Screening For Alcohol Use Research Articles

Feasibility of alcohol screening among patients receiving opioid treatment in primary care.

BackgroundIdentifying and treating problem alcohol use among people who also use illicit drugs is a challenge. Primary care is well placed to address this challenge but there are several barriers which may prevent this occurring. The objective of this study was to determine if a complex intervention designed to support screening and brief intervention for problem alcohol use among people receiving opioid agonist treatment is feasible and acceptable to healthcare providers and their patients in a primary care setting.MethodsA randomised, controlled, pre-and-post design measured feasibility and acceptability of alcohol screening based on recruitment and retention rates among patients and practices. Efficacy was measured by screening and brief intervention rates and the proportion of patients with problem alcohol use.ResultsOf 149 practices that were invited, 19 (12.8 %) agreed to participate. At follow up, 13 (81.3 %) practices with 81 (62.8 %) patients were retained. Alcohol screening rates in the intervention group were higher at follow up than in the control group (53 % versus 26 %) as were brief intervention rates (47 % versus 19 %). Four (18 %) people reduced their problem drinking (measured by AUDIT-C), compared to two (7 %) in the control group.ConclusionsAlcohol screening among people receiving opioid agonist treatment in primary care seems feasible. A definitive trial is needed. Such a trial would require over sampling and greater support for participating practices to allow for challenges in recruitment of patients and practices.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0548-2) contains supplementary material, which is available to authorized users.

Patient-Reported Offers of Alcohol Treatment for Primary Care Patients at High-Risk for an Alcohol Use Disorder.

This study assessed patient-reported alcohol treatment offers by health care providers following routine annual screening for alcohol use in primary care. A telephone interview within 30 days of the annual screen assessed demographics, alcohol and other drug use, mental health symptoms, and offers of formal treatment for alcohol by a Veterans Affairs health care provider. We included male patients (n = 349) at high risk for an alcohol use disorder (AUD) who had not received alcohol treatment in the past 3 months. We assessed self-reported receipt of any offers of formal treatment for alcohol use and associations of offers of formal treatment for alcohol with demographic and clinical variables. A total of 145 patients (41.5%) reported an offer of at least 1 type of formal treatment for alcohol use. More severe alcohol misuse (odds ratio, 1.07; 95% confidence interval, 1.03-1.11) and younger age (odds ratio, 0.97, 95% confidence interval, 0.95-0.99) were associated with reporting an offer of formal treatment. Most primary care patients at high risk for an AUD were not offered treatment following annual screening. Our results highlight the importance of training primary care providers in what constitutes appropriate medical treatment for this population and the most effective ways of offering treatment.

An EEG-based machine learning method to screen alcohol use disorder.

Screening alcohol use disorder (AUD) patients has been challenging due to the subjectivity involved in the process. Hence, robust and objective methods are needed to automate the screening of AUD patients. In this paper, a machine learning method is proposed that utilized resting-state electroencephalography (EEG)-derived features as input data to classify the AUD patients and healthy controls and to perform automatic screening of AUD patients. In this context, the EEG data were recorded during 5min of eyes closed and 5min of eyes open conditions. For this purpose, 30 AUD patients and 15 aged-matched healthy controls were recruited. After preprocessing the EEG data, EEG features such as inter-hemispheric coherences and spectral power for EEG delta, theta, alpha, beta and gamma bands were computed involving 19 scalp locations. The selection of most discriminant features was performed with a rank-based feature selection method assigning a weight value to each feature according to a criterion, i.e., receiver operating characteristics curve. For example, a feature with large weight was considered more relevant to the target labels than a feature with less weight. Therefore, a reduced set of most discriminant features was identified and further be utilized during classification of AUD patients and healthy controls. As results, the inter-hemispheric coherences between the brain regions were found significantly different between the study groups and provided high classification efficiency (Accuracy=80.8, sensitivity=82.5, and specificity=80, F-Measure=0.78). In addition, the power computed in different EEG bands were found significant and provided an overall classification efficiency as (Accuracy=86.6, sensitivity=95, specificity=82.5, and F-Measure=0.88). Further, the integration of these EEG feature resulted into even higher results (Accuracy=89.3%, sensitivity=88.5%, specificity=91%, and F-Measure=0.90). Based on the results, it is concluded that the EEG data (integration of the theta, beta, and gamma power and inter-hemispheric coherence) could be utilized as objective markers to screen the AUD patients and healthy controls.

