The Readiness Ruler as a measure of readiness to change poly-drug use in drug abusers

Characterizing Engagement with Web-Based Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Traumatic Stress and Substance Misuse After Interpersonal Violence

Screening, brief intervention, and referral to treatment (SBIRT) is a widely used public health approach for delivering early intervention for substance misuse. SBIRT adaptations that incorporate content on interpersonal violence and posttraumatic stress disorder (PTSD) symptoms may be warranted, as experiences of interpersonal violence are prevalent and associated with greater substance misuse; however, more research is needed to refine the delivery of PTSD-substance use content within the SBIRT model. This study examined clinical data collected as part of a web-based SBIRT developed for co-occurring substance misuse and PTSD symptoms after interpersonal violence to characterize the clinical symptoms and responses of adults presenting to agencies serving intimate partner and sexual violence survivors. The respondents (N = 52) completed self-report measures during the SBIRT tool to personalize the recommendations, as well as motivational enhancement exercises. Descriptive statistics were conducted. The results underscored high rates of probable PTSD, substance use, and trauma-related motives for substance use. The respondents were ready to change their substance use on average after receiving personalized feedback. Many expressed values related to trauma recovery and self-empowerment, perceived these values as useful for substance use reduction, and set goals to seek mental health services or reduce their drinking quantity. The findings point to several clinical targets for integrated PTSD-substance misuse interventions for interpersonal violence survivors.

Collaborating to heal addiction and mental health in primary care (CHAMP): A protocol for a hybrid type 2a trial

BACKGROUND

The gold-standard treatment for opioid use disorder (OUD) is medication for OUD (MOUD). However, less than a quarter of people with OUD initiate MOUD. Expanding the Collaborative Care Model (CoCM) to include primary care patients with OUD could improve access to and initiation of MOUD. This paper presents the methods and baseline sample characteristics of a Hybrid Type 2a trial comparing the effectiveness of CoCM for OUD and co-occurring mental health symptoms (MHS) to CoCM for MHS only.

METHOD

42 primary care clinics were cluster randomized and 254 primary care patients with OUD and elevated MHS were enrolled. Recruitment was terminated early by the Data and Safety Monitoring Board for futility. Participants completed research assessments at baseline, 3 months, and 6 months. The multiple primary outcomes were past-month number of days of nonmedical opioid use and SF12 Mental Health Component Summary (MCS) scores.

RESULTS

MCS scores were over a standard deviation below the national mean (M = 34.5). Nearly half (47.6 %) of participants had previously overdosed in their lifetimes. Three quarters (76.0 %) were already being prescribed MOUD at baseline, only 30.4 % reported non-medical use of opioids, and only 33.9 % reported being bothered by opioid cravings.

CONCLUSION

The unexpectedly high proportion of enrollees already prescribed MOUD at baseline indicates that most patients were in the maintenance rather than acute phase of treatment. Challenges identifying and enrolling patients in the acute phase of OUD treatment implies that intervention effectiveness will depend on its success preventing the discontinuation of MOUD rather than initiating MOUD.

Motivational Interviewing for the Prevention and Treatment of Pediatric Obesity: A Primer

Motivational interviewing (MI), which is recommended for prevention and treatment of pediatric obesity, is a patient-centered counseling style used to modify behaviors. When using MI, pediatric providers generally avoid direct attempts to convince or persuade. Instead, they help patients or parents think about and verbalize their reasons for and against change and how their behavior aligns with their values and goals. MI relies on specific techniques, including reflective listening, to strategically balance the need to "comfort the afflicted" and "afflict the comfortable"; to balance the expression of empathy with the need to build discrepancy for change, thereby encouraging "change talk".

Effect of a Smartphone App (S-Check) on Actual and Intended Help-Seeking and Motivation to Change Methamphetamine Use Among Adult Consumers of Methamphetamine in Australia: Randomized Waitlist-Controlled Trial

BACKGROUND

Interventions are required that address delays in treatment-seeking and low treatment coverage among people consuming methamphetamine.

OBJECTIVE

We aim to determine whether a self-administered smartphone-based intervention, the "S-Check app" can increase help-seeking and motivation to change methamphetamine use, and determine factors associated with app engagement.

METHODS

This study is a randomized, 28-day waitlist-controlled trial. Consenting adults residing in Australia who reported using methamphetamine at least once in the last month were eligible to download the app for free from Android or iOS app stores. Those randomized to the intervention group had immediate access to the S-Check app, the control group was wait-listed for 28 days before gaining access, and then all had access until day 56. Actual help-seeking and intention to seek help were assessed by the modified Actual Help Seeking Questionnaire (mAHSQ), modified General Help Seeking Questionnaire, and motivation to change methamphetamine use by the modified readiness ruler. χ2 comparisons of the proportion of positive responses to the mAHSQ, modified General Help Seeking Questionnaire, and modified readiness ruler were conducted between the 2 groups. Logistic regression models compared the odds of actual help-seeking, intention to seek help, and motivation to change at day 28 between the 2 groups. Secondary outcomes were the most commonly accessed features of the app, methamphetamine use, feasibility and acceptability of the app, and associations between S-Check app engagement and participant demographic and methamphetamine use characteristics.

RESULTS

In total, 560 participants downloaded the app; 259 (46.3%) completed eConsent and baseline; and 84 (32.4%) provided data on day 28. Participants in the immediate access group were more likely to seek professional help (mAHSQ) at day 28 than those in the control group (n=15, 45.5% vs n=12, 23.5%; χ21=4.42, P=.04). There was no significant difference in the odds of actual help-seeking, intention to seek help, or motivation to change methamphetamine use between the 2 groups on the primary logistic regression analyses, while in the ancillary analyses, the imputed data set showed a significant difference in the odds of seeking professional help between participants in the immediate access group compared to the waitlist control group (adjusted odds ratio 2.64, 95% CI 1.19-5.83, P=.02). For participants not seeking help at baseline, each minute in the app increased the likelihood of seeking professional help by day 28 by 8% (ratio 1.08, 95% CI 1.02-1.22, P=.04). Among the intervention group, a 10-minute increase in app engagement time was associated with a decrease in days of methamphetamine use by 0.4 days (regression coefficient [β] -0.04, P=.02).

CONCLUSIONS

The S-Check app is a feasible low-resource self-administered intervention for adults in Australia who consume methamphetamine. Study attrition was high and, while common in mobile health interventions, warrants larger studies of the S-Check app.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12619000534189; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377288&isReview=true.

Quasi-randomized trial of solution-focused brief therapy intervention for readiness to change and alcohol and other drug use in a Brazilian community-based treatment center

OBJECTIVE

Strategies to increase readiness to change may enhance community-based substance use treatment outcomes. This study evaluated the effect of solution-focused brief therapy (SFBT) on readiness to change and substance use compared to treatment as usual (TAU) in a Brazilian community-based substance use treatment center.

METHODS

One hundred two adults (M = 36.79, SD = 10.29) were quasi-randomized into SFBT or TAU groups. Assessments were completed at baseline, post-test, and 1-month follow-up. The primary outcome was the changes in readiness to change at post-test and 1-month follow-up. The secondary outcome was the change in substance use at 1-month follow-up.

RESULTS

Through Quade non-parametric analysis of covariance (ANCOVA), both groups decreased tobacco, alcohol, and cocaine/crack use at 1-month follow-up, but SFBT had greater reductions in alcohol use (p = .05). ANCOVA analysis demonstrated no differences between groups on readiness to change at any time point. However, among participants who used multiple substances (n = 59), SFBT showed higher readiness to change at post-test (p = .05).

CONCLUSIONS

These findings strengthen the evidence that SFBT holds promise for positive community-based substance use treatment outcomes.

Incremental Predictive Validity of the Dualistic Model of Passion for Cannabis Use Among College Undergraduate Students With and Without a Cannabis Use Disorder

Introduction

We examined whether the Dualistic Model of Passion (DMP; i.e., obsessive passion [OP] and harmonious passion [HP]) for cannabis use was prospectively associated with cannabis use and use-related outcomes, and with academic performance, relationship attachment style, and social connectedness among college students. We also explored whether the DMP was associated with outcomes when included in a model using established constructs (e.g., coping motives, refusal self-efficacy, cannabis use disorder [CUD] symptoms) as predictors of cannabis use and outcomes.

