AUDIT-C Scores Research Articles

Penile implants and other high risk practices in French Guiana's correctional facility: A cause for concern.

BackgroundPrisoners in French Guiana, a French territory located in South America, have a HIV and hepatitis B prevalence of 4%. Body modifications such as penile implants, tattoos, and body piercings are common among detainees, increasing the risk of blood-borne virus transmission.MethodsWe conducted a cross-sectional randomised survey in which the primary objective was to estimate the prevalence of high risk ‘bloody practices’ (penile implants, tattoos, body piercings) in French Guiana’s only correctional facility. The secondary objective was to describe the risk factors for penile implants, the procedures and motivations for insertion, the reported complications, their risk factors and adverse impact on condom use.ResultsOf the 221 male inmates interviewed, 19% had tattoos or body piercings while incarcerated, and 68% had penile implants, of which, 85% had been inserted inside the correctional facility. Addictive behaviors such as cannabis use and alcohol addiction (positive AUDIT-C score), early age at first sexual intercourse, and the number of incarcerations correlated positively with having inserted one or more penile implants while incarcerated. In contrast, having reported previous psychiatric hospitalizations and having a high knowledge score for HIV/AIDS and sexually transmitted infections (STIs) were negatively correlated with the insertion of penile implants while incarcerated. Penile implants were inserted in poor hygienic conditions, usually using the sharp lid of a canned food container, with 18% of early complications, mostly haemorrhage and edema. Condom use was negatively impacted for 52% of men with penile implants.ConclusionsOur results highlight the need for prevention interventions which should aim at increasing knowledge levels and at implementing comprehensive risk-reduction measures.

Utility of routine alcohol screening for monitoring changes in alcohol consumption

BackgroundRoutine alcohol screening scores are increasingly available in electronic health records (EHRs). Changes in such scores could be useful for monitoring response to brief intervention or treatment of alcohol use disorder. However, it is unclear whether changes in clinically-documented AUDIT-C alcohol screening scores reflect true changes in drinking. This study evaluated associations between changes in EHR AUDIT-C scores and changes in high density lipoprotein cholesterol (HDL), a laboratory test that reflects average alcohol consumption. MethodsNational U.S. Veterans Affairs EHR data (2004–2007) were used to identify patients screened with the AUDIT-C (0–12 points), on two occasions at least a year apart, who had HDL measured in the year after each screen. First differencing linear regression estimated associations between changes in AUDIT-C score (-12 to 12 points; modeled categorically to allow for non-linear associations) and subsequent changes in HDL (mg/dL), adjusting for baseline HDL. Additional analyses evaluated whether associations between changes in AUDIT-C and changes in HDL were modified by baseline AUDIT-C. ResultsAmong 316,712 patients, increases—but not decreases—in AUDIT-C scores were associated with commensurate changes in HDL. However, a significant interaction was observed with baseline AUDIT-C score (p < 0.00001), which revealed that decreases in AUDIT-C scores were also associated with commensurate decreases in HDL (p-values<0.05) except among the 1.5% of patients with the highest baseline AUDIT-C scores (10–12). ConclusionsFindings suggest that changes in EHR AUDIT-C scores reflect changes in drinking. These results support the use of clinically-documented alcohol screening scores for monitoring patients’ alcohol use over time.

Evaluation of the dualistic model of passion for alcohol consumption among emerging adults engaged in risky drinking

Background: Understanding factors influencing risky drinking among emerging adults could enhance interventions to reduce adverse outcomes. As a motivational construct, the dualistic model of passion (i.e., obsessive passion: drinking is compelling and conflicts with other life activities/values; harmonious passion: drinking is an important, but not overwhelming, part of life) offers a novel explanation for persistent alcohol use. Yet, the dualistic model of passion has not yet been evaluated in this at-risk population. Therefore, we examined whether the variables proposed by the dualistic model of passion were associated with sex, binge-drinking, and alcohol-related consequences among young risky drinkers.Method: We analyzed cross-sectional baseline data collected as part of an ongoing randomized controlled trial of emerging adults (n = 327; Mage=22.6, SD = 1.1, range 21–24; 61% female; 76% White non-Hispanic) engaged in risky drinking (AUDIT-C score ≥ 4 females, ≥ 5 males) recruited nationally via social media advertisements.Results: A path analysis revealed significant positive direct effects between obsessive passion and binge drinking and alcohol-related consequences, and significant negative direct effects between male sex and harmonious passion and binge drinking. There was also a positive direct effect between binge drinking and alcohol-related consequences. Male sex and obsessive passion were both indirectly related to alcohol-related consequences via binge drinking.Conclusion: Type of passion and male sex differentiates risky drinkers who binge drink and who experienced alcohol-related consequences. Future research should examine whether targeting obsessive passion reduces binge drinking and negative outcomes.

