Management Of Alcohol Problems Research Articles

Universal screening for alcohol misuse in acute medical admissions is feasible and identifies patients at high risk of liver disease

Many people who die from alcohol related liver disease (ARLD) have a history of recurrent admissions to hospital, representing potential missed opportunities for intervention. Universal screening for alcohol misuse has been advocated but it is not known if this is achievable or effective at detecting individuals at high risk of ARLD. We systematically screened all admissions to the Acute Medical Unit (AMU) of a large acute hospital using an electronic data capture system in real time. Patients at an increasing risk of alcohol harm were referred for either brief intervention (BI) or further assessment by an Alcohol Specialist Nursing Service (ASNS). Additional data were recorded on admission diagnoses, alcohol unit consumption, previous attendances, previous admissions, length of stay and mortality. Between July 2011 and March 2014, there were 53,165 admissions and 48,211 (90.68%) completed screening. Of these, 1,122 (2.3%) were classified as "increasing", and 1,921 (4.0%) as "high" risk of alcohol harm. High risk patients had more hospital admissions in the three previous years (average 4.74) than the low (3.00) and increasing (2.92) risk groups (p<0.001). The high risk patients also had more frequent emergency department (ED) attendances (7.68) than the lower (2.64) and increasing (3.81) groups (p<0.001 for both). A total of 1,396 (72.6%) of the high risk group were seen by the ASNS and 1,135 (81.2%) had an Alcohol Use Disorders Identification Test (AUDIT) score over 20 with 527 (37.8%) recording the maximum value of 40. Compared to the other groups, high risk patients had a distinct profile of admissions with the most common diagnoses being mental health disorders, gastro-intestinal bleeding, poisoning and liver disease. Universal screening of admissions for alcohol misuse is feasible and identifies a cohort with frequent ED attendances, recurrent admissions and an elevated risk of ARLD. An additional group of patients at an increasing risk of alcohol harm can be identified in a range of common presentations. These patients can be targeted with interventions to reduce the burden of alcohol related harm. Lay summary: Many people who die from alcohol related liver disease (ARLD) have a recent history of recurrent admissions to hospital. These admissions may represent missed opportunities to intervene earlier and offer effective therapies for alcohol misuse. Unfortunately, we know that patients are often missed because medical staff may not routinely ask about alcohol consumption. In our study of over 50,000 admissions, we have demonstrated the feasibility of offering screening for alcohol misuse to all medical admissions to hospital and delivered this 24hours a day, 7days a week, with automatic referral to treatment services. We have shown that it is possible to identify those people who are at the highest risk of dependency, those who have attended the emergency department the most and those who are at an increased risk of ARLD. We hope this study will lead to improved detection and management of alcohol problems in acute hospitals.

Can Doctors Be Divided Into Groups Based on Their Attitudes to Addressing Alcohol Issues in Their Patients? Analyses From a Survey of Portuguese General Practitioners

ABSTRACTBackground: The effectiveness of interventions to increase general practitioners' management of alcohol problems is affected by their attitudes toward at-risk drinkers. Tailoring training programs to general practitioners' attitudes may be useful in increasing alcohol screening and brief advice. Objectives: to determine whether general practitioners could be divided into distinct groups based on their attitudes toward at-risk drinkers. Another aim of this study was to develop and validate a model for classifying general practitioners into distinct groups. Methods: A total of 234 general practitioners answered the questionnaire. Physicians' attitudes toward patients with hazardous or harmful alcohol use were measured with the Short Alcohol and Alcohol Problems Perception Questionnaire. Cluster analysis was performed to identify distinct general practitioner groups based on their attitudes toward at-risk drinkers. Logistic regression analysis was used to develop a model for predicting group membership. Results: Cluster analysis identified two distinct groups of general practitioners, one with more positive attitudes (adequacy = 10.8 ± 1.6, legitimacy = 11.8 ± 1.7, motivation = 9.8 ± 1.7, satisfaction = 8.1 ± 1.9, and self-esteem = 9.7 ± 2.1), the other with more negative attitudes (adequacy = 8.9 ± 1.8, legitimacy = 11.0 ± 1.8, motivation = 7.8 ± 1.6, satisfaction = 5.7 ± 2.0, and self-esteem = 6.8 ± 1.7). The predictors in the final model were self-esteem, motivation, and adequacy. The model predicted general practitioner groups on the training set with 90.4% accuracy (area under receiver operating characteristic [ROC] curve = 0.96), and maintained its predictive performance when applied to the test set (accuracy 93.6%, area under ROC curve = 0.97). Conclusions: General practitioners could be divided into distinct groups based on their attitudes toward at-risk drinkers. These findings may prove useful in designing alcohol-specific training programs for general practitioners.