High-risk alcohol use and associated socio-demographic, health and psychosocial factors in patients with HIV infection in three primary health care clinics in South Africa

Alcohol use may have a negative impact on the course of HIV disease and the effectiveness of its treatment. We studied patients with HIV who use alcohol and associated socio-demographic, health and psychosocial factors. Outcomes from this study may help in selecting patients from clinical practice with high-risk alcohol use and who are likely to benefit most from alcohol reduction interventions. In a cross sectional study in three primary health care clinics in Pretoria, South Africa, from January 2012 to June 2012, patients with HIV infection were interviewed and patients' medical files were reviewed to obtain data on levels of alcohol use (Alcohol Use Disorder Identification Test), patients' socio-demographic characteristics, HIV-related information, health related quality of life (WHOQoL-HIVBref), internalized AIDS stigma, symptoms of depression and adherence to antiretroviral therapy. Analyses consisted of descriptive statistics, bi- and multivariate logistic regression models. A total of 2230 patients (1483 [66.5%] female) were included. The median age was 37 years (interquartile range 31-43), 99.5% were black Africans, 1975 (88.6%) had started ART and the median time on ART was 22 months (interquartile range 9-40). No alcohol was used by 64% of patients, 8.9% were low risk drinkers, 25.1% of patients were hazardous or harmful drinkers and 2.0% had possible alcohol dependence. In multivariate analysis high-risk drinking was positively associated with male gender, never being married, tobacco use, a higher score for the 'level of independence'-domain measured with the WHOQoL-HIVBref questionnaire, and with more depressive symptoms compared to low-risk drinking. This study shows a high prevalence of hazardous or harmful drinking in patients with HIV infection (especially men) attending primary health care clinics in South Africa. Routine screening for alcohol use should be introduced in these clinics and harm reduction interventions should be evaluated, taking into account associated factors.

Harm reduction-a systematic review on effects of alcohol reduction on physical and mental symptoms.

Based on the knowledge that alcohol misuse causes a multitude of diseases and increased mortality, this systematic review examines whether a reduction of the individual alcohol consumption can contribute to a minimization of health risks within a harm reduction approach. In fact, the reviewed 63 studies indicate that interventions aiming at alcohol reduction (including total abstinence as one possible therapeutic aim) indeed resulted in or were associated with positive effects in harmful, hazardous or alcohol-dependent drinkers. Major benefits were observed for reducing alcohol-associated injuries, recovery of ventricular heart function in alcoholic cardiomyopathy, blood pressure lowering, normalization of biochemical parameter, body weight reduction, histological improvement in pre-cirrhotic alcohol-related liver disease and slowed progression of an already existing alcohol-attributable liver fibrosis. Furthermore, reduced withdrawal symptoms, prevalence of psychiatric episodes and duration of in-patient hospital days, improvement of anxiety and depression symptoms, self-confidence, physical and mental quality of life, fewer alcohol-related adverse consequences as well as lower psychosocial stress levels and better social functioning can result from reduced alcohol intake. The reviewed literature demonstrated remarkable socioeconomic cost benefits in areas such as the medical health-care system or workforce productivity. Individuals with heightened vulnerability further benefit significantly from alcohol reduction (e.g. hypertension, hepatitis C, psychiatric co-morbidities, pregnancy, but also among adolescents and young adults). Concluding, the reviewed studies strongly support and emphasize the importance and benefits of early initial screening for problematic alcohol use followed by brief and other interventions in first contact medical health-care facilities to reduce alcohol intake.

