Fentanyl abuse proportion in methadone maintenance treatment, and patients' knowledge about its risks

INTRODUCTION

Fentanyl is not yet routinely monitored among methadone maintenance treatment (MMT) patients in Israel. We aimed 1. to evaluate urine fentanyl proportion changes over 3 years and characterize patients' characteristics 2. To study patients' self-report on fentanyl usage, and compare knowledge about fentanyl risk, before and following brief educational intervention.

METHODS

Fentanyl in the urine of all current MMT patients was tested every 3 months year between 2021 and 2023, and patients with positive urine fentanyl were characterized. Current patients were interviewed using a fentanyl knowledge questionnaire (effects, indications, and risks) before and following an explanation session.

RESULTS

Proportion of fentanyl ranged between 9.8 and 15.1%, and patients with urine positive for fentanyl (September 2023) were characterized as having positive urine for pregabalin, cocaine, and benzodiazepine (logistic regression). Of the current 260 patients (87% compliance), 78(30%) self-reported of fentanyl lifetime use ("Ever"), and 182 "never" use. The "Ever" group had higher Knowledge scores than the "Never", both groups improved following the explanatory session (repeated measure). The "Ever" group patients were found with urine positive for cannabis and benzodiazepine on admission to MMT, they were younger, did not manage to gain take-home dose privileges and had a higher fentanyl knowledge score (logistic regression).

CONCLUSIONS

In the absence of routine fentanyl tests, a high knowledge score, shorter duration in MMT, benzodiazepine usage on admission, and current cannabis usage, may hint of the possibility of fentanyl abuse.

The effectiveness of a brief intervention for intensive care unit patients with hazardous alcohol use: a randomized controlled trial

BACKGROUND

Screening for hazardous alcohol use and performing brief interventions (BIs) are recommended to reduce alcohol-related negative health consequences. We aimed to compare the effectiveness (defined as an at least 10% absolute difference) of BI with usual care in reducing alcohol intake in intensive care unit survivors with history of hazardous alcohol use.

METHODS

We used Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) score to assess history of alcohol use.

PATIENTS

Emergency admitted adult ICU patients in three Finnish university hospitals, with an AUDIT-C score > 5 (women), or > 6 (men). We randomized consenting eligible patients to receive a BI or treatment as usual (TAU).

INTERVENTION

BI was delivered by the time of ICU discharge or shortly thereafter in the hospital ward.

CONTROLS

Control patients received TAU.

OUTCOME

The primary outcome was self-reported alcohol consumption during the preceding week 6 and 12 months after randomization. Secondary outcomes were the change in AUDIT-C scores from baseline to 6 and 12 months, health-related quality of life, and mortality. The trial was terminated early due to slow recruitment during the pandemic.

RESULTS

We randomized 234 patients to receive BI (N = 117) or TAU (N = 117). At 6 months, the median alcohol intake in the BI and TAU groups were 6.5 g (interquartile range [IQR] 0-141) and 0 g (0-72), respectively (p = 0.544). At 12 months, it was 24 g (0-146) and 0 g (0-96) in the BI and TAU groups, respectively (p = 0.157). Median change in AUDIT-C from baseline to 6 months was - 1 (- 4 to 0) and 2 (- 6 to 0), (p = 0.144) in the BI and TAU groups, and to 12 months - 3 (- 5 to - 1) and - 4 (- 7 to - 1), respectively (p = 0.187). In total, 4% (n = 5) of patients in the BI group and 11% (n = 13) of patients in the TAU group were abstinent at 6 months, and 10% (n = 12) and 15% (n = 17), respectively, at 12 months. No between-groups difference in mortality emerged.

CONCLUSION

As underpowered, our study cannot reject or confirm the hypothesis that a single BI early after critical illness is effective in reducing the amount of alcohol consumed compared to TAU. However, a considerable number in both groups reduced their alcohol consumption.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT03047577).

Patient and pharmacist perspectives on opioid misuse screening and brief interventions in community pharmacies

BACKGROUND

Pharmacy-based screening and brief interventions (SBI) offer opportunities to identify opioid misuse and opioid safety risks and provide brief interventions that do not overly burden pharmacists. Currently, such interventions are being developed without patient input and in-depth contextual data and insufficient translation into practice. The purpose of this study is to qualitatively explore and compare patient and pharmacist perceptions and needs regarding a pharmacy-based opioid misuse SBI and to identify relevant SBI features and future implementation strategies.

METHODS

Using the Consolidated Framework for Implementation Research, we conducted semi-structured interviews with 8 patients and 11 pharmacists, to explore needs and barriers to participating in a pharmacy-based SBI. We recruited a purposive sample of English-speaking patients prescribed opioids for chronic or acute pain and pharmacists practicing in varied pharmacies (small independent, large-chain, specialty retail) settings. We used an inductive content analysis approach to analyze patient interview data. Then through a template analysis approach involving comparison of pharmacist and patient themes, we developed strategies for SBI implementation.

RESULTS

Most patient participants were white, older, described living in suburban areas, and were long-term opioid users. We identified template themes related to individual, interpersonal, intervention, and implementation factors and inferred applications for SBI design or potential SBI implementation strategies. We found that patients needed education on opioid safety and general opioid use, regardless of opioid use behaviors. Pharmacists described needing patient-centered training, protocols, and scripts to provide SBI. A short-self-reported screening and brief interventions including counseling, naloxone, and involving prescribers were discussed by both groups.

CONCLUSIONS

Through this implementation-focused qualitative study, we identified patient needs such as opioid safety education delivered in a private and convenient format and pharmacist needs including training, workflow integration, protocols, and a time-efficient intervention for effective pharmacy-based SBI. Alternate formats of SBI using digital health technologies may be needed for effective implementation. Our findings can be used to develop patient-centered pharmacy-based SBI that can be implemented within actual pharmacy practice.

A randomized controlled trial of therapist-facilitated brief online behavioral parent training for reducing child disruptive behavior

Background

Addressing child disruptive behavior in low and middle-income countries (LMICs) is challenging. Therapist-facilitated, multisession, brief, online group parent training offers hope for mitigating this issue. However, trials, particularly in Asia, are limited.

Objective

This study primarily assessed the effectiveness of Brief Behavior Parent Training Vietnam (BBPTV) in reducing child disruptive behavior.

Method

This study was a randomized controlled trial involving 109 Vietnamese parents (mean age = 34.1, 96 % were mothers) of preschool children displaying ongoing disruptive behaviors. Interventions included the BBPTV group (n = 56) receiving a therapist-facilitated, four-session program conducted through online group meetings and the care-as-usual (CAU) group (n = 53) having a 15 min individual online consultation. Primary outcomes, assessed online at two and six months postintervention, encompassed the intensity and frequency of children's disruptive problems. Secondary outcomes involved parenting practices, coercive interactions, marital conflicts, parenting self-efficacy, and parental mental health.

Results

In contrast to CAU, the BBPTV group showed lower child disruptive intensity, reduced parent-child coercive interactions, and diminished marital conflicts, with a higher score in involving parenting two months post-intervention. Six months postintervention, BBPTV also exhibited significantly lower scores in child disruptive intensity and problems, harsh parenting, and coercive processes compared to CAU.

Conclusions

The therapist-facilitated, four-session, internet-delivered group parent intervention resulted in superior and sustained improvements in child disruptive behavior, parenting practices, and parent-child coercive interaction compared to usual care, highlighting the potential for online BBPT to extend mental health care in Vietnam and other LMICs.

Improving Children's Behavior in Seven Sessions: A Randomized Controlled Trial of Parent-Child Care (PC-CARE) for Children Aged 2-10 Years

Parent-Child Care (PC-CARE) is a brief intervention for children with externalizing behaviors designed to address issues with their access to and retention in treatment. A growing evidence base of open trials and comparison studies support PC-CARE's benefits, but no randomized controlled trials (RCTs) of its effectiveness exist. The current study presents the first RCT of PC-CARE, a 7-session dyadic parenting intervention (trial number removed for blind review). Participants included a racially/ethnically diverse sample of 49 children (29% female) aged 2-10 years and their caregivers. Participants were randomly assigned to PC-CARE or waitlist control. Families participating in PC-CARE showed greater reductions in children's externalizing behaviors, improvements in children's adaptive skills, declines in parental stress, and increases in parents' positive communication skills, compared to families on the waitlist. The results of this first RCT of PC-CARE support the effectiveness of this brief intervention in improving children's behaviors.

Identifying brief intervention factors to improve cannabis related outcomes in adolescents and young adults: A systematic review of sample characteristics and intervention components

INTRODUCTION

Prior systematic and meta-analytic reviews observed mixed evidence for the efficacy of cannabis brief interventions (BIs). Inconsistent support for cannabis BIs may be the result of intersecting methodological factors, including intervention structure and content, participant eligibility criteria, and outcome assessment measures. The current systematic review of cannabis BI studies narratively synthesizes these data to guide intervention development decision-making in future cannabis BI studies (PROSPERO CRD42022285990).

METHODS

We searched PubMed/MEDLINE, PsycINFO, and CINAHL databases in January 2022 and again in June 2023 to capture newly published studies. Studies were included if they were a randomized trial, enrolled adolescents (13-17) and/or young adults (18-30), specified cannabis use and/or problems inclusion criteria, and evaluated a cannabis BI (defined as ≤4 sessions). We extracted and synthesized data on intervention characteristics (e.g., components, length/duration, modality), cannabis inclusion criteria and recruitment setting, baseline cannabis use descriptives and treatment-seeking status, and outcome assessment measures to discern if/how they may intersect to determine intervention efficacy. The Cochrane Risk of Bias Tool 2 assessed study quality.

