Unhealthy Drug Research Articles

The spectrum of unhealthy drug use and quality of care for hypertension and diabetes

Background Addiction is associated with medical consequences, due to direct drug effects, poor adherence to health-care recommendations, and poor quality of care. But little is known about how the spectrum of illicit drug use in primary care patients affects quality of medical care measures for chronic conditions. The objectives of this study were to determine the association between drug use (drug, frequency of use, and severity) and quality measures indicating failure to meet criteria for good blood pressure (BP) and blood glucose (BG) control among primary care patients identified by screening as using illicit drugs who also have hypertension and/or diabetes. Materials and methods The study population was adult patients presenting for primary care visits in an urban, safety-net hospital with recent illicit drug use or prescription drug misuse identified by screening and either hypertension or diabetes mellitus. The outcomes were failure to control: a blood pressure (primary), defined as systolic BP of 140 or higher or diastolic BP of 90 or higher, and b) blood glucose (secondary), defined as hemoglobin A1c of 8 percent or higher (National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data and Information Set [HEDIS] measures). Main independent variables were: days of drug use in the past month; drug type (i.e., opioid, cocaine, marijuana); and severity of use (Alcohol, Smoking and Substance Involvement Screening Test global drug risk score (tertiles). We fit separate longitudinal logistic regression models for each measure of drug use and each outcome.

Recreational Drug Use and Fluctuating Asymmetry: Testing the Handicap Principle

Zahavi's handicap principle suggests that only organisms with good genetic quality can afford to engage in costly behaviors. Recreational drug use can be harmful to one's health and therefore might be viewed as a costly signal of one's genetic quality. One of the measurements of genetic quality is bodily symmetry assessed by fluctuating asymmetry. If unhealthy drug use is a behavioral example of Zahavi's handicap principle, then men who use different stimulants or recreational drugs should be more symmetrical than men who do not use them at all or use them only in low quantity. The aim of this study was to examine the relationships between drug use and fluctuating asymmetry. The subjects were 190 young women and 202 young men. Six bilaterally symmetrical traits were measured: length of II-V digits, wrist breadth, and ear height. Questionnaires included questions about smoking, alcohol drinking, drug use, and designer drug use. There was no relationship between bodily symmetry and smoking frequency, alcohol drinking frequency, drug or designer drug use, total substance use, age of smoking initiation, or reason of this initiation. The results indicate that drug use does not reflect genetic quality and does not necessarily relate to the handicap hypothesis.

Screening and brief intervention for unhealthy drug use: little or no efficacy.

Unhealthy drug use ranges from use that risks health harms through severe drug use disorders. This narrative review addresses whether screening and brief intervention (SBI), efficacious for risky alcohol use, has efficacy for reducing other drug use and consequences. Brief intervention among those seeking help shows some promise. Screening tools have been validated though most are neither brief nor simple enough for use in general health settings. Several randomized trials have tested the efficacy of brief intervention for unhealthy drug use identified by screening in general health settings (i.e., in people not seeking help for their drug use). Substantial evidence now suggests that efficacy is limited or non-existent. Reasons likely include a range of actual and perceived severity (or lack of severity), concomitant unhealthy alcohol use and comorbid mental health conditions, and the wide range of types of unhealthy drug use (e.g., from marijuana, to prescription drugs, to heroin). Although brief intervention may have some efficacy for unhealthy drug users seeking help, the model of SBI that has effects in primary care settings on risky alcohol use may not be efficacious for other drug use.

Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial.