P198 Comparison of recreational drug use (RDU) and sexually transmitted infections (STIs) in HIV positive men who have sex with men (MSM) and HIV negative MSM receiving post exposure prophylaxis (PEP): Abstract P198 Table 1

Introduction Recreational drug use (RDU) in a sexualised context (“chemsex”) is increasing amongst MSM regardless of HIV status and is associated with poor sexual health outcomes. National guidelines for both PEP and HIV management suggest regular sexual health screens (SHS) and screening for RDU and alcohol use. Aim(s)/objectives To audit the documentation of SHS and RDU history from HIV positive MSM attending routine outpatient clinics compared to HIV negative MSM accessing PEP. Methods Retrospective review of 45 randomly selected MSM attending routine HIV care (HIV+ group) OR receiving PEP (PEP group) at each of 2 London clinics during 2014/15. Results Discussion High levels of STIs and RDU were seen in both groups but most significantly in the PEP group. This highlights the importance of identifying RDU/chemsex in PEP patients, which may be an opportunity for intervention to reduce risk of acquisition of HIV through risky sex.

A Screening Tool for Assessing Alcohol Use Risk among Medically Vulnerable Youth.

BackgroundIn an effort to reduce barriers to screening for alcohol use in pediatric primary care, the National Institute on Alcoholism and Alcohol Abuse (NIAAA) developed a two-question Youth Alcohol Screening Tool derived from population-based survey data. It is unknown whether this screening tool, designed for use with general populations, accurately identifies risk among youth with chronic medical conditions (YCMC). This growing population, which comprises nearly one in four youth in the US, faces a unique constellation of drinking-related risks.MethodTo validate the NIAAA Youth Alcohol Screening Tool in a population of YCMC, we performed a cross-sectional validation study with a sample of 388 youth ages 9–18 years presenting for routine subspecialty care at a large children’s hospital for type 1 diabetes, persistent asthma, cystic fibrosis, inflammatory bowel disease, or juvenile idiopathic arthritis. Participants self-administered the NIAAA Youth Alcohol Screening Tool and the Diagnostic Interview Schedule for Children as a criterion standard measure of alcohol use disorders (AUD). Receiver operating curve analysis was used to determine cut points for identifying youth at moderate and highest risk for an AUD.ResultsNearly one third of participants (n = 118; 30.4%) reported alcohol use in the past year; 86.4% (106) of past year drinkers did not endorse any AUD criteria, 6.8% (n = 8) of drinkers endorsed a single criterion, and 6.8% of drinkers met criteria for an AUD. Using the NIAAA tool, optimal cut points found to identify youth at moderate and highest risk for an AUD were ≥ 6 and ≥12 drinking days in the past year, respectively.ConclusionsThe NIAAA Youth Alcohol Screening Tool is highly efficient for detecting alcohol use and discriminating disordered use among YCMC. This brief screen appears feasible for use in specialty care to ascertain alcohol-related risk that may impact adversely on health status and disease management.

Fetal Alcohol Syndrome and Maternal Alcohol Biomarkers in Sera: A Register-Based Case-Control Study.

