Alcohol Screening Research Articles

The predictive validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for moderate- to high-risk cannabis, methamphetamine and opioid use after release from prison.

Illicit substance use is common among people entering prisons, as is returning to substance use after release from prison. We aimed to assess the predictive validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for returning to substance use after release from prison. A longitudinal design with baseline survey conducted between 2008 and 2010 in the 6weeks before expected prison release and up to three follow-up surveys in the 6months after release. Prisons in Queensland, Australia. A total of 1054 adults within 6 weeks of expected release from prison. The ASSIST was used to assess problematic use of cannabis, methamphetamine, heroin and other non-prescribed opioids in the 3months before incarceration. Post-incarceration substance use was measured at 1, 3 and 6months after release. We calculated the area under the receiver operating characteristic curve (AUROC) and the optimal ASSIST cut-off score for each substance, using Youden's index (J). Forty-one per cent (n = 434) of the cohort reported any substance use during follow-up: 33% (n = 344) used cannabis, 20% (n = 209) methamphetamine, 10% (n = 109) heroin and 9% (n = 97) illicit other opioids. The optimal ASSIST cut-off score was ≥ 4 for heroin, methamphetamine and cannabis and ≥ 1 for other opioids. Using these cut-offs, the AUROC was highest for heroin in predicting both any use (AUROC = 0.82) and weekly use (AUROC = 0.88) in the past 4weeks. AUROCs for other drugs ranged from 0.73 to 0.79. The ASSIST shows promise as an accurate and potentially scalable tool that may be useful for predicting a return to substance use after release from prison and could inform service delivery. The substantial rates of returning to substance use after release from prison suggest that prison serves to interrupt rather than cease substance use.

Increased harmful alcohol consumption since the COVID-19 pandemic: causes, impacts and risk screening

An alcohol care team in an acute hospital in the North East of England had first-hand experience of the documented increase in harmful alcohol consumption during COVID-19 pandemic lockdown. Patients linked this increase in use to anxiety, boredom and isolation, driven by economic pressures and uncertainty about the future. Studies suggest that drinking levels stayed higher after lockdown, with major long-term consequences. Thus, alcohol services should engage with the post-pandemic economic climate, highlight the risks of liver disease and provide alcohol screening at every opportunity to identify those at risk of future alcohol-related harm.

Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA: a mathematical modelling study

Alcohol use, tobacco use, and other substance use often co-occur with depression, anxiety, and chronic pain, forming a constellation of alcohol, substance, and mood-related (CASM) conditions that disproportionately affects people with HIV in the USA. We used a microsimulation model to evaluate how alternative screening strategies accounting for CASM interdependence could affect life expectancy in people with HIV in the USA. We augmented a microsimulation model previously validated to predict US adult life expectancy, including in people with HIV. Using data from the Veterans Aging Cohort Study, we incorporated CASM co-occurrence, inferred causal relationships between CASM conditions, and assessed the effects of CASM on HIV treatment and preventive care. We simulated an in-care HIV cohort exposed to alternative CASM screening and diagnostic assessment strategies, ranging from currently recommended screenings (alcohol, tobacco, and depression, with diagnostic assessments for conditions screening positive) to a series of integrated strategies (screening for alcohol, tobacco, or depression with additional diagnostic assessments if any screened positive) to a maximal saturation strategy (diagnostic assessments for all CASM conditions). The saturation strategy increased life expectancy by 0·95 years (95% CI 0·93-0·98) compared with no screening. Recommended screenings provided much less benefit: 0·06 years (0·03-0·09) gained from alcohol screening, 0·08 years (0·06-0·11) from tobacco screening, 0·10 years (0·08-0·11) from depression screening, and 0·25 years (0·22-0·27) from all three screenings together. One integrated strategy (screening alcohol, tobacco, and depression with diagnostic assessment for all CASM conditions if any screened positive) produced near-maximal benefit (0·82 years [0·80-0·84]) without adding substantial screening burden, albeit requiring additional diagnostic assessments. Primary care providers for people with HIV should consider comprehensive diagnostic assessment of CASM conditions if one or more conditions screen positive. US National Institute on Alcohol Abuse and Alcoholism.

