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Goldschmidt L, Mncina B, Langa M, Rebello S, Budaza T, Tshabalala J, Achoki T. Lay counsellors' experiences of administering the AUDIT-C as a brief screening tool in a South African township. BMC Health Serv Res 2023; 23:1227. [PMID: 37946216 PMCID: PMC10633970 DOI: 10.1186/s12913-023-10230-2] [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: 01/15/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND South Africa presents one of the riskiest patterns of alcohol consumption, with per capita consumption above the African regional average. Globally, there has been an increased focus on the potential of appointing lay counsellors to administer alcohol intervention strategies in resource-limited contexts. Given the increasing need for relevant and efficient intervention strategies in response to high-risk alcohol consumption, screening instruments such as the AUDIT-C have gained increased attention. METHODS This paper explores the experiences of 15 lay counsellors in response to the training received on how to administer the AUDIT-C instrument, as well as provide interventions such as brief advice or an appropriate referral, in the resource-limited South African township of Alexandra, Johannesburg. A focus group was facilitated for this purpose and, thereafter, a thematic content analysis was applied to identify the themes most central to the lay counsellors' experiences. RESULTS The research findings suggest that the lay counsellors perceived the training to be adequate in preparing them for administrating the AUDIT-C and for providing any relevant interventions, and that their confidence in administering the instrument developed as the project progressed. However, recruitment and administration challenges were experienced in primary healthcare and community settings, and lay counsellors perceived home visits to be more appropriate with respect to issues related to confidentiality and stigmatisation. CONCLUSION Overall, while lay counsellors feel that the training they received on the tool and the tool itself is useful for effectively implementing the AUDIT-C in low-resource communities, the availability and efficiency of alcohol treatment services in Alexandra Township need to be improved.
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Affiliation(s)
- Lynne Goldschmidt
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa.
| | - Buyisile Mncina
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
| | - Malose Langa
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
- Centre for the Study of Violence and Reconciliation, CSVR, Johannesburg, South Africa
| | | | | | | | - Tom Achoki
- ABInBev Foundation, New York, USA
- Africa Institute for Health Policy, Nairobi, Kenya
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Lehikoinen A, Voutilainen R, Romppanen J, Heinonen S. The effect of maternal alcohol and drug abuse on first trimester screening analytes: a retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:562. [PMID: 32977750 PMCID: PMC7517691 DOI: 10.1186/s12884-020-03171-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to determine whether first trimester trisomy screening (FTS) parameters are affected by alcohol and drug use. Methods A routine combined FTS including measurements of maternal serum levels of free β-human chorionic gonadotropin subunit (free β-hCG) and pregnancy-associated plasma protein A (PAPP-A) were measured at 9–11 weeks of gestation, and fetal nuchal translucency thickness (NTT) at 11–13 weeks of gestation. In total 544 women with singleton pregnancies [71 alcohol and drug abusers, 88 smokers, 168 non-smokers delivering a small for gestational age (SGA) child, and 217 unexposed control women] were assessed. Results Free β-hCG levels were higher in alcohol and drug abusing than in unexposed pregnant women [mean 1.5 vs. 1.2 multiples of medians (MoM); P = 0.013]. However, stepwise multiple linear regression analyses suggested that smoking could explain increased free β-hCG. Additionally, we observed lower PAPP-A levels in the smoking mothers (0.9 vs. 1.2 MoM; P = 0.045) and in those giving birth to an SGA child compared to the controls (1.1 vs.. 1.2 MoM; P < 0.001). Fetal NTT did not differ significantly between any of the groups. Conclusions The present study shows increased free β-hCG levels in alcohol and drug abusers, but maternal smoking may explain the result. Maternal serum PAPP-A levels were lower in smoking than non-smoking mothers, and in mothers delivering an SGA child. However, FTS parameters (PAPP-A, free β-hCG and NTT) seem not to be applicable for the use as alcohol biomarkers because of their clear overlap between alcohol abusers and healthy controls.
