Screening For Alcohol Problems Research Articles

Screening for Substance Use Disorder Among Incarcerated Men with the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST): A Comparative Analysis of Computer-Administered and Interviewer-Administered Modalities

Substance use disorders are overrepresented in incarcerated male populations. Cost-effective screening for alcohol and substance use problems among incarcerated populations is a necessary first step forward intervention. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) holds promise because it has strong psychometric properties, requires minimal training, is easy to score, is available in the public domain but, because of complicated skip patterns, cannot be self-administered. This study tests the feasibility, reliability, and validity of using computer-administered self-interviewing (CASI) versus interviewer-administered interviewing (IAI) to screen for substance use problems among incarcerated men using the ASSIST. A 2×2 factorial design was used to randomly assign 396 incarcerated men to screening modality. Findings indicate that computer screening was feasible. Compared to IAI, CASI produced equally reliable screening information on substance use and symptom severity, with test–retest intraclass correlations for ASSIST total and substance-specific scores ranging from 0.7 to 0.9, and ASSIST substance-specific scores and a substance abuse disorder diagnosis based on the Structured Clinical Interview (SCID) were significantly correlated for IAI and CASI. These findings indicate that data on substance use and symptom severity using the ASSIST can be reliably and validly obtained from CASI technology, increasing the efficiency by which incarcerated populations can be screened for substance use problems and, those at risk, identified for treatment.

Alcohol Consumption for People Admitted in French Emergency Departments: A Protocol for a Multi-Center Cluster Trial

Background: According to a 2014 report by the World Health Organization, the highest alcohol consumption levels per capita continue to be found in the developed world, particularly in the European region. Drinking alcohol does not only lead to alcohol dependence; it also be linked to a higher risk for acute medical and surgical events. In France, recent data show that alcohol consumption levels in the general population are important and have remained relatively stable since 2010. In the Emergency Department population, few French data are available, while studies conducted across the Atlantic show that patients admitted into emergency rooms are reported to have high levels of alcohol consumption. Emergency Departments are an important location for the identification and early intervention of issues related to alcohol consumption. Therefore, the aim of this study is to carry out an epidemiological picture of alcohol consumption and search for indicators of harmful alcohol use in patients in the French emergency rooms of the Rhone-Alpes-Auvergne interregion. Methods and Analysis: This observational, and descriptive and randomized clinical study on human beings will consists of a collection of clinical variables on all patients that will be admitted to the Emergency Departments of the RAA Rhone-Alpes-Auvergne interregion aged of (16 years or older) and who will be agree to participate to the study. It will include one visit where the patient will respond to three auto-administrating screening tests on his or her alcohol consumption: Alcohol Use Disorders Identification Test – C (AUDIT C), Cut-down, Annoyed, Guilty, Eye-opener test (CAGE) and the Rapid Alcohol Problems Screen – Quantity Frequency test (RAPS4 – QF). Similarly, they will answer two self-administering questionnaires on socio-demographic and emergency data.

Dépistage des facteurs de risques psychiatriques dans une population de traumatisés faciaux. Validation d’un questionnaire

We recorded similarities between patients managed in the psychiatry department and in the maxillo-facial surgical unit. Our hypothesis was that some psychiatric conditions act as risk factors for facial trauma. We had for aim to test our hypothesis and to validate a simple and efficient questionnaire to identify these psychiatric disorders. Fifty-eight consenting patients with facial trauma, recruited prospectively in the 3 maxillo-facial surgery departments of the Marseille area during 3 months (December 2012-March 2013) completed a self-questionnaire based on the French version of 3 validated screening tests (Self Reported Psychopathy test, Rapid Alcohol Problem Screening test quantity-frequency, and Personal Health Questionnaire). This preliminary study confirmed that psychiatric conditions detected by our questionnaire, namely alcohol abuse and dependence, substance abuse, and depression, were risk factors for facial trauma. Maxillo-facial surgeons are often unaware of psychiatric disorders that may be the cause of facial trauma. The self-screening test we propose allows documenting the psychiatric history of patients and implementing earlier psychiatric care.

Screening and Intervention for Comorbid Substance Disorders, PTSD, Depression, and Suicide: A Trauma Center Survey.