Methods

Using a longitudinal cohort design (baseline, 5-month, 10-month [timepoints chosen to better correspond to 9-month academic year]), 513 undergraduate students from two universities who reported using cannabis at least four times in the past month completed a baseline survey (308 meeting criteria for CUD). We used Generalized Estimating Equations to assess longitudinal associations between OP/HP and cannabis use and academic/social outcomes at 5-month and 10-month.

Results

At baseline, participants were young adults (Mean age = 20.57, SD = 2.51), 78.8% non-Hispanic, 83.8% White, 55.0% female, and 72.3% heterosexual. Greater HP was not associated with greater past month cannabis use or cannabis-related problems. Greater OP was associated with greater past month cannabis use and more cannabis-related problems. There were no significant passion by time interactions. Greater HP was associated with more anxious attachment. OP was associated with less social connection.

Conclusion

This research suggests that the DMP provides novel information about factors associated with cannabis use and use-related consequences, which can aid in our understanding of cannabis use, misuse, and CUD among college students.

Effectiveness and feasibility of a motivational interviewing intake (MII) intervention for increasing client engagement in outpatient addiction treatment: an effectiveness-implementation hybrid design protocol

BACKGROUND

Client discontinuation from outpatient addiction treatment programs is common, and the initial intake is the service delivery point with the highest attrition rate. Replacing the comprehensive intake assessment with a person-centered Motivational Interviewing (MI) intervention is a potential solution to address provider and client concerns about the disengaging, time-intensive nature of the typical initial intake. It remains unclear whether the use of an alternative to the standard intake at the initial visit can fit within typical organizational reporting requirements, whether it decreases attrition, and whether implementation of person-centered intake procedures within outpatient addiction treatment programs is feasible, acceptable, and can be sustained.

PURPOSE

To describe the methods and design of an effectiveness-implementation hybrid type 1 trial of a Motivational Interviewing at Intake (MII) intervention using the Consolidated Framework for Implementation Research (CFIR).

METHODS

The study will determine the effectiveness of two intake conditions: (1) standard comprehensive intake assessment (intake-as-usual [IAU]), and (2) MII consisting of a person-centered discussion between provider and client about the client's desire and intent to enter treatment. Although both interventions are focused on understanding client presenting complaints and needs for treatment, the delivery differs as the IAU uses a semi-structured assessment guide, while MII applies the theory of MI to have a conversation about treatment engagement. Adults seeking outpatient addiction treatment services will be randomly assigned to the MII condition (n = 75) or the IAU condition (n = 75). Primary outcomes will be client engagement (i.e., treatment entry, attendance, and completion) obtained from the electronic medical record. Secondary outcomes (client motivation and therapeutic alliance) will be putative mechanisms of client engagement assessed immediately before and after the intake. The trial also will explore determinants of effective, sustainable implementation using assessments of organizational readiness and capacity to change, as well as interviews on MII implementation feasibility.

CONCLUSION

This trial of an MII intervention will investigate the feasibility of a motivational intervention as an initial contact with substance use treatment-seeking clients as well as indicators of intervention effectiveness within the systems where it is employed. Trial registration Clinicaltrials.gov identifier: NCT05489068.

Prevalence of cannabis use disorder among individuals using medical cannabis at admission to inpatient treatment for substance use disorders

INTRODUCTION

Cannabis is used for medical and recreational purposes and may result in cannabis use disorder (CUD). This study explored the prevalence of cannabis use disorder and other psychiatric comorbidities among inpatients undergoing treatment for substance use disorder who reported medical cannabis use at admission.

METHODS

We assessed CUD and other substance use disorders based on DSM-5 symptoms, anxiety with the Generalized Anxiety Disorder scale (GAD-7), depression with the Patient Health Questionnaire (PHQ-9), and post-traumatic stress disorder with the PTSD Checklist for DSM-5 (PCL-5). We compared the prevalence of CUD and other psychiatric comorbidities between inpatients who endorsed the use of cannabis for medical purposes only vs those endorsing use for medical and recreational purposes.

RESULTS

Among 125 inpatients, 42% reported medical use only, and 58% reported medical and recreational use (dual motives). For CUD, 28% of Medical-Only and 51% of Dual-Use motives patients met the diagnostic criteria for CUD (p = 0.016). High psychiatric comorbidities were present: 79% and 81% screened positive for an anxiety disorder, 60% and 61% screened positive for depression, and 66% and 57% screened positive for PTSD for the Medical-Only and Dual-Use inpatients, respectively.

CONCLUSIONS

Many treatment-seeking individuals with substance use disorder who report medical cannabis use meet criteria for CUD, particularly those reporting concurrent recreational use.

Computer-based intervention for residents of domestic violence shelters with substance use: A randomized pilot study

BACKGROUND

Intimate Partner Violence (IPV) is a significant public health problem often associated with serious mental health and physical health implications. Substance use disorders (SUDs) are one of the most common comorbidities among women with IPV, increasing risk of subsequent IPV.

METHODS

The current study examined the feasibility, acceptability, and preliminary effectiveness of a brief computerized intervention to reduce alcohol and drug use among women with IPV. Fifty women with recent IPV and alcohol and drug use risk were recruited from domestic violence shelters and randomized to the experimental computerized intervention or to an attention and time control condition. The primary outcome was percent heavy drinking or drug using days in 3 month increments over the 6 months after leaving the shelter. Receipt of substance use services and IPV severity were evaluated as secondary outcomes.

RESULTS

The computerized intervention was feasible and acceptable, with high (n = 20, 80%) completion rates, engagement with the intervention, and satisfaction scores. As expected in this pilot trial, there were no significant differences between conditions in percent heavy drinking/drug using days or receipt of substance use services and large individual differences in outcomes. For example, receipt of substance use services decreased by a mean of 0.05 times/day from the baseline to the 6-month time period in the control condition (range -1.00 to +0.55) and increased by a mean of 0.06 times/day in the intervention condition (range -0.13 to +0.89). There were large decreases in IPV severity over time in both conditions, but directions of differences favored the control condition for IPV severity.

CONCLUSION

A computerized intervention to reduce the risk of alcohol/drug use and subsequent IPV is feasible and acceptable among residents of a domestic violence shelter. A fully powered trial is needed to conclusively evaluate outcomes.

Deploying a robotic positive psychology coach to improve college students' psychological well-being

Despite the increase in awareness and support for mental health, college students' mental health is reported to decline every year in many countries. Several interactive technologies for mental health have been proposed and are aiming to make therapeutic service more accessible, but most of them only provide one-way passive contents for their users, such as psycho-education, health monitoring, and clinical assessment. We present a robotic coach that not only delivers interactive positive psychology interventions but also provides other useful skills to build rapport with college students. Results from our on-campus housing deployment feasibility study showed that the robotic intervention showed significant association with increases in students' psychological well-being, mood, and motivation to change. We further found that students' personality traits were associated with the intervention outcomes as well as their working alliance with the robot and their satisfaction with the interventions. Also, students' working alliance with the robot was shown to be associated with their pre-to-post change in motivation for better well-being. Analyses on students' behavioral cues showed that several verbal and nonverbal behaviors were associated with the change in self-reported intervention outcomes. The qualitative analyses on the post-study interview suggest that the robotic coach's companionship made a positive impression on students, but also revealed areas for improvement in the design of the robotic coach. Results from our feasibility study give insight into how learning users' traits and recognizing behavioral cues can help an AI agent provide personalized intervention experiences for better mental health outcomes.

Assessing Stage of Change and Harm Reduction Strategies for Synthetic Cannabinoid Use Among Individuals Experiencing Homelessness in Houston, Texas

Synthetic cannabinoids (SCs) are low-cost substances that have been associated with adverse health outcomes and an increase in emergency department visits over recent years, particularly among people experiencing homelessness. This mixed methods study explored the connection between homelessness, SC use, and readiness to quit in order to inform the development of harm reduction strategies. Individuals (18+) residing in homeless encampments in Houston, TX with experiences of SC use were eligible to participate. Participants ( N = 65) completed an interviewer-administered survey about their SC use. Most participants were Black/African American (65.7%), male (82.9%), and most (75.4%) reported using SCs to avoid positive drug tests. Many wanted to quit using SCs (69.2%) and already employed harm reduction strategies while using SCs. Organizations supporting individuals experiencing homelessness who use SCs should focus on reducing barriers to stopping SC use and increasing the availability of housing and supportive services.