Managing Alcohol Problems in General Practice in Europe: Results from the European ODHIN Survey of General Practitioners.

Aims: To document the attitudes of general practitioners (GPs) from eight European countries to alcohol and alcohol problems and how these attitudes are associated with self-reported activity in managing patients with alcohol and alcohol problems. Methods: A total of 2345 GPs were surveyed. The questionnaire included questions on the GP's demographics, reported education and training on alcohol, attitudes towards managing alcohol problems and self-reported estimates of numbers of patients managed for alcohol and alcohol problems during the previous year. Results: The estimated mean number of patients managed for alcohol and alcohol problems during the previous year ranged from 5 to 21 across the eight countries. GPs who reported higher levels of education for alcohol problems and GPs who felt more secure in managing patients with such problems reported managing a higher number of patients. GPs who reported that doctors tended to have a disease model of alcohol problems and those who felt that drinking was a personal rather than a medical responsibility reported managing a lower number of patients. Conclusion: The extent of alcohol education and GPs' attitudes towards alcohol were associated with the reported number of patients managed. Thus, it is worth exploring the extent to which improved education, using pharmacotherapy in primary health care and a shift to personalized health care in which individual patients are facilitated to undertake their own assessment and management (individual responsibility) might increase the number of heavy drinkers who receive feedback on their drinking and support to reduce their drinking.

Stosunek lekarzy rodzinnych do interwencji związanych z używaniem alkoholu – polskie wyniki międzynarodowego projektu badawczego ODHIN

BackgroundBrief interventions for alcohol use are considered an effective method of reducing alcohol drinking and alcohol-attributable mortality. The aim of the study was to document the attitudes of Polish general practitioners (GPs) to alcohol and alcohol problems, and examine how these attitudes are associated with self-reported activity in managing patients for alcohol use and alcohol-related problems. MethodsA total of 276 GPs were surveyed. The questionnaire included items on the GP's reported education and training on alcohol, attitudes and self-confidence in managing alcohol problems and self-reported estimates of patient numbers managed for alcohol and alcohol problems during the previous year. In addition, potential barriers and facilitators for conducting brief interventions in GP setting were investigated. ResultsMore than half of GPs (55.3%) reported 6 or less patients managed for alcohol and alcohol problems during the previous year. GPs reporting higher levels of education for alcohol problems declared more emphasis on disease prevention, felt more secure in managing patients with alcohol problems and delivered a higher number of brief interventions. DiscussionQualifications and positive experiences rather than declarations about importance and preparation towards conducting brief interventions are associated with higher number of patients managed for drinking alcohol. ConclusionGeneral practitioners in Poland very rarely manage patients for alcohol use and alcohol-related problems. Complex interventions, with special emphasis on training on alcohol reduction strategies, are needed to improve this situation.

Managing alcohol problems in general practice in Europe: results from the European ODHIN survey of general practitioners.

