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Moe J, Koh J, Ma JA, Pei LX, MacLean E, Keech J, Maguire K, Ronsley C, Doyle-Waters MM, Brubacher JR. Screening for harmful substance use in emergency departments: a systematic review. Int J Emerg Med 2024; 17:52. [PMID: 38584266 PMCID: PMC11000386 DOI: 10.1186/s12245-024-00616-2] [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: 09/24/2023] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Substance use-related emergency department (ED) visits have increased substantially in North America. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthesizes evidence on diagnostic accuracy of ED screening tools to detect harmful substance use. METHODS We included derivation or validation studies, with or without comparator, that included adult (≥ 18 years) ED patients and evaluated screening tools to identify general or specific substance use disorders or harmful use. Our search strategy combined concepts Emergency Department AND Screening AND Substance Use. Trained reviewers assessed title/abstracts and full-text articles for inclusion, extracted data, and assessed risk of bias (QUADAS-2) independently and in duplicate. Reviewers resolved disagreements by discussion. Primary investigators adjudicated if necessary. Heterogeneity precluded meta-analysis. We descriptively summarized results. RESULTS Our search strategy yielded 2696 studies; we included 33. Twenty-one (64%) evaluated a North American population. Fourteen (42%) applied screening among general ED patients. Screening tools were administered by research staff (n = 21), self-administered by patients (n = 10), or non-research healthcare providers (n = 1). Most studies evaluated alcohol use screens (n = 26), most commonly the Alcohol Use Disorders Identification Test (AUDIT; n = 14), Cut down/Annoyed/Guilty/Eye-opener (CAGE; n = 13), and Rapid Alcohol Problems Screen (RAPS/RAPS4/RAPS4-QF; n = 12). Four studies assessing six tools and screening thresholds for alcohol abuse/dependence in North American patients (AUDIT ≥ 8; CAGE ≥ 2; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-2] ≥ 1; RAPS ≥ 1; National Institute on Alcohol Abuse and Alcoholism [NIAAA]; Tolerance/Worry/Eye-opener/Amnesia/K-Cut down [TWEAK] ≥ 3) reported both sensitivities and specificities ≥ 83%. Two studies evaluating a single alcohol screening question (SASQ) (When was the last time you had more than X drinks in 1 day?, X = 4 for women; X = 5 for men) reported sensitivities 82-85% and specificities 70-77%. Five evaluated screening tools for general substance abuse/dependence (Relax/Alone/Friends/Family/Trouble [RAFFT] ≥ 3, Drug Abuse Screening Test [DAST] ≥ 4, single drug screening question, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST] ≥ 42/18), reporting sensitivities 64%-90% and specificities 61%-100%. Studies' risk of bias were mostly high or uncertain. CONCLUSIONS Six screening tools demonstrated both sensitivities and specificities ≥ 83% for detecting alcohol abuse/dependence in EDs. Tools with the highest sensitivities (AUDIT ≥ 8; RAPS ≥ 1) and that prioritize simplicity and efficiency (SASQ) should be prioritized.
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Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Justin Koh
- Department of Emergency Medicine, Queen's University, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Jennifer A Ma
- Department of Emergency Medicine, University of Manitoba, S203 Medical Sciences Building, 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W2, Canada
| | - Lulu X Pei
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Eleanor MacLean
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - James Keech
- School of Medicine, Queen's University, 15 Arch Street, Kingston, ON, K7L 3N6, Canada
| | - Kaitlyn Maguire
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Claire Ronsley
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Cherpitel CJ, Ye Y, Poznyak V. Single episode of alcohol use resulting in injury: a cross-sectional study in 21 countries. Bull World Health Organ 2018; 96:335-342. [PMID: 29875518 PMCID: PMC5985422 DOI: 10.2471/blt.17.202093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the empirical basis for including the diagnostic category of "a single episode of harmful substance use" in the 11th revision of the International statistical classification of diseases and related health problems (ICD-11). METHODS We used data on patients admitted to emergency departments in 21 countries with alcohol-related injuries (i.e. with drinking within the preceding six hours) who had no sign of alcohol intoxication or withdrawal, no alcohol in blood and no sign of alcohol dependence or harmful drinking as described in the ICD-10. We obtained data on alcohol-related injuries, the patient's causal attribution of injury to drinking, the alcohol amount consumed, blood alcohol concentration and usual drinking pattern. Patients with and without alcohol dependence or harmful drinking were compared. FINDINGS We included a representative sample of 18 369 patients. After adjustment for unequal sampling, 18.8% reported drinking in the six hours before injury and 47.1% of these attributed their injury to drinking; 16.3% of those reporting drinking and 10.3% of those attributing their injury to drinking were not alcohol dependent or harmful drinkers. The majority of these last two groups reported never having had five or more drinks on one occasion during the last year and had a blood alcohol concentration less than 0.05%. CONCLUSION Some individuals attending emergency departments had alcohol-attributable injuries due to a single episode of drinking but had no history of harmful use or dependence. These findings highlight the public health relevance of including the new diagnostic category in the ICD-11.