A Robotic Companion for Psychological Well-being: A Long-term Investigation of Companionship and Therapeutic Alliance

Social support plays a crucial role in managing and enhancing one's mental health and well-being. In order to explore the role of a robot's companion-like behavior on its therapeutic interventions, we conducted an eight-week-long deployment study with seventy participants to compare the impact of (1) a control robot with only assistant-like skills, (2) a coach-like robot with additional instructive positive psychology interventions, and (3) a companion-like robot that delivered the same interventions in a peer-like and supportive manner. The companion-like robot was shown to be the most effective in building a positive therapeutic alliance with people, enhancing participants' well-being and readiness for change. Our work offers valuable insights into how companion AI agents could further enhance the efficacy of the mental health interventions by strengthening their therapeutic alliance with people for long-term mental health support.

Promoting benzodiazepine cessation through an electronically-delivered patient self-management intervention (EMPOWER-ED): Randomized controlled trial protocol

Background

Long-term benzodiazepine dependence carries significant health risks which might be reduced with low-cost patient self-management interventions. A booklet version of one such intervention (Eliminating Medications Through Patient Ownership of End Results; EMPOWER) proved effective in a Canadian clinical trial with older adults. Digitizing such an intervention for electronic delivery and tailoring it to different populations could expand its reach. Accordingly, this article describes the protocol for a randomized controlled trial to test the effectiveness of an electronically-delivered, direct-to-patient benzodiazepine cessation intervention tailored to U.S. military veterans.

Methods

Design: Two-arm individually randomized controlled trial.

Setting

US Veterans Health Administration primary care clinics.

Participants

Primary care patients taking benzodiazepines for three or more months and having access to a smartphone, tablet or desktop computer.

Intervention and comparator

Participants will be randomized to receive either the electronically-delivered EMPOWER (EMPOWER-ED) protocol or asked to continue to follow provider recommendations regarding their benzodiazepine use (treatment-as-usual).

Measurements

The primary outcomes are complete benzodiazepine cessation and 25% dose reduction, assessed using administrative and self-report data, between baseline and six-month follow-up. Secondary outcomes are self-reported anxiety symptoms, sleep quality, and overall health and quality of life, measured at baseline and 6-month follow-up, and benzodiazepine cessation at 12-month follow-up.

Comments

This randomized controlled trial will evaluate whether the accessibility and effectiveness of a promising intervention for benzodiazepine cessation can be improved through digitization and population tailoring.

Opioid Use Disorder Among Clients of Community Mental Health Clinics: Prevalence, Characteristics, and Treatment Willingness

OBJECTIVE

The authors examined the prevalence of co-occurring opioid use disorder and willingness to engage in treatment among clients of eight Los Angeles County Department of Mental Health outpatient clinics.

METHODS

Adults presenting for an appointment over a 2-week period were invited to complete a voluntary, anonymous health survey. Clients who indicated opioid use in the past year were offered a longer survey assessing probable opioid use disorder. Willingness to take medication and receive treatment also was assessed.

RESULTS

In total, 3,090 clients completed screening. Among these, 8% had a probable prescription (Rx) opioid use disorder and 2% a probable heroin use disorder. Of the clients with probable Rx opioid use or heroin use disorder, 49% and 25% were female, respectively. Among those with probable Rx opioid use disorder, 43% were Black, 33% were Hispanic, and 12% were White, and among those with probable heroin use disorder, 24% were Black, 22% were Hispanic, and 39% were White. Seventy-eight percent of those with Rx opioid use disorder had never received any treatment, and 82% had never taken a medication for this disorder; 39% of those with heroin use disorder had never received any treatment, and 39% had never received a medication. The strongest predictor of willingness to take a medication was believing that it would help stop opioid use (buprenorphine, β=13.54, p=0.003, and naltrexone long-acting injection, β=15.83, p<0.001).

CONCLUSIONS

These findings highlight the need to identify people with opioid use disorder and to educate clients in mental health settings about medications for these disorders.

Use of a Mobile Peer Support App Among Young People With Nonsuicidal Self-injury: Small-scale Randomized Controlled Trial

BACKGROUND

Nonsuicidal self-injury (NSSI) is a widespread behavior among adolescents and young adults. Although many individuals who self-injure do not seek treatment, there is evidence for web-based help-seeking through web-based communities and mobile peer support networks. However, few studies have rigorously tested the efficacy of such platforms on outcomes relevant for NSSI recovery.

OBJECTIVE

The aim of this small-scale preregistered randomized controlled trial is to provide preliminary insight into the shorter- and longer-term efficacy of the use of a peer support app, TalkLife, in reducing NSSI frequency and urges and increasing readiness to change. In addition, we explore contact with informal support, interest in therapy, and attitudes toward professional help-seeking.

METHODS

Individuals aged 16-25 years with current (within 3 months) and chronic (>6 episodes in the past year) NSSI history were eligible to participate in this study. After baseline assessments, the intervention group was instructed to use the app actively (eg, post or comment at least three times per week) and the control group received weekly psychoeducational materials through email, for 8 weeks. Follow-up was assessed at 1 month and 2 months. Linear mixed modeling was used to evaluate condition and time point effects for the primary outcomes of NSSI frequency and urges, readiness to change, contact with informal support, interest in therapy, and attitudes toward professional help-seeking.

RESULTS

A total of 131 participants were included in the analysis. We evidenced a significant effect of condition on NSSI frequency such that the participants using the peer support app self-injured less over the course of the study (mean 1.30, SE 0.18) than those in the control condition (mean 1.62, SE 0.18; P=.02; η2=0.02). We also evidenced a significant condition effect of readiness to change such that the treatment participants reported greater confidence in their ability to change their NSSI behavior (mean 6.28, SE 0.41) than the control participants (mean 5.67, SE 0.41; P=.04; η2=0.02). No significant differences were observed for contact with informal support, interest in therapy, or attitudes toward professional help-seeking.

CONCLUSIONS

Use of the peer support app was related to reduced NSSI frequency and greater confidence in one's ability to change NSSI behavior over the course of the study period, but no effects on NSSI urges, contact with informal support, interest in therapy, or attitudes toward professional help-seeking were observed. The findings provide preliminary support for considering the use of mobile peer support apps as a supplement to NSSI intervention and point to the need for larger-scale trials.

TRIAL REGISTRATION

Open Science Foundation; https://osf.io/3uay9.

Telephone based smoking cessation intervention for adults with serious mental illness during the COVID-19 pandemic

Background

The high rates of smoking in adults with serious mental illness (SMI) increases risk for COVID-19 infection. The purpose of this paper is to present the results of a smoking cessation intervention that was adapted to be offered by phone during a Shelter in Place (SIP) period in San Francisco, California, at the beginning of the COVID-19 pandemic.

Methods

During the SIP, we offered counseling sessions by phone to five participants. At the end of each session, we assessed readiness to quit, tobacco cessation or reduction, and inquired about the impact of the shelter in place on smoking habits and mental health. Grounded theory guided data collection and analysis.

Results

The categories that emerged around barriers and facilitators for smoking cessation were COVID-19-related stressors, having purpose, structure and feelings of connections, and the importance of quitting aides for smoking cessation.

Conclusion

Offering telephone based smoking cessation counseling to adults with SMI while they shelter in place may improve their readiness to quit.

Readiness to Quit Smoking among Smokers in Substance Use Treatment: Associations with Stress, Substance Use Severity, Relapse Concerns and Gender

Smoking prevalence among individuals in substance use treatment remains higher than in the general population. Given that many smokers in substance use treatment are reluctant to quit smoking, it is important to understand the factors that impede smokers' readiness to quit. The current study used baseline data from a randomized controlled trial involving 60 adult smokers receiving substance use treatment to investigate relations between the severity of substance use problems (SSUP), perceived stress (PS), concerns about relapse (i.e., concerns that quitting smoking would hurt one's recovery process (CR)), and readiness to quit smoking. This study also investigated moderating roles of concerns about relapse and gender. Regression analyses showed a significant main effect of concerns about relapse on readiness to quit in the next 30 days, but no effect for either severity of substance use problems, perceived stress, or the SSUPxCR interaction. There were significant interaction effects between PS and both gender and CR. Among men and those with lower concerns about relapse, higher perceived stress was significantly associated with lower readiness to quit. Findings suggest that psychoeducation to alleviate concerns that quitting smoking could limit substance use recovery could be beneficial. Stress management interventions may be especially beneficial to men.