Drug addiction among high school students in Toamasina I Madagascar in 2020

Introduction: The problematic use of psychoactive substances by high school students is currently more and more widespread social phenomenon. The dangerousness of these misuses is cognitive decline and behavioral disorders with legal consequences. The objectives of the study is to show a screening of the socio-demographic and clinical profile of high school students taking psychoactive substances in the Region of Toamasina I Madagascar. Research methods: This is a cross-sectional study carried out on a sample of population made by high school students from the Region of Toamasina I Madagascar, from the class of Second to Terminale, among 6 high schools establishments, obtained after a draw, from October 01st to November 30th, 2020. Students were asked to fill out questionnaires and submitting them immediately. The content of the questionnaires was made up of the standardized assessment items ASSIST Version 3.0 (Alcohol, Smoking, and Substance Involvement Screening Test). It was studied the social and demographic parameters with the clinical symptoms presented by high school students who reported a notion of taking or using psychoactive substances and finaly, the level of dependence on these substances. Conclusion: Almost of high school students are classified as occasional users who, during a meeting with their classmates or during a trip, would allow themselves to be convinced of the need to accept drug use as symbol of sharing and brotherhood. Sensitizations must be initiated to aware of the imminence of this dangerous health problem.

Alcohol Use, Screening, and Brief Intervention Among Pregnant Persons — 24 U.S. Jurisdictions, 2017 and 2019

Alcohol use during pregnancy is a major preventable cause of adverse alcohol-related outcomes, including birth defects and developmental disabilities.* Alcohol screening and brief intervention (ASBI) is an evidence-based primary care tool that has been shown to prevent or reduce alcohol consumption during pregnancy; interventions have resulted in an increase in the proportion of pregnant women reporting abstinence (odds ratio=2.26; 95% CI = 1.43-3.56) (1). Previous national estimates have not characterized ASBI in populations of pregnant persons. Using 2017 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) data, CDC examined prevalence of ASBI and characteristics of pregnant persons and nonpregnant women aged 18-49 years (reproductive-aged women) residing in jurisdictions that participated in the BRFSS ASBI module. During their most recent health care visit within the past 2 years, approximately 80% of pregnant persons reported being asked about their alcohol use; however, only 16% of pregnant persons who self-reported current drinking at the time of the survey (at least one alcoholic beverage in the past 30 days) were advised by a health care provider to quit drinking or reduce their alcohol use. Further, the prevalence of screening among pregnant persons who did not graduate from high school was lower than that among those who did graduate from high school or had at least some college education. This gap between screening and brief intervention, along with disparities in screening based on educational level, indicate missed opportunities to reduce alcohol use during pregnancy. Strategies to enhance ASBI during pregnancy include integrating screenings into electronic health records, increasing reimbursement for ASBI services, developing additional tools, including electronic ASBI, that can be implemented in a variety of settings (2,3).

The Alcohol Use Disorders Identification Test and Mortality 20 Years later

Abstract The objective was to test whether Alcohol Use Disorders Identification Test (AUDIT) results may predict mortality after 20 years. An observational study was conducted. It included an interview of a general population sample aged 18 to 64 in northern Germany in the years 1996 − 1997 (baseline) and a mortality-follow-up in the years 2017 − 2018. Study participants were 3581 persons who had consumed alcohol during the last 12 months prior to the baseline assessment. It included the AUDIT which was filled in by study participants. At follow-up, death cases were ascertained including the date of death. Official records and death certificates from local health authorities were used. Cox proportional hazards regression revealed that the AUDIT predicted time to death. The hazard ratio was 1.70 (95% confidence interval: 1.43 − 2.02) with the lowest AUDIT zone of values as the reference group. Competing risks regression analysis for diagnosis-specific mortality data revealed that the AUDIT predicted cardiovascular mortality (subhazard ratio, 1.84; 95% confidence interval, 1.49 − 2.27). It is concluded that the alcohol screening predicted total and cardiovascular mortality in this adult general population sample.

