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Bonar EE, Goldstick JE, Rostker MJ, Dailey SE, Augustiniak AN, Brin C, Manderachia DA, Bourque C, Girard R, Sulkowski L, Lin LA. Testing a new model of telehealth-delivered treatment for primary care patients with alcohol use disorder: A randomized controlled trial protocol. Contemp Clin Trials 2024; 142:107549. [PMID: 38679140 DOI: 10.1016/j.cct.2024.107549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/05/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The majority of adults suffering from alcohol use disorders (AUD) do not receive treatment. To address this gap in care, we must develop new models to increase identification, engagement and delivery of accessible and effective treatment. This paper describes the protocol for a randomized controlled trial (RCT) testing a novel telehealth treatment model for primary care patients with untreated AUD. METHODS We aim to recruit 300 adults across 2 healthcare systems for this two-arm RCT. Participants, initially identified for recruitment based on AUD-related indicators in their electronic health record (EHR), are RCT-eligible if they meet AUD criteria (mild, moderate, severe), report ≥ 3 drinking days/week in past 30 days, and have not received AUD psychotherapy in the past 90 days. Participants are randomized to an intervention or enhanced usual care control (EUC) condition, both individually-delivered. The intervention includes a telephone-delivered motivational interviewing (MI) engagement session and 8 sessions of MI-Cognitive Behavioral Therapy (MI-CBT). EUC involves AUD psychoeducation, advice to reduce drinking and seek treatment, and provision of community resources. Outcomes will be measured at 3-, 6-, and 12-months; primary outcomes include: AUD psychotherapy initiation and engagement (within the study and external community) and alcohol consumption (percent drinking days and heavy drinking days). CONCLUSIONS This study addresses whether proactive patient identification and engagement and delivery of patient-centered telehealth psychotherapy to patients with untreated AUD is effective in increasing treatment use and improving alcohol outcomes. If effective, this could be a highly scalable model for reducing the public health impact of AUD. TRIAL REGISTRATION ClinicalTrials.gov # NCT05410561. University of Michigan HUM00204315. Ann Arbor VA IRB #1655886.
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Affiliation(s)
- Erin E Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Michigan Innovations in Addiction Care through Research & Education, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA.
| | - Jason E Goldstick
- Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Matthew J Rostker
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Shayla E Dailey
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Alyssa N Augustiniak
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Carly Brin
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Deborah A Manderachia
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109, USA
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Rachel Girard
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI 02881, USA
| | - Lisa Sulkowski
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Lewei Allison Lin
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Michigan Innovations in Addiction Care through Research & Education, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Addiction Center, Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109, USA
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Yao J, Han K, Cui H, Chen N, Xiu M, Wu F. Grouping motivational interviewing is only effective for younger patients with alcohol dependence in the rehabilitation stage. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01736-1. [PMID: 38123714 DOI: 10.1007/s00406-023-01736-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023]
Abstract
Alcohol dependence (AD) is a risk factor for death and disability. Relapse prevention for AD has been exclusively dominated by psychotherapy intervention for many years. Our study aimed to investigate the efficacy of group motivational interviewing (MI) on the psychological craving for alcohol and depressive symptoms in AD patients in the rehabilitation phase, as well as the impact of age. The participants included 108 individuals with AD in the rehabilitation phase. All participants were assigned to the MI intervention group or the control group and were treated for 6 weeks. The severity of psychological craving for alcohol was assessed by the Penn Alcohol Craving Scale (PACS), and psychological status was evaluated by the Hamilton Depression Rating Scale (HAMD). We found that group MI significantly reduced the psychological craving for alcohol in patients with AD in the rehabilitation phase (p < 0.05). In addition, when patients were divided into two groups according to their ages, we found that group MI interventions tended to be effective only in younger patients with AD, but not in older patients. Our findings provide further evidence that the efficacy of group MI interventions was influenced by the age of patients with AD in the rehabilitation stage.
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Affiliation(s)
- Jing Yao
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Kun Han
- Qingdao Mental Health Center, Qingdao, China
| | - Hongmei Cui
- Qingdao Mental Health Center, Qingdao, China
| | - Nan Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 510370, China.
- Department of Biomedical Engineering, Guangzhou Medical University, Liwan District, Guangzhou, 510370, China.
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Liwan District, Guangzhou, 510370, China.