Few investigations have examined screening and intervention procedures for comorbid substance use and mental disorders at trauma centers in the United States, although these disorders are endemic among survivors of traumatic injury. In 2006, the American College of Surgeons (ACS) mandated that level I and level II trauma centers screen for alcohol use problems and that level I centers provide brief intervention for those who screen positive. The ACS is expected to recommend best practice policy guidelines for screening for drug use problems and posttraumatic stress disorder (PTSD). This study examined screening and intervention procedures for the full spectrum of comorbid mental and substance use disorders at U.S. trauma centers. Respondents at all level I and level II trauma centers (N=518) in the United States were asked to complete a survey describing screening and intervention procedures for alcohol and drug use problems, suicidality, depression, and PTSD. There were 391 (75%) respondents. Over 80% of trauma centers routinely screened for alcohol and drug use problems. Routine screening and intervention for suicidality, depression, and PTSD were markedly less common; in fact, only 7% of centers reported routine screening for PTSD. Consistent with ACS policy, level I centers were significantly more likely than level II centers to provide alcohol intervention. Alcohol screening and intervention occurred frequently at U.S. trauma centers and appeared to be responsive to ACS mandates. In the future, efforts to orchestrate clinical investigation and policy could enhance screening and intervention procedures for highly prevalent, comorbid mental disorders.

Accuracy of one or two simple questions to identify alcohol-use disorder in primary care: a meta-analysis.

There is much interest in ultra-short alcohol screening in primary care that may support brief alcohol interventions. Brief screening consisting of one or two questions might be used alone or in combination with longer tests as recommended by the Primary Care Service Framework. To investigate whether a simple one and two question screening might prove an accurate and acceptable screening method in primary care. A systematic literature search, critical appraisal and meta-analysis were conducted. A comprehensive search identified 61 analyses of single questions to detect alcohol problems including 17 that took place in primary care, using a robust interview standard. Despite focusing alcohol-use disorder in primary care settings, heterogeneity remained high, therefore random effects and bivariate meta-analyses were used. After adjustments, diagnostic accuracy of a single-question approach was given by a sensitivity of 54.5% (95% CI = 43.0% to 65.5%) and a specificity of 87.3% (95% CI = 81.5% to 91.5%) using meta-analytic weighting. Two questions had a sensitivity of 87.2% (95% CI = 69.9% to 97.7%) and specificity of 79.8% (95% CI = 75.7% to 83.6%). Looking at each question individually, the most successful single question was a modification of the Single Alcohol Screening Question (SASQ) namely, 'How often do you have six or more drinks on one occasion?'. The optimal approach appears to be two questions followed by the CAGE questionnaire, which achieved an overall accuracy of 90.9% and required only 3.3 questions per attendee. Two brief questions can be used as an initial screen for alcohol problems but only when combined with a second-step screen. A brief alcohol intervention should be considered in those individuals who answer positively on both steps.