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Affiliation(s)
- Anni Lehikoinen
- Department of Pediatrics, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland. .,Department of Pediatrics, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
| | - Raimo Voutilainen
- Department of Pediatrics, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland.,Department of Pediatrics, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Jarkko Romppanen
- Eastern Finland Laboratory Centre Joint Authority Enterprise (ISLAB), P.O. Box 1700, 70211, Kuopio, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, P.O. Box 140, 00029, Helsinki, Finland.,Department of Obsteterics and Gynecology, University of Helsinki, P.O. Box 63, 00014, Helsinki, Finland.,Department of Obsteterics and Gynecology, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland
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Sun J, Zhang X, Wang Y, Wang J, Li J, Cao F. The associations of interpersonal sensitivity with mental distress and trait aggression in early adulthood: a prospective cohort study. J Affect Disord 2020; 272:50-57. [PMID: 32379620 DOI: 10.1016/j.jad.2020.03.161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/20/2020] [Accepted: 03/29/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND To explore the longitudinal associations of interpersonal sensitivity (IS) with mental distress and trait aggression among participants passing through adolescence into adulthood. METHODS A total of 306 participants were recruited at baseline and received a 24-month follow-up. Questionnaires investigating sociodemographics; IS; depression, anxiety, and stress; and trait aggression were used. Univariable and multivariable logistic regression and cross-lagged analyses were also performed. RESULTS At base, 22.5%, 18.3%, 24.2%, and 9.2% of the participants reported higher levels of IS, depressive, anxious, and stressful symptoms. IS at baseline was a partial risk factor for new problems, including anxiety, stress, and anger at follow-up. Newly developed or persistent IS was significantly associated with ongoing symptoms. Discontinued IS, however, only resolved the association with stress and anxiety symptoms. Similarly, newly developed or persistent IS was significantly associated with increased persistence of some problems (anxiety symptoms and physical aggression), while the discontinuation of IS was associated with a lessening of these outcomes. Cross-lagged analyses revealed bidirectional associations of IS with anxiety symptom and stress symptom. LIMITATIONS All subjects were recruited from one medical college, which could limit applicability. This study had a relatively small sample size. Self-reported questionnaires can lead to recall bias. Further research is needed to test causality. CONCLUSIONS IS can predict adolescents' newly developed partial mental distress and aggression. Our findings highlight the crucial role of early recognition of both higher levels of interpersonal sensitivity and associated behavioral problems.
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Affiliation(s)
- Jiwei Sun
- School of Nursing, Shandong University, No.44 Wenhua Xi Road, Jinan, China.
| | - Xuan Zhang
- School of Nursing, Shandong University, No.44 Wenhua Xi Road, Jinan, China.
| | - Ying Wang
- School of Nursing, Shandong University, No.44 Wenhua Xi Road, Jinan, China.
| | - Juan Wang
- School of Nursing, Shandong University, No.44 Wenhua Xi Road, Jinan, China.
| | - Jiahuan Li
- School of Nursing, Shandong University, No.44 Wenhua Xi Road, Jinan, China.
| | - Fenglin Cao
- School of Nursing, Shandong University, No.44 Wenhua Xi Road, Jinan, China.
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Klimas J, Nosova E, Socías E, Nolan S, Brar R, Hayashi K, Milloy MJ, Kerr T, Wood E. Factors associated with discontinuation of methadone maintenance therapy (MMT) among persons who use alcohol in Vancouver, Canada. Drug Alcohol Depend 2018; 186:182-186. [PMID: 29604525 PMCID: PMC6154800 DOI: 10.1016/j.drugalcdep.2018.01.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/22/2018] [Accepted: 01/27/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND We sought to examine the factors associated with discontinuation of MMT among persons on methadone who use alcohol. METHODS We evaluated the impact of drug-related and other factors on discontinuation of MMT among persons enrolled in MMT and who reported any use of alcohol versus those who were enrolled in two community-recruited prospective cohorts of people who use illicit drugs (PWUD). Extended Cox models with time-dependent variables identified factors independently associated with time to first MMT discontinuation. RESULTS Between December 2005 and 2015, 823 individuals on MMT who also reported using alcohol at least once were included in these analyses. During the study period, 391 (47.5%) discontinued methadone. Daily heroin injection (Adjusted Hazard Ratio [AHR] = 2.67, 95% Confidence Interval [CI]: 2.10-3.40) and homelessness (AHR = 1.42, 95% CI: 1.10-1.83) were positively associated with MMT discontinuation, whereas receiving other concurrent addiction treatment in addition to MMT (AHR = 0.07, 95% CI: 0.05-0.08), as well as >60 mg methadone dose (AHR = 0.48, 95% CI: 0.39-0.60), Hepatitis C virus seropositivity (AHR = 0.65, 95% CI: 0.47-0.90), and HIV seropositivity (AHR = 0.72, 95% CI: 0.57-0.91) were negatively associated with MMT discontinuation. Any/heavy alcohol use was not independently associated with MMT discontinuation. CONCLUSIONS This study reinforces the known risks of continued heroin injection and homelessness for MMT discontinuation among individuals who also consume alcohol and highlights the protective effect of both MMT dose and receipt of concurrent addiction treatment.