RESULTS

Our search resulted in a final sample of 25 study records including 4094 participants. Recruitment setting seemed to provide an influential backdrop for how well inclusion criteria determined baseline cannabis use level, as well as for the type/length of the BI evaluated. Motivational interviewing (MI) and personalized feedback (PF) were the most frequently used BI components overall; however, some differences were observed in the proportion of BIs with reported intervention effects using MI vs. PF. Frequency of use days was the most commonly used outcome measure, although this may not be the most sensitive measure for assessing cannabis BI efficacy.

CONCLUSIONS

Our systematic review indicates that cannabis BI studies require greater precision in their design, giving special attention to matching the content and structure of the BI to the needs of the target population and selecting outcomes commensurate to the goals of the BI and the target population to more accurately reflect the efficacy of the BI. However, consistent with prior reviews, all included studies demonstrated at least some concerns for risk of bias, and most were at high risk.

A smartphone application to reduce problematic drinking: a feasibility trial

BACKGROUND

Problematic drinking is common among college students and associated with various somatic and mental health problems. Given significant evidence for the efficacy of smartphone-based interventions and the frequent use of smartphones among college students, it can be assumed that such interventions have great potential to facilitate access to evidence-based interventions for students suffering from problematic drinking. Thus, we developed a brief intervention that combined a counseling session with an app that utilizes approach-avoidance modification training to reduce alcohol consumption.

METHODS

To test the feasibility and explore the potential efficacy of the intervention, we conducted a before-after single-arm study with N = 11 participants reportedly engaging in problematic drinking, who were instructed to practice with the app for 14 days. Feasibility was assessed with the System Usability Scale (SUS). Outcomes included the reduction of self-reported problematic drinking behavior, dysfunctional attitudes about alcohol, and craving, as well as implicit associations between alcohol and self during the training period. Additionally, self-reported problematic drinking behavior was assessed at a 4-week follow-up.

RESULTS

On average, participants rated app usability on the SUS (possible range: 0 to 100) with M = 84.32 (SD = 6.53). With regard to efficacy, participants reported a significant reduction of problematic drinking behavior (dpre vs. post = 0.91) which was sustained at follow-up (dfollow-up vs. baseline = 1.07). Additionally, participants reported a significant reduction of dysfunctional attitudes about alcohol (dpre vs. post = 1.48). Results revealed no significant changes in craving nor in implicit associations regarding alcohol.

CONCLUSIONS

Findings from this feasibility study provide preliminary evidence that smartphone-based interventions might help reduce problematic drinking in college students. Further research needs to replicate these findings with larger samples in randomized controlled trials.

TRIAL REGISTRATION

DRKS00014675 (retrospectively registered).

A prevention program for binge drinking among students based on mindfulness and implementation intention (ALCOMEDIIT): a randomized controlled trial

BACKGROUND

The emergence of new problematic alcohol consumption practices among young people requires new dynamics in prevention strategies. In this context, the ADUC project (Alcohol and Drugs at the University of Caen) aims to develop a better understanding of alcohol consumption, and in particular the practice of binge drinking (BD) in students, in order to develop relevant and adapted prevention tools. The ALCOMEDIIT study (Rin Normandie and IRESP funding; Agreement 20II31-00 - ADUC part 3) is a randomized controlled trial that focuses on the specific determinant of impulsivity. The main objective of this experiment is to assess a program for the prevention of BD practices based on motivational interviewing (MI) associated with implementation intention (II) and mindfulness meditation (MBM) in a student environment.

METHODS

This study will include 170 healthy subjects who will be students at the university, alcohol users, with a BD score > 1 in the month preceding the inclusion but not presenting any specific disorder. The trial will be proposed by e-mail and students who meet the inclusion criteria will join either a control group which will benefit from a MI or an experimental group which will additionally benefit from an initiation to MBM with II (initial visit T0). In order to measure the effectiveness of the prevention program in terms of BD decrease, a follow-up at 1 month (T1) as well as a follow-up at 6 months (T6; exploratory) will be proposed to all participants. The total duration of this research protocol is 21 months.

DISCUSSION

The purpose of this study is to evaluate the interest of associating mindfulness meditation practices and implementation of self-regulation strategies to optimize their use, with a motivational interview in an innovative prevention program aiming at reducing alcohol use and BD practice in the student population.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05565989, September 30, 2022. https://clinicaltrials.gov/study/NCT05565989 Protocol version 2.0 (September 2022) No.

ID-RCB

2022-A00983-40.

Screening and Brief Intervention for Cannabis Misuse in Individuals on Buprenorphine Treatment for Opioid Use Disorder: Double-Blind Randomized Clinical Trial

Cannabis misuse and opioid use disorder (OUD) are highly comorbid but under-treated and associated with poorer outcomes. This paper reports a double-blind, parallel-group randomized controlled trial to determine the efficacy of single-session, clinician-delivered screening and brief intervention (SBI) for reducing cannabis risk. The primary outcome was the cannabis-specific Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) scores, measured at three-month post-intervention. The secondary objectives were to determine the efficacy of SBI in reducing the frequency of cannabis use, in risk transition from moderate to low risk, and in prescription and non-prescription opioid use. One hundred forty-three participants were randomly allocated to receive either SBI (n = 72) or control (n = 71) interventions. We performed Per-protocol (PP) (n = 125) and Intention-to-treat (ITT) analysis (n = 143). We adjusted our analysis for age, sex, and baseline ASSIST score. The ITT showed that the SBI group had a significant reduction (F = 39.46, p < .001, Effect size 0.22) in the mean ASSIST at follow-up. PP analyses too revealed a similar positive effect of SBI (F = 53.1; p < .001, Effect size 0.31). At follow-up, the SBI group had a higher number of days of cannabis abstinence. Care providers and policymakers may consider SBI for cannabis use in individuals on medications for OUD.

Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Primary Care, School-Based Health Clinics, and Mental Health Clinics

Adolescent cannabis use is a modifiable health behavior with potential adverse developmental, cognitive, psychological, and health effects. Over the last 2 decades, work to promote implementation of screening, brief intervention, and referral to treatment has improved screening, use of validated screening tools, and preventive messaging. Current intervention strategies for cannabis use are associated with modest, short-term effects, and referral to treatment is limited by availability of resources for adolescent substance use. This article provides an update on the evidence base for screening, brief intervention, referral to treatment, and the current state of implementation focused on management of cannabis use disorder.

Feasibility and acceptability of a peer provider delivered substance use screening and brief intervention program for youth in Kenya

BACKGROUND

Youth in sub-Saharan Africa are at high risk of substance use yet lack access to substance use interventions. The goal of this project was to evaluate the feasibility and acceptability of a peer-delivered, single-session substance use screening and brief intervention program for youth in Kenya.

METHODS

This was a convergent parallel mixed methods study utilizing both quantitative and qualitative approaches. Two trained peer providers administered the screening and brief intervention program to 100 youth aged 15-24 years. To evaluate the implementation of the intervention, we collected quantitative and qualitative data. Feasibility and acceptability were quantitatively assessed using the Dissemination and Implementation Measures. Fidelity was assessed by rating all 100 audio-recorded sessions using a checklist. To obtain qualitative feedback on the intervention, we conducted five focus group discussions with 25 youths and six semi-structured interviews with two peer providers and four clinic leaders. The semi-structured interviews were guided by the Consolidated Framework for Implementation Research. Quantitative data was analyzed via descriptive statistics using STATA. Qualitative data was analyzed using thematic analysis with NVIVO.

RESULTS

The lifetime prevalence of any substance use was 50%. The mean level of acceptability of the intervention from the perspective of the youth was 3.53 (SD 0.15), meaning that the youth found the intervention to be acceptable "a lot" of the time. Mean levels of implementation outcomes (acceptability, adoption, Acceptability, Appropriateness, Feasibility, Reach/access, Organizational climate, General leadership skills, and Sustainability) as rated by peer providers and clinic staff ranged between 2.61 ("a moderate amount") and 4.0 ("a lot"). In qualitative data, youth reported that the intervention was helpful and useful in enabling them to stop or reduce substance use. The peer providers felt that the intervention was easy to implement, while the clinic leaders felt that available resources were adequate, and that the intervention aligned well with the goals of the clinic.

CONCLUSION

Our findings suggest that the peer-delivered screening and brief intervention program was perceived as acceptable to the youth and feasible to implement.

TRIAL REGISTRATION

NCT04998045 Registration date: 10/08/2021.

Do in-person and computer-based brief alcohol interventions reduce tobacco smoking among general hospital patients? Secondary outcomes from a randomized controlled trial

BACKGROUND

At-risk alcohol use and tobacco smoking often co-occur. We investigated whether brief alcohol interventions (BAIs) among general hospital patients with at-risk alcohol use may also reduce tobacco smoking over 2 years. We also investigated whether such effects vary by delivery mode; i.e. in-person versus computer-based BAI.

