Implications For Brief Interventions Research Articles

Order of Cannabis and Alcohol Use on Pregaming and Non-Pregaming Days among College Students.

Pregaming is common among college students and is associated with heavy drinking and negative alcohol-related consequences. The use of cannabis on pregaming days may exacerbate negative alcohol-related consequences, and the ordering of when cannabis is used on these days may buffer against or intensify these consequences. Considering the growing rates of simultaneous use of cannabis and alcohol among college students, it is necessary to examine the role of pregaming behaviors in the context of cannabis use and resulting effects on alcohol-related consequences. In the present study, college students (N=485) completed a baseline survey and 14 days of daily surveys, reporting on daily alcohol and cannabis use and alcohol-related negative consequences. Multilevel Structural Equation Models were fit to evaluate cannabis outcomes on pregaming versus non-pregaming drinking days and ordering effects on alcohol-related consequences controlling for number of drinks, age, and sex. Across all drinking days, pregaming on that day as well as cannabis use during drinking on that day were associated with greater risk for alcohol-related consequences. On days that did not involve pregaming, use of cannabis before drinking was associated with greater risk for negative alcohol-related consequences, while cannabis use after drinking was associated with less risk for consequences. These effects were observed on non-pregaming days only and not on days with pregaming. Findings have implications for brief interventions with students, as analyses suggested that both cannabis use and pregaming, independent of number of drinks consumed, are risky behaviors associated with alcohol-related consequences.

The impact of a brief structured intervention on young offenders masculine identity: a mixed methods study

PurposeMasculinity in young men can be considered a dynamic risk factor. However, there is a lack of interventions designed to support men and young men to explore the ways in which the concept of masculinity contributes to shaping their individual identity. The purpose of this paper is to explore young offenders’ perceptions of a programme designed to address masculinity and criminogenic attitudes and evaluate whether the programme contributed to any personal change/development and what core learning they took from the course.Design/methodology/approachThe research utilised a mixed-methods approach to address aims and objectives.FindingsThe quantitative results found that there was a pre-/post-course reduction in toughness and increase in self-esteem and risk-taking perceptions. The qualitative results identified four superordinate themes reconstruing masculine self-realisation awareness and reflection group dynamics and course relationships and unintended consequences. The course-assisted participants in helping to reconstrue aspects of being a man made them think about the future and allowed for participants to consider their possible and desired selves.Research limitations/implicationsThe research has policy and practice implications for brief interventions targeted at young offenders.Originality/valueThe research evaluates a novel intervention aimed at addressing young offenders masculine beliefs and identities. The research has implications for working with this client group.

Factors influencing patients' recovery and the efficacy of a psychosocial post-discharge intervention: post hoc analysis of a randomized controlled trial.

The aim of this post hoc analysis was to examine self-reported recovery following a post-discharge intervention and to focus on the moderators of this intervention programme. RCT using parallel group block randomisation, including 151 patients with≤3 hospitalisations within the last 3years, a GAF score≤60, and aged 18-64years, assessed at two psychiatric hospitals from Zurich, Switzerland, between September 2011 and February 2014. In the present study, the main outcome was the OQ-45 as assessed prior to discharge from the index hospitalisation and at 12-month follow-up. Participants received either the post-discharge intervention provided by a social worker or treatment as usual (TAU). Patients in the intervention group showed substantially less recovery over the 12-month observation period than controls (d=0.44). In the TAU group, 15.6% remained clinically impaired at 12-month follow-up as opposed to 48.1% in the intervention group (p=0.001). Among participants in the intervention group, an interdisciplinary meeting of significant network members was associated with less recovery (d=0.46). Involuntary index admission (d=0.42) and high educational degree (d=0.52) were significant moderators of the intervention. Both factors related to less recovery over time in the intervention group relative to TAU. According to the OQ-45, this psychosocial post-discharge intervention revealed an unintended negative effect on self-reported recovery over time. Specifically, the meeting of significant network members related to a moderate deteriorating effect, suggesting that the involvement of some carers, relatives, or friends may cause harm to the patient. Considering with reservation pending replication, these findings could have important implications for brief interventions targeted at patients' social networks. This study was supported by a private foundation. ISRCTN58280620.