To document the attitudes of general practitioners (GPs) from eight European countries to alcohol and alcohol problems and how these attitudes are associated with self-reported activity in managing patients with alcohol and alcohol problems. A total of 2345 GPs were surveyed. The questionnaire included questions on the GP's demographics, reported education and training on alcohol, attitudes towards managing alcohol problems and self-reported estimates of numbers of patients managed for alcohol and alcohol problems during the previous year. The estimated mean number of patients managed for alcohol and alcohol problems during the previous year ranged from 5 to 21 across the eight countries. GPs who reported higher levels of education for alcohol problems and GPs who felt more secure in managing patients with such problems reported managing a higher number of patients. GPs who reported that doctors tended to have a disease model of alcohol problems and those who felt that drinking was a personal rather than a medical responsibility reported managing a lower number of patients. The extent of alcohol education and GPs' attitudes towards alcohol were associated with the reported number of patients managed. Thus, it is worth exploring the extent to which improved education, using pharmacotherapy in primary health care and a shift to personalized health care in which individual patients are facilitated to undertake their own assessment and management (individual responsibility) might increase the number of heavy drinkers who receive feedback on their drinking and support to reduce their drinking.

GPs' role security and therapeutic commitment in managing alcohol problems: a randomised controlled trial of a tailored improvement programme.

BackgroundGeneral practitioners with more positive role security and therapeutic commitment towards patients with hazardous or harmful alcohol consumption are more involved and manage more alcohol-related problems than others. In this study we evaluated the effects of our tailored multi-faceted improvement implementation programme on GPs’ role security and therapeutic commitment and, in addition, which professional related factors influenced the impact of the implementation programme.MethodsIn a cluster randomised controlled trial, 124 GPs from 82 Dutch general practices were randomised to either the intervention or control group. The tailored, multi-faceted programme included combined physician, organisation, and patient directed alcohol-specific implementation strategies to increase role security and therapeutic commitment in GPs. The control group was mailed the national guideline and patients received feedback letters. Questionnaires were completed before and 12 months after start of the programme. We performed linear multilevel regression analysis to evaluate effects of the implementation programme.ResultsParticipating GPs were predominantly male (63%) and had received very low levels of alcohol related education before start of the study (0.4 h). The programme increased therapeutic commitment (p = 0.005; 95%-CI 0.13 – 0.73) but not role security (p = 0.58; 95%-CI −0.31 – 0.54). How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs’ reported proportion of patients asked about alcohol consumption at baseline, contributed to the effect of the programme on therapeutic commitment.ConclusionsA tailored, multi-faceted programme aimed at improving GP management of patients with hazardous and harmful alcohol consumption improved GPs’ therapeutic commitment towards patients with alcohol-related problems, but failed to improve GPs’ role security. How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs’ reported proportion of patients asked about alcohol consumption at baseline, both increased the impact of the programme on therapeutic commitment. It might be worthwhile to monitor proceeding of role security and therapeutic commitment throughout the year after the implementation programme, to see whether the programme is effective on short term but faded out on the longer term.Trial registrationClinicalTrials.gov Identifier: NCT00298220

Attitudes and managing alcohol problems in general practice in Europe: results from the European ODHIN study

Methods A total of 2435 general practitioners (GPs) from 9 European countries (Catalonia, Czech Republic, Italy, Netherlands, Poland, Portugal, Slovenia, Sweden and UK) were surveyed. The questionnaire included questions on demographic, education and training on alcohol, received by general practitioners, as well as their attitudes towards management of alcohol problems. In addition, the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ) was used.

Involvement of general practitioners in managing alcohol problems: a randomized controlled trial of a tailored improvement programme

To assess the effect of a tailored multi-faceted improvement programme on general practitioners' (GPs') behaviour towards prevention of hazardous and harmful alcohol consumption. The improvement programme consisted of activities aimed at the GP, organization and patient. Educational training sessions and visits by a facilitator were tailored to the GPs' needs and attitudes. Cluster randomized controlled trial. General practices in the Netherlands. Seventy-seven general practices; 119 GPs participated. Data from 6318 patients were available, of whom 765 (12.1%) were at risk. A total of 1502 patients' electronic medical records were reviewed. The primary outcome was the number of eligible patients who received screening and advice. Difficulties in recruiting GPs and in motivating GPs for participation in the tailored parts of the programme impeded optimal implementation of the programme. Although GPs in both groups became more involved after enrolment, this improvement waned during the trial. The quality improvement programme enhanced the initial improvement in behaviour and it tempered waning (intervention group), compared to our control condition, resulting in average improvement rates of 5% (screening) and 2% (advice-giving) at 12-month follow-up (not significant). A tailored, multi-faceted programme aimed at improving general practitioner management of alcohol consumption in their patients failed to show an effect and proved difficult to implement. There remains little evidence to support the use of such an intensive implementation programme to improve the management of harmful and hazardous alcohol consumption in primary care.