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Conner KR, Maisto SA, Abar B, Szafranski S, Chiang A, Hutchison M, Aldalur A, Stecker T. Brief, cognitive-behavioral intervention to promote treatment seeking in adults with severe alcohol use disorder: A randomized controlled trial. Addiction 2023; 118:2342-2351. [PMID: 37488997 PMCID: PMC10805959 DOI: 10.1111/add.16300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND AND AIMS There is little RCT evidence that brief interventions improve treatment seeking in individuals with severe alcohol use disorder (AUD) or treatment seeking reduces alcohol use. The aim was to test the efficacy of a brief intervention to increase treatment seeking in treatment naïve adults with severe AUD and measure its effects on alcohol use. DESIGN Parallel group, non-pharmacologic RCT with intervention (n = 197) and active control (n = 203) conditions, with blinded assessors conducting follow-ups at 1, 3 and 6 months. SETTING Online recruitment in a 17-county region of upstate New York, USA. PARTICIPANTS Inclusion criteria consisted of ages ≥18 years, Alcohol Use Disorders Identification Test score ≥16, exceeds recommended limits for alcohol use and no history of AUD treatment. n = 400; 50% female; 79% white; mean age, 40.7; mean education, 14.6 years. INTERVENTION AND COMPARATOR One-session telephone-delivered interventions: Cognitive-Behavioral Therapy for Treatment Seeking (CBT-TS; intervention), review of a National Institute on Alcohol Abuse and Alcoholism pamphlet on AUD treatment (control). MEASUREMENTS Self-report of any AUD treatment use over 3 months (primary outcome) and two standard measures of alcohol use over 6 months (secondary outcomes). FINDINGS Intent-to-treat analyses were used. Assessment follow-up rates were ≥93%. Any alcohol-related treatment use over 3-month follow-up was obtained by 38 (19%) intervention participants and 36 (18%) control participants, a non-significant difference, χ2 [1] = 0.16, P = 0.689. Secondary analysis showed a significant interaction term between sex and intervention assignment (β = -1.197, P = 0.027). The interaction suggested CBT-TS was effective in men (22% vs 13%), although the evidence was somewhat weak (P = 0.071), and it was not effective in women (17% vs 24%). CONCLUSIONS A one-session cognitive-behavioral therapy intervention to increase treatment seeking in treatment naïve adults with severe alcohol use disorder did not increase treatment seeking.
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Affiliation(s)
- Kenneth R Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah Szafranski
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Morica Hutchison
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
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Gaume J, Blanc S, Magill M, McCambridge J, Bertholet N, Hugli O, Daeppen JB. Who benefits from brief motivational intervention among young adults presenting to the emergency department with alcohol intoxication: A latent-class moderation analysis. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1614-1623. [PMID: 37515697 DOI: 10.1111/acer.15128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Research has not identified which patients optimally benefit from brief Motivational Interviewing (bMI) for heavy drinking when delivered to young adults in the Emergency Department (ED). METHODS We conducted secondary analyses of data from a randomized controlled trial in which 344 young adults (18-35 years) presenting to the ED with alcohol intoxication received either bMI or Brief Advice (BA, control group). We used Latent Class Analysis to derive participants' profiles from baseline characteristics (i.e., sex, age, severity of alcohol use disorder, attribution of ED admission to alcohol use, importance, and confidence to change, cognitive discrepancy, anxiety, depression, and trait reactance). We then conducted a moderation analysis to assess the number of heavy drinking days at short-term (1-month) and long-term (12-month) follow-up using negative binomial regressions with interactions between the intervention and derived classes. RESULTS Fit statistics indicated that a 4-class solution best fit the data. Class 3 (high severity, importance and discrepancy, and low confidence and anxiety) benefitted more from bMI than BA at short- and long-term follow-up than Class 1 (younger; lowest severity, importance, discrepancy, reactance, anxiety and depression, and highest confidence). Class 2 (older; highest severity, importance, discrepancy, reactance, anxiety and depression, and lowest confidence) also benefitted more from bMI than BA than did Class 1 at short-term follow-up. In these significant contrasts, Class 1 benefitted more from BA than bMI. There were no significant interactions involving Class 4 (more likely to be women; low severity; high levels of anxiety, depression, and reactance). CONCLUSIONS This study identified the patient profiles that benefitted more from bMI than BA among nontreatment-seeking young adults who present intoxicated to the ED. The findings have implications for intervention design and argue for the importance of research aimed at developing intervention content tailored to patient profiles.
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Affiliation(s)
- Jacques Gaume
- Department of Psychiatry - Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stéphanie Blanc
- Department of Psychiatry - Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Nicolas Bertholet
- Department of Psychiatry - Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Department of Psychiatry - Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Blow FC, Walton M, Ilgen M, Ignacio RV, Walters H, Massey L, Barry KL, McCormick R, Coughlin LN. Peer- and web-based interventions for risky drinking among US National Guard members: Mission Strong randomized controlled trial. Addiction 2023; 118:1246-1257. [PMID: 37041669 DOI: 10.1111/add.16172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 02/07/2023] [Indexed: 04/13/2023]
Abstract
AIMS To test separatel the efficacy of a web-based and a peer-based brief intervention (BI), compared with an expanded usual care control (EUC) group, among military reserve component members using alcohoI in a hazardous and harmful manner. DESIGN In the randomized controlled trial, participants were assigned to: [1] web-based BI with web-based boosters (BI + web), [2] web-based BI with peer-based boosters (BI + peer) or [3] enhanced usual care (EUC). SETTING Michigan, USA. PARTICIPANTS A total of 739 Michigan Army National Guard members who reported recent hazardous alcohol use; 84% were male, the mean age was 28 years. INTERVENTION The BI consisted of an interactive program guided by a personally selected avatar. Boosters were delivered either on the web or personally by a trained veteran peer. A pamphlet, given to all participants, included information on hazardous alcohol use and military-specific community resources and served as the EUC condition. MEASUREMENTS The primary outcome measure was binge drinking episodes in the past 30 days, measured at 12 months after the BI. FINDINGS All randomized participants were included in the outcome analyses. In adjusted analyses, BI + peer [beta = -0.43, 95% confidence interval (CI) = -0.56 to -0.31, P < 0.001] and BI + web (beta = -0.34, 95% CI = -0.46 to -0.23, P < 0.001) reduced binge drinking compared with EUC. CONCLUSION This satudy was a web-based brief intervention for hazardous alcohol use, with either web- or peer-based boosters, reduced binge alcohol use among Army National Guard members.
