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Birditt KS, Turkelson A, Polenick CA, Cranford JA, Smith JA, Ware EB, Blow FC. Alcohol Use and Mortality Among Older Couples in the United States: Evidence of Individual and Partner Effects. Gerontologist 2024; 64:gnad101. [PMID: 37487060 PMCID: PMC10825846 DOI: 10.1093/geront/gnad101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Spouses with concordant (i.e., similar) drinking behaviors often report better quality marriages and are married longer compared with those who report discordant drinking behaviors. Less is known regarding whether concordant or discordant patterns have implications for health, as couples grow older. The present study examined whether drinking patterns among older couples are associated with mortality over time. RESEARCH DESIGN AND METHODS The Health and Retirement Study (HRS) is a nationally representative sample of individuals and their partners (married/cohabiting) over age 50 in the United States, in which participants completed surveys every 2 years. Participants included 4,656 married/cohabiting different-sex couples (9,312 individuals) who completed at least 3 waves of the HRS from 1996 to 2016. Participants reported whether they drank alcohol at all in the last 3 months, and if so, the average amount they drank per week. Mortality data were from 2016. RESULTS Analyses revealed concordant drinking spouses (both indicated they drank in the last 3 months) survived longer than discordant drinking spouses (1 partner drinks and the other does not) and concordant nondrinking spouses. Analysis of average drinks per week showed a quadratic association with mortality such that light drinking predicted better survival rates among individuals and their partners compared with abstaining and heavy drinking. Further, similar levels of drinking in terms of the amount of drinking were associated with greater survival, particularly among wives. DISCUSSION AND IMPLICATIONS This study moves the field forward by showing that survival varies as a function of one's own and one's partner's drinking.
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Affiliation(s)
- Kira S Birditt
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela Turkelson
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | | | - James A Cranford
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer A Smith
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin B Ware
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Ilgen MA, Olson-Madden JH, Price A, Brenner LA, King CA, Blow FC. Cognitive behavioral therapy for suicide prevention among Veterans receiving substance use disorder treatment: Results from a randomized trial. J Psychiatr Res 2023; 168:344-352. [PMID: 37956631 DOI: 10.1016/j.jpsychires.2023.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/29/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
Veterans receiving substance use disorder (SUD) treatment are at a clear elevated risk for engaging in suicidal behaviors. Intervening to reduce suicide risk during an episode of SUD treatment could meaningfully target a key high-risk group of Veterans. Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) was developed to reduce the frequency and duration of suicidal ideation, as well as decrease suicidal behaviors. The form of CBT-SP in this study progressed from building an understanding of the cognitive model to practicing new skills, and highlighted the links between substance use, craving, self-efficacy and suicidal ideation and attempts. CBT-SP was compared to an attention matched 8-session control condition (termed Supportive Psychoeducational Control [SPC]) during a multi-site randomized controlled trial for 299 Veterans receiving outpatient SUD treatment services within the Veterans Health Administration. The frequency of suicidal ideation remained relatively constant over 24-months of follow-up, however the duration of suicidal ideation decreased, and suicide attempts decreased relative to baseline in both conditions. Forty-two participants (14%) reported at least one suicide attempt during the 2-year follow-up period. No statistically significant differences were found between CBT-SP and SPC on any of these outcomes. Analyses of secondary outcomes indicate that preparatory behaviors for suicide were less common among those in the CBT-SP condition than SPC across the 24-month follow-up (OR, 95%CI = 0.44 (0.25, 0.79); p = 0.02). Veterans in SUD treatment are a high-risk group and delivery of suicide-specific interventions is feasible during SUD care. However, results did not indicate that CBT-SP was superior to SPC on any primary outcomes, underscoring the importance of identifying and testing alternative approaches that support suicide reduction in this group.
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Affiliation(s)
- Mark A Ilgen
- Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Jennifer H Olson-Madden
- VA Rocky Mountain Mental Illness Research Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA
| | - Amanda Price
- Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center for Veteran Suicide Prevention, Aurora, CO, USA; Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cheryl A King
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Frederic C Blow
- Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Blow FC, Walton M, Ilgen M, Ignacio RV, Walters H, Massey L, Barry KL, McCormick R, Coughlin LN. Peer- and web-based interventions for risky drinking among US National Guard members: Mission Strong randomized controlled trial. Addiction 2023; 118:1246-1257. [PMID: 37041669 DOI: 10.1111/add.16172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 02/07/2023] [Indexed: 04/13/2023]
Abstract
AIMS To test separatel the efficacy of a web-based and a peer-based brief intervention (BI), compared with an expanded usual care control (EUC) group, among military reserve component members using alcohoI in a hazardous and harmful manner. DESIGN In the randomized controlled trial, participants were assigned to: [1] web-based BI with web-based boosters (BI + web), [2] web-based BI with peer-based boosters (BI + peer) or [3] enhanced usual care (EUC). SETTING Michigan, USA. PARTICIPANTS A total of 739 Michigan Army National Guard members who reported recent hazardous alcohol use; 84% were male, the mean age was 28 years. INTERVENTION The BI consisted of an interactive program guided by a personally selected avatar. Boosters were delivered either on the web or personally by a trained veteran peer. A pamphlet, given to all participants, included information on hazardous alcohol use and military-specific community resources and served as the EUC condition. MEASUREMENTS The primary outcome measure was binge drinking episodes in the past 30 days, measured at 12 months after the BI. FINDINGS All randomized participants were included in the outcome analyses. In adjusted analyses, BI + peer [beta = -0.43, 95% confidence interval (CI) = -0.56 to -0.31, P < 0.001] and BI + web (beta = -0.34, 95% CI = -0.46 to -0.23, P < 0.001) reduced binge drinking compared with EUC. CONCLUSION This satudy was a web-based brief intervention for hazardous alcohol use, with either web- or peer-based boosters, reduced binge alcohol use among Army National Guard members.
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Affiliation(s)
- Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
| | - Maureen Walton
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Mark Ilgen
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
- Department of Veteran Affairs Healthcare, System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA
| | - Rosalinda V Ignacio
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Heather Walters
- Department of Veteran Affairs Healthcare, System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA
| | - Lynn Massey
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Kristen L Barry
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
| | - Richard McCormick
- Center for Healthcare Research and Policy, MetroHealth/Case Western Reserve University, Cleveland, OH, USA
| | - Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
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4
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Walton MA, Carter PM, Seewald L, Ngo Q, Battisti KA, Pearson C, Blow FC, Cunningham RM, Bourque C, Kidwell KM. Adaptive interventions for alcohol misuse and violent behaviors among adolescents and emerging adults in the emergency department: A sequential multiple assignment randomized controlled trial protocol. Contemp Clin Trials 2023; 130:107218. [PMID: 37148999 PMCID: PMC10947472 DOI: 10.1016/j.cct.2023.107218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/08/2023]
Abstract
Alcohol use and violent behaviors among youth are associated with morbidity and mortality. An emergency department (ED) visit provides an opportunity to initiate prevention efforts. Despite promising findings from our single session SafERteens brief intervention (BI), impact is limited by modest effect sizes, with data lacking on optimal boosters to enhance effects. This paper describes the protocol for a sequential, multiple assignment, randomized trial (SMART). Adolescents and emerging adults (ages 14-20) in the ED screening positive for alcohol use and violent behaviors (physical aggression) were randomly assigned to: 1) SafERteens BI + Text Messaging (TM), or 2) SafERteens BI + remote Health Coach (HC). Participants completed weekly surveys over 8 weeks after the ED visit to tailor intervention content and measure mechanisms of change. At one-month, intervention response/non-response is determined (e.g., binge drinking or violent behaviors). Responders are re-randomized to continued intervention condition (e.g., maintenance) or minimized condition (e.g., stepped down). Non-responders are re-randomized to continued condition (e.g., maintenance), or intensified condition (e.g., stepped up). Outcomes were measured at 4 and 8 months, including primary outcomes of alcohol consumption and violence, with secondary outcomes of alcohol consequences and violence consequences. Although the original goal was to enroll 700 participants, COVID-19 impacts on research diminished recruitment in this trial (enrolled n = 400). Nonetheless, the proposed SMART is highly innovative by blending real-time assessment methodologies with adaptive intervention delivery among teens with comorbid alcohol misuse and violent behaviors. Findings will inform the content and timing booster interventions to alter risk behavior trajectories. Trial Registration:ClinicalTrials.govNCT03344666. University of Michigan # HUM00109156.
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Affiliation(s)
- Maureen A Walton
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA.
| | - Patrick M Carter
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109-2800, USA
| | - Laura Seewald
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109-2800, USA
| | - Quyen Ngo
- Hazelden Betty Ford Foundation, 15251 Pleasant Valley Road, Center City, MN 55012, USA
| | - Katherine A Battisti
- Department of Pediatrics, Central Michigan University and Covenant Hospital, Saginaw, MI 48602, USA
| | - Claire Pearson
- Wayne State University, Department of Emergency Medicine, and St. John Hospital, Detroit, MI 48109, USA
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Rebecca M Cunningham
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109-2800, USA
| | - Carrie Bourque
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
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5
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Bonar EE, Bauermeister JA, Blow FC, Bohnert ASB, Bourque C, Coughlin LN, Davis AK, Florimbio AR, Goldstick JE, Wisnieski DM, Young SD, Walton MA. A randomized controlled trial of social media interventions for risky drinking among adolescents and emerging adults. Drug Alcohol Depend 2022; 237:109532. [PMID: 35759874 PMCID: PMC9745675 DOI: 10.1016/j.drugalcdep.2022.109532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Alcohol use among adolescents and emerging adults is an important public health issue requiring prevention approaches. Herein, we describe outcomes from a randomized controlled trial testing the efficacy of group-based social media interventions targeting risky drinking among youth. PROCEDURES Using social media advertisements to screen potential participants, we recruited 955 youth (ages 16-24) reporting recent risky drinking. After completing a baseline assessment, participants were randomized to 8-week secret Facebook group conditions: Social Media Intervention + Incentives for engagement, Social Media Intervention only, and attention-placebo control. Electronic coaches trained in motivational interviewing facilitated interaction in intervention groups. Primary outcomes include past 3-month alcohol use and consequences over 3-, 6-, and 12-month follow-ups. Secondary outcomes include other drug use, consequences, and impaired driving. We also measured intervention engagement and acceptability. RESULTS The interventions were well-received, with significantly greater acceptability ratings and engagement in the SMI+I condition relative to other groups. In adjusted analyses, there were no significant differences between interventions and control on alcohol-related outcomes, with all groups showing reductions. Regarding secondary outcomes (70.4% used other drugs), compared to control, the incentivized group reduced other drug use, consequences, and cannabis-impaired driving; the non-incentivized group did not significantly differ from the control condition. CONCLUSIONS Among this predominantly poly-substance using sample, findings were mixed, with significant effects of the incentivized social media intervention on drug (but not alcohol) outcomes. Future studies are needed to further refine social media-delivered interventions to reduce alcohol and other drug use. TRIAL REGISTRATION ClinicalTrials.gov NCT02809586; University of Michigan HUM#00102242.
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Affiliation(s)
- Erin E. Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - José A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Veterans Health Administration, Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109, USA
| | - Amy S. B. Bohnert
- Veterans Health Administration, Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109, USA,Department of Anesthesiology, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Lara N. Coughlin
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Alan K. Davis
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, 1947 College Rd, Columbus, OH 43210 USA,Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224 USA
| | - Autumn Rae Florimbio
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Jason E. Goldstick
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA,Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI 48109, USA,Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48105
| | - Diane M. Wisnieski
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Sean D. Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA 92697,Department of Emergency Medicine, University of California Irvine, Irvine, CA 92697
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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Maust DT, Takamine L, Wiechers IR, Blow FC, Bohnert ASB, Strominger J, Min L, Krein SL. Strategies Associated With Reducing Benzodiazepine Prescribing to Older Adults: A Mixed Methods Study. Ann Fam Med 2022; 20:328-335. [PMID: 35879067 PMCID: PMC9328717 DOI: 10.1370/afm.2825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 01/11/2022] [Accepted: 03/01/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Unlike in many community-based settings, benzodiazepine (BZD) prescribing to older veterans has decreased. We sought to identify health care system strategies associated with greater facility-level reductions in BZD prescribing to older adults. METHODS We completed an explanatory sequential mixed methods study of health care facilities in the Veterans Health Administration (N = 140). Among veterans aged ≥75 years receiving long-term BZD treatment, we stratified facilities into relatively high and low performance on the basis of the reduction in average daily dose of prescribed BZD from October 1, 2015 to June 30, 2017. We then interviewed key facility informants (n = 21) who led local BZD reduction efforts (champions), representing 11 high-performing and 6 low-performing facilities. RESULTS Across all facilities, the age-adjusted facility-level average daily dose in October 2015 began at 1.34 lorazepam-equivalent mg/d (SD 0.17); the average rate of decrease was -0.27 mg/d (SD 0.09) per year. All facilities interviewed, regardless of performance, used passive strategies primarily consisting of education regarding appropriate prescribing, alternatives, and identifying potential patients for discontinuation. In contrast, champions at high-performing facilities described leveraging ≥1 active strategies that included individualized recommendations, administrative barriers to prescribing, and performance measures to incentivize clinicians. CONCLUSIONS Initiatives to reduce BZD prescribing to older adults that are primarily limited to passive strategies, such as education and patient identification, might have limited success. Clinicians might benefit from additional recommendations, support, and incentives to modify prescribing practices.
