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Morris J, Tattan-Birch H, Albery IP, Heather N, Moss AC. Look away now! Defensive processing and unrealistic optimism by level of alcohol consumption. Psychol Health 2024:1-19. [PMID: 38379336 DOI: 10.1080/08870446.2024.2316681] [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: 04/04/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE Health risk information is insufficient as a means of reducing alcohol use, particularly when it evokes negative emotional states amongst those for whom it is most personally relevant. Appraisal biases, or 'defensive processing', may be employed to mitigate the psychological discomfort posed by such information. Few studies have evaluated the role of defensive processing in people with different levels of alcohol consumption. DESIGN Online participants (n = 597) completed measures of defensive processing of a health risk infographic, perceived susceptibility and severity of alcohol use, efficacy for resisting alcohol use, unrealistic optimism, the Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) and demographics. RESULTS AUDIT-C scores were positively and linearly associated with all defensive processing measures (Pearson's correlation r from.16 to .36), threat and susceptibility (r = .16) and unrealistic optimism (r = .50). AUDIT-C scores were also negatively associated with efficacy for controlling alcohol use (r = -0.48). CONCLUSION People with alcohol use disorder (AUD) engaged in much more defensive processing of alcohol-related messages, offering an explanation for why such messages are limited at eliciting behaviour change. High levels of unrealistic optimism in people with alcohol use disorder may reflect low problem recognition in order to maintain a problem-free drinking identity.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, United Kingdom
| | | | - I P Albery
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - N Heather
- University of Northumbria, Newcastle upon Tyne, United Kingdom
| | - A C Moss
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, United Kingdom
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Bedendo A, Gaume J, Studer J, Tober G, Raistrick D, Heather N, Souza-Formigoni MLO, McCambridge J. Mediational Analyses of the Effects of Social Behaviour and Network Therapy on Alcohol Use. Eur Addict Res 2023; 30:14-22. [PMID: 38048760 DOI: 10.1159/000535200] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/03/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Social behaviour and network therapy involves an active participation of the practitioner in recruiting a supportive network to change the client's alcohol use. Despite achieving beneficial effects on alcohol consumption, its possible mechanisms of change are a relatively under-studied topic compared to those of other alcohol treatment interventions. This study aimed to explore therapist skills through which social behaviour and network therapy may achieve effects on alcohol consumption in comparison with motivational enhancement therapy. METHODS This study was secondary analysis of data from the UK Alcohol Treatment Trial, a multicentre, pragmatic, randomized controlled trial. The sample comprised 376 participants randomized to motivational enhancement therapy or social behaviour and network therapy. We used the UK Alcohol Treatment Trial Process Rating Scale to assess therapist skills. Outcomes drinks per drinking day and percentage of days abstinent were assessed 12 months after treatment initiation. Analyses were conducted in a simple mediation framework. RESULTS Therapist skills score (combining frequency and quality) for involving others in behaviour change mediated social behaviour and network therapy effects on percentage of days abstinent (b = 0.06, 95% CI: 0.02; 0.10, p = 0.01). The frequency with which therapists acted as an active agent for change also mediated the effects of social behaviour and network therapy on percentage of days abstinent (b = 0.03, 95% CI: 0.003; 0.05, p = 0.03). The frequency with which the therapist stressed social support as a key factor in achieving change unexpectedly mediated an increase in drinks per drinking day (b = 0.10, 95% CI: 0.01; 0.18, p = 0.02). The two latter mediation effects were not sustained when quality was considered. All other indirect effects tested were non-significant. DISCUSSION/CONCLUSIONS How social behaviour and network therapy exerts effects on alcohol outcomes is not yet well understood and in this study was not attributable to observed ratings of therapist treatment-specific skills. Therapist skill in planning the involvement of others during treatment, however, warrants further study. We suggest that the present findings should be regarded as hypothesis generating as it identifies specific targets for further investigation in alcohol treatment process studies.
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Affiliation(s)
- Andre Bedendo
- Department of Health Sciences, University of York, York, UK
- Research Center on Alcohol and Drug Use, Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jacques Gaume
- Department of Psychiatry - Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joseph Studer
- Department of Psychiatry - Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gillian Tober
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Duncan Raistrick
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Nick Heather
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle, UK
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Gaume J, Heather N, Tober G, Studer J, Bedendo A, Raistrick D, McCambridge J. Serial mediation analysis of treatment-specific processes in two contrasting alcohol treatments. J Subst Abuse Treat 2022; 140:108799. [DOI: 10.1016/j.jsat.2022.108799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/31/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
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Shorter GW, Heather N, Berman AH, Giles EL, Barbosa C, Monteiro MG, Cowell AJ, Toner P, Bray JW. The ORBITAL Core Outcome Set: Response to de Bejczy et al. (2022) on Biomarkers and Methodological Innovation in Core Outcome Sets. J Stud Alcohol Drugs 2022; 83:298-300. [PMID: 35254254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- Gillian W Shorter
- Centre for Improving Health Related Quality of Life, School of Psychology Queen's University Belfast, United Kingdom
- Drug and Alcohol Research Network, Queen's University Belfast, United Kingdom
| | - Nick Heather
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Anne H Berman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Emma L Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | | | | | - Alex J Cowell
- Carolina Complete Health Network, Durham, North Carolina, United States
| | - Paul Toner
- Centre for Improving Health Related Quality of Life, School of Psychology Queen's University Belfast, United Kingdom
| | - Jeremy W Bray
- Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, North Carolina, United States
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Shorter GW, Heather N, Berman AH, Giles EL, Barbosa C, Monteiro MG, Cowell AJ, Toner P, Bray JW. The ORBITAL Core Outcome Set: Response to on Biomarkers and Methodological Innovation in Core Outcome Sets. J Stud Alcohol Drugs 2022. [DOI: 10.15288/jsad.2022.83.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Gillian W. Shorter
- Centre for Improving Health Related Quality of Life, School of Psychology Queen's University Belfast, United Kingdom
- Drug and Alcohol Research Network, Queen's University Belfast, United Kingdom
| | - Nick Heather
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Anne H. Berman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Emma L. Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | | | | | - Alex J. Cowell
- Carolina Complete Health Network, Durham, North Carolina, United States
| | - Paul Toner
- Centre for Improving Health Related Quality of Life, School of Psychology Queen's University Belfast, United Kingdom
| | - Jeremy W. Bray
- Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, North Carolina, United States
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Alsweiler JM, Heather N, Harris DL, McKinlay CJD. Application of the screening test principles to screening for neonatal hypoglycemia. Front Pediatr 2022; 10:1048897. [PMID: 36568425 PMCID: PMC9768220 DOI: 10.3389/fped.2022.1048897] [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: 09/20/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Severe and prolonged neonatal hypoglycemia can cause brain injury, while the long-term consequences of mild or transitional hypoglycemia are uncertain. As neonatal hypoglycemia is often asymptomatic it is routine practice to screen infants considered at risk, including infants of mothers with diabetes and those born preterm, small or large, with serial blood tests over the first 12-24 h after birth. However, to prevent brain injury, the gold standard would be to determine if an infant has neuroglycopenia, for which currently there is not a diagnostic test. Therefore, screening of infants at risk for neonatal hypoglycemia with blood glucose monitoring does not meet several screening test principles. Specifically, the long-term neurodevelopmental outcomes of transient neonatal hypoglycemia are not well understood and there is no direct evidence from randomized controlled trials that treatment of hypoglycemia improves long-term neurodevelopmental outcomes. There have been no studies that have compared the long-term neurodevelopmental outcomes of at-risk infants screened for neonatal hypoglycemia and those not screened. However, screening infants at risk of hypoglycemia and treating those with hypoglycaemic episodes to maintain the blood glucose concentrations ≥2.6 mmol/L appears to preserve cognitive function compared to those without episodes. This narrative review explores the evidence for screening for neonatal hypoglycemia, the effectiveness of blood glucose screening as a screening test and recommend future research areas to improve screening for neonatal hypoglycemia. Screening babies at-risk of neonatal hypoglycemia continues to be necessary, but as over a quarter of all infants may be screened for neonatal hypoglycemia, further research is urgently needed to determine the optimal method of screening and which infants would benefit from screening and treatment.
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Affiliation(s)
- J M Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - N Heather
- Newborn Metabolic Screening Programme, LabPlus, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - D L Harris
- School of Nursing, Midwifery and Health Practice, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - C J D McKinlay
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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Morris J, Moss A, Albery I, Heather N. The "alcoholic other": Harmful drinkers resist problem recognition to manage identity threat. Addict Behav 2022; 124:107093. [PMID: 34500234 DOI: 10.1016/j.addbeh.2021.107093] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Harmful drinkers represent an important Alcohol Use Disorder (AUD) group in public health terms, accounting for significant health and social costs. However, harmful drinkers are characterized by low problem recognition; they tend to construct their drinking identity as positive and problem-free, actively setting themselves apart from the stigmatised 'alcoholic other'. As such, harmful drinkers rarely engage in treatment and represent an important opportunity for lower threshold interventions and self-change. The present study sought to explore AUD problem framing and stigma effects on problem recognition. METHODS Harmful drinkers without perceived addiction experience recruited online (n = 244, 54% male, 46% female, 96% British) were randomised to one of six conditions comprising beliefs about alcohol problems (control, continuum, binary disease model) and stigma (stigma, non-stigma), and completed measures relating to problem recognition. RESULTS As predicted, results found that harmful drinkers exposed to binary disease model beliefs and stigmatising language had significantly lower problem recognition than those in other conditions. However, no support was found for the prediction that continuum beliefs would be associated with higher problem recognition. Results suggest that the interaction of binary disease model beliefs and stigma prompted alcoholic label avoidance. CONCLUSION These findings suggest that problem framing has important consequences for harmful drinkers. Implications for behaviour change amongst harmful drinkers through mechanisms of problem framing and identity are discussed.
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Richards DK, Pearson MR, Hallgren KA, Heather N, Witkiewitz K. An application of moderated nonlinear factor analysis to develop a commensurate measure of alcohol problems across four alcohol treatment studies. Drug Alcohol Depend 2021; 229:109068. [PMID: 34628095 PMCID: PMC8671250 DOI: 10.1016/j.drugalcdep.2021.109068] [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: 05/19/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Self-report measures of alcohol problems are commonly included in studies evaluating treatment and recovery from alcohol use disorder (AUD), but no prior study has examined the replicability of the measurement of alcohol problems across studies with various measures and diverse samples. Further, it is unclear which items may be better indicators of alcohol problems for patient subgroups. In the present study, we integrated data from four large alcohol treatment studies to develop a commensurate measure of alcohol problems using moderated nonlinear factor analysis (MNLFA). METHODS Data were from the COMBINE study, Project MATCH, the Relapse Replication and Extension Project (RREP), and the United Kingdom Alcohol Treatment Trial (UKATT), yielding a total sample size of 4414. MNLFA was carried out on the Drinker Inventory of Consequences (COMBINE, MATCH, RREP) and Alcohol Problems Questionnaire (UKATT). RESULTS We successfully created a 78-item commensurate measure of alcohol problems and examined differential item functioning (DIF) by study membership, time, and socio-demographic characteristics. Sixty-two items demonstrated intercept DIF, suggesting differences in rates of item endorsement for clients with the same underlying levels of alcohol problems across patient subgroups. Six items demonstrated loading DIF, suggesting differences in the extent to which the items were indicative of alcohol problems across patient subgroups. CONCLUSIONS The self-reported measurement of alcohol problems replicates across measures and diverse samples. Items with DIF have clinical implications for the treatment of AUD. Finally, MNLFA scores can be used to test substantive research questions across these studies.