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Affiliation(s)
- Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
| | - Maureen Walton
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Mark Ilgen
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
- Department of Veteran Affairs Healthcare, System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA
| | - Rosalinda V Ignacio
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Heather Walters
- Department of Veteran Affairs Healthcare, System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA
| | - Lynn Massey
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Kristen L Barry
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
| | - Richard McCormick
- Center for Healthcare Research and Policy, MetroHealth/Case Western Reserve University, Cleveland, OH, USA
| | - Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
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Simpson T, Sistad R, Brooks JT, Newberger NG, Livingston NA. Seeking care where they can: A systematic review of global trends in online alcohol treatment utilization among non-veteran and veteran women. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100116. [PMID: 36844155 PMCID: PMC9948922 DOI: 10.1016/j.dadr.2022.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
Background Findings from a person-level meta-analysis of online alcohol intervention trials suggest that women disproportionately seek out such interventions (Riper et al., 2018). Although women may be a "hidden population" that is particularly drawn to online alcohol interventions, trial design features may explain women's apparent over-representation in these trials. Methods This systematic review examined associations between gender-tailored recruitment/inclusion criteria and proportions of women enrolled in online alcohol intervention trials, evaluated whether community samples have greater proportions of women than clinical samples, and compared country-specific average proportions of women in trials to country-specific proportions of women with Alcohol Use Disorder (AUD). Results Forty-four trials met inclusion/exclusion criteria, 34 community samples and 10 drawn from clinical settings; 4 studies included U.S. veterans and were examined separately. The average proportion of community-recruited women across the studies was 51.20% and the average proportion of clinically-recruited women was 35.81%, a difference that was statistically significant. Across the countries with relevant trials, the expected proportion of those with AUD who are women is 27.1% (World Population Review, 2022). Only 2 studies used targeted recruitment for women so no between-group tests were conducted. There was not a statistically significant difference in the proportion of women across trials that did and did not use gender-tailored alcohol inclusion criteria. Conclusions Results from this systematic review suggest that study design factors do not account for the marked over-representation of women in online alcohol interventions, indicating that women are indeed a "hidden population" whose needs should be understood and accommodated.
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Affiliation(s)
- Tracy Simpson
- Center of Excellence in Substance Addiction Treatment & Education, VA Puget Sound Healthcare System, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Rebecca Sistad
- VA Boston Healthcare System, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jack T. Brooks
- VA Boston Healthcare System, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Noam G. Newberger
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
| | - Nicholas A. Livingston
- VA Boston Healthcare System, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
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Fernandez AC, Chapman L, Ren TY, Baxley C, Hallway AK, Tang MJ, Waljee JF, Friedmann PD, Mello M, Borsari B, Blow F. Preoperative alcohol interventions for elective surgical patients: Results from a randomized pilot trial. Surgery 2022; 172:1673-1681. [PMID: 36283843 PMCID: PMC10686250 DOI: 10.1016/j.surg.2022.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND High-risk alcohol use is a common surgical risk factor. Stopping or reducing alcohol use in the weeks before and after surgery could improve surgical health and outcomes. The purpose of this study was to evaluate the feasibility and acceptability of 2 interventions that address high-risk alcohol use in the context of surgery. METHODS Participants included patients scheduled for elective surgeries at an academic health system in the Midwestern United States. Recruitment took place by phone and text. Participants were included if they were 18 to 75 years old, scheduled for elective surgeries, and scored ≥5 on the Alcohol Use Disorders Identification Test-Consumption Tool. Participants were randomized to either a low-intensity intervention, brief advice (10-minute phone-based psychoeducation plus feedback session), or a higher-intensity intervention, health coaching (two 45-minute sessions including education, feedback, motivational interviewing, and goal setting). Assessments took place at baseline and at 1-month and 4-month follow-ups. Alcohol biomarkers were collected the day of surgery. RESULTS The final study sample included (n = 51) participants randomized to brief advice and health coaching conditions. Participants in both conditions rated interventions as satisfactory and personally relevant. Trial retention was high (86.3%) at 4 months. Attrition was significantly higher in brief advice (n = 6) relative to health coaching (n = 1). Average weekly alcohol use decreased 50% to 60% between baseline and follow-ups in both conditions. Biomarkers corroborated self-report. CONCLUSION The trial demonstrated intervention feasibility and acceptability. Alcohol use changed in expected directions. The next steps include a randomized controlled trial to test intervention efficacy in reducing alcohol use and surgical complications.
