploring BI content and mechanisms of action may be a promising way to enhance efficacy and effectiveness. Medline and PsychInfo, as well as references of retrieved publications were searched for original research or review on active ingredients (components or mechanisms) of face-to-face BIs [and its subtypes, including brief advice and brief motivational interviewing (BMI)] for alcohol. Overall, BI active ingredients have been scarcely investigated, almost only within BMI, and mostly among patients in the emergency room, young adults, and US college students. This body of research has shown that personalized feedback may be an effective component; specific MI techniques showed mixed findings; decisional balance findings tended to suggest a potential detrimental effect; while change plan exercises, advice to reduce or stop drinking, presenting alternative change options, and moderation strategies are promising but need further study. Client change talk is a potential mediator of BMI effects; change in norm perceptions and enhanced discrepancy between current behavior and broader life goals and values have received preliminary support; readiness to change was only partially supported as a mediator; while enhanced awareness of drinking, perceived risks/benefits of alcohol use, alcohol treatment seeking, and self-efficacy were seldom studied and have as yet found no significant support as such. Research is obviously limited and has provided no clear and consistent evidence on the mechanisms of alcohol BI. How BI achieves the effects seen in randomized trials remains mostly unknown and should be investigated to inform the development of more effective interventions.
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Affiliation(s)
- Jacques Gaume
- Alcohol Treatment Center, Department of Community Health and Medicine, Lausanne University Hospital , Lausanne , Switzerland
| | - Jim McCambridge
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine , London , UK
| | - Nicolas Bertholet
- Alcohol Treatment Center, Department of Community Health and Medicine, Lausanne University Hospital , Lausanne , Switzerland
| | - Jean-Bernard Daeppen
- Alcohol Treatment Center, Department of Community Health and Medicine, Lausanne University Hospital , Lausanne , Switzerland
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Willenbring ML. Gaps in clinical prevention and treatment for alcohol use disorders: costs, consequences, and strategies. Alcohol Res 2014; 35:238-43. [PMID: 24881332 PMCID: PMC3908715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Heavy drinking causes significant morbidity, premature mortality, and other social and economic burdens on society, prompting numerous prevention and treatment efforts to avoid or ameliorate the prevalence of heavy drinking and its consequences. However, the impact on public health of current selective (i.e., clinical) prevention and treatment strategies is unclear. Screening and brief counseling for at-risk drinkers in ambulatory primary care has the strongest evidence for efficacy, and some evidence indicates this approach is cost-effective and reduces excess morbidity and dysfunction. Widespread implementation of screening and brief counseling of nondependent heavy drinkers outside of the medical context has the potential to have a large public health impact. For people with functional dependence, no appropriate treatment and prevention approaches currently exist, although such strategies might be able to prevent or reduce the morbidity and other harmful consequences associated with the condition before its eventual natural resolution. For people with alcohol use disorders, particularly severe and recurrent dependence, treatment studies have shown improvement in the short term. However, there is no compelling evidence that treatment of alcohol use disorders has resulted in reductions in overall disease burden. More research is needed on ways to address functional alcohol dependence as well as severe and recurrent alcohol dependence.
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Affiliation(s)
- Mark L. Willenbring
- Mark L. Willenbring, M.D., former director of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism, is founder and CEO of Alltyr: Transforming Treatment for Addictions, St. Paul, Minnesota.