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Affiliation(s)
- Donovan T Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan .,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Linda Takamine
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Ilse R Wiechers
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, University of California San Francisco, San Francisco, California.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Amy S B Bohnert
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Julie Strominger
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Lillian Min
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sarah L Krein
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Birditt KS, Turkelson A, Polenick CA, Cranford JA, Blow FC. Alcohol Use and Blood Pressure Among Older Couples: The Moderating Role of Negative Marital Quality. J Gerontol B Psychol Sci Soc Sci 2022; 77:1592-1602. [PMID: 35219278 PMCID: PMC9434470 DOI: 10.1093/geronb/gbac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Spouses often have concordant drinking behaviors and important influences on one another's cardiovascular health. However, little is known about the implications of dyadic drinking patterns for blood pressure, and the marital factors that confer risk or resilience. This article examined links between alcohol use and blood pressure within individuals and opposite-sex couples over time, and whether those links vary by negative marital quality among older adults. METHODS Participants were from the nationally representative longitudinal Health and Retirement Study that included 4,619 respondents in 2,682 opposite-sex couples who participated in at least 2 of the waves from 2006 to 2016. Participants reported the number of drinks they typically consume per week, negative marital quality, and had their blood pressure measured via a cuff. RESULTS Analyses revealed that greater drinking was associated with increased systolic blood pressure among both husbands and wives. Furthermore, husbands who drank more had higher blood pressure when wives drank more alcohol, whereas there was no association between husbands' drinking and blood pressure when wives drank less alcohol. Interactions with negative marital quality showed that drinking concordance may be associated with increased blood pressure over time in more negative marriages. DISCUSSION Findings indicated that spousal drinking concordance, although often associated with positive marital quality, may have negative long-term health effects.
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Affiliation(s)
- Kira S Birditt
- Address correspondence to: Kira S. Birditt, PhD, Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI 48104, USA. E-mail:
| | - Angela Turkelson
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | | | - James A Cranford
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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8
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Bonar EE, Souweidane MA, Blow FC, Bohnert ASB, Bauermeister JA, Young SD, Walton MA. High-intensity drinking among adolescent and emerging adult risky drinkers. Subst Abus 2022; 43:713-721. [PMID: 35100097 PMCID: PMC9720995 DOI: 10.1080/08897077.2021.2007513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: High-intensity drinking (HID; 8+ U.S. standard drinks for women, 10+ men) is initiated during adolescence/emerging adulthood, increasing risk for negative outcomes, including blackouts. We examined baseline data from a study of risky drinking youth to identify factors associated with HID. Methods: Risky drinkers (ages 16-24) were recruited online (positive 3-month AUDIT-C score) as part of a larger study to examine social media interventions for risky drinking. We used baseline survey data to examine HID in relation to demographics, substance use-related variables, and individual and social factors. Results: Among 931 risky drinkers, 29.8% reported past-month HID, and those with HID reported greater substance use and consequences. In multivariable analysis, HID was associated with male sex; greater social motives, impulsivity, and motivation; lower self-efficacy; and greater likelihood of not living with parents, drinking with important peers, and parental disapproval of posting drinking pictures. When examining age group interactions (16-20; 21-24), underage drinkers with high sensation-seeking scores and lower parental disapproval of posting drinking pictures on social media reported greater HID. Conclusions: Among risky drinking youth, male sex, social motives, impulsivity, higher motivation to and lower-self-efficacy to reduce drinking, living away from parents, more frequent drinking with important peers, and lower parental disapproval of posting drinking pictures on social media were positively associated with HID. Further, HID was associated with greater health consequences, underscoring the need for HID interventions. Such interventions may benefit from enhancing motivation and self-efficacy, particularly in social contexts, as well as increasing positive peer and leisure activities to reduce HID.
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Affiliation(s)
- Erin E. Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Mariam A. Souweidane
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,VA Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800
| | - Amy S. B. Bohnert
- VA Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800,Department of Anesthesiology, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800
| | - José A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104
| | - Sean D. Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA 92697,Department of Emergency Medicine, School of Medicine, University of California Irvine, Irvine, CA 92697
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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9
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Coughlin LN, Blow FC, Walton M, Ignacio RV, Walters H, Massey L, Barry KL, McCormick R. Predictors of Booster Engagement Following a Web-Based Brief Intervention for Alcohol Misuse Among National Guard Members: Secondary Analysis of a Randomized Controlled Trial. JMIR Ment Health 2021; 8:e29397. [PMID: 34698652 PMCID: PMC8579213 DOI: 10.2196/29397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/22/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol misuse is a major health concern among military members. Reserve component members face unique barriers as they live off base with limited access to behavioral health services. Web and app-based brief interventions are a promising means to improve access to treatment for those who misuse alcohol, with the use of booster sessions to enhance effectiveness, solidify gains, and reinforce changes. However, little is known about who will engage in booster sessions. OBJECTIVE This study aims to evaluate booster engagement across booster delivery modalities (Web and Peer) and identify participant-specific factors associated with booster session engagement. METHODS Following a brief web-based alcohol misuse intervention in National Guard members (N=739), we examined engagement in a series of three booster sessions. Using unadjusted and adjusted models, demographic and clinical characteristics that may serve as predictors of booster session engagement were examined across the 2 arms of the trial with different types of booster sessions: peer-delivered (N=245) and web-delivered (N=246). RESULTS Booster session completion was greater for Peer than Web Booster sessions, with 142 (58%) service members in the Peer Booster arm completing all three boosters compared with only 108 (44%) of participants in the Web Booster arm (χ23=10.3; P=.006). In a model in which the 2 groups were combined, socioeconomic factors predicted booster engagement. In separate models, the demographic and clinical predictors of booster engagement varied between the 2 delivery modalities. CONCLUSIONS The use of peer-delivered boosters, especially among subsets of reserve members at risk of lack of engagement, may foster greater uptake and improve treatment outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT02181283; https://clinicaltrials.gov/ct2/show/NCT02181283.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,VA Center for Clinical Management Research, Department of Veteran Affairs Healthcare System, Ann Arbor, MI, United States
| | - Maureen Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Rosalinda V Ignacio
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Heather Walters
- VA Center for Clinical Management Research, Department of Veteran Affairs Healthcare System, Ann Arbor, MI, United States
| | - Lynn Massey
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Kristen L Barry
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Richard McCormick
- Center for Healthcare Research and Policy, MetroHealth/Case Western Reserve University, Cleveland, OH, United States
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10
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Coughlin LN, Bonar EE, Bohnert AS, Blow FC, Bauermeister JA, Cross Y, Cunningham R, Young SD, Walton MA. Patterns of same-day alcohol and cannabis use in adolescents and young adults with risky alcohol use. Addict Res Theory 2021; 30:89-95. [PMID: 36093415 PMCID: PMC9455920 DOI: 10.1080/16066359.2021.1936511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/16/2021] [Accepted: 05/26/2021] [Indexed: 06/14/2023]
Abstract
Same-day alcohol and cannabis use is relatively common in adolescents and young adults, constituting a higher-risk behavior relative to single-substance use. However, the association between quantity of alcohol and cannabis use on co-use days is understudied. We examined the association between the quantity of alcohol and same-day cannabis use with a multilevel regression analysis in a sample of youth (16-24 years old) with risky alcohol use. Participants reported one or more days of alcohol and cannabis over the past month (N = 468). Quantity of cannabis use was highest on heavy drinking days [M = 0.91 grams, SD = 0.68] followed by moderate drinking days (M = 0.78 grams, SD = 0.63), and lowest on days without alcohol use (M = 0.74 grams, SD = 0.64, p < 0.001). In multilevel modeling analyses, adjusted for clustering within individuals, greater quantity of drinking on a given day was associated with greater cannabis use (estimate = 0.03, p < 0.001). When using alcohol and cannabis on the same day, greater alcohol use was associated with greater cannabis use. Preventing days of heavy use of multiple substances, particularly among at-risk drinkers, may complement interventions addressing co-use generally to prevent substance-related consequences.
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Affiliation(s)
- Lara N. Coughlin
- Department of Psychiatry, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
| | - Erin E. Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
| | - Amy S.B Bohnert
- VA Center for Clinical Management Research, North Campus Research Complex, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, North Campus Research Complex, Ann Arbor, MI, USA
| | - José A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Yazmyn Cross
- Department of Psychiatry, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
| | - Rebecca Cunningham
- Injury Prevention Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
| | - Sean D. Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA, USA
- Department of Emergency Medicine, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
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11
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Wilson TD, Barry KL, Maust DT, Blow FC. Association between relationship quality and concurrent alcohol use and sedative-tranquilizer misuse in middle and later life. Aging Ment Health 2021; 25:1110-1114. [PMID: 32090595 PMCID: PMC7442615 DOI: 10.1080/13607863.2020.1727850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Mid-life adults have notably higher rates of alcohol and other substance misuse than older adults and maintain higher levels of use over time. Social isolation has been linked to higher risk use with increasing age. The purpose of this study is to examine the associations between social relationships, drinking, and misuse of sedative-tranquilizers. METHODS The data for this study come from the national Midlife in the United States study wave 2 (MIDUS 2) of adults (N = 3378; 53.3% women) aged 40 and older. Past month alcohol use and past year sedative medication misuse were assessed with social support and strain. Multinomial logistic regressions evaluated the relationship of (a) support and (b) strain to use and co-use of alcohol and sedatives. RESULTS Of the sample, 58.4% used alcohol only, 1.7% only misused sedatives, and 3.5% co-used alcohol/misused sedative-tranquilizers. Support from friends was associated with 1.18 increased risk of co-using compared to not using either substance. Source of strain was associated with co-use for middle-aged and older adults. Familial strain was associated with increased risk of co-using for middle-aged adults. Friend-related strain was associated with increased risk of co-use for older adults. CONCLUSION Evidence suggests that older co-users may differ from those in midlife in terms of social risk factors. As the aging population increases, elucidating the potential mechanisms by which social factors impact concurrent alcohol use and sedative-tranquilizer medication misuse aid the development of targeted interventions and prevention programs in these groups.
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Affiliation(s)
- Tomorrow D. Wilson
- Department of Psychiatry, University of Michigan, Ann Arbor, United States of America,Tomorrow Wilson, Ph.D., Mailing address: 2800 Plymouth Rd., NCRC Bldg. 16, Ann Arbor, MI 48109, , Phone: 734-232-0296
| | - Kristen L. Barry
- Department of Psychiatry, University of Michigan, Ann Arbor, United States of America
| | - Donovan T. Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, United States of America,Center for Clinical Management Research, VA Ann Arbor, Ann Arbor, United States of America
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, United States of America,Center for Clinical Management Research, VA Ann Arbor, Ann Arbor, United States of America
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12
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Mellinger JL, Shedden K, Winder GS, Fernandez AC, Lee BP, Waljee J, Fontana R, Volk ML, Blow FC, Lok ASF. Bariatric surgery and the risk of alcohol-related cirrhosis and alcohol misuse. Liver Int 2021; 41:1012-1019. [PMID: 33529460 PMCID: PMC8204517 DOI: 10.1111/liv.14805] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/29/2020] [Accepted: 01/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Bariatric surgery is common, but alcohol misuse has been reported following these procedures. We aimed to determine if bariatric surgery is associated with increased risk of alcohol-related cirrhosis (AC) and alcohol misuse. METHODS Retrospective observational analysis of obese adults with employer-sponsored insurance administrative claims from 2008 to 2016. Subjects with diagnosis codes for bariatric surgery were included. Primary outcome was risk of AC. Secondary outcome was risk of alcohol misuse. Bariatric surgery was divided into before 2008 and after 2008 to account for patients who had a procedure during the study period. Cox proportional hazard regression models using age as the time variable were used with interaction analyses for bariatric surgery and gender. RESULTS A total of 194 130 had surgery from 2008 to 2016 while 209 090 patients had bariatric surgery prior to 2008. Age was 44.1 years, 61% women and enrolment was 3.7 years. A total of 4774 (0.07%) had AC. Overall risk of AC was lower for those who received sleeve gastrectomy and laparoscopic banding during the study period (HR 0.4, P <.001; HR 0.43, P =.02) and alcohol misuse increased for Roux-en-Y and sleeve gastrectomy recipients (HR 1.86 and 1.35, P <.001, respectively). In those who had surgery before 2008, women had increased risk of AC and alcohol misuse compared to women without bariatric surgery (HR 2.1 [95% CI: 1.79-2.41] for AC; HR 1.98 [95% CI 1.93-2.04]). CONCLUSIONS Bariatric surgery is associated with a short-term decreased risk of AC but potential long-term increased risk of AC in women. Post-operative alcohol surveillance is necessary to reduce this risk.
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Affiliation(s)
- Jessica L. Mellinger
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, MI
| | | | | | | | - Jennifer Waljee
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Robert Fontana
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Michael L. Volk
- Transplantation Institute, Loma Linda University Health, Loma Linda CA
| | - Frederic C. Blow
- Department of Psychiatry, Ann Arbor, MI,VA Center for Clinical Management Research (CCMR), Ann Arbor, MI
| | - Anna SF Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
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13
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Bonar EE, Cunningham RM, Sweezea EC, Blow FC, Drislane LE, Walton MA. Piloting a brief intervention plus mobile boosters for drug use among emerging adults receiving emergency department care. Drug Alcohol Depend 2021; 221:108625. [PMID: 33631541 PMCID: PMC8026691 DOI: 10.1016/j.drugalcdep.2021.108625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE There are few efficacious prevention interventions for emerging adults (ages 18-25) drug use and concomitant risks (e.g., sexual risk behaviors). We developed and evaluated the feasibility and acceptability of an Emergency Department (ED)-initiated brief intervention (BI) combined with booster messaging as a clinician-extender primarily focusing on drug use, with a secondary focus on condomless sex. We examined descriptive outcomes of alcohol, drug use, and condomless sex. PROCEDURES We recruited N = 63 emerging adults who used drugs (primarily cannabis) from an ED (72.4 % participation rate). Their mean age was 21.7 years (SD = 2.3); 67 % were female and 52.4 % were Black/African American. Participants randomized to the intervention (N = 31) received a BI and 28 days of tailored booster messaging (based on drug use motives) daily, and the control condition received a community resource brochure. A post-test occurred at 1-month with a follow-up at 2-months. RESULTS The intervention was well-received (83.9 % allocated completed the BI) with 79 % overall liking the BI and 71 % finding it helpful to discuss substances. Mean ratings of booster messages were >4.0 (5-point scale); 77 % liked the daily messages and 91 % found them helpful. Descriptively, the intervention group evidenced absolute reductions over time on alcohol outcomes, cannabis use, and condomless sex. CONCLUSIONS This BI with booster messages was feasible and acceptable in the target population of emerging adults who use drugs (i.e., mostly cannabis). This intervention model, initiated during a healthcare visit and accompanied by a clinician-extender, should be tested in a future fully-powered trial.