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Affiliation(s)
- Jan Klimas
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Dublin 4, Ireland; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Ekaterina Nosova
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Eugenia Socías
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Seonaid Nolan
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Rupinder Brar
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kanna Hayashi
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - M-J Milloy
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Evan Wood
- British Columbia Centres for Substance Use and Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Lehikoinen AI, Kärkkäinen OK, Lehtonen MA, Auriola SO, Hanhineva KJ, Heinonen ST. Alcohol and substance use are associated with altered metabolome in the first trimester serum samples of pregnant mothers. Eur J Obstet Gynecol Reprod Biol 2018; 223:79-84. [DOI: 10.1016/j.ejogrb.2018.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 11/16/2022]
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Klimas J, Wood E, Nosova E, Milloy MJ, Kerr T, Hayashi K. Prevalence of Heavy Alcohol Use Among People Receiving Methadone Following Change to Methadose. Subst Use Misuse 2018; 53:270-275. [PMID: 28605308 PMCID: PMC5726952 DOI: 10.1080/10826084.2017.1302960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND A recent switch in methadone formulation from methadone (1 mg/mL) to Methadose (10 mg/mL) in British Columbia (BC), Canada, was associated with increased reports of opioid withdrawal and increases in illicit opioid use. Impacts on other forms of drug use have not been assessed. Since alcohol use is common among people receiving Medication-Assisted Treatment (MAT), we assessed if switch was associated with increased prevalence of heavy alcohol use. METHODS Drawing on data from two open prospective cohort studies of people who inject drugs in Vancouver, BC, generalized estimating equations (GEE) model examined relationship between methadone formulation change and heavy alcohol use, defined by National Institute for Alcohol Abuse and Alcoholism (NIAAA). A sub-analysis examined relationship with heavier drinking defined as at least eight drinks per day on average in last six months. RESULTS Between June 2013 and May 2015, a total of 787 participants on methadone were eligible for the present analysis, of which 123 (15.6%) reported heavy drinking at least once in last six months. In an unadjusted GEE model, Methadose use was not significantly associated with an increased likelihood of heavy drinking [Odds Ratio (OR) = 1.03; 95% Confidence interval (CI) = 0.87-1.21]. Methadose use was not significantly associated with an increased likelihood of drinking at least eight drinks daily on average (OR = 1.09, 95% CI = 0.72-1.65). CONCLUSIONS Despite reported changes in opioid use patterns coinciding with the change, there appeared to be no effect of the methadone formulation change on heavy drinking in this setting.
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Affiliation(s)
- Jan Klimas
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- School of Medicine, University College Dublin, Coombe Healthcare Centre, Dolphins barn, Dublin 8, Ireland
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Ekaterina Nosova
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, CANADA, V5A 1S6
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BRUFFAERTS RONNY, MORTIER PHILIPPE, KIEKENS GLENN, AUERBACH RANDYP, CUIJPERS PIM, DEMYTTENAERE KOEN, GREEN JENNIFERG, NOCK MATTHEWK, KESSLER RONALDC. Mental health problems in college freshmen: Prevalence and academic functioning. J Affect Disord 2018; 225:97-103. [PMID: 28802728 PMCID: PMC5846318 DOI: 10.1016/j.jad.2017.07.044] [Citation(s) in RCA: 320] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mental health problems in college and their associations with academic performance are not well understood. The main aim of this study was to investigate to what extent mental health problems are associated with academic functioning. METHODS As part of the World Mental Health Surveys International College Student project, 12-month mental health problems among freshmen (N = 4921) was assessed in an e-survey of students at KU Leuven University in Leuven, Belgium. The associations of mental health problems with academic functioning (expressed in terms of academic year percentage [or AYP] and grade point average [GPA]) were examined across academic departments. RESULTS Approximately one in three freshman reports mental health problems in the past year, with internalizing and externalizing problems both associated with reduced academic functioning (2.9-4.7% AYP reduction, corresponding to 0.2-0.3 GPA reduction). The association of externalizing problems with individual-level academic functioning was significantly higher in academic departments with comparatively low average academic functioning. LIMITATIONS Limited sample size precluded further investigation of interactions between department-level and student-level variables. No information was available on freshman secondary school academic performance. CONCLUSIONS Mental health problems are common in college freshman, and clearly associated with lower academic functioning. Additional research is needed to examine the potentially causal nature of this association, and, if so, whether interventions aimed at treating mental health problems might improve academic performance.