METHODS

A proactively recruited sample of 961 general hospital patients with at-risk alcohol use aged 18 to 64 years was allocated to three BAI study groups: in-person BAI, computer-based BAI, and assessment only. In-person- and computer-based BAI included motivation-enhancing intervention contacts to reduce alcohol use at baseline and 1 and 3 months later. Follow-ups were conducted after 6, 12, 18 and 24 months. A two-part latent growth model, with self-reported smoking status (current smoking: yes/no) and number of cigarettes in smoking participants as outcomes, was estimated.

RESULTS

Smoking participants in computer-based BAI smoked fewer cigarettes per day than those assigned to assessment only at month 6 (meannet change = - 0.02; 95% confidence interval = - 0.08-0.00). After 2 years, neither in-person- nor computer-based BAI significantly changed smoking status or number of cigarettes per day in comparison to assessment only or to each other (ps ≥ 0.23).

CONCLUSIONS

While computer-based BAI also resulted in short-term reductions of number of cigarettes in smoking participants, none of the two BAIs were sufficient to evoke spill-over effects on tobacco smoking over 2 years. For long-term smoking cessation effects, multibehavioural interventions simultaneously targeting tobacco smoking along with at-risk alcohol use may be more effective.

TRIAL REGISTRATION NUMBER

NCT01291693.

The Impact of Brief Interventions With Condom Demonstrations on Youth: A Systematic Review

PURPOSE

This review examined whether there is evidence that brief interventions with condom demonstration lessons have impacts on behavioral and nonbehavioral outcomes for youth and young adults.

METHODS

We conducted a systematic review using a prespecified search strategy and processes consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified a pool of 11 eligible studies that tested the effectiveness of a single-session intervention that was no longer than 60 minutes and included a condom demonstration. We included all outcomes at all time points and organized them into eight domains.

RESULTS

Single-session interventions with condom demonstrations showed favorable short-term and long-term impacts for samples of largely sexually active youth. Studies found statistically significant impacts in 29%-50% of the tests for effects on attitudes toward condoms, knowledge of sexual health and condom use, perceptions of condom use and sexuality, and condoms use intentions.

DISCUSSION

Our review found evidence that brief interventions with condom demonstrations have potential effects on behavioral and nonbehavioral outcomes for vulnerable and transient sexually active youth warranting future studies to assess condom demonstrations in isolation.

Investigating for Whom Brief Substance Use Interventions Are Most Effective: An Individual Participant Data Meta-analysis

Prior research suggests that brief interventions (BIs) for alcohol and other drug use may vary in effectiveness across patient sociodemographic factors. The objective of this individual participant data (IPD) meta-analysis was to explore for whom BIs delivered in general healthcare settings are more or less effective. We examined variability in BI effects by patient age, sex, employment, education, relationship status, and baseline severity of substance use using a two-stage IPD meta-analysis approach. All trials included in a parent aggregate data meta-analysis (k = 116) were invited to contribute IPD, and 29 trials provided patient-level data (12,074 participants). Among females, BIs led to significant reductions in binge alcohol consumption ([Formula: see text] = 0.09, 95% CI [0.03, 0.14]), frequency of alcohol consumption ([Formula: see text] = 0.10, 95% CI [0.03, 0.17]), and alcohol-related consequences ([Formula: see text] = 0.16, 95% CI [0.08, 0.25]), as well as greater substance use treatment utilization ([Formula: see text] = 0.25, 95% CI [0.21, 0.30]). BIs yielded larger reductions in frequency of alcohol consumption at 3-month follow-up for individuals with less than a high school level education ([Formula: see text] = 0.16, 95% CI [0.09, 0.22]). Given evidence demonstrating modest BI effects on alcohol use and mixed or null findings for BI effects on other drug use, BI research should continue to investigate potential drivers of effect magnitude and variation.  PROTOCOL REGISTRATION DETAILS: The protocol for this review was pre-registered in PROSPERO #CRD42018086832 and the analysis plan was pre-registered in OSF: osf.io/m48g6.

Randomized Clinical Trial of Stigma Counseling and HIV Testing Access Interventions to Increase HIV Testing Among Black Sexual Minority Men and Transwomen

Advances in HIV prevention tools have outpaced our ability to ensure equitable access to these tools. Novel approaches to reducing known barriers to accessing HIV prevention, such as stigma and logistical-related factors, are urgently needed. To evaluate the efficacy of a randomized controlled trial with four intervention arms to address barriers to HIV/STI testing uptake (primary outcome) and PrEP use, depression, and HIV test results (secondary outcomes). We tested a 2 × 2 research design: main effect 1-stigma-focused vs. health information evaluation-focused counseling, main effect 2-offering HIV/STI testing appointments in person vs. at home with a counselor via video chat, and the interaction of the main effects. Participants (N = 474) residing in the southeastern USA were screened and enrolled in a longitudinal trial. Intervention efficacy was established using generalized linear modeling with binomial or Poisson distributions. Intervention efficacy demonstrated an increase in HIV/STI testing uptake when testing was made available at home with a counselor via video chat vs. in person (83% vs. 75% uptake, p < .05), and participants were also more likely to test positive for HIV over the course of the study in the at-home condition (14.5% vs. 9.4%, p < .05). Stigma-focused counseling resulted in lower depression scores and greater uptake of PrEP among participants < 30 years of age when compared with health information counseling (15.4% vs. 9.6%, p < .05). In order to prevent further disparities between HIV prevention advances and access to HIV prevention tools, we must prioritize improvements in linking people to care. Novel interventions, such as those proposed here, offer a practical, evidence-based path to addressing long-standing barriers to HIV prevention strategies. Trial registration: NCT03107910.

A randomized controlled trial of brief intervention for patients with cannabis use disorder

Objectives

Effective interventions for cannabis use disorders are fairly limited. The present randomized controlled trial (RCT) aimed to compare the reduction in cannabis use (number of days cannabis used) with brief intervention and simple advice in patients with cannabis use disorder.

Materials and Methods

This non-blinded and parallel two-group RCT included 100 male patients with cannabis use disorder. A semi-structured pro forma and severity of dependence scale (SDS) were used. Participants were then randomized to either of the two arms (brief intervention and simple advice) in a 1:1 ratio. Cannabis use patterns and SDS scores were assessed over the phone at week 4, week 8, and week 12.

Results

The two groups were comparable in sociodemographics and cannabis use characteristics. Participants in both groups were using cannabis for 30 days in the past month before enrolment. The brief intervention group had a lesser number of days of cannabis use vis-a-vis the simple advice group at 4, 8, and 12 weeks. There was a significant time effect for change in SDS scores (F = 30.629, P < 0.001), but the group effect was not significant (F = 0.379, P = 0.541).

Conclusion

In this population of regular cannabis users, brief intervention may be useful in reducing cannabis usage. It can be integrated into routine assessments and management of those with regular use of cannabis.

Using Motivational Interviewing to Increase HIV PrEP Initiation and Adherence: a Scoping Review

Despite evidence that pre-exposure prophylaxis (PrEP) reduces HIV risk, initiation and adherence remain low among vulnerable communities. Motivational interviewing (MI) can improve HIV prevention behaviors. However, limited research identifies how MI impacts PrEP uptake and adherence. This scoping review examines essential components of MI-based interventions that aimed to improve PrEP use, including the number and duration of sessions, counselor characteristics, and interview content. We searched four databases, PubMed, CINAHL Plus, Embase, and Web of Science, and reviewed 379 articles. Studies were considered if they (a) were published between 2012 and 2023, (b) used MI independently or part of a multi-component intervention strategy, and (c) focused on improving PrEP initiation or adherence. Seven articles met inclusion criteria. Regarding intervention components, the number of MI sessions varied and duration ranged between 15 and 60 min. MI counselors varied in credentialing and demographic characteristics. MI content included PrEP education, identifying initiation and adherence barriers, and strategizing ways to overcome barriers. MI is an important component of interventions that aim to improve PrEP initiation and adherence. However, the variability and limited details across studies hinder our ability to assess MI efficacy on PrEP initiation and adherence or replicate these approaches in future interventions.

A randomized controlled trial of a brief motivational interviewing-based group intervention for emerging adults experiencing homelessness: 12-Month effects on substance use and sexual risk behavior

INTRODUCTION

Few brief evidence-based risk reduction programs for emerging adults experiencing homelessness focus on the interrelated problems of substance use and sexual risk behavior. This study examines outcomes from a 12-month evaluation of AWARE, a brief Motivational Interviewing (MI)-based group risk reduction intervention for this population.

METHODS

In a cluster randomized crossover trial, N = 276 18-25-year-olds received AWARE or usual care at drop-in centers serving homeless youth in Los Angeles County. We evaluated intervention effects on substance use and condomless sex (primary outcomes), as well as drinking consequences and protective strategies, number of casual partners, self-efficacy, and motivation for change (secondary outcomes).

RESULTS

AWARE participants self-reported reductions in their alcohol use and negative consequences from drinking, and an increase in use of drinking protective strategies. AWARE participants also reported an initial decrease in drug use other than marijuana, followed by a slight uptake later on, as well as an initial increase in importance of cutting down on other drug use followed by a decrease. Control group participants did not show change in these outcomes. Among those who reported casual sex partners at both baseline and 12-month surveys, exploratory analyses indicated that AWARE participants had a 29 % decline in condomless sex with casual partners compared to a 6 % decline for control group participants.

CONCLUSIONS

Findings build on our pilot work by demonstrating that AWARE has long-term benefits on drinking among emerging adults experiencing homelessness. Further work should seek to strengthen its long-term effectiveness in reducing drug use in this population.