Improving alcohol management in primary health care in Mexico: A return-on-investment analysis.

Alcohol screening, brief advice and referral to treatment (SBIRT) in primary health care is an effective strategy to decrease alcohol consumption at population level. However, there is relatively scarce evidence regarding its economic returns in non-high-income countries. The current paper aims to estimate the return-on-investment of implementing a SBIRT program in Mexican primary health-care settings. Empirical data was collected in a quasi-experimental study, from 17 primary health-care centres in Mexico City regarding alcohol screening delivered by 145 health-care providers. This data was combined with data from a simulation study for a period of 10 years (2008 to 2017). Economic investments were calculated from a public sector health-care perspective as clinical consultation costs (salary and material costs) and program costs (set-up, adaptation, implementation strategies). Economic return was calculated as monetary gains in the public sector health-care, estimated via simulated reductions in alcohol consumption, dependent on population coverage of alcohol interventions delivered to primary health-care patients. Results showed that scaling up a SBIRT program in Mexico over a 10-year period would lead to positive return-on-investment values ranging between 21% in scenario 4 (confidence interval -8.6%, 79.5%) and 110% in scenario 5 (confidence interval 51.5%, 239.8%). Moreover, over the 10-year period, up to 16,000 alcohol-related deaths could be avoided as a result of implementing the program. SBIRT implemented at national level in Mexico may lead to substantial financial gains from a public sector health-care perspective.

Port Workers' Use of Medical Services in a Maritime Container Terminal in Costa Rica.

Supervised by three or four medical doctors and one nurse in rotating shifts, the medical clinic in Costa Rica's Moín Container Terminal is open 24/7 for visits from port workers. In our study, we aimed to identify the sociodemographic and clinical characteristics of a consecutive series of patients who attended the medical clinic for outpatient services during an 8-month period. Our descriptive study involved collecting patient records from the medical clinic during the first 8 months of 2021 (i.e., 1 January-31 August 2021), during which 3050 visits from 1301 port workers were registered. Terminal tractor drivers, crane operators, and stevedores were the most frequent job categories among the patients. Doping (i.e., ICD-10 Z03.6) was observed in 64% of the visits. The top ICD-10 codes among all other patients not observed to have engaged in doping (n = 469) were diseases of the musculoskeletal system (7.2%) and abnormal clinical and laboratory symptoms (6.2%). Problems with the musculoskeletal system were primarily back pain (36.0%), muscle contracture (30.1%), and secondary headache (25.2%). Two-thirds of the visits were due to screening for alcohol and drugs or doping; however, inconsistency in the coding system complicates the analysis of data, and a dropdown menu in the registration is therefore needed to prevent errors. Relative risk calculations are impossible due to a lack of data about the at-risk population but should be pursued under different circumstances in future studies. In the support chain of goods, the medical clinic in the port plays a key role in saving time in shipping, which means that the injured or sick employees in most cases can continue working. For the shipping industry, quick un- and offloading is very important to stay competitive in the market for transport.

Country and policy factors influencing the implementation of primary care-based alcohol screening: A comparison of Colombia, Mexico and Peru

ABSTRACT Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes.

Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study

ObjectivesTo evaluate associations between alcohol brief intervention (BI) in primary care and 12-month drinking outcomes and 18-month health outcomes among adults with hypertension and type 2 diabetes (T2D).DesignA population-based observational...

A reactive matrix for in situ chemical derivatisation and specific detection of cis-diol compounds by matrix-assisted laser desorption/ionisation mass spectrometry.