Brief screening for alcohol and drug problems among prisoners

s / Drug and Alcohol Dependence 140 (2014) e169–e251 e239 therefore be an appropriate and potentially effective cognitive rehabilitation tool in this population. Financial support: NIDA, NIMH. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.660 Abuse potential assessment of novel opioid analgesic NKTR-181: Implications for labeling and scheduling Lynn R. Webster1, S. Smith2, J. Silowsky2, K. Gogas2, A. Odinecs2, M. Eldon2, N. Abrouk2, R. Medve2, J. Henningfield3, A. Buchhalter3, E. Cone3, R. Fant3, S. Schnoll3 1 CRI Lifetree, Salt Lake City, UT, United States 2 Nektar, San Francisco, CA, United States 3 PinneyAssociates, Bethesda, MD, United States Aims: Discuss challenges to opioid development when early data suggest the possibility of less restrictive scheduling than CII. Thiswill be illustratedby initial findings forNKTR-181.NKTR-181 is a newmolecule intended to provide analgesic efficacy of prototypic mu-opioids but with reduced respiratory depression, sedation and abuse potential. Mu-opioid activity of NKTR-181 is retained in a morphinan core to which polymers are covalently bound resulting in slower and lower brain penetration upon oral or parenteral administration to animals than prototypic opioids. Morphinans are placed inSchedule II duringdevelopmentandcanonlybe rescheduled if the abuse potential assessment by FDA (during review of the New Drug Application) warrants less restrictive scheduling. This regulatorychallenge isnotunique toNKTR-181butdata concerning NKTR-181 will be included to support the commentary. Although oralNKTR-181 is readily absorbed, time course of pupil constriction lags drug plasma appearance 2–3h, consistent with a reduced rate of CNS uptake. These effects are maintained after repeat administration with no evidence of tolerance. Nonclinical studies suggest mu-opioid CNS effects are of substantially lower potency for NKTR181 compared to other opioids with mixed findings across models, e.g., NKTR-181 produced dose-related generalization similar to prototypic opioids at doses many times analgesic doses but with significantly reduced reinforcing effects. Opioid-like side-effects linked with abuse potential (e.g., “dreamy”, “sleepy”, “high”) were not reported in healthy volunteers at expected therapeutic doses with central effects no different than placebo. Conclusions: A preliminary 8-factor analysis of NKTR-181 suggests lower abuse potential than prototypic Schedule II opioids. How FDA addresses this challenge to drug development and scheduling will have implications for other drugs in development. Financial support: Nektar. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.661 Brief screening for alcohol and drug problems among prisoners Matthew Webster, Carl Leukefeld, Michele Staton-Tindall, Jamieson L. Duvall, Carrie B. Oser, Jennifer R. Havens Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States Aims: Although drug and alcohol abuse rates are high among prisoners, these problems often go undetected, which represent lost treatment opportunities. Brief, no-cost screening instruments can be used to efficiently identify individuals who could be further assessed and who may benefit from treatment. The purpose of this study is to examine the feasibility of using the Alcohol Use Disorders Identification Test (AUDIT) as a brief screener for alcohol use among prisoners and whether it can identify other drug problems. Methods: The AUDIT and the NIDA-modified Alcohol, Smoking, Substance Involvement Screening Test (NM-ASSIST) were administered to 382 prisoners in four Kentucky state prisons who were approaching release and consented to participate in NIDA Criminal Justice Drug Abuse Treatment Studies (CJDATS 2) cooperative agreement protocols. Participants were divided into two groups based on whether they screened positive (n=189) or negative (n=193) on the AUDIT. NM-ASSIST Substance Involvement (SI) scores were calculated for each of the nine drugs measured by the NM-ASSIST and compared between AUDIT groups. Results: No significant differences in age, race, or rurality for AUDIT groups were found, but the AUDIT positive group had a significantly higher percentage of males (73.0% vs. 61.5%). ANCOVAs, controlling for gender, found significantly higher SI scores (p< .05) for the AUDIT positive group for cannabis (15.0 vs. 10.3), cocaine (15.3 vs. 8.0), prescription stimulants (5.0 vs. 1.9), inhalants (0.6 vs. 0.2), sedatives (10.7 vs. 5.7), hallucinogens (1.1 vs. 0.5), and prescription opiates (15.6 vs. 11.1). No differences were found for SI scores for methamphetamine or street opioids. Conclusions: Findings suggest that prisoners who screen positive on the AUDIT have higher drug risk than those who screen negative, which suggests that the AUDIT may be an indirect screening for other substance problems. The majority of SI scores fell in the moderate risk range (4–26), suggesting that prisoners have drug risk for multiple drugs. Financial support: CJDATS 2 is funded by NIDA in collaboration with SAMSHA and DOJ. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.662 Association of the A335G polymorphism with striatal dopamine D2/3 receptor availability in healthy men and women Elise Weerts, M. McCaul, H. Kuwabara, M. Stephens, X. Xu, D. Wong, G.S. Wand Johns Hopkins University, Baltimore, MD, United

Abuse potential assessment of novel opioid analgesic NKTR-181: Implications for labeling and scheduling