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Affiliation(s)
- Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI, 48109, USA; Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI, 48109, USA.
| | - Rebecca M Cunningham
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI, 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI, 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA; Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, USA
| | - Emily C Sweezea
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA; VA Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI, 48109-2800, USA
| | - Laura E Drislane
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA; Department of Psychology and Philosophy, Sam Houston State University, 1901 Avenue I, Huntsville, TX, 77340, USA
| | - Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI, 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI, 48109, USA
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14
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Fernandez AC, Guetterman TC, Borsari B, Mello MJ, Mellinger J, Tonnesen H, Hosanagar A, Morris AM, Blow FC. Gaps in Alcohol Screening and Intervention Practices in Surgical Healthcare: A Qualitative Study. J Addict Med 2021; 15:113-119. [PMID: 32769774 DOI: 10.1097/adm.0000000000000706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Risky alcohol use before surgery is associated with an increased risk of postoperative complications and longer hospital stays. Preoperative alcohol interventions can improve surgical outcomes but are not commonly integrated into routine care. This study sought to better understand patient's and provider's perceptions of alcohol-related surgical health and healthcare practices and illuminate gaps in care and how they could be improved. METHODS This study used a descriptive qualitative research design. Data were collected between July 2017 and March 2018. One-on-one interviews assessed domains related to knowledge, gaps in alcohol-related screening and intervention, and interest in enhancing alcohol-related care. Key themes emerged from a process of iterative coding and thematic analysis. RESULTS Participants included elective surgical patients who met alcohol screening criteria (n = 20) and surgical healthcare providers (n = 9). Participants had modest or low awareness of alcohol-related surgical health risks. Basic alcohol screening was a routine part of care, but results were often discounted or overlooked. Providers did not routinely initiate preoperative alcohol education or intervention. Providers viewed improving alcohol-related clinical practices as a low priority. Patients were interested in receiving alcohol interventions before surgery if they were delivered in a nonjudgement style and focused on surgical health optimization. CONCLUSIONS This study highlights potential gaps in alcohol-related knowledge and care, and found providers place a low priority on alcohol interventions in the perioperative context. Given the high complication rate associated with preoperative alcohol use, these topics are worthy of future research. To be successful strategies to overcome specific barriers to alcohol screening and intervention must address the needs of patients and providers.
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Affiliation(s)
- Anne C Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, MI (ACF, AH, FCB); Department of Family Medicine, University of Michigan, Ann Arbor, MI (TCG); Mental Health Service, San Francisco VA Health Care System, San Francisco, CA (BB); Department of Psychiatry, University of California, San Francisco, 982 Mission St, San Francisco, CA 94103 (BB); Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI (MJM); Department of Health Services, Practice and Policy, Brown University School of Public Health, Providence, RI (MJM); Department of Gastroenterology, University of Michigan, Ann Arbor, MI (JM); Clinical Health Promotion Centre, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Denmark (HT); Mental Health Service, VA Ann Arbor Health System, Ann Arbor, MI (AH, FCB); S-SPIRE Center, Department of Surgery, Stanford University School of Medicine, Stanford, CA (AMM)
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15
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Lin LA, Bohnert ASB, Blow FC, Gordon AJ, Ignacio RV, Kim HM, Ilgen MA. Polysubstance use and association with opioid use disorder treatment in the US Veterans Health Administration. Addiction 2021; 116:96-104. [PMID: 32428386 DOI: 10.1111/add.15116] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/14/2020] [Accepted: 05/12/2020] [Indexed: 11/28/2022]
Abstract
AIMS To understand the role of comorbid substance use disorders (SUDs), or polysubstance use, in the treatment of opioid use disorder (OUD), this study compared patients with OUD only to those with additional SUDs and examined association with OUD treatment receipt. DESIGN, SETTING AND PARTICIPANTS Retrospective national cohort study of Veterans diagnosed with OUD (n = 65 741) receiving care from the US Veterans Health Administration (VHA) in fiscal year (FY) 2017. MEASUREMENTS Patient characteristics were compared among those diagnosed with OUD only versus those with one other SUD (OUD + 1 SUD) and with multiple SUDs (OUD + ≥ 2 SUDs). The study examined the relationship between comorbid SUDs and receipt of buprenorphine, methadone and SUD outpatient treatment during 1-year follow-up, adjusting for patient demographic characteristics and clinical conditions. FINDINGS Among the 65 741 Veterans with OUD in FY 2017, 41.2% had OUD only, 22.9% had OUD + 1 SUD and 35.9% had OUD + ≥ 2 SUDs. Common comorbid SUDs included alcohol use disorder (41.3%), cocaine/stimulant use disorder (30.0%) and cannabis use disorder (22.4%). Adjusting for patient characteristics, patients with OUD + 1 SUD [adjusted odds ratio (aOR) = 0.87, 95% confidence interval (CI) = 0.82-0.93] and patients with OUD +≥ 2 SUDs (aOR = 0.65, 95% CI = 0.61-0.69) had lower odds of receiving buprenorphine compared with OUD only patients. There were also lower odds of receiving methadone for patients with OUD + 1 SUD (aOR = 0.91, 95% CI = 0.86-0.97)and for those with OUD + ≥2 SUDs (aOR = 0.79, 95% CI = 0.74-0.84). Patients with OUD + 1 SUD (aOR = 1.85, 95% CI = 1.77-1.93) and patients with OUD + ≥2 SUDs (aOR = 3.25, 95% CI = 3.103.41) were much more likely to have a SUD clinic visit. CONCLUSIONS The majority of Veterans in the US Veterans Health Administration diagnosed with opioid use disorder appeared to have at least one comorbid substance use disorder and many have multiple substance use disorders. Despite the higher likelihood of a substance use disorder clinic visit, having a non-opioid substance use disorder is associated with lower likelihood of buprenorphine treatment, suggesting the importance of addressing polysubstance use within efforts to expand treatment for opioid use disorder.
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Affiliation(s)
- Lewei A Lin
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Amy S B Bohnert
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Frederic C Blow
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Rosalinda V Ignacio
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - H Myra Kim
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Consulting for Statistics, Computing and Analytics Research (CSCAR), University of Michigan, Ann Arbor, MI, USA
| | - Mark A Ilgen
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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16
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Ilgen MA, Coughlin LN, Bohnert ASB, Chermack S, Price A, Kim HM, Jannausch M, Blow FC. Efficacy of a Psychosocial Pain Management Intervention for Men and Women With Substance Use Disorders and Chronic Pain: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:1225-1234. [PMID: 32725178 PMCID: PMC7391182 DOI: 10.1001/jamapsychiatry.2020.2369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Chronic pain is common in those with substance use disorders (SUDs) and predicts poorer addiction treatment outcomes. A critical challenge for addiction treatment is to develop effective methods to improve pain-related and substance use-related outcomes for those in treatment for SUDs. OBJECTIVE To examine the efficacy of an integrated behavioral pain management intervention (Improving Pain During Addiction Treatment [ImPAT]) for men and women with SUDs to treat pain, functioning, and substance use. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial, 8 sessions of ImPAT were compared with 8 sessions of a supportive psychoeducational control (SPC) condition for adults with pain treated at a large residential SUD treatment program. Follow-up occurred at 3, 6, and 12 months postbaseline. A total of 1372 adults were screened, including 960 men and 412 women, and 510 adults were randomized, including 264 men and 246 women. The goal was to recruit approximately equal numbers of men and women to examine results separately in men and women. A total of 470 of 510 participants (92.2%) completed at least 1 follow-up assessment. Data were collected from October 3, 2011, to January 14, 2016. Data were analyzed from February 1, 2016, to May 1, 2020. INTERVENTIONS ImPAT focused on how a psychosocial model of pain was associated with functioning and relapse prevention and provides skills to manage pain. SPC served as the active control condition and involved discussions of topics like nutrition and the course of addiction, which were intended to be relevant to the patient population and to have face validity but be distinct from the content of ImPAT. MAIN OUTCOMES AND MEASUREMENTS The primary outcomes were pain intensity, pain-related functioning, and behavioral pain tolerance at 12 months. Secondary outcomes were frequency of alcohol and drug use over 12 months. RESULTS Of the 510 included participants, the mean (SD) age was 34.8 (10.3) years. A total of 133 men and 122 women were assigned to ImPAT, and a total of 131 men and 124 women were assigned to the SPC condition. Over 12 months of follow-up, randomization to the ImPAT intervention was associated with higher tolerance of pain among men, higher by a mean score of 0.11 (95% CI, 0.03 to 0.18; P = .004; Cohen d = 0.40) at 3 months and by 0.07 (95% CI, -0.01 to 0.19; P = .11; Cohen d = 0.25) at 12 months. Women receiving the ImPAT intervention experienced a reduction in pain intensity from 3 to 12 months, while women receiving the SPC condition experienced an increase in pain intensity, resulting in lower pain in the ImPAT condition by a mean score of 0.58 (95% CI, -0.07 to 1.22; P = .08; Cohen d = -0.22) at 12 months. No differences were found between the ImPAT and SPC conditions on alcohol or drug use. CONCLUSIONS AND RELEVANCE Behavioral pain management is not typically included in addiction treatment, but the present results indicate that this type of intervention was associated with better pain-related outcomes, including pain tolerance in men and pain intensity in women. Improvements in substance use-related outcomes beyond that achieved by treatment as usual were not observed. Treatment programs should consider providing psychosocial pain management services to augment standard addiction treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01372267.
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Affiliation(s)
- Mark A. Ilgen
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Lara N. Coughlin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Amy S. B. Bohnert
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Stephen Chermack
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Amanda Price
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - H. Myra Kim
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Mary Jannausch
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Frederic C. Blow
- VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan,Department of Psychiatry, University of Michigan Medical School, Ann Arbor
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Maust DT, Kim HM, Wiechers IR, Ignacio RV, Bohnert ASB, Blow FC. Benzodiazepine Use among Medicare, Commercially Insured, and Veteran Older Adults, 2013-2017. J Am Geriatr Soc 2020; 69:98-105. [PMID: 32951209 DOI: 10.1111/jgs.16825] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Benzodiazepines (BZDs) are widely prescribed to older adults. Although prescribing has declined in the U.S. Department of Veterans Affairs (VA), Medicare introduced BZD coverage in 2013. It is unknown whether declines in the VA have been widespread among older adults in the United States. DESIGN Observational study in traditional fee-for-service Medicare, commercial insurance, and the VA. SETTING United States, 2013-2017. PARTICIPANTS Adults aged 55 and older in traditional Medicare (234,290,693 person-months), commercial insurance (337,827,125 person-months), and the VA (256,590,369 person-months). MEASUREMENTS (1) Change in BZD and BZD-opioid co-prescribing modeled by Poisson regression over time; and (2) standardized ratios of BZD and BZD-opioid co-prescribing, using Medicare as the reference. RESULTS From April 2013 to December 2017, the monthly percentage of adults aged 55 and older who received BZDs fell from 10.4% to 9.3% in Medicare, 6.6% to 6.5% in commercial insurance, and 5.7% to 3.0% in the VA. Monthly BZD-opioid co-prescribing over the same time fell from 4.0% to 3.0% in Medicare, 2.3% to 2.0% in commercial, and 2.2% to .6% for the VA. Age- and sex-adjusted rates of decline for BZD and BZD-opioid co-prescribing were statistically significant for all systems. Annual BZD rate reductions were .98 (Medicare), .99 (commercial), and .87 (VA; P < .001 for all); co-prescribing rate reductions were .95, .99, and .75 (P < .001 for all). Using standardized ratios accounting for demographic and clinical characteristics, both prescribing and co-prescribing were lowest for the VA relative to Medicare (standardized BZD ratio = .40; 95% confidence interval [CI] = .39-.40; standardized BZD-opioid co-prescribing ratio = .35; 95% CI = .35-.35). Prescribing in commercial insurance was also lower (BZD = .65; 95% CI = .65-.65; BZD-opioid co-prescribing = .65; 95% CI = .65-.65). CONCLUSION BZD prescribing has declined much more to older adults receiving care through the VA than Medicare or commercial insurance. Other systems may learn from strategies implemented in the VA.
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Affiliation(s)
- Donovan T Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - H Myra Kim
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan
| | - Ilse R Wiechers
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, University of California, San Francisco, San Francisco, California.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Rosalinda V Ignacio
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Amy S B Bohnert
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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18
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Arterberry BJ, Goldstick JE, Walton MA, Cunningham RM, Blow FC, Bonar EE. Alcohol and cannabis motives: Differences in daily motive endorsement on alcohol, cannabis, and alcohol/cannabis co-use days in a cannabis-using sample. Addict Res Theory 2020; 29:111-116. [PMID: 34248450 PMCID: PMC8262404 DOI: 10.1080/16066359.2020.1787390] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Same day use of alcohol and cannabis is prevalent among emerging/young adults and increases the risk for negative consequences. Although motives for alcohol and cannabis use are well-documented, specific motives on co-use days are under-investigated. We examined differences in motives on single substance use (i.e., alcohol or cannabis) versus co-use days in a sample of primarily cannabis-using emerging/young adults. METHODS Participants (N=97) aged 18-25 (Mage=22.2) were recruited from an urban Emergency Department (55.7% female, 46.4% African American, 57.7% public assistance) for a prospective daily diary study about risk behaviors. Participants received prompts for 28 daily text message assessments (up to 2716 surveys possible) of substance use and motives (social, enhancement, coping, conformity). We divided use days into three groups: alcohol use only (n=126), cannabis use only (n=805), and co-use (n=237). Using fixed effects regression modeling, we fit models to estimate within-person effects of alcohol and cannabis motives on day type (alcohol/cannabis co-use versus single use). RESULTS In adjusted models, greater cannabis-related enhancement and social motives were associated with increased likelihood of co-use days compared to cannabis-only days. In contrast, greater alcohol-related social motives were associated with co-use days versus alcohol-only days in unadjusted, but not in adjusted models. CONCLUSIONS Findings suggest that cannabis use motives associated with increasing positive affect may be most compelling for those engaging in alcohol/cannabis use on a given day. Intervention programs for alcohol/cannabis use should address alcohol and cannabis use motives in relation to increasing positive affect and engaging in social situations.