Unhealthy alcohol use and brief intervention rates among high and low complexity veterans seeking primary care services in the Veterans Health Administration

INTRODUCTION

Brief intervention (BI) is recommended for all primary care (PC) patients who screen positive for unhealthy alcohol use; however, patients with multiple chronic health conditions who are at high-risk of hospitalization (i.e., "high complexity" patients) may face disparities in receiving BIs in PC. The current study investigated whether high complexity and low complexity patients in the Veterans Health Administration (VHA) differed regarding screening positive for unhealthy alcohol use, alcohol-use severity, and receipt of BI for those with unhealthy alcohol use.

METHODS

Patients were veterans receiving PC services at the VHA in a mid-Atlantic region of the United States. The study extracted VHA administrative and clinical data for a total of 282,242 patients who had ≥1 PC visits between 1/1/2014 and 12/31/2014, during which they were screened for unhealthy alcohol use by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). The study defined high complexity patients as those within and above the 90th percentile of risk for hospitalization per the VHA's Care Assessment Need Score. Logistic regression models assessed if being a high complexity patient was associated with screening positive for unhealthy alcohol use (AUDIT-C ≥ 5), severity of unhealthy alcohol use in those who screened positive (AUDIT-C score range 5-12), and receipt of BI in those who screened positive.

RESULTS

Our sample was 94.5% male, 83% White, 13% Black, 4% other race, and 1.7% Hispanic. A total of 10,813 (3.8%) patients screened positive for unhealthy alcohol use from which we identified 569 (5.3%) high complexity and 10,128 (93.6%) low complexity patients (n = 116 removed due to missing complexity data). Relative to low complexity patients, high complexity patients were less likely to screen positive for unhealthy alcohol use (3.3% vs. 4.1%, AOR = 0.59, p < .001); however, in patients who screened positive, high complexity patients had higher AUDIT-C scores (Mean AUDIT-C = 7.75 vs. 6.87, AOR = 1.46, p < .001) and were less likely to receive a BI (78.0% vs. 92.6%, AOR = 0.42, p < .001).

CONCLUSIONS

Disparities in BI exist for highly complex patients despite having more severe unhealthy alcohol use. Future research should examine the specific patient- and/or clinic-level factors impeding BI delivery for complex patients.

Intervention for marijuana using, court-involved non-incarcerated youth

INTRODUCTION

Justice-involved youth (JIY) are at elevated risk for substance use and for substance use-related harm compared to non-JIY. Marijuana use is of significant concern in this population, as it is tied to reoffending. Motivational enhancement therapy (MET) and electronic interventions show promise in reducing youth substance use; the degree to which these findings extend to JIY requires additional research attention. Thus, the purpose of this study was to test the preliminary feasibility and effectiveness of a combined brief electronic parenting intervention plus a brief MET-based electronic intervention for JIY adolescents, followed by feedback and development of a change plan with a court worker, on marijuana use.

METHODS

Participants were 83 parent-youth dyads recruited from a diversionary family court program who screened positive for past-year marijuana use. At baseline and 3- and 6-month follow-ups, youth self-reported on their substance use, parental monitoring, peer substance use, and dyads completed a discussion task querying parental monitoring, limit setting, and substance use. The study randomized dyads to psychoeducation or the experimental intervention condition post-baseline. The MET-based intervention involved the self-administered e-TOKE (an electronic, marijuana-specific assessment and feedback tool) and a brief follow-up meeting with court staff counselors to review feedback and create a marijuana use change plan. Caregivers completed a computer program aimed at improving parenting and communication with their adolescents. The study administered feasibility and acceptability measures for both conditions.

RESULTS

Feasibility of study procedures was demonstrated through recruitment and retention (∼75 % success). Acceptability ratings from youth, parents, and court staff were high and positive. While levels of parental monitoring, as assessed by an observational task, improved over the course of the study, the intervention did not result in a significant change in any of the outcomes tested.

CONCLUSIONS

Despite high acceptability and feasibility ratings for the use of an electronic plus in-person MET intervention, reduction of marijuana and other substances was limited for most youth. This suggests that a more intensive intervention, such as stepped care, may be necessary for JIY who are not specifically referred for court proceedings due to marijuana use or those with already well-established use patterns.

Understanding Patients' Experiences with a Brief Alcohol Reduction Intervention among People Living with HIV in Uganda: A Qualitative Study

Background: Brief alcohol reduction interventions for people living with HIV (PLWH) have resulted in mixed findings with some studies showing null or limited treatment effects. To better understand factors that may contribute to their success or failure, this qualitative study sought to explore participants' experiences in a randomized trial (RCT) of a brief counseling-based alcohol reduction intervention, including challenges that may have impeded alcohol reduction. Methods: We conducted in-depth semi-structured interviews with 24 PLWH engaging in unhealthy alcohol use, who were enrolled in an RCT to reduce alcohol consumption conducted in southwestern Uganda in 2019-2020 (NCT03928418). We used a collaborative thematic approach to analyze data from transcribed and translated audio recordings. Results: Perceived benefits of the intervention included increased awareness of alcohol use and its impact on personal finances, the relationship between alcohol use and violence, and a commitment to drinking reduction. Participants experienced several barriers to decreasing their alcohol use, including: prevailing social norms about alcohol use, lack of social support, and economic and social consequences of the COVID-19 pandemic. Conclusion: Factors in the immediate contexts of PLWH in low-income settings, including social norms influencing alcohol consumption and lack of social support, may impede the impact of alcohol reduction interventions, especially during times of stress such as the COVID-19 pandemic.

Acceptability of a Chinese version of volitional help sheet to prevent self-harm repetition: qualitative study

BACKGROUND

Individuals who self-harm have increased suicide rates. Brief interventions are associated with reduced repeated suicide attempts. However, very few previous studies investigated the acceptability of brief interventions before implementing new trials.

AIMS

We aimed to explore the perceptions of individuals who self-harm toward a brief intervention, the Chinese version of the volitional help sheet (VHS-C), which encourages people to link a critical situation with an appropriate response.

METHOD

Fourteen participants who presented to hospitals with self-harm were interviewed about their perspectives regarding the acceptability of the paper- and web-based VHS-C. Data were analysed with the framework method.

RESULTS

The participants could understand the intended goal of the VHS-C by reading the written instructions, but indicated that having verbal instructions would also help. They shared the reasons why they felt the VHS-C was helpful (e.g. relatable contents, useful coping strategies and appropriate instructions that made them feel understood) or unhelpful (e.g., being not specific enough, not useful during the crisis and triggering negative emotional responses). Some indicated that the VHS-C might not be applicable to people experiencing ongoing distress in emergency departments. Most participants preferred the web-based to the paper-based VHS-C, and suggested that the format and frequency of follow-up reminders could leave the patient to decide.

CONCLUSIONS

The contents of the VHS-C were acceptable for people who presented to hospitals with self-harm. The VHS-C may be more helpful before individuals encounter suicidal thoughts than when they have an ongoing crisis.

Screening and treating problematic substance use among patients in psychiatry - obstacles and solutions

OBJECTIVE

In Sweden, national guidelines recommend that all staff in the healthcare system systematically screen patients for alcohol use and illicit substance use. Where hazardous use is identified, it should be addressed as soon as possible, preferably through brief interventions (BI). Results from a previous national survey showed that most clinic directors stated that they had clear guidelines for screening alcohol use and illicit substance use, but that fewer staff than expected used screening in their work. This study aims to identify obstacles and solutions to screening and brief intervention, based on survey respondents' free-text responses to open-ended questions.

RESULTS

A qualitative content analysis yielded four codes: guidelines, continuing education, cooperation and resources. The codes indicated that staff would need (a) clearer routines in order to optimize compliance with the national guidelines; (b) more knowledge about how to treat patients with problematic substance use; (c) better cooperation between addiction care and psychiatry; and (d) increased resources to improve routines at their own clinic. We conclude that increased resources could contribute to better routines and cooperation, and provide increased opportunities for continuing education. This could increase guideline compliance and increase healthy behavior changes among patients in psychiatry with problematic substance use.

Improving alcohol health literacy and reducing alcohol consumption: recommendations for Germany

BACKGROUND

Although the detrimental health effects of alcohol are well established, consumption levels are high in many high-income countries such as Germany. Improving alcohol health literacy presents an integrated approach to alcohol prevention and an important complement to alcohol policy. Our aim was to identify and prioritize measures to enhance alcohol health literacy and hence to reduce alcohol consumption, using Germany as an example.

METHODS

A series of recommendations for improving alcohol health literacy were derived from a review of the literature and subsequently rated by five experts. Recommendations were rated according to their likely impact on enhancing (a) alcohol health literacy and (b) reducing alcohol consumption. Inter-rater agreement was assessed using a two-way intra-class correlation coefficient (ICC).

RESULTS

Eleven recommendations were established for three areas of action: (1) education and information, (2) health care system, and (3) alcohol control policy. Education and information measures were rated high to increase alcohol health literacy but low to their impact on alcohol consumption, while this pattern was reversed for alcohol control policies. The ratings showed good agreement (ICC: 0.85-0.88).

CONCLUSIONS

Improving alcohol health literacy and reducing alcohol consumption should be considered complementary and become part of a comprehensive alcohol strategy to curb the health, social, and economic burden of alcohol.