s / Drug and Alcohol Dependence 140 (2014) e169–e251 e239 therefore be an appropriate and potentially effective cognitive rehabilitation tool in this population. Financial support: NIDA, NIMH. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.660 Abuse potential assessment of novel opioid analgesic NKTR-181: Implications for labeling and scheduling Lynn R. Webster1, S. Smith2, J. Silowsky2, K. Gogas2, A. Odinecs2, M. Eldon2, N. Abrouk2, R. Medve2, J. Henningfield3, A. Buchhalter3, E. Cone3, R. Fant3, S. Schnoll3 1 CRI Lifetree, Salt Lake City, UT, United States 2 Nektar, San Francisco, CA, United States 3 PinneyAssociates, Bethesda, MD, United States Aims: Discuss challenges to opioid development when early data suggest the possibility of less restrictive scheduling than CII. Thiswill be illustratedby initial findings forNKTR-181.NKTR-181 is a newmolecule intended to provide analgesic efficacy of prototypic mu-opioids but with reduced respiratory depression, sedation and abuse potential. Mu-opioid activity of NKTR-181 is retained in a morphinan core to which polymers are covalently bound resulting in slower and lower brain penetration upon oral or parenteral administration to animals than prototypic opioids. Morphinans are placed inSchedule II duringdevelopmentandcanonlybe rescheduled if the abuse potential assessment by FDA (during review of the New Drug Application) warrants less restrictive scheduling. This regulatorychallenge isnotunique toNKTR-181butdata concerning NKTR-181 will be included to support the commentary. Although oralNKTR-181 is readily absorbed, time course of pupil constriction lags drug plasma appearance 2–3h, consistent with a reduced rate of CNS uptake. These effects are maintained after repeat administration with no evidence of tolerance. Nonclinical studies suggest mu-opioid CNS effects are of substantially lower potency for NKTR181 compared to other opioids with mixed findings across models, e.g., NKTR-181 produced dose-related generalization similar to prototypic opioids at doses many times analgesic doses but with significantly reduced reinforcing effects. Opioid-like side-effects linked with abuse potential (e.g., “dreamy”, “sleepy”, “high”) were not reported in healthy volunteers at expected therapeutic doses with central effects no different than placebo. Conclusions: A preliminary 8-factor analysis of NKTR-181 suggests lower abuse potential than prototypic Schedule II opioids. How FDA addresses this challenge to drug development and scheduling will have implications for other drugs in development. Financial support: Nektar. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.661 Brief screening for alcohol and drug problems among prisoners Matthew Webster, Carl Leukefeld, Michele Staton-Tindall, Jamieson L. Duvall, Carrie B. Oser, Jennifer R. Havens Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States Aims: Although drug and alcohol abuse rates are high among prisoners, these problems often go undetected, which represent lost treatment opportunities. Brief, no-cost screening instruments can be used to efficiently identify individuals who could be further assessed and who may benefit from treatment. The purpose of this study is to examine the feasibility of using the Alcohol Use Disorders Identification Test (AUDIT) as a brief screener for alcohol use among prisoners and whether it can identify other drug problems. Methods: The AUDIT and the NIDA-modified Alcohol, Smoking, Substance Involvement Screening Test (NM-ASSIST) were administered to 382 prisoners in four Kentucky state prisons who were approaching release and consented to participate in NIDA Criminal Justice Drug Abuse Treatment Studies (CJDATS 2) cooperative agreement protocols. Participants were divided into two groups based on whether they screened positive (n=189) or negative (n=193) on the AUDIT. NM-ASSIST Substance Involvement (SI) scores were calculated for each of the nine drugs measured by the NM-ASSIST and compared between AUDIT groups. Results: No significant differences in age, race, or rurality for AUDIT groups were found, but the AUDIT positive group had a significantly higher percentage of males (73.0% vs. 61.5%). ANCOVAs, controlling for gender, found significantly higher SI scores (p< .05) for the AUDIT positive group for cannabis (15.0 vs. 10.3), cocaine (15.3 vs. 8.0), prescription stimulants (5.0 vs. 1.9), inhalants (0.6 vs. 0.2), sedatives (10.7 vs. 5.7), hallucinogens (1.1 vs. 0.5), and prescription opiates (15.6 vs. 11.1). No differences were found for SI scores for methamphetamine or street opioids. Conclusions: Findings suggest that prisoners who screen positive on the AUDIT have higher drug risk than those who screen negative, which suggests that the AUDIT may be an indirect screening for other substance problems. The majority of SI scores fell in the moderate risk range (4–26), suggesting that prisoners have drug risk for multiple drugs. Financial support: CJDATS 2 is funded by NIDA in collaboration with SAMSHA and DOJ. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.662 Association of the A335G polymorphism with striatal dopamine D2/3 receptor availability in healthy men and women Elise Weerts, M. McCaul, H. Kuwabara, M. Stephens, X. Xu, D. Wong, G.S. Wand Johns Hopkins University, Baltimore, MD, United

Culturally prevalent unrecorded alcohol consumption in Sikkim, North East India: cross-sectional situation assessment