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Affiliation(s)
- RONNY BRUFFAERTS
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Universitair Psychiatrisch Centrum – KU Leuven, Leuven, Belgium
| | - PHILIPPE MORTIER
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium
| | - GLENN KIEKENS
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium
| | - RANDY P AUERBACH
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | - PIM CUIJPERS
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam
| | - KOEN DEMYTTENAERE
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Universitair Psychiatrisch Centrum – KU Leuven, Leuven, Belgium
| | | | - MATTHEW K NOCK
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - RONALD C KESSLER
- Harvard Medical School, Department of Health Care Policy, Harvard University, Boston, MA, USA
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Could trisialotransferrin be used as an additional biomarker to CDT in order to improve detection of chronic excessive alcohol intake? Clin Biochem 2014; 47:1203-8. [DOI: 10.1016/j.clinbiochem.2014.05.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 01/29/2023]
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Pecoraro A, Ewen E, Horton T, Mooney R, Kolm P, McGraw P, Woody G. Using the AUDIT-PC to predict alcohol withdrawal in hospitalized patients. J Gen Intern Med 2014; 29:34-40. [PMID: 23959745 PMCID: PMC3889973 DOI: 10.1007/s11606-013-2551-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 12/11/2012] [Accepted: 06/27/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alcohol withdrawal syndrome (AWS) occurs when alcohol-dependent individuals abruptly reduce or stop drinking. Hospitalized alcohol-dependent patients are at risk. Hospitals need a validated screening tool to assess withdrawal risk, but no validated tools are currently available. OBJECTIVE To examine the admission Alcohol Use Disorders Identification Test-(Piccinelli) Consumption (AUDIT-PC) ability to predict the subsequent development of AWS among hospitalized medical-surgical patients admitted to a non-intensive care setting. DESIGN Retrospective case–control study of patients discharged from the hospital with a diagnosis of AWS. All patients with AWS were classified as presenting with AWS or developing AWS later during admission. Patients admitted to an intensive care setting and those missing AUDIT-PC scores were excluded from analysis. A hierarchical (by hospital unit) logistic regression was performed and receiver-operating characteristics were examined on those developing AWS after admission and randomly selected controls. Because those diagnosing AWS were not blinded to the AUDIT-PC scores, a sensitivity analysis was performed. PARTICIPANTS The study cohort included all patients age ≥18 years admitted to any medical or surgical units in a single health care system from 6 October 2009 to 7 October 2010. KEY RESULTS After exclusions, 414 patients were identified with AWS. The 223 (53.9 %) who developed AWS after admission were compared to 466 randomly selected controls without AWS. An AUDIT-PC score ≥4 at admission provides 91.0 % sensitivity and 89.7 % specificity (AUC=0.95; 95 % CI, 0.94–0.97) for AWS, and maximizes the correct classification while resulting in 17 false positives for every true positive identified. Performance remained excellent on sensitivity analysis (AUC=0.92; 95 % CI, 0.90–0.93). Increasing AUDIT-PC scores were associated with an increased risk of AWS (OR=1.68, 95 % CI 1.55–1.82, p<0.001). CONCLUSIONS The admission AUDIT-PC score is an excellent discriminator of AWS and could be an important component of future clinical prediction rules. Calibration and further validation on a large prospectivecohort is indicated.