Preliminary Efficacy of a Web-Based Alcohol and Emotion Regulation Intervention on Intimate Partner Aggression Among College Women

Objective

Intimate partner aggression (IPA), encompassing psychological and physical aggression, is a public health concern due to its high rates among young adults. Research and theory connect heavy drinking and emotion regulation (ER) difficulties to IPA and highlight their potential role in reducing IPA. A web-based intervention combining alcohol reduction strategies with ER skills demonstrated initial efficacy at reducing heavy drinking and improving ER abilities among college women with sexual assault victimization histories.

Method

The present study represents a secondary analysis of this brief web-based intervention to evaluate its preliminary efficacy on IPA. The sample comprised 200 heavy drinking college women with histories of sexual assault victimization randomized to an assessment only control or the intervention consisting of 14 brief online alcohol reduction and ER skill building modules administered daily over a two-week period. The analytic sample included 103 women who reported their psychological and physical IPA at both the 1- and 6-month follow-up surveys.

Results

After controlling for alcohol use, repeated measures mixed models examining changes from baseline to 6-month follow-up by condition revealed a significant time-by-intervention interaction effect on psychological IPA. Women who received the intervention had a significant decrease in psychological IPA from baseline to 6-month follow-up; there was no change in psychological IPA among women in the control condition. There was no significant effect of the intervention on physical IPA.

Conclusion

Reducing alcohol use and improving ER skills may be beneficial in helping women cope with relational conflict, thereby decreasing their use of psychological IPA.

A randomised controlled trial of volitional and motivational interventions to improve cervical cancer screening uptake

OBJECTIVE

Cervical cancer is the fourth most common cancer to occur in women worldwide. In the UK, the NHS cervical screening programme invites eligible individuals to take part in screening every 3-5 years. At present, around 70% of individuals attend screening when invited. The present study aimed to test the effectiveness of a volitional and a motivational intervention alone and in combination on screening uptake at 16-week follow up.

METHODS

14,536 participants were recruited from the list of eligible participants invited for screening in Yorkshire, Humber and the North East regions of England in December 2021. They were randomised to a social norm-based motivational intervention (SNA); implementation intention-based Volitional Help Sheet (VHS); combined intervention (SNA + VHS); or treatment as usual control. The primary outcome was screening uptake measured via patient screening records at 16 weeks.

RESULTS

Of the 14,466 participants with eligible data for analysis, 5793 (40.0%) attended for cervical cancer screening in the 16 weeks after the intervention mailing. Both age and deprivation influenced screening uptake, with lower uptake in the youngest individuals and those from more deprived areas. Compared to control, there was no evidence of any benefit from the VHS implementation intervention alone (Adj.OR = 0.99, 95% CI 0.90 to 1.10), the SNA motivational intervention alone (Adj.OR = 0.89; 95% CI: 0.80 to 0.99), or the combined intervention (Adj.OR = 0.96, 95% CI 0.86 to 1.06).

CONCLUSION

The study did not support any benefit of either VHS or SNA interventions alone or in combination on cervical cancer screening uptake. It did demonstrate alarmingly low levels of screening uptake at 16 weeks which were well below the average rate. Future research needs to urgently investigate and understand the barriers to uptake following on from the COVID-19 pandemic.

Alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care

BACKGROUND

Attempts to routinely embed brief interventions in health systems have long been challenging, with healthcare professionals concerned about role adequacy, legitimacy, and support. This is the first study to explore clinical pharmacists' experiences of discussing alcohol with patients in their new role in UK primary care, in developing a novel approach to brief intervention. It investigates their confidence with the subject of alcohol in routine practice and explores views on a new approach, integrating alcohol into the medication review as another drug directly linked to the patient's health conditions and medicines, rather than a separated 'healthy living' issue. The study forms part of wider efforts to repurpose and reimagine the potential application of brief interventions and to rework their contents.

METHODS

Longitudinal qualitative study of 10 recruits to the new clinical pharmacist role in English primary care, involving three semi-structured interviews over approximately 16 months, supplemented by 10 one-off interviews with pharmacists already established in general practice.

RESULTS

When raised at all, enquiring about alcohol in medication reviews was described in terms of calculating dose and level of consumption, leading to crude advice to reduce drinking. The idea was that those who appeared dependent should be referred to specialist services, though few such referrals were recalled. Pharmacists acknowledged that they were not currently considering alcohol as a drug in their practice and were interested in learning more about this concept and the approach it entailed, particularly in relation to polypharmacy. Some recognised a linked need to enhance consultation skills.

CONCLUSIONS

Alcohol complicates routine clinical care and adversely impacts patient outcomes, even for those drinking at seemingly unremarkable levels. Changing clinical practice on alcohol requires engaging with, and supportively challenging, routine practices and entrenched ideas of different kinds. Framing alcohol as a drug may help shift the focus from patients with alcohol problems to problems caused for patients by alcohol. This is less stigmatising and provides role legitimacy for pharmacists to address alcohol clinically in medication reviews, thus providing one element in the formation of a new prevention paradigm. This approach invites further innovations tailored to other healthcare professional roles.

'I can feel myself coming out of the rut': a brief intervention for supporting behaviour change is acceptable to patients with chronic musculoskeletal conditions

AIM

To a) understand the perceptions and experiences of patients with musculoskeletal (MSK) conditions in relation to their physiotherapy care and their acceptability of 'Making Every Contact Count Healthy Conversation Skills' (MECC HCS) as a brief intervention within this care and, b) explore the mechanisms through which MECC HCS might facilitate behaviour change and enhance self-management in patients with MSK conditions.

METHODS

This study adopted an exploratory qualitative design, in which individual, semi-structured interviews with participants were conducted. Eight participants were interviewed. Five had been engaging with physiotherapists trained in and delivering MECC HCS within their routine physiotherapy appointments and three had been engaging with physiotherapists who had not received this training and were instead delivering usual care. MECC HCS is a person-centred approach to behaviour change that aims to empower individuals to take control of their health behaviours by building self-efficacy. The MECC HCS training programme helps healthcare professionals to develop skills in i) using 'open discovery' questions to explore context and allow patients to identify barriers and generate solutions; ii) listening more than giving information/ making suggestions; iii) reflecting on practice and iv) supporting Specific, Measurable, Action-oriented, Realistic, Timed, Evaluated, Reviewed (SMARTER) goal setting.

RESULTS

Those who had engaged with MECC HCS trained physiotherapists found their physiotherapy care highly acceptable and felt that their physiotherapist listened to them, tried to understand their context and world, and helped them plan for change. These individuals experienced increases in self-efficacy and motivation for self-managing their MSK conditions. A need for continued support following physiotherapy treatment was, however, emphasised for long-term self-management.

CONCLUSIONS

MECC HCS is highly acceptable to patients with MSK conditions and pain and may successfully facilitate health-promoting behaviour change and enhance self-management. Providing opportunities to join support groups following physiotherapy treatment may promote long-term self-management and provide social and emotional benefits for individuals. The positive findings of this small qualitative study warrant further investigation on the differences in experiences and outcomes between patients engaging with MECC HCS physiotherapists and those receiving treatment as usual during routine physiotherapy care.

Screening, brief intervention, and referral to treatment (SBIRT) for cannabis: A scoping review

INTRODUCTION

Screening, brief intervention, and referral to treatment (SBIRT) has been used to change substance use behavior. Despite cannabis being the most prevalent federally illicit substance, we have limited understanding of use of SBIRT for managing cannabis use. This review aimed to summarize the literature on SBIRT for cannabis use across age groups and contexts over the last two decades.

METHODS

This scoping review followed the a priori guide outlined by the PRISMA (Preferred Reporting Items for Scoping Reviews and Meta-Analyses) statement. We gathered articles from PsycINFO, PubMed, Sage Journals Online, ScienceDirect, and SpringerLink.

RESULTS

The final analysis includes forty-four articles. Results indicate inconsistent implementation of universal screens and suggest screens assessing cannabis-specific consequences and utilizing normative data may increase patient engagement. Broadly, SBIRT for cannabis demonstrates high acceptability. However, the impact of SBIRT on behavior change across various modifications to intervention content and modality has been inconsistent. In adults, patients with primary cannabis use are not engaging in recommended treatment at similar rates to other substances. Results also suggest a lack of research addressing referral to treatment in adolescents and emerging adults.

DISCUSSION

Based on this review, we offer several to improve each component of SBRIT that may increase implementation of screens, effectiveness of brief interventions, and engagement in follow-up treatment.

Costs of a Brief Alcohol Consumption Reduction Intervention for Persons Living with HIV in Southwestern Uganda: Comparisons of Live Versus Automated Cell Phone-Based Booster Components

Low-cost interventions are needed to reduce alcohol use among persons with HIV (PWH) in low-income settings. Brief alcohol interventions hold promise, and technology may efficiently deliver brief intervention components with high frequency. We conducted a costing study of the components of a randomized trial that compared a counselling-based intervention with two in-person one-on-one sessions supplemented by booster sessions to reinforce the intervention among PWH with unhealthy alcohol use in southwest Uganda. Booster sessions were delivered twice weekly by two-way short message service (SMS) or Interactive Voice Response (IVR), i.e. via technology, or approximately monthly via live calls from counsellors. We found no significant intervention effects compared to the control, however the cost of the types of booster sessions differed. Start up and recurring costs for the technology-delivered booster sessions were 2.5 to 3 times the cost per participant of the live-call delivered booster intervention for 1000 participants. These results suggest technology-based interventions for PWH are unlikely to be lower cost than person-delivered interventions unless they are at very large scale.