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Affiliation(s)
- Dylan K Richards
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico, United States.
| | - Matthew R Pearson
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico, United States
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States
| | - Nick Heather
- Department of Psychology, Northumbria University, United Kingdom
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, And Addictions (CASAA), University of New Mexico, United States; Department of Psychology, University of New Mexico, United States
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Shorter GW, Bray JW, Heather N, Berman AH, Giles EL, Clarke M, Barbosa C, O'Donnell AJ, Holloway A, Riper H, Daeppen JB, Monteiro MG, Saitz R, McNeely J, McKnight-Eily L, Cowell A, Toner P, Newbury-Birch D. The "Outcome Reporting in Brief Intervention Trials: Alcohol" (ORBITAL) Core Outcome Set: International Consensus on Outcomes to Measure in Efficacy and Effectiveness Trials of Alcohol Brief Interventions. J Stud Alcohol Drugs 2021; 82:638-646. [PMID: 34546911 PMCID: PMC8819610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/07/2021] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVE The purpose of this study was to report the "Outcome Reporting in Brief Intervention Trials: Alcohol" (ORBITAL) recommended core outcome set (COS) to improve efficacy and effectiveness trials/evaluations for alcohol brief interventions (ABIs). METHOD A systematic review identified 2,641 outcomes in 401 ABI articles measured by 1,560 different approaches. These outcomes were classified into outcome categories, and 150 participants from 19 countries participated in a two-round e-Delphi outcome prioritization exercise. This process prioritized 15 of 93 outcome categories for discussion at a consensus meeting of key stakeholders to decide the COS. A psychometric evaluation determined how to measure the outcomes. RESULTS Ten outcomes were voted into the COS at the consensus meeting: (a) typical frequency, (b) typical quantity, (c) frequency of heavy episodic drinking, (d) combined consumption measure summarizing alcohol use, (e) hazardous or harmful drinking (average consumption), (f) standard drinks consumed in the past week (recent, current consumption), (g) alcohol-related consequences, (h) alcohol-related injury, (i) use of emergency health care services (impact of alcohol use), and (j) quality of life. CONCLUSIONS The ORBITAL COS is an international consensus standard for future ABI trials and evaluations. It can improve the synthesis of new findings, reduce redundant/selective reporting (i.e., reporting only some, usually significant outcomes), improve between-study comparisons, and enhance the relevance of trial and evaluation findings to decision makers. The COS is the recommended minimum and does not exclude other, additional outcomes.
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Affiliation(s)
- Gillian W. Shorter
- Centre for Improving Health Related Quality of Life, School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
- Drug and Alcohol Research Network, Queen’s University Belfast, Belfast, United Kingdom
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, United Kingdom
| | - Jeremy W. Bray
- Department of Economics, Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Nick Heather
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Anne H. Berman
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Emma L. Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen’s University Belfast, Belfast, United Kingdom
| | - Carolina Barbosa
- Behavioral Health Economics Program, RTI International, Research Triangle Park, North Carolina
| | - Amy J. O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Aisha Holloway
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Heleen Riper
- Faculty of Behavioural and Movement Sciences, Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jean-Bernard Daeppen
- Département universitaire de médecine et santé communautaires (DUMSC), Lausanne University Hospital, Lausanne, Switzerland
| | | | - Richard Saitz
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, School of Medicine, Boston University, Boston, Massachusetts
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
| | - Jennifer McNeely
- New York University Grossman School of Medicine, New York, New York
| | | | - Alex Cowell
- Behavioral Health Economics Program, RTI International, Research Triangle Park, North Carolina
| | - Paul Toner
- Centre for Improving Health Related Quality of Life, School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
| | - Dorothy Newbury-Birch
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, United Kingdom
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Shorter GW, Bray JW, Heather N, Berman AH, Giles EL, Clarke M, Barbosa C, O'Donnell AJ, Holloway A, Riper H, Daeppen JB, Monteiro MG, Saitz R, McNeely J, McKnight-Eily L, Cowell A, Toner P, Newbury-Birch D. The “Outcome Reporting in Brief Intervention Trials: Alcohol” (ORBITAL) Core Outcome Set: International Consensus on Outcomes to Measure in Efficacy and Effectiveness Trials of Alcohol Brief Interventions. J Stud Alcohol Drugs 2021. [PMID: 34546911 PMCID: PMC8819610 DOI: 10.15288/jsad.2021.82.638] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: The purpose of this study was to report the “Outcome Reporting in Brief Intervention Trials: Alcohol” (ORBITAL) recommended core outcome set (COS) to improve efficacy and effectiveness trials/evaluations for alcohol brief interventions (ABIs). Method: A systematic review identified 2,641 outcomes in 401 ABI articles measured by 1,560 different approaches. These outcomes were classified into outcome categories, and 150 participants from 19 countries participated in a two-round e-Delphi outcome prioritization exercise. This process prioritized 15 of 93 outcome categories for discussion at a consensus meeting of key stakeholders to decide the COS. A psychometric evaluation determined how to measure the outcomes. Results: Ten outcomes were voted into the COS at the consensus meeting: (a) typical frequency, (b) typical quantity, (c) frequency of heavy episodic drinking, (d) combined consumption measure summarizing alcohol use, (e) hazardous or harmful drinking (average consumption), (f) standard drinks consumed in the past week (recent, current consumption), (g) alcohol-related consequences, (h) alcohol-related injury, (i) use of emergency health care services (impact of alcohol use), and (j) quality of life. Conclusions: The ORBITAL COS is an international consensus standard for future ABI trials and evaluations. It can improve the synthesis of new findings, reduce redundant/selective reporting (i.e., reporting only some, usually significant outcomes), improve between-study comparisons, and enhance the relevance of trial and evaluation findings to decision makers. The COS is the recommended minimum and does not exclude other, additional outcomes.
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Affiliation(s)
- Gillian W. Shorter
- Centre for Improving Health Related Quality of Life, School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
- Drug and Alcohol Research Network, Queen’s University Belfast, Belfast, United Kingdom
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, United Kingdom
| | - Jeremy W. Bray
- Department of Economics, Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Nick Heather
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Anne H. Berman
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Emma L. Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen’s University Belfast, Belfast, United Kingdom
| | - Carolina Barbosa
- Behavioral Health Economics Program, RTI International, Research Triangle Park, North Carolina
| | - Amy J. O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Aisha Holloway
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Heleen Riper
- Faculty of Behavioural and Movement Sciences, Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jean-Bernard Daeppen
- Département universitaire de médecine et santé communautaires (DUMSC), Lausanne University Hospital, Lausanne, Switzerland
| | | | - Richard Saitz
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, School of Medicine, Boston University, Boston, Massachusetts
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
| | - Jennifer McNeely
- New York University Grossman School of Medicine, New York, New York
| | | | - Alex Cowell
- Behavioral Health Economics Program, RTI International, Research Triangle Park, North Carolina
| | - Paul Toner
- Centre for Improving Health Related Quality of Life, School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
| | - Dorothy Newbury-Birch
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, United Kingdom
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Heather N. Let's not turn back the clock: Comments on Kelly et al., "Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers". Alcohol Alcohol 2021; 56:377-379. [PMID: 33316028 DOI: 10.1093/alcalc/agaa137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nick Heather
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
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Witkiewitz K, Heather N, Falk DE, Litten RZ, Hasin DS, Kranzler HR, Mann KF, O'Malley SS, Anton RF. World Health Organization risk drinking level reductions are associated with improved functioning and are sustained among patients with mild, moderate and severe alcohol dependence in clinical trials in the United States and United Kingdom. Addiction 2020; 115:1668-1680. [PMID: 32056311 PMCID: PMC7841874 DOI: 10.1111/add.15011] [Citation(s) in RCA: 33] [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: 07/26/2019] [Revised: 11/11/2019] [Accepted: 02/10/2020] [Indexed: 02/04/2023]
Abstract
AIMS To examine whether World Health Organization (WHO) risk-level reductions in drinking were achievable, associated with improved functioning and maintained over time among patients at varying initial alcohol dependence severity levels. Design and setting Secondary data analysis of multi-site randomized clinical trials: the US Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study and the UK Alcohol Treatment Trial (UKATT). PARTICIPANTS Individuals with alcohol dependence enrolled in COMBINE (n = 1383; 68.8% male) and seeking treatment for alcohol problems in UKATT (n = 742; 74.1% male). Interventions Naltrexone, acamprosate or placebo, and combined behavioral intervention or medication management in COMBINE. Social behavior network therapy or motivational enhancement therapy in UKATT. MEASUREMENTS WHO risk-level reductions were assessed via the calendar method. Alcohol dependence was measured by the Alcohol Dependence Scale, the Leeds Dependence Questionnaire and the Diagnostic and Statistical Manual of Mental Disorders. Measures of functioning included alcohol-related consequences (Drinker Inventory of Consequences and Alcohol Problems Questionnaire), mental health (Short Form Health Survey) and liver enzyme tests. FINDINGS One- and two-level reductions in WHO risk levels in the last month of treatment were maintained at the 1-year follow-up [adjusted odds ratio (OR), 95% confidence interval (CI) = one-level reduction in COMBINE: 3.51 (2.73, 4.29) and UKATT: 2.65 (2.32, 2.98)] and associated with fewer alcohol-related consequences [e.g. B, 95% CI = one-level reduction COMBINE: -26.22 (-30.62, -21.82)], better mental health [e.g. B, 95% CI = one-level reduction UKATT: 9.53 (7.36, 11.73)] and improvements in γ-glutamyltransferase [e.g. B, 95% CI = one-level reduction UKATT: -89.77 (-122.50, -57.04)] at the end of treatment, even among patients with severe alcohol dependence. Results were similar when abstainers were excluded. Conclusions Reductions in World Health Organization risk levels for alcohol consumption appear to be achievable, associated with better functioning and maintained over time in both the United States and the United Kingdom.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque NM, USA
| | - Nick Heather
- Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Daniel E. Falk
- National Institute on Alcohol Abuse and Alcoholism Bethesda MD USA
| | - Raye Z. Litten
- National Institute on Alcohol Abuse and Alcoholism Bethesda MD USA
| | | | - Henry R. Kranzler
- Department of Psychiatry University of Pennsylvania Philadelphia PA USA
| | - Karl F. Mann
- Central Institute of Mental Health, Medical Faculty Mannheim Heidelberg University Mannheim Germany
| | | | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences Medical University of South Carolina Charleston SC USA
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Heather N. The concept of akrasia as the foundation for a dual systems theory of addiction. Behav Brain Res 2020; 390:112666. [PMID: 32437886 DOI: 10.1016/j.bbr.2020.112666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/22/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022]
Abstract
The aim of this article is to argue that the ancient concept of akrasia can serve as the conceptual foundation and theoretical justification for a dual systems theory of addiction. Akrasia refers to acting against one's better judgement and thus to behaviour that agents know is bad for them and have previously resolved to abjure, addiction being seen as an extreme form of akrasia. In this way akrasia can provide the basis for accounts of addictive behaviour that stress its inconsistency over time and the great difficulty addicts experience in changing it. A definition of addiction consistent with this view is offered and defended, and some of its general advantages for understanding and responding to addiction described. A consequence of defining addiction in this way is that it should be seen as a disorder of choice or, alternatively, of self-regulation, and reasons are given why the latter term should be preferred. It is then proposed that the concept of akrasia and the perspective on addiction that follows from it lead logically to the need for a dual systems theory of addiction. Although no such theory is presented here, terminological issues are clarified, criticisms of dual systems theories are noted, and a rudimentary description of what an integrated dual systems theory of addiction might look like is provided.