Introduction: India is a major producer and consumer of unrecorded alcohol, an under recognized public health problem. This situation assessment was conducted in Sikkim, a state in north east India with a strong culture of unrecorded alcohol, to describe patterns of consumption and possible alcohol problems.Methods: This cross-sectional study combined primary and secondary information. About 395 participants with current unrecorded alcohol consumption completed a baseline assessment. Key informant survey enrolled 28 participants, who responded to a 23-item questionnaire on public health and social impact of unrecorded alcohol.Results: Mean age of participants was 37.5 ± 11.4 years. This assessment did not detect underage regular drinking. Most unrecorded alcohol are home brewed chang (rice beer) and raksi (distilled from cereals). Early hour first drink and “no effect of alcohol today” signified alcohol problems. Key informants confirmed cultural use, household production, cheap price and alcohol problems; but did not approve commercial production and sale.Conclusion: This study shows widespread unrecorded alcohol consumption in Sikkim. There was no evidence of underage drinking, but indications of alcohol problems were present. Stakeholders agreed that unrecorded alcohol is cultural, but accepted harmful effects and need for intervention and legal provisions. Community based outreach and screening for alcohol problems; licensing and quality control; and alternative livelihood are possible policy implications.

Differences in Risk of Injury in the U.S. General Population by Injury Treatment Type: Data from the 1995 to 2010 National Alcohol Surveys

While emergency room (ER) studies have documented a strong association of alcohol with injury, these studies are not necessarily representative of the general population. To evaluate comparative risk of injury from drinking for those treated in the ER with non-ER-treated injuries (those treated elsewhere or those not treated), data on alcohol and injury are analyzed in the U.S. general population by type of injury treatment. Relative risk (RR) of injury from drinking within 6 hours prior to the event was analyzed using case-crossover analysis based on respondents' usual frequency of drinking in 4 (1995 to 2010) National Alcohol Surveys (n = 4,819). RR was 1.01 for the total injured and significantly elevated for ER-treated injured (1.46), but not for those treated elsewhere (0.75) and those not treated (1.02). RR was significantly elevated for those aged 18 to 30 years (1.45; 1.14, 1.85), Blacks (1.54; 1.11, 2.14) and Hispanics (1.98; 1.51, 2.59), those positive on the Rapid Alcohol Problems Screen (RAPS4) as a measure of alcohol dependence (2.41; 1.86, 3.11), and for motor vehicle injuries (2.61; 1.49, 4.58) or cutting/piercing injuries (2.04, 1.10, 3.81). For those reporting ER-treated injuries, significant effect modification was found for those aged 18 to 30 years (RR = 2.29), Blacks (RR = 2.59) and Hispanics (RR = 2.68), high risk-taking (RR = 1.71), positive RAPS4 (RR = 3.69), and for motor vehicle (RR = 3.79) and cutting/piercing injuries (RR = 2.60). Data suggest alcohol plays a larger role in injuries for which ER treatment is sought than for other injuries, and estimates for injury from drinking derived from ER studies may be elevated. Future general population studies should take into account intensity of exposure to alcohol prior to injury, potential recall bias (by eliciting data on the proximity of injury to time of the respondent interview) and severity of injury, for improving estimates of the attributable burden of alcohol to injury in society.