Analysis of cis-diol compounds is essential, because they play important roles in cosmetics, food, pharmaceuticals, and living organisms. Herein, we describe the development of a matrix-assisted laser desorption/ionisation mass spectrometry (MALDI-MS) method to analyse cis-diol compounds. In this method, a 6-borono-1-methylquinoline-1-ium (BMQI) reactive matrix was designed for in situ derivatisation of cis-diol compounds based on the boronate affinity interaction between boronic acid and cis-diol groups. Compared to traditional commercial matrices and other boronic acid reagents, BMQI can significantly accelerate the desorption/ionisation process, improve reproducibility, exhibit free background interference, and enhance signal intensity in the analysis of various cis-diol compounds even for amounts as low as 1 nmol. The BMQI-assisted laser desorption/ionisation mass spectrometry (LDI-MS) was successfully applied to the rapid screening and identification of sugar alcohols in different sugar-free foods. This work provides an alternative method to the LDI-MS analysis of cis-diol-containing molecules, and the method can be extended to other food samples and biofluids.

Substance use and associated factors among high school students in Northwest Ethiopia.

substance abuse is the use of a drug that affects both the function and the structure of the brain by altering the activity neurotransmitters of particular pathways in the central nervous system that affect the mood, perception, and consciousness of the person. a cross-sectional study design was employed among 422 high school students. Study participants were selected by simple random sampling from all five high school students. A self-reported questionnaire was used that included alcohol, smoking, and substance involvement screening test, Oslo-3 social support, and other instruments. Data were checked, coded, and entered into Epi-Data version 4.6.2 then exported to the statistical package for social sciences version 20 for analysis. Bi-variable and multi-variable logistic regression analyses were used to identify factors associated with substance use. Adjusted odds ratios with 95% confidence intervals were determined and predictors with a p-value of <0.05 were counted as significantly associated. a total of 406 students have participated with an overall response rate of 96.2% (n=406). Of the participants 235 were female and 171 were male. The mean age was 17.51 with a standard deviation of ±1.42. The prevalence of substance use among study participants was 52.5%. Being male aOR: 1.77, 95% CI 1.11-2.77, family history of substance use aOR: 3.07, 95% CI 1.57-6.01, and having close friends´ pressure aOR: 5.77, 95% CI 2.39-13.89 were significantly associated with substances use among high school students. the prevalence of substance use among high school students was high. Being male, family history of substance use, and having peer pressures were strongly associated with substance use.

A cross-sectional study of sociodemographic profile, availability, pattern of use, and service utilization by opioid users in a tertiary care hospital

Background: The menace of substance abuse is not only socially unacceptable but also emerging as a major public health challenge in many States of India, including Rajasthan. Aims: The aim of this study is to study the sociodemographic profile, pattern of use, availability of opioids, and process of seeking treatment services for opioid dependence. Subjects and Methods: After ethical clearance, a cross-sectional observational study was carried out among those who fulfilled the screening criteria at a tertiary care hospital. A self-designed pro forma was used, which included a sociodemographic profile, drug use profile and pattern, behaviors and practices, service access, and the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Results were analyzed using SPSS version 22. Results: The mean age of the participants was 41.25 (±12.4) years. The majority (98.3%) were males, married (91.7%), illiterate (33.3%), farmers (61.7%), 45.7% lived in Bikaner District, and 83.3% lived in rural areas. Crude opium was the most common drug used in the lifetime of 98% of users. The most common comorbid substance used was tobacco, used by 75% of them. In 85% of cases, opioid drugs were purchased with their own legal earnings. The major reasons for starting opioid drugs were peer pressure (38.3%), to relieve pain/stress (25%), and to increase physical stamina for work (33.3%). The majority (73.3%) of them had utilized services for deaddiction purposes earlier. Conclusion: The rural population in Western Rajasthan was highly affected by opium dependence. Participants were mainly low-potency opioid users without significant impairment in socio-occupational functioning, and their use was mainly to relieve stress and pain and to increase work capacity.

Assist-linked brief intervention to reduce risky pattern of substance use in male workers employed at a tertiary care hospital in India: A randomized controlled trial.