Awareness of alcohol marketing, ownership of alcohol branded merchandise, and the association with alcohol consumption, higher-risk drinking, and drinking susceptibility in adolescents and young adults: a cross-sectional survey in the UK

ObjectivesTo explore awareness of alcohol marketing and ownership of alcohol branded merchandise in adolescents and young adults in the UK, what factors are associated with awareness and ownership, and what...

Predictors of Unhealthy Alcohol Consumption Behavior in Canadian Men

Aims Men are more likely to engage in alcohol consumption, which can have long-term consequences. The objective of our study was to sample Canadian men to determine predictors of hazardous alcohol hazardous as well as predictors for change. Methods Canadian men were surveyed investigating demographics, medical comorbidities, health behaviours, and willingness to change. Alcohol consumption was classified based on validated Audit-C scoring (&gt;3 was positive for dependency or abuse). Stages of change were classified based on the transtheoretical model of change (pre-contemplation, contemplation, preparation, action, and maintenance). Multivariate regression was performed to determine demographic factors as predictors for consumption and change. Results After exclusions and sample stratification, 2000 participants were included. Participants were aged 19–94 (median 48, IQR 34–60). Approximately 773 (38.7%) screened positive based on Audit-C scores. On multivariate analysis, minority status, age, work, income, retirement, living situation, geographic location, and level of education were associated with hazardous drinking. Of those engaging in hazardous drinking, the majority were in pre-contemplation or contemplation 488 (63.1%). On multivariate analysis, various demographic factors were associated with the five stages of change. Conclusion Our study illustrates that approximately 40% of men screen positive for unhealthy drinking behaviour and associated demographic risk factors for those at highest risk. The majority are in the earliest stages in transtheoretical model for change (&gt;60%), and there exist only a few associated demographic risk factors. This warrants awareness of this national problem, insight for patient education and targeted interventions to address hazardous behaviour and reduce morbidity and mortality.

Fibrosis and steatosis in type 2 diabetes mellitus patients evaluated with transient elastography and controlled attenuation parameter

The aim of the study was to assess the severity of liver fibrosis and steatosis in a cohort of type 2 diabetic patients, using non-invasive Methods: Transient Elastography (TE) and Controlled Attenuation Parameter (CAP). Material and Method: The study included 704 type 2 diabetic patients prospectively randomized, evaluated in the same session by means of TE and CAP (FibroScan, EchoSens) to assess both liver fibrosis and steatosis. Reliable liver stiffness measurements (LSM) were defined as the median value of 10 LSM with an IQR/median 300 db/m. Results: Out of 704 diabetics screened we excluded those with associated viral hepatitis, those with an AUDIT-C score ≥ 8 and those with unreliable LSM. The final analysis included 485 subjects (54.3% women, mean age 60 ± 9.5; mean BMI = 31.6 ± 6.1 kg/m2) with reliable LSM. 32.1% of patients had obesity grade I, 17.9 % had obesity grade II and 8.9% had obesity grade III (IMC ≥ 40 kg/m2). Mild, moderate and severe steatosis by means of CAP was found in 15.6%, 15.6 % and 59.3% cases, respectively. The median CAP values of patients with mild, moderate and severe steatosis were 260 db/m, 287.5 db/m and 354 db/m. Clinically relevant fibrosis was detected by means of TE in 19.6% (95/485) of subjects. Conclusion: In our group, 59.3% of diabetic patients had severe steatosis by means of CAP. Regarding the liver fibrosis, we found that 19.6% of them had severe fibrosis (TE ≥ 10.1kPa), suggesting the need for further assessment.

High prevalence of binge drinking among people living with HIV in four African countries.