Alcohol-Related Brain Damage: Report from a Medical Council on Alcohol Symposium, June 2010

### Alcohol-Related Brain Damage: Challenges and Opportunities Colin Drummond National Addiction Centre, Institute of Psychiatry, King's College London, UK Alcohol is a toxic and dependence-producing substance that can damage most organs in the body, and is implicated in more than 60 different diseases (Oforei-Adjei et al. , 2007). Alcohol is now the third leading cause of ill health in Europe (Rehm et al. , 2009). In the UK, alcohol-related morbidity and mortality have been increasing over the last 30 years, and alcohol-related hospital admissions now exceed 1 million per annum in England (North West Public Health Observatory, 2011). The brain is particularly sensitive to the toxic effects of alcohol either directly, particularly in the foetus and young people, or in the context of malnutrition and thiamine deficiency leading to Wernicke–Korsakoff syndrome; or following repeated episodes of alcohol withdrawal. The precise mechanisms of alcohol-related brain damage (ARBD) remain to be fully understood and several papers in this series describe the limits of knowledge. However, enough is already known to make a significant impact on the prevalence of ARBD through relatively inexpensive preventive strategies. Yet, such preventive strategies are poorly implemented in the UK. Why is this the case? First, there has been a lack of training and clear guidance to clinicians on preventing and managing alcohol problems, including ARBD. This has resulted in low levels of identification and intervention of patients at risk of alcohol-related complications in medical and psychiatric care (Barnaby et al. , 2003; Cheeta et al. , 2008). The recently published suite of NICE guidance on alcohol-use disorders aims to improve detection, prevention and management (NICE, 2010a, b, 2011). However, effective implementation will require a significant investment in staff training to raise awareness, knowledge and skills. Secondly, there is the issue of stigma. Patients who misuse alcohol face stigma and opprobrium, …

