Screening For At-Risk Alcohol Use Research Articles

Effectiveness of a web-based screening and brief intervention with weekly text-message-initiated individualised prompts for reducing risky alcohol use among teenagers: study protocol of a randomised controlled trial within the ProHEAD consortium

BackgroundEarly and excessive alcohol use is a significant threat to healthy development. Evidence supports the effectiveness of electronic alcohol interventions for young drinkers. However, effects are typically small and studies targeting under 18-year-olds are scarce. This trial is the first to evaluate the effectiveness of a single-session, brief, motivational, web-based intervention (ProWISE) plus weekly text-message-initiated individualised prompts (TIPs) in reducing alcohol consumption and alcohol-related harm among children and adolescents aged ≥ 12 years. TIPs are designed to decrease risky alcohol use by reaching youth in the contexts of their everyday lives and by providing individualised feedback on drinking intentions, actual drinking and succession in achieving personal goals for low-risk drinking or abstinence.Methods/DesignThe trial is part of the multicentre consortium ProHEAD testing e-interventions for mental health problems in children and adolescents. Participants in grades 6–13 aged ≥ 12 years will be recruited in schools which participate in ProHEAD (target N = 15,000). Main criterion for inclusion in the ProWISE-TIP trial is a positive screening for at-risk alcohol use in the CRAFFT-d questionnaire (target n = 1076). In a multicentre, four-arm, randomised controlled design the following groups will be compared: (A) web-based intervention plus TIPs for 12 weeks; (B) web-based intervention plus text-message-initiated assessment of alcohol consumption for 12 weeks; (C) web-based intervention only; and (D) alcohol-related psychoeducation. TIPs will be delivered shortly before and after high-risk situations for excessive alcohol use and will be tailored to age, gender, drinking motives and alcohol consumption. Study participants will be followed up at three, six and nine months in the ProWISE-TIP trial and at one and two years in the ProHEAD consortium. Primary outcome is alcohol use in the past 30 days at nine months after enrolment. Secondary outcomes are alcohol-related problems, co-occurring substance use, health service utilisation, mental health problems and quality of life.DiscussionTrial results will generate important evidence on how to enhance effectiveness of single-session, web-based alcohol interventions for youth. The ProWISE-TIP intervention, if effective, can be used as a stand-alone alcohol intervention or as an add-on to school-based or community-based alcohol prevention programs.Trial registrationGerman Clinical Trials Register, DRKS00014606 Registered on 20 April 2018.

Screening Women for At-Risk Alcohol Use: An Introduction to Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Women's Health.

A significant number of women engage in at-risk drinking behavior, or heavy alcohol use. Women are especially at risk for the negative impact of excessive alcohol consumption secondary to gender differences in body structure, chemistry, and alcohol absorption. In addition, women who drink alcohol during pregnancy risk fetotoxic effects. Screening for at-risk alcohol use is considered best practice during primary care and prenatal care visits and is an integral component of preventive care services for women. The purpose of this brief report is to introduce the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model as it applies to alcohol use and its importance in women's health care services. SBIRT resources are evidence based, allowing the clinician to screen for use of alcohol, implement a brief intervention, and conduct referral to treatment, if necessary. Implementing SBIRT improves recognition of at-risk alcohol use or alcohol use disorder, facilitates awareness and education about use, enhances the referral-to-treatment process, and decreases overall health care costs.

Screening for At-Risk Alcohol Consumption in Primary Care: A Randomized Evaluation of Screening Approaches.

The aim of the study was to explore the relative efficiency and effectiveness of targeted versus universal screening for at-risk alcohol use in a primary care population in the UK. The study was a randomized evaluation of screening approach (targeted versus universal) for consecutive attendees at primary care aged 18 years or more. Targeted screening involved screening any patient attending with one of the targeted presentations, conditions associated with excessive alcohol consumption: mental health, gastrointestinal, hypertension, minor injuries or a new patient registration. In the universal arm of the study all presentations in the recruitment period were included. Universal screening included all patients presenting to allocated practices. A total of 3562 potential participants were approached. The odds ratio of being screen positive was higher for the targeted group versus the universal group. Yet the vast majority of those screening positive in the universal group of the study would have been missed by a targeted approach. A combination of age and gender was a more efficient approach than targeting by clinical condition or context. While screening targeted by age and gender is more efficient than universal screening, targeting by clinical condition or presentation is not. Further universal screening is more effective in identifying the full range of patients who could benefit from brief alcohol interventions, and would therefore have greater public health impact. Current Controlled Trials ISRCTN06145674.

Screening for At-Risk Alcohol Use in Older Adults: What Progress Have We Made?

About one in every seven Americans is an older adult (13.7%). Almost half (41.7%) of this population reported current alcohol use in 2013 with a little more than 1 in 10 (11.2%) reporting at-risk use of alcohol, placing them at risk for adverse consequences associated with alcohol use such as injury, use of alcohol-interactive medications, and use of alcohol contraindicated in other comorbid medical and psychiatric diagnoses, underlying the importance of having reliable and valid methods to screening for at-risk alcohol use in older adults. The question is, "are we making progress in this area?". The purpose of this review is to present two publications, a decade apart, focused on systematically screening older adults to prevent or reduce the harms associated with alcohol use. In addition, this review includes an examination of the shift from focusing on identifying older adults with a possible alcohol use disorder to identifying alcohol-related health risks across the continuum of use in older adults.

Residents' knowledge of standard drink equivalents: Implications for screening and brief intervention for at‐risk alcohol use

Screening and brief intervention for reducing alcohol consumption has been demonstrated to be effective in various medical settings. The NIAAA has recommended that physicians screen all patients for at-risk and problem drinking. Often, screening is based on the concept of a "standard drink." We administered a survey to residents (N=270) in order to assess their knowledge of standard drink equivalents and quantities of alcohol in various sizes of bottles. Although 89% of the responders stated that they had previously learned about screening for at-risk alcohol use, the majority did not know basic facts about standard drink equivalents. Many trainees are not familiar with typical standard drink equivalents. This can have a significant impact on the screening of patients for problem drinking using screening tools that rely on standard drink equivalents.

Screening for At-Risk Alcohol Use and Drug Use in an Emergency Department: Integration of Screening Questions Into Electronic Triage Forms Achieves High Screening Rates

Previous studies have shown that brief interventions for at-risk alcohol and drug use are significantly more likely to occur if patients are screened with a standardized, validated instrument, but high screening rates have traditionally been difficult to attain. Use of very brief screens can enable brief intervention specialists to focus their efforts on assessing and assisting patients most likely to need a brief intervention or more intensive treatment. This study describes the results of integrating brief substance abuse screens into an urban emergency department's (ED's) triage process. As part of a comprehensive initiative to increase alcohol and drug screening, brief intervention, and referral to treatment (SBIRT), 3 single-item screening questions were programmed into the electronic triage tool used in the ED to detect tobacco use, at-risk alcohol use, illicit drug use, or prescription drug misuse. Project staff conducted training sessions with nurses to ensure the questions were asked properly and ED supervisors provided ongoing performance feedback. Names of patients with positive responses to the alcohol or drug questions automatically populated a list forwarded to health education specialists, who provided assessments, brief interventions, and referrals. Screening was conducted with 145,394 of 151,597 eligible patients, a 96% screening rate. Electronic reports revealed an 89% screening rate 30 days postimplementation and gradually increasing and stabilizing at approximately 97%. The overall percentage of patients screening positive for alcohol or drug use was similar to that of other ED-based studies (22%) but varied substantially by patient demographics. High rates of screening can be achieved if properly integrated into a clinical setting's existing patient care processes with well-planned information technology support.