IntroductionExcessive alcohol consumption leads to unfavourable outcomes in people living with HIV (PLHIV), including reduced adherence to antiretroviral therapy (ART) and engagement into care. However, there is limited information on alcohol consumption patterns among PLHIV in sub‐Saharan Africa.MethodsUsing a cross‐sectional approach, the Alcohol Use Disorders Identification Test (AUDIT‐C) was administered to PLHIV attending HIV clinics in Côte d'Ivoire, Togo, Senegal and Zambia (2013 to 2015). Hazardous drinking was defined as an AUDIT‐C score ≥4 for men or ≥3 for women, and binge drinking as ≥6 drinks at least once per month. The prevalence of binge drinking was compared to estimates from the general population using data from the World Health Organization. Factors associated with binge drinking among persons declaring any alcohol use in the past year were assessed using a logistic regression model to estimate odds ratio (OR) and their corresponding 95% confidence intervals (CI).ResultsAmong 1824 PLHIV (median age 39 years, 62.8% female), the prevalence of hazardous alcohol use ranged from 0.9% in Senegal to 38.4% in Zambia. The prevalence of binge drinking ranged from 14.3% among drinkers in Senegal to 81.8% in Zambia, with higher estimates among PLHIV than in the general population. Male sex (OR 2.4, 95% CI 1.6 to 3.7), tobacco use (OR 1.7, 95% CI 1.0 to 2.9) and living in Zambia were associated with binge drinking.ConclusionsAlcohol consumption patterns varied widely across settings and binge drinking was more frequent in HIV‐positive individuals compared to the general population. Interventions to reduce excessive alcohol use are urgently needed to optimize adherence in the era of universal ART.

Changes in alcohol use associated with changes in HIV disease severity over time: A national longitudinal study in the Veterans Aging Cohort

BackgroundAmong groups of persons living with HIV (PLWH), high-risk drinking trajectories are associated with HIV severity. Whether changes in individuals’ alcohol use are associated with changes in HIV severity over the same period is unknown. MethodsVeterans Aging Cohort Study (VACS) data from VA’s EHR (2/1/2008-9/30/2016) identified AUDIT-C screens for all PLWH. Pairs of AUDIT-C screens within 9–15 months were included if CD4 and/or viral load (VL) was measured within 9 months after baseline and follow-up AUDIT-Cs. Linear regression assessed change in HIV severity (CD4 and logVL) associated with AUDIT-C change adjusted for confounders. Mean changes in HIV severity were estimated for each AUDIT-C change value. For all measures of change, positive values indicate improvements (lower drinking and improved HIV severity). ResultsAmong PLWH, 21,999 and 22,143 were eligible for CD4 and VL analyses, respectively. Most had non- or low-level drinking and stable consumption over time (mean AUDIT-C change = .08, SD = 1.91). HIV severity improved over time [mean CD4 change = 20.5 (SD 180.8); mean logVL change = 0.12 (SD 0.71)]. AUDIT-C changes were associated non-linearly with changes in CD4 (p = 0.03) and logVL (p < 0.001). Improvement in HIV severity was greatest among those with stable AUDIT-C scores over time; those with greater AUDIT-C increases fared worse than those with smaller increases in or stable AUDIT-Cs. ConclusionsImprovement in HIV severity was greatest among PLWH with relatively stable drinking, most of whom initially did not drink or drank at low levels. Those with large changes (especially increases) in drinking appear at greatest risk for poor HIV control.

Receipt of alcohol-related care among patients with HCV and unhealthy alcohol use

BackgroundAlcohol use—particularly unhealthy alcohol use—exacerbates risks associated with Hepatitis C virus (HCV). However, whether unhealthy alcohol use is appropriately addressed among HCV+ patients is understudied. We examined receipt of alcohol-related care among HCV+ patients and unhealthy alcohol use. MethodsAll positive alcohol screens (AUDIT-C score ≥5) documented 10/01/09-5/30/13 were identified from national electronic health records data from the Veterans Health Administration (VA). Regression models estimated unadjusted and adjusted proportions of HCV+ and HCV- patients receiving 1) brief intervention within 14 days of positive screening, 2) specialty addictions treatment, and 3) pharmacotherapy for alcohol use disorder (AUD) in the year following positive screening. Adjusted models included demographics, alcohol use severity, and mental health and substance use disorder comorbidities. ResultsAmong 830,825 VA outpatients with positive alcohol screening, 31,841 were HCV+. Among HCV+, unadjusted and adjusted prevalences were 69.2% (CI, 68.7–69.6) and 71.9% (CI, 71.4–72.4) for brief intervention, 29.9% (CI, 29.4–30.4) and 12.7% (CI 12.5–12.9) for specialty addictions treatment, and 5.9% (CI, 5.7–6.1) and 3.3% (CI, 3.1–3.4) for pharmacotherapy, respectively. Among the 20,320 (64%) patients with HCV and documented AUD, unadjusted and adjusted prevalences were 40.0% (CI, 39.3–40.6) and 26.7% (CI, 26.3–27.1) for specialty addictions treatment and 8.1% (CI, 7.7–8.4) and 6.4% (CI, 6.1–6.6) for pharmacotherapy, respectively. Receipt of alcohol-related care was generally similar across HCV status. ConclusionsFindings highlight under-receipt of recommended alcohol-related care, particularly pharmacotherapy, among patients with HCV and unhealthy alcohol use who are particularly vulnerable to adverse influences of alcohol use.