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Affiliation(s)
- Brooke J Arterberry
- Department of Psychology, Lagomarcino Hall, 901 Stange Road, Ames IA 50011-1041
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
| | - Jason E Goldstick
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109
| | - Maureen A Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
| | - Rebecca M Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109
- Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503
| | - Frederic C Blow
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105
| | - Erin E Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Coughlin LN, Walton MA, McCormick R, Blow FC. Prevalence and Severity of Alcohol and Cannabis Use Across the Urban-Rural Continuum in the Michigan National Guard. J Rural Health 2020; 36:234-239. [PMID: 31840327 PMCID: PMC7102927 DOI: 10.1111/jrh.12412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The National Guard provides critical support both domestically and abroad with soldiers dispersed throughout America and spanning the urban-rural continuum. To determine if location-specific interventions may be needed, we compared the prevalence and severity of cannabis and alcohol use among National Guard members across localities. METHODS Michigan National Guard members were enrolled (N = 2,746) during drill weekends as part of a larger randomized behavioral trial. Cannabis (ASSIST; prevalence = 5%) and alcohol use (AUDIT; prevalence = 82%) were compared using hurdle regression models across locality status after adjusting for covariates. FINDINGS Prevalence of cannabis and alcohol use was predicted by locality (adjusted odds ratio [AOR] = 0.913, 95% CI: 0.838-0.986, P = .029; AOR = 0.963, 95% CI: 0.929-0.998, P = .038, respectively), with more use in urban localities. Neither severity of cannabis nor alcohol use was predicted by locality status. CONCLUSIONS Prevalence of cannabis and alcohol use in the National Guard is differentially elevated across localities with higher prevalence in more central, densely populated areas. Findings may inform future work considering accessibility and utilization of prevention and treatment services for Guard members across the urban-rural continuum.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan
| | - Richard McCormick
- Center for Healthcare Research and Policy, Case Western Reserve University, Cleveland, Ohio
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
- Department of Veteran Affairs Healthcare System, VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan
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21
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Drislane LE, Waller R, Martz ME, Bonar EE, Walton MA, Chermack ST, Blow FC. Therapist and computer-based brief interventions for drug use within a randomized controlled trial: effects on parallel trajectories of alcohol use, cannabis use and anxiety symptoms. Addiction 2020; 115:158-169. [PMID: 31400240 PMCID: PMC6933089 DOI: 10.1111/add.14781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/11/2019] [Accepted: 08/02/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS Despite their high comorbidity, the effects of brief interventions (BI) to reduce cannabis use, alcohol use and anxiety symptoms have received little empirical attention. The aims of this study were to examine whether a therapist-delivered BI (TBI) or computer-guided BI (CBI) to address drug use, alcohol consumption (when relevant) and HIV risk behaviors, relative to enhanced usual care (EUC), was associated with reductions in parallel trajectories of alcohol use, cannabis use and anxiety symptoms, and whether demographic characteristics moderated reductions over time. DESIGN Latent growth curve modeling was used to examine joint trajectories of alcohol use, cannabis use and anxiety symptoms assessed at 3, 6 and 12 months after baseline enrollment. SETTING Hurley Medical Center Emergency Department (ED) in Flint, MI, USA. PARTICIPANTS The sample was 780 drug-using adults (aged 18-60 years; 44% male; 52% black) randomly assigned to receive either a TBI, CBI or EUC through the HealthiER You study. INTERVENTIONS AND COMPARATOR ED-delivered TBI and CBIs involved touchscreen-delivered and audio-assisted content. The TBI was administered by a Master's-level therapist, whereas the CBI was self-administered using a virtual health counselor. EUC included a review of health resources brochures in the ED. MEASUREMENTS Assessments of alcohol use (10-item Alcohol Use Disorders Identification Test), cannabis use (past 30-day frequency) and anxiety symptoms (Brief Symptom Inventory-18) occurred at baseline and 3-, 6- and 12-month follow-up. FINDINGS TBI, relative to EUC, was associated with significant reductions in cannabis use [B = -0.49, standard error (SE) = 0.20, P < 0.05) and anxiety (B = -0.04, SE = 0.02, P < 0.05), but no main effect for alcohol use. Two of 18 moderation tests were significant: TBI significantly reduced alcohol use among males (B = -0.60, SE = 0.19, P < 0.01) and patients aged 18-25 years in the TBI condition showed significantly greater reductions in cannabis use relative to older patients (B = -0.78, SE = 0.31, P < 0.05). Results for CBI were non-significant. CONCLUSIONS Emergency department-based therapist-delivered brief interventions to address drug use, alcohol consumption (when relevant) and HIV risk behaviors may also reduce alcohol use, cannabis use and anxiety over time, accounting for the overlap of these processes.
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Affiliation(s)
- Laura E. Drislane
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109
| | - Rebecca Waller
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109,University of Pennsylvania, Department of Psychology, Stephen A. Levin Building, 425 S University Ave, Philadelphia, PA 19104
| | - Meghan E. Martz
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109
| | - Erin E. Bonar
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109
| | - Maureen A. Walton
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109
| | - Stephen T. Chermack
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109,Veterans Health Administration, Center for Clinical Management Research, Health Services Research & Development, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800,Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, 2215 Fuller Rd, Ann Arbor, MI 48105
| | - Frederic C. Blow
- University of Michigan, Addiction Center, Department of Psychiatry, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109,Veterans Health Administration, Center for Clinical Management Research, Health Services Research & Development, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800
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Coughlin LN, Bonar EE, Bohnert KM, Jannausch M, Walton MA, Blow FC, Ilgen MA. Changes in urban and rural cigarette smoking and cannabis use from 2007 to 2017 in adults in the United States. Drug Alcohol Depend 2019; 205:107699. [PMID: 31707265 PMCID: PMC6951810 DOI: 10.1016/j.drugalcdep.2019.107699] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/23/2019] [Accepted: 10/13/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Rural-urban differences in cigarette and cannabis use have traditionally shown higher levels of cigarette smoking in rural areas and of cannabis use in urban areas. To assess for changes in this pattern of use, we examined trends and prevalence of cigarette, cannabis, and co-use across urban-rural localities. METHODS Urban-rural trends in current cigarette and/or cannabis use was evaluated using 11 cohorts (2007-2017) of the National Survey on Drug Use and Health (NSDUH; N = 397,542). We used logistic regressions to model cigarette and cannabis use over time, adjusting for demographics (age, gender, race/ethnicity, income, education), in addition to assessing patterns of cannabis use among cigarette smokers and nonsmokers. RESULTS Despite decreases in cigarette smoking overall, between 2007 and 2017, the urban-rural disparity in cigarette smoking increased (AOR = 1.17), with less reduction in rural as compared to urban cigarette smokers. Cannabis use increased in general (AOR = 1.88 by 2017), with greater odds in urban than rural regions. Cannabis use increased more rapidly in non-cigarette smokers than smokers (AOR = 1.37 by 2017), with 219% greater odds of cannabis use in rural non-cigarette smokers in 2017 versus 2007. CONCLUSIONS Rurality remains an important risk factor for cigarette smoking in adults and the fastest-growing group of cannabis users is rural non-cigarette smokers; however, cannabis use is currently still more prevalent in urban areas. Improved reach and access to empirically-supported prevention and treatment, especially in rural areas, along with dissemination and enforcement of policy-level regulations, may mitigate disparities in cigarette use and slow the increase in rural cannabis use.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; Injury Prevention Center, Department of Emergency Medicine, University of Michigan, United States
| | - Kipling M Bohnert
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; VA Center for Clinical Management Research (CCMR), Department of Veteran Affairs Healthcare System, Ann Arbor, MI, United States
| | - Mary Jannausch
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; VA Center for Clinical Management Research (CCMR), Department of Veteran Affairs Healthcare System, Ann Arbor, MI, United States
| | - Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; VA Center for Clinical Management Research (CCMR), Department of Veteran Affairs Healthcare System, Ann Arbor, MI, United States
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; VA Center for Clinical Management Research (CCMR), Department of Veteran Affairs Healthcare System, Ann Arbor, MI, United States
| | - Mark A Ilgen
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; VA Center for Clinical Management Research (CCMR), Department of Veteran Affairs Healthcare System, Ann Arbor, MI, United States
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Dooley-Hash S, Adams M, Walton MA, Blow FC, Cunningham RM. The prevalence and correlates of eating disorders in adult emergency department patients. Int J Eat Disord 2019; 52:1281-1290. [PMID: 31322755 PMCID: PMC7047774 DOI: 10.1002/eat.23140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study describes the prevalence of eating disorders among adult patients who present to the emergency department for medical care and examines the relationship between eating disorders, depression, and substance use disorders. METHOD Emergency department patients aged 21-65 years (n = 1,795) completed a computerized questionnaire that included validated screening tools for eating disorders, risky drinking behavior, other substance use, and depression. Analyses were conducted comparing individuals who screened positive for an eating disorder with those who did not based on demographics (gender, age, race, income, education), body mass index (BMI), risky drinking behavior, other substance use, and depression. RESULTS Nearly 16% (15.9%) of all patients screened positive for an eating disorder regardless of their reason for presenting to the emergency department. Patients who screened positive for an eating disorder were significantly more likely to have a BMI > 30 (odds ratio [OR] = 2.68, confidence interval [CI] = 1.98, 3.62, p < .001), to also screen positive for depression (OR = 3.19, CI = 2.28, 4.47, p < .001) and to be female (OR = 2.37, CI = 1.76, 3.19, p < .001). No differences in the prevalence of positive screens for eating disorders were seen across age or racial groups, level of education or income, or for any of the included substance use variables. DISCUSSION Eating disorders are common among adult emergency department patients and are associated with high rates of comorbid depression and higher BMI. Given the significant morbidity and mortality associated with eating disorders, targeted screening may be warranted in the emergency department setting.
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Affiliation(s)
- Suzanne Dooley-Hash
- department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan,The Center for Eating Disorders, Ann Arbor, Michigan
| | - Mackenzie Adams
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Injury Prevention Center, University of Michigan, Ann Arbor, Michigan
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M. Cunningham
- department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan,Injury Prevention Center, University of Michigan, Ann Arbor, Michigan
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Arterberry BJ, Davis AK, Walton MA, Bonar EE, Cunningham RM, Blow FC. Predictors of empirically derived substance use patterns among sexual minority groups presenting at an emergency department. Addict Behav 2019; 96:76-81. [PMID: 31048112 DOI: 10.1016/j.addbeh.2019.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/28/2022]
Abstract
AIM Minority sexual orientation (i.e., Lesbian, Gay, Bisexual; LGB) is a risk indicator for mental health and substance use problems. Findings are inconsistent across studies investigating LGB substance use and risk factors, possibly due to heterogeneity in LGB subgroups. To inform models of substance use risk, we identified empirical patterns of substance use and related risk behaviors among LGB individuals. METHOD LGB participants (N = 343; Mage = 35.5, SD = 11.8; 71.4% = Female; 80.5% = White) were screened in an Emergency Department as part of a randomized controlled trial of an alcohol brief intervention. We conducted latent class analyses using the AUDIT-C (12 month; frequency, quantity, & binge) and ASSIST (12 month; illicit or misused prescription substance). Multinomial regression was performed to test predictors of class membership including depression symptoms, driving after alcohol or marijuana, and sexually transmitted infection (STI) history. RESULTS A 3-class model fit best and included "low use alcohol, marijuana, and tobacco users," (Low use; n = 244) "hazardous alcohol, tobacco and marijuana users," (Hazardous; n = 74) and "high-risk polysubstance users" (HPU; n = 25). The Low use class comprised the largest proportion of the sample across age, race/ethnicity, and sexual orientation. Compared to the Low use class, higher likelihood of depression symptoms, driving after alcohol or marijuana use, and STI was found for both Hazardous and HPU classes. CONCLUSION Researchers and clinicians should consider substance use patterns within the LGB population to inform interventions that address a variety of complex needs such as allocating more support for LGB individuals endorsing high-risk polysubstance use.
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Affiliation(s)
- Brooke J Arterberry
- Department of Psychology, Lagomarcino Hall, 901 Stange Road, Ames, IA 50011-1041, USA.
| | - Alan K Davis
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Maureen A Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA
| | - Erin E Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA
| | - Rebecca M Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; University of Michigan School of Medicine, Department of Emergency Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; University of Michigan School of Public Health, Health Behavior and Health Education, 1415 Washington Heights Ann Arbor, MI 48109, USA
| | - Frederic C Blow
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Health Services Research & Development, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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Waller R, Bonar EE, Fernandez AC, Walton MA, Chermack ST, Cunningham RM, Blow FC. Exploring the components of an efficacious computer brief intervention for reducing marijuana use among adults in the emergency department. J Subst Abuse Treat 2019; 99:67-72. [PMID: 30797396 PMCID: PMC6538032 DOI: 10.1016/j.jsat.2019.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine the efficacious components of a computer-delivered brief intervention (CBI) for reducing marijuana use among adults presenting to a low-income urban emergency department (ED), which a prior report found to decrease marijuana use at a 6-month follow-up. METHOD Participants were 237 ED patients reporting recent drug use (46% male; 54% African-American; mean age, 30.7) who were randomized to receive a CBI consisting of an interactive program guided by a virtual health counselor. The primary outcome was past 30-day marijuana use at 6-month follow-up assessed using the Timeline Follow-Back (TLFB). Intervention components related to change in marijuana use at 6 month follow-up examined in the current study included participant responses to items within five CBI domains that were rooted in motivational interviewing: goals for change, strengths, evoking-change (concerns about use and benefits of change), challenges, and tools for change. RESULTS The evoking-change domain was related to significant reductions in marijuana use at 6 months (B = -2.91, SE = 1.10, p < .01). Within this domain, items focused on concerns about family and friends were related to reductions in marijuana use of up to 5.5 fewer days of marijuana use in the past month (B = -5.49, SE = 1.63, p < .01). CONCLUSIONS An ED-based brief intervention, delivered by computer, was effective in reducing marijuana use. Intervention components focused on perceived concerns about use and benefits of change in relation to family and friends were critical domains within a CBI associated with reductions in marijuana use at 6-month follow-up.