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Affiliation(s)
- Nick Heather
- Department of Psychology, Northumbria University, 8 Roseworth Terrace, NE3 1LU, Newcastle upon Tyne, UK.
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Morris J, Albery IP, Heather N, Moss AC. Continuum beliefs are associated with higher problem recognition than binary beliefs among harmful drinkers without addiction experience. Addict Behav 2020; 105:106292. [PMID: 32007833 DOI: 10.1016/j.addbeh.2020.106292] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 11/18/2022]
Abstract
Low problem recognition may be an important barrier to opportunities for self-change or help-seeking in harmful drinkers. Little is known about how the beliefs harmful drinkers hold about the nature and causes of alcohol problems affect problem recognition and subsequent behaviour change processes. Participants (n = 597) recruited online were randomised to one of two conditions designed to promote beliefs according to (a) a continuum model of alcohol problems or (b) a binary disease model, or (c) a control condition. Participants completed measures of alcohol problem beliefs, problem recognition and other indices including the Alcohol Use Disorder Identification Test (AUDIT), addiction beliefs, addiction experience and demographics. Results showed that harmful drinkers without addiction experience exposed to the continuum condition had significantly higher problem recognition than those in binary disease model or control conditions. Continuum beliefs appear to offer self-evaluative benefits for harmful drinkers with low alcohol problem recognition, thus potentially facilitating help-seeking or self-change regarding alcohol use. Further research to understand the mechanisms by which continuum beliefs may promote more accurate drinking self-evaluation and its potential for behaviour change is warranted. The role of continuum beliefs may have important consequences for alcohol-related messaging and interventions seeking to promote self-change or help-seeking.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom.
| | - I P Albery
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - N Heather
- Faculty of Health & Life Sciences, Northumbria University, United Kingdom
| | - A C Moss
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
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Field M, Heather N, Murphy JG, Stafford T, Tucker JA, Witkiewitz K. Recovery from addiction: Behavioral economics and value-based decision making. Psychol Addict Behav 2019; 34:182-193. [PMID: 31599604 DOI: 10.1037/adb0000518] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Behavioral economics provides a general framework to explain the shift in behavioral allocation from substance use to substance-free activities that characterizes recovery from addiction, but it does not attempt to explain the internal processes that prompt those behavioral changes. In this article we outline a novel analysis of addiction recovery based on computational work on value-based decision making (VBDM), which can explain how people with addiction are able to overcome the reinforcement pathologies and decision-making vulnerabilities that characterize the disorder. The central tenet of this account is that shifts in molar reinforcer preferences over time from substance use to substance-free activities can be attributed to changes in evidence accumulation rates and response thresholds in the context of choices involving substance use and substance-free alternatives. We discuss how this account can be reconciled with the established mechanisms of action of psychosocial interventions for addiction and demonstrate how it has the potential to empirically address longstanding debates regarding the nature of impairments to self-control in addiction. We also highlight conceptual and methodological issues that require careful consideration in translating VBDM to addiction and recovery. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Shorter GW, Bray JW, Giles EL, O’Donnell AJ, Berman AH, Holloway A, Heather N, Barbosa C, Stockdale KJ, Scott SJ, Clarke M, Newbury-Birch D. The Variability of Outcomes Used in Efficacy and Effectiveness Trials of Alcohol Brief Interventions: A Systematic Review. J Stud Alcohol Drugs 2019. [DOI: 10.15288/jsad.2019.80.286] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Gillian W. Shorter
- Institute of Mental Health Sciences, School of Psychology, Ulster University, Coleraine, Northern Ireland
- School of Health and Social Care, Teesside University, Middlesbrough, England
| | - Jeremy W. Bray
- Department of Economics, Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Emma L. Giles
- School of Health and Social Care, Teesside University, Middlesbrough, England
| | - Amy J. O’Donnell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
| | - Anne H. Berman
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Aisha Holloway
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Nick Heather
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, England
| | - Carolina Barbosa
- Behavioral Health Economics Program, RTI International, Chicago, Illinois
| | - Kelly J. Stockdale
- School of Psychological and Social Sciences, York St. John University,York, England
| | - Stephanie J. Scott
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, England
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen’s University Belfast, Belfast, Northern Ireland
| | - Dorothy Newbury-Birch
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, England
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Shorter GW, Bray JW, Giles EL, O'Donnell AJ, Berman AH, Holloway A, Heather N, Barbosa C, Stockdale KJ, Scott SJ, Clarke M, Newbury-Birch D. The Variability of Outcomes Used in Efficacy and Effectiveness Trials of Alcohol Brief Interventions: A Systematic Review. J Stud Alcohol Drugs 2019; 80:286-298. [PMID: 31250793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE The purpose of this study was to characterize recent alcohol brief intervention (ABI) efficacy and effectiveness trials, summarize outcomes, and show how variability in outcomes and reporting compromises the evidence base. METHOD A systematic review and narrative synthesis of articles from 10 databases were undertaken (January 2000-November 2017); study selection represented recent, readily available publications. The National Institute of Care Excellence (NICE) Public Health Guideline 24 (Alcohol use disorders: prevention) informed ABI definitions. The review was conducted using Centre for Reviews and Dissemination (CRD) guidance and pre-registered on PROSPERO (CRD42016047185). Seven a priori specified domains were used to classify outcomes: biomarkers, alcohol-related outcomes, economic factors/resource use, health measures, life impact, intervention factors, and psychological/behavioral factors. RESULTS The search identified 405 trials from 401 eligible papers. In 405 trials, 2,641 separate outcomes were measured in approximately 1,560 different ways. The most common outcomes used were the number of drinks consumed in a week and frequency of heavy episodic drinking. Biomarkers were least frequently used. The most common primary outcome was weekly drinks. By trial type, the most frequent outcome in efficacy and effectiveness trials was frequency of heavy drinking. CONCLUSIONS Consumption outcomes predominated; however, no single outcome was found in all trials. This comprehensive outcome map and methodological detail on ABI effectiveness and efficacy trials can aid decision making in future trials. There was a diversity of instruments, time points, and outcome descriptions in methods and results sections. Compliance with reporting guidance would support data synthesis and improve trial quality. This review establishes the need for a core outcome set (COS)/minimum data standard and supports the Outcome Reporting in Brief Interventions: Alcohol initiative (ORBITAL) to improve standards in the ABI field through a COS for effectiveness and efficacy randomized trials.
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Affiliation(s)
- Gillian W Shorter
- Institute of Mental Health Sciences, School of Psychology, Ulster University, Coleraine, Northern Ireland
- School of Health and Social Care, Teesside University, Middlesbrough, England
| | - Jeremy W Bray
- Department of Economics, Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Emma L Giles
- School of Health and Social Care, Teesside University, Middlesbrough, England
| | - Amy J O'Donnell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
| | - Anne H Berman
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Aisha Holloway
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Nick Heather
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, England
| | - Carolina Barbosa
- Behavioral Health Economics Program, RTI International, Chicago, Illinois
| | - Kelly J Stockdale
- School of Psychological and Social Sciences, York St. John University, York, England
| | - Stephanie J Scott
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, England
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen's University Belfast, Belfast, Northern Ireland
| | - Dorothy Newbury-Birch
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, England
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Shorter GW, Heather N, Bray JW, Berman AH, Giles EL, O'Donnell AJ, Barbosa C, Clarke M, Holloway A, Newbury-Birch D. Prioritization of Outcomes in Efficacy and Effectiveness of Alcohol Brief Intervention Trials: International Multi-Stakeholder e-Delphi Consensus Study to Inform a Core Outcome Set. J Stud Alcohol Drugs 2019; 80:299-309. [PMID: 31250794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE Outcomes used in alcohol brief intervention trials vary considerably. Achieving consensus about key outcomes can enhance evidence synthesis and improve healthcare guidelines. This international, e-Delphi study sought to prioritize outcomes for alcohol brief intervention trials as part of a larger program of work develop an alcohol brief intervention core outcome set. METHOD In total, 150 registrants from 19 countries, representing researchers, policymakers, and patients, participated in a two-round e-Delphi study. In Round 1, participants (n = 137) rated 86 outcomes, derived from a review of the literature and a patient and public involvement panel, by importance. In Round 2, participants (n = 114) received feedback on importance ratings for each outcome, and a reminder of their personal rating, before rating the outcomes for importance a second time. Seven additional outcomes suggested in Round 1 were added to the Round 2 questionnaire. We defined consensus a priori as 70% agreement across all stakeholder groups. RESULTS Seven consumption outcomes met inclusion criteria: typical frequency, typical quantity, frequency of heavy drinking, alcohol-related problems, weekly drinks, at-risk drinking, and combined consumption measures. Others meeting the threshold were alcohol-related injury, quality of life, readiness to change, and intervention fidelity. CONCLUSIONS This is the first international e-Delphi study to identify and prioritize outcomes for use in alcohol brief intervention trials. The use and reporting of outcomes in future alcohol brief intervention trials should improve evidence synthesis in systematic reviews and meta-analyses. Further work is required to refine these outcomes into a core outcome set that includes guidance for measurement of outcomes.