Fetal alcohol syndrome (FAS) is a well-known consequence of prenatal alcohol exposure. However, women tend to deny or underreport their alcohol use during pregnancy. The aim of this study was to explore the usability of various alcohol biomarkers for FAS screening in a data set without information on self-reported alcohol use. A nationwide register study with a case-control design was conducted. The target population consisted of all live births in Finland from 1987 to 2005. FAS cases (n=565) were identified from the Finnish Register of Congenital Malformations. Mothers of FAS cases and their controls were selected in a ratio of 1 to 2 from the Finnish Maternity Cohort (FMC). Background information was obtained from the Finnish Medical Birth Register. Serum samples, collected at the mother's first visit to the maternity care, were obtained from the national FMC biobank. Biomarkers of alcohol consumption, gamma-glutamyltransferase (GGT), carbohydrate-deficient transferrin (%CDT), combination of GGT and CDT (GGT-CDT), and ethylglucuronide (EtG) were analyzed from mothers of FAS cases (n=385) and their controls (n=745). Median levels of all biomarkers were significantly higher among the mothers of FAS children than in control mothers. Using previously validated cutoffs for EtG, GGT, %CDT, and GGT-CDT, nearly half (46%) of the mothers with affected offspring could be identified. The predictive association was highest for GGT-CDT combination and significant also for all the other biomarkers. In this explorative case-control study, we demonstrate that the FMC biobank can be used to screen alcohol biomarkers for epidemiological research purposes. According to our results, the use of alcohol biomarkers during the first trimester may help to identify the high-risk pregnancies for FAS. A more systematic use of alcohol biomarkers at maternity care may open new possibilities for screening and intervention of alcohol use among pregnant mothers.

Improving the provision of pregnancy care for Aboriginal and Torres Strait Islander women: a continuous quality improvement initiative.

BackgroundAustralian Aboriginal and Torres Strait Islander (Indigenous) women are at greater risk of adverse pregnancy outcomes than non-Indigenous women. Pregnancy care has a key role in identifying and addressing modifiable risk factors that contribute to adverse outcomes. We investigated whether participation in a continuous quality improvement (CQI) initiative was associated with increases in provision of recommended pregnancy care by primary health care centers (PHCs) in predominantly Indigenous communities, and whether provision of care was associated with organizational systems or characteristics.MethodsLongitudinal analysis of 2220 pregnancy care records from 50 PHCs involved in up to four cycles of CQI in Australia between 2007 and 2012. Linear and logistic regression analyses investigated associations between documented provision of pregnancy care and each CQI cycle, and self-ratings of organizational systems. Main outcome measures included screening and counselling for lifestyle-related risk factors.ResultsWomen attending PHCs after ≥1 CQI cycles were more likely to receive each pregnancy care measure than women attending before PHCs had completed one cycle e.g. screening for cigarette use: baseline = 73 % (reference), cycle one = 90 % [odds ratio (OR):3.0, 95 % confidence interval (CI):2.2-4.1], two = 91 % (OR:5.1, 95 % CI:3.3-7.8), three = 93 % (OR:6.3, 95 % CI:3.1-13), four = 95 % (OR:11, 95 % CI:4.3-29). Greater self-ratings of overall organizational systems were significantly associated with greater screening for alcohol use (β = 6.8, 95 % CI:0.25-13), nutrition counselling (β = 8.3, 95 % CI:3.1-13), and folate prescription (β = 7.9, 95 % CI:2.6-13).ConclusionParticipation in a CQI initiative by PHCs in Indigenous communities is associated with greater provision of pregnancy care regarding lifestyle-related risk factors. More broadly, these findings support incorporation of CQI activities addressing systems level issues into primary care settings to improve the quality of pregnancy care.

Screening and Brief Interventions for Illicit Drug Use and Alcohol Use in Methadone Maintained Opiate-Dependent Patients: Results of a Pilot Cluster Randomized Controlled Trial Feasibility Study

ABSTRACTBackground and Objectives: The present study evaluated the effectiveness of a single clinician delivered brief intervention (BI) to reduce problem alcohol use and illicit substance use in an opiate-dependent methadone maintained cohort of patients attending for treatment. Methods: Four addiction treatment centers were randomly assigned to either treatment as usual (TAU; control group) or BI (intervention group). Clinicians screened patients using the alcohol, smoking, and substance involvement screening test (ASSIST) screening tool at baseline and again at three-month follow up. Fidelity checks were performed to ensure that training was delivered effectively and uniformly across all study sites. Feasibility of administering a BI within daily practice was assessed through intervention fidelity checks, patient satisfaction questionnaires and process evaluation. Results: A total of 465 patients were screened (66% of the overall eligible population) with a total of 433 (93%) ASSIST positive cases. Randomization was effective, with no differences in the control versus the intervention arms at baseline for key demographic or clinical indicators including substance us. There was a statistically significant difference between global risk score for the intervention (x = 39.36, sd = 25.91) group and the control group (x = 45.27, SD = 27.52) at 3-month follow-up (t(341) = −2.07, p < .05). Conclusions: This trial provides the first evidence that a single clinician delivered BI can result in a reduction in substance use within a methadone maintained opiate-dependent cohort, and this effect is sustained at three month follow up.