Evaluation of a Brief, Tailored Skin Cancer Risk Assessment and Referral Intervention for Community-Based Health Educators: Brief Report

Skin cancer rates are rising and earlier detection through screening leads to better outcomes. Health educators in community centers are well-situated to assess skin cancer risk, deliver tailored health information, and refer high-risk patients to a dermatologist for a screening. This study describes the evaluation of a brief, tailored skin cancer risk assessment, and referral intervention training. The training was developed as part of a pilot feasibility study and seven health educators were trained in an interactive session. Knowledge, attitudes, and efficacy were assessed before and after training. Health educators showed overall improvements of 22% in skin cancer risk knowledge, 50% improvement in positive attitudes toward assessment and referral, and a 40% increase in efficacy to intervene with patients. Community-based health educators that completed the training were able to successfully assess their patients for skin cancer risk and refer high-risk patients for a screening with a healthcare provider.

A randomized controlled trial of an online alcohol and sexual risk prevention program for college students studying abroad

INTRODUCTION

American college students who study abroad experience increases in their drinking behavior, concerning risky sexual behaviors, and high rates of sexual violence while abroad. Despite these concerns, institutions offer limited programming to students prior to departure to address these risks and no empirically supported interventions currently exist that are targeted toward preventing increased drinking, risky sexual behavior, and sexual violence abroad. To help address alcohol and sexual risk abroad, we designed a brief, single-session online predeparture intervention focused on risk and protective factors known to associate with alcohol and sexual risk abroad.

METHODS

Using a sample of 650 college students from 40 home institutions, we conducted a randomized controlled trial of the intervention and tested its effects on drinking (drinks per week, binge drinking frequency, alcohol related-consequences), risky sexual behaviors, and sexual violence victimization during the trip abroad (first month, last month abroad) and one-month and three-months after return home.

RESULTS

We observed small, but nonsignificant, intervention effects on drinks per week and binge drinking days during the first month abroad and three months after they had returned home to the United States, and small, significant effects on risky sexual behaviors during the first month abroad. The study found no observable effects at any time point for alcohol-related consequences or for sexual violence victimization abroad.

CONCLUSIONS

Though mostly nonsignificant, small initial intervention effects were promising in this first empirical test of an alcohol and sexual risk prevention program for study abroad students. However, students may need more intensive programming with booster sessions to experience lasting intervention effects during this particularly high-risk period.

CLINICALTRIALS

GOV IDENTIFIER

NCT03928067.

The Practice and Feasibility of Screening, Treatment, and Referral for Gaming Problems in Gambling, Alcohol and Other Drugs, and Youth Services

Screening, brief intervention, and referral to treatment (SBIRT) is a comprehensive approach to identifying people at risk of addiction, but its feasibility for gaming disorder is unknown. This study surveyed 88 clinicians from gambling, alcohol and other drugs, and youth services in New Zealand. Results indicated that the most frequent GD screening method was an unstructured interview (61%), but 74% stated they would use a standardized tool if available. Responsivity to the detection of GD was an immediate intervention (84%), and rates of referral were low (28%). Around 50% of clinicians indicated high confidence in administering motivational approaches and relapse prevention. There was strong support for screening training (85%), treatment guidelines (88%), self-help materials (92%), and access to internet-delivered CBT that could be used in conjunction with other treatment (84%). Clinicians appear motivated and willing to implement SBIRT for GD but report lacking necessary training and resources, including access to screening tools and treatment guidelines.

Magis - A magical adventure: Using a mobile game to deliver an ACT intervention for elementary schoolchildren in classroom settings

Studies of the effects of the COVID-19 pandemic have shown that this health emergency has affected especially young people. Supporting the well-being of children is thus particularly urgent. However, the high prevalence of ill-being among children requires novel approaches to providing help. Health care resources are limited, and many children did not receive support even before the pandemic. The current study presents a novel approach to delivering brief interventions for school-aged children. A mobile game based on acceptance and commitment therapy was used to increase psychological flexibility and well-being among 10 to 12-year-old schoolchildren. A sample of 106 students played the game in four weekly sessions as part of normal teaching practice in school. The effectiveness of the brief game intervention was examined as a universal intervention among the whole sample and among subgroups created on the basis of baseline psychological flexibility (i.e., based on the need for an intervention). The results show that higher psychological flexibility was associated with less emotional and behavioral problems, higher health-related quality of life, mood, and school satisfaction, and less loneliness (r = 0.46-0.63). While a significant effect was not detected in the whole sample, the subsample of children with initially high psychological inflexibility benefitted from participating in the intervention (Cohen's d = 0.35). These preliminary findings suggest that the brief game-based intervention can increase psychological flexibility among children when the need for an intervention is considered. Further research is necessary to examine the stability of improvements in psychological flexibility.

Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Primary Care, School-Based Health Clinics, and Mental Health Clinics

Adolescent cannabis use is a modifiable health behavior with potential adverse developmental, cognitive, psychological, and health effects. Over the last 2 decades, work to promote implementation of screening, brief intervention, and referral to treatment has improved screening, use of validated screening tools, and preventive messaging. Current intervention strategies for cannabis use are associated with modest, short-term effects, and referral to treatment is limited by availability of resources for adolescent substance use. This article provides an update on the evidence base for screening, brief intervention, referral to treatment, and the current state of implementation focused on management of cannabis use disorder.

Reducing Khat use among Somalis living in Kenya: a controlled pilot study on the modified ASSIST-linked brief intervention delivered in the community

BACKGROUND

During recent decades, the consumption of the stimulant khat (catha edulis) has profoundly changed in countries around the Horn of Africa, and excessive use patterns have emerged-especially evident among displaced Somalis. This is related to the development of severe somatic and psychiatric disorders. There are currently no preventive or interventional studies targeting khat use. This study's aim was to test screening and brief intervention (SBI) to reduce khat use among urban Somali refugees living in Kenya with limited access to public healthcare.

METHODS

In this controlled study, 330 male Somali khat users from the community were either assigned to SBI (161) or an assessment-only control condition (AC; 169); due to field conditions a rigorous experimental design could not be implemented. The World Health Organization's (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)-linked brief intervention was adapted to khat and Somali culture. Trained local counselors administered the intervention. The amount and frequency of khat use was assessed using the time-line-follow-back method. We compared the month before the intervention (t1) to the two months after it (t2, t3). Baseline differences in khat use frequency were corrected by partial matching and mixed effect models used to evaluate intervention effects.

RESULTS

SBI was well accepted and feasible for khat users. Over the complete observation period and from t1 to t2, khat use amount and frequency decreased (p < .001) and the intervention group showed a greater reduction (group x time effects with p ≤ .030). From t2 to t3, no further reduction and no group differences emerged.

CONCLUSION

The results provide preliminary evidence that khat use amount and frequency can be reduced in community settings by SBI, requiring little resources. Thorough assessment alone might have intervention-like effects. The non-treatment-seeking community sample and the non-professional counselors are distinct from SBI studies with other substances in other countries, but support the feasibility of this approach in khat use countries and especially in Somali populations with limited access to healthcare. Future studies that employ rigorous experimental design are needed.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02253589. Date of first registration 01/10/2014, retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02253589 . First participant 16/09/2014.

Effectiveness of a pharmacist-delivered primary care telemedicine intervention to increase access to pharmacotherapy and specialty treatment for alcohol use problems: Protocol for the alcohol telemedicine consult cluster-randomized pragmatic trial

BACKGROUND

Alcohol use problems are associated with serious medical, mental health and socio-economic consequences. Yet even when patients are identified in healthcare settings, most do not receive treatment, and use of pharmacotherapy is rare. This study will test the effectiveness of the Alcohol Telemedicine Consult (ATC) Service, a novel, personalized telehealth intervention approach for primary care patients with alcohol use problems.

METHODS

This cluster-randomized pragmatic trial, supplemented by qualitative interviews, will include adults with a primary care visit between 9/10/21-3/10/23 from 16 primary care clinics at two large urban medical centers within Kaiser Permanente Northern California, a large, integrated healthcare system. Clinics are randomized to the ATC Service (intervention), including alcohol pharmacotherapy and SBIRT (screening, MI (Motivational Interviewing)-based brief intervention and referral to addiction treatment) delivered by clinical pharmacists, or the Usual Care (UC) arm that provides systematic alcohol SBIRT. Primary outcomes include a comparison of the ATC and UC arms on 1) implementation outcomes (alcohol pharmacotherapy prescription rates, specialty addiction treatment referrals); and 2) patient outcomes (medication fills, addiction treatment initiation, alcohol use, healthcare services utilization) over 1.5 years. A general modeling approach will consider clustering of patients/providers, and a random effects model will account for intra-class correlations across patients within providers and across clinics. Qualitative interviews with providers will examine barriers and facilitators to implementation.

DISCUSSION

The ATC study examines the effectiveness of a pharmacist-provided telehealth intervention that combines pharmacotherapy and MI-based consultation. If effective, the ATC study could affect treatment models across the spectrum of alcohol use problems.

CLINICAL TRIALS REGISTRATION

This study has been registered on ClinicalTrials.gov (NCT05252221).