성인 음주자의 영양소 섭취실태: 2011 국민건강영양조사 자료 분석

This study analyzed the dietary habits and nutrient intake status of adult drinkers in Korea. Alcohol drinking patterns were obtained from the Korea National Health and Nutrition Examination Survey (KNHANES). Among 4,968 persons, 91.5% were drinkers. Classification of their drinking patterns by the Alcohol Use Disorders Identification Test (AUDIT) score showed 64.5% of the drinkers were normal drinkers, 22.4% problem drinkers and 13.2% alcohol-dependent drinkers. Overall, 47% of the drinkers were considered alcohol-dependent in the Rapid Alcohol Problems Screen (RAPS4). Significant differences were found between those who abstained from alcohol (86.8%) and alcohol-dependent drinkers (68.9%); when asked about breakfast habits 73.4% of non-drinkers often had family meals, while only 55.4% of the alcohol-dependent drinkers had family meals. Dietary energy, alcohol energy, and total energy intake significantly increased for the alcohol-dependents (P<0.001). In addition, the intake of eight nutrients (protein, vitamin A, vitamin <TEX>$B_1$</TEX>, vitamin <TEX>$B_2$</TEX>, niacin, calcium, phosphorous and iron), significantly increased in the following order (least to highest): abstainers, normal drinkers, drinkers with a moderate addiction to alcohol and alcohol-dependent drinkers (P <0.05). Nutrient Adequacy Ratios (NAR) of all nutrients, except vitamin C, and the Mean nutrient Adequacy Ratio (MAR) significantly increased in the following order (least to highest): abstainers, normal drinkers, drinkers with a moderate addiction to alcohol and alcohol-dependent drinkers (P<0.05). The intake of vitamin <TEX>$B_1$</TEX>, vitamin <TEX>$B_2$</TEX>, and niacin per 1,000 kcal, according to drinking pattern, decreased in the order of abstainers, normal drinkers, drinkers with a moderate addiction to alcohol, and alcohol-dependent drinkers (P<0.001). The above results show that the nutrient intake of normal drinkers, drinkers with a moderate addiction to alcohol, and alcohol-dependent drinkers are higher than abstainers. However, overall intake of vitamin <TEX>$B_1$</TEX>, vitamin <TEX>$B_2$</TEX>, and niacin per 1,000 kcal was low. Therefore it is necessary to increase vitamin <TEX>$B_1$</TEX>, vitamin <TEX>$B_2$</TEX>, and niacin intake for drinkers.

Medical specialists' views on the impact of reducing alcohol consumption on prognosis of, and risk of, hospital admission due to specific medical conditions: results from a Delphi survey

To find consensus, or lack thereof, on the impact of reducing alcohol consumption on prognosis and the risk of hospital admissions for a number of alcohol-attributable disorders. A modified two-round Delphi survey utilizing web-based questionnaires to collect quantitative and qualitative data was used. Alcohol treatment experts from cardiology, emergency medicine, gastroenterology and oncology in the United Kingdom were invited to participate. The main outcomes were median impact ratings (on a scale of 1-9) and consensus (unanimous, strong, moderate, weak or no consensus). Of 192 experts invited to participate, 59 completed first questionnaires. The overall retention rate to the second questionnaires was about 51% (30/59). There was strong support that reducing alcohol consumption could result in improvement in prognosis for gastroenterology and emergency medicine patients; but uncertainty on the benefits for cardiology and oncology patients. Overall, the responses from the expert panel did not reflect the assumption that reducing alcohol consumption would result in benefits on hospital admissions for any of the specialties. The specialists viewed the severity of disorders as important when considering the impact of reducing alcohol consumption. The highest impact of treatment for problem drinking in hospitals is considered to be for alcohol-related disorders associated with gastroenterology and emergency medicine. At policy level, if targeted screening for alcohol problems by presenting disease or condition is the strategy of choice, it would be logical to implement screening and easily accessible interventions or addiction specialists within these areas where alcohol treatment is considered as having a high impact.

Provider payment approaches and incentives to implement screening

Screening in primary care is widely recommended (e.g. U.S. Preventive Services Task Force and UK National Institute for Health and Care Excellence), and is increasingly targeted for improvement. As health care payers try to influence the implementation and delivery of alcohol screening and brief intervention (SBI), some are using provider payment approaches. These include specific reimbursement for conducting screening, other financial incentives and linking payment with performance measures. We present 2010 data from a nationally representative survey of private US health plans and US health plan claims data (private health plans and Medicare), supplemented by literature review. Results indicate, among private health plan products in the US, 72.6% report allowing primary care physicians to bill for alcohol SBI, yet claims data analysis found only 0.01% of individuals in private plans or Medicare had an SBI procedure code on a medical claim in 2010. As of April 2013 the UK National Health Service requires that primary care practices conduct screening of individuals 16 and over and reimburses for SBI. In the US, although financial incentives for providers are becoming more common in private health plans (used by 31.6% for any condition), only 6% of health plans provided financial incentives for primary care screening for alcohol and drug use problems. Provider payment policies may be tied to performance measures to improve the quality of care. Alcohol screening is one of more than 300 performance measures selected for inclusion in the US Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting System. Despite this recognition, CMS analyses indicate the alcohol screening measure was not among the top five measures chosen by primary care providers. Although alcohol SBI is beneficial, it is not as widely implemented as it could be. Favorable payment policies are necessary, but not sufficient to encourage implementation of SBI.