Exercise prescription improves exercise tolerance in young children with CHD: a randomised clinical trial

Objective

The main objective of this study was to ascertain if a structured intervention programme can improve the biophysical health of young children with congenital heart disease (CHD). The primary end point was an increase in measureable physical activity levels following the intervention.

Methods

Patients aged 5–10 years with CHD were identified and invited to participate. Participants completed a baseline biophysical assessment, including a formal exercise stress test and daily activity monitoring using an accelerometer. Following randomisation, the intervention group attended a 1 day education session and received an individual written exercise plan to be continued over the 4-month intervention period. The control group continued with their usual level of care. After 4 months, all participants were reassessed in the same manner as at baseline.

Results

One hundred and sixty-three participants (mean age 8.4 years) were recruited, 100 of whom were male (61.3%). At baseline, the majority of the children were active with good exercise tolerance. The cyanotic palliated subgroup participants, however, were found to have lower levels of daily activity and significantly limited peak exercise performance compared with the other subgroups. One hundred and fifty-two participants (93.2%) attended for reassessment. Following the intervention, there was a significant improvement in peak exercise capacity in the intervention group. There was also a trend towards increased daily activity levels.

Conclusion

Overall physical activity levels are well preserved in the majority of young children with CHD. A structured intervention programme significantly increased peak exercise capacity and improved attitudes towards positive lifestyle changes.

Using an Optimized Marijuana Purchase Task to Examine Cannabis Demand in Relation to Cannabis Misuse in Heavy Drinking Emerging Adults

OBJECTIVE

A behavioral economic approach to cannabis misuse emphasizes a crucial role of high drug demand (i.e., reinforcing value), which may be measured using a marijuana purchase task (MPT). The multiple indices from this measure have been associated with cannabis misuse, but somewhat inconsistently, possibly because of task variability across studies. Based on recent qualitative research, the current study implemented an optimized MPT to examine the underlying factor structure and the relationship between cannabis demand and both cannabis misuse and motivation to change.

METHOD

Participants were two independent samples of emerging adults who reported cannabis use and heavy episodic drinking in the last month, one Canadian (n = 396) and the other American (n = 275). Both were assessed using an MPT, the Cannabis Use Disorder Identification Test (CUDIT), the Marijuana Adverse Consequences Questionnaire (MACQ), and readiness to change items.

RESULTS

Principal component analyses of the MPT indices revealed the same two-factor latent structure in both samples, interpreted as Amplitude (intensity, Omax, elasticity) and Persistence (breakpoint, Pmax). Regressions revealed that Amplitude was significantly associated with CUDIT and MACQ in both samples. In the Canadian sample, Persistence was also significantly associated with CUDIT and MACQ, and both factors were associated with motivation to change.

CONCLUSIONS

The optimized MPT generated a two-factor latent structure that was parallel across samples, and the Amplitude factor was consistently associated with cannabis misuse. The current findings indicate the robust relevance of behavioral economic demand for cannabis in relation to cannabis misuse but suggest that links to motivation may be sample-specific.

Additive effectiveness and feasibility of a theory-driven instant assessment and feedback system in brief cannabis intervention: A randomised controlled trial

Assessment and personalised feedback are important components of brief interventions (BIs) for cannabis use. A key outcome is to increase motivation to change during this short interaction. The diversity of available assessments and time burden scoring them pose a challenge for routine use in clinical practice. An instant assessment and feedback (iAx) system was developed to administer assessments informed by bioSocial Cognitive Theory, that were instantly scored and benchmarked against clinical norms, to provide patient feedback and guide treatment planning. This study evaluated the feasibility and additive effectiveness of the iAx on motivation to change cannabis use, when compared to treatment as usual (TAU), in a single-session BI. A randomised controlled trial was conducted in a public hospital alcohol and drug outpatient clinic. Eighty-seven cannabis users (M_age = 26.41; 66% male) were assigned to the BI utilising the iAx (iAx; n = 44) or to the standard BI (TAU; n = 43). Patients completed pre- and post-BI assessments of motivation to change and a post-BI measure of treatment satisfaction. Practitioners completed a feedback survey. Patients receiving iAx reported a significantly greater increase in motivation to change from pre- to post-BI compared to patients receiving TAU (d = 0.49, p = .03). Treatment satisfaction was high across both conditions, with no significant difference between groups (p = .57). Practitioners also reported a high level of satisfaction with the iAx system. In summary, findings support the feasibility and additive effectiveness of the iAx to enhance patient motivation during cannabis BI.

Development of an integrated digital health intervention to promote engagement in and adherence to medication for opioid use disorder

BACKGROUND

Buprenorphine-naloxone is an evidence-based treatment for Opioid Use Disorder. However, despite its efficacy, nearly half of participants are unsuccessful in achieving stabilization (i.e., period of time following medication induction in which medication dose is adjusted to be effective in reducing cravings/withdrawal, minimize potential side effects, and eliminate illicit substance use). This paper presents the study design and protocol for a digital health intervention designed to promote engagement in and adherence to buprenorphine treatment, offered through an outpatient addiction treatment center, through motivational enhancement and distress tolerance skills training. Personalized feedback interventions represent a promising method to effectively motivate engagement in and adherence to buprenorphine treatment. These interventions are generally brief, individually tailored, and have the potential to be delivered via mobile platforms. Distress tolerance, a transdiagnostic vulnerability factor, has been implicated in the development and maintenance of substance use. Targeting distress tolerance may improve substance use treatment outcomes by promoting the ability to persist in goal-directed activity even when experiencing physical or emotional distress.

METHODS

The study aims are to: (1) develop and refine an interactive computer- and text message-delivered personalized feedback intervention that incorporates distress tolerance skills training for persons who have elected to initiate outpatient buprenorphine treatment (iCOPE); (2) examine the feasibility, acceptability, and preliminary efficacy of iCOPE for increasing abstinence, adherence, and retention in treatment compared to a treatment as usual comparison condition; and, (3) examine potential mechanisms that may underlie the efficacy of iCOPE in improving outcomes, including motivation, distress tolerance, self-regulation, and negative affect.

DISCUSSION

Results of this study will be used to determine whether to proceed with further testing through a large-scale trial. This work has the potential to improve treatment outcomes by reducing illicit opioid use, increasing adherence/retention, and preventing future overdose and other complications of illicit opioid use. Trial Registration NCT03842384.

Manaaki - a cognitive behavioral therapy mobile health app to support people experiencing gambling problems: a randomized control trial protocol

Background

The low utilisation of current treatment services by people with gambling problems highlights the need to explore new modalities of delivering treatment interventions. This protocol presents the design of a pragmatic randomized control trial aimed at assessing the effectiveness and acceptability of cognitive behavioral therapy (CBT) delivered via a mobile app for people with self-reported gambling problems.

Methods

An innovative CBT mobile app, based on Deakin University’s GamblingLess online program, has been adapted with end-users (Manaaki). Six intervention modules have been created. These are interwoven with visual themes to represent a journey of recovery and include attributes such as avatars, videos, and animations to support end-user engagement. An audio facility is used throughout the app to cater for different learning styles. Personalizing the app has been accomplished by using greetings in the participant’s language and their name (e.g. Kia ora Tāne) and by creating personalized feedback.

A pragmatic, randomized control two-arm single-blind trial, will be conducted in New Zealand. We aim to recruit 284 individuals. Eligible participants are ≥18 years old, seeking help for their gambling, have access to a smartphone capable of downloading an app, able to understand the English language and are willing to provide follow-up information at scheduled time points. Allocation is 1:1, stratified by ethnicity, gender, and gambling symptom severity based on the Gambling Symptom Assessment Scale (G-SAS). The intervention group will receive the full mobile cognitive behavioural programme and the waitlist group will receive a simple app that counts down the time left before they have access to the full app and the links to the data collection tools. Data collection for both groups are: baseline, 4-, 8-, and 12-weeks post-randomisation. The primary outcome is a change in G-SAS scores. Secondary measures include changes in gambling urges, frequency, expenditure, and readiness to change. Indices of app engagement, utilisation and acceptability will be collected throughout the delivery of the intervention.