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Affiliation(s)
- Gillian W Shorter
- Institute for Mental Health Sciences, School of Psychology, Ulster University, Coleraine, Northern Ireland
- School of Health and Social Care, Teesside University, Middlesbrough, England
| | - Nick Heather
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, England
| | - Jeremy W Bray
- Bryan School of Business & Economics, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Anne H Berman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Emma L Giles
- School of Health and Social Care, Teesside University, Middlesbrough, England
| | - Amy J O'Donnell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, England
| | - Carolina Barbosa
- Behavioral Health Economics Program, RTI International, Chicago, Illinois
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen's University of Belfast, Belfast, Northern Ireland
| | - Aisha Holloway
- Nursing Studies, School of Health in Social Sciences, The University of Edinburgh, Edinburgh, Scotland
| | - Dorothy Newbury-Birch
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, England
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Coulton S, Dale V, Deluca P, Gilvarry E, Godfrey C, Kaner E, McGovern R, Newbury-Birch D, Patton R, Parrott S, Perryman K, Phillips T, Shepherd J, Drummond C, Heather N. Corrigendum: Screening for At-Risk Alcohol Consumption in Primary Care: A Randomized Evaluation of Screening Approaches. Alcohol Alcohol 2018; 53:499. [PMID: 29617716 DOI: 10.1093/alcalc/agy022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Indexed: 11/13/2022] Open
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Abstract
OBJECTIVE To determine whether treatment outcomes are mediated by therapist behaviors consistent with the theoretical postulates on which two contrasting treatments are based. METHOD We used data from the U.K. Alcohol Treatment Trial (UKATT), a pragmatic, multicenter, randomized controlled trial comparing the effectiveness of Motivational Enhancement Therapy (MET) and Social Behavior and Network Therapy (SBNT) in the treatment of alcohol problems. N = 376 clients (mean age 42.5, 74.5% male) had 12-month follow-up data and one treatment session recorded and coded using the UKATT Process Rating Scale, a reliable manual-based assessment of treatment fidelity including frequency and quality ratings of treatment-specific therapist tasks and therapist styles. Analyses were conducted using a mediation framework. RESULTS Analysis of individual paths from treatment condition to treatment process indices (a path) and from treatment process indices to alcohol outcomes (b path) showed that (a) SBNT therapists more often used SBNT-specific behaviors, and did so with overall higher quality; (b) MET therapists more often used MET-specific behaviors, but there was no evidence that they performed these behaviors with higher quality than SBNT therapists; (c) only the quality of MET behaviors significantly predicted 12-month alcohol outcomes, irrespective of treatment condition. Consistently, there were no significant indirect effects. Multiple component analysis indicated that therapist quality of specific tasks influenced outcomes. CONCLUSIONS The quality of delivery of the same treatment tasks in both treatments studied transcended the impact of delivering treatments according to different theoretical underpinnings in UKATT. (PsycINFO Database Record
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Affiliation(s)
- Jacques Gaume
- Alcohol Treatment Centre, Lausanne University Hospital
| | - Nick Heather
- Department of Psychology, Northumbria University
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21
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Dienes Z, Coulton S, Heather N. Using Bayes factors to evaluate evidence for no effect: examples from the SIPS project. Addiction 2018; 113:240-246. [PMID: 28804980 DOI: 10.1111/add.14002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 04/07/2017] [Revised: 06/20/2017] [Accepted: 08/08/2017] [Indexed: 11/29/2022]
Abstract
AIMS To illustrate how Bayes factors are important for determining the effectiveness of interventions. METHOD We consider a case where inappropriate conclusions were drawn publicly based on significance testing, namely the SIPS project (Screening and Intervention Programme for Sensible drinking), a pragmatic, cluster-randomized controlled trial in each of two health-care settings and in the criminal justice system. We show how Bayes factors can disambiguate the non-significant findings from the SIPS project and thus determine whether the findings represent evidence of absence or absence of evidence. We show how to model the sort of effects that could be expected, and how to check the robustness of the Bayes factors. RESULTS The findings from the three SIPS trials taken individually are largely uninformative but, when data from these trials are combined, there is moderate evidence for a null hypothesis (H0) and thus for a lack of effect of brief intervention compared with simple clinical feedback and an alcohol information leaflet (B = 0.24, P = 0.43). CONCLUSION Scientists who find non-significant results should suspend judgement-unless they calculate a Bayes factor to indicate either that there is evidence for a null hypothesis (H0) over a (well-justified) alternative hypothesis (H1), or that more data are needed.
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Affiliation(s)
- Zoltan Dienes
- School of Psychology, University of Sussex, Brighton, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Nick Heather
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
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22
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Raistrick D, Tober G, Heather N, Clark JA. Validation of the Social Satisfaction Questionnaire for outcome evaluation in substance use disorders. Psychiatr bull 2018. [DOI: 10.1192/pb.bp.106.014258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo develop a scale to measure social satisfaction in people with substance use disorders and to test its psychometric properties. The rationale is that social satisfaction is more universal and relevant to treatment planning than assessing social problems. The new Social Satisfaction Questionnaire (SSQ) was derived from an existing social problems questionnaire and validation was undertaken on two large clinic populations.ResultsAn eight-item SSQ was tested and found to have good psychometric properties in terms of test–retest reliability, internal consistency, distribution of responses and concurrent validity.Clinical ImplicationsThe SSQ is suitable for use as the social domain element of an outcome measures package.
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23
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Gavin J, Ashton JJ, Heather N, Marino LV, Beattie RM. Nutritional support in paediatric Crohn's disease: outcome at 12 months. Acta Paediatr 2018; 107:156-162. [PMID: 28901585 DOI: 10.1111/apa.14075] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/10/2017] [Accepted: 09/08/2017] [Indexed: 12/22/2022]
Abstract
AIM Paediatric Crohn's disease (CD) is associated with growth delay and poor nutritional status. Maintenance enteral nutrition (MEN) supplementation is a potential adjunct to improve growth/prolong remission. METHODS Newly diagnosed CD patients were identified. Anthropometry, treatments and outcomes were collected for 12 months following diagnosis. Data are presented as medians. RESULTS A total of 102 patients were identified (age = 13 years, 76% male), 58 (57%) completed exclusive enteral nutrition (EEN) as induction therapy, and 77 (75%) entered clinical remission. Following induction, 58 (57%) of all patients continued MEN and 44 (43%) consumed normal diet (ND). BMI Z-score increased (diagnosis-12 months) for EEN (-1.41 to -0.21 (p = <0.0001)) and steroid groups (-0.97 to -0.11 (p = 0.001)). BMI Z-score increased (post induction - 12 months) for MEN (-0.62 to -0.44 (p = 0.04)) but not ND (-0.33 to -0.4 (p = 0.79)). Height Z-score did not increase for any treatment group over 12 months. MEN and ND group relapse rates were similar at six months, MEN = 21/58 (36%); ND = 21/44 (48%) (p = 0.24) and 12 months, MEN = 24/58 (41%); ND = 13/44 (30%) (p = 0.22). Fewer patients treated with EEN then MEN relapsed less than six months, 14 of 43 (33%), compared to patients treated with steroids then ND 16/29 (55%) (p = 0.09). CONCLUSION BMI Z-score increased but height Z-score remained unchanged over 12 months for the MEN group. Use of MEN was not associated with prolonged time to relapse. Prospective studies are required to examine the utility of MEN.
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Affiliation(s)
- J Gavin
- Department of Dietetics; University Hospital Southampton Foundation NHS Trust; Southampton UK
| | - JJ Ashton
- Department of Paediatric Gastroenterology; Southampton Children's Hospital; University Hospitals Southampton; Southampton UK
- Department of Human Genetics and Genomic Medicine; University of Southampton; Southampton UK
| | - N Heather
- Department of Dietetics; University Hospital Southampton Foundation NHS Trust; Southampton UK
| | - LV Marino
- Department of Dietetics; University Hospital Southampton Foundation NHS Trust; Southampton UK
| | - RM Beattie
- Department of Paediatric Gastroenterology; Southampton Children's Hospital; University Hospitals Southampton; Southampton UK
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Shorter GW, Heather N, Bray JW, Giles EL, Holloway A, Barbosa C, Berman AH, O'Donnell AJ, Clarke M, Stockdale KJ, Newbury-Birch D. The 'Outcome Reporting in Brief Intervention Trials: Alcohol' (ORBITAL) framework: protocol to determine a core outcome set for efficacy and effectiveness trials of alcohol screening and brief intervention. Trials 2017; 18:611. [PMID: 29273070 PMCID: PMC5741954 DOI: 10.1186/s13063-017-2335-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/31/2017] [Indexed: 11/12/2022] Open
Abstract
Background The evidence base to assess the efficacy and effectiveness of alcohol brief interventions (ABI) is weakened by variation in the outcomes measured and by inconsistent reporting. The ‘Outcome Reporting in Brief Intervention Trials: Alcohol’ (ORBITAL) project aims to develop a core outcome set (COS) and reporting guidance for its use in future trials of ABI in a range of settings. Methods/design An international Special Interest Group was convened through INEBRIA (International Network on Brief Interventions for Alcohol and Other Drugs) to inform the development of a COS for trials of ABI. ORBITAL will incorporate a systematic review to map outcomes used in efficacy and effectiveness trials of ABI and their measurement properties, using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. This will support a multi-round Delphi study to prioritise outcomes. Delphi panellists will be drawn from a range of settings and stakeholder groups, and the Delphi study will also be used to determine if a single COS is relevant for all settings. A consensus meeting with key stakeholder representation will determine the final COS and associated guidance for its use in trials of ABI. Discussion ORBITAL will develop a COS for alcohol screening and brief intervention trials, with outcomes stratified into domains and guidance on outcome measurement instruments. The standardisation of ABI outcomes and their measurement will support the ongoing development of ABI studies and a systematic synthesis of emerging research findings. We will track the extent to which the COS delivers on this promise through an exploration of the use of the guidance in the decade following COS publication.
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Affiliation(s)
- G W Shorter
- Alcohol and Public Health Research Team, School of Health and Social Care, Teesside University, Middlesbrough, UK.,Psychotraumatology, Mental Health & Suicidal Behaviour Research Group, Psychology Research Institute, Ulster University, Coleraine, UK.,Inspire, Belfast, UK.,College of Medicine, Biology and Environment, Australian National University, Canberra, ACT, Australia
| | - N Heather
- Faculty of Health and Life Science, Northumbria University, Newcastle upon Tyne, UK
| | - Jeremy W Bray
- Department of Economics, Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, NC, USA.
| | - E L Giles
- Alcohol and Public Health Research Team, School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - A Holloway
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - C Barbosa
- Behavioral Health Economics Program, RTI International, Chicago, IL, USA
| | - A H Berman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - A J O'Donnell
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - M Clarke
- Northern Ireland Methodology Hub, Queen's University of Belfast, Belfast, UK
| | - K J Stockdale
- Alcohol and Public Health Research Team, School of Health and Social Care, Teesside University, Middlesbrough, UK.,School of Psychological and Social Sciences, York St. John University, York, UK
| | - D Newbury-Birch
- Alcohol and Public Health Research Team, School of Health and Social Care, Teesside University, Middlesbrough, UK
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Heather N. Is the concept of compulsion useful in the explanation or description of addictive behaviour and experience? Addict Behav Rep 2017; 6:15-38. [PMID: 29450234 PMCID: PMC5800587 DOI: 10.1016/j.abrep.2017.05.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 05/09/2017] [Accepted: 05/14/2017] [Indexed: 12/21/2022] Open
Abstract
The concept of compulsion, in which addictive behaviour is said to be carried out against the will, is central to the disease theory of addiction and ubiquitous in modern definitions. The aims of this article are: (i) to describe various meanings of compulsion in the literature; (ii) to compare the part thought to be played by compulsion in addiction with its suggested role in obsessive-compulsive disorder; (iii) to critically examine the place of compulsion in influential neurobiological accounts of addiction; (iv) to summarise the empirical evidence bearing on the usefulness of the compulsion concept, evidence that seems at first sight incompatible with the notion of compulsion. This is followed by a discussion of which possible meanings of compulsion can survive an empirical test and what role they might play in understanding addiction, paying particular attention to a distinction between strong and weak senses of compulsion. A conclusion is that addictive behaviour cannot be considered compulsive at the time it is carried out, though other possible meanings of compulsion as an explanation or description of addictive behaviour and experience are discussed. Among other conclusions, it is suggested that, although in some senses of the term it may seem arbitrary whether or not 'compulsion' should be retained, its use has important consequences for the public understanding of addiction, and is likely to deter people's attempts to overcome their addictions and their chances of success.