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Clark BJ, Jones J, Cook P, Tian K, Moss M. Facilitators and barriers to initiating change in medical intensive care unit survivors with alcohol use disorders: a qualitative study. J Crit Care 2013; 28:849-56. [PMID: 23876701 PMCID: PMC4117201 DOI: 10.1016/j.jcrc.2013.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/12/2013] [Accepted: 06/16/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Alcohol abuse and dependence are collectively referred to as alcohol use disorders (AUD). An AUD is present in up to one third of patients admitted to an intensive care unit (ICU). We sought to understand the barriers and facilitators to change in ICU survivors with an AUD to provide a foundation upon which to tailor alcohol-related interventions. METHODS We used a qualitative approach with a broad constructivist framework, conducting semistructured interviews in medical ICU survivors with an AUD. Patients were included if they were admitted to 1 of 2 medical ICUs and were excluded if they refused participation, were unable to participate, or did not speak English. Digitally recorded and professionally transcribed interviews were analyzed using a general inductive approach and grouped into themes. RESULTS Nineteen patients were included, with an average age of 51 (interquartile range, 36-51) years and an average Acute Physiology and Chronic Health Evaluation II score of 9 (interquartile range, 5-13); 68% were white, 74% were male, and the most common reason for admission was alcohol withdrawal (n=8). We identified 5 facilitators of change: empathy of the inpatient health care environment, recognition of accumulating problems, religion, pressure from others to stop drinking, and trigger events. We identified 3 barriers to change: missed opportunities, psychiatric comorbidity, and cognitive dysfunction. Social networks were identified as either a barrier or facilitator to change depending on the specific context. CONCLUSIONS Alcohol-related interventions to motivate and sustain behavior change could be tailored to ICU survivors by accounting for unique barriers and facilitators.
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Affiliation(s)
- Brendan J Clark
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO.
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Bonar EE, Walton MA, Cunningham RM, Chermack ST, Bohnert ASB, Barry KL, Booth BM, Blow FC. Computer-enhanced interventions for drug use and HIV risk in the emergency room: preliminary results on psychological precursors of behavior change. J Subst Abuse Treat 2013; 46:5-14. [PMID: 24035142 DOI: 10.1016/j.jsat.2013.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/31/2013] [Accepted: 08/01/2013] [Indexed: 11/16/2022]
Abstract
This article describes process data from a randomized controlled trial among 781 adults recruited in the emergency department who reported recent drug use and were randomized to: intervener-delivered brief intervention (IBI) assisted by computer, computerized BI (CBI), or enhanced usual care (EUC). Analyses examined differences between baseline and post-intervention on psychological constructs theoretically related to changes in drug use and HIV risk: importance, readiness, intention, help-seeking, and confidence. Compared to EUC, participants receiving the IBI significantly increased in confidence and intentions; CBI patients increased importance, readiness, confidence, and help-seeking. Both groups increased relative to the EUC in likelihood of condom use with regular partners. Examining BI components suggested that benefits of change and tools for change were associated with changes in psychological constructs. Delivering BIs targeting drug use and HIV risk using computers appears promising for implementation in healthcare settings. This trial is ongoing and future work will report behavioral outcomes.
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Affiliation(s)
- Erin E Bonar
- University of Michigan, Department of Psychiatry, Ann Arbor, MI, 48109, USA.