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

BackgroundReducing underage drinking is a public health priority given increased risk for injury and other consequences. Emergency department (ED) visits offer a potential “teachable moment” to initiate interventions among youth engaged in risky drinking. Given mixed findings for alcohol brief interventions (BIs), this paper examined baseline markers of BI response in order to inform future interventions. MethodWe conducted secondary analyses of data from a randomized controlled trial of an alcohol BI delivered to youth in an ED. Among 475 participants (Mage = 18.6, SD = 1.4; 48.7% Female, 78.6% White/Caucasian) receiving a computer or therapist BI, we examined baseline characteristics (i.e., demographic, substance use, mood, risk/protective factors, and readiness to change) that predicted positive intervention response (i.e., BI responder) at 3-month follow-up using AUDIT-C scores (cut offs: <3 for ages 14–17; <4 for ages 18–20). ResultsMediated logistic regression analysis (controlling for demographics) showed that greater readiness to change at baseline was positively related to BI response and baseline alcohol consumption was negatively related to BI response. Having a mentor was indirectly related to BI response via baseline alcohol consumption. Baseline readiness to change and alcohol consumption mediated the association between positive peer influences and BI response, whereas readiness to change mediated the relation between depression and BI response. ConclusionFindings suggest that BI response is influenced by protective social factors, such as positive peers and mentors, and depression, via baseline alcohol severity indicators (i.e., readiness to change, consumption), thus providing clues for enhancing the content and dose of early interventions.

Effect of a text message intervention to reduce hazardous drinking among injured patients discharged from a trauma ward: a randomized controlled trial

Screening and brief intervention for hazardous alcohol use in trauma care settings is known to reduce alcohol intake and injury recidivism, but is often not implemented due to resource constraints. Brief interventions delivered by mobile phone could overcome this challenge. This study aimed to evaluate the effect of a mobile phone text message intervention (YourCallTM) on hazardous drinkers admitted for an injury. The parallel two-group, single-blind, randomised controlled trial enrolled 598 injured patients aged 16–69 years identified as medium-risk drinkers at recruitment. The intervention group (n = 299) received 16 text messages incorporating brief intervention principles in the 4 weeks following discharge from hospital. Controls (n = 299) received usual care and one text message acknowledging participation in the trial. The primary outcome was the difference in hazardous alcohol use (assessed using AUDIT-C) between study groups at 3 months, with the maintenance of effect examined at 6 and 12 months’ follow-up. Data were analysed using a mixed-effects model for repeated measures. Both groups had similar baseline features. Compared to controls, hazardous drinking was significantly lower in the intervention group at 3 months and maintained over the 12-month follow-up period (least squares mean difference in AUDIT-C scores: −0.322; 95% CI: −0.636, −0.008; p = 0.04). The intervention effect was similar among Māori (New Zealand’s indigenous population) and non-Māori (interaction p = 0.59), and among younger (16–29 years) and older (30–69 years) patients (p = 0.77). The effectiveness of this intervention reflects the potential of low cost, scalable mobile health technologies to overcome common barriers in implementing alcohol harm reduction strategies following injury.