Online screening for alcohol and other drug problems: an acceptable method for accessing help

Online screening for alcohol and other drug problems: an acceptable method for accessing help

Screening and brief interventions for hazardous and harmful alcohol use among university students in South Africa: results from a randomized controlled trial.

The aim of this study was to assess the effectiveness of Screening and Brief Intervention (SBI) for alcohol problems among university students in South Africa. The study design for this efficacy study is a randomized controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by hazardous and harmful drinkers in a university setting. The unit of randomization is the individual university student identified as a hazardous or harmful drinker attending public recruitment venues in a university campus. University students were screened for alcohol problems, and those identified as hazardous or harmful drinkers were randomized into an experimental or control group. The experimental group received one brief counseling session on alcohol risk reduction, while the control group received a health education leaflet. Results indicate that of the 722 screened for alcohol and who agreed to participate in the trial 152 (21.1%) tested positive for the Alcohol Use Disorder Identification Test (AUDIT) (score 8 or more). Among the 147 (96.7%) university students who also attended the 12-month follow-up session, the intervention effect on the AUDIT score was −1.5, which was statistically significant (P = 0.009). Further, the depression scores marginally significantly decreased over time across treatment groups, while other substance use (tobacco and cannabis use), self-rated health status and Posttraumatic Stress Disorder (PTSD) scores did not change over time across treatment groups. The study provides evidence of effective brief intervention by assistant nurses with hazardous and harmful drinkers in a university setting in South Africa. The short duration of the brief intervention makes it a realistic candidate for use in a university setting.

Compulsive use of alcohol among college students

Among college students alcohol consumption is associated with other high-risk behaviors that can lead to short- and long-term negative health consequences. Identification of college students consuming alcohol who are at high risk for problems may have important public health implications. This study examines the ability of the CHQ compulsive use of alcohol item to detect high-risk behaviors relative to other screening measures and its association with different dimensions of compulsive drinking. Three hundred thirty-two college students completed measures on compulsive drinking and hazardous behaviors. Results showed that among male students the CHQ compulsive use of alcohol item was not sensitive to detect hazardous alcohol consumption but co-occurred with the use of illicit drugs. Among female students it was sensitive to detect heavy drinking but not alcohol or drug problems. Among college students compulsive use of alcohol corresponds to an urge to consume alcohol that may be associated with use of illicit drugs in male students, with heavy drinking in female students and with substance use problems. This study suggest that the CHQ compulsive use of alcohol item should not be used as a stand-alone screening for alcohol or drug problems but it could be considered a marker for at-risk behaviors.

Introducing mental health and substance use screening into a community-based health service in Australia: usefulness and implications for service change

Mental health issues such as depression or anxiety and alcohol or other drug (AOD) problems often remain undiagnosed and untreated despite their prevalence in the community. This paper reports on the implementation and evaluation of an AOD and depression/anxiety screening programme within two Community Health Services (CHS) in Australia. Study 1 examined results from 5 weeks of screening (March-April 2008) using the Patient Health Questionnaire (two- and nine-item, Kroenke et al. 2001, 2003), the Conjoint Screen for Alcohol and other Drug Problems (Brown et al. 2001) and the Alcohol, Smoking and Substance Involvement Screening Test (Humeniuk & Ali 2006). Of the 55 clients screened, 33% were at risk of depression or anxiety, 22% reporting moderate-severe depression. Thirteen per cent were at risk of substance use disorders. A substantial proportion of at-risk clients were not currently accessing help for these issues from the CHS and therefore screening can facilitate identification and treatment referral. However, the majority of eligible clients were not screened, limiting screening reach. A second study evaluated the screening implementation from a process perspective via thematic analysis of focus group data from six managers and 14 intake/assessment workers (April 2008). This showed that when screening occurred, it facilitated opportunities for education and intervention with at-risk clients, although cultural mores, privacy concerns and shame/stigma could affect accuracy of screen scores at times. Importantly, the evaluation revealed that most decisions not to screen were made by workers, not by clients. Reasons for non-screening related to worker discomfort in asking sensitive questions and/or managing client distress, and a reluctance to spend long periods of time screening in time-pressured environments. The evaluation suggested that these problems could be resolved by splitting screening responsibilities, enhancing worker training and expanding follow-up screening. Findings will inform any community-based health system considering introducing screening.