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Affiliation(s)
- Anne C Fernandez
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI.
| | - Lyndsay Chapman
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Tom Y Ren
- Central Michigan University College of Medicine, Mt. Pleasant, MI
| | - Catherine Baxley
- San Francisco Veterans Affairs Health Care System, San Francisco, CA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA
| | | | | | - Jennifer F Waljee
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Peter D Friedmann
- Office of Research and Department of Medicine, University of Massachusetts Chan Medical School, Baystate, Springfield, MA
| | - Michael Mello
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Department of Health Services, Practice and Policy, Brown University School of Public Health, Providence, RI
| | - Brian Borsari
- San Francisco Veterans Affairs Health Care System, San Francisco, CA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA
| | - Frederic Blow
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
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Staudt A, Freyer-Adam J, Meyer C, Bischof G, John U, Baumann S. The Moderating Effect of Educational Background on the Efficacy of a Computer-Based Brief Intervention Addressing the Full Spectrum of Alcohol Use: Randomized Controlled Trial. JMIR Public Health Surveill 2022; 8:e33345. [PMID: 35771621 PMCID: PMC9284353 DOI: 10.2196/33345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/29/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background The alcohol-attributable burden of disease is high among socially disadvantaged individuals. Interventional efforts intending to have a public health impact should also address the reduction of social inequalities due to alcohol. Objective The aim was to test the moderating role of educational background on the efficacy of a computer-based brief intervention addressing the full spectrum of alcohol use. Methods We recruited 1646 adults from the general population aged 18 to 64 years (920 women, 55.9%; mean age 31 years; 574 with less than 12 years of school education, 34.9%) who reported alcohol use in the past year. The participants were randomly assigned a brief alcohol intervention or to assessment only (participation rate, 66.9%, 1646/2463 eligible persons). Recruitment took place in a municipal registry office in one German city. All participants filled out a self-administered, tablet-based survey during the recruitment process and were assessed 3, 6, and 12 months later by study assistants via computer-assisted telephone interviews. The intervention consisted of 3 computer-generated and individualized feedback letters that were sent via mail at baseline, month 3, and month 6. The intervention was based on the transtheoretical model of behavior change and expert system software that generated the feedback letters automatically according to previously defined decision rules. The outcome was self-reported change in number of alcoholic drinks per week over 12 months. The moderator was school education according to highest general educational degree (less than 12 years of education vs 12 years or more). Covariates were sex, age, employment, smoking, and alcohol-related risk level. Results Latent growth modeling revealed that the intervention effect after 12 months was moderated by educational background (incidence rate ratio 1.38, 95% CI 1.08-1.76). Individuals with less than 12 years of school education increased their weekly alcohol use to a lesser extent when they received the intervention compared to assessment only (incidence rate ratio 1.30, 95% CI 1.05-1.62; Bayes factor 3.82). No difference was found between groups (incidence rate ratio 0.95, 95% CI 0.84-1.07; Bayes factor 0.30) among those with 12 or more years of school education. Conclusions The efficacy of an individualized brief alcohol intervention was moderated by the participants’ educational background. Alcohol users with less than 12 years of school education benefited, whereas those with 12 or more years did not. People with lower levels of education might be more receptive to the behavior change mechanisms used by brief alcohol interventions. The intervention approach may support the reduction of health inequalities in the population at large if individuals with low or medium education can be reached. Trial Registration German Clinical Trials Register DRKS00014274; https://www.drks.de/DRKS00014274
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Affiliation(s)
- Andreas Staudt
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany
| | - Christian Meyer
- German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany.,Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrich John
- German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany.,Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sophie Baumann
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Schulte MH, Boumparis N, Huizink AC, Riper H. Technological Interventions for the Treatment of Substance Use Disorders. COMPREHENSIVE CLINICAL PSYCHOLOGY 2022. [PMCID: PMC7500918 DOI: 10.1016/b978-0-12-818697-8.00010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Substance use disorders (SUDs) pose a major public health concern. In recent years, technological (i.e., e-health) interventions have emerged and are increasingly offered in a variety of settings, including substance use treatment. E-health interventions encompass a wide variety of advantages depending on the chosen delivery format. This chapter discusses existing interventions and the effectiveness of delivering them as an e-health intervention, with a focus on randomized controlled trials, for the treatment of alcohol, cannabis, opioid, psychostimulant, or poly-substance use, as well as in transdiagnostic interventions. Based on the literature, suggestions for future research and clinical implications are discussed.