Screening and brief intervention for unhealthy substance use in patients with chronic medical conditions: a systematic review.

This systematic review describes studies evaluating screening tools and brief interventions for addressing unhealthy substance use in primary care patients with hypertension, diabetes or depression. Primary care is the main entry point to the health care system for most patients with comorbid unhealthy substance use and chronic medical conditions. Although of great public health importance, systematic reviews of screening tools and brief interventions for unhealthy substance use in this population that are also feasible for use in primary care have not been conducted. Systematic review. We systematically review the research literature on evidence-based tools for screening for unhealthy substance use in primary care patients with depression, diabetes and hypertension, and utilising brief interventions with this population. Despite recommendations to screen for and intervene with unhealthy substance use in primary care patients with chronic medical conditions, the review found little indication of routine use of these practices. Limited evidence suggested the Alcohol Use Disorders Identification Test and Alcohol Use Disorders Identification Test-C screeners had adequate psychometric characteristics in patients with the selected chronic medical conditions. Screening scores indicating more severe alcohol use were associated with health-risk behaviours and poorer health outcomes, adding to the potential usefulness of screening for unhealthy alcohol use in this population. Studies support brief interventions' effectiveness with patients treated for hypertension or depression who hazardously use alcohol or cannabis, for both substance use and chronic medical condition outcomes. Although small, the international evidence base suggests that screening with the Alcohol Use Disorders Identification Test or Alcohol Use Disorders Identification Test-C and brief interventions for primary care patients with chronic medical conditions, delivered by nurses or other providers, are effective for identifying unhealthy substance use and associated with healthy behaviours and improved outcomes. Lacking are studies screening for illicit drug use, and using single-item screening tools, which could be especially helpful for frontline primary care providers including nurses.

A randomised trial of a computer-delivered screening and brief intervention for postpartum alcohol use.

Most women cut down or quit alcohol use during pregnancy, but return to pre-pregnancy levels of use after giving birth. Universal screening and brief intervention for alcohol use has shown promise, but has proven challenging to implement and has rarely been evaluated with postpartum women. This trial evaluated a single 20-min, electronic screening and brief intervention (e-SBI) for alcohol use among postpartum women. In this parallel group randomised trial, 123 postpartum, low-income, primarily African-American women meeting criteria for unhealthy alcohol use were randomly assigned to either a tailored e-SBI (n = 61) or a time-matched control condition (n = 62), with follow-up at 3 and 6 months. Hypotheses predicted that 7-day point-prevalence abstinence and drinking days would favour the e-SBI condition. No group differences were significant. Blinded follow-up evaluation revealed 7-day point prevalence of 75% for the e-SBI condition versus 82% for control at 3 months (odds ratio = 1.6) and 72% versus 73%, respectively, at 6 months. Drinking days in the past 90 and mean number of drinks per week also showed no significant differences. This pilot trial failed to support a single-session e-SBI for alcohol use among postpartum women, although findings at the 3-month time point suggested that greater power might confirm transient effects of the e-SBI. As efficacy is likely to vary with e-SBI content and approach, future research should leverage technology's reproducibility and modularity to isolate key components. [Ondersma SJ, Svikis DS, Thacker LR, Beatty JR, Lockhart N. A randomised trial of a computer-delivered screening and brief intervention for postpartum alcohol use. Drug Alcohol Rev 2016;35:710-718].