Exploring older adults’ views about alcohol consumption: implications for brief interventions with older heavy drinkers

Increasing alcohol consumption among older individuals in the UK is a public health concern. Although brief interventions (BIs) can effectively reduce heavy drinking in older age groups generally, social and contextual factors may influence implementation and effectiveness. Identities offer a useful theoretical concept to explain why the potential for public health messages to reduce rates of heavy drinking in this sector has not been realised, and can inform preventive approaches. A qualitative study explored older people’s reasoning about drinking in later life and how this interacted with health concerns, to inform future, targeted prevention in this group. A diverse sample of older adults in North East England (ages 51-90) participated in interviews (n=24, 12m, 12f) and three focus groups (participants n=27). Data were analysed using grounded theory and discursive psychology methods. Older adults portrayed drinking less alcohol as an appropriate response if one experienced impaired health. However continued heavy drinking could be presented as normal behaviour for someone experiencing relative wellbeing in later life, or if ill health was construed as unrelated to alcohol consumption. When talking about alcohol use older people oriented strongly towards opposed identities of normal or problematic drinker, defined by propriety rather than health considerations. These identities were flexible in older people’s talk since they could be applied to either moderate or heavy drinking. Older people displayed scepticism about health advice on alcohol when avoiding stigmatised identity as a drinker. Findings indicate that older UK adults do not recognise unhealthy drinking as distinct from dependent drinking, and are highly sensitive to stigma when discussing alcohol consumption. Preventive strategies should encourage older people’s identification of heavy drinking as neither healthy nor synonymous with dependence. BIs for heavy drinkers in later life should be tailored to address lay reasoning that is resistant to recognition of health risks.

Gender differences in alcohol misuse and estimated blood alcohol levels among emergency department patients: implications for brief interventions

To ultimately create more effective brief interventions (BIs), we compared the extent of alcohol misuse severity and estimated blood alcohol levels (BALs) between male and female emergency department (ED) patients. We surveyed a random sample of nonintoxicated subcritically ill or injured 18-64 year-old English- or Spanish-speaking patients on randomly selected dates and times at two EDs in July-August 2009. Participants self-administered the Alcohol Use Disorders Identification Test (AUDIT) and a questionnaire about their alcohol use in the past 30 days. Using the formulae by Mathews and Miller, gender-specific BALs were estimated for participants according to their weight and the number of alcoholic drinks consumed on days when typically drinking and on days of heavy episodic drinking (≥5 drinks per occasion for men, ≥ 4d rinks per occasion for women). Gender-specific alcohol misuse severity levels (harmful, hazardous, or dependent) were calculated using AUDIT scores. Wilcoxon rank-sum and Pearson’s chi-squared tests were used to compare outcomes by gender. Of the 513 participants, 52% were women. Mean AUDIT scores were greater for men than women (7.5 versus 5.3; p < 0.001), although alcohol misuse severity levels were similar between men and women (24.4% versus 26.6% for hazardous drinking, 2.8% versus 2.2% for harmful drinking, and 6.5% versus 3.4% for dependence, respectively; p < 0.38). Men reported greater mean alcohol consumption than women when typically drinking (4.3 versus 3.3 drinks per day; p < 0.001) and during heavy episodic drinking (8.6 versus 5.3 drinks per occasion; p < 0.001). However, the mean BALs for men and women were similar when typically drinking (0.05 and 0.06, respectively; p < 0.13) and during heavy episodic drinking (0.13 and 0.12, respectively; p < 0.13). For future ED brief interventions, women may benefit from realizing that, despite drinking less alcohol on average than their male peers, they are reaching similar BALs with comparable levels of alcohol misuse.

Sex differences in alcohol misuse and estimated blood alcohol concentrations among emergency department patients: implications for brief interventions.