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Affiliation(s)
- Cheryl J Cherpitel
- Alcohol Research Group, Public Health Institute, Suite 450, 6001 Shellmound Street, Emeryville, California, CA 94608, United States of America
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, Suite 450, 6001 Shellmound Street, Emeryville, California, CA 94608, United States of America
| | - Vladimir Poznyak
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Paulus DJ, Vujanovic AA, Schuhmann BB, Smith LJ, Tran J. Main and interactive effects of depression and posttraumatic stress in relation to alcohol dependence among urban male firefighters. Psychiatry Res 2017; 251:69-75. [PMID: 28189939 DOI: 10.1016/j.psychres.2017.02.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/31/2017] [Accepted: 02/05/2017] [Indexed: 11/24/2022]
Abstract
Depression, posttraumatic stress, and alcohol use are highly prevalent among firefighters. However, no study has evaluated the interactive effects of depression and posttraumatic stress with regard to alcohol use among firefighters. The current study examined main and interactive effects of depression and posttraumatic stress in terms of alcohol dependence symptoms, positive alcohol dependence screen, and drinks per occasion. Participants included 2707 male urban firefighters. There was a main effect of posttraumatic stress in relation to all alcohol-related outcomes and a main effect of depression only for alcohol dependence symptoms. There was a significant interaction of depression and posttraumatic stress with regard to symptoms of alcohol dependence, positive screen for alcohol dependence, and number of drinks per occasion. Interactions were evident above main effects and covariates (age, presence of a spouse/partner, tenure in the fire department, history of active duty in the U.S. armed forces, and racial/ethnic minority status). Overall, heightened depression was positively associated with alcohol-related outcomes for those with lower but not higher levels of posttraumatic stress in all models. Posttraumatic stress and depression may pose unique interactive risks for alcohol dependence in urban male firefighters. Implications for clinical intervention in firefighters are discussed.
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Affiliation(s)
- Daniel J Paulus
- University of Houston, Department of Psychology, Houston, TX, USA
| | - Anka A Vujanovic
- University of Houston, Department of Psychology, Houston, TX, USA
| | | | - Lia J Smith
- University of Houston, Department of Psychology, Houston, TX, USA
| | - Jana Tran
- Houston Fire Department, Houston, TX, USA
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Martin CE, Vujanovic AA, Paulus DJ, Bartlett B, Gallagher MW, Tran JK. Alcohol use and suicidality in firefighters: Associations with depressive symptoms and posttraumatic stress. Compr Psychiatry 2017; 74:44-52. [PMID: 28092775 DOI: 10.1016/j.comppsych.2017.01.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/07/2016] [Accepted: 01/04/2017] [Indexed: 11/19/2022] Open
Abstract
Both suicidality and alcohol use disorders are significant public health concerns among firefighters, and alcohol use is associated with increased suicide risk. In addition, firefighters endorse high rates of symptoms of depression and posttraumatic stress disorder (PTSD). Thus, the current investigation examined associations between alcohol dependence and suicide risk among a large sample of firefighters. Specifically, this study examined the indirect effects of alcohol dependence on suicidality outcomes via both depression and posttraumatic stress, using structural equation modeling. A total of 2883 male firefighters completed a self-report survey, containing measures of alcohol use, suicidality, PTSD, and depressive symptoms. Results indicated good model fit. The latent alcohol dependence variable was directly related to the latent suicide risk variable. However, when depression and posttraumatic stress latent variables were added into the model, alcohol dependence was no longer associated with suicide risk. Furthermore, alcohol dependence was indirectly related to suicide risk via latent depression and posttraumatic stress variables. Indirect effects were established after controlling for relevant covariates. Clinical implications are discussed.