Discussion

If effective, this study will contribute to the improvement of health outcomes for people experiencing gambling problems and have great potential to reach population groups who do not readily engage with current treatment services.

Ethics approval

NZ Health and Disability Ethics Committee (Ref: 19/STH/204)

Trial registration

Australian New Zealand Clinical Trial Registry (ANZCTRN 12619001605189) Registered 1 November 2019.

Developing a clinical decision support for opioid use disorders: a NIDA center for the clinical trials network working group report

There is an urgent need for strategies to address the US epidemic of prescription opioid, heroin and fentanyl-related overdoses, misuse, addiction, and diversion. Evidence-based treatment such as medications for opioid use disorder (MOUD) are available but lack numbers of providers offering these services to meet the demands. Availability of electronic health record (EHR) systems has greatly increased and led to innovative quality improvement initiatives but this has not yet been optimized to address the opioid epidemic or to treat opioid use disorder (OUD). This report from a clinical decision support (CDS) working group convened by the NIDA Center for the Clinical Trials Network aims to converge electronic technology in the EHR with the urgent need to improve screening, identification, and treatment of OUD in primary care settings through the development of a CDS algorithm that could be implemented as a tool in the EHR. This aim is consistent with federal, state and local government and private sector efforts to improve access and quality of MOUD treatment for OUD, existing clinical quality and HEDIS measures for OUD or drug and alcohol use disorders, and with a recent draft grade B recommendation from the US Preventative Services Task Force (USPSTF) for screening for illicit drug use in adults when appropriate diagnosis, treatment and care services can be offered or referred. Through a face-to-face expert panel meeting and multiple follow-up conference calls, the working group drafted CDS algorithms for clinical care felt to be essential for screening, diagnosis, and management of OUD in primary care. The CDS algorithm was reviewed by addiction specialists and primary care providers and revised based on their input. A clinical decision support tool for OUD screening, assessment, and treatment within primary care systems may help improve healthcare delivery to help address the current epidemic of opioid misuse and overdose that has outpaced the capacity of specialized treatment settings. A semi-structured outline of clinical decision support for OUD was developed to facilitate implementation within the EHR. Further work for adaptation at specific sites and for testing is needed.

Outreach to people who survive opioid overdose: Linkage and retention in treatment

Cognitive motivation theories contend that individuals have greater readiness for behavioral change during critical periods or life events, and a non-fatal overdose could represent such an event. The objective of this study was to examine if the use of a specialized mobile response team (assertive outreach) could help identify, engage, and retain people who have survived an overdose into a comprehensive treatment program. We developed an intervention, consisting of mobile outreach followed by medication and behavioral treatment, in Houston Texas between April and December 2018. Our primary outcome variables were the level of willingness to engage in treatment, and percent who retained in treatment after 30 and 90 day endpoints. We screened 103 individuals for eligibility, and 34 (33%) elected to engage in the treatment program, while two-thirds chose not to engage in treatment, primarily due to low readiness levels. The average age was 38.2 ± 12 years, 56% were male, 79% had no health insurance, and the majority (77%) reported being homeless or in temporary housing. There were 30 (88%) participants still active in the treatment program after 30 days, and 19 (56%) after 90 days. Given the high rates of relapse using conventional models, which wait for patients to present to treatment, our preliminary results suggest that assertive outreach could be a promising strategy to motivate people to enter and remain in long-term treatment.

Interventions to Reduce Unhealthy Alcohol Use among Primary Care Patients with HIV: the Health and Motivation Randomized Clinical Trial

BACKGROUND

Unhealthy alcohol use has adverse effects on HIV treatment. Screening, brief intervention, and referral to treatment (SBIRT) has some evidence of efficacy but may not be sufficient for those with low motivation or comorbid substance use.

OBJECTIVE

To examine the effectiveness of motivational interviewing (MI) and emailed feedback (EF) among primary care HIV-positive patients, compared with treatment as usual care (UC) only, which included SBIRT.

DESIGN

Randomized clinical trial.

PARTICIPANTS

Six hundred fourteen adult HIV-positive patients in Kaiser Permanente Northern California who reported prior-year unhealthy alcohol use.

INTERVENTION

Participants were randomized to either three sessions of MI (one in person and two by phone), information regarding alcohol risks via EF through a patient portal, or UC alone. MI and EF participants who reported unhealthy alcohol use at 6 months were offered additional MI and EF treatment, respectively.

MAIN MEASURES

Participant-reported unhealthy alcohol use (defined as ≥ 4/≥ 5 drinks per day for women/men), alcohol problems at 12 months, based on blinded telephone interviews. Secondary outcomes included drug use and antiretroviral (ART) adherence.

KEY RESULTS

At 12 months, there were no overall group differences, but in all three arms, there were declines in unhealthy alcohol use and alcohol-related problems (p < 0.001). Participants reporting low motivation to reduce drinking at baseline were less likely to report unhealthy alcohol use if they received MI vs. EF and UC (p = 0.013). At 6 months, reported illegal drug use/misuse of prescription drugs other than marijuana was lower in the MI arm than EF or UC (p = 0.012). There were no differences in ART adherence between groups.

CONCLUSIONS

In a randomized trial of HIV-positive patients using two behavioral interventions compared with SBIRT alone, participants in all three conditions reduced unhealthy alcohol use. MI may provide added benefit for patients with low motivation or who report illegal drug use/misuse of prescription drugs.

TRIAL REGISTRATION

NCT01671501 ( ClinicalTrials.gov ).

Motivation to Change and Treatment Participation Among Syringe Service Program Utilizers in Rural Kentucky

PURPOSE

Kentucky experiences a disproportionate burden of substance use disorder (SUD), particularly in rural areas of the state. Multiple factors increase vulnerability to SUD and limit access to services in rural communities. However, the recent implementation and expansion of syringe service programs (SSPs) in rural Kentucky may provide a leverage point to reach at-risk people who inject drugs (PWID).

METHODS

Data were collected as part of an ongoing NIDA-funded study designed to examine uptake of SSPs among PWID in Appalachian Kentucky. Using Respondent Driven Sampling (RDS), the study enrolled a sample of 186 PWID SSP attenders across 3 rural Appalachian Kentucky counties and conducted face-to-face interviews regarding health behaviors, injecting practices, SSP utilization, and treatment services. Using logistic regression analyses, we examined consistent SSP use, as well as importance and confidence to reduce substance use as predictors of current treatment participation.

FINDINGS

For the prior 6 months, 44.6% of the sample reported consistent SSP use. Consistent use of SSPs was associated with treatment participation in the unadjusted logistic regression models. Significant predictors of treatment participation in the adjusted model included high confidence to reduce substance use, and not reporting primary methamphetamine injection.

CONCLUSIONS

Rurally located SSPs may play an important role in supporting confidence and motivation to change substance use behaviors among PWID impacted by SUD. SSPs may be critical venues for integration and expansion of prevention, health promotion, and treatment linkage services for this underserved population.

Utilization of the Transtheoretical Model to Determine the Qualitative Impact of a Tribal FASD Prevention Program

Alcohol consumption during pregnancy can lead to damaging effects on an infant's health, including fetal alcohol spectrum disorders. Project Changing High-risk alcOhol use and Increasing Contraception Effectiveness Study (CHOICES), a program developed to reduce alcohol-exposed pregnancies through decreased alcohol consumption and increased birth control use, has been implemented with success in a variety of populations. The CHOICES program was structured to align with the transtheoretical model (Stages of Change), a popular public health model. Although studies have described the Stages of Change in the context of a variety of health behaviors, none have addressed the qualitatively distinct characteristics of each stage in the context of American Indian (AI) women's alcohol and birth control use. A framework analysis of 203 participants' written responses during their experience in the Oglala Sioux Tribe (OST) CHOICES Program was conducted. As a conceptual framework, the transtheoretical model of behavior change was applied to the participants' experiences, with two staff reading the open-ended responses and coding based on the stage of change. Participants' responses suggest qualitatively distinct stages as well as a progression through the stages for both behaviors during the course of the program. Many participants mentioned their children, education, and work as inspiration to decrease their unhealthy behaviors. Common barriers to behavior change were found across both behaviors. The open-ended responses uncover common themes in the experiences of the participants. These results can help inform future programs which hope to address the needs of AI communities.