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Bonar EE, Souweidane MA, Blow FC, Bohnert ASB, Bauermeister JA, Young SD, Walton MA. High-intensity drinking among adolescent and emerging adult risky drinkers. Subst Abus 2022; 43:713-721. [PMID: 35100097 PMCID: PMC9720995 DOI: 10.1080/08897077.2021.2007513] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: High-intensity drinking (HID; 8+ U.S. standard drinks for women, 10+ men) is initiated during adolescence/emerging adulthood, increasing risk for negative outcomes, including blackouts. We examined baseline data from a study of risky drinking youth to identify factors associated with HID. Methods: Risky drinkers (ages 16-24) were recruited online (positive 3-month AUDIT-C score) as part of a larger study to examine social media interventions for risky drinking. We used baseline survey data to examine HID in relation to demographics, substance use-related variables, and individual and social factors. Results: Among 931 risky drinkers, 29.8% reported past-month HID, and those with HID reported greater substance use and consequences. In multivariable analysis, HID was associated with male sex; greater social motives, impulsivity, and motivation; lower self-efficacy; and greater likelihood of not living with parents, drinking with important peers, and parental disapproval of posting drinking pictures. When examining age group interactions (16-20; 21-24), underage drinkers with high sensation-seeking scores and lower parental disapproval of posting drinking pictures on social media reported greater HID. Conclusions: Among risky drinking youth, male sex, social motives, impulsivity, higher motivation to and lower-self-efficacy to reduce drinking, living away from parents, more frequent drinking with important peers, and lower parental disapproval of posting drinking pictures on social media were positively associated with HID. Further, HID was associated with greater health consequences, underscoring the need for HID interventions. Such interventions may benefit from enhancing motivation and self-efficacy, particularly in social contexts, as well as increasing positive peer and leisure activities to reduce HID.
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Affiliation(s)
- Erin E. Bonar
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
| | - Mariam A. Souweidane
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,VA Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800
| | - Amy S. B. Bohnert
- VA Center for Clinical Management Research, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800,Department of Anesthesiology, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800
| | - José A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104
| | - Sean D. Young
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA 92697,Department of Emergency Medicine, School of Medicine, University of California Irvine, Irvine, CA 92697
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Addiction Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 16, Ann Arbor, MI 48109, USA,Injury Prevention Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd. Building 10, Ann Arbor, MI 48109, USA
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Coughlin LN, Blow FC, Walton M, Ignacio RV, Walters H, Massey L, Barry KL, McCormick R. Predictors of Booster Engagement Following a Web-Based Brief Intervention for Alcohol Misuse Among National Guard Members: Secondary Analysis of a Randomized Controlled Trial. JMIR Ment Health 2021; 8:e29397. [PMID: 34698652 PMCID: PMC8579213 DOI: 10.2196/29397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/22/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol misuse is a major health concern among military members. Reserve component members face unique barriers as they live off base with limited access to behavioral health services. Web and app-based brief interventions are a promising means to improve access to treatment for those who misuse alcohol, with the use of booster sessions to enhance effectiveness, solidify gains, and reinforce changes. However, little is known about who will engage in booster sessions. OBJECTIVE This study aims to evaluate booster engagement across booster delivery modalities (Web and Peer) and identify participant-specific factors associated with booster session engagement. METHODS Following a brief web-based alcohol misuse intervention in National Guard members (N=739), we examined engagement in a series of three booster sessions. Using unadjusted and adjusted models, demographic and clinical characteristics that may serve as predictors of booster session engagement were examined across the 2 arms of the trial with different types of booster sessions: peer-delivered (N=245) and web-delivered (N=246). RESULTS Booster session completion was greater for Peer than Web Booster sessions, with 142 (58%) service members in the Peer Booster arm completing all three boosters compared with only 108 (44%) of participants in the Web Booster arm (χ23=10.3; P=.006). In a model in which the 2 groups were combined, socioeconomic factors predicted booster engagement. In separate models, the demographic and clinical predictors of booster engagement varied between the 2 delivery modalities. CONCLUSIONS The use of peer-delivered boosters, especially among subsets of reserve members at risk of lack of engagement, may foster greater uptake and improve treatment outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT02181283; https://clinicaltrials.gov/ct2/show/NCT02181283.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,VA Center for Clinical Management Research, Department of Veteran Affairs Healthcare System, Ann Arbor, MI, United States
| | - Maureen Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Rosalinda V Ignacio
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Heather Walters
- VA Center for Clinical Management Research, Department of Veteran Affairs Healthcare System, Ann Arbor, MI, United States
| | - Lynn Massey
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Kristen L Barry
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Richard McCormick
- Center for Healthcare Research and Policy, MetroHealth/Case Western Reserve University, Cleveland, OH, United States
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Meredith LR, Grodin EN, Karno MP, Montoya AK, MacKillop J, Lim AC, Ray LA. Preliminary study of alcohol problem severity and response to brief intervention. Addict Sci Clin Pract 2021; 16:54. [PMID: 34429151 PMCID: PMC8386030 DOI: 10.1186/s13722-021-00262-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Findings have been mixed as to whether brief intervention (BI) is appropriate and effective for individuals with more severe alcohol use problems. Motivation to change drinking has been supported as a mechanism of behavior change for BI. This exploratory study examined aspects of motivation as mechanisms of clinical response to BI and alcohol problem severity as a moderator of treatment effects. Methods Non-treatment-seeking heavy drinkers (average age = 35 years; 57% male) were randomized to receive BI (n = 27) or attention-matched control (n = 24). Three indices of motivation to change were assessed at baseline and post-intervention: importance, confidence, and readiness. Moderated mediation analyses were implemented with treatment condition as the focal predictor, changes in motivation as mediator, 1-month follow-up drinks per day as the outcome, and an alcohol severity factor as second-stage moderator. Results Analysis of importance displayed a significant effect of intervention condition on importance (p < 0.003) and yielded a significant index of moderated mediation (CI − 0.79, − 0.02), indicating that the conditional indirect effect of treatment condition on drinking through importance was stronger for those with higher alcohol severity. For all motivation indices, alcohol severity moderated the effect of post-intervention motivation levels on drinking (p’s < 0.05). The direct effect of treatment condition on drinking was not significant in any model. Conclusions Findings highlight the relevance of considering one’s degree of alcohol problem severity in BI and alcohol screening efforts among non-treatment seeking heavy drinkers. These nuanced effects elucidate both potential mechanisms and moderators of BI response. Trial registration Clinicaltrials.gov: NCT04710095. Registered January 14, 2021—retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT04710095.