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Affiliation(s)
| | | | | | | | - Matthew W Gallagher
- University of Houston, Texas Institute of Measurement Evaluation and Statistics (TIMES)
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Crutzen R, Giabbanelli PJ, Jander A, Mercken L, de Vries H. Identifying binge drinkers based on parenting dimensions and alcohol-specific parenting practices: building classifiers on adolescent-parent paired data. BMC Public Health 2015; 15:747. [PMID: 26243154 PMCID: PMC4526422 DOI: 10.1186/s12889-015-2092-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 07/24/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Most Dutch adolescents aged 16 to 18 engage in binge drinking. Previous studies have investigated how parenting dimensions and alcohol-specific parenting practices are related to adolescent alcohol consumption. Mixed results have been obtained on both dimensions and practices, highlighting the complexity of untangling alcohol-related factors. The aim of this study was to investigate (1) whether parents' reports of parenting dimensions and alcohol-specific parenting practices, adolescents' perceptions of these dimensions and practices, or a combination are most informative to identify binge drinkers, and (2) which of these parenting dimensions and alcohol-specific parenting practices are most informative to identify binge drinkers. METHODS Survey data of 499 adolescent-parent dyads were collected. The computational technique of data mining was used to allow for a data driven exploration of nonlinear relationships. Specifically, a binary classification task, using an alternating decision tree, was conducted and measures regarding the performance of the classifiers are reported after a 10-fold cross-validation. RESULTS Depending on the parenting dimension or practice, parents' reports correctly identified the drinking behaviour of 55.8% (using psychological control) up to 70.2% (using rules) of adolescents. Adolescents' perceptions were best at identifying binge drinkers whereas parents' perceptions were best at identifying non-binge drinkers. CONCLUSIONS Of the parenting dimensions and practices, rules are particularly informative in understanding drinking behaviour. Adolescents' perceptions and parents' reports are complementary as they can help identifying binge drinkers and non-binge drinkers respectively, indicating that surveying specific aspects of adolescent-parent dynamics can improve our understanding of complex addictive behaviours.
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Affiliation(s)
- Rik Crutzen
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Philippe J Giabbanelli
- UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, CB2 0QQ, Cambridge, UK. .,Interdisciplinary Research in the Mathematical and Computational Sciences (IRMACS) Centre, Simon Fraser University, Burnaby, Canada.
| | - Astrid Jander
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Hein de Vries
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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Cherpitel CJ, Ye Y. ALCOHOL AND VIOLENCE-RELATED INJURIES AMONG EMERGENCY ROOM PATIENTS IN AN INTERNATIONAL PERSPECTIVE. J Am Psychiatr Nurses Assoc 2010; 16:227-235. [PMID: 20824198 PMCID: PMC2930831 DOI: 10.1177/1078390310374876] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
While alcohol has been found to be more closely associated with violence-related injury than with injury from other causes, little data is available which documents heterogeneity in this association across countries or cultures, taking into consideration usual drinking patterns and other socio-cultural variables. Data are reported from 15 countries comprising the Emergency Room Collaborative Alcohol Analysis Project and the WHO Collaborative Study on Alcohol and Injury. Case-crossover analysis was used to analyze the risk of injury (among current drinkers) from drinking six hours prior to the event, based on frequency of usual drinking, for violence-related injuries and separately for non-violence related injuries. Relative risk (RR) for a violence-related injury was significantly greater than for injuries from other causes across all countries (pooled RR=22.22 vs. 4.33), but the magnitude of risk varied considerably (ranging from 4.68 in Spain to 942 in Canada). Pooled effect size was found to be heterogeneous across countries, and was explained, in part, by the level of detrimental drinking pattern in a country. Risk for a violence-related injury was not significantly different by age (<30 and 30+), reporting 5 or more drinks on at least one occasion during the last year, or reporting symptoms of alcohol dependence. A number of methodological concerns suggest that risk of a violence-related injury compared to injuries from other causes may be inflated, and such variables as context of drinking should be taken into consideration in establishing relative risk and alcohol attributable fraction of violence-related injury across countries and cultures.
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Abstract
In the fourth in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Vivek Benegal and colleagues discuss the treatment of alcohol use disorders.
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Affiliation(s)
- Vivek Benegal
- Deaddiction Centre, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Manoleas P. Integrated primary care and behavioral health services for Latinos: a blueprint and research agenda. SOCIAL WORK IN HEALTH CARE 2008; 47:438-454. [PMID: 19042495 DOI: 10.1080/00981380802344480] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Disparities in Latino utilization of mental health services have been documented for some years. Factors such as stigma, low rates of health insurance, paucity of culturally competent providers, and linguistic inaccessibility have contributed to this underutilization. The documented tendency of many Latinos to experience the mind and body as a unified whole, often referred to as "non-dualism"; provides a unique opportunity to address these disparities in utilization. This article advocates a specific model of engagement of Latinos into a continuum of needed behavioral health services via the primary care clinic, and suggests a variety of clinical and administrative outcome measures for evaluating the effectiveness of the model. The model centers on the inclusion of a behavioral health specialist who is "nested" within the primary care team. The preparation and perspectives of clinically trained social workers make them ideal for this role.
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Affiliation(s)
- Peter Manoleas
- School of Social Welfare, University of California at Berkeley, Berkeley 94703, USA.