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Witkiewitz K, Pearson MR, Hallgren KA, Maisto SA, Roos CR, Kirouac M, Wilson AD, Montes KA, Heather N. Who achieves low risk drinking during alcohol treatment? An analysis of patients in three alcohol clinical trials. Addiction 2017; 112:2112-2121. [PMID: 28511286 PMCID: PMC5673549 DOI: 10.1111/add.13870] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 12/18/2016] [Revised: 02/08/2017] [Accepted: 05/05/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS There is evidence that low-risk drinking is possible during the course of alcohol treatment and can be maintained following treatment. Our aim was to identify characteristics associated with low-risk drinking during treatment in a large sample of individuals as they received treatment for alcohol dependence. DESIGN Integrated analysis of data from the Combined Pharmacotherapies and Behavioral Intervention (COMBINE) study, Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) and the United Kingdom Alcohol Treatment Trial (UKATT) using repeated-measures latent class analysis to identify patterns of drinking and predictors of low-risk drinking patterns during treatment. SETTING United States and United Kingdom. PARTICIPANTS Patients (n = 3589) with alcohol dependence receiving treatment in an alcohol clinical trial were primarily male (73.0%), white (82.0%) and non-married (41.7%), with an average age of 42.0 (standard deviation = 10.7). MEASUREMENTS Self-reported weekly alcohol consumption during treatment was assessed using the Form-90 and validated with biological verification or collateral informants. FINDINGS Seven patterns of drinking during treatment were identified: persistent heavy drinking (18.7% of the sample), increasing heavy drinking (9.6%), heavy and low-risk drinking (6.7%), heavy drinking alternating with abstinence (7.9%), low-risk drinking (6.8%), increasing low-risk drinking (10.5%) and abstinence (39.8%). Lower alcohol dependence severity and fewer drinks per day at baseline significantly predicted low-risk drinking patterns [e.g. each additional drink prior to baseline predicted a 27% increase in the odds of expected classification in heavy drinking versus low-risk drinking patterns; odds ratio = 1.27 (95% confidence interval (CI) = 1.10, 1.47, P = 0.002]. Greater negative mood and more heavy drinkers in the social network were significant predictors of expected membership in heavier drinking patterns. CONCLUSIONS Low-risk drinking is achievable for some individuals as they undergo treatment for alcohol dependence. Individuals with lower dependence severity, less baseline drinking, fewer negative mood symptoms and fewer heavy drinkers in their social networks have a higher probability of achieving low-risk drinking during treatment.
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Holloway AS, Ferguson J, Landale S, Cariola L, Newbury-Birch D, Flynn A, Knight JR, Sherritt L, Harris SK, O’Donnell AJ, Kaner E, Hanratty B, Loree AM, Yonkers KA, Ondersma SJ, Gilstead-Hayden K, Martino S, Adam A, Schwartz RP, Wu LT, Subramaniam G, Sharma G, McNeely J, Berman AH, Kolaas K, Petersén E, Bendtsen P, Hedman E, Linderoth C, Müssener U, Sinadinovic K, Spak F, Gremyr I, Thurang A, Mitchell AM, Finnell D, Savage CL, Mahmoud KF, Riordan BC, Conner TS, Flett JAM, Scarf D, McRee B, Vendetti J, Gallucci KS, Robaina K, Clark BJ, Jones J, Reed KD, Hodapp RM, Douglas I, Burnham EL, Aagaard L, Cook PF, Harris BR, Yu J, Wolff M, Rogers M, Barbosa C, Wedehase BJ, Dunlap LJ, Mitchell SG, Dusek KA, Gryczynski J, Kirk AS, Oros MT, Hosler C, O’Grady KE, Brown BS, Angus C, Sherborne S, Gillespie D, Meier P, Brennan A, de Vargas D, Soares J, Castelblanco D, Doran KM, Wittman I, Shelley D, Rotrosen J, Gelberg L, Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Deng Y, Dziura J, Fiellin LE, O’Connor PG, Bedimo R, Gibert C, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Justice AC, Bryant KJ, Fiellin DA, Giles EL, Coulton S, Deluca P, Drummond C, Howel D, McColl E, McGovern R, Scott S, Stamp E, Sumnall H, Vale L, Alabani V, Atkinson A, Boniface S, Frankham J, Gilvarry E, Hendrie N, Howe N, McGeechan GJ, Ramsey A, Stanley G, Clephane J, Gardiner D, Holmes J, Martin N, Shevills C, Soutar M, Chi FW, Weisner C, Ross TB, Mertens J, Sterling SA, Shorter GW, Heather N, Bray J, Cohen HA, McPherson TL, Adam C, López-Pelayo H, Gual A, Segura-Garcia L, Colom J, Ornelas IJ, Doyle S, Donovan D, Duran B, Torres V, Gaume J, Grazioli V, Fortini C, Paroz S, Bertholet N, Daeppen JB, Satterfield JM, Gregorich S, Alvarado NJ, Muñoz R, Kulieva G, Vijayaraghavan M, Adam A, Cunningham JA, Díaz E, Palacio-Vieira J, Godinho A, Kushir V, O’Brien KHM, Aguinaldo LD, Sellers CM, Spirito A, Chang G, Blake-Lamb T, LaFave LRA, Thies KM, Pepin AL, Sprangers KE, Bradley M, Jorgensen S, Catano NA, Murray AR, Schachter D, Andersen RM, Rey GN, Vahidi M, Rico MW, Baumeister SE, Johansson M, Sinadinovic C, Hermansson U, Andreasson S, O’Grady MA, Kapoor S, Akkari C, Bernal C, Pappacena K, Morley J, Auerbach M, Neighbors CJ, Kwon N, Conigliaro J, Morgenstern J, Magill M, Apodaca TR, Borsari B, Hoadley A, Scott Tonigan J, Moyers T, Fitzgerald NM, Schölin L, Barticevic N, Zuzulich S, Poblete F, Norambuena P, Sacco P, Ting L, Beaulieu M, Wallace PG, Andrews M, Daley K, Shenker D, Gallagher L, Watson R, Weaver T, Bruguera P, Oliveras C, Gavotti C, Barrio P, Braddick F, Miquel L, Suárez M, Bruguera C, Brown RL, Capell JW, Paul Moberg D, Maslowsky J, Saunders LA, McCormack RP, Scheidell J, Gonzalez M, Bauroth S, Liu W, Lindsay DL, Lincoln P, Hagle H, Wallhed Finn S, Hammarberg A, Andréasson S, King SE, Vargo R, Kameg BN, Acquavita SP, Van Loon RA, Smith R, Brehm BJ, Diers T, Kim K, Barker A, Jones AL, Skinner AC, Hinman A, Svikis DS, Thacker CL, Resnicow K, Beatty JR, Janisse J, Puder K, Bakshi AS, Milward JM, Kimergard A, Garnett CV, Crane D, Brown J, West R, Michie S, Rosendahl I, Andersson C, Gajecki M, Blankers M, Donoghue K, Lynch E, Maconochie I, Phillips C, Pockett R, Phillips T, Patton R, Russell I, Strang J, Stewart MT, Quinn AE, Brolin M, Evans B, Horgan CM, Liu J, McCree F, Kanovsky D, Oberlander T, Zhang H, Hamlin B, Saunders R, Barton MB, Scholle SH, Santora P, Bhatt C, Ahmed K, Hodgkin D, Gao W, Merrick EL, Drebing CE, Larson MJ, Sharma M, Petry NM, Saitz R, Weisner CM, Young-Wolff KC, Lu WY, Blosnich JR, Lehavot K, Glass JE, Williams EC, Bensley KM, Chan G, Dombrowski J, Fortney J, Rubinsky AD, Lapham GT, Forray A, Olmstead TA, Gilstad-Hayden K, Kershaw T, Dillon P, Weaver MF, Grekin ER, Ellis JD, McGoron L, McGoron L. Proceedings of the 14th annual conference of INEBRIA. Addict Sci Clin Pract 2017. [PMCID: PMC5606215 DOI: 10.1186/s13722-017-0087-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Witkiewitz K, Roos CR, Pearson MR, Hallgren KA, Maisto SA, Kirouac M, Forcehimes AA, Wilson AD, Robinson CS, McCallion E, Tonigan JS, Heather N. How Much Is Too Much? Patterns of Drinking During Alcohol Treatment and Associations With Post-Treatment Outcomes Across Three Alcohol Clinical Trials. J Stud Alcohol Drugs 2017; 78:59-69. [PMID: 27936365 DOI: 10.15288/jsad.2017.78.59] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE This secondary data analysis examined patterns of drinking during alcohol treatment and associated drinking outcomes during the first year following treatment. The goal was to provide clinicians with guidance on which patients may be most at risk for negative long-term outcomes based on drinking patterns during treatment. METHOD This study was an analysis of existing data (N = 3,851) from three randomized clinical trials for alcohol use disorder: the COMBINE Study (n = 1,383), Project MATCH (n = 1,726), and the United Kingdom Alcohol Treatment Trial (n = 742). Indicators of abstinence, non-heavy drinking, and heavy drinking (defined as 4/5 or more drinks per day for women/men) were examined during each week of treatment using repeated-measures latent class analysis. Associations between drinking patterns during treatment and drinking intensity, drinking consequences, and physical and mental health 12 months following intake were examined. RESULTS Seven drinking patterns were identified. Patients who engaged in persistent heavy drinking throughout treatment and those who returned to persistent heavy drinking during treatment had the worst long-term outcomes. Patients who engaged in some heavy drinking during treatment had better long-term outcomes than persistent heavy drinkers. Patients who reported low-risk drinking or abstinence had the best long-term outcomes. There were no differences in outcomes between low-risk drinkers and abstainers. CONCLUSIONS Abstinence, low-risk drinking, or even some heavy drinking during treatment are associated with the best long-term outcomes. Patients who are engaging in persistent heavy drinking are likely to have the worst outcomes and may require a higher level of care.
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Affiliation(s)
| | - Corey R Roos
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico.,Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Matthew R Pearson
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Kevin A Hallgren
- Center for the Study of Health and Risk Behaviors, University of Washington, Seattle, Washington
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Megan Kirouac
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico.,Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Alyssa A Forcehimes
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Adam D Wilson
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico.,Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Charles S Robinson
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Elizabeth McCallion
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico.,Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - J Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Nick Heather
- Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
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Dale V, Heather N, Adamson S, Coulton S, Copello A, Godfrey C, Hodgson R, Orford J, Raistrick D, Tober G. Predicting drinking outcomes: Evidence from the United Kingdom Alcohol Treatment Trial (UKATT). Addict Behav 2017; 71:61-67. [PMID: 28273487 DOI: 10.1016/j.addbeh.2017.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 11/26/2022]
Abstract
AIMS To explore client characteristics that predict drinking outcomes using data from the UK Alcohol Treatment Trial (UKATT). METHODS Multiple linear regression was used to determine if there were any characteristics, measured before the start of treatment, that could predict drinking outcomes at three and 12months, as measured by percent day abstinent (PDA) and drinks per drinking day (DDD) over the preceding 90days. RESULTS Lower baseline DDD score and greater confidence to resist drinking predicted lower DDD at both three and twelve months following entry to treatment. In addition to baseline PDA and having greater confidence to resist heavy drinking, female gender, aiming for abstinence, more satisfaction with family life and a social network that included less support for drinking were predictors of percent days abstinent. CONCLUSIONS Overall the strongest and most consistent predictors of outcome were confidence to avoid heavy drinking and social support for drinking. More predictors were identified for percent of days abstinent than for drinks per drinking day. For percent of days abstinent, a number of client characteristics at baseline consistently predicted outcome at both month three and month twelve.