Substance use in workplace leads to adverse effects both on the employees and on the workplace. Existing research focuses on alcohol-related harm, while workplace use of other substances has been neglected. There are no randomized controlled studies of brief interventions in Indian hospital settings. To evaluate the efficacy of World Health Organization (WHO) alcohol, smoking, and substance involvement screening test (ASSIST)-linked brief intervention (ALBI) for reducing risky patterns of substance use in male workers at a tertiary-care hospital in North India. The study was conducted in two phases. In Phase-I, a random list of 400 employees was generated from the entire pool of male hospital workers, of which 360 participated. Data on the ASSIST risk categories (mild, moderate, and high) were generated from Phase I. In Phase-II, moderate- or high-risk subjects ('ASSIST screen-positive') were randomized into intervention and control groups, with 35 screen-positive subjects in each group. The intervention group was provided a 15-30-min structured session per ALBI protocol, while the control group was given a 15-30-min general talk on health-related consequences associated with substance use. The subjects were compared on ASSIST score, WHO quality-of-life brief version (WHOQOL-BREF) and readiness to change questionnaire (RCQ) at baseline and at 3-month follow up. The prevalence of moderate-to-high-risk use of tobacco, alcohol, and cannabis in the total sample was 28.6%, 27.5%, and 6.9%, respectively. At 3-months postintervention follow-up of the randomized sample, recipients of ALBI had significant reduction of ASSIST scores for all substances compared to the control group (p < 0.001). More participants receiving ALBI were ready to change to RCQ action stage (p values for tobacco, alcohol, and cannabis <0.001, <0.001 and 0.007, respectively). WHOQOL-BREF scores significantly improved in ALBI group across all domains. ALBI was effective in reducing risky substance use, increasing readiness to change and improving the QOL of the subjects at workplace setting.

The Impact of Trauma Exposure on Mental Health Outcomes an Examination of Depression, Anxiety, and Substance use Disorders among Trauma Survivors

Background: The impact of trauma exposure on mental health outcomes has been extensively studied; however, there is a need for further investigation into the specific relationship between trauma exposure, depression, anxiety, and substance use disorders among trauma survivors. Aim: This study aims to examine the association between trauma exposure and negative mentalincluding depression, anxiety, and substance use disorders, among trauma survivors. Methods: The study employed a cross-sectional correctional design to study the relationship between trauma exposure, mental health, and substance use disorders. Trauma exposure is assessed using the Life Events Checklist for DSM-5 (LEC-5). Depression levels are measured using the Beck Depression Inventory-II (BDI-II), anxiety levels are assessed using the Beck Anxiety Inventory (BAI), and substance use and associated risk levels are evaluated using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Results: Correlation analysis revealed that trauma exposure is strongly correlated with depression (r = .965, p &lt; .01), anxiety (r = .851, p &lt; .01), and substance use scores, including tobacco (r = .624, p &lt; .01), alcohol (r = .654, p &lt; .01),] marijuana (r = .553, p &lt; .01), amphetamine (r = .300, p &lt; .01), and inhalant (r = .420,p &lt; .01). However, no significant correlation is found between trauma exposure and substance use types such as cocaine (r = .063, p &lt; .01), sedative (r = .029, p &lt; .01), hallucinogen (r = .068, p &lt; .01), and opioid (r = .032, p &lt; .01). Conclusion: The study provides evidence of a significant relationship between trauma exposure and negative mental= health outcomes, including depression, anxiety, and substance use disorders, among trauma survivors. These findings underscore the importance of addressing trauma exposure in therapeutic interventions to mitigate the risk of developing mental health disorders and substance abuse problems in individuals who have experienced trauma.

Factors associated with reduced function and quality of life among adult people with HIV with depression and substance use in the Asia-Pacific region.