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Affiliation(s)
- Rebecca Waller
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA; Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Anne C Fernandez
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Stephen T Chermack
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Rebecca M Cunningham
- Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Place, Flint, MI 48503, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, Ann Arbor Veterans Affairs Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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Sripada RK, Blow FC, Rauch SAM, Ganoczy D, Hoff R, Harpaz-Rotem I, Bohnert KM. Examining the nonresponse phenomenon: Factors associated with treatment response in a national sample of veterans undergoing residential PTSD treatment. J Anxiety Disord 2019; 63:18-25. [PMID: 30785007 DOI: 10.1016/j.janxdis.2019.02.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although several treatments for PTSD have demonstrated efficacy, a substantial portion of patients do not experience clinically significant improvement. Predictors of treatment response are poorly understood. The current study was designed to investigate predictors of PTSD symptom change in a large national sample of treatment-seeking Veterans with PTSD. METHOD We analyzed predictors of treatment response among Veterans engaged in residential PTSD treatment from 2012 to 2013 (N = 2715). Multilevel modeling was used to assess the association between individual-level factors and symptom improvement from treatment entry to post-discharge. Guided by the theory of Resources, Life Events and Changes in Psychological States, we hypothesized that individuals with greater psychological, social/contextual, material, and physical health resources would exhibit better treatment response. RESULTS In adjusted analyses, accounting for facility, factors that predicted better treatment response included female gender, more psychological and social/contextual protective factors, and more years of education. Factors that predicted worse treatment response included Black race, comorbid personality disorder, greater pain severity, and current application for disability-related compensation. CONCLUSIONS These findings highlight factors that place individuals at risk of poor treatment response. Treatment modifications may be needed in order to optimize response for subgroups who are less likely to benefit from residential PTSD treatment.
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Affiliation(s)
- Rebecca K Sripada
- Veterans Affairs Center for Clinical Management Research and Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, United States; University of Michigan, Department of Psychiatry, Ann Arbor, MI, United States.
| | - Frederic C Blow
- Veterans Affairs Center for Clinical Management Research and Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, United States; University of Michigan, Department of Psychiatry, Ann Arbor, MI, United States
| | - Sheila A M Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States; Atlanta VA Medical Center, Atlanta, GA, United States
| | - Dara Ganoczy
- Veterans Affairs Center for Clinical Management Research and Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, United States
| | - Rani Hoff
- Veterans Affairs Northeast Program Evaluation Center, West Haven, CT, United States; Veterans Affairs National Center for PTSD, Veteran Affairs Connecticut Healthcare System, West Haven, CT, United States; Yale University, Department of Psychiatry, New Haven, CT, United States
| | - Ilan Harpaz-Rotem
- Veterans Affairs Northeast Program Evaluation Center, West Haven, CT, United States; Veterans Affairs National Center for PTSD, Veteran Affairs Connecticut Healthcare System, West Haven, CT, United States; Yale University, Department of Psychiatry, New Haven, CT, United States
| | - Kipling M Bohnert
- Veterans Affairs Center for Clinical Management Research and Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, United States; University of Michigan, Department of Psychiatry, Ann Arbor, MI, United States
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Chermack ST, Bonar EE, Goldstick JE, Winters J, Blow FC, Friday S, Ilgen MA, Rauch SA, Perron BE, Ngo QM, Walton MA. A randomized controlled trial for aggression and substance use involvement among Veterans: Impact of combining Motivational Interviewing, Cognitive Behavioral Treatment and telephone-based Continuing Care. J Subst Abuse Treat 2019; 98:78-88. [DOI: 10.1016/j.jsat.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/24/2018] [Accepted: 01/02/2019] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE Goals were to determine the prevalence of benzodiazepine use (as prescribed and misuse), characterize misuse, and examine variation by age. METHODS A cross-sectional analysis was conducted of 2015 and 2016 National Survey on Drug Use and Health data limited to adults ≥18 (N=86,186) and data from those respondents reporting benzodiazepine use (N=10,290). Measurements included past-year prescription benzodiazepine use and misuse ("any way a doctor did not direct"), substance use disorders, mental illness, and demographic characteristics. Misuse was compared between younger (18-49) and older (≥50) adults. RESULTS A total of 30.6 million adults (12.6%) reported past-year benzodiazepine use-25.3 million (10.4%) as prescribed and 5.3 million (2.2%) misuse. Misuse accounted for 17.2% of overall use. Adults ages 50-64 had the highest prescribed use (12.9%). Those ages 18-25 had the highest misuse (5.2%), and those ages ≥65 had the lowest (.6%). Misuse and abuse of or dependence on prescription opioids or stimulants were strongly associated with benzodiazepine misuse. Benzodiazepine misuse without a prescription was the most common type of misuse, and a friend or relative was the most common source. Adults ages ≥50 were more likely than younger adults to use a benzodiazepine more often than prescribed and to use a benzodiazepine to help with sleep. CONCLUSIONS Benzodiazepine use among U.S. adults was higher than previously reported, and misuse accounted for nearly 20% of use overall. Use by adults ages 50-64 now exceeds use by those ages ≥65. Patients also prescribed stimulants or opioids should be monitored for benzodiazepine misuse. Improved access to behavioral interventions for sleep or anxiety may reduce some misuse.
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Affiliation(s)
- Donovan T Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, and Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor
| | - Lewei A Lin
- Department of Psychiatry, University of Michigan, Ann Arbor, and Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, and Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor
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Mellinger JL, Fernandez A, Shedden K, Winder GS, Fontana RJ, Volk ML, Blow FC, Lok ASF. Gender Disparities in Alcohol Use Disorder Treatment Among Privately Insured Patients with Alcohol-Associated Cirrhosis. Alcohol Clin Exp Res 2019; 43:334-341. [PMID: 30667521 DOI: 10.1111/acer.13944] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/26/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The burden of alcohol-associated cirrhosis (AC) is high, and though alcohol cessation improves mortality, many patients fail to engage in alcohol use disorder (AUD) treatment and continue drinking. Our aim was to determine rates, predictors, and outcomes of AUD treatment utilization in AC patients with private insurance. METHODS We collected data from persons with AC (diagnosed by ICD-9/ICD-10 codes), aged 18 to 64 years, enrolled in the Truven MarketScan Commercial Claims and Encounters database (2009 to 2016). We determined rates and predictors of substance abuse treatment visits as well as rates of alcohol relapse prevention medication prescriptions, weighted to the national employer-sponsored insured population. Effects of AUD treatment utilization on decompensation rates were calculated using proportional hazards regression with propensity score adjustment. RESULTS A total of 66,053 AC patients were identified, 32% were female, and mean age at diagnosis was 54.5 years. About 72% had insurance coverage for substance abuse treatment. Overall, AUD treatment utilization rates were low, with only 10% receiving a face-to-face mental health or substance abuse visit and only 0.8% receiving a Food and Drug Administration (FDA)-approved relapse prevention medication within 1 year of index diagnosis. Women were less likely to receive a face-to-face visit (hazard ratio [HR] 0.84, p < 0.001) or an FDA-approved relapse prevention medication (0.89, p = 0.05) than men. AC patients who had a clinic visit for AUD treatment or used FDA-approved relapse medication showed decreased risk of decompensation at 1 year (HR 0.85, p < 0.001 for either). CONCLUSIONS AUD treatment utilization is associated with lower decompensation rates among privately insured patients with AC. Women were less likely to utilize AUD treatment visits. Efforts to reduce gender-specific barriers to treatment are urgently needed to improve outcomes.
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Affiliation(s)
- Jessica L Mellinger
- Division of Gastroenterology and Hepatology , University of Michigan, Ann Arbor, Michigan
| | - Anne Fernandez
- Department of Psychiatry , University of Michigan, Ann Arbor, Michigan
| | - Kerby Shedden
- Department of Statistics , University of Michigan, Ann Arbor, Michigan
| | - G Scott Winder
- Department of Psychiatry , University of Michigan, Ann Arbor, Michigan
| | - Robert J Fontana
- Division of Gastroenterology and Hepatology , University of Michigan, Ann Arbor, Michigan
| | - Michael L Volk
- Transplantation Institute , Loma Linda University Health, Loma Linda, California
| | - Frederic C Blow
- Department of Psychiatry , University of Michigan, Ann Arbor, Michigan.,VA Center for Clinical Management Research , Ann Arbor, Michigan
| | - Anna S F Lok
- Division of Gastroenterology and Hepatology , University of Michigan, Ann Arbor, Michigan
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Fernandez AC, Waller R, Walton MA, Bonar EE, Ignacio RV, Chermack ST, Cunningham RM, Booth BM, Ilgen MA, Barry KL, Blow FC. Alcohol use severity and age moderate the effects of brief interventions in an emergency department randomized controlled trial. Drug Alcohol Depend 2019; 194:386-394. [PMID: 30485827 PMCID: PMC6342480 DOI: 10.1016/j.drugalcdep.2018.10.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The primary aim of this study was to examine the efficacy of two motivational interviewing-based alcohol brief interventions (BIs) among adults presenting to an emergency department (ED). The secondary aim was to evaluate moderators of intervention effects. METHODS Participants were 750 ED patients reporting recent alcohol misuse. Participants were randomly assigned to: 1) computer-delivered BI (Computer BI), 2) therapist-delivered BI with computer guidance (Therapist BI-CG), or 3) control. The BIs focused on reduction of alcohol use and risk behaviors. The outcome measure was trajectories of alcohol consumption (measured by the AUDIT-C) across baseline, 3-, 6- and 12-month follow-up assessments, analyzed using latent growth curve modeling. Moderation of intervention effect by gender, age, and baseline alcohol use disorder severity was examined. RESULTS Across the full sample (40% males, mean age = 35.8, SD = 12.3), there was an overall reduction in alcohol consumption across 12 months. The main effects of the Therapist and Computer BI were not significant relative to control. Moderation analysis revealed that the impact of Therapist BI-CG, relative to control, was greater on reductions in alcohol consumption in participants with moderate to severe symptoms of alcohol use disorder compared to those with mild symptoms. The effect of the Computer BI on alcohol use, relative to control, was greater among younger participants compared to older participants. CONCLUSIONS While no overall effect was shown, ED-based Therapist BI-CG with computer guidance may be effective among patients with moderate-severe drinking patterns, whereas Computer BIs may be more effective for younger participants.
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Affiliation(s)
- Anne C Fernandez
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA.
| | - Rebecca Waller
- University of Pennsylvania, Department of Psychology, Philadelphia, PA 19104, USA
| | - Maureen A Walton
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Michigan Medicine, Injury Prevention Center, Ann Arbor, MI, 48109, USA
| | - Erin E Bonar
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Michigan Medicine, Injury Prevention Center, Ann Arbor, MI, 48109, USA
| | - Rosalinda V Ignacio
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, 48109, USA
| | - Stephen T Chermack
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, 48105, USA
| | - Rebecca M Cunningham
- Michigan Medicine, Injury Prevention Center, Ann Arbor, MI, 48109, USA; Michigan Medicine, Department of Emergency Medicine, Ann Arbor, MI, 48109, United States; Hurley Hospital, Flint, MI, 48503, USA; University of Michigan, School of Public Health, Ann Arbor, MI, 48109, USA
| | - Brenda M Booth
- University of Arkansas for Medical Sciences, Department of Psychiatry, Little Rock, AR, 72205, USA
| | - Mark A Ilgen
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, 48105, USA
| | - Kristen L Barry
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA
| | - Frederic C Blow
- Michigan Medicine, Addiction Center, Department of Psychiatry, Ann Arbor, MI, 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, 48109, USA
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Bohnert ASB, Walton MA, Cunningham RM, Ilgen MA, Barry K, Chermack ST, Blow FC. Overdose and adverse drug event experiences among adult patients in the emergency department. Addict Behav 2018; 86:66-72. [PMID: 29198490 DOI: 10.1016/j.addbeh.2017.11.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 11/10/2017] [Accepted: 11/15/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Overdose is a leading cause of injury and death in the United States. Emergency Department (ED) patients have an elevated prevalence of substance use. This study describes overdose/adverse drug event experiences among adult ED patients to inform strategies to address overdose risk. METHODS Patients seeking care at a large ED in the city of Flint, Michigan participated in a computerized self-assessment during 2011-2013 (n=4571). Overdose was assessed with a broad definition and included occurrences that could be considered adverse drug events. Among those with this type of experience, additional items assessed symptoms, outcomes, and intent. RESULTS 12% reported an overdose history. Of participants' most serious overdoses, 74% were without clear intent for self-harm, although this was true of only 61% of overdoses involving opiates or sedatives, and 52% had symptoms present that indicated that it was life-threatening. Binge drinking on a monthly basis (ORs=1.4) was associated with a medically serious overdose compared to never having an overdose. Compared to no drug use in the last year, use of one drug was associated with an OR of 1.8, two drugs was associated with an OR of 5.8, three drugs was associated with an OR of 8.4, and four or more drugs was associated with an OR of 25.1 of having had a medically serious overdose (all p<0.05). CONCLUSIONS Most overdose experiences among ED patients were without clear intent of self-harm. The ED may be an appropriate setting for efforts to reduce overdose risk, especially among polysubstance users.