The United States has invested substantially in screening and brief intervention for illicit drug use and prescription drug misuse, based in part on evidence of efficacy for unhealthy alcohol use. However, it is not a recommended universal preventive service in primary care because of lack of evidence of efficacy. To test the efficacy of 2 brief counseling interventions for unhealthy drug use (any illicit drug use or prescription drug misuse)-a brief negotiated interview (BNI) and an adaptation of motivational interviewing (MOTIV)-compared with no brief intervention. This 3-group randomized trial took place at an urban hospital-based primary care internal medicine practice; 528 adult primary care patients with drug use (Alcohol, Smoking, and Substance Involvement Screening Test [ASSIST] substance-specific scores of ≥4) were identified by screening between June 2009 and January 2012 in Boston, Massachusetts. Two interventions were tested: the BNI is a 10- to 15-minute structured interview conducted by health educators; the MOTIV is a 30- to 45-minute intervention based on motivational interviewing with a 20- to 30-minute booster conducted by master's-level counselors. All study participants received a written list of substance use disorder treatment and mutual help resources. Primary outcome was number of days of use in the past 30 days of the self-identified main drug as determined by a validated calendar method at 6 months. Secondary outcomes included other self-reported measures of drug use, drug use according to hair testing, ASSIST scores (severity), drug use consequences, unsafe sex, mutual help meeting attendance, and health care utilization. At baseline, 63% of participants reported their main drug was marijuana, 19% cocaine, and 17% opioids. At 6 months, 98% completed follow-up. Mean adjusted number of days using the main drug at 6 months was 12 for no brief intervention vs 11 for the BNI group (incidence rate ratio [IRR], 0.97; 95% CI, 0.77-1.22) and 12 for the MOTIV group (IRR, 1.05; 95% CI, 0.84-1.32; P = .81 for both comparisons vs no brief intervention). There were also no significant effects of BNI or MOTIV on any other outcome or in analyses stratified by main drug or drug use severity. Brief intervention did not have efficacy for decreasing unhealthy drug use in primary care patients identified by screening. These results do not support widespread implementation of illicit drug use and prescription drug misuse screening and brief intervention. clinicaltrials.gov Identifier: NCT00876941.

Screening and Brief Intervention and Referral to Treatment for Drug Use in Primary Care