Depression and substance use (SU) disorders are prevalent among people with HIV (PWH) and impact health outcomes despite successful antiretroviral therapy (ART). We explored quality of life, functional ability and associated factors among PWH screened positive for depression and/or SU. This cross-sectional study recruited adult PWH during routine follow-up at five HIV clinical sites in the Asia-Pacific region. Participants were screened for depression using Patient Health Questionnaire-9 and SU using Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Quality of life (QoL) was assessed with WHOQOL-HIV BREF and functional ability with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Factors associated with mean QoL and disability scores were analysed using linear regression. Of 864 PWH enrolled, 753 screened positive for depression or SU. The median (interquartile range, IQR) age was 38 (31-47) years and 97% were on ART. Overall mean WHOQOL-HIV BREF and WHODAS scores indicated greater impairment with increasing depressive symptom severity and SU risk. In multivariate analysis, PWH reporting previous trauma/stress (difference = 2.7, 95% confidence interval [CI] 1.5-3.9, P < 0.001) and past mental health diagnosis (difference = 5.0, 95% CI 2.9-7.1, P < 0.001) were associated with greater disability and poorer QoL scores across multiple domains ( P < 0.01 for all). Higher CD4 T-cell counts was also associated with better QoL scores and functional ability. PWH with depression/SU experienced poorer QoL and function despite routine engagement in HIV care. Efforts to integrate mental health services and interventions addressing disability into HIV management should be prioritized in the region.

TALKING ABOUT AT-RISK DRINKING WITH OLDER ADULTS AGING WITH HIV

Abstract Older adults living with HIV (OALWH) may have health conditions that amplify the negative health effects of alcohol use. Traditional alcohol screening tools do not consider comorbidities or age. We adapted the Comorbidity Alcohol Risk Evaluation Tool screening tool for at-risk drinking to reflect HIV-related conditions and medications. We tested a brief intervention with Black OALWH and collected usability data. Participants, n=27, 53.2 average age in years, 21 average years living with HIV. Three themes: (1) Expectations of doctors (“Doctors better ask me questions about my alcohol use...”); (2) It’s how you say it (“[Doctors] talk down to me like I don’t know my freaking disease …”); and (3) Effects of surviving HIV (“I am fully aware of the effects of alcohol…. I’m probably better informed than most people…”). We identified strategies to address at-risk drinking with OALWH.

A multiple baseline trial of adapted prolonged exposure psychotherapy for individuals with early phase psychosis, comorbid substance misuse, and a history of adversity: A study protocol.

Adversity is prevalent among people with psychotic disorders, especially those within the first 5 years of a psychotic disorder, called early phase psychosis. Although adversity can lead to many negative outcomes (e.g., posttraumatic stress symptoms), very few treatments for adversity-related sequelae have been tested with individuals with psychotic disorders, and even fewer studies have specifically tested interventions for people in early phase psychosis. Furthermore, people who misuse substances are commonly excluded from adversity treatment trials, which is problematic given that individuals with early phase psychosis have high rates of substance misuse. For the first time, this trial will examine the outcomes of an adapted 15-session prolonged exposure protocol (i.e., PE+) to observe whether reductions in adversity-related psychopathology occurs among people with early phase psychosis and comorbid substance misuse. This study will use a multiple-baseline design with randomization of participants to treatment start time. Participants will complete baseline appointments prior to therapy, engage in assessments between each of the five therapy modules, and complete a series of follow-up appointments 2 months after the completion of therapy. Primary hypothesized outcomes include clinically significant reductions in (1) negative psychotic symptoms measured using the Positive and Negative Syndrome Scale, (2) adversity-related sequelae measured using the Trauma Symptom Checklist-40, and (3) substance use frequency and overall risk score measured with the Alcohol, Smoking, and Substance Involvement Screening Test. We also anticipate that clinically significant reductions in hopelessness and experiential avoidance, measured with the Beck Hopelessness Scale and Brief Experiential Avoidance Questionnaire, the theorized mechanisms of change of PE+, will also be observed. A secondary outcome is a hypothesized improvement in functioning, measured using the Clinical Global Impression and Social and Occupational Functioning Assessment scales. The results of this treatment trial will contribute to the advancement of treatment research for individuals in early phase psychosis who have current substance misuse and a history of adversity, and the findings may provide evidence supporting the use of hopelessness and experiential avoidance as mechanisms of change for this treatment. Clinicaltrials.gov, NCT04546178; registered August 28, 2020, https://clinicaltrials.gov/ct2/show/NCT04546178?term=NCT04546178&draw=2&rank=1.

Remote Screening for Alcohol, Smoking, and Substance Involvement by Sex, Age, Lockdown Condition, and Psychological Care-Seeking in the Primary Care Setting during the COVID-19 Pandemic in México.