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Screening and brief interventions for hazardous and harmful alcohol use among hospital outpatients in South Africa: results from a randomized controlled trial. BMC Public Health 2013; 13:644. [PMID: 23844552 PMCID: PMC3849548 DOI: 10.1186/1471-2458-13-644] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 06/12/2013] [Indexed: 11/10/2022] Open
Abstract
Background High prevalence rates of hazardous and harmful alcohol use have been found in a hospital outpatient setting in South Africa. Hospital settings are a particularly valuable point of contact for the delivery of brief interventions because of the large access to patient populations each year. With this in mind, the primary purpose of this randomized controlled trial is to provide screening for alcohol misuse and to test the effectiveness of brief interventions in reducing alcohol intake among hospital outpatients in South Africa. Methods The study design for this effectiveness study is a randomized controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by hazardous or harmful drinkers in a hospital setting. Outpatients were screened for alcohol problems, and those identified as hazardous or harmful drinkers were randomized into an experimental or control group. The experimental group received one brief counselling session on alcohol risk reduction, while the control group received a health education leaflet. Results Of the 1419 screened for alcohol misuse who agreed to participate in the trial 392 (27.6%) screened positive for hazardous or harmful use on the Alcohol Use Disorder Identification Test (AUDIT) (score 7/8-19) and 51 (3.6%) had an AUDIT score of 20 or more. Among the 282 (72%) hospital outpatients who also attended the 12-month follow-up session, the time effects on the AUDIT scores were significant [F (1,195 = 7.72), P < 0.01] but the intervention effect on the AUDIT score was statistically not significant [F (1,194 = 0.06), P < 0.804]. Conclusion Given the lack of difference in outcome between control and intervention group, alcohol screening and the provision of an alcohol health education leaflet may in itself cause reduction in drinking. Trial registration PACTR201110000319392
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Suffoletto B, Callaway CW, Kristan J, Monti P, Clark DB. Mobile phone text message intervention to reduce binge drinking among young adults: study protocol for a randomized controlled trial. Trials 2013; 14:93. [PMID: 23552023 PMCID: PMC3652768 DOI: 10.1186/1745-6215-14-93] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 03/14/2013] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Heavy episodic (binge) drinking is common among young adults and can lead to injury and illness. Young adults who seek care in the Emergency Department (ED) may be disproportionately affected with binge drinking behavior, therefore provide an opportunity to reduce future risk through screening, brief intervention and referral to treatment (SBIRT). Mobile phone text messaging (SMS) is a common form of communication among young adults and has been shown to be effective at providing behavioral support to young adult drinkers after ED discharge. Efficacy of SMS programs to reduce binge drinking remains unknown. METHODS/DESIGN We will conduct a three parallel arm, randomized trial. A convenience sample of adults aged 18 to 25 years attending three EDs in Pittsburgh, PA and willing to participate in the study will be screened for hazardous alcohol consumption. Participants identified as hazardous drinkers will then be allocated to either 12 weeks of weekly SMS drinking assessments with feedback (SA+F), SMS drinking assessments without feedback (SA), or a control group. Randomization will be via an independent and remote computerized randomization and will be stratified by study site. The SA+F group will be asked to provide pre-weekend drinking intention as well as post-weekend consumption via SMS and will receive feedback messages focused on health consequences of alcohol consumption, personalized normative feedback, protective drinking strategies and goal setting. Follow-up data on alcohol use and injury related to alcohol will be collected through a password-protected website three, six and nine months later. The primary outcome for the study is binge drinking days (≥4 drinks for women; ≥5 drinks for men) during the previous month, and the main secondary outcome is the proportion of participants who report any injury related to alcohol in the prior three months. DISCUSSION This study will test the hypothesis that a mobile phone text-messaging program will result in immediate and durable reductions in binge drinking among at-risk young adults. By testing an intervention group to an assessment-only and control group, we will be able to separate the effect of assessment reactivity. By collecting pre-weekend drinking intentions and post-weekend consumption data in the SA+F group, we will be able to better understand mechanism of change. TRIAL REGISTRATION Clinicaltrials.gov NCT01688245.