Screening and brief intervention for alcohol use disorder risk in three middle-income countries

Background

This study examined the prevalence of screening and brief intervention (SBI) for alcohol use disorder (AUD) risk in samples of adult drinkers in three middle-income countries (Brazil, China, South Africa), and the extent to which meeting criteria for AUD risk was associated with SBI.

Methods

Cross-sectional survey data were collected from adult samples in two cities in each country in 2018. Survey measures included past-year alcohol use, the CAGE assessment for AUD risk, talking to a health care professional in the past year, alcohol use screening by a health care professional, receiving advice about drinking from a health care professional, and sociodemographic characteristics. The prevalence of SBI was determined for past-year drinkers in each country and for drinkers who had talked to a health care professional. Logistic regression analyses were conducted to examine whether meeting criteria for AUD risk was associated with SBI when adjusting for sociodemographic characteristics.

Results

Among drinkers at risk for AUD, alcohol use screening rates ranged from 6.7% in South Africa to 14.3% in Brazil, and brief intervention rates ranged from 4.6% in South Africa to 8.2% in China. SBI rates were higher among drinkers who talked to a health care professional in the past year. In regression analyses, AUD risk was positively associated with SBI in China and South Africa, and with brief intervention in Brazil.

Conclusion

Although the prevalence of SBI among drinkers at risk for AUD in Brazil, China, and South Africa appears to be low, it is encouraging that these drinkers were more likely to receive SBI.

Supplementary information

The online version contains supplementary material available at 10.1186/s12889-022-14358-4.

Comparing the Effectiveness of Cognitive-Behavioral Therapy and Brief Intervention on Relapse Prevention among Drug Users

BACKGROUND

This study aimed to compare the effectiveness and stability of group cognitive-behavioral therapy (CBT) and brief intervention (BI) for relapse prevention (RP) among drug users of drop-in-centers (DICs) in Ahvaz, Iran.

METHODS

The present study was a quasi-experimental one with a pretest-posttest design, a follow-up phase, and a control group. The statistical population included all drug users of drop- in-centers of Ahvaz in 2021. The sample of the study included 78 drug users selected randomly and assigned to two experimental groups and one control group (each 26 members). A morphine test (special kits) that detects the presence of morphine in urine was used to check the relapse. Data were analyzed using repeated measures ANOVA with SPSS (version 24).

FINDINGS

The results showed BI and CBT had a significant effect on reducing RP in drug users (P<0.001). The BI was more effective than CBT for RP.

CONCLUSION

It can be concluded that both BI and CBT can be effective in reducing the likelihood of relapse among drug users but BI is more effective than CBT for RP.

Payment and Financing for Substance Use Screening and Brief Intervention for Adolescents and Adults in Health, School, and Community Settings

Screening and brief intervention (SBI) is an evidence-based, cost-effective practice to address unhealthy substance use. With SBI services expanding beyond healthcare settings (e.g., schools, community organizations) and reaching younger populations, sustainability efforts must consider payment and financing. This narrative review incorporated rapid scoping review methods and a search of the gray literature to determine payment and financing approaches for SBI with adolescents and to describe related barriers and facilitators for its sustainability. We sought information relevant to adolescents and settings in which they receive SBI, but also reviewed sources with an adult focus. Few peer-reviewed articles met inclusion criteria, and those mostly highlighted healthcare settings. School-based settings were better described in the gray literature; little was found about community settings. SBI is mostly paid through grant funding and public and commercial insurance; school-based settings use a range of approaches including grants, public insurance, and other public funding. We call upon researchers and providers to describe the payment and financing of SBI, to inform how the uptake of SBI may be practicable and sustainable. The increasing activation and use of insurance billing codes, and the expansion of SBI beyond healthcare, is encouraging to address unhealthy substance use by adolescents.

Screening and Brief Intervention With Low-Income Youth in Community-Based Settings

PURPOSE

We described screening, brief intervention, and referral to treatment (SBIRT) results and assessed whether SBIRT is associated with positive changes in substance use, risky use, and educational/employment outcomes for youth in community-based settings that are not healthcare focused.

METHODS

YouthBuild USA serves youth of ages 16-24 who are neither in school nor employed. In an SBIRT intervention, youth completed substance use surveys and Alcohol Use Disorders Identification Test and Drug Abuse Screening Test screenings at entry and program completion. Staff reported on services provided in response to screening scores. Regression models compared changes in youth screening results and substance use from intake to follow-up and, with aggregate program-level data, youth outcomes across programs with and without the SBIRT intervention.

RESULTS

Youth significantly reduced Alcohol Use Disorders Identification Test (3.1 vs. 2.3, p < .001) and Drug Abuse Screening Test (1.9 vs. 1.4, p < .001) scores, positive screens (64% vs. 54%, p < .001), and need for referrals to treatment (48% vs. 37%, p < .001), indicating less risky substance use, although self-reports of substance use in the past 30 days did not decrease. Proportionately more youth in SBIRT programs attained a high school diploma or equivalent (49% vs. 42%, p = .01) and were still in educational/job placements 3 months after program completion (67% vs. 59%, p = .02), compared to youth in non-SBIRT programs.

DISCUSSION

These findings suggest that community-based SBIRT is associated with positive outcomes-both reduced risky substance use and improved education and employment-that relate to longer-term positive development for youth. SBIRT appears to be an evidence-based approach to intervene and help youth.

Young Adult Substance Use and Healthcare Use Associated With Screening, Brief Intervention and Referral to Treatment in Pediatric Primary Care

PURPOSE

Screening, brief intervention, and referral to treatment (SBIRT) may impact future comorbidity and healthcare utilization among adolescents screening positive for substance use or mood problems.

METHODS

In a randomized trial sample, we compared an SBIRT group to usual care for substance use, mental health, medical diagnoses, and healthcare utilization over 7 years postscreening.

RESULTS

In logistic regression models adjusting for patient characteristics, the SBIRT group had lower odds of any substance (Odds Ratio[OR] = 0.80, 95% Confidence Interval [CI] = 0.66-.98), alcohol (OR = 0.69, 95% CI = 0.51-0.94), any drug (OR = 0.73, 95% CI = 0.54-0.98), marijuana (OR = 0.70, 95% CI = 0.50-0.98), and tobacco (OR = 0.83, 95% CI = 0.69-1.00) diagnoses, and lower odds of any inpatient hospitalizations (OR = 0.59, 95% CI = 0.41-0.85) compared with usual care. Negative binomial models examining number of visits among adolescents with at least one visit of that type found that those in the SBIRT group had fewer primary care (incidence rate ratio[iRR] = 0.90, p < .05) and psychiatry (iRR = 0.64, p < .01) and more addiction medicine (iRR = 1.52, p < .01) visits over 7 years compared with usual care. In posthoc analyses, we found that among Hispanic patients, those in the SBIRT group had lower odds of any substance, any drug and marijuana use disorder diagnoses compared with usual care, and among Black/African American patients, those in the SBIRT group had lower odds of alcohol use disorder diagnoses compared with usual care.

DISCUSSION

Beneficial effects of adolescent SBIRT on substance use and healthcare utilization may persist into young adulthood.

An Alcohol Symptom Checklist identifies high rates of alcohol use disorder in primary care patients who screen positive for depression and high-risk drinking

Background

Although alcohol use disorder can complicate depression management, there is no standard process for assessing AUD symptoms (i.e., AUD diagnostic criteria) in primary care for patients who screen positive for depression. This study characterizes the association between depressive symptoms and high-risk drinking reported by primary care patients on screening measures in routine care. Then, using data from a novel clinical program, this study characterizes the association between depressive symptoms and AUD symptoms reported by primary care patients with high-risk drinking via an Alcohol Symptom Checklist.

Methods

In this cross-sectional study, electronic health record data were obtained from patients who visited 33 Kaiser Permanente Washington primary care clinics between 03/2018 and 02/2020 and completed depression (PHQ-2) and alcohol consumption (AUDIT-C) screening measures as part of routine care (N = 369,943). Patients who reported high-risk drinking (AUDIT-C scores 7–12) also completed an Alcohol Symptom Checklist where they reported the presence or absence of 11 AUD criteria as defined by the DSM-5 (N = 8,184). Generalized linear models estimated and compared the prevalence of high-risk drinking (AUDIT-C scores 7–12) and probable AUD (2–11 AUD symptoms on Alcohol Symptom Checklists) for patients with and without positive depression screens.

Results

Patients who screened positive for depression had a 131% higher prevalence of high-risk drinking than those who screened negative (5.2% vs. 2.2%; p < 0.001). Among patients with high-risk drinking, positive depression screens were associated with a significantly higher prevalence of probable AUD (69.8% vs. 48.0%; p < 0.001), with large differences in the prevalence of probable AUD observed with increasing PHQ-2 scores (e.g., probable AUD prevalence of 37.6%, 55.3% and 65.2%, for PHQ-2 scores of 0, 1, and 2, respectively). Although the overall prevalence of high-risk drinking was higher for male patients, similar patterns of association between depression screens, high-risk drinking, and AUD symptoms were observed for male and female patients.

Conclusions

Patients with positive depression screens are more likely to have high-risk drinking. Large percentages of patients with positive depression screens and high-risk drinking report symptoms consistent with AUD to healthcare providers when given the opportunity to do so using an Alcohol Symptom Checklist.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08408-1.