Predictors of positive drinking outcomes among youth receiving an alcohol brief intervention in the emergency department

BACKGROUND

Reducing underage drinking is a public health priority given increased risk for injury and other consequences. Emergency department (ED) visits offer a potential "teachable moment" to initiate interventions among youth engaged in risky drinking. Given mixed findings for alcohol brief interventions (BIs), this paper examined baseline markers of BI response in order to inform future interventions.

METHOD

We conducted secondary analyses of data from a randomized controlled trial of an alcohol BI delivered to youth in an ED. Among 475 participants (Mage = 18.6, SD = 1.4; 48.7% Female, 78.6% White/Caucasian) receiving a computer or therapist BI, we examined baseline characteristics (i.e., demographic, substance use, mood, risk/protective factors, and readiness to change) that predicted positive intervention response (i.e., BI responder) at 3-month follow-up using AUDIT-C scores (cut offs: <3 for ages 14-17; <4 for ages 18-20).

RESULTS

Mediated logistic regression analysis (controlling for demographics) showed that greater readiness to change at baseline was positively related to BI response and baseline alcohol consumption was negatively related to BI response. Having a mentor was indirectly related to BI response via baseline alcohol consumption. Baseline readiness to change and alcohol consumption mediated the association between positive peer influences and BI response, whereas readiness to change mediated the relation between depression and BI response.

CONCLUSION

Findings suggest that BI response is influenced by protective social factors, such as positive peers and mentors, and depression, via baseline alcohol severity indicators (i.e., readiness to change, consumption), thus providing clues for enhancing the content and dose of early interventions.

Associated factors of readiness to change in young adult risky drinkers

BACKGROUND

Readiness to change alcohol use has been associated with a number of predictors including emotional distress, drinking severity, and consequence severity, as well as with static demographic factors such as gender and race/ethnicity.

OBJECTIVE

To examine the relationships among these variables and readiness to change alcohol use in young adults.

METHODS

Structural equation modeling was used to test pathways of readiness to change in 1,256 young adult patients (78% male/22% female) ages 18-29 who were provided screening, brief intervention and referral to treatment (SBIRT) as part of a Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Capacity Expansion Project.

RESULTS

The strongest relationships were between emotional distress, drinking severity, and consequence severity with readiness to change. Results indicated that participants with more severe alcohol problems demonstrated higher levels of readiness to change alcohol use and therefore, may be more amenable to behavior change. Additionally, females, Hispanic/Latino, and Black non-Hispanic (Black) participants demonstrated higher levels of readiness to change when compared to other groups.

CONCLUSION

These results lend support to the concept that young adults are using alcohol to modulate their emotions. Furthermore, resultant severity of consequences from drinking may play an important role in their readiness to change risky drinking. This may be especially true for females, who reported greater emotional distress, and for Hispanic/Latinos and Blacks, who reported greater drinking severity with greater emotional distress. Caregivers may be better equipped to address young adult alcohol use with this added understanding.

A Readiness Ruler for Assessing Motivation to Change in People with Eating Disorders

OBJECTIVE

We examined the psychometric properties of the Eating Disorder Readiness Ruler a simple self-report instrument designed to enable rapid assessment of readiness to change problematic eating behaviours in people with clinical eating disorders.

METHOD

We administered the ED-RR, the Eating Disorders Examination Questionnaire and a measure of autonomous and controlled motivation for change to 206 individuals receiving outpatient treatment for an eating disorder.

RESULTS

A principal axis factoring analysis of the ED-RR yielded a significant two-factor solution (explaining 59% of variance)-one factor pertaining to restriction and body image preoccupation (four items), the other to binge-eating and vomiting symptoms (two items). The ED-RR showed good internal consistency (alpha coefficients for the two factors being .77 and .84 respectively). Furthermore, individuals reporting higher readiness showed higher scores on independent measures of autonomous motivation and greater symptom reductions over time.

DISCUSSION

Results suggest that the ED-RR is a psychometrically sound tool with potential clinical utility. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

GAMBLINGLESS: FOR LIFE study protocol: a pragmatic randomised trial of an online cognitive-behavioural programme for disordered gambling

INTRODUCTION

The prevalence of disordered gambling worldwide has been estimated at 2.3%. Only a small minority of disordered gamblers seek specialist face-to-face treatment, and so a need for alternative treatment delivery models that capitalise on advances in communication technology, and use self-directed activity that can complement existing services has been identified. As such, the primary aim of this study is to evaluate an online self-directed cognitive-behavioural programme for disordered gambling (GamblingLess: For Life).

METHODS AND ANALYSIS

The study will be a 2-arm, parallel group, pragmatic randomised trial. Participants will be randomly allocated to a pure self-directed (PSD) or guided self-directed (GSD) intervention. Participants in both groups will be asked to work through the 4 modules of the GamblingLess programme over 8 weeks. Participants in the GSD intervention will also receive weekly emails of guidance and support from a gambling counsellor. A total of 200 participants will be recruited. Participants will be eligible if they reside in Australia, are aged 18 years and over, have access to the internet, have adequate knowledge of the English language, are seeking help for their own gambling problems and are willing to take part in the intervention and associated assessments. Assessments will be conducted at preintervention, and at 2, 3 and 12 months from preintervention. The primary outcome is gambling severity, assessed using the Gambling Symptom Assessment Scale. Secondary outcomes include gambling frequency, gambling expenditure, psychological distress, quality of life and additional help-seeking. Qualitative interviews will also be conducted with a subsample of participants and the Guides (counsellors).

ETHICS AND DISSEMINATION

The study has been approved by the Deakin University Human Research and Eastern Health Human Research Ethics Committees. Findings will be disseminated via report, peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

ACTRN12615000864527; results.

A test of core psychopathic traits as a moderator of the efficacy of a brief motivational intervention for substance-using offenders

OBJECTIVE

In a randomized controlled trial we studied a brief motivational intervention (BMI) for substance use, examining core psychopathic traits as a moderator of treatment efficacy.

METHOD

Participants were 105 males and females who were 18 years of age and older and in a pretrial jail diversion program. The sample was approximately 52% Black and other minorities and 48% White. Outcome variables at a 6-month follow-up were frequency of substance use (assessed with the Timeline Follow-back Interview and objective toxicology screens), substance use consequences (Short Inventory of Problems-Alcohol and Drug version), and self-reported participation in nonstudy mental health and/or substance use treatment. Psychopathy was assessed using the Psychopathy Checklist-Revised (PCL-R).

RESULTS

BMI interacted with core psychopathic traits to account for 7% of the variance in substance use at follow-up. Treatment was associated with greater use among individuals with high levels of core psychopathic traits. Toxicology screening results were consistent with self-report data. The treatment and standard care groups did not differ on substance use consequences or nonstudy treatment participation at follow-up, and no moderation was found with these outcomes. An exploratory analysis indicated that low levels of affective traits of psychopathy were associated with benefit from the BMI in terms of decreased substance use.

DISCUSSION

Findings suggest that caution is warranted when applying BMIs among offenders; individuals with high levels of core psychopathic traits may not benefit and may be hindered in recovery. Conversely, they indicate that a low-psychopathy subgroup of offenders benefits from these brief and efficient treatments for substance use.

Motivational Interviewing Approach Used by a Community Mental Health Team

The current study aimed to (a) evaluate the effectiveness of motivational interviewing, as applied by a community mental health team (CMHT) based in Singapore; (b) reduce hospital admissions and length of hospital stay; and (c) improve global functioning and satisfaction of individuals with mental illness. The current study used a quasi-experimental method. A convenience sample of 120 participants was selected from the caseload of the CMHT. Participants received motivational interviewing sessions at least once every month for 1 year. Data on the number of hospital admissions, length of hospitalization, Global Assessment of Functioning, and patient satisfaction were collected at baseline and 6 and 12 months. Participants who underwent the CMHT services with motivational interviewing were more compliant to treatment, resulting in significant reduction in hospitalization and improvement in functionality. Motivational interviewing is effective in facilitating better illness management for patients in the community. Adoption of the motivational interviewing approach may potentially provide significant benefits for psychiatric support services in the community.