The COVID-19 pandemic has created a psychoactive substance use crisis in many countries, including México. Remote valid tools to identify high-risk groups in need for treatment are a prerequisite for cost-effective interventions in primary care settings. To determine the validity and correlates of the remote applications of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) with sex, age, and psychological care-seeking, offered remotely in primary settings, during the COVID-19 pandemic in Mexico, a total sample of 19,109 Mexicans, with an average age of 34.38years (SD = 12.28, range = 18-80), 65.8% of whom were women (n = 12,578), 29.6% in lockdown (5,660), 39.8% in partial lockdown (7,611), 30.60% not in lockdown (5,838), and 14.75% of whom were seeking psychological care (n = 2,819), completed ASSIST through a programmed Web application. The dimensionality of the scale to verify construct validity evidence was achieved through a confirmatory factor analysis model (CFA). We represented the distribution of subjects by sex, age, lockdown condition, and psychological care-seeking, based on their lifetime consumption in 2021. We also compared the total distribution by consumption risk level and recommended type of intervention, psychological care-seeking, and age. The tool included ten dimensions (one for each substance, such as tobacco use), confirmed through the CFA. In general, our findings indicated that men reported high lifetime psychoactive substance use and risky drug use levels. A high percentage of 18 to 19-year-old women reported lifetime tobacco and alcohol use. Additionally, a high number of all-age women reported lifetime sedative and opioid use. Also, a high proportion of partially lockdown participants reported lifetime drug use. Moreover, a high percentage of subjects seeking psychological care were at a moderate and high risk of drug use, which required brief or intensive treatment. Our findings indicate that it was possible to validate the factor structure of the programmed ASSIST for remote use. More men than women reported high lifetime psychoactive substance use and risky levels because of their consumption. At the same time, younger women reported similar and even higher lifetime tobacco, alcohol, and cocaine use than same-age men. More all-age women reported lifetime use of sedatives than all-age men. More all-age partially lockdown participants reported lifetime use of drugs. In general, subjects at greater risk and those requiring psychological care are more likely to seek care. Community and primary care screening will make it possible to implement effective early interventions to reduce the substance use risks associated with health emergencies. Future studies are required to determine the diagnosis of substance use disorders to evaluate the cut-off points in the screening test to discriminate between the presence and absence of symptoms and evaluate the effect of remote psychological care.

Factorial Structure and Diagnostic Accuracy of a Digital Version of the Alcohol Use Disorders Identification Test (d-AUDIT) to Detect Hazardous and Problematic Drinking in Primary Care.

We studied the factorial structure and diagnostic performance in primary care of a digital version of the Alcohol Use Disorders Identification Test (d-AUDIT) for screening for excessive drinking. In two primary care centers in Santiago, Chile, we conducted a cross-sectional study involving 330 people 18 years of age or older who had drunk alcohol six or more times in the last year. The d-AUDIT was developed from the paper version validated in Chile and was self-administered on 7-inch tablets. Trained psychologists evaluated the participants using a 1-year Timeline Followback and the alcohol use disorders section from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We used confirmatory factorial analysis to examine the structure of the d-AUDIT and areas under the receiver operating characteristic curves (AUCs) to examine the diagnostic performance of the d-AUDIT. A two-factor model presented good overall fit, with item loads in the 0.53-0.88 range. The correlation among factors was .74, reflecting a good discriminant validity. The total score and the Fast Alcohol Screening Test (FAST) score (i.e., bingeing, role failure, blackouts, and others' concern items) obtained the best diagnostic performance for problematic drinking, with AUCs of 0.94 (CI [0.91, 0.97]) and 0.92 (CI [0.88, 0.96]), respectively. The FAST could differentiate hazardous drinking (cut point three in men and one in women) from problematic drinking (cut point four in men and two in women). We replicated prior factor analysis findings of a two-factor structure for the d-AUDIT with a good discriminant validity. The FAST obtained excellent diagnostic performance and retained some ability to discriminate between hazardous and problematic drinking.