The objective was to assess the relationship between alcohol use and misuse and patient sex among emergency department (ED) patients by comparing self-reported estimates of quantity and frequency of alcohol use, estimated blood alcohol concentrations (eBACs) when typically drinking and during heavy episodic drinking (binging), and alcohol misuse severity, to understand sex differences in alcohol use and misuse for this population. The authors surveyed a random sample of nonintoxicated, subcritically ill or injured, 18- to 64-year-old English- or Spanish-speaking patients on randomly selected dates and times at two EDs during July 2009 and August 2009. Participants self-administered a questionnaire about their self-reported alcohol use during a typical month within the past 12 months and the Alcohol Use Disorders Identification Test (AUDIT). Using the formulae by Matthews and Miller, sex-specific eBACs were calculated for participants according to their reported weight and the number of reported alcoholic drinks consumed on days when typically drinking and on days of heavy episodic (binge) drinking (five or more drinks/occasion for men, four or more drinks for women). Sex-specific alcohol misuse severity levels (low-risk, harmful, hazardous, and dependence) were calculated using AUDIT scores. Wilcoxon rank-sum and Pearson's chi-square tests were used to compare outcomes by sex. Negative binomial regression was used to assess the relationship between sex and the number of drinks consumed on a typical day, the number of days spent drinking and binging, and estimated AUDIT scores. Logistic regression was used to assess the outcome of the presence of binging according to sex. Multinomial logistic regression was used to compare by sex the percentage of days spent drinking and binging in 1 month, eBACs when typically drinking and when binging, and AUDIT at-risk drinking levels. Incidence rate ratios (IRRs) and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. All models were adjusted for patient demographic characteristics. Of the 513 participants, 52.1% were women, 55.8% were white non-Hispanic, and their median age was 34 years (interquartile range [IQR] = 25 to 46 years). Men reported greater mean alcohol consumption than women when typically drinking (4.3 vs. 3.3 drinks/day; p < 0.001) and during heavy episodic drinking (8.6 vs. 5.3 drinks/occasion; p < 0.001). Men spent more days drinking (IRR = 1.41, 95% CI = 1.19 to 1.65) and engaging in heavy episodic drinking (IRR = 1.68, 95% CI = 1.31 to 2.17) than women. Additionally, men were more likely to engage in heavy episodic drinking (AOR = 1.72, 95% CI = 1.16 to 2.56) than women. However, the mean eBACs for men and women were similar when typically drinking (0.05 vs. 0.06; p < 0.13) and during heavy episodic drinking (0.13 vs. 0.12; p < 0.13). Mean AUDIT scores were greater for men than women (7.5 vs. 5.3; p < 0.001), although alcohol misuse severity levels were similar between men and women (24.4% vs. 26.6% for hazardous, 2.8% vs. 2.2% for harmful, and 6.5% vs. 3.4% for dependence; p < 0.38). Although men drink more than women, women have similar eBACs with comparable levels of alcohol misuse. Women may benefit from recognizing that they are reaching similar levels of intoxication compared to men. Addressing these differences and possible health implications in future ED brief interventions may induce changes in problematic alcohol use among women.

Changes in drinking behavior among control group participants in early intervention studies targeting unhealthy alcohol use recruited in general hospitals and general practices

BackgroundThis study aims to analyze the influence of setting variables on drinking behavior in patients with unhealthy alcohol consumption recruited proactively in general medical practices (GP) and internal and surgical wards of two general hospitals (GH) assigned to control groups. MethodThis analysis compared two control groups of RCTs targeting unhealthy alcohol consumption: one outpatient sample (GP; n=99) with one inpatient sample (GH; n=173). Both groups were recruited via systematic screening of all patients aged between 18 and 64 years and were included in the studies if drank above the at-risk criteria of the British Medical Association (20/30g alcohol/daily) and/or fulfilled criteria of alcohol abuse or – dependence according to DSM-IV. Both samples received a non-alcohol specific brochure on healthy living after study inclusion and were re-assessed 12 months later. ResultsGH patients were significantly older, included of more males, had received less schooling and had a higher readiness to change at baseline than GP patients. Groups did not differ concerning alcohol-related diagnoses or smoking status. At the 12-month follow-up, significantly more GH patients revealed abstinence or drinking below the inclusion criteria (50.0% vs. 26.1%, p<.001). In a multivariate analysis, medical setting (GH vs. GP) remained a significant predictor for non-problematic drinking or abstinence even after controlling for baseline differences between groups. ConclusionsFindings suggest that untreated change from problematic alcohol use may be more intense after non-alcohol-related inpatient treatment than after having been a GP patient. Implications for brief interventions in inpatients are discussed.

Dose–response expectancies for alcohol: Validation and implications for brief interventions

Brief interventions for alcohol problems are informed by elements of behavioural motivation theories and behaviour change models. However, motivations across drinking occasions have yet to be explored. This paper addresses this need and presents initial validity statistics for a new construct, Dose Response Expectancies for Alcohol Metrics (DREAM) that can be used to investigate expectancies across the drinking session and thus inform novel interventions. Twenty-seven participants completed a test-retest reliability assessment. Hypothesised systematic relationships between the hypothetical number of drinks consumed across a drinking session and anticipated affective responses were assessed. The DREAM questionnaire yielded good test-retest statistics for anticipated happiness and nausea in the hours following drinking. Consistent with hypotheses, DREAM yielded a systematic relationship between anticipated alcohol dose and affective response. DREAM offers a novel means to investigate alcohol dose-response expectancies across drinking sessions and to therefore provide a theoretical platform that can be used to inform effective brief interventions for young people.[Adey GE, Moore SC, Chestnutt IG. Dose-response expectancies for alcohol: Validation and implications for brief interventions.