Consulting with the alcohol industry

Drug and Alcohol ReviewVolume 27, Issue 5 p. 463-465 Free Access Consulting with the alcohol industry Peter Anderson, Corresponding Author Peter Anderson Regional Editor Europe Apartat de Correus 352, 17230, Palamos, Girona, SpainE-mail: [email protected]Search for more papers by this author Peter Anderson, Corresponding Author Peter Anderson Regional Editor Europe Apartat de Correus 352, 17230, Palamos, Girona, SpainE-mail: [email protected]Search for more papers by this author First published: 29 May 2009 https://doi.org/10.1080/09595230802263413Citations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 World Health Organisation (WHO). Documentation of the World Health Assembly. Geneva: WHO, 2008. Available at: http:www.who.intgbee_wha61.html (accessed June 2008). 2 Anderson P., Baumberg B. Alcohol in Europe: a public health perspective. 2006. Available at: http:ec.europa.euhealthph_determinantslife_stylealcoholdocumentsalcohol_europe.pdf (accessed June 2008). 3 European Commission. EC Treaty: Title XIII: Public health—Article 152. n.d. Available at: http:eur-lex.europa.euLexUriServLexUriServ.do ?uri=CELEX:12002E152:EN:HTML (accessed June 2008). 4 European Commission. Communication on alcohol. 2006. Available at: http:ec.europa.euhealthph_determinantslife_stylealcoholalcohol_com_en.htm (accessed June 2008). 5 European Commission. Charter establishing the European Alcohol and Health Forum. 2007. Available at: http:ec.europa.euhealthph_determinantslife_stylealcoholdocumentsAlcohol_charter2007.pdf (accessed June 2008). 6 European Commission. European Alcohol Health Forum. 2007. Overview of commitments received as of 29–02–2008. Available at: http:ec.europa.euhealthph_determinantslife_stylealcoholForumdocsoverview_commitments_en.pdf (accessed June 2008). 7 Jones L., James M., Jefferson T., et al. A review of the effectiveness and cost-effectiveness of interventions delivered in primary and secondary schools to prevent and/or reduce alcohol use by young people under 18 years old. Alcohol and schools: review of effectiveness and cost effectiveness. Main report (PHIAC 14.3a). 2007. http:guidance.nice.org.uk page.aspx?o=427775 (accessed June 2008). 8 Babor TF, Caetano R., Casswell S., et al. Alcohol: no ordinary commodity. Research and public policy. Oxford: Oxford Medical Publication, Oxford University Press, 2003. 9 Jones SC, Donovan RJ. Self-regulation of alcohol advertising: is it working for Australia J Public Affairs 2002; 3: 153– 65. 10 Jones SC, Hall D., Munro G. How effective is the revised regulatory code for alcohol advertising in Australia. Drug Alcohol Rev 2008; 27: 29– 38. 11 Ayres I., Brathwaite J. Responsive regulation: transcending the deregulation debate. Oxford: Oxford University Press, 1992. 12 Ker K., Chinnock P. Interventions in the alcohol server setting for preventing injuries. Cochrane Database Syst Rev 2006;issue 2:CD005244.pub2. DOI: 10.1002/14651858.CD005244.pub2. 13 Anderson P. Binge drinking and Europe. London: Institute of Alcohol Studies, 2007. Available at: http:www.dhs.demakeitcmscms_uploaddhsbinge_drinking_report.pdf (accessed June 2008). 14 Anderson P., Laurant M., Kaner E., Grol R., Wensing M. Engaging general practitioners in the management of alcohol problems: results of a meta-analysis. J Stud Alcohol 2004; 65: 191– 9. 15 Bekelman JE, Li Y., Gross CP. Scope and impact of financial conflicts of interest in biomedical research: a systematic review. JAMA 2003; 289: 454– 65. 16 Michaels D. Doubt is their product. Oxford: Oxford University Press, 2008. 17 De Bruijn A. No reason for optimism: the expected impact of commitments in the European Commission's Alcohol and Health Forum. Addiction, in press. 18 National Health and Medical Research Council. Australian guidelines for low risk drinking (draft), 2007. Available at: http:www.nhmrc.gov.auconsult_filesdraft_australian_alcohol_guidelines.pdf (accessed June 2008). 19 Nuffield Council on Bioethics. Public health: ethical issues. London, UK: Nuffield Council on Bioethics, 2007. Available at: http:www.nuffieldbioethics.orggoourworkpublichealthintroduction (accessed June 2008). 20 Chaloupka FJ, Grossman M., Saffer H. The effects of price on alcohol consumption and alcohol-related problems. Alcohol Res Health 2002; 26: 22– 34. Citing Literature Volume27, Issue5September 2008Pages 463-465 ReferencesRelatedInformation

Knowledge, attitudes and management of alcohol problems in general practice in rural South Africa

Background: There has been increasing emphasis on the role of primary health care in the prevention and management of alcoholrelated harm. The aim of this study was to determine attitudes to and management of alcohol problems in general practice in rural South Africa. Methods: A total of 61 general practitioners (GPs) were interviewed with the aid of a structured questionnaire (response rate 50%) in two rural districts. Results: The results indicate that 51% of the GPs felt that alcohol is an important issue in general practice. GPs were able to discriminate accurately between cases of problem drinking and alcohol dependence. GPs who reported high levels of alcoholrelated education and training were more prepared to counsel problem drinkers, expressed more therapeutic commitment in their role and reported more appropriate management of these patients than did GPs with lower levels of Continuing Medical Education (CME) experience. Alcohol problems are recognised as an important problem in general practice, and improved training could increase the identification and management of alcohol problems in primary care. GPs rated the most critical barriers to alcohol interventions as competency training, role endorsement, not being adequately reimbursed, health policy not supporting prevention and their own alcohol problem. Conclusion: Alcohol problems are recognised as an important problem in general practice, and improved training, adequate reimbursement and health policy support could increase the identification and management of alcohol problems in primary care. This article has been peer reviewed. Full text available at www.safpj.co.za

CE: Managing alcohol problems, Part 2

Part 1 of this two-part series examined the social, economic, and health effects of alcohol problems. Now that readers recognize how alcohol can affect clients' overall health and well-being, what's a case manager to do about it?