Advanced practice nursing students’ use of screening and brief intervention in the clinical setting

Introduction More than 30% of US adults are estimated to drink at risky levels or meet criteria for harmful or dependent alcohol use. Screening, brief intervention and referral to treatment (SBIRT) in primary care settings is recommended and nurses, particularly advanced practice nurses (nurse practitioners), are being called upon to perform SBIRT for alcohol. This study assessed if knowledge, attitudes, and beliefs about SBIRT, evaluated after a three-part, educational training, predicted whether 21 family nurse practitioner (FNP) students screened for alcohol use during subsequent patient encounters in their clinical practica. Objectives Learners will be able to: – describe the general purpose and procedures of SBIRT; – identify three strategies for integrating SBIRT into current practice setting. Aims To help in development of SBIRT skills, the Substance Abuse and Mental Health Services Administration expanded training grant opportunities in 2013, for education programs to multiple groups of medical professionals. Findings from this study are presented to show the effectiveness of the training for nursing professionals. Method Immediately following training, students completed a survey and then documented implementation of SBIRT during their clinical practica. Results Students who reported higher levels of perceived Competence in their post-training surveys were more likely to screen patients for alcohol use in their clinical practica settings. Conclusion Screening for alcohol use and identifying patients at risk for or engaged in hazardous drinking meet important NP practice competencies. Further research is needed to explore training programs that specifically emphasize activities to increase competence, knowledge, and comfort regarding SBIRT.

Validation of a brief, two-question depression screen in trauma patients.

Increasingly, depression following traumatic injury is recognized as a complication of injury. Unlike mandated screening for risky alcohol use in trauma centers, screening for psychological risks is not required by the American College of Surgeons' Committee on Trauma. Limited resources and time constraints are commonly given reasons against routine screening. The purpose of this study was to determine if a two-item screen was as valid as an eight-question screen for depression. A total of 421 patients were given the Patient Health Questionnaire 8 (PHQ-8) during initial hospitalization to assess depression in a prospective study at a Level I trauma center. A cutoff score of 10 or higher (possible range, 0-24) on the PHQ-8 is used as diagnostic for depression. The PHQ-2 (possible range, 0-6) is derived from the first two questions of the PHQ-8 and contains items assessing sad mood and loss of interest/pleasure during the previous 2 weeks. A cutoff score of 3 or higher was considered to be a positive screen result. Discriminatory ability of the PHQ-2 was calculated. The sample was predominantly male (65%) and white (67%). The majority (85%) sustained a blunt trauma, and the primary cause of injury was motor vehicle collision (37%), with a mean Injury Severity Score (ISS) of 11.6. A total of 142 patients (34%) were positive for depression on the PHQ-8. When comparing the PHQ-2 with the PHQ-8, a sensitivity of 76.1 and a specificity of 92.8 were found, as well as a positive predictive value of 84.4. The result of our study confirms that depression is a frequent condition (34%) among individuals who sustain physical injury. The PHQ-2 seems to have acceptable sensitivity and specificity to identify depression in this population. The use of a two-item screening questionnaire is a minimal addition to the evaluation of patients after injury, allowing for earlier intervention and better outcomes. Diagnostic study, level IV; prognostic/epidemiologic study, level III.

HIV primary care providers—Screening, knowledge, attitudes and behaviors related to alcohol interventions