Prevalence of undiagnosed and untreated attention deficit hyperactivity disorder in men with alcohol dependence – A case-control study

Aim of the studyTo compare the prevalence of adult attention deficit hyperactivity disorder (ADHD) among male alcohol users.Subject or material and methodsThe current case-control study included 50 male patients with alcohol abuse and 50 age-matched healthy controls. Clinical Institute Withdrawal Assessment of Alcohol Scale-Revised, severity of alcohol dependence questionnaire, alcohol use disorders identification test, Mini-International Neuropsychiatric Interview Scale, adult ADHD self-report scale version 1.1 screener, diagnostic and statistical manual of mental disorders criteria for adult ADHD, and ADHD-rating scale-IV were used to assess the patients. The data obtained were analyzed using EPIINFO 7 and compared using paired t-test, student’s t-test, and Pearson’s chi-square test (P ≤ 0.05).ResultsThe prevalence of undiagnosed ADHD was significantly higher in alcohol abuse cases when compared to healthy controls (31 vs. 4; P &lt; 0.0001). The most common (16) subtype of ADHD in alcohol abuse cases was the hyperactive/impulsive type, whereas in controls, it was the inattentive type (3). The severity of alcohol dependence was moderate in alcohol abuse cases with adult ADHD (25), whereas mild dependence was observed in cases without adult ADHD (9). The SAD-Q (34.46 ± 7.70 vs. 32.12 ± 10.17) and AUDIT-C (31.34 ± 3.63 vs. 29.23 ± 5.43) scores were higher in cases with adult ADHD as compared to cases without ADHD.DiscussionA significant association between alcohol abuse and the prevalence of ADHD was observed. The majority of the patients were young adults indicating that alcohol abuse with or without ADHD tends to commence early in life.ConclusionsPatients diagnosed with alcohol abuse should be screened frequently and treated for ADHD.

Associations Between MAOA-uVNTR Genotype, Maltreatment, MAOA Methylation, and Alcohol Consumption in Young Adult Males.

Epigenetic mechanisms are candidate moderators of the effect of maltreatment on brain and behavior. Interactions between maltreatment and the monoamine oxidase A upstream variable number tandem repeat genotype (MAOA-uVNTR) are associated with alcohol-related problems. However, presently it is not known whether DNA methylation moderates this association. The study focused on 53 young adult males and aimed to determine whether MAOA methylation moderated the association of alcohol-related problems with the interaction of MAOA-uVNTR and maltreatment, and whether alcohol consumption moderated the association of MAOA methylation with the interaction of MAOA-uVNTR and maltreatment. MAOA-uVNTR genotypes with ≤ 3 and > 3 repeats were categorized as short (S) and long (L), respectively. Data on maltreatment were obtained retrospectively, using self-reported questionnaires. DNA methylation of 16 candidate CpGs within part of the MAOA first exon and intron was assessed and grouped based on principal component analyses. Alcohol-related problems were assessed using the Alcohol Use Disorders Identification Test (AUDIT). Alcohol consumption was measured using AUDIT-C. Moderation effects were assessed and probed using the moderated moderation model and Johnson-Neyman's method, respectively. Carriers of the S allele, who experienced maltreatment and displayed lower Component 1 (mean of CpGs 13-16 in the first intron) MAOA methylation levels, reported higher AUDIT score in contrast to L-allele carriers. Carriers of the S allele, who reported higher AUDIT-C score and experienced maltreatment, displayed lower Component 3 (mean of CpGs 2-6 in the first exon) MAOA methylation levels than L-allele carriers. Intronic methylation moderated the association of alcohol-related problems with the interaction of MAOA-uVNTR and maltreatment. Alcohol consumption moderated the association of exonic methylation with the interaction of MAOA-uVNTR and maltreatment. These results suggest that epigenetic factors as well as genotype and maltreatment play a role in the development of alcohol misuse among young adult males.

Self-Reported Knowledge, Correct Knowledge and use of UK Drinking Guidelines Among a Representative Sample of the English Population