CE: Managing alcohol problems, Part 1

Alcohol is the most widely used and abused drug in the United States. Each year, 17 million adults experience a serious problem with alcohol, but only 3 million get help. Risky or problem drinking can jeopardize the health and safety of not only those who drink but also their families, coworkers, and communities. Because of their collaborative approach to helping clients achieve wellness and independence, case managers are in a prime position to identify and address clients' alcohol problems.

Initial Steps Taken by Nine Primary Care Practices to Implement Alcohol Screening Guidelines with Hypertensive Patients

Many medical conditions are caused or exacerbated by heavy drinking, necessitating alcohol screening and discussion in primary care practices. This is particularly true of hypertension, the most common primary diagnosis in the United States, which has been linked to the regular consumption of 3 or more standard alcoholic beverages a day. The Accelerating Alcohol Screening-Translating Research into Practice (AA-TRIP) project was designed to improve detection and management of alcohol problems in primary care patients with hypertension. Medical providers are being trained using the Practice Partner Research Network's-Translating Research into Practice (PPRNet-TRIP) quality improvement model. This includes a multi-method intervention (electronic medical records, on-site academic detailing, practice feedback reports and annual network meetings) to help practices increase adherence to clinical guidelines. Qualitative analyses of initial steps taken by nine primary care practices toward the routine implementation of alcohol screening guidelines are presented. Organizational factors and provider and patient characteristics all influenced the method and consistency of alcohol screening and intervention. Perceived time constraints, patient sensitivity to questions about alcohol, and possible stigma associated with a diagnosis of alcoholism were also relevant barriers requiring problem solving.

Family Medicine Residents’ Performance with Detected Versus Undetected Simulated Patients Posing as Problem Drinkers

:Background: Simulated patients are commonly used to evaluate medical trainees. Unannounced simulated patients provide an accurate measure of physician performance.Purpose: To determine the effects of detection of SPs on physician performance, and identify factors leading to detection.Methods: Fixty-six family medicine residents were each visited by two unannounced simulated patients presenting with alcohol-induced hypertension or insomnia. Residents were then surveyed on their detection of SPs.Results: SPs were detected on 45 out of 104 visits. Inner city clinics had higher detection rates than middle class clinics. Residents’ checklist and global rating scores were substantially higher on detected than undetected visits, for both between-subject and within-subject comparisons. The most common reasons for detection concerned SP demographics and behaviour; the SP “did not act like a drinker” and was of a different social class than the typical clinic patient.Conclusions: Multi-clinic studies involving residents experienced with SPs should ensure that the SP role and behavior conform to physician expectations and the demographics of the clinic. SP station testing does not accurately reflect physicians’ actual clinical behavior and should not be relied on as the primary method of evaluation. The study also suggests that physicians’ poor performance in identifying and managing alcohol problems is not entirely due to lack of skill, as they demonstrated greater clinical skills when they became aware that they were being evaluated. Physicians’ clinical priorities, sense of responsibility and other attitudinal determinants of their behavior should be addressed when training physicians on the management of alcohol problems.

General practitioners' diagnostic skills and referral practices in managing patients with drug and alcohol‐related health problems: implications for medical training and education programmes

The aim of this study was to determine the current practices of established general practitioners in managing patients with drug and alcohol-related problems and identify gaps in training. A random sample of general practitioners completed a survey assessing diagnostic skills and referral practices concerning alcohol and illicit drug use in general practices in February 1999, comprising 110 general practitioners registered with the Central Sydney Division of General Practice. The main outcome measures were competent skills and knowledge, willingness to treat. The majority (96%) of GPs provided clinically appropriate responses for at least one drug category, although none received this rating for all six. Most general practitioners reported that they were unwilling to treat heroin and cocaine problems themselves but expressed willingness to refer patients appropriately. More than a quarter of general practitioners were unaware of the safe drinking levels for men and women or the appropriate treatment for patients consuming above such levels. Age, years in practice, type of practice, willingness to obtain drug use histories and post-graduate training were all significantly associated with general practitioners' willingness to treat and competence in managing drug and alcohol-related problems. In this study, general practioners reported low levels of skills and referrals for treatment of illicit drug use and suboptimal skills in the management of alcohol problems. The results suggest that a more comprehensive approach to education and training is required to bring about a change in practice behaviour. [Fucito LM, Gomes BS, Murnion B, Haber PS. General practitioners' diagnostic skills and referral practices in managing patients with drug and alcohol-related health problems: implications for medical training and education programmes.