Development and Preliminary Validation of a Comprehensive Marijuana Motives Questionnaire

Relatively little research has evaluated motives for using marijuana based on users' self-reported reasons. This article details the construction and psychometric validation of a new marijuana motives questionnaire. Participants included 346 marijuana-using college students who completed online assessments regarding their motives for, frequency of, and problems associated with their marijuana use. Exploratory and confirmatory factor analysis supported a 12-factor scale, including the following: (1) Enjoyment, (2) Conformity, (3) Coping, (4) Experimentation, (5) Boredom, (6) Alcohol, (7) Celebration, (8) Altered Perception, (9) Social Anxiety, (10) Relative Low Risk, (11) Sleep/Rest, and (12) Availability. Regression results indicated enjoyment, boredom, altered perception, relative low-risk, and sleep/rest were each uniquely associated with greater frequency of use. Experimentation and availability motives were associated with less use. After accounting for use, coping and sleep/rest were associated with significantly more consequences whereas enjoyment was associated with fewer consequences. Additional results comparing the scale to an existing marijuana motives measure indicated comparatively good convergent validity. Emerging adult college students may have several different reasons for using marijuana, which are uniquely related to use and negative consequences. Results are considered in terms of their implications for brief interventions.

Social Motives and the Interaction Between Descriptive and Injunctive Norms in College Student Drinking

Social norms are a key determinant of young adult drinking, yet little research has evaluated potential interactive effects among different types of norms. The present research was designed to evaluate perceptions of friends' approval of drinking (i.e., injunctive norms) as a moderator of the relationship between perceived prevalence of friends' drinking (i.e., descriptive norms) and personal alcohol consumption. We also evaluated whether social drinking motives further influence this relationship. Participants included 1,400 first-year college students (61% women) who completed Web-based assessments of descriptive and injunctive norms, personal drinking, and social drinking motives. Results revealed that both descriptive and injunctive norms regarding close friends were uniquely and positively associated with drinking behavior. The relationship between perceived descriptive norms and personal alcohol consumption was stronger among those who also perceived their friends as being more approving of drinking but only among students who reported stronger social motives for drinking. Descriptive and injunctive norms are distinct constructs and are not interchangeable, having both unique and interactive effects, and vary as a function of social motives. Results are considered in terms of their implications for brief interventions.

Treating addictive behaviors in the employee assistance program: Implications for brief interventions

Employee assistance programs (EAPs) are widely available to assist employees with a variety of problems. This research examined factors related to utilization and outcome by individuals with addictive behaviors (ABs) versus other problem areas. The specific aims of this study were to evaluate referral source and treatment outcome by gender and presenting problem. The sample included 3890 men and women who attended the EAP for a variety of concerns. Men were less likely than women to self-refer and more likely to be mandated to the EAP. Men were also much more likely to present with ABs. Relative to clients presenting with other issues, individuals with ABs were less likely to self-refer, have their problems resolved in the EAP, and were seen for fewer sessions. These results suggest that EAPs may be well suited for implementation of brief interventions (BIs) that have been empirically supported in other contexts.

Predictors of motivation to change after medical treatment for drinking-related events in adolescents.

Characteristics associated with intention to change drinking were examined in 254 adolescents treated in an emergency department for alcohol. Younger age, living at home, lower baseline level of drinking and drinking problems, greater depression, having penalties for breaking family drinking rules, higher injury severity, being frightened, and being admitted to the hospital predicted greater intention to change drinking at the time of the event. Baseline characteristics related to being in the action stage of change 3 months later were younger age; lower drinking; having penalties for breaking family drinking rules; injury severity; and number of anticipated consequences, including being in trouble with parents. This study has implications for brief interventions that capitalize on potential teachable moments with problem-drinking adolescents.

Factors influencing remission from alcohol dependence without formal help in a representative population sample.

To analyse factors related to remission without formal help by using a representative sample and standardized instruments. Two groups of untreated alcohol-dependent subjects were compared. General population survey. Thirty-two subjects fully remitted without formal help (NFH) and 26 current alcohol-dependent individuals (CAD) according to DSM-IV drawn from a representative general population sample in northern Germany (response rate: 70.2%, n = 4075). Data focusing on the 2 years prior to remission from NFH were compared with past-year data from CAD. Groups were compared on variables found to be associated with remission without formal help in previous research. Logistic regression analysis revealed that individuals remitted from alcohol-dependence without formal help reported a higher non-physiological severity of alcohol dependence, less social pressure to quit drinking and more incidents of driving while intoxicated. Furthermore, they tended to report more satisfaction with work and financial situation and were more likely to live in a stable partnership. Findings support the concept of psychosocial resources as important enabling factors in remission from alcohol dependence without formal help. Implications for brief interventions are discussed.