BackgroundAlcohol has particularly harmful health effects in HIV-infected patients; therefore, HIV clinics are an important setting for integration of brief alcohol intervention and alcohol pharmacotherapy to improve patient outcomes. Current practices of alcohol screening, counseling, and prescription of pharmacotherapy by HIV providers are unknown. MethodsWe conducted a cross-sectional survey of HIV providers from 8 HIV clinical sites across the United States. Surveys queried knowledge and use of alcohol screening, brief advice, counseling and pharmacotherapy, confidence and willingness to prescribe pharmacotherapy and barriers to their use of alcohol pharmacotherapy. We used multivariable logistic regression to examine provider factors associated with confidence and willingness to prescribe pharmacotherapy. ResultsProviders (N=158) were predominantly female (58%) and Caucasian (73%); almost half were infectious disease physicians and 31% had been in practice 10–20 years. Most providers (95%) reported always or usually screening for alcohol use, although only 10% reported using a formal screening tool. Over two-thirds never or rarely treated alcohol-dependent patients with pharmacotherapy themselves. Most (71%) referred alcohol-dependent patients for treatment. Knowledge regarding alcohol pharmacotherapy was low. The major barrier to prescribing pharmacotherapy was insufficient training on use of pharmacotherapy. Provider confidence ratings were positively correlated with their practice patterns. ConclusionsHIV providers reported high rates of screening for alcohol use, though few used a formal screening tool. Most providers referred alcohol dependent patients to outside resources for treatment. Few reported prescribing alcohol pharmacotherapy. Increased training on alcohol pharmacotherapy may increase confidence in prescribing and use of these medications in HIV care settings.

Usefulness of Heavy Drinking and Binge Drinking for the Diagnosis of Alcohol Use Disorder.

BackgroundThis research investigated the sensitivity and specificity of heavy and binge drinking for screening of alcohol use disorder.MethodsThis retrospective study was conducted with 976 adults who visited the Sun Health Screening Center for health screenings in 2015. Daily drinking amount, drinking frequency per week, and weekly drinking amount were investigated. Using criteria from the National Institute on Alcohol Abuse and Alcoholism, participants were classified as normal drinkers, heavy drinkers, or binge drinkers, and grouped by age and sex. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of heavy and binge drinking were compared for the diagnosis of alcohol abuse and alcohol dependence using the Diagnostic and Statistical Manual of Mental Disorders (DSM) 4th edition-text revision and alcohol use disorder using the DSM 5th edition.ResultsThe sensitivity of heavy and binge drinking for the diagnosis of alcohol abuse, alcohol dependence, and alcohol use disorder were 51.7%, 43.8%, and 35.3%, and 69.0%, 62.5%, and 48.2%, respectively. The specificity of these were 90.1%, 91.7%, and 95.5%, and 84.3%, 86.8%, and 91.2%, respectively. The PPV of these were 24.8%, 40.5%, and 72.7%, and 21.7%, 38.0%, and 65.2%, respectively. The NPV of these were 96.7%, 92.6%, and 81.2%, and 97.8%, 94.7%, and 83.7%, respectively.ConclusionHeavy and binge drinking did not show enough diagnostic power to screen DSM alcohol use disorder although they did show high specificity and NPV.

Screening for harmful alcohol use with the alcohol, smoking, and substance involvement screening test in clients recruited from workplace settings of a Tertiary Care Hospital of North India

Background: World Health Organization developed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) as the first screening test for rapidly detecting the harmful use of all major psychoactive substances. However, epidemiological research on substance use screening using ASSIST in Indian populations is limited. Aims and Objectives: To screen for harmful alcohol use in the Indian workplace settings using ASSIST. Subjects and Methods: In this cross-sectional study, 162 class C employees were randomly screened in their workplace settings from a tertiary care hospital based on the criteria of ASSIST. Results: The study found that nearly one-fourth (24.06%, n = 39) of the total participants as moderate and high-risk users of alcohol as per ASSIST scores. In addition, one-fifth (19.74%, n = 32) of the total participants used both alcohol and tobacco in moderate or high-risk manner. Conclusion: The results of the study indicate the alarming magnitude of harmful alcohol use in workplace settings and advocate that ASSIST is an important screening tool for detecting harmful substance use in this population.

Improving Access to Maternity Care for Women with Opioid Use Disorders: Colocation of Midwifery Services at an Addiction Treatment Program.