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Affiliation(s)
- Lindsay R Meredith
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Erica N Grodin
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Mitchell P Karno
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Amanda K Montoya
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - James MacKillop
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Aaron C Lim
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Lara A Ray
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA. .,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
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13
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Siegel R, Sullivan N, Monte AA, Vargas NM, Cooper ZD, Ma Y, Meltzer AC. Motivational interviewing to treat substance use disorders in the emergency department: A scoping review. Am J Emerg Med 2021; 51:414-417. [PMID: 33840549 DOI: 10.1016/j.ajem.2021.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rebecca Siegel
- Brookdale University Hospital and Medical Center, Department of Emergency Medicine, The Department of Emergency Medicine, 1 Brookdale Plaza, Brooklyn, NY 11212, United States of America
| | - Natalie Sullivan
- The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, United States of America
| | - Andrew A Monte
- University of Colorado School of Medicine, Department of Emergency Medicine and Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, University of Colorado Hospital (UCH), 12605 E. 16th Ave, Aurora, CO 80045, United States of America
| | - Nataly Montano Vargas
- The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, United States of America
| | - Ziva D Cooper
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences and UCLA Cannabis Research Initiative, Jane & Terry Semel Institute for Neuroscience & Human Behavior, UCLA Cannabis Research Initiative, Jane & Terry Semel Institute for Neuroscience & Human Behavior, Office 37-418, Los Angeles, CA 90095, United States of America
| | - Yan Ma
- The George Washington University, Milken Institute School of Public Health, Department of Biostatistics and Bioinformatics, The George Washington University, 950 New Hampshire Ave NW, 5th Fl, Washington, DC, 20052, United States of America
| | - Andrew C Meltzer
- The George Washington University School of Medicine and Health Sciences, Department of Emergency Medicine, The Department of Emergency Medicine, 2120 L Street NW, Suite 450, Washington, DC 20037, United States of America.
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Emergency department interventions for homelessness: a systematic review. CAN J EMERG MED 2021; 23:111-122. [PMID: 33683611 DOI: 10.1007/s43678-020-00008-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/20/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND The social determinants of health are economic and social conditions that contribute to health. Access to housing is a major social determinant of health and homeless patients often rely on emergency departments (EDs) for their healthcare. These patients are frequently discharged back to the street which further perpetuates the cycle of homelessness and negatively affects their health. Previous work has described the financial and systems implications of ED-housed interventions for homeless patients; this review summarizes ED-based interventions that seek to improve the social determinants of health of homeless patients. METHODS We conducted a search of multiple databases and gray literature for studies investigating interventions for homelessness that were initiated in the ED. Studies had to use a control group or use a pre/post-intervention design and measure outcomes that demonstrate an effect on health or the social determinants of health. RESULTS Thirteen studies were identified that met the inclusion criteria. Two studies were housing first interventions and were effective in providing housing and improving health. Seven studies used variations of case management and were able to address many of the social needs of people who are homeless. CONCLUSION This review demonstrated that ED interventions can be effective in improving the social determinants of health of homeless individuals and can be the place to initiate housing interventions. ED providers must advocate for the resources necessary to properly address the social needs of this marginalized population. Equipped with the proper resources, EDs can be one place where the cycle of homelessness is broken.
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Im SC, Lee DH. Effects of screening and brief intervention on alcohol consumption in an emergency department. Clin Exp Emerg Med 2021; 7:310-318. [PMID: 33440109 PMCID: PMC7808834 DOI: 10.15441/ceem.19.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/02/2020] [Indexed: 11/23/2022] Open
Abstract
Objective Alcohol use is associated with high levels of morbidity and mortality. Alcohol problems are common in emergency departments (EDs). This study investigated the effect of screening and a new brief intervention (BI) protocol on alcohol consumption of ED patients. Methods The participants of this study were those aged 18 years or older who visited the ED due to injury over 12 weeks. BI was offered to patients with a score of 8 or higher on alcohol use disorders identification test (AUDIT) screening. Follow-up telephone assessments were conducted at one week, one month, and three months. Results The risk drinker (RD) group (AUDIT 8–15) comprised 101 patients, and the alcohol use disorder (AUD) group (AUDIT >16) comprised 41 patients. Before the BI, the weekly mean alcohol intake amount for the RD group was 180.90±98.34 g and for the AUD group was 358.00± 110.62 g. Alcohol consumption was reduced to 132.39±75.87 g in the RD group and 181.86± 78.11 g in the AUD group in the 3-month follow-up assessment. Alcohol consumption in the AUD group reduced significantly compared to the RD group (P<0.001). Conclusion Alcohol screening and BI contributed to alcohol intake reduction in ED patients. Specifically, the BI effect was greater in the AUD group than the RD group. The ED can be an effective place to begin implementing screening and intervention for alcohol use patients at risk.