Randomized controlled trial on the effects of a skills‐based workshop on medical students’ management of problem drinking and alcohol dependence

The purpose of this study was to determine whether a skills‐based workshop will improve medical students' management of problem drinking and alcohol dependence in simulated patients. Seventy‐six 3rd and 4th year Ontario medical students were randomized to receive a 3‐h workshop on either problem drinking and alcohol dependence or depression (control condition). Students then completed eight simulated office visits (OSCE stations) with simulated patients presenting with depression, problem drinking or alcohol dependence. Examiners completed a checklist of the questions asked and advice given by the student, and simulated patients and examiners completed a global rating scale. Four months later, students were sent a survey on their knowledge, attitudes, and behavior towards patients with alcohol problems. The alcohol group received significantly higher assessment and management checklist scores and global rating scores than did the depression group (p < 0.01) and performed better on almost all aspects of clinical management of both problem drinking and alcohol dependence. On the follow‐up survey (n = 55) the alcohol group showed a significant increase in beliefs about self‐efficacy in managing alcohol problems (p < 0.05) and had greater knowledge of reduced drinking strategies, but the two groups did not differ on other measures. A skills‐based workshop causes marked short‐term improvements in medical students' management of problem drinking and alcohol dependence, an increase from baseline to postworkshop in self‐efficacy beliefs that was sustained through to follow‐up, and greater knowledge of reduced drinking strategies. Repeated reinforcement of clinical skills may be required for a long‐term impact on clinical behavior.

Factors Associated with Probation Officers' Use of Criminal Justice Coercion to Mandate Alcohol Treatment

Alcohol problems are widespread among individuals in county criminal justice probation systems. However, it is unclear why only a small fraction of these problem drinkers receive treatment. In this study, self‐administered questionnaires were mailed to 145 probation officers in nine California counties to identify factors that predicted probation officers' use of coercion to mandate alcohol treatment. The questionnaire measured characteristics of probation officers, characteristics of their caseloads, and perceptions about their departments. Principle components analysis combined some of the items into six factor‐based scales. Multiple regression analyses identified two significant predictors of use of coercion into treatment: a belief that treatment was effective and a belief that one's peers in the department were using coercion frequently. Implications for increasing treatment entry of probationers with drinking problems include educating probation officers about the effectiveness of substance abuse treatment in general and about coerced treatment in particular. Probation departments are encouraged to develop management styles that facilitate shared normative beliefs about assessing and managing alcohol problems among probationers.

Treating alcohol dependence in a district general hospital.

A strategy for managing alcohol problems within the general hospital setting should involve improved recognition of acute physical complications of alcohol withdrawal and dependence. Research shows that opportunistic interventions at this stage can reduce alcohol consumption by 25% in excessive drinkers. Support should be available from a local community alcohol service.

Alcohol education for general practitioners in the United Kingdom - a window of opportunity?

Alcohol misuse is a major public health problem. In the UK, general practitioners are perceived as key players in prevention and management of alcohol problems, but may not be prepared sufficiently to undertake this work. A systematic review of the literature by computerized search of the Medline database, hand search of review article citations and a survey of relevant educational and training organizations and agencies were undertaken. Although there is no shortage of educational materials, there has been little evaluation of their effectiveness. A need for more training and support has been identified, but this requires better co-ordination and a more multidisciplinary approach. Forthcoming changes in the National Health Service and the organization of continuing professional development offer a unique opportunity to advance this agenda.