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Affiliation(s)
- Anna Pecoraro
- />Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- />NIDA Clinical Trials Network, Delaware Valley Node, Philadelphia, PA USA
| | - Edward Ewen
- />Department of Medicine,, Christiana Care Health System, Newark, DE USA
| | - Terry Horton
- />NIDA Clinical Trials Network, Delaware Valley Node, Philadelphia, PA USA
- />Department of Medicine,, Christiana Care Health System, Newark, DE USA
| | - Ruth Mooney
- />Department of Nursing,, Christiana Care Health System, Newark, DE USA
| | - Paul Kolm
- />Center for Outcomes Research,, Christiana Care Health System, Newark, DE USA
| | - Patty McGraw
- />Department of Medicine,, Christiana Care Health System, Newark, DE USA
| | - George Woody
- />Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- />NIDA Clinical Trials Network, Delaware Valley Node, Philadelphia, PA USA
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Pecoraro A, Horton T, Ewen E, Becher J, Wright PA, Silverman B, McGraw P, Woody GE. Early data from Project Engage: a program to identify and transition medically hospitalized patients into addictions treatment. Addict Sci Clin Pract 2012. [PMID: 23185969 PMCID: PMC3507657 DOI: 10.1186/1940-0640-7-20] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Patients with untreated substance use disorders (SUDs) are at risk for frequent emergency department visits and repeated hospitalizations. Project Engage, a US pilot program at Wilmington Hospital in Delaware, was conducted to facilitate entry of these patients to SUD treatment after discharge. Patients identified as having hazardous or harmful alcohol consumption based on results of the Alcohol Use Disorders Identification Test-Primary Care (AUDIT-PC), administered to all patients at admission, received bedside assessment with motivational interviewing and facilitated referral to treatment by a patient engagement specialist (PES). This program evaluation provides descriptive information on self-reported rates of SUD treatment initiation of all patients and health-care utilization and costs for a subset of patients. Methods Program-level data on treatment entry after discharge were examined retrospectively. Insurance claims data for two small cohorts who entered treatment after discharge (2009, n = 18, and 2010, n = 25) were reviewed over a six-month period in 2009 (three months pre- and post-Project Engage), or over a 12-month period in 2010 (six months pre- and post-Project Engage). These data provided descriptive information on health-care utilization and costs. (Data on those who participated in Project Engage but did not enter treatment were unavailable). Results Between September 1, 2008, and December 30, 2010, 415 patients participated in Project Engage, and 180 (43%) were admitted for SUD treatment. For a small cohort who participated between June 1, 2009, and November 30, 2009 (n = 18), insurance claims demonstrated a 33% ($35,938) decrease in inpatient medical admissions, a 38% ($4,248) decrease in emergency department visits, a 42% ($1,579) increase in behavioral health/substance abuse (BH/SA) inpatient admissions, and a 33% ($847) increase in outpatient BH/SA admissions, for an overall decrease of $37,760. For a small cohort who participated between June 1, 2010, and November 30, 2010 (n = 25), claims demonstrated a 58% ($68,422) decrease in inpatient medical admissions; a 13% ($3,308) decrease in emergency department visits; a 32% ($18,119) decrease in BH/SA inpatient admissions, and a 32% ($963) increase in outpatient BH/SA admissions, for an overall decrease of $88,886. Conclusions These findings demonstrate that a large percentage of patients entered SUD treatment after participating in Project Engage, a novel intervention with facilitated referral to treatment. Although the findings are limited by the retrospective nature of the data and the small sample sizes, they do suggest a potentially cost-effective addition to existing hospital services if replicated in prospective studies with larger samples and controls.
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Affiliation(s)
- Anna Pecoraro
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Meneses-Gaya C, Crippa JAS, Zuardi AW, Loureiro SR, Hallak JEC, Trzesniak C, Machado de Sousa JP, Chagas MHN, Souza RM, Martín-Santos R. The fast alcohol screening test (FAST) is as good as the AUDIT to screen alcohol use disorders. Subst Use Misuse 2010; 45:1542-57. [PMID: 20590374 DOI: 10.3109/10826081003682206] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study was aimed at assessing the psychometric qualities of the fast alcohol screening test (FAST), and at comparing these qualities to those of the alcohol use disorders identification test (AUDIT) in three samples of Brazilian adults: (i) subjects attended at an emergency department (530); (ii) patients from a psychosocial care center (40); and (iii) university students (429). The structured clinical interview for diagnosis (SCID)-IV was used as gold standard. The FAST demonstrated high test-retest and interrater reliability coefficients, as well as high predictive and concurrent validity values. The results attest the validity and reliability of the Brazilian version of the FAST for the screening of indicators of alcohol abuse and dependence.