The use of drugs other than alcohol is a leading cause of fatal injury in the United States, accounting for more than 40 000 deathsperyear.1 Increases intherateofdrug-attributabledeaths over the past 2 decades have beenfueledbyoverdosesof illicitlyusedprescriptiondrugs (such as opioids and sedatives, sometimes in combination with alcohol). In 2011, an estimated 1 280 134 hospitalizations were related to drug overdosesnationwide,ofwhich1 021 563 (80%) involveddrugsonly and258 571 (20%) involveddrugs incombinationwithalcohol.2 National roadside research surveys have detected more drivers on roads after using drugs than alcohol,3 and severalmetaanalyses indicate that fatal trafficcrashrisksofdriverswhohave simultaneously used drugs and alcohol exceed the fatal crash risk of driving after either alone.4,5 In addition, marijuana use has increased in the past decade,6,7 perhaps accelerated by legalizationofmedicalmarijuanain22statesandWashington,DC, and legalization of recreational use by Colorado andWashington State. These public health trends underscore the need for continuing research to develop effective interventions for unhealthy drug use, and the emphasis on primary care in health care system reforms suggests that approaches to identify and effectively intervenewith patients exhibiting risky patterns of drug use should be evaluated in a variety of clinical settings. A substantial number of experimental studies have indicated that screeningandbriefnegotiated intervention (BNI) are effective inadultprimarycare inreducingriskyalcoholmisuse.8 Other research, such as a study of illicit drug screening and intervention for adults in anurgent care setting9 andanobservational study of screening and interventions in a broad array of generalmedical settings,10havesuggested thatBNImayalsobe effective in helping patients reduce their use of illicit drugs. A large multicenter international study showed overall significanteffects inprimarycare,althoughnosignificanteffectswere identifiedwhentheUSsiteswereexaminedseparately.11 Buildingonthesestudies, this issueofJAMA includesreports12,13 from 2well-designedandimplementedrandomizedclinical trials that foundscreeningandbrief interventions ingeneralmedical settings were not effective for reducing drug use. In a 3-group randomized trial, Saitz et al12 tested the efficacyof2briefcounseling interventions for illicitdruguseorprescription drug misuse. Adult primary care patients with Alcohol,Smoking,andSubstanceInvolvementScreeningTestscores of 4 or greaterwere studied (N = 528). The authors compared a 15-minute BNI and a 30to 45-minute adaption of motivational interviewing (MOTIV) and a booster with no brief intervention. The BNI included motivational interviewing feedback, review of “pros” and “cons” of use, and development of plans forchange.TheMOTIVinterventionelicitedpossible links betweendruguseandhealth concerns, highlighteddiscrepanciesbetweennegativedruguseoutcomesandvaluedgoals, enhanced self-efficacy about behavior change, and provided options for change. At intake, the reported main drug use was marijuana (63%), cocaine (19%), andopioids (17%), andboth interventionsaddressedalcohol in the15%forwhomitwasaconcern. In addition, all patients received a written list of substance use disorder treatment andmutual help resources. At the6-month follow-up, therewereno significantdifferences between groups inmeanmain drug use days in the past month, inanydruguse,or in riskofdrugdependence.Norwere there significant differences in drug use consequences, injectiondruguse, unsafe sex, hospitalizations, emergencydepartmentvisits, ormutualhelp attendance. Lackof effectwas consistent regardless of drug used, severity, alcohol use, and substance-relatedhealthcondition.Theauthorsconcludedthat if other trials yield consistent results, widespread implementation of drug screening and brief interventionwith referral to treatment should be reconsidered. Of note, contrary to many studies on alcohol screening and brief intervention, there was notareduction inheavydrinking.This raises thepossibility that drugandalcohol-using, single, low-incomepatientswithhigh unemployment and comorbidities may benefit less from BNI. In another study in this issue, Roy-Byrne et al13 randomized 868 adult (age ≥18 years) primary care patients in 7 safetynet clinics to receive enhanced care as usual or a brief 30minute intervention and booster within 2 weeks providing feedback on drug use, discussing pros and cons of use, raising participant confidence in being able to change, and presenting options for change. Patients in both groups received a handout depicting their drug problem, severity score, and a list of substance abuse treatment resources. The authors identified and trackedpast30-dayuseof themost frequentlyuseddrug,aswell as chemicaldependence treatment records, statealcohol arrest records,andin-patienthospitalizationanddeathrecords. Inboth groups, follow-up at 3, 6, 9, and 12monthswasmore than87%. During follow-up, therewerenosignificantdifferencesbetween the2 studygroupsondaysofdruguse,AddictionSeverity Indexdruguse,oranysecondaryoutcomesoradmissions to chemicaldependency.Bothgroupsreduceddrugusefrequency Related articles pages 492 and 502 Opinion

Incorporating Screening, Brief Intervention, and Referral to Treatment Into Emergency Nursing Workflow Using An Existing Computerized Physician Order Entry/Clinical Decision Support System

The objective of this study was to evaluate whether screening, brief intervention, and referral to treatment (SBIRT) could be incorporated into the emergency nursing workflow using a computerized physician order entry/clinical decision support system. We report demographic and operational factors associated with failure to initiate the protocol and revenue collection from SBIRT. We conducted a retrospective, observational cohort analysis of a protocol adding SBIRT to the emergency nursing workflow of a single, tertiary care urban emergency department for all adult patient visits in 2012. Emergency nurses prescreened for unhealthy alcohol or drug use during triage assessment and, when positive, administered SBIRT during treatment area care, all documented in the computerized physician order entry/clinical decision support system. Using multivariable logistic regression, we report demographic and operational factors associated with failure to initiate the protocol. From October 2012, we submitted charges for brief interventions and analyzed collection results. The inclusion criteria were met for 47,693 visits. Of these, 39,758 (83.4%) received triage protocol initiation. Variables associated with decreased odds of protocol initiation were younger age (odds ratio [OR] for rising age, 1.044; 95% confidence interval [CI], 1.042-1.045), arrival by ambulance (OR, 0.37; 95% CI, 0.35-0.40), and higher triage acuity (OR, 0.08; 95% CI, 0.07-0.09). Of visits with protocol initiation, 21.4% were documented as positive for at-risk alcohol and/or drug use. However, brief interventions were only administered during 971 visits. During the billing period, $3617.53 was collected on charges of $10,829.15 for 262 completed brief interventions. In this study electronic documentation of adults with at-risk alcohol and/or drug use was feasible by emergency nurses, but SBIRT execution and subsequent revenue collection were challenging.