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Abstract
This article uses Marc Lewis' work as a springboard to discuss the socio-political context of the brain disease model of addiction (BDMA). The claim that promotion of the BDMA is the only way the general public can be persuaded to withhold blame and punishment from addicts is critically examined. After a discussion of public understandings of the disease concept of addiction, it is pointed out that it is possible to develop a scientific account of addiction which is neither a disease nor a moral model but which the public could understand. Evidence is reviewed to suggest that public acceptance of the disease concept is largely lip-service and that the claim the BDMA removes stigma among the public and professionals is unsupported by evidence. Further, there is good evidence that biogenetic explanations of mental/behavioural disorders in general have been counterproductive in the attempt to ally stigma. A model of addiction as a disorder of choice may attract special problems in public-facing communications and risks being misunderstood. However, ways of presenting this model to the public are suggested that may avoid such risks. Lastly, the claim that the BDMA is the only way of ensuring access to treatment and of maintaining research funding for addiction is disputed and a way in which these benefits can be retained under a disorder-of-choice model proposed. The article concludes by enthusiastically endorsing Lewis' call for a third stage in the governing image of addiction.
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Affiliation(s)
- Nick Heather
- Department of Psychology, Northumbria University, 8 Roseworth Terrace, Newcastle on Tyne, NE3 1LU UK
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Glass JE, Andréasson S, Bradley KA, Finn SW, Williams EC, Bakshi AS, Gual A, Heather N, Sainz MT, Benegal V, Saitz R. Rethinking alcohol interventions in health care: a thematic meeting of the International Network on Brief Interventions for Alcohol & Other Drugs (INEBRIA). Addict Sci Clin Pract 2017; 12:14. [PMID: 28490342 PMCID: PMC5425968 DOI: 10.1186/s13722-017-0079-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/14/2017] [Indexed: 11/29/2022] Open
Abstract
In 2016, the International Network on Brief Interventions for Alcohol & Other Drugs convened a meeting titled “Rethinking alcohol interventions in health care”. The aims of the meeting were to synthesize recent evidence about screening and brief intervention and to set directions for research, practice, and policy in light of this evidence. Screening and brief intervention is efficacious in reducing self-reported alcohol consumption for some with unhealthy alcohol use, but there are gaps in evidence for its effectiveness. Because screening and brief intervention is not known to be efficacious for individuals with more severe unhealthy alcohol use, recent data showing the lack of evidence for referral to treatment as part of screening and brief intervention are alarming. While screening and brief intervention was designed to be a population-based approach, its reach is limited. Implementation in real world care also remains a challenge. This report summarizes practice, research, and policy recommendations and key research developments from our meeting. In order to move the field forward, a research agenda was proposed to (1) address evidence gaps in screening, brief intervention, and referral to treatment, (2) develop innovations to address severe unhealthy alcohol use within primary care, (3) describe the stigma of unhealthy alcohol use, which obstructs progress in prevention and treatment, (4) reconsider existing conceptualizations of unhealthy alcohol use that may influence health care, and (5) identify efforts needed to improve the capacity for addressing unhealthy alcohol consumption in all world regions.
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Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
| | - Sven Andréasson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Sara Wallhed Finn
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Emily C Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ann-Sofie Bakshi
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, ICN, Hospital Clínic, IDIBAPS, RTA, Barcelona, Spain
| | - Nick Heather
- Department of Psychology, Faculty of Health & Social Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Marcela Tiburcio Sainz
- Department of Social Sciences in Health, Ramón de la Fuente Muñiz, National Institute of Psychiatry, Mexico City, Mexico
| | - Vivek Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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Heather N. Spreading alcohol brief interventions from health care to non-health care settings: Is it justified? Drugs: Education, Prevention and Policy 2016. [DOI: 10.1080/09687637.2016.1187113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fitzgerald N, Angus K, Elders A, de Andrade M, Raistrick D, Heather N, McCambridge J. Weak evidence on nalmefene creates dilemmas for clinicians and poses questions for regulators and researchers. Addiction 2016; 111:1477-87. [PMID: 27262594 PMCID: PMC5089629 DOI: 10.1111/add.13438] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/15/2015] [Accepted: 04/21/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Nalmefene has been approved in Europe for the treatment of alcohol dependence and subsequently recommended by the UK National Institute for Health and Care Excellence (NICE). This study examines critically the evidence base underpinning both decisions and the issues arising. METHODS Published studies of nalmefene were identified through a systematic search, with documents from the European Medicines Agency, the NICE appraisal and public clinical trial registries also examined to identify methodological issues. RESULTS Efficacy data used to support the licensing of nalmefene suffer from risk of bias due to lack of specification of a priori outcome measures and sensitivity analyses, use of post-hoc sample refinement and the use of inappropriate comparators. Despite this, evidence for the efficacy of nalmefene in reducing alcohol consumption in those with alcohol dependence is, at best, modest, and of uncertain significance to individual patients. The relevance of existing trial data to routine primary care practice is doubtful. CONCLUSIONS Problems with the registration, design, analysis and reporting of clinical trials of nalmefene did not prevent it being licensed and recommended for treating alcohol dependence. This creates dilemmas for primary care clinicians and commissioning organisations where nalmefene has been heavily promoted, and poses wider questions about the effectiveness of the medicines regulation system and how to develop the alcohol treatment evidence base.
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Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco Alcohol StudiesUniversity of StirlingScotlandUK
| | - Kathryn Angus
- Institute for Social Marketing, UK Centre for Tobacco Alcohol StudiesUniversity of StirlingScotlandUK
| | | | - Marisa de Andrade
- School of Health in Social ScienceUniversity of EdinburghEdinburghScotlandUK
| | | | - Nick Heather
- Department of Psychology, Faculty of Health and Life SciencesNorthumbria UniversityNewcastle upon TyneUK
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Witkiewitz K, McCallion E, Vowles KE, Kirouac M, Frohe T, Maisto SA, Hodgson R, Heather N. Association between physical pain and alcohol treatment outcomes: The mediating role of negative affect. J Consult Clin Psychol 2015; 83:1044-57. [PMID: 26098375 DOI: 10.1037/ccp0000033] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Physical pain and negative affect have been described as risk factors for alcohol use following alcohol treatment. The current study was a secondary analysis of 2 clinical trials for alcohol use disorder (AUD) to examine the associations between pain, negative affect and AUD treatment outcomes. METHOD Participants included 1,383 individuals from the COMBINE Study (COMBINE Pharmacotherapies and Behavioral Interventions for Alcohol Dependence; COMBINE Study Research Group, 2003; 31% female, 23% ethnic minorities, average age = 44.4 [SD = 10.2]), a multisite combination pharmacotherapy and behavioral intervention study for AUD in the United States, and 742 individuals from the United Kingdom Alcohol Treatment Trial (UKATT Research Team, 2001; 25.9% female, 4.4% ethnic minorities, average age = 41.6 [SD = 10.1]) a multisite behavioral intervention study for AUD in the United Kingdom. The Form-90 was used to collect alcohol use data, the Short Form Health Survey and Quality of Life measures were used to assess pain, and negative affect was assessed using the Brief Symptom Inventory (COMBINE) and the General Health Questionnaire (UKATT). RESULTS Pain scores were significantly associated with drinking outcomes in both datasets. Greater pain scores were associated with greater negative affect and increases in pain were associated with increases in negative affect. Negative affect significantly mediated the association between pain and drinking outcomes and this effect was moderated by social behavior network therapy (SBNT) in the UKATT study, with SBNT attenuating the association between pain and drinking. CONCLUSION Findings suggest pain and negative affect are associated among individuals in AUD treatment and that negative affect mediated pain may be a risk factor for alcohol relapse.
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Affiliation(s)
| | | | | | | | - Tessa Frohe
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | | | | | - Nick Heather
- Department of Psychology, Northumbria University
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Abstract
Little research has been done on the role of the therapeutic working alliance in treatment for alcohol problems. This longitudinal study’s objectives were (a) to identify predictors of working alliance and (b) to investigate whether client and/or therapist reports of the working alliance predicted posttreatment motivation and then later treatment outcome. Client and therapist perceptions of the working alliance were assessed after the first treatment session using a short form of the Working Alliance Inventory (WAI) among 173 clients taking part in the United Kingdom Alcohol Treatment Trial (UKATT) and randomized to motivational enhancement therapy (MET) or social behavior and network therapy (SBNT) with complete data on all measures of interest. Structural equation models were fitted to identify predictors of WAI scores and investigate the relationships between WAI and measures of drinking during treatment, posttreatment motivation, and successful treatment outcome (abstinent or nonproblem drinker), and measures of drinks per drinking day and nondrinking days, assessed 9 months after the conclusion of treatment. Motivation to change drinking when treatment began was a strong predictor of client—adjusted coefficient = 2.21 (95% confidence interval [CI] [0.36, 4.06]—but not therapist WAI. Client WAI predicted successful treatment outcome—adjusted odds ratios (OR) = 1.09 (95% CI [1.02, 1.17])—and had effects on drinking during treatment, and on posttreatment motivation to change. There was evidence for effect modification by treatment, with strong associations between WAI and posttreatment motivation, and evidence of WAI prediction of treatment outcomes in the MET group, but no evidence of associations for SBNT. Therapist WAI was not strongly associated with treatment outcome (adjusted OR = 1.05; 95% CI [0.99, 1.10]). The working alliance is important to treatment outcomes for alcohol problems, with client evaluation of the alliance strongly related to motivation to change drinking throughout treatment for MET. It was also much more important than therapist-rated alliance in this study.
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Affiliation(s)
- Sarah Cook
- Department of Noncommunicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine
| | - Nick Heather
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University
| | - Jim McCambridge
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
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Cook S, Heather N, McCambridge J. Posttreatment motivation and alcohol treatment outcome 9 months later: findings from structural equation modeling. J Consult Clin Psychol 2014; 83:232-237. [PMID: 25244390 PMCID: PMC4352962 DOI: 10.1037/a0037981] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: To investigate the association between posttreatment motivation to change as measured by the Readiness to Change Questionnaire Treatment Version and drinking outcomes 9 months after the conclusion of treatment for alcohol problems. Method: Data from 392 participants in the United Kingdom Alcohol Treatment Trial were used to fit structural equation models investigating relationships between motivation to change pre- and posttreatment and 5 outcomes 9 months later. The models included pathways through changes in drinking behavior during treatment and adjustment for sociodemographic information. Results: Greater posttreatment motivation (being in action vs. preaction) was associated with 3 times higher odds of the most stringent definition of positive outcome (being abstinent or entirely a nonproblem drinker) 9 months later (odds ratio = 3.10, 95% confidence interval [1.83, 5.25]). A smaller indirect effect of pretreatment motivation on this outcome was seen from pathways through drinking behavior during treatment and posttreatment motivation (probit coefficient = 0.08, 95% confidence interval [0.03, 0.14]). A similar pattern of results was seen for other outcomes evaluated. Conclusion: Posttreatment motivation to change has hitherto been little studied and is identified here as a clearly important predictor of longer term treatment outcome. This study found that those individuals who reported that they were ready to change their drinking at the end of a treatment program were much more likely to show positive outcomes 9 months subsequently than were persons not indicating such a readiness to change. This suggests that attempting to enhance motivation throughout the process may be an important component of successful alcohol treatment.