Could an advance practice nurse improve detection of alcohol misuse in the emergency department?

Alcohol misuse is a prevalent problem in New Zealand society, and one that exacts a considerable cost in terms of health, social cohesion, and economic productivity. Despite the burden of alcohol misuse, screening, brief assessment, and interventions for alcohol problems are frequently poorly performed within general health services. In this paper we explore the response to alcohol problems in a New Zealand emergency department and discuss difficulties encountered in improving rates of detection by emergency department personnel. We report the results of a clinical audit of alcohol screening and brief assessment and a staff education programme designed to improve practice in this area, but which met with limited success. The potential role for an advanced practice nurse providing a clinical consultation and liaison service to the emergency department staff is explored. We argue that such a role has potential to reduce the health and social costs of alcohol misuse, and to meet the national policy objective of providing a treatment response to people with alcohol-related problems in contact with health services.

CAGE, RAPS4, RAPS4-QF and AUDIT screening tests for men and women admitted for acute alcohol intoxication to an emergency department: are standard thresholds appropriate?

A number of screening instruments are routinely used in Emergency Department (ED) situations to identify alcohol-use disorders (AUD). We wished to study the psychometric features, particularly concerning optimal thresholds scores (TSs), of four assessment scales frequently used to screen for abuse and/or dependence, the cut-down annoyed guilty eye-opener (CAGE), Rapid Alcohol Problem Screen 4 (RAPS4), RAPS4-quantity-frequency and AUD Identification Test (AUDIT) questionnaires, particularly in the sub-group of people admitted for acute alcohol intoxication (AAI). All included patients [AAI admitted to ED (blood alcohol level ≥0.8 g/l)] were assessed by the four scales, and with a gold standard (alcohol dependence/abuse section of the Mini International Neuropsychiatric Interview), to determine AUD status. To investigate the TSs of the scales, we used Youden's index, efficiency, receiver operating characteristic (ROC) curve techniques and quality ROC curve technique for optimized TS (indices of quality). A total of 164 persons (122 males, 42 females) were included in the study. Nineteen (11.60%) were identified as alcohol abusers alone and 128 (78.1%) as alcohol dependents (DSM-IV). Results suggest a statistically significant difference between men and women (P < 0.05) in performance of the screening tests RAPS4 (≥1) and CAGE (≥2) for detecting abuse. Also, in this population, we show an increase in TSs of RAPS4 (≥2) and CAGE (≥3) for detecting dependence compared with those typically accepted in non-intoxicated individuals. The AUDIT test demonstrates good performance for detecting alcohol abuse and/or alcohol-dependent patients (≥7 for women and ≥12 for men) and for distinguishing alcohol dependence (≥11 for women and ≥14 for men) from other conditions. Our study underscores for the first time the need to adapt, taking into account gender, the thresholds of tests typically used for detection of abuse and dependence in this population.

Alcoholism Research, Treatment to Get Special Emphasis

Alcoholism Research, Treatment to Get Special Emphasis

Screening and brief intervention for alcohol problems in Dr George Mukhari Hospital out-patients in Gauteng, South Africa: a single-blinded randomized controlled trial protocol

BackgroundFor alcohol drinkers in South Africa it has been found that annual consumption per drinker is among the highest in the world. High prevalence rates of hazardous and harmful alcohol use have also been found in a hospital out-patient setting in South Africa. Hospital settings are a particularly valuable point of contact for the delivery of brief interventions because of the large access to patient populations each year. With this in mind, the primary purpose of this randomized controlled trial is to provide screening for alcohol misuse and to test the efficacy of brief interventions in reducing alcohol intake among hospital out-patients in South Africa.Methods/DesignThe study design for this efficacy study is a randomised controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by problem drinkers in a hospital setting. The unit of randomisation is the individual out-patient identified as a medium risk drinker attending Dr George Mukhari Hospital. Out-patients will be screened for alcohol problems, and those identified as medium risk drinkers will be randomized into an experimental or control group. The experimental group will receive one brief counselling session on alcohol risk reduction, while the control group will receive a health education leaflet.DiscussionThe trial will evaluate the impact of alcohol screening and brief interventions for patients with alcohol problems in a hospital out-patient setting in South Africa. The findings will impact public health and will enable the health ministry to formulate policy related to brief alcohol interventions, which will result in reduction in alcohol use.Trial registrationPACTR201110000319392