Physician Detection of Unhealthy Substance Use on Inpatient Teaching and Hospitalist Medical Services

Background: Screening, brief intervention, and referral to treatment for substance use depends on reliable identification. The goal of this study was to determine the rate of detection of unhealthy substance use by physicians on teaching and nonteaching medical services at a community teaching hospital. Methods: This cross-sectional study was conducted from February to June 2009. All new medicine admissions to the Teaching Service or the nonteaching Hospitalist Service were assessed for unhealthy substance use using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and Drug Abuse Screening Test (DAST). All patients identified with substance use completed the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Medical record review was also performed to assess physician documentation. Results: Of 442 eligible patients, 414 consented to participate. Patients on the Teaching Service were more likely to be male, younger, unmarried, non-white, uninsured or receiving publicly funded insurance, and current smokers (p < .01 for all comparisons). Overall, the detection rate for unhealthy substance use was 64.3% (63 of 98 confirmed cases), with service-specific rates of 73.4% for the Teaching Service, compared with 47.1% for the Hospitalist Service (p = .011). ICD-9 coding accounted for 53.1% of identified cases on the Teaching Service and 14.7% of identified cases on the Hospitalist Service (p < .001). Assignment to the Hospitalist Service, being married, and isolated unhealthy drug use were independently associated with decreased physician detection rates. Conclusions: Our study suggests that unhealthy substance use is more likely to be detected on a Teaching Service than on a Hospitalist Service.

Screening and brief intervention (SBI): has it hit the tipping point?

In 1961, Chafetz [1] reported the results of a randomized trial of brief advice by a psychiatrist to patients with alcoholism in the Massachusetts General Hospital (MGH) emergency department (ED); 42% of patients in the advice arm reported to an alcohol clinic versus only 1% in the control group. Fifty years later, in the Liberty Hotel, the same space as the former Charles Street Jail in Boston where there was a “drunk tank” and across from that same MGH ED, over 200 researchers and clinicians gathered to present over 100 abstracts and plenary sessions on screening and brief intervention (SBI). In those 50 years, thousands of patients participated in randomized trials of SBI; the US Institute of Medicine (in 1990) encouraged identification and intervention for unhealthy alcohol use for people across the spectrum from risky use through dependence; the World Health Organization validated assessment tools and showed SBI’s effectiveness in primary care settings; and the US Substance Abuse and Mental Health Services Administration allocated substantial funding for SBI for both alcohol and other drugs across many general health settings. Research presented at the September 2011 International Network on Brief Interventions for Alcohol and Other Drugs (INEBRIA) conference in Boston was from around the globe, covered alcohol and other drugs, crossed a variety of health settings and practitioners, and showed the sophistication that has been reached in the field. Research discussed when, where, and for whom SBI has or might not have efficacy, how to implement SBI programs, adaptations of SBI, costs and effectiveness, and many other topics. Nonetheless, despite the excitement, breadth, and sophistication, the fact remains that few patients eligible for SBI receive the service, and, as a result, opportunities to improve health and save health care costs are missed. Most people with alcohol and drug use disorders receive no treatment. At least in some cases, SBI is ready for dissemination. And, with solid evidence available, health reforms promised in the US and elsewhere, and an international discussion taking serious shape regarding the integration of care for medical, mental health, and substance use conditions, SBI may have reached a tipping point for dissemination and implementation as well as for small- and large-scale studies of remaining efficacy and effectiveness questions. The editors of ASCP invited INEBRIA attendees and presenters to submit their studies for peer review and possible publication. The initial core of this thematic series, “Screening and brief intervention for unhealthy alcohol and other drug use,” is the result of that call for papers, a seed that we expect will grow as the SBI literature continues to become more robust. Papers will cover a range of topics from what the efficacy of SBI really is, to effectiveness in people with mental health and drug use conditions, to adolescent SBI, to health professional attitudes towards SBI, to SBI implementation research and even to state-of-the-art SBI research protocol design, among others. We hope this series begins a long and serious conversation.