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Affiliation(s)
- Amy S B Bohnert
- Department of Psychiatry, Mental Health Innovations, Services, and Outcomes program, University of Michigan, 2800 Plymouth Rd, Bldg. 16, Ann Arbor, MI 48109, United States; Veterans Affairs Center for Clinical Management Research, 2800 Plymouth Rd, Bldg. 16, Ann Arbor, MI 48109, United States; University of Michigan Injury Center, 2800 Plymouth Rd, Suite B10-G080, Ann Arbor, MI 48109, United States.
| | - Maureen A Walton
- University of Michigan Injury Center, 2800 Plymouth Rd, Suite B10-G080, Ann Arbor, MI 48109, United States; Department of Psychiatry, Addiction Center, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, United States.
| | - Rebecca M Cunningham
- University of Michigan Injury Center, 2800 Plymouth Rd, Suite B10-G080, Ann Arbor, MI 48109, United States; University of Michigan, Department of Emergency Medicine, 1500 Medical Center Dr, Ann Arbor, MI 48109, United States.
| | - Mark A Ilgen
- Veterans Affairs Center for Clinical Management Research, 2800 Plymouth Rd, Bldg. 16, Ann Arbor, MI 48109, United States; Department of Psychiatry, Addiction Center, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, United States.
| | - Kristen Barry
- Department of Psychiatry, Addiction Center, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, United States.
| | - Stephen T Chermack
- Veterans Affairs Center for Clinical Management Research, 2800 Plymouth Rd, Bldg. 16, Ann Arbor, MI 48109, United States; Department of Psychiatry, Addiction Center, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, United States.
| | - Frederic C Blow
- Veterans Affairs Center for Clinical Management Research, 2800 Plymouth Rd, Bldg. 16, Ann Arbor, MI 48109, United States; Department of Psychiatry, Addiction Center, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, United States.
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Sripada RK, Hoff R, Pfeiffer PN, Ganoczy D, Blow FC, Bohnert KM. Latent classes of PTSD symptoms in veterans undergoing residential PTSD treatment. Psychol Serv 2018; 17:84-92. [PMID: 30284867 DOI: 10.1037/ser0000284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although most veterans in the Department of Veterans Affairs (VA) health system are treated for posttraumatic stress disorder (PTSD) in the outpatient setting, the VA has approximately 40 residential PTSD treatment facilities across the country for those requiring more intensive care. The symptom profiles of these veterans are poorly understood. Thus, the current study was designed to characterize classes of PTSD symptoms in a national sample of veterans undergoing residential treatment. We analyzed latent classes of PTSD symptoms among 2,452 veterans entering VA PTSD residential treatment in fiscal year 2013. The model with the best fit was a 4-class model comprising a low symptom class, moderate symptom class with high reexperiencing symptoms, a moderate symptom class with high emotional numbing, and a high symptom class. Compared to classes identified in outpatient samples, these classes were similar in type but greater in severity. Classes differed by age, race/ethnicity, trauma type, co-occurring medical conditions, co-occurring psychiatric conditions, and social functioning. Compared to the moderate class with high emotional numbing, those in the moderate class with high reexperiencing symptoms were more likely to be non-White, have greater pain severity, greater sleep problems, and were less likely to be depressed. Our findings suggest that veterans in residential treatment who have more severe PTSD symptoms also experience other medical and psychosocial stressors. A better understanding of symptom profiles may help to create more individualized treatment planning and thus potentially improve care for these veterans. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Rani Hoff
- Veteran Affairs Northeast Program Evaluation Center
| | | | - Dara Ganoczy
- Veterans Affairs Center for Clinical Management Research
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Tzilos Wernette G, Bonar EE, Blow FC, Walton MA. Psychosocial Correlates of Marijuana Use among Pregnant and Nonpregnant Adolescent Girls. J Pediatr Adolesc Gynecol 2018; 31:490-493. [PMID: 29751095 DOI: 10.1016/j.jpag.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/23/2018] [Accepted: 04/30/2018] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVE Pregnant and nonpregnant populations in the United States report marijuana as the most commonly used illicit drug. Patterns of marijuana use and psychosocial correlates are unclear among non-treatment-seeking teenage girls. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: The objective of this study was to use cross-sectional data to examine the psychosocial correlates of recent marijuana use among a sample of 646 pregnant and nonpregnant adolescent girls presenting to urban primary care clinics (mean age = 15.6 years, SD = 1.9 years; 65% African American; 8.8% pregnant). RESULTS In Poisson regression analysis, frequency of marijuana use was significantly associated with greater likelihood of pregnancy (incident rate ratio [IRR], 1.30; 95% CI, 1.03-1.65), alcohol use (IRR, 1.11; 95% CI, 10.08-1.14), condomless sex (IRR, 1.95; 95% CI, 1.61-2.37), parents' drug use (IRR, 1.04; 95% CI, 1.02-1.05), and negative peer influences (IRR, 1.12; 95% CI, 1.10-1.16). CONCLUSION Marijuana use among adolescent girls in this sample was associated with a number of risk behaviors as well as parental and peer influences. Culturally sensitive screening and intervention approaches for marijuana use among adolescent girls should address multiple individual, relationship, and community factors, to prevent unwanted pregnancy as well as to reduce marijuana use during this vulnerable time.
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Affiliation(s)
- Golfo Tzilos Wernette
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; University of Michigan Addiction Center, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
| | - Erin E Bonar
- University of Michigan Addiction Center, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; University of Michigan Injury Center, Ann Arbor, Michigan
| | - Frederic C Blow
- University of Michigan Addiction Center, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management Research, HSR & D, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Maureen A Walton
- University of Michigan Addiction Center, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; University of Michigan Injury Center, Ann Arbor, Michigan
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Mellinger JL, Shedden K, Winder GS, Tapper E, Adams M, Fontana RJ, Volk ML, Blow FC, Lok ASF. The high burden of alcoholic cirrhosis in privately insured persons in the United States. Hepatology 2018; 68:872-882. [PMID: 29579356 DOI: 10.1002/hep.29887] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/13/2018] [Accepted: 03/01/2018] [Indexed: 12/13/2022]
Abstract
UNLABELLED Alcoholic cirrhosis (AC) is a major cause of liver-related morbidity and mortality in the United States. Rising rates of alcohol use disorders in the United States will likely result in more alcoholic liver disease. Our aim was to determine the prevalence, health care use, and costs of AC among privately insured persons in the United States. We collected data from persons aged 18-64 with AC (identified by codes from the International Classification of Diseases, Ninth and Tenth Revisions) enrolled in the Truven MarketScan Commercial Claims and Encounters database (2009-2015). We determined yearly prevalence, weighted to the national employer-sponsored, privately insured population. Using competing risk analysis, we estimated event rates for portal hypertensive complications and estimated the association between AC and costs as well as admissions and readmissions. In 2015, 294,215 people had cirrhosis and 105,871 (36%) had AC. Mean age at AC diagnosis was 53.5 years, and 32% were women. Over the 7 years queried, estimated national cirrhosis prevalence rose from 0.19% to 0.27% (P < 0.001) and for AC from 0.07% to 0.10% (P < 0.001). Compared to non-AC, AC enrollees were significantly more likely to have portal hypertensive complications at diagnosis and higher yearly cirrhosis and alcohol-related admissions (25 excess cirrhosis admissions and 6.3 excess alcohol-related admissions per 100 enrollees) as well as all-cause readmissions. Per-person costs in the first year after diagnosis nearly doubled for AC versus non-AC persons (US$ 44,835 versus 23,319). CONCLUSION In a nationally representative cohort of privately insured persons, AC enrollees were disproportionately sicker at presentation, were admitted and readmitted more often, and incurred nearly double the per-person health care costs compared to those with non-AC. (Hepatology 2018).
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Affiliation(s)
- Jessica L Mellinger
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, MI
| | - Gerald Scott Winder
- Department of Psychiatry, VA Center for Clinical Management Research, Ann Arbor, MI
| | - Elliot Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Megan Adams
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI.,VA Center for Clinical Management Research, Ann Arbor, MI
| | - Robert J Fontana
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Michael L Volk
- Transplantation Institute, Loma Linda University Health, Loma Linda, CA
| | - Frederic C Blow
- Department of Psychiatry, VA Center for Clinical Management Research, Ann Arbor, MI.,VA Center for Clinical Management Research, Ann Arbor, MI
| | - Anna S F Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
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Davis AK, Arterberry BJ, Bonar EE, Chermack ST, Blow FC, Cunningham RM, Walton MA. Predictors of positive drinking outcomes among youth receiving an alcohol brief intervention in the emergency department. Drug Alcohol Depend 2018; 188:102-108. [PMID: 29758380 PMCID: PMC6261455 DOI: 10.1016/j.drugalcdep.2018.03.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reducing underage drinking is a public health priority given increased risk for injury and other consequences. Emergency department (ED) visits offer a potential "teachable moment" to initiate interventions among youth engaged in risky drinking. Given mixed findings for alcohol brief interventions (BIs), this paper examined baseline markers of BI response in order to inform future interventions. METHOD We conducted secondary analyses of data from a randomized controlled trial of an alcohol BI delivered to youth in an ED. Among 475 participants (Mage = 18.6, SD = 1.4; 48.7% Female, 78.6% White/Caucasian) receiving a computer or therapist BI, we examined baseline characteristics (i.e., demographic, substance use, mood, risk/protective factors, and readiness to change) that predicted positive intervention response (i.e., BI responder) at 3-month follow-up using AUDIT-C scores (cut offs: <3 for ages 14-17; <4 for ages 18-20). RESULTS Mediated logistic regression analysis (controlling for demographics) showed that greater readiness to change at baseline was positively related to BI response and baseline alcohol consumption was negatively related to BI response. Having a mentor was indirectly related to BI response via baseline alcohol consumption. Baseline readiness to change and alcohol consumption mediated the association between positive peer influences and BI response, whereas readiness to change mediated the relation between depression and BI response. CONCLUSION Findings suggest that BI response is influenced by protective social factors, such as positive peers and mentors, and depression, via baseline alcohol severity indicators (i.e., readiness to change, consumption), thus providing clues for enhancing the content and dose of early interventions.
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Affiliation(s)
- Alan K Davis
- Behavioral Pharmacology Research Unit, Department of Psychiatry, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Brooke J Arterberry
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Erin E Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA; University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI, 48109, USA
| | - Stephen T Chermack
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Frederic C Blow
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA; HSR and D Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Floor 2, Ann Arbor, MI, 48109, USA
| | - Rebecca M Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI, 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 10-G080, Ann Arbor, MI, 48109-2800, USA
| | - Maureen A Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA; HSR and D Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 16, Floor 2, Ann Arbor, MI, 48109, USA
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Ma J, Li XD, Wang TY, Li SX, Meng SQ, Blow FC, Ilgen M, Degenhardt L, Lappin J, Wu P, Shi J, Bao YP, Lu L. Relationship between the duration of methamphetamine use and psychotic symptoms: A two-year prospective cohort study. Drug Alcohol Depend 2018; 187:363-369. [PMID: 29715654 DOI: 10.1016/j.drugalcdep.2018.03.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/22/2018] [Accepted: 03/25/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Psychosis is a key harm associated with methamphetamine (MA) use. This study examined the relationship between the duration of MA use and risk of psychotic symptoms. METHODS A cohort of 528 individuals with chronic MA use was followed for two years after leaving treatment center in Guangdong, China. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale at baseline and four follow-up visits (6, 12, 18 and 24 months after baseline). MA use during the past six months was investigated at each assessment. Generalized Estimating Equations for longitudinal panel data were developed to examine the risk of MA-associated psychotic symptoms among individuals with different durations of MA use. 340 MA users who completed at least one follow-up were included in the analysis. RESULTS During 6-month intervals, participants who reported MA use showed a two-fold increase in the risk of psychotic symptoms compared to those with no MA use (odds ratio [OR] = 2.15, 95% confidence interval [CI] = 1.33-3.49). A dose-response effect was found between the duration of MA use and the risk of psychotic symptoms (continued 12-month MA use vs. no use: OR = 2.84, 95% CI = 1.39-5.77; continued 18-month MA use vs. no use: OR = 9.93, 95% CI = 3.58-27.57). There was no assessment for 24-month intervals due to a small sample size of the continuous use group. CONCLUSIONS Longer periods of MA use predicted a higher risk of experiencing psychotic symptoms. Early prevention of MA use could help reduce the risk of psychosis in MA users.
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Affiliation(s)
- Jun Ma
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China; School of Public Health, Peking University, Beijing, 100191, China
| | - Xiao-Dong Li
- Zhuhai Jinding Vocabulary Rehabilitation Hospital, Zhuhai, Guangdong, 519085, China
| | - Tong-Yu Wang
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China; School of Public Health, Peking University, Beijing, 100191, China
| | - Su-Xia Li
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China
| | - Shi-Qiu Meng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Mark Ilgen
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Julia Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Ping Wu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
| | - Lin Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China; Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing, 100191, China; Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100191, China.
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Leggett AN, Conroy DA, Blow FC, Kales HC. Bright Light as a Preventive Intervention for Depression in Late-Life: A Pilot Study on Feasibility, Acceptability, and Symptom Improvement. Am J Geriatr Psychiatry 2018; 26:598-602. [PMID: 29269208 PMCID: PMC6181116 DOI: 10.1016/j.jagp.2017.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 10/25/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We examined the feasibility and acceptability of a portable bright light intervention and its impact on sleep disturbance and depressive symptoms in older adults. METHODS One-arm prevention intervention pilot study of the Re-Timer (Re-Timer Pty Ltd, Adelaide, Australia) bright light device (worn 30 minutes daily for 2 weeks) in 1 older adults (age 65 + years) with subsyndromal symptoms of depression and poor sleep quality. Participants were assessed on intervention acceptability and adherence, depressive symptoms (Patient Health Questionnaire- 9), and sleep (Pittsburgh Sleep Quality Index, Insomnia Severity Index, actigraphy and daily diary reports). RESULTS The Re-Timer device was rated positively by participants, and, on average, participants only missed 1 day of utilization. Although depressive symptoms declined and self-reported sleep improved, improvement was seen largely before the start of intervention. CONCLUSIONS An effective preventive intervention that is targeted towards a high risk group of older adults has the potential to reduce distress and costly health service use.