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Affiliation(s)
- Sarah Cook
- London School of Hygiene & Tropical Medicine
| | - Nick Heather
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University
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Abstract
Three recent sets of null findings from trials of alcohol brief intervention (BI) have been disappointing to those who wish to see a reduction in alcohol-related harm through the widespread dissemination of BI. Saitz (7) has suggested that these null findings result from a failure to translate the effects of BI seen in efficacy trials, which are thought to contribute mainly to the beneficial effects of BI shown in meta-analyses, to effectiveness trials conducted in real-world clinical practice. The present article aims to: (i) clarify the meaning of the terms “efficacy” and “effectiveness” and other related concepts; (ii) review the method and findings on efficacy-effectiveness measurement in the 2007 Cochrane Review by Kaner and colleagues; and (iii) make suggestions for further research in this area. Conclusions are: 1) to avoid further confusion, terms such as “efficacy trial”, “effectiveness trial”, “clinical representativeness”, etc. should be clearly defined and carefully used; 2) applications of BI to novel settings should begin with foundational research and developmental studies, followed by efficacy trials, and political pressures for quick results from premature effectiveness trials should be resisted; 3) clear criteria are available in the literature to guide progress from efficacy research, through effectiveness research, to dissemination in practice; 4) to properly interpret null findings from effectiveness studies, it is necessary to ensure that interventions are delivered as intended; 5) in future meta-analyses of alcohol BI trials, more attention should be paid to the development and application of a psychometrically robust scale to measure efficacy-effectiveness or clinical representativeness; 6) the null findings under consideration cannot be firmly attributed to a failure to translate effects from efficacy trials to real-world practice, because it is possible that the majority of trials included in meta-analyses on which the evidence for the beneficial effects of alcohol BI was based tended to be effectiveness rather than efficacy trials; and 7) a hypothesis to explain the null findings in question is that they are due to lack of fidelity in the implementation of BI in large, organizationally complex, cluster randomized trials.
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Affiliation(s)
- Nick Heather
- Department of Psychology, Faculty of Health & Social Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne NE1 8ST, UK.
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Newbury-Birch D, Coulton S, Bland M, Cassidy P, Dale V, Deluca P, Gilvarry E, Godfrey C, Heather N, Kaner E, McGovern R, Myles J, Oyefeso A, Parrott S, Patton R, Perryman K, Phillips T, Shepherd J, Drummond C. Alcohol screening and brief interventions for offenders in the probation setting (SIPS Trial): a pragmatic multicentre cluster randomized controlled trial. Alcohol Alcohol 2014; 49:540-8. [PMID: 25063992 DOI: 10.1093/alcalc/agu046] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
AIM To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in the probation setting. Offender managers were randomized to three interventions, each of which built on the previous one: feedback on screening outcome and a client information leaflet control group, 5 min of structured brief advice and 20 min of brief lifestyle counselling. METHODS A pragmatic multicentre factorial cluster randomized controlled trial. The primary outcome was self-reported hazardous or harmful drinking status measured by Alcohol Use Disorders Identification Test (AUDIT) at 6 months (negative status was a score of <8). Secondary outcomes were AUDIT status at 12 months, experience of alcohol-related problems, health utility, service utilization, readiness to change and reduction in conviction rates. RESULTS Follow-up rates were 68% at 6 months and 60% at 12 months. At both time points, there was no significant advantage of more intensive interventions compared with the control group in terms of AUDIT status. Those in the brief advice and brief lifestyle counselling intervention groups were statistically significantly less likely to reoffend (36 and 38%, respectively) than those in the client information leaflet group (50%) in the year following intervention. CONCLUSION Brief advice or brief lifestyle counselling provided no additional benefit in reducing hazardous or harmful drinking compared with feedback on screening outcome and a client information leaflet. The impact of more intensive brief intervention on reoffending warrants further research.
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Affiliation(s)
- Dorothy Newbury-Birch
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Simon Coulton
- Centre for Health Service Studies, University of Kent, The Registry, Canterbury, CT2 7NZ, UK
| | - Martin Bland
- Department of Health Sciences, University of York, Seebholm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Paul Cassidy
- Teams Family Practice, Watson Street, Gateshead, NE8 2PQ, UK
| | - Veronica Dale
- Department of Health Sciences, University of York, Seebholm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Paolo Deluca
- Addictions Department, Institute of Psychiatry, King's College London 4 Windsor Walk, London, SE5 8AF, UK
| | - Eilish Gilvarry
- Northumberland, Tyne & Wear NHS Foundation Trust, Newcastle and North Tyneside Addictions Service, Plummer Court, Carliol Place, Newcastle upon Tyne, NE1 6UR, UK
| | - Christine Godfrey
- Department of Health Sciences, University of York, Seebholm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Nick Heather
- School of Life Sciences, Northumbria University, Northumberland Building, Newcastle upon Tyne, NE1 8ST, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Judy Myles
- Division of Population Health Sciences and Education, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Adenekan Oyefeso
- Division of Population Health Sciences and Education, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, Seebholm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Robert Patton
- Addictions Department, Institute of Psychiatry, King's College London 4 Windsor Walk, London, SE5 8AF, UK
| | - Katherine Perryman
- Institute of Population Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Tom Phillips
- Addictions Department, Institute of Psychiatry, King's College London 4 Windsor Walk, London, SE5 8AF, UK Humber NHS Foundation Trust, Beverley Road, Willerby, HU10 6ED, UK
| | - Jonathan Shepherd
- Violence Research Group, Cardiff University, Heath Park, Cardiff, Wales, CF14 4XY, UK
| | - Colin Drummond
- Addictions Department, Institute of Psychiatry, King's College London 4 Windsor Walk, London, SE5 8AF, UK
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Affiliation(s)
- Nick Heather
- Department of Psychology, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
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Drummond C, Deluca P, Coulton S, Bland M, Cassidy P, Crawford M, Dale V, Gilvarry E, Godfrey C, Heather N, McGovern R, Myles J, Newbury-Birch D, Oyefeso A, Parrott S, Patton R, Perryman K, Phillips T, Shepherd J, Touquet R, Kaner E. The effectiveness of alcohol screening and brief intervention in emergency departments: a multicentre pragmatic cluster randomized controlled trial. PLoS One 2014; 9:e99463. [PMID: 24963731 PMCID: PMC4070907 DOI: 10.1371/journal.pone.0099463] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/12/2014] [Indexed: 11/18/2022] Open
Abstract
Background Alcohol misuse is common in people attending emergency departments (EDs) and there is some evidence of efficacy of alcohol screening and brief interventions (SBI). This study investigated the effectiveness of SBI approaches of different intensities delivered by ED staff in nine typical EDs in England: the SIPS ED trial. Methods and Findings Pragmatic multicentre cluster randomized controlled trial of SBI for hazardous and harmful drinkers presenting to ED. Nine EDs were randomized to three conditions: a patient information leaflet (PIL), 5 minutes of brief advice (BA), and referral to an alcohol health worker who provided 20 minutes of brief lifestyle counseling (BLC). The primary outcome measure was the Alcohol Use Disorders Identification Test (AUDIT) status at 6 months. Of 5899 patients aged 18 or more presenting to EDs, 3737 (63·3%) were eligible to participate and 1497 (40·1%) screened positive for hazardous or harmful drinking, of whom 1204 (80·4%) gave consent to participate in the trial. Follow up rates were 72% (n = 863) at six, and 67% (n = 810) at 12 months. There was no evidence of any differences between intervention conditions for AUDIT status or any other outcome measures at months 6 or 12 in an intention to treat analysis. At month 6, compared to the PIL group, the odds ratio of being AUDIT negative for brief advice was 1·103 (95% CI 0·328 to 3·715). The odds ratio comparing BLC to PIL was 1·247 (95% CI 0·315 to 4·939). A per protocol analysis confirmed these findings. Conclusions SBI is difficult to implement in typical EDs. The results do not support widespread implementation of alcohol SBI in ED beyond screening followed by simple clinical feedback and alcohol information, which is likely to be easier and less expensive to implement than more complex interventions. Trial Registration Current Controlled Trials ISRCTN 93681536
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Affiliation(s)
- Colin Drummond
- Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Paolo Deluca
- Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom
- * E-mail:
| | - Simon Coulton
- Centre for Health Service Studies, University of Kent, Canterbury, United Kingdom
| | - Martin Bland
- Department of Health Sciences, University of York, York, United Kingdom
| | - Paul Cassidy
- Teams Family Practice, Gateshead, United Kingdom
| | - Mike Crawford
- Department of Psychological Medicine, Imperial College, London, United Kingdom
| | - Veronica Dale
- Department of Health Sciences, University of York, York, United Kingdom
| | - Eilish Gilvarry
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
- Northern Regional Drug and Alcohol Services, Newcastle, United Kingdom
| | - Christine Godfrey
- Department of Health Sciences, University of York, York, United Kingdom
| | - Nick Heather
- Faculty of Health and Life Sciences, Northumbria University, Newcastle, United Kingdom
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Judy Myles
- Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | | | - Adenekan Oyefeso
- Division of Population Health Sciences and Education, St George's, University of London, London, United Kingdom
- Jeesal Cawston Park Hospital, Norfolk, United Kingdom
| | - Steve Parrott
- Department of Health Sciences, University of York, York, United Kingdom
| | - Robert Patton
- Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Katherine Perryman
- Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Tom Phillips
- Addictions Department, Institute of Psychiatry, King's College London, London, United Kingdom
- Humber NHS Foundation Trust, Willerby, United Kingdom
| | - Jonathan Shepherd
- Violence Research Group, Cardiff University, Cardiff, United Kingdom
| | - Robin Touquet
- Emergency Department, Kingston Hospital, Kingston upon Thames, London, United Kingdom
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
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Heather N. Toward an understanding of the effective mechanisms of alcohol brief interventions. Alcohol Clin Exp Res 2014; 38:626-8. [PMID: 24428398 DOI: 10.1111/acer.12336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 10/30/2013] [Accepted: 11/14/2013] [Indexed: 11/30/2022]
Abstract
Research on effective mechanisms of alcohol brief interventions has been neglected, but Bertholet and colleagues provide an example of such research in a re-analysis of combined data from 3 trials of brief motivational interviewing (BMI). However, it is disappointing that, in a well-designed and well-conducted analysis, little support was found for highly plausible hypotheses relating treatment processes to outcome of intervention. It is argued here that, because BMI must be assumed to work by increasing client motivation to cut down drinking, some measure of overall motivation before and after intervention is necessary to elucidate the pathway by which treatment processes are translated into positive outcomes. In pioneering research on physician advice on smoking cessation by Russell and colleagues, it was possible to distinguish between whether intervention worked by motivating more people to try to stop smoking, by increasing the success rate among those who did try, or by reducing the relapse rate among those who quit. It is recommended that similar measures be employed in research on how alcohol brief interventions work. A further consideration bearing on the relationship between treatment processes and outcome is whether or not individuals are dependent on alcohol and this is reminiscent of a dispute in the literature concerning the relative priority that should be given to motivational or dependence variables in the prediction of smoking cessation. In order to improve the effectiveness of alcohol brief interventions, future research should focus more on effective mechanisms of behavior change.