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Affiliation(s)
- Soo Chul Im
- Department of Emergency Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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16
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Pot AL, Le Faou AL, Airagnes G, Limosin F. [Not Available]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2020; 32:315-327. [PMID: 33512098 DOI: 10.3917/spub.204.0315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Given the high prevalence of alcohol use disorder (AUD) amongst patients in Emergency Rooms (ER), it is recommended to carry out a systematized screening of at-risk drinkers, followed if necessary by a brief intervention (BI) to prevent AUD-related damages. This intervention has been the subject of numerous efficacy and feasibility studies. The purpose of this review of the literature is to identify optimal strategies for systematic screening and BI that can be deployed in the ER. METHODS We selected randomized controlled trials, meta-analysis and reviews of the literature published between July 2014 and March 2019 evaluating the effectiveness of BI in the ER on reducing alcohol consumption. RESULTS Thirteen articles were included. There is a significant heterogeneity of the methodologies used and the interventions carried out. The majority of studies conclude in the effectiveness of BI on reducing alcohol consumption, with however differences between the studies in effect size, and an effectiveness that seems to decrease over time. CONCLUSION The BI in the ER appears to be effective on reducing alcohol consumption but with a modest effect size and heterogeneity of the interventions tested, so that the optimal modalities of its implementation remain to be defined. Further studies to compare different interventions and identify at-risk subgroups would be needed to optimize the use of BI in the ER.
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Abstract
Abstract
Purpose
Only about 20% of people suffering from substance use disorders access available treatments due to various obstacles; digital interventions could potentially overcome some of these. Meta-analyses suggest the strongest evidence for interventions targeting alcohol use reduction, followed by cannabis and illicit substances. However, most randomized controlled trials (RCTs) used unguided standalone interventions compared to non-active controls, with limited follow-up periods and disregarded comorbidity. This review examines the literature published over the last three years (2016–2019), with a focus on recent RCTs and whether they addressed some of these gaps.
Recent findings
Except for digital interventions targeting alcohol use, the number of RCTs in the last three years is limited. Although there is considerable heterogeneity between the studies, most of them applied unguided add-on interventions compared to active control groups, and a limited number investigated guided interventions. In addition, there is a need for longer follow-up periods, active rather than non-active control groups, outcome standardization, and increased focus on comorbidity.
Summary
Although the number of studies using guided add-on or blended interventions compared to active controls has increased, future studies should consider our identified gaps and suggestions to further strengthen the evidence of digital interventions for reducing the use of alcohol and other substances.
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Dooley-Hash S, Adams M, Walton MA, Blow FC, Cunningham RM. The prevalence and correlates of eating disorders in adult emergency department patients. Int J Eat Disord 2019; 52:1281-1290. [PMID: 31322755 PMCID: PMC7047774 DOI: 10.1002/eat.23140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study describes the prevalence of eating disorders among adult patients who present to the emergency department for medical care and examines the relationship between eating disorders, depression, and substance use disorders. METHOD Emergency department patients aged 21-65 years (n = 1,795) completed a computerized questionnaire that included validated screening tools for eating disorders, risky drinking behavior, other substance use, and depression. Analyses were conducted comparing individuals who screened positive for an eating disorder with those who did not based on demographics (gender, age, race, income, education), body mass index (BMI), risky drinking behavior, other substance use, and depression. RESULTS Nearly 16% (15.9%) of all patients screened positive for an eating disorder regardless of their reason for presenting to the emergency department. Patients who screened positive for an eating disorder were significantly more likely to have a BMI > 30 (odds ratio [OR] = 2.68, confidence interval [CI] = 1.98, 3.62, p < .001), to also screen positive for depression (OR = 3.19, CI = 2.28, 4.47, p < .001) and to be female (OR = 2.37, CI = 1.76, 3.19, p < .001). No differences in the prevalence of positive screens for eating disorders were seen across age or racial groups, level of education or income, or for any of the included substance use variables. DISCUSSION Eating disorders are common among adult emergency department patients and are associated with high rates of comorbid depression and higher BMI. Given the significant morbidity and mortality associated with eating disorders, targeted screening may be warranted in the emergency department setting.