Promotion of lower risk drinking guidelines is a commonly used public health intervention with various purposes, including communicating alcohol consumption risks, informing drinkers' decision-making and, potentially, changing behaviour. UK drinking guidelines were revised in 2016. To inform potential promotion of the new guidelines, we aimed to examine public knowledge and use of the previous drinking guidelines, including by population subgroup. A demographically representative, cross-sectional online survey of 2100 adults living in England in July 2015 (i.e. two decades after adoption of previous guidelines and prior to introduction of new guidelines). Univariate and multivariate logistic regressions examined associations between demographic variables, alcohol consumption (AUDIT-C), smoking, and knowledge of health conditions and self-reported knowledge and use of drinking guidelines. Multinomial logistic regression examined the same set of variables in relation to accurate knowledge of drinking guidelines (underestimation, accurate-estimation, overestimation). In total, 37.8% of drinkers self-reported knowing their own-gender drinking guideline, of whom 66.2% gave an accurate estimate. Compared to accurate estimation, underestimation was associated with male gender, lower education and AUDIT-C score, while overestimation was associated with smoking. Few (20.8%) reported using guidelines to monitor drinking at least sometimes. Drinking guideline use was associated with higher education, overestimating guidelines and lower AUDIT-C. Correctly endorsing a greater number of health conditions as alcohol-related was associated with self-reported knowledge of guidelines, but was not consistently associated with accurate estimation or use to monitor drinking. Two decades after their introduction, previous UK drinking guidelines were not well known or used by current drinkers. Those who reported using them tended to overestimate recommended daily limits. We examined public knowledge and use of UK drinking guidelines just before new guidelines were released (2016). Despite previous guidelines being in place for two decades, only one in four drinkers accurately estimated these, with even fewer using guidelines to monitor drinking. Approximately 8% of drinkers overestimated maximum daily limits.

Identification of heavy drinking in the 10-item AUDIT: Results from a prospective study among 18–21 years old non-dependent German males

BackgroundAlcohol consumption is pivotal for the subsequent development of alcohol use disorders (AUD). The Alcohol Use Disorders Identification Test (AUDIT) is a recommended AUD screening tool for prevention and primary care settings. The objectives of this study were to test how many participants with heavy drinking are unidentified by the AUDIT, if proportions of unidentified participants vary over time, and whether this unidentified risk group (URG) was clinically relevant in terms of drinking behavior reports and AUD risk factors, as well as future adverse outcomes, such as craving, dependence symptoms, or depression. MethodsOur prospective cohort study followed 164 German males aged 18–19years without an alcohol dependence diagnosis over 24months. Only men were included due to higher AUD prevalence and gender-specific differences in metabolism, drinking patterns, and progression to AUD. All participants were screened via telephone interview and answered questionnaires both in person and via internet. Heavy drinking was classified using the AUDIT consumption score (AUDIT-C≥4.50). Standardized AUD diagnoses and symptoms, as well as alcohol use-related outcome criteria were assessed via standardized Composite International Diagnostic Interview (CIDI), and self-report questionnaires. ResultsOne in four participants (22–28% across all four follow-ups) reported heavy drinking but was unidentified by AUDIT total score (i.e. score<8), thus qualifying for URG status. The URG status did not fluctuate considerably across follow-ups (repeated-measures ANOVA, p=0.293). URG participants identified at the six-month follow-up did not generally differ from participants without URG status in terms of AUD family history or temperament (multivariate ANOVA, p=0.114), except for anxiety sensitivity (pBonferroni<0.001). After two years, URG participants reported a similar level of adverse outcomes compared to low-risk participants (multivariate ANOVA, p=0.438), but less alcohol-related problems and less loss of control due to craving compared to high-risk participants (pBonferroni≤0.007). ConclusionsDespite the considerable number of heavy-drinking individuals unidentified by AUDIT total scores, an additional classification according to AUDIT-C values did not prove useful. Combining AUDIT and AUDIT-C scores might not be sufficient for identifying AUD risk groups among young adult German males. There is an urgent need for a replication of our findings among female participants.

Delivery of screening and brief intervention for unhealthy alcohol use in an urban academic Federally Qualified Health Center

BackgroundScreening and brief intervention (SBI) for unhealthy drinking has not been widely implemented in primary care partly due to reliance on physicians to perform it.MethodsWe implemented a model of nursing staff-delivered SBI for unhealthy drinking for adult patients receiving primary care at an academically-affiliated Federally Qualified Health Center in the Bronx, NY. Our model consisted of nursing staff screening all patients with the alcohol use disorders identification test consumption questions (AUDIT-C) and, if screening positive, providing BI or referral to specialty services. We developed a clinical decision support tool integrated into the electronic health record to guide nursing staff and record SBI provision. To evaluate this model, we determined overall SBI delivery to patients and factors associated with receiving SBI.ResultsBetween October 2013 and September 2014, 9119 unique adult patients made 24,285 visits. Patients were majority women (67.5%) and Hispanic/Latino (54.5%). Overall, 46.2% were screened, with 19.0–35.8% of eligible patients screened in each month. Increasing age (OR: 0.82 [95% CI 0.80–0.85] for a 10-year increase), female sex (OR: 0.83 [95% CI 0.77–0.91]), and chronic conditions like hypertension (OR: 0.62 [95% CI 0.56–0.70]) and diabetes (OR: 0.66 [95% CI 0.58–0.75]), among others, were associated with a lower odds of being screened. Of all patients screened, 225 (5.3%) screened positive and of those patients, 122 (54.2%) received a BI. Patients with higher AUDIT-C scores were more likely to receive a BI (OR: 1.24 [95% CI 1.04–1.47] for a 1-point increase) and non-English speaking patients were less likely to receive a BI than those who spoke English (OR: 0.42 [95% CI 0.18–0.97]).ConclusionsOur model of SBI resulted in screening of nearly half of all eligible patients and BI provision to over half of those screening positive. Future efforts to improve SBI delivery should focus on groups such as older adults, women, and those with chronic medical conditions.