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Affiliation(s)
- Amanda N. Leggett
- Department of Psychiatry and Program for Positive Aging, University of Michigan
| | - Deirdre A. Conroy
- Department of Psychiatry and Behavioral Sleep Medicine Program, University of Michigan
| | - Frederic C. Blow
- Department of Psychiatry and UM Addiction Center and Substance Abuse Section, University of Michigan
| | - Helen C. Kales
- Department of Psychiatry and Program for Positive Aging, University of Michigan, Department of Veterans Affairs, HSR&D Center for Clinical Management Research, Geriatric Research, Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System
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Walton MA, Ngo QM, Chermack ST, Blow FC, Ehrlich PF, Bonar EE, Cunningham RM. Understanding Mechanisms of Change for Brief Alcohol Interventions Among Youth: Examination of Within-Session Interactions. J Stud Alcohol Drugs 2018; 78:725-734. [PMID: 28930060 DOI: 10.15288/jsad.2017.78.725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Alcohol brief interventions (BIs) for youth are efficacious, but effect sizes found have been modest. This article presents secondary data analyses from a randomized controlled trial of motivational interviewing-based (MI) alcohol BIs among youth in an emergency department, examining within-session predictors of alcohol outcomes at 3 months among those receiving BIs. METHOD Risky drinkers (ages 14-20) received either a computer BI (n = 277) or therapist BI (n = 278). Within-session measures were obtained via computer metrics (therapist and computer BIs) and coding of audiotapes (therapist BI only). Parallel structural equation models examined direct and indirect effects of BI components on 3-month alcohol consumption and consequences, with posttest precursors of behavior change (e.g., importance, readiness, and intentions) as potential mediators. Components examined included reasons to avoid or reduce drinking, strengths, strategies for change, benefits of change, and leisure activities (computer BI only), and MI global ratings and MI-adherent behaviors (therapist BI only). RESULTS For both BIs, greater number of strategies directly predicted greater posttest scores, with posttest scores mediating the relationship between strategies and alcohol consumption at 3 months. Greater number of strengths directly predicted fewer alcohol-related consequences at 3 months for both BIs; however, strengths also indirectly predicted greater consumption, mediated by posttest scores. Greater number of reasons to avoid or reduce drinking directly predicted greater alcohol consumption for the therapist BI only. CONCLUSIONS These findings suggest ways to optimize the content and efficacy of alcohol BIs. Reviews of strategies such as refusal skills, protective behavioral strategies, and coping with negative affect may be particularly salient for reducing alcohol misuse.
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Affiliation(s)
- Maureen A Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Injury Center, University of Michigan, Ann Arbor, Michigan
| | - Quyen M Ngo
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.,Institute on Women and Gender Studies, University of Michigan, Ann Arbor, Michigan
| | - Stephen T Chermack
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Mental Health Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.,Mental Health Innovation, Services, and Outcomes Section, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Peter F Ehrlich
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, Michigan
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- Injury Center, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.,School of Public Health, University of Michigan, Ann Arbor, Michigan
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Bonar EE, Arterberry BJ, Davis AK, Cunningham RM, Blow FC, Collins RL, Walton MA. Prevalence and motives for drugged driving among emerging adults presenting to an emergency department. Addict Behav 2018; 78:80-84. [PMID: 29128710 DOI: 10.1016/j.addbeh.2017.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/30/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Drugged driving [DD] is a public health concern, particularly among emerging adults who have the highest rates of drug use. Understanding involvement with DD could inform prevention efforts for this population. We evaluated the prevalence of, motives for, and correlates of past-year DD among emerging adults from an urban, under-resourced community. METHODS Emerging adults (N=586) ages 18-25years (54% male, 56% African American, 34% European American) seeking care in an urban emergency department completed past-year surveys of demographics, frequency of DD within 4h of substance use, reasons for DD, and substance use. RESULTS DD was reported by 24% of participants (with 25% of those engaging in high frequency DD). DD after cannabis use was most common (96%), followed by prescription opioids, sedatives, and stimulants (9%-19%). Common reasons for DD were: needing to go home (67%), not thinking drugs affected driving ability (44%), not having to drive far (33%), and not feeling high (32%). Demographics were not associated with DD, but, as expected, those with DD had riskier substance use. CONCLUSIONS In this clinical sample, using a conservative measure, DD, particularly following cannabis use, was relatively common among emerging adults. Based on these data, clinical interventions for cannabis and other drug use should include content on prevention of DD, with particular attention to motives such as planning ahead for alternatives to get home safely and weighing benefits and risks of DD.
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Affiliation(s)
- Erin E Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, United States; University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, United States.
| | - Brooke J Arterberry
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Alan K Davis
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Rebecca M Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, United States; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109, United States; Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, United States
| | - Frederic C Blow
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, United States; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States
| | - R Lorraine Collins
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY 14260, United States
| | - Maureen A Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, United States; University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, United States
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Bonar EE, Walton MA, Barry KL, Bohnert AS, Chermack ST, Cunningham RM, Massey LS, Ignacio RV, Blow FC. Sexual HIV risk behavior outcomes of brief interventions for drug use in an inner-city emergency department: Secondary outcomes from a randomized controlled trial. Drug Alcohol Depend 2018; 183:217-224. [PMID: 29291549 PMCID: PMC5803438 DOI: 10.1016/j.drugalcdep.2017.10.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Drug use is an established risk factor for HIV. Brief Interventions (BIs) targeting reductions in both drug use and HIV risk behaviors may help curtail these related epidemics. The present study evaluates the impact of BIs for drug use and HIV risk reduction on sexual HIV risk behaviors among a primarily marijuana-using sample during a 12-month post-intervention follow-up period. METHODS We conducted a randomized controlled trial of 780 adult patients in an Emergency Department (ED) with past 3-month drug use (primarily non-injecting). This study used a 3 × 2 factorial design (3 ED-based conditions: computer-delivered brief intervention [Computer BI], therapist-delivered, computer-guided BI [Therapist BI], or enhanced usual care (EUC-ED) for drug-using adults; 2 follow-up conditions at 3 months: booster or control). This analysis examines the outcomes of the BIs on sexual HIV risk behaviors at 3-, 6-, and 12-months. RESULTS Compared to the enhanced usual care control, the combined Therapist BI with booster resulted in significant reductions in scores on the sexual risk subscale of the HIV Risk Taking Behaviour Scale over 12-months, when controlling for baseline sexual risk, gender, and drug dependency status. The baseline interventions alone, booster alone, and Computer BI plus booster did not differ from the comparison group (EUC plus control). CONCLUSIONS A therapist-delivered BI for drug use and HIV risk behaviors, combined with a follow-up therapist-delivered booster, shows promise for reducing sexual HIV risk behaviors among a primarily marijuana using, non-injecting sample.
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Affiliation(s)
- Erin E. Bonar
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA
| | - Maureen A. Walton
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA
| | - Kristen L. Barry
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA
| | - Amy S.B. Bohnert
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Stephen T. Chermack
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Mental Health Service, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Rebecca M. Cunningham
- Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA,Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109, USA,Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Place, Flint, MI 48503, USA,Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Lynn S. Massey
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA
| | - Rosalinda V. Ignacio
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Frederic C. Blow
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109 USA,Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10- G080, Ann Arbor, Michigan, 48109, USA,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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Abstract
OBJECTIVE Wives and husbands may influence one another's alcohol use, but little is known about within-couple patterns of alcohol consumption over time during midlife and later life. Drawing from a nationally representative U.S. sample of middle-aged and older married couples, we examined individual stability and partner influence in alcohol use across a 16-year period. METHOD The analytic sample comprised 1,257 married couples age 40 and older who completed nine waves of the Health and Retirement Study (1996-2012). Dyadic multilevel models were estimated to simultaneously examine the stability of one's own alcohol use (number of drinks per occasion and per week) over time as well as whether partner drinking predicted subsequent alcohol use within couples. Models controlled for marital duration. RESULTS Wives' and husbands' own prior alcohol use positively predicted alcohol use across waves, demonstrating individual stability in drinking patterns. Partners' alcohol use also positively predicted wives' and husbands' subsequent alcohol use, revealing partner influence in drinking patterns. Both stability and influence effects were stronger for husbands than for wives. CONCLUSIONS This study provides evidence of stability and mutual influence in long-term patterns of alcohol use within mid- and late-life married couples. Findings highlight the interdependence between spouses and indicate that partners' drinking should be considered when examining men's and women's alcohol use over time.
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Affiliation(s)
- Courtney A. Polenick
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Correspondence may be sent to: Courtney A. Polenick at the Department of Psychiatry, University of Michigan, 2800 Plymouth Rd, Building 16, Room 200S, Ann Arbor, MI 48109, or via email at:
| | - Kira S. Birditt
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, Michigan
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Cranford JA, Arnedt JT, Conroy DA, Bohnert KM, Bourque C, Blow FC, Ilgen M. Prevalence and correlates of sleep-related problems in adults receiving medical cannabis for chronic pain. Drug Alcohol Depend 2017; 180:227-233. [PMID: 28926791 PMCID: PMC5648597 DOI: 10.1016/j.drugalcdep.2017.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/20/2017] [Accepted: 08/18/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE To examine the prevalence and correlates of sleep problems in a sample of medical cannabis patients. PROCEDURES Adults ages 21 and older (N=801,M age=45.8) who were seeking medical cannabis certification (either for the first time or as a renewal) for chronic pain at medical cannabis clinics in southern Michigan completed baseline measures of cannabis use, sleep, pain, and other related constructs. FINDINGS Over half of the sample (59%) met criteria for past 1-month sleep disturbance, defined as at least one sleep problem occurring on 15 or more nights in the past month. Most participants (86%) reported that sleep problems were due to their current pain. Approximately 80% of participants reported using cannabis in the past 6 months to improve sleep and, among these participants, cannabis was rated as helpful for improving sleep. Sleep-related cannabis side effects were rare (35%), but sleep-related cannabis withdrawal symptoms were relatively common (65%). Statistically significant correlates of past 1-month sleep disturbance included a) being female, b) being white, c) being on disability, d) not having a medical cannabis card, and e) frequency of using cannabis to help sleep. CONCLUSIONS Sleep problems are highly prevalent and frequent in medical cannabis patients and are closely tied to pain. Sleep-related cannabis withdrawal symptoms are relatively common but their clinical relevance is unknown. The association between frequency of cannabis use to help sleep with higher odds of sleep problems will need to be clarified by longitudinal studies.
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Affiliation(s)
- James A. Cranford
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States,
| | - J. Todd Arnedt
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States,
| | - Deirdre A. Conroy
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States,
| | - Kipling M. Bohnert
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States, ,VA Center for Clinical Management Research (CCMR), Veterans Health Administration, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, United States
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States,
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States, ,VA Center for Clinical Management Research (CCMR), Veterans Health Administration, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, United States
| | - Mark Ilgen
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States, ,VA Center for Clinical Management Research (CCMR), Veterans Health Administration, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, United States
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Maust DT, Kales HC, McCammon RJ, Blow FC, Leggett A, Langa KM. Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs. Am J Geriatr Psychiatry 2017; 25:1074-1082. [PMID: 28754586 PMCID: PMC5600647 DOI: 10.1016/j.jagp.2017.02.025] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/04/2017] [Accepted: 02/28/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Explore the relationship between behavioral and psychological symptoms of dementia (BPSD; specifically, delusions, hallucinations, and agitation/aggression) and associated caregiver distress with emergency department (ED) utilization, inpatient hospitalization, and expenditures for direct medical care. DESIGN/SETTING/PARTICIPANTS Retrospective cross-sectional cohort of participants with dementia (N = 332) and informants from the Aging, Demographics, and Memory Study, a nationally representative survey of U.S. adults >70 years old. MEASUREMENTS BPSD of interest and associated informant distress (trichotomized as none/low/high) were assessed using the Neuropsychiatric Inventory (NPI). Outcomes were determined from one year of Medicare claims and examined according to presence of BPSD and associated informant distress, adjusting for participant demographics, dementia severity, and comorbidity. RESULTS Fifty-eight (15%) participants with dementia had clinically significant delusions, hallucinations, or agitation/aggression. ED visits, inpatient admissions, and costs were not significantly higher among the group with significant BPSD. In fully adjusted models, a high level of informant distress was associated with all outcomes: ED visit incident rate ratio (IRR) 3.03 (95% CI: 1.98-4.63; p < 0.001), hospitalization IRR 2.78 (95% CI: 1.73-4.46; p < 0.001), and relative cost ratio 2.00 (95% CI: 1.12-3.59; p = 0.02). CONCLUSIONS A high level of informant distress related to participant BPSD, rather than the symptoms themselves, was associated with increased healthcare utilization and costs. Effectively identifying, educating, and supporting distressed caregivers may help reduce excess healthcare utilization for the growing number of older adults with dementia.
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Affiliation(s)
- Donovan T. Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, MI,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Helen C. Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | | | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, MI,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Amanda Leggett
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Kenneth M. Langa
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,Department of Medicine, University of Michigan, Ann Arbor, MI,Institute for Social Research, University of Michigan, Ann Arbor, MI
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Bonar EE, Goldstick JE, Collins RL, Cranford JA, Cunningham RM, Chermack ST, Blow FC, Walton MA. Daily associations between cannabis motives and consumption in emerging adults. Drug Alcohol Depend 2017; 178. [PMID: 28647681 PMCID: PMC5548614 DOI: 10.1016/j.drugalcdep.2017.05.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Increasing rates of cannabis use among emerging adults is a growing public health problem. Intensive longitudinal data can provide information on proximal motives for cannabis use, which can inform interventions to reduce use among emerging adults. METHOD As part of a larger longitudinal study, patients aged 18-25 years (N=95) recruited from an urban Emergency Department completed daily text message assessments of risk behaviors for 28days, including daily cannabis quantity and motives. Using a mixed effects linear regression model, we examined the relationships between daily quantity of cannabis consumed and motives (i.e., enhancement, social, conformity, coping, and expansion). RESULTS Participants were, on average, 22.0 years old (SD=2.2); 48.4% were male, 45.3% were African American, and 56.8% received public assistance. Results from the multi-level analysis (clustering day within individual), controlling for gender, race, and receipt of public assistance, indicated daily use of cannabis use for enhancement (β=0.27), coping (β=0.15), and/or social motives (β=0.34) was significantly associated with higher quantities of daily cannabis use; whereas expansion and conformity motives were not. CONCLUSIONS Daily data show that emerging adults who use cannabis for enhancement, social, and coping motives reported using greater quantities of cannabis. Future research should examine more comprehensive cannabis motives (e.g., boredom, social anxiety, sleep) and test tailored interventions focusing on alternative cognitive/behavioral strategies to address cannabis motives.