Perinatal drug and alcohol use is associated with serious medical and psychiatric morbidity for pregnant and postpartum women and their newborns. Participation in prenatal care has been shown to improve outcomes, even in the absence of treatment for substance use disorders. Unfortunately, women with substance use disorders often do not receive adequate prenatal care. Barriers to accessing care for pregnant women with substance use disorders include medical and psychiatric comorbidities, transportation, caring for existing children, housing and food insecurity, and overall lack of resources. In a health care system where care is delivered by each discipline separately, lack of communication between providers causes poorly coordinated services and missed opportunities. The integration of mental health and substance use treatment services in medical settings is a goal of health care reform. However, this approach has not been widely promoted in the context of maternity care. The Dartmouth-Hitchcock Medical Center Perinatal Addiction Treatment Program provides an integrated model of care for pregnant and postpartum women with substance use disorders, including the colocation of midwifery services in the context of a dedicated addiction treatment program. A structured approach to screening and intervention for drug and alcohol use in the outpatient prenatal clinic facilitates referral to treatment at the appropriate level. Providing midwifery care within the context of a substance use treatment program improves access to prenatal care, continuity of care throughout pregnancy and the postpartum, and availability of family planning services. The evolution of this innovative approach is described. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.

Substance Abuse, General Principles

1. Kirstin A. M. Nackers, MD* 2. Patricia Kokotailo, MD, MPH* 3. Sharon J. L. Levy, MD† 1. *Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI. 2. †Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA. The American Academy of Pediatrics recommends screening for alcohol and other drug use at adolescent health supervision visits and appropriate acute-care visits, (1) yet many clinicians find addressing substance use with youth to be a challenge. After completing this article, the reader should be able to: 1. Describe the use trends for alcohol and common other drugs by youth in the United States. 2. Explain the primary care clinician’s role in screening and management of alcohol and substance use. 3. Using motivational interviewing techniques, adopt an in-office brief intervention across the spectrum of adolescent substance use. 4. Analyze the utility of urine drug testing in various clinical situations, such as random screening in a low-risk patient/population, testing an adolescent who self-reports ongoing substance use, monitoring adherence to treatment for a substance use disorder, and evaluating a patient with signs/symptoms of acute toxicity. Adolescent drug and alcohol use remains a major issue in the United States. The American Academy of Pediatrics (AAP) recommends screening for use of these substances at adolescent health supervision visits and appropriate acute-care visits. (1) Primary care clinicians (PCCs) serve an important role in both the identification and management of alcohol and substance use disorders (SUDs). This role comes with many challenges, including managing the dynamics of families that may be in crisis, issues of adolescent confidentiality, and high variability of local resources to support patients in need of treatment for SUDs. In this article, we review the epidemiology of alcohol and substance use, the approach to screening and treatment, the issue of adolescent confidentiality, and the role of urine drug testing. ### Epidemiology The epidemiology of adolescent substance use must be …

Alcohol Use Disorders in Primary Health Care: What Do We Know and Where Do We Go?

To analyze the current paradigm and clinical practice for dealing with alcohol use disorders (AUD) in primary health care. Analyses of guidelines and recommendations, reviews and meta-analyses. Many recommendations or guidelines for interventions for people with alcohol use problems in primary health care, from hazardous drinking to AUD, can be summarized in the SBIRT principle: screening for alcohol use and alcohol-related problems, brief interventions for hazardous and in some cases harmful drinking, referral to specialized treatment for people with AUD. However, while there is some evidence that these procedures are effective in reducing drinking levels, they are rarely applied in clinical practice in primary health care, and no interventions are initiated, even if the primary care physician had detected problems or AUD. Rather than asking primary health care physicians to conduct interventions which are not typical for medical doctors, we recommend treatment initiation for AUD at the primary health care level. AUD should be treated like hypertension, i.e. with regular checks for alcohol consumption, advice for behavioral interventions in case of consumption exceeding thresholds, and pharmaceutical assistance in case the behavioral interventions were not successful. Minimally, alcohol consumption should be screened for in all situations where there is a co-morbidity with alcohol being a potential cause (such as hypertension, insomnia, depression or anxiety disorders). A paradigm shift is proposed for dealing with problematic alcohol consumption in primary health care, where initiation for treatment for AUD is seen as the central element.