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Affiliation(s)
- Nick Heather
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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Abstract
The effectiveness of alcohol brief intervention (ABI) has been established by a succession of meta-analyses but, because the effects of ABI are small, null findings from randomized controlled trials are often reported and can sometimes lead to skepticism regarding the benefits of ABI in routine practice. This article first explains why null findings are likely to occur under null hypothesis significance testing (NHST) due to the phenomenon known as "the dance of the p-values." A number of misconceptions about null findings are then described, using as an example the way in which the results of the primary care arm of a recent cluster-randomized trial of ABI in England (the SIPS project) have been misunderstood. These misinterpretations include the fallacy of "proving the null hypothesis" that lack of a significant difference between the means of sample groups can be taken as evidence of no difference between their population means, and the possible effects of this and related misunderstandings of the SIPS findings are examined. The mistaken inference that reductions in alcohol consumption seen in control groups from baseline to follow-up are evidence of real effects of control group procedures is then discussed and other possible reasons for such reductions, including regression to the mean, research participation effects, historical trends, and assessment reactivity, are described. From the standpoint of scientific progress, the chief problem about null findings under the conventional NHST approach is that it is not possible to distinguish "evidence of absence" from "absence of evidence." By contrast, under a Bayesian approach, such a distinction is possible and it is explained how this approach could classify ABIs in particular settings or among particular populations as either truly ineffective or as of unknown effectiveness, thus accelerating progress in the field of ABI research.
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Affiliation(s)
- Nick Heather
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University , Newcastle upon Tyne , UK
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Abstract
Aims: To evaluate relationships between clients' self-reported ‘stage of change’ and outcomes after treatment for alcohol problems. Methods: Using data from the ‘United Kingdom Alcohol Treatment Trial’, clients who had received at least one session of treatment and who had complete data (n = 392) entered the analysis. Two continuous measures of drinking behaviour (% days abstinent (PDA) and drinks per drinking day (DDD)) and categorical outcomes at the 12-month follow-up were compared between clients in Pre-action and Action stages of change at either pre- or post-treatment assessment. Multiple and logistic regression analyses examined the relationships between stage of change and treatment outcomes, evaluating the strength of these relationships by controlling for likely confounders. Results: Pre-treatment stage of change did not predict outcome but post-treatment stage of change predicted PDA and DDD at the 12-month follow-up. In unadjusted and adjusted analyses, clients in Action at post-treatment were two to three times more likely to show a favourable categorical outcome, variously defined, than those in Pre-action. There were no differences between clients who had received Motivational Enhancement Therapy and those who had received Social Behaviour and Network Therapy in proportions maintaining or moving towards Action from before to after treatment. Conclusions: These findings confirm previous reports that motivational variables predict outcome of treatment but add that such a relationship is seen for post-treatment stage of change. For therapists, it would seem important to monitor the client's stage of change—which in good clinical practice often occurs in informal ways—and have strategies to deal with low motivation to change whenever it occurs throughout treatment. The findings are also consistent with a ‘common factors’ perspective on effective treatment for alcohol problems.
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Affiliation(s)
- Nick Heather
- Department of Psychology, Faculty of Health and Life Sciences, Northumberland Building, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK.
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Kaner E, Bland M, Cassidy P, Coulton S, Dale V, Deluca P, Gilvarry E, Godfrey C, Heather N, Myles J, Newbury-Birch D, Oyefeso A, Parrott S, Perryman K, Phillips T, Shepherd J, Drummond C. Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial. BMJ 2013; 346:e8501. [PMID: 23303891 PMCID: PMC3541471 DOI: 10.1136/bmj.e8501] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in primary care. The hypothesis was that more intensive intervention would result in a greater reduction in hazardous or harmful drinking. DESIGN Pragmatic cluster randomised controlled trial. SETTING Primary care practices in the north east and south east of England and in London. PARTICIPANTS 3562 patients aged 18 or more routinely presenting in primary care, of whom 2991 (84.0%) were eligible to enter the trial: 900 (30.1%) screened positive for hazardous or harmful drinking and 756 (84.0%) received a brief intervention. The sample was predominantly male (62%) and white (92%), and 34% were current smokers. INTERVENTIONS Practices were randomised to three interventions, each of which built on the previous one: a patient information leaflet control group, five minutes of structured brief advice, and 20 minutes of brief lifestyle counselling. Delivery of the patient leaflet and brief advice occurred directly after screening and brief lifestyle counselling in a subsequent consultation. MAIN OUTCOME MEASURES The primary outcome was patients' self reported hazardous or harmful drinking status as measured by the alcohol use disorders identification test (AUDIT) at six months. A negative AUDIT result (score <8) indicated non-hazardous or non-harmful drinking. Secondary outcomes were a negative AUDIT result at 12 months, experience of alcohol related problems (alcohol problems questionnaire), health utility (EQ-5D), service utilisation, and patients' motivation to change drinking behaviour (readiness to change) as measured by a modified readiness ruler. RESULTS Patient follow-up rates were 83% at six months (n=644) and 79% at 12 months (n=617). At both time points an intention to treat analysis found no significant differences in AUDIT negative status between the three interventions. Compared with the patient information leaflet group, the odds ratio of having a negative AUDIT result for brief advice was 0.85 (95% confidence interval 0.52 to 1.39) and for brief lifestyle counselling was 0.78 (0.48 to 1.25). A per protocol analysis confirmed these findings. CONCLUSIONS All patients received simple feedback on their screening outcome. Beyond this input, however, evidence that brief advice or brief lifestyle counselling provided important additional benefit in reducing hazardous or harmful drinking compared with the patient information leaflet was lacking. TRIAL REGISTRATION Current Controlled Trials ISRCTN06145674.
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Affiliation(s)
- Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle NE2 4AX, UK.
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Deluca P, Drummond C, Coulton S, Kaner E, Newbury-Birch D, Phillips T, Perryman K, Heather N, Godfrey C. A randomized controlled trial of different methods of alcohol screening and brief intervention in routine accident and emergency department care: 12-month outcomes. Addict Sci Clin Pract 2012. [PMCID: PMC3480137 DOI: 10.1186/1940-0640-7-s1-a80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
The rationale and methodology behind the Australian Quality Assurance Project is described. The Project aimed to develop guidelines for treatment content based on three sources of information: research findings, current practice and expert opinion. The issue of the gap between research and practice is discussed, as well as the role of dissemination in altering clinician behaviour.
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Affiliation(s)
- N Heather
- National Drug and Alcohol Research Centre, University of New South Wales, PO Box 1, Kensington, NSW, 2033, Australia
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Abstract
A distinction is made between the clinical and public health justifications for screening and brief intervention (SBI) against hazardous and harmful alcohol consumption. Early claims for a public health benefit of SBI derived from research on general medical practitioners’ (GPs’) advice on smoking cessation, but these claims have not been realized, mainly because GPs have not incorporated SBI into their routine practice. A recent modeling exercise estimated that, if all GPs in England screened every patient at their next consultation, 96% of the general population would be screened over 10 years, with 70-79% of excessive drinkers receiving brief interventions (BI); assuming a 10% success rate, this would probably amount to a population-level effect of SBI. Thus, a public health benefit for SBI presupposes widespread screening; but recent government policy in England favors targeted versus universal screening, and in Scotland screening is based on new registrations and clinical presentation. A recent proposal for a national screening program was rejected by the UK National Health Service’s National Screening Committee because 1) there was no good evidence that SBI led to reductions in mortality or morbidity, and 2) a safe, simple, precise, and validated screening test was not available. Even in countries like Sweden and Finland, where expensive national programs to disseminate SBI have been implemented, only a minority of the population has been asked about drinking during health-care visits, and a minority of excessive drinkers has been advised to cut down. Although there has been research on the relationship between treatment for alcohol problems and population-level effects, there has been no such research for SBI, nor have there been experimental investigations of its relationship with population-level measures of alcohol-related harm. These are strongly recommended. In this article, conditions that would allow a population-level effect of SBI to occur are reviewed, including their political acceptability. It is tentatively concluded that widespread dissemination of SBI, without the implementation of alcohol control measures, might have indirect influences on levels of consumption and harm but would be unlikely on its own to result in public health benefits. However, if and when alcohol control measures were introduced, SBI would still have an important role in the battle against alcohol-related harm.
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Affiliation(s)
- Nick Heather
- Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
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Heather N, Hassan E. Efficacy of Leptospermum petersonii oil, on Plutella xylostella, and its parasitoid, Trichogramma pretiosum. J Econ Entomol 2012; 105:1379-1384. [PMID: 22928319 DOI: 10.1603/ec11382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The efficacy of lemon-scented tea tree oil (LSO), Leptospermum petersonii (FM. Bailey), was evaluated against the diamondback moth, Plutella xylostella (L.) under laboratory conditions. Feeding activity and development of larval stages were significantly reduced on broccoli leaves that had been dipped in LSO. Oviposition deterrence was also found when an adult stage was exposed to treated leaves. Fecundity dropped by >50% at concentrations >0.5%. The LC50 value for third instar larvae was estimated to be 2.93% 7 d after treatment. Experiments were also conducted under greenhouse conditions to assess the efficacy of LSO against the diamond-back moth. Our results suggest that LSO has modest potential for development as a botanical insecticide. The oil was also tested at concentrations from 0.5 to 6% for oviposition deterrence of an egg parasitoid of the diamondback moth, Trichogramma pretiosum (Riley). LSO deterred parasitization in choice tests but not in no-choice tests. LSO did not cause mortality of T. pretiosum during 24 h in a contact toxicity test. We conclude that LSO had no significant effects on the parasitoid, and therefore LSO is compatible with this biocontrol agent for integrated management of the diamondback moth.
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Heather N. Commentary on Seppänen and colleagues (2012): Institutionalization of brief alcohol intervention in primary health care-the Finnish case. Alcohol Clin Exp Res 2012; 36:1311-3. [PMID: 22758647 DOI: 10.1111/j.1530-0277.2012.01893.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 06/01/2012] [Indexed: 11/27/2022]
Abstract
Despite good evidence for the effectiveness of brief intervention (BI) for hazardous and harmful drinking delivered in primary health care, the uptake of such interventions among physicians and other healthcare staff still leaves much to be desired. Seppänen and colleagues (2012) report an evaluation of efforts funded by the Finnish government to "institutionalize" BI among primary care physicians in Finland. The evaluation was based on 2 surveys of Finnish primary healthcare physicians, one conducted in 2002 before the government-funded implementation project had begun and the other in 2007 after it had ended. Major findings were that the proportion of physicians offering BI had increased between the 2 surveys from 59.2 to 78.5% and that, of those who said they offered BI in 2007, 52.4% reported increased activity compared with 5 years earlier. However, in the 2007 survey, regular BI activity was reported by 17.2% of the sample but 61.3% reported only occasional activity. Also, a separate survey of the Finnish general population indicated that the extent to which people are asked by health professionals about their alcohol consumption, and the extent to which heavy drinkers receive advice about it, still appears to be low. Thus, the claim that the institutionalization of BI in the Finnish primary care system has been successful is tentative. The clinical benefits of increased BI activity are unquestionable but it can be argued that, for a public health benefit to occur, a greater proportion of hazardous and harmful drinkers need to receive BI than is suggested in the data reported by Seppänen and colleagues.
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Affiliation(s)
- Nick Heather
- Department of Psychology, School of Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
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Coulton S, Newbury-Birch D, Cassidy P, Dale V, Deluca P, Gilvarry E, Godfrey C, Heather N, Kaner E, Oyefeso A, Parrott S, Phillips T, Shepherd J, Drummond C. Screening for Alcohol Use in Criminal Justice Settings: An Exploratory Study. Alcohol Alcohol 2012; 47:423-7. [DOI: 10.1093/alcalc/ags048] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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