Subtyping based on readiness and confidence: the identification of help-seeking profiles for gamblers accessing web-based counselling

BACKGROUND AND AIMS

Problem gamblers are not a homogeneous group and recent data suggest that subtyping can improve treatment outcomes. This study administered three readiness rulers and aimed to identify subtypes of gamblers accessing a national web-based counselling service based on these rulers.

METHODS

Participants were 1204 gamblers (99.4% problem gamblers) who accessed a single session of web-based counselling in Australia. Measures included three readiness rulers (importance, readiness and confidence to resist an urge to gamble), demographics and the Problem Gambling Severity Index (PGSI).

RESULTS

Gamblers reported high importance of change [mean = 9.2, standard deviation (SD) = 1.51] and readiness to change (mean = 8.86, SD = 1.84), but lower confidence to resist an urge to gamble (mean = 3.93, SD = 2.44) compared with importance and readiness. The statistical fit indices of a latent class analysis identified a four-class model. Subtype 1 was characterized by a very high readiness to change and very low confidence to resist an urge to gamble (n = 662, 55.0%) and subtype 2 reported high readiness and low confidence (n = 358, 29.7%). Subtype 3 reported moderate ratings on all three rulers (n = 139, 11.6%) and subtype 4 reported high importance of change but low readiness and confidence (n = 45, 3.7%). A multinomial logistic regression indicated that subtypes differed by gender (P < 0.001), age (P = 0.01), gambling activity (P < 0.05), preferred mode of gambling (P < 0.001) and PGSI score (P < 0.001).

CONCLUSIONS

Problem gamblers in Australia who seek web-based counselling comprise four distinct subgroups based on self-reported levels of readiness to change, confidence to resist the urge to gamble and importance of change.

Readiness to change and reasons for intended reduction of alcohol consumption in emergency department versus trauma population

Introduction

The primary objective was to identify the most common reasons for intending to cut back on alcohol use, in emergency department (ED) and trauma patient populations. The secondary objective was to determine the association between reason to cut back on alcohol and education level.

Methods

We conducted the study at a level one trauma center in California between 2008 and 2012. This was a retrospective analysis of data collected from computerized alcohol screening and intervention (CASI). We excluded patients who drank too little, and those whose scores were consistent with dependency (Alcohol Use Disorders Identification Test [AUDIT]>19). The CASI database includes the patient’s age, gender, language, education level, an AUDIT score (1–40 scale), a readiness to change score (1–10), and the option to choose any of 10 “reasons to cut back” on their alcohol consumption.

Results

From 10,537 patients, 1,202 met criteria for the study (848 ED, 354 trauma). Overall, the most common reasons cited for cutting back on alcohol were “To avoid health problems” (68.5%), “To avoid getting a DUI” (43.6%), “It could save me money” (42.0%), and “To avoid situations where I could get hurt” (41.0%). Trauma patients cited the following reasons significantly more than ED patients: “To avoid situations where I could get hurt” (46.3% versus 38.8%, respectively), “So I can be in control of my behavior” (40.7% versus 32.2%), and “My partner or spouse wants me to stop” (20.1% versus 15.0%). Additionally, those patients who cited “To avoid health problems” reported 1.2 points higher than average (p<0.001) on the 10-point readiness to change scale. Those who have completed some college or an associate degree cited “To avoid health problems” less often than high school graduates (odds ratio [OR] 0.45), while they cited “To avoid situations where I could get hurt” (OR 2.5) and “To avoid being in a car crash caused by alcohol use” (OR 3.8) more often than high school graduates.

Conclusion

Health, injury, finances, and legal issues remain top concerns for patients, while trauma patients specifically had proportionately more concerns with situations where they could get hurt.

Predictors of readiness to change young adult drug use in community health settings

This study evaluated readiness to change drug use in young adult patients aged 18-25 years who were provided screening and brief intervention as part of a Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Capacity Expansion Project. Non-treatment-seeking young adults at risk for drug problems (n = 1,560) were assessed for readiness to change. Structural equation modeling examined latent constructs: emotional distress, age, drug use severity, criminal behavior, gender, and race/ethnicity. Drug use severity fully mediated the relationship between emotional distress and readiness. In addition, females and young adults with more severe drug problems may be more amenable to behavior change.

Predicting substance abuse treatment completion using a new scale based on the theory of planned behavior

We examined whether a 9-item scale based on the theory of planned behavior (TPB) predicted substance abuse treatment completion. Data were collected at a public, outpatient program among clients initiating treatment (N=200). Baseline surveys included measures of treatment-related attitudes, norms, perceived control, and intention; discharge status was collected from program records. As expected, TPB attitude and control components independently predicted intention (model R-squared=.56), and intention was positively associated with treatment completion even including clinical and demographic covariates (model R-squared=.24). TPB components were generally associated with the alternative readiness scales as expected, and the TPB remained predictive at higher levels of coercion. Meanwhile, none of the standard measures of readiness (e.g., the URICA and TREAT) or treatment coercion were positively associated with treatment participation. Results suggest promise for application of the TPB to treatment completion and support use of the intention component as a screener, though some refinements are suggested.

Computer-enhanced interventions for drug use and HIV risk in the emergency room: preliminary results on psychological precursors of behavior change

This article describes process data from a randomized controlled trial among 781 adults recruited in the emergency department who reported recent drug use and were randomized to: intervener-delivered brief intervention (IBI) assisted by computer, computerized BI (CBI), or enhanced usual care (EUC). Analyses examined differences between baseline and post-intervention on psychological constructs theoretically related to changes in drug use and HIV risk: importance, readiness, intention, help-seeking, and confidence. Compared to EUC, participants receiving the IBI significantly increased in confidence and intentions; CBI patients increased importance, readiness, confidence, and help-seeking. Both groups increased relative to the EUC in likelihood of condom use with regular partners. Examining BI components suggested that benefits of change and tools for change were associated with changes in psychological constructs. Delivering BIs targeting drug use and HIV risk using computers appears promising for implementation in healthcare settings. This trial is ongoing and future work will report behavioral outcomes.

Descriptive Aspects of Injection Drug Users in Iran's National Harm Reduction Program by Methadone Maintenance Treatment

BACKGROUND

The Ministry of Health, Treatment and Medical Education of Iran has recently announced an estimated figure of 200,000 injecting drug users (IDUs). The aim of this study was to pilot a national program using demographics, types of drug abuse and prevalence of blood-borne infections among IDUs.

METHODS

In order to elicit data on demographics, types of drug abuse and prevalence of blood-borne infections among IDUs, a questionnaire was designed in the Bureau of Mental-Social Health and Addiction in collaboration with Iran's Drug Control Headquarters of the Police Department. Therapeutical alliance of addiction in Shafagh Center was based on Methadone Maintenance Therapy (MMT).

RESULTS

Among 402 reported IDUs most of them were male, single and in age range of 20 to 39 years old with 72.7% history of imprisonment. Most of them had elementary and high school education and a history of addiction treatment. The majority were current users of opioid, heroin and crack. The prevalence of blood-borne infections was 65.9% and 18.8% for HCV and HIV/AIDS infections, respectively.

CONCLUSION

Prevention programs about harm reduction, treatment and counseling should include young IDUs as a core focus of their intervention structure.

Assessment of readiness to change and relationship to AUDIT score in a trauma population utilizing computerized alcohol screening and brief intervention

Trauma patient readiness-to-change score and its relationship to the Alcohol Use Disorder Identification Test (AUDIT) score were assessed in addition to the feasibility of computerized alcohol screening and brief intervention (CASI). A bilingual computerized tablet for trauma patients was utilized and the data were analyzed using Stata. Twenty-five percent of 1145 trauma patients drank more than recommended and 4% were dependent. As many Spanish-speaking as English-speaking males did not drink, but a higher percentage of Spanish-speaking males drank more than recommended and were dependent. Half of patients who drank more than recommended rated themselves 8 or higher on a 10-point readiness-to-change scale. CASI also provided personalized feedback. A high percentage of trauma patients (92%) found CASI easy and a comfort in use (87%). Bilingual computerized technology for trauma patients is feasible, acceptable, and an innovative approach to alcohol screening, brief intervention, and referral to treatment in a tertiary care university.