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Roche AM, Freeman T, Skinner N. From data to evidence, to action: findings from a systematic review of hospital screening studies for high risk alcohol consumption. Drug Alcohol Depend 2006; 83:1-14. [PMID: 16310323 DOI: 10.1016/j.drugalcdep.2005.10.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 10/18/2005] [Accepted: 10/18/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To conduct a systematic review of hospital alcohol screening studies to identify effective and efficient evidence-based strategies. METHOD Sixty-five studies (N=100,980) of alcohol problem prevalence amongst hospital patients were reviewed. RESULTS Prevalence of positive alcohol screens varied according to hospital location, screening tool and patient characteristics. BAC measures (26%) were nearly twice as likely (OR=1.92, p<.001) to reveal positive screens in the ED than self-reports (16%). No difference was found in prevalence of self-report positive screens between ED (16%) and ward settings (17%). Males were two to four times more likely than females to screen positive (BAC: OR=2.37, p<.001, ED self-report: OR=3.07, p<.001, ward self-report: OR=4.30, p<.001). ED patients aged 20-40 years and ward patients aged 30-50 years had the highest prevalence of positive screens. CONCLUSIONS Prevalence of risky or problematic drinking among hospital patients is high and warrants systematic screening and intervention. Many hospitals lack sufficient resources to undertake widespread screening programs. For optimum return on resources, it is recommended to screen males in the ED using BAC measures. Established protocols applying priority criteria and staff training can increase screening accuracy and effectiveness.
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Affiliation(s)
- Ann M Roche
- National Centre for Education and Training on Addiction, Flinders University, South Australia, GPO Box 2100, Adelaide, SA 5001, Australia.
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Chapter 6. Psychosocial Stressors, Psychiatric Diagnoses and Utilization of Mental Health Services Among Undocumented Immigrant Latinos. ACTA ACUST UNITED AC 2005. [DOI: 10.1300/j191v03n01_06] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cherpitel CJ, Borges G. Screening for drug use disorders in the emergency department: performance of the rapid drug problems screen (RDPS). Drug Alcohol Depend 2004; 74:171-5. [PMID: 15099660 DOI: 10.1016/j.drugalcdep.2003.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Revised: 12/02/2003] [Accepted: 12/04/2003] [Indexed: 11/30/2022]
Abstract
Little research is available on brief screening instruments for identify those meeting diagnostic criteria for drug dependence or abuse. A brief, four-item screening instrument, called the rapid drug problems screen (RDPS), was developed from a similar instrument for alcohol use disorders, the rapid alcohol problems screen (RAPS). Performance of the RDPS was evaluated against DSM-IV and ICD-10 criteria for drug dependence and for dependence or abuse in a sample of 703 emergency department patients in Mexico City. Among males, sensitivity and specificity were 91 and 96%, respectively, for dependence and 93 and 96%, respectively, for dependence or abuse. Neither of the two females meeting diagnostic criteria for dependence or abuse were identified by the RDPS. Area under the receiver-operating characteristic curve indicates an optimum cut point of 1. The data suggest that the RDPS may hold promise as a brief screening instrument for substance use among males, but should be tested in larger populations of females meeting diagnostic criteria for drug use disorders, and across ethnic subgroups in other geographic locales.
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Affiliation(s)
- Cheryl J Cherpitel
- Alcohol Research Group, Public Health Institute, 2000 Hearst Avenue, Berkeley, CA 94709, USA.
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Barnett NP, Monti PM, Cherpitel C, Bendtsen P, Borges G, Colby SM, Nordqvist C, Johansson K. Identification and brief treatment of alcohol problems with medical patients: an international perspective. Alcohol Clin Exp Res 2003; 27:262-70. [PMID: 12605075 DOI: 10.1097/01.alc.0000057123.36127.8b] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article summarizes the proceedings of a symposium at the 2002 RSA meeting in San Francisco, California. The chair was Peter Monti and co-chair was Nancy Barnett. The aim of the symposium was to bring together researchers from the United States, Sweden, and Mexico to present current findings on the development and implementation of screening and intervention research in Emergency Departments (ED). Cheryl Cherpitel presented findings on the performance of the Rapid Alcohol Problems Screen (RAPS4), a 4-item instrument used for screening for alcohol dependence and harmful drinking in the ED. Dr. Cherpitel also presented for her collaborator, Guilherme Borges, their research on the performance of a number of screening measures including the RAPS among Mexicans and Mexican-Americans with alcohol-related disorders in the ED. Preben Bendtsen described the implementation of an alcohol screening and intervention procedure delivered by ordinary ED staff in Sweden. Nancy Barnett presented data on characteristics related to readiness to change alcohol use in a sample of young adults who were treated in an ED for injury or intoxication.
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Affiliation(s)
- Nancy P Barnett
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island 02912, USA.
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