Effectiveness of a Brief Group Intervention for Harmful Alcohol Use in Men at a Primary Health Care Facility in Brazil: A Randomized Clinical Trial

To evaluate the effectiveness of a brief group intervention (BGI) in reducing the use of alcohol and increasing the readiness to change in men with risky and harmful alcohol use. A randomized clinical trial with follow-ups at 30 and 90 days that was conducted in a primary health care (PHC) facility in the central region of São Paulo (Brazil). A total of 112 men were randomized to the experimental group (EG) (n = 55) or the control group (CG) (n = 57). To identify the pattern of alcohol use and the readiness to change, the Alcohol Use Disorders Identification Test (AUDIT) and the readiness to change (RTC) rule were used. The EG received a BGI session applied by nurses using the Feedback, Responsibility, Advice, Menu of options, Empathy, Self-efficacy (FRAMES) model. The CG was instructed to continue with the standard service of the unit after an initial interview. Intergroup analyses using the generalized equation estimation (GEE) method were performed. A significant difference in the pattern of use was observed between the EG and CG at follow-up evaluated (EG T1 (7.73 ± 5.14), CG T1 (12, 48 ± 5.62)) and EG T2 (6.65 ± 4.83), CG T2 (11.68 ± 6.65)). When compared the baseline (T0) measures (13.04) with the last time (T2) (6.65) at EG, it was identified a reduction of 6.39 in the AUDIT score. Differences between groups were found for readiness to change at follow-up ((EG T1 (8.50 ± 2.44) and CG T1 (5.67 ± 3.10) and (EG T2 (8.80 ± 1.73) and CG T2 (5.36 ± 3.33)), when contrasting with the baseline. The data suggest that the BGI was effective when compared to the control condition, as there was a reduction in risky and harmful use of alcohol for low-risk use, according to the alcohol use scores, and an increase in the stages of readiness to change.

Efficacy of screening and brief intervention for hazardous alcohol use in patients with mood disorders: A randomized clinical trial from a psychiatric out-patient clinic in India

AIM

To determine the efficacy of individual-based, face-to-face screening and brief intervention (SBI) for hazardous alcohol use among treatment-seeking outpatients with mood disorders.

METHODS

It was a parallel-group, single-blind, randomized controlled trial of 84 participants who met the selection criteria for hazardous alcohol use, defined by alcohol use disorder identification test (AUDIT) score 8-19. Participants were randomly allocated to either SBI or general advice group. Both groups had received a standard care for mood disorders. The outcome was assessed after 3 months. The primary outcome was a change in the mean AUDIT score and the secondary outcomes were a change in frequency of heavy episodic drinking and stages of motivation.

RESULTS

Majority (60%) had major depressive episodes. There was no significant difference in baseline demography and clinical variables between the groups. Both intention to treat and per-protocol analyses showed a small but significant effect of SBI on mean AUDIT score. Age, baseline AUDIT, and motivation did not moderate the effect. SBI was associated with a significant decrease in the frequency of heavy drinking and improvement in stages of motivation.

CONCLUSION

SBI among patients with mood disorders had a small but significant effect on alcohol use.

The Relationship Between Drinking Behavior and Conversational Processes During a Brief Alcohol Reduction Intervention for People with HIV

People with HIV (PWH) frequently engage in unhealthy alcohol use, which can adversely affect antiretroviral adherence and HIV disease progression. Brief interventions based on Motivational Interviewing (MI), including the Brief Negotiated Interview (BNI), can help to reduce drinking. This study examines MI processes observed during a single 15-20 min BNI session delivered by social workers to PWH with unhealthy alcohol use (N = 59) in the context of a stepped care intervention to reduce alcohol consumption. BNI sessions were coded for technical and relational processes encouraged in MI, such as autonomy support, instructive language, and self-exploration. Multiple regression analyses explored the relationship between: (1) Participants' pre-intervention drinking behaviors (weekly drinks and heavy drinking days) and these MI processes, and (2) MI processes and intervention outcomes. Results indicated that PWH who reported more weekly drinks at baseline engaged in less self-exploration, while social workers delivering the BNI used less instructive language for those who reported more heavy drinking days. PWH who engaged in more self-exploration and received more autonomy support had fewer heavy drinking days 6 months after the intervention. These findings suggest the value of providing more opportunities within BNIs to encourage self-exploration, as it may help to enhance intervention efficacy.

Open trial of a personalized feedback intervention and substance-free activity supplement for veterans with PTSD and hazardous drinking

This study reports findings from an open trial of a two-session intervention for veterans with symptoms of PTSD and hazardous drinking. Rooted in behavioral economic theory, this intervention aimed to decrease alcohol use and increase alcohol-free activities through personalized and normative feedback. This trial assessed the feasibility and acceptability of the intervention in a sample of 15 veterans. Participants completed assessments at baseline and post-intervention (1-month and 3-months). Thirteen participants (86.6%) were retained between the baseline assessment and second intervention session. Acceptability data indicated that veterans overwhelmingly viewed the intervention positively with little dropout between the two sessions. Further, participants in our study reduced alcohol consumption from 37.30 (SD = 17.30) drinks per week at baseline to 22.50 (SD = 27.75) drinks per week at the 1-month assessment and then to 14.60 (SD = 18.64) at the 3-months assessment, representing medium to large effects. PTSD severity also decreased from 57.20 (SD = 16.72) at baseline to 48.90 (SD = 18.99) at the 1-month assessment, representing a small effect. Though effect sizes from pilot trials should be interpreted with caution, findings suggest that this intervention was well-received, feasible to deliver, and may have resulted in improvements in intervention targets.

Listening to women and pregnant and postpartum people: Qualitative research to inform opioid use disorder treatment for pregnant and postpartum people

Background

The diagnosis of Opioid Use Disorder (OUD) during pregnancy has increased 2-to-5-fold over the past decade and barriers to treatment are significant. Technology-based solutions have the potential to overcome these barriers and deliver evidence-based treatment. However, these interventions need to be informed by end-users. The goal of this study is to gain feedback from peripartum people with OUD and obstetric providers about a web-based OUD treatment program.

Methods

Qualitative interviews were conducted with peripartum people with OUD (n = 18) and focus groups were conducted with obstetric providers (n = 19). Feedback from these interviews informed the development of text message-based screening, brief phone-based intervention and referral to treatment program, called Listening to Women and Pregnant and Postpartum People (LTWP). Once developed, further qualitative interviews with peripartum people with OUD (n = 12) and obstetric providers (n = 21) were conducted to gather feedback about the LTWP program.

Results

Patients reported that a relationship with a trusted provider is paramount for treatment engagement. Providers reported that time constraints and complex patient needs prohibit them from treating OUD and that evidence-based Screening, Brief Intervention and Referral to Treatment (SBIRT) are not implemented effectively in routine prenatal care. Neither patients nor providers were enthusiastic about our web-based intervention for OUD; thus, results were used to guide the development of LTWP to improve implementation of SBIRT during prenatal care.

Conclusions

End-user informed, technology-enhanced SBIRT has the potential to improve the implementation of SBIRT during routine prenatal care, and in turn, improve maternal and child health.

Development of evidence-informed bridge programming to support an increased need for eating disorder services during the COVID-19 pandemic

Over the course of the COVID-19 pandemic, rates of eating disorders have increased, further straining systems of care that were already overburdened. The current paper describes novel interventions, largely informed by Family-Based Treatment (FBT), that were implemented by a tertiary specialist adolescent eating disorders service. In response to the pandemic, programming was designed to bridge access to care while waiting for availability of evidence-based therapy. The Brief Psychology Consultation Clinic provides several sessions to patients and families, focused on psychoeducation and problem-solving informed by FBT and other evidence-based therapies. Two groups, the FBT Caregiver Workshop Series and FBT Caregiver Support Group, provide psychoeducation and support for caregivers of youth with eating disorders. Perceived strengths and benefits of these services, as well as barriers to implementation and future research directions are discussed.

[Screening and brief intervention on alcohol consumption]

La morbilidad asociada al consumo de alcohol incluye patología digestiva, psiquiátrica, neurológica, infecciosa, cáncer de diversos tipos, enfermedades cardiovasculares, lesiones intencionales, no intencionales, patología social y problemas familiares. Las evidencias más recientes no indican que el consumo «moderado» sea beneficioso para la salud. Por lo tanto, debe enfatizarse más bien la idea de evitar los consumos de riego y transmitir a los pacientes que lo más beneficioso para la salud sería no consumir alcohol o hacerlo en dosis de bajo riesgo. El instrumento más adecuado de cribado es el AUDIT-C. Las bases de la intervención breve consisten en estrategias cognitivo-conductuales y motivacionales. Hay que dar una información positiva sobre los beneficios de la moderación e informar sobre el peligro de la ingesta de alcohol. En fases precoces de la dependencia se contempla la oferta de tratamiento farmacológico de desintoxicación, deshabituación y seguimiento. Los casos más graves requieren coordinación con los servicios de adicciones. En España se ha podido comprobar que la intervención breve es efectiva y que disminuye el consumo 100 gramos de alcohol a la semana. Las estrategias comunitarias son el marco normativo adecuado para lograr los mejores resultados de la intervención breve. Estas deberán ir encaminadas a reducir la oferta y la disponibilidad para el consumo, mediante la adopción de medidas legislativas, de manera que se limite tanto la accesibilidad económica como la física. Por otra parte, habrá que implementar medidas para disminuir la demanda del alcohol mediante la educación para la salud a determinados grupos de riesgo.