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Affiliation(s)
- Brian Suffoletto
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A 3600 Forbes Avenue, Pittsburgh, PA 15261, USA
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A 3600 Forbes Avenue, Pittsburgh, PA 15261, USA
| | - Jeffrey Kristan
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A 3600 Forbes Avenue, Pittsburgh, PA 15261, USA
| | - Peter Monti
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI, 02912, USA
| | - Duncan B Clark
- Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
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Mdege ND, Watson J. Predictors of study setting (primary care vs. hospital setting) among studies of the effectiveness of brief interventions among heavy alcohol users: A systematic review. Drug Alcohol Rev 2013; 32:368-80. [DOI: 10.1111/dar.12036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/05/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Noreen Dadirai Mdege
- Addiction Research Group; Department of Health Sciences; University of York; York; UK
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Zatzick DF, Donovan DM, Dunn C, Jurkovich GJ, Wang J, Russo J, Rivara FP, Zatzick CD, Love JR, McFadden CR, Gentilello LM. Disseminating Organizational Screening and Brief Intervention Services (DO-SBIS) for alcohol at trauma centers study design. Gen Hosp Psychiatry 2013; 35:174-80. [PMID: 23273831 PMCID: PMC3594343 DOI: 10.1016/j.genhosppsych.2012.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 11/19/2012] [Accepted: 11/20/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In 2005, the American College of Surgeons passed a mandate requiring that Level I trauma centers have a mechanism to identify patients who are problem drinkers and have the capacity to provide an intervention for patients who screen positive. The aim of the Disseminating Organizational Screening and Brief Intervention Services (DO-SBIS) cluster randomized trial is to test a multilevel intervention targeting the implementation of high-quality alcohol screening and brief intervention (SBI) services at trauma centers. METHOD Twenty sites selected from all United States Level I trauma centers were randomized to participate in the trial. Intervention site providers receive a combination of workshop training in evidence-based motivational interviewing (MI) interventions and organizational development activities prior to conducting trauma-center-based alcohol SBI with blood-alcohol-positive injured patients. Control sites implement care as usual. Provider MI skills, patient alcohol consumption, and organizational acceptance of SBI implementation outcomes are assessed. RESULTS The investigation has successfully recruited provider, patient and trauma center staff samples into the study, and outcomes are being followed longitudinally. CONCLUSION When completed, the DO-SBIS trial will inform future American College of Surgeons' policy targeting the sustained integration of high-quality alcohol SBI at trauma centers nationwide.
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Affiliation(s)
- Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Box 359911, Seattle, WA 98104, USA.
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Davydow DS, Zatzick D, Hough CL, Katon WJ. A longitudinal investigation of alcohol use over the course of the year following medical-surgical intensive care unit admission. PSYCHOSOMATICS 2013; 54:307-16. [PMID: 23414847 DOI: 10.1016/j.psym.2013.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 01/08/2013] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND There have been no studies describing post-intensive care unit (ICU) alcohol use among medical-surgical ICU survivors. OBJECTIVE To examine alcohol use and identify potentially modifiable risk factors, such as in-hospital probable acute stress disorder, for increased alcohol use following medical-surgical ICU admission. METHOD This longitudinal investigation included 150 medical-surgical ICU survivors. In-hospital interviews obtained baseline characteristics including pre-ICU alcohol use with the Alcohol Use Disorders Identification Test (AUDIT) and in-hospital probable acute stress disorder with the Post-traumatic Stress Disorder Checklist-civilian version. Clinical factors were obtained from medical records. Post-ICU alcohol use was ascertained via telephone interviews at 3 and 12 months post-discharge using the AUDIT. Mixed-model linear regression was used to examine potential risk factors for increased post-ICU alcohol use. RESULTS There was a significant decline in the mean AUDIT score from baseline (3.9, 95% confidence interval [95% CI]: 2.9, 5.0) to 3 months post-ICU (1.5, 95% CI: 1.0, 2.1) (P < 0.001 by one-way analysis of variance [ANOVA]), with a significant increase between 3 and 12 months post-ICU (2.7, 95% CI: 1.8, 3.5) (P < 0.001 by one-way ANOVA). After adjusting for patient and clinical factors, in-hospital probable acute stress disorder (beta: 3.0, 95% CI: 0.9, 5.0) and pre-ICU unhealthy alcohol use (beta: 5.4, 95% CI: 3.4, 7.4) were independently associated with increased post-ICU alcohol use. CONCLUSIONS Alcohol use decreases in the early aftermath of medical-surgical ICU admission and then increases significantly by one year post-ICU. Interventions for unhealthy alcohol use among medical-surgical ICU survivors that take into account comorbid psychiatric symptoms are needed.
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Affiliation(s)
- Dimitry S Davydow
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98104, USA.
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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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