Alcohol-related and mental health care for patients with unhealthy alcohol use and posttraumatic stress disorder in a National Veterans Affairs cohort

ObjectiveUnhealthy alcohol use and posttraumatic stress disorder (PTSD) frequently co-occur. Patients with both conditions have poorer functioning and worse treatment adherence compared to those with either condition alone. Therefore, it is possible that PTSD, when co-occurring with unhealthy alcohol use, may influence receipt of evidence-based alcohol-related care and mental health care. We evaluated receipt of interventions for unhealthy alcohol use and receipt of mental health follow-up care among patients screening positive for unhealthy alcohol use with and without PTSD in a national sample from the Veterans Health Administration (VA). MethodsNational clinical and administrative data from VA's electronic medical record were used to identify all patients who screened positive for unhealthy alcohol use (AUDIT-C score≥5) between 10/1/09–5/30/13. Unadjusted and adjusted Poisson regression models were fit to estimate the relative rate and prevalence of receipt of: brief interventions (advice to reduce or abstain from drinking≤14days after positive screening), specialty addictions treatment for alcohol use disorder (AUD; documented visit≤365days after positive screening), pharmacotherapy for AUD (filled prescription≤365days after positive screening), and mental health care ≤14days after positive screening for patients with and without PTSD (documented with ICD-9 CM codes). In secondary analyses, we tested effect modification by both severity of unhealthy alcohol use and age. ResultsAmong 830,825 patients who screened positive for unhealthy alcohol use, 140,388 (16.9%) had documented PTSD. Of the full sample, 71.6% received brief interventions, 10.3% received specialty AUD treatment, 3.1% received pharmacotherapy for AUD, and 24.0% received mental health care. PTSD was associated with increased likelihood of receiving all types of care. Adjusted relative rates were 1.04 (95% CI 1.03–1.05) for brief interventions, 1.06 (1.05–1.08) for specialty AUD treatment, 1.35 (1.31–1.39) for AUD pharmacotherapy, and 1.82 (1.80–1.84) for mental health care. Alcohol use severity modified effects of PTSD for specialty AUD treatment, AUD pharmacotherapy, and mental health care such that effects were maintained at lower severity but attenuated among patients with severe unhealthy alcohol use. Age modified all effects with the strength of the association between PTSD and care outcomes being strongest for younger (18–29years) and older veterans (65+ years) and weaker or non-significant for middle-aged veterans (30–44 and 45–64years). ConclusionsIn this large national sample of patients with unhealthy alcohol use, PTSD was associated with increased likelihood of receiving alcohol-related and mental health care. PTSD does not appear to be a barrier to care among VA patients with unhealthy alcohol use.

Young construction workers: substance use, mental health, and workplace psychosocial factors

PurposeYoung Australian workers are at elevated risk of mental health and alcohol and other drug related problems. The purpose of this paper is to examine the relationship between alcohol and drug (AOD) use, psychological wellbeing, and the workplace psychosocial environment among young apprentices in the construction industry.Design/methodology/approachA cross-sectional survey of a cohort of 169 construction industry apprentices in their first year of training was undertaken. The survey included measures of psychological distress (K10), quantity/frequency measures of alcohol and illicit drug use, and workplace psychosocial factors.FindingsConstruction industry apprentices are at elevated risk of AOD related harm and poor mental health. Levels of psychological distress and substance use were substantially higher than age/gender equivalent Australian population norms. Job stress, workplace bullying, and general social support accounted for 38.2 per cent of the variance in psychological distress. General social support moderated the effects of job stress and bullying on psychological distress. Substance use was not associated with psychological distress. However, workplace social support accounted for 2.1 per cent of the variance in AUDIT-C scores, and 2.0 per cent of the variance in cannabis use. Workplace bullying explained 2.4 per cent of the variance in meth/amphetamine use.Practical implicationsConstruction trades apprentices are a high-risk group for harmful substance use and poor mental health. Study results indicate that psychosocial wellbeing interventions are warranted as a harm reduction strategy.Originality/valueThis is the first study of its kind to describe a cohort of Australian construction trade apprentices in terms of their substance use and psychological wellbeing. The study shows workplace psychosocial factors may predict young workers psychological wellbeing.