Buprenorphine from detox and beyond: preliminary evaluation of a pilot program to increase heroin dependent individuals' engagement in a full continuum of care

Absence of successful transition to post-detoxification treatment leads to high rates of relapse among detoxified heroin users. The present study evaluated a pilot buprenorphine treatment program (BTP). Heroin dependent individuals were inducted onto buprenorphine/naloxone in detox, maintained while transitioning through an intensive inpatient program (IIP), and gradually tapered off medication over 5 months of outpatient (OP) treatment. Compared to programmatic indicators of treatment engagement in the year prior to BTP implementation, referrals from detox to IIP, entry into and completion of IIP and subsequent OP, and days in OP treatment increased substantially. BTP completers, compared to non-completers, viewed abstinence as more difficult and as requiring more assistance to achieve, were less likely to be current cocaine and alcohol users or to have relapsed during the course of treatment. Although preliminary and in need of replication, initial adjunctive use of buprenorphine in an abstinence-based continuum of care may improve post-detoxification treatment entry, engagement, and completion.

Predictive value of readiness, importance, and confidence in ability to change drinking and smoking

Background

Visual analog scales (VAS) are sometimes used to assess change constructs that are often considered critical for change. Aims of Study: 1.) To determine the association of readiness to change, importance of changing and confidence in ability to change alcohol and tobacco use at baseline with the risk for drinking (more than 21 drinks per week/6 drinks or more on a single occasion more than once per month) and smoking (one or more cigarettes per day) six months later. 2.) To determine the association of readiness, importance and confidence with alcohol (number of drinks/week, number of binge drinking episodes/month) and tobacco (number of cigarettes/day) use at six months.

Methods

This is a secondary analysis of data from a multi-substance brief intervention randomized trial. A sample of 461 Swiss young men was analyzed as a prospective cohort. Participants were assessed at baseline and six months later on alcohol and tobacco use, and at baseline on readiness to change, importance of changing and confidence in ability to change constructs, using visual analog scales ranging from 1–10 for drinking and smoking behaviors. Regression models controlling for receipt of brief intervention were employed for each change construct. The lowest level (1–4) of each scale was the reference group that was compared to the medium (5–7) and high (8–10) levels.

Results

Among the 377 subjects reporting unhealthy alcohol use at baseline, mean (SD) readiness, importance and confidence to change drinking scores were 3.9 (3.0), 2.7 (2.2) and 7.2 (3.0), respectively. At follow-up, 108 (29%) reported no unhealthy alcohol use. Readiness was not associated with being risk-free at follow-up, but high importance (OR 2.94; 1.15, 7.50) and high confidence (OR 2.88; 1.46, 5.68) were. Among the 255 smokers at baseline, mean readiness, importance and confidence to change smoking scores were 4.6 (2.6), 5.3 (2.6) and 5.9 (2.7), respectively. At follow-up, 13% (33) reported no longer smoking. Neither readiness nor importance was associated with being a non-smoker, whereas high confidence (OR 3.29; 1.12, 9.62) was.

Conclusions

High confidence in ability to change was associated with favorable outcomes for both drinking and smoking, whereas high importance was associated only with a favorable drinking outcome. This study points to the value of confidence as an important predictor of successful change for both drinking and smoking, and shows the value of importance in predicting successful changes in alcohol use.

Trial registration number

ISRCTN78822107

Harm reduction text messages delivered during alcohol drinking: feasibility study protocol

BACKGROUND

Recent research using mobile phone interventions to address public health issues such as smoking, obesity, depression, and diabetes provides a basis for trialing a similar approach toward reducing the negative consequences of risky drinking.

OBJECTIVE

This feasibility study aims to recruit drinkers between 18-34 years to a website where they will design and enter their own personal messages (repeating or one-off) to be sent to their mobile phones when they are drinking to remind them of their pre-drinking safety intentions.

METHODS/DESIGN

Participants in the treatment group will have access to the messaging function for 3 months and will be compared to a control group who will have 3 months access to a web chat site only. Data collection will occur at baseline, 3 months, and 6 months. The primary outcome is a change in unintended negative consequences from drinking at 3 months. Secondary outcomes include the acceptability of the intervention to this population, recruitment rate, participant retention, reduction in alcohol consumption, and the self-motivation discourse in participant messages.

DISCUSSION

Existing alcohol interventions in New Zealand attempt to reduce alcohol consumption in the population, but with little effect. This study aims to target unintended negative consequences resulting from drinking by empowering the drinkers themselves to deliver safety messages during the drinking session. If proven effective, this strategy could provide a cost-effective means of reducing the public health burden associated with risky drinking.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000242921.

Readiness to change, drinking, and negative consequences among Polish SBIRT patients

The aim of this study is to examine the longitudinal relationship of readiness to change, drinking pattern, amount of alcohol consumed, and alcohol-related negative consequences among at-risk and dependent drinkers enrolled in a Screening, Brief Intervention and Referral to Treatment (SBIRT) trial in an emergency department in southern Poland. The study examined 299 patients randomized to either an assessment or intervention condition and followed at 3 and 12 months after initial presentation. Patients indicating a readiness or were unsure of changing drinking behavior were significantly more likely to decrease the maximum number of drinks per occasion and the usual number of drinks in a sitting in the 3-months following study entry when compared to those that rated changing drinking behavior as unimportant. Readiness to change was not predictive of outcomes between the baseline and 12-month follow-up. Drinking outcomes and negative consequences by readiness and research condition were non-significant. This is the first Polish study utilizing SBIRT to enable patients to identify their hazardous drinking and reduce alcohol consumption. While some drinking outcomes improved with motivation, these improvements were not maintained at 12-months following SBIRT. Attention to additional constructs of readiness to change and drinking patterns may augment the effectiveness of SBIRT.

Communication during brief intervention, intention to change, and outcome

OBJECTIVES

To explore the relationship between patient's intention to change regarding future alcohol consumption following brief alcohol intervention (BAI) and changes in alcohol consumption 12-months later and the communication characteristics between patient and counselor during BAI.

DESIGN, SETTING AND SUBJECTS

Data from 367 patients (experimental arm) of a pragmatic randomized controlled trial were used to assess the effectiveness of BAI among hazardous drinkers attending an Emergency Department (Lausanne University Hospital, Lausanne, Switzerland). Alcohol outcome measures at baseline and 12 months follow-up included usual number of drinks per week, monthly frequency of heavy episodic drinking (5 or more standard drinks for men; 4 or more for women), and the Alcohol Use Disorders Identification Test (AUDIT) score. In addition, the communication characteristics between patient and counselor were analyzed via tape recordings using the Motivational Interviewing Skill Code (MISC) from 97 participants. Patient readiness and importance to change on a 10-point Likert scale (readiness/importance to change ruler) was asked during BAI, and patient intention to change alcohol consumption (yes/no) was asked at the last step. Differences in alcohol outcome at follow-up between the 367 patients who did or did not have an intention to change consumption at baseline were compared, as were differences between these two groups in communication characteristics for the 97 who completed tape recordings.

RESULTS

Patients with an intention to decrease alcohol consumption reduced alcohol use and related problems more often, and reported higher levels of importance and readiness to change than did their counterparts. Analyses of MISC-coded data showed a significantly higher use of MI-consistent skills among those with a moderation intention, but no group differences on the 8 other counselor communication skills measures were found. Analyses of patient speech during the intervention indicated that those with an intention to change their alcohol consumption significantly more often self-explored personal ambivalence towards alcohol, expressed more intensely their ability, commitment, desire, need and reason to change their alcohol use than did those in the no decrease group.

CONCLUSIONS

The intention expressed by hazardous drinkers when concluding BAI is associated with both patient change talk during BAI and drinking outcome 12 months later, but is mainly independent of counselor communication skills. This intention may be an important clinical indicator of which hazardous drinkers are most likely to improve after BAI.