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Affiliation(s)
- Carolina Meneses-Gaya
- São Paulo University, Neurosciences and Behavior, INCT Translational Medicine, Ribeirão Preto, Brazil
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Meneses-Gaya C, Zuardi AW, Loureiro SR, Hallak JEC, Trzesniak C, de Azevedo Marques JM, Machado-de-Sousa JP, Chagas MHN, Souza RM, Crippa JAS. Is the full version of the AUDIT really necessary? Study of the validity and internal construct of its abbreviated versions. Alcohol Clin Exp Res 2010; 34:1417-24. [PMID: 20491736 DOI: 10.1111/j.1530-0277.2010.01225.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study was aimed at assessing the psychometric qualities of the abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT-3, AUDIT-4, AUDIT-C, AUDIT-PC, AUDIT-QF, FAST, and Five-Shot) and at comparing them to the 10-item AUDIT and the CAGE in 2 samples of Brazilian adults. METHODS The validity and internal consistency of the scales were assessed in a sample of 530 subjects attended at an emergency department and at a Psychosocial Care Center for Alcohol and Drugs. The Structured Clinical Interview for DSM-IV was used as the diagnostic comparative measure for the predictive validity assessment. The concurrent validity between the scales was analyzed by means of Pearson's correlation coefficient. RESULTS The assessment of the predictive validity of the abbreviated versions showed high sensitivity (of 0.78 to 0.96) and specificity (of 0.74 to 0.94) indices, with areas under the curve as elevated as those of the AUDIT (0.89 and 0.92 to screen for abuse and 0.93 and 0.95 in the screening of dependence). The CAGE presented lower indices: 0.81 for abuse and 0.87 for dependence. The analysis of the internal consistency of the AUDIT and its versions exhibited Cronbach's alpha coefficients between 0.83 and 0.94, while the coefficient for the CAGE was 0.78. Significant correlations were found between the 10-item AUDIT and its versions, ranging from 0.91 to 0.99. Again, the results for the CAGE were satisfactory (0.77), although inferior to the other instruments. CONCLUSIONS The results obtained in this study confirm the validity of the abbreviated versions of the AUDIT for the screening of alcohol use disorders and show that their psychometric properties are as satisfactory as those of the 10-item AUDIT and the CAGE.
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Affiliation(s)
- Carolina Meneses-Gaya
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Cremonte M, Cherpitel CJ. Performance of screening instruments for alcohol use disorders in emergency department patients in Argentina. Subst Use Misuse 2008; 43:125-38. [PMID: 18189209 DOI: 10.1080/10826080701212337] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The performance of the Alcohol Use Disorders Identification Test (AUDIT), CAGE, Brief Michigan Alcohol Screening Test (Brief MAST), Rapid Alcohol Problems Screen (RAPS), Rapid Alcohol Problems Screen-Quantity and Frequency (RAPS4-QF), and TWEAK was evaluated against a diagnosis of alcohol dependence and harmful drinking or alcohol abuse from ICD-10 and DSM-IV criteria. Data were collected from a probability sample of 779 patients admitted to the emergency department of a public general hospital in Mar del Plata, Argentina, during the year 2001. The majority of the patients sampled were male. The age range was 18 to 89 years, with a mean value of 36 years and a median of 31 years. Almost half of the sample had an elementary school education or less. All instruments were more sensitive for alcohol dependence than for harmful drinking or abuse and more sensitive for men than for women. Findings suggest the RAPS4 and RAPS4-QF may be preferred when screening for alcohol use disorders in the emergency department in Argentina. The study's limitations are noted.
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Affiliation(s)
- Mariana Cremonte
- Universidad Nacional de Mar del Plata, Mar del Plata, Argentina.
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Bortolotti F, De Paoli G, Tagliaro F. Carbohydrate-deficient transferrin (CDT) as a marker of alcohol abuse: a critical review of the literature 2001-2005. J Chromatogr B Analyt Technol Biomed Life Sci 2006; 841:96-109. [PMID: 16725384 DOI: 10.1016/j.jchromb.2006.05.005] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2006] [Revised: 05/03/2006] [Accepted: 05/04/2006] [Indexed: 01/21/2023]
Abstract
The diagnosis of alcohol abuse based on objective data is a necessary requirement in both clinical and forensic environments. Among the different biomarkers of chronic alcohol abuse, carbohydrate-deficient transferrin (CDT) is world wide recognized as the most reliable indicator. However, several problems about the real meaning of CDT and the reliability of its use for the diagnosis of alcohol abuses are still open, as reported by numerous research articles and reviews. The present article presents a critical review of the literature on CDT appeared in the period from 2001 to 2005 (included). The article is organized in the following sections: (1) introduction, (2) definition and structure of human serum CDT, (3) pathomechanisms of the ethanol-induced CDT increase, (4) preanalysis, (5) analysis, (6) data interpretation, (7) review papers, (8) conclusions. As many as 127 papers appeared in the international literature and retrieved by the search engines PubMed and Scopus are quoted.