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Affiliation(s)
- Suzanne Dooley-Hash
- department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
- The Center for Eating Disorders, Ann Arbor, Michigan
| | - Mackenzie Adams
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Maureen A. Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M. Cunningham
- department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan
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Lee JH, Lee DH. Comparison of injury pattern and clinical outcomes between young adults and elderly patients with alcohol-related injury in South Korea 2011-2016. PeerJ 2019; 7:e7704. [PMID: 31579598 PMCID: PMC6768054 DOI: 10.7717/peerj.7704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022] Open
Abstract
Background Alcohol is an important factor that contributes to emergency department (ED) visits due to injury. However, the role of alcohol in elderly patients visiting ED due to injury has not been clearly defined. This study aims to examine age and alcohol as risk factors of injury severity and clinical outcomes. Methods This study included patients who visited EDs between January 2011 and December 2016. Data was obtained from the Emergency Department-Based Injury In-depth Surveillance of the Korea Centers for Disease Control and Prevention, South Korea. Injury patients aged ≥18 years were included, but those who visited the ED more than 48 hours after injury, with unknown clinical outcomes (admission, mortality, and excess mortality ratio-adjusted injury severity score [EMR-ISS]) were excluded. Results We analyzed 887,712 patients, of whom 131,708 (17.7%) non-elderly and 9,906 (7.0%) elderly had alcohol-related injury. Falls and slips are the most common injury mechanism (37.9%) in patients consuming alcohol (36.3% non-elderly/58.40% elderly). The injury occurred on roads (40.6%), houses (33.8%), and commercial facilities (11.9%) in elderly patients consuming alcohol. Suicide rate was 12.0% in elderly and 9.7% in non-elderly patients. According to the time of day of injury, evening (60.8%) was the most common in elderly and night (62.6%) in non-elderly patients. Admission rate (odds ratio [OR] 2.512 confidence interval [CI] 2.407–2.621), intensive care unit (ICU) care rate (OR 5.507 [CI] 5.178–5.858), mortality rate (OR 4.593 [CI] 4.086–5.162), and EMR-ISS >25 (OR 5.498 [CI] 5.262–5.745) were compared between patients with alcohol-related injury and non-elderly with non-alcohol-related injury patients. Alcohol consumption in elderly patients results in significant impairment and increases EMR-ISS, ICU care rate, and mortality rate. To reduce injury in elderly patients, alcohol screening, appropriate counseling, and intervention are needed.
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Affiliation(s)
- Jae Hee Lee
- Department of Emergency Medicine, Ewha Womans University, Seoul, South Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University, Seoul, South Korea
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20
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Arterberry BJ, Davis AK, Walton MA, Bonar EE, Cunningham RM, Blow FC. Predictors of empirically derived substance use patterns among sexual minority groups presenting at an emergency department. Addict Behav 2019; 96:76-81. [PMID: 31048112 PMCID: PMC6736643 DOI: 10.1016/j.addbeh.2019.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/28/2022]
Abstract
AIM Minority sexual orientation (i.e., Lesbian, Gay, Bisexual; LGB) is a risk indicator for mental health and substance use problems. Findings are inconsistent across studies investigating LGB substance use and risk factors, possibly due to heterogeneity in LGB subgroups. To inform models of substance use risk, we identified empirical patterns of substance use and related risk behaviors among LGB individuals. METHOD LGB participants (N = 343; Mage = 35.5, SD = 11.8; 71.4% = Female; 80.5% = White) were screened in an Emergency Department as part of a randomized controlled trial of an alcohol brief intervention. We conducted latent class analyses using the AUDIT-C (12 month; frequency, quantity, & binge) and ASSIST (12 month; illicit or misused prescription substance). Multinomial regression was performed to test predictors of class membership including depression symptoms, driving after alcohol or marijuana, and sexually transmitted infection (STI) history. RESULTS A 3-class model fit best and included "low use alcohol, marijuana, and tobacco users," (Low use; n = 244) "hazardous alcohol, tobacco and marijuana users," (Hazardous; n = 74) and "high-risk polysubstance users" (HPU; n = 25). The Low use class comprised the largest proportion of the sample across age, race/ethnicity, and sexual orientation. Compared to the Low use class, higher likelihood of depression symptoms, driving after alcohol or marijuana use, and STI was found for both Hazardous and HPU classes. CONCLUSION Researchers and clinicians should consider substance use patterns within the LGB population to inform interventions that address a variety of complex needs such as allocating more support for LGB individuals endorsing high-risk polysubstance use.
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Affiliation(s)
- Brooke J Arterberry
- Department of Psychology, Lagomarcino Hall, 901 Stange Road, Ames, IA 50011-1041, USA.
| | - Alan K Davis
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Maureen A Walton
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA
| | - Erin E Bonar
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA
| | - Rebecca M Cunningham
- University of Michigan Injury Prevention Center, University of Michigan School of Medicine, 2800 Plymouth Road, NCRC10-G080, Ann Arbor, MI 48109, USA; University of Michigan School of Medicine, Department of Emergency Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; University of Michigan School of Public Health, Health Behavior and Health Education, 1415 Washington Heights Ann Arbor, MI 48109, USA
| | - Frederic C Blow
- University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Center for Clinical Management Research, Health Services Research & Development, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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