Effects of a stand-alone web-based electronic screening and brief intervention targeting alcohol use in university students of legal drinking age: A randomized controlled trial

BackgroundMany intervention efforts targeting student drinking were developed to address US college students, which usually involves underage drinking. It remains unclear, if research evidence from these interventions is generalizable to university and college students of legal drinking age, e.g., in Europe. ObjectiveTo evaluate the effectiveness of a translated and adapted version of the eCHECKUP TO GO, applied as stand-alone web-based electronic screening and brief intervention (e-SBI), in German university students at risk for hazardous drinking. MethodsA fully automated web-based two-arm parallel-group randomized controlled trial was conducted. Participants were randomized to an e-SBI or assessment-only (AO) condition. The current paper analyzed students with baseline AUDIT-C scores ≥3 for women and ≥4 for men (sample at baseline: e-SBI [n=514], AO [n=467]; 3-month follow-up: e-SBI [n=194], AO [n=231]; 6-month follow-up: e-SBI [n=146], AO [n=200]). The primary outcome was prior four weeks' alcohol consumption. Secondary outcomes were frequency of heavy drinking occasions, peak blood alcohol concentration, and number of alcohol-related problems. ResultsMixed linear model analyses revealed significant interaction effects between groups and time points on the primary outcome after 3 and 6months. Compared to students in the AO condition, students in the e-SBI condition reported consuming 4.11 fewer standard drinks during the previous four weeks after 3months, and 4.78 fewer standard drinks after 6months. Mixed results were found on secondary outcomes. ConclusionsThe results indicate that evidence on and knowledge of web-based e-SBIs based on US college student samples is transferable to German university students of legal drinking age. However, knowledge of what motivates students to complete programs under voluntary conditions, although rare, is needed.

Cut-Point Levels of Phosphatidylethanol to Identify Alcohol Misuse in a Mixed Cohort Including Critically Ill Patients.

Although alcohol misuse is associated with deleterious outcomes in critically ill patients, its detection by either self-report or examination of biomarkers is difficult to obtain consistently. Phosphatidylethanol (PEth) is a direct alcohol biomarker that can characterize alcohol consumption patterns; however, its diagnostic accuracy in identifying misuse in critically ill patients is unknown. PEth values were obtained in a mixed cohort comprising 122 individuals from medical and burn intensive care units (n=33), alcohol detoxification unit (n=51), and healthy volunteers (n=38). Any alcohol misuse and severe misuse were referenced by Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C scores separately. Mixed-effects logistic regression analysis was performed, and the discrimination of PEth was evaluated using the area under the receiver-operating characteristic (ROC) curve. The area under the ROC curve for PEth was 0.927 (95% CI: 0.877, 0.977) for any misuse and 0.906 (95% CI: 0.850, 0.962) for severe misuse defined by AUDIT. By AUDIT-C, the area under the ROC curves was 0.948 (95% CI: 0.910, 0.956) for any misuse and 0.913 (95% CI: 0.856, 0.971) for severe misuse. The PEth cut-points of ≥250 and ≥400ng/ml provided optimal discrimination for any misuse and severe misuse, respectively. The positive predictive value for ≥250ng/ml was 88.7% (95% CI: 77.5, 95.0), and the negative predictive value was 86.7% (95% CI: 74.9, 93.7). PEth≥400ng/ml achieved similar values, and similar results were shown for AUDIT-C. In a subgroup analysis of critically ill patients only, test characteristics were similar to the mixed cohort. PEth is a strong predictor and has good discrimination for any and severe alcohol misuse in a mixed cohort that includes critically ill patients. Cut-points at 250ng/ml for any, and 400ng/ml for severe, are favorable. External validation will be required to establish these cut-points in critically ill patients.