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Affiliation(s)
- Federica Bortolotti
- University of Verona, Department Medicine/Public Health, Chair of Forensic Medicine, Policlinico G.B. Rossi, I-37134 Verona, Italy
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Bråthen G, Ben-Menachem E, Brodtkorb E, Galvin R, Garcia-Monco JC, Halasz P, Hillbom M, Leone MA, Young AB. EFNS guideline on the diagnosis and management of alcohol-related seizures: report of an EFNS task force. Eur J Neurol 2005; 12:575-81. [PMID: 16053464 DOI: 10.1111/j.1468-1331.2005.01247.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Despite being a considerable problem in neurological practice and responsible for one-third of seizure-related admissions, there is little consensus as to the optimal investigation and management of alcohol-related seizures. The final literature search was undertaken in September 2004. Consensus recommendations are given graded according to the EFNS guidance regulations. To support the history taking, use of a structured questionnaire is recommended. When the drinking history is inconclusive, elevated values of carbohydrate-deficient transferrin and/or gammaglutamyl transferase can support a clinical suspicion. A first epileptic seizure should prompt neuroimaging (CT or MRI). Before starting any carbohydrate containing fluids or food, patients presenting with suspected alcohol overuse should be given prophylactic thiamine parenterally. After an alcohol withdrawal seizure (AWS), the patient should be observed in hospital for at least 24 h and the severity of withdrawal symptoms needs to be followed. For patients with no history of withdrawal seizures and mild to moderate withdrawal symptoms, routine seizure preventive treatment is not necessary. Generally, benzodiazepines are efficacious and safe for primary and secondary seizure prevention; diazepam or, if available, lorazepam, is recommended. The efficacy of other drugs is insufficiently documented. Concerning long-term recommendations for non-alcohol dependent patients with partial epilepsy and controlled seizures, small amounts of alcohol may be safe. Alcohol-related seizures require particular attention both in the diagnostic work-up and treatment. Benzodiazepines should be chosen for the treatment and prevention of recurrent AWS.
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Affiliation(s)
- G Bråthen
- Department of Neurology and Clinical Neurophysiology, Trondheim University Hospital, Trondheim, Norway.
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Aertgeerts B, Buntinx F, Kester A. The value of the CAGE in screening for alcohol abuse and alcohol dependence in general clinical populations: a diagnostic meta-analysis. J Clin Epidemiol 2004; 57:30-9. [PMID: 15019008 DOI: 10.1016/s0895-4356(03)00254-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2003] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To perform a meta-analysis to assess diagnostic characteristics of the CAGE in screening for alcohol abuse or dependence in a general clinical population and to test a new method for pooling of ROC curves. METHODS Medline search performed over the period 1/1/1974 to 31/12/2001. MEASUREMENT Calculation of diagnostic values. RESULTS We identified 35 articles using the DSM criteria as the gold standard to test the diagnostic value of the CAGE. Only 10 studies could be included for the meta-analysis. With a cutoff point > or =2, the pooled sensitivity is far better in inpatients (0.87) than in primary care patients (0.71) or ambulatory patients (0.60). The pooled specificity also differs for each group. The likelihood ratios seem to be relatively constant over the populations (overall LR+:3.44;LR-:0.18). We calculated a pooled AUC of 0.87 (95% CI 0.85-0.89). At low specificity values, the sensitivity was homogeneous over the studies, and at a low sensitivity, the specificity was heterogeneous. CONCLUSION The diagnostic value of the CAGE is of limited value using this test for screening purposes at his recommended cutpoint of > or =2.
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Affiliation(s)
- B Aertgeerts
- Department of General Practice, Clinical Epidemiology Unit, Katholicke Universiteit Leuven, Kapucijnenvoer 33, Blok J, B-3000 Leuven, Belgium.
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