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Affiliation(s)
- Erin E. Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
| | - Jason E. Goldstick
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109
| | - R. Lorraine Collins
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, 14260
| | - James A. Cranford
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
| | - Rebecca M. Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109,Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109,Department of Emergency Medicine, Hurley Medical Center, 1Hurley Plaza, Flint, MI 48503,Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109
| | - Stephen T. Chermack
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105
| | - Frederic C. Blow
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105
| | - Maureen A. Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109,University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
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Blow FC, Walton MA, Bohnert ASB, Ignacio RV, Chermack S, Cunningham RM, Booth BM, Ilgen M, Barry KL. A randomized controlled trial of brief interventions to reduce drug use among adults in a low-income urban emergency department: the HealthiER You study. Addiction 2017; 112:1395-1405. [PMID: 28127808 DOI: 10.1111/add.13773] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/20/2016] [Accepted: 01/26/2017] [Indexed: 11/27/2022]
Abstract
AIMS To examine efficacy of drug brief interventions (BIs) among adults presenting to a low-income urban emergency department (ED). DESIGN Randomized controlled trial on drug use outcomes at 3, 6 and 12 months. Participants were assigned to (1) computer-delivered BI (Computer BI), (2) therapist-delivered, computer-guided BI (Therapist BI) or (3) enhanced usual care (EUC-ED) for drug-using adults. Participants were re-randomized after the 3-month assessment to either adapted motivational enhancement therapy (AMET) booster or enhanced usual care booster (EUC-B). SETTING Patients recruited from low-income urban emergency departments (ED) in Flint, Michigan, USA. PARTICIPANTS A total of 780 ED patients reporting recent drug use, 44% males, mean age = 31 years. INTERVENTIONS Computer BI consisted of an interactive program guided by a virtual health counselor. Therapist BI included computer guidance. The EUC-ED conditions included review of community health and HIV prevention resources. The BIs and boosters were based on motivational interviewing, focusing on reduction of drug use and HIV risk behaviors. MEASUREMENTS Primary outcome was past 90 days using drugs at 6 and 12 months and secondary outcomes were weighted drug-days and days of marijuana use. FINDINGS Percentage changes in mean days used any drug from baseline to 12 months were: Computer BI + EUC-B: -10.9%, P = 0.0844; Therapist BI + EUC-B: -26.7%, P = 0.0041, for EUC-ED + EUC-B: -20.9, P = 0.0011. In adjusted analyses, there was no significant interaction between ED intervention and booster AMET for primary and secondary outcomes. Compared with EUC-ED, Therapist BI reduced number of days using any drug [95% confidence interval (CI) = -0.41, -0.07, P = 0.0422] and weighted drug-days (95% CI = -0.41, -0.08, P = 0.0283). Both Therapist and Computer BI had significantly fewer number of days using marijuana compared to EUC-ED (Therapist BI: 95% CI = -0.42, -0.06, P = 0.0104, Computer BI: 95% CI = -0.34, -0.01, P = 0.0406). Booster effects were not significant. CONCLUSIONS An emergency department-based motivational brief intervention, delivered by a therapist and guided by computer, appears to reduce drug use among adults seeking emergency department care compared with enhanced usual care.
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Affiliation(s)
- Frederic C Blow
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Maureen A Walton
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA
| | - Amy S B Bohnert
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Injury Center, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Rosalinda V Ignacio
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Stephen Chermack
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, USA
| | - Rebecca M Cunningham
- Injury Center, University of Michigan, Ann Arbor, MI, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, MI and Hurley Hospital, Flint, MI, USA.,School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Brenda M Booth
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Mark Ilgen
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Mental Health Service, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Kristen L Barry
- University of Michigan, Addiction Center, Department of Psychiatry, Ann Arbor, MI, USA
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Bonar EE, Cunningham RM, Collins RL, Cranford JA, Chermack ST, Zimmerman MA, Blow FC, Walton MA. Feasibility and Acceptability of Text Messaging to Assess Daily Substance Use and Sexual Behaviors among Urban Emerging Adults. Addict Res Theory 2017; 26:103-113. [PMID: 29632458 PMCID: PMC5889069 DOI: 10.1080/16066359.2017.1310205] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Daily process research can help distinguish causal relationships between substance use and sexual risk behaviors in high-risk groups, such as urban emerging adults. We employed text messaging to assess 18-25 year-olds' daily substance use and sexual risk behaviors over 28 days. We describe the implementation of this method, attitudes regarding the daily surveys, and correlates of survey completion. METHOD We recruited 111 emerging adults from an urban Emergency Department in a resource-limited area who reported recent drug use and unprotected sex (Mage=22.0; 53.2% female; 45.1% African American; 43.2% receiving public assistance). RESULTS Respondents completed M=18.0 (SD = 8.7) of 28 daily surveys (27 items each). Participants completing a 1-month follow-up found the surveys not at all/only a little annoying (90.3%) and were comfortable with questions about drugs/alcohol (97.9%) and sex (94.6%). Completion was higher on weekdays versus weekends, and earlier in the study. Daily survey completion was unrelated to same-day substance use measured by the Timeline Follow Back at follow-up; polysubstance use and drinks consumed were associated with lower odds of next-day completion. School enrollment, public assistance, unlimited texting plan, lower baseline alcohol use, and depression symptoms at follow-up were associated with higher completion. Technology difficulties were commonly mentioned barriers to completion. CONCLUSIONS Participants in this urban, resource-constrained sample found the daily text message methodology acceptable for reporting sensitive information. With rapid advancements in technologies and increased accessibility, text messaging remains a promising methodology for the study of daily processes in substance use and HIV risk behaviors. Keywords: text messaging; assessment; emerging adults; substance use; risky sex; mobile technology.
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Affiliation(s)
- Erin E. Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
| | - Rebecca M. Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109
- Emergency Medicine, Hurley Medical Center, 1Hurley Plaza, Flint, MI 48503
| | - R. Lorraine Collins
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, 14260
| | - James A. Cranford
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
| | - Stephen T. Chermack
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105
| | - Marc A. Zimmerman
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPHI, Ann Arbor, MI 48109
| | - Frederic C. Blow
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105
| | - Maureen A. Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, Michigan, 48109
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Maust DT, Gerlach LB, Gibson A, Kales HC, Blow FC, Olfson M. Trends in Central Nervous System-Active Polypharmacy Among Older Adults Seen in Outpatient Care in the United States. JAMA Intern Med 2017; 177:583-585. [PMID: 28192559 PMCID: PMC5378654 DOI: 10.1001/jamainternmed.2016.9225] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses data from the National Ambulatory Medical Care Survey to describe the central nervous system polypharmacy practices among outpatient older adults.
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Affiliation(s)
- Donovan T Maust
- Department of Psychiatry, University of Michigan, Ann Arbor2Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | | | | | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor2Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan, Ann Arbor2Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York5New York State Psychiatric Institute, New York
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Walton MA, Epstein-Ngo Q, Carter PM, Zimmerman MA, Blow FC, Buu A, Goldstick J, Cunningham RM. Marijuana use trajectories among drug-using youth presenting to an urban emergency department: Violence and social influences. Drug Alcohol Depend 2017; 173:117-125. [PMID: 28219802 PMCID: PMC5366264 DOI: 10.1016/j.drugalcdep.2016.11.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 01/14/2023]
Abstract
AIMS This paper examined longitudinal marijuana use trajectories among drug-using youth presenting to the ED to inform intervention development. METHODS Given interest in substance use and violence, this study oversampled those presenting with assault injuries. Assault-injured youth (ages 14-24) endorsing past 6-month drug use (n=349), and a sex and age proportionally-sampled comparison group (n=250) endorsing drug use, completed a baseline assessment and follow-ups at 6, 12, 18, and 24 months. Latent class trajectory analyses examined days of marijuana use over 2 years. Multinomial regression analyses examined baseline, 12-month and 24-month factors associated with substance use trajectory groups. RESULTS Trajectory analyses identified 5 groups: Low (Low; 28.2%; n=169); Intermittent (INT; 16.2%; n=97); Moderate Decline (MD; 12.0%; n=72); High decline (HD, 13.2%; n=79) and Chronic (C; 30.4%; n=182). At baseline, as compared to the Low group, the other trajectory groups were more likely to be male and have greater levels of physical aggression. At 12- and 24-months, negative and positive peer influences, incarceration and community violence were additional characteristics associated with the greater marijuana use trajectories (as compared to the Low group). CONCLUSIONS Interventions for drug-using youth presenting to the urban ED should address peer influences, physical aggression and community violence exposure, given the association between these characteristics and greater marijuana use trajectories.
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Affiliation(s)
- Maureen A Walton
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Quyen Epstein-Ngo
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Institute on Women and Gender Studies, University of Michigan, 500 South State St., Ann Arbor, MI 48109, USA
| | - Patrick M Carter
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, USA; Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, USA
| | - Marc A Zimmerman
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights 3790A SPH I, Ann Arbor, MI 48109, USA
| | - Frederic C Blow
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Anne Buu
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls, Room 4346, Ann Arbor, MI 48109, USA
| | - Jason Goldstick
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA
| | - Rebecca M Cunningham
- University of Michigan Injury Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48105, USA; Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503, USA
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Maust DT, Blow FC, Wiechers IR, Kales HC, Marcus SC. National Trends in Antidepressant, Benzodiazepine, and Other Sedative-Hypnotic Treatment of Older Adults in Psychiatric and Primary Care. J Clin Psychiatry 2017; 78:e363-e371. [PMID: 28448697 PMCID: PMC5408458 DOI: 10.4088/jcp.16m10713] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 08/12/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe how use of antidepressants, benzodiazepines, and other anxiolytic/sedative-hypnotics among older adults (age ≥ 65 years) has changed over time among visits to primary care providers and psychiatrists. METHODS Data were from the National Ambulatory Medical Care Survey (years 2003-2005 and 2010-2012), a nationally representative cross-section of outpatient physician visits. Analysis focused on visits to primary care providers (n = 14,282) and psychiatrists (n = 1,095) at which an antidepressant, benzodiazepine, or other anxiolytic/sedative-hypnotic was prescribed, which were stratified by demographic and clinical characteristic (including ICD-9-CM diagnosis) and compared across study intervals. Odds of medication use were calculated for each stratum, adjusting for demographic and clinical characteristics. RESULTS The visit rate by older adults to primary care providers where any of the medications were prescribed rose from 16.4% to 21.8% (adjusted odds ratio [AOR] = 1.43, P < .001) while remaining steady among psychiatrists (75.4% vs 68.5%; AOR = 0.69, P = .11). Primary care visits rose for antidepressants (9.9% to 12.3%; AOR = 1.28, P = .01) and other anxiolytic/sedative-hypnotics (3.4% to 4.7%; AOR = 1.39, P = .01), but the largest growth was among benzodiazepines (5.6% to 8.7%; AOR = 1.62, P < .001). Among patients in primary care, increases primarily occurred among men, non-Hispanic white patients, and those with pain diagnoses as well as those with no mental health or pain diagnoses. CONCLUSIONS From 2003 to 2012, use of the most common psychotropic medications among older adults seen in primary care increased, with concentration among patients with no mental health or pain diagnosis. As the population of older adults grows and receives mental health treatment in primary care, it is critical to examine the appropriateness of psychotropic use.
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Affiliation(s)
- Donovan T. Maust
- Department of Psychiatry and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Frederic C. Blow
- Department of Psychiatry and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Ilse R. Wiechers
- Northeast Program Evaluation Center, Office of Mental Health Operations, U.S. Department of Veterans Affairs, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Helen C. Kales
- Department of Psychiatry and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Steven C. Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
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Maust DT, Langa KM, Blow FC, Kales HC. Psychotropic use and associated neuropsychiatric symptoms among patients with dementia in the USA. Int J Geriatr Psychiatry 2017; 32:164-174. [PMID: 26889640 PMCID: PMC4990518 DOI: 10.1002/gps.4452] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/28/2016] [Accepted: 01/28/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the national prevalence of psychotropic use and association with neuropsychiatric symptoms among patients with dementia. METHODS Participants diagnosed with dementia (n = 414) in the Aging, Demographics, and Memory Study, a nationally representative survey of US adults >70 years old. Diagnosis was based on in-person clinical assessment and informant interview. Information collected included demographics, place of residence, 10-item Neuropsychiatric Inventory (NPI), and prescribed medications (antipsychotic, sedative-hypnotic, antidepressant, mood stabilizer). RESULTS Of 414 participants with dementia, 41.4% were prescribed a psychotropic medication, including 84.0% of nursing home residents and 28.6% of community-dwellers. Of participants, 23.5% were prescribed an antidepressant. Compared with the total NPI score of those on no medication (4.5), those on antipsychotics and those on sedative-hypnotics had much higher scores (respectively: 12.6, p < 0.001; 11.8, p = 0.03), although those antidepressants did not (6.9, p = 0.15). A larger proportion of patients on antipsychotics exhibited psychosis and agitation compared with those on no medication, while those on antidepressants exhibited more depressive symptoms. In multivariable logistic regression that included dementia severity and nursing home residence, nursing home residence was the characteristic most strongly associated with psychotropic use (odds ratio ranging from 8.96 [p < 0.001] for antipsychotics to 15.59 [p < 0.001] for sedative-hypnotics). More intense psychotic symptoms and agitation were associated with antipsychotic use; more intense anxiety and agitation were associated with sedative-hypnotic use. More intense depression and apathy were not associated with antidepressant use. CONCLUSIONS In this nationally representative sample, 41.4% of patients were taking psychotropic medication. While associated with neuropsychiatric symptoms, nursing home residence was most strongly tied to use. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Donovan T. Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, MI,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Kenneth M. Langa
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,Department of Internal Medicine, University of Michigan, Ann Arbor, MI,Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, MI,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Helen C. Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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