Science to improve care for people affected by unhealthy alcohol and other drug use

The last 20 years have brought two major changes in the field of addiction. First, the US Institute of Medicine (IOM) encouraged recognition of a spectrum of alcohol and other drug use that affects health and is not limited to those with the highest severity [1]. Unhealthy use (the spectrum from use that risks consequences through addiction [2]) among those without addiction is much more common than addiction itself. The second major shift also began in the 1990s with an emphasis on addiction as a chronic illness [3,4] and on unhealthy use as a health condition.

Screening and Brief Intervention for Unhealthy Drug Use in Primary Care Settings: Randomized Clinical Trials Are Needed

The efficacy of screening and brief intervention (SBI) for drug use in primary care patients is largely unknown. Because of this lack of evidence, US professional organizations do not recommend it. Yet, a strong theoretical case can be made for drug SBI. Drug use is common and associated with numerous health consequences, patients usually do not seek help for drug abuse and dependence, and SBI has proven efficacy for unhealthy alcohol use. On the other hand, the diversity of drugs of abuse and the high prevalence of abuse and dependence among those who use them raise concerns that drug SBI may have limited or no efficacy. Federal efforts to disseminate SBI for drug use are underway, and reimbursement codes to compensate clinicians for these activities have been developed. However, the discrepancies between science and policy developments underscore the need for evidence-based research regarding the efficacy of SBI for drug use. This article discusses the rationale for drug SBI and existing research on its potential to improve drug-use outcomes and makes the argument that randomized controlled trials to determine its efficacy are urgently needed to bridge the gap between research, policy, and clinical practice.

Integrating Project ASSERT: A Screening, Intervention, and Referral to Treatment Program for Unhealthy Alcohol and Drug Use Into an Urban Emergency Department

The objective was to evaluate the effects of Project Alcohol and Substance Abuse Services Education and Referral to Treatment (ASSERT), an emergency department (ED)-based screening, brief intervention, and referral to treatment program for unhealthy alcohol and other drug use. Health promotion advocates (HPAs) screened ED patients for alcohol and/or drug problems 7 days a week using questions embedded in a general health questionnaire. Patients with unhealthy drinking and/or drug use received a brief negotiation interview (BNI), with the goal of reducing alcohol/drug use and/or accepting a referral to a specialized treatment facility (STF), depending on severity of use. Patients referred to an STF were followed up at 1 month by phone or contact with the STF to determine referral completion and enrollment into the treatment program. Over a 5-year period (December 1999 through December 2004), 22,534 adult ED patients were screened. A total of 10,246 (45.5%) reported alcohol consumption in the past 30 days, of whom 5,533 (54%) exceeded the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for low-risk drinking. Use of at least one illicit drug was reported by 3,530 patients (15.7%). Over one-fourth of screened patients received BNIs (6,266, or 27.8%). Of these, 3,968 (63%) were referred to an STF. Eighty-three percent of patients were followed at 1 month, and 2,159 (65%) had enrolled in a program. Patients who received a direct admission to an STF were 30 times more likely to enroll than those who were indirectly referred (odds ratio = 30.71; 95% confidence interval = 18.48 to 51.04). After 3 years, funding for Project ASSERT was fully incorporated into the ED budget. Project ASSERT has been successfully integrated into an urban ED. A direct, facilitated referral for patients with alcohol and other drug problems results in a high rate of enrollment in treatment programs.

Caracterización de estudiantes de la carrera de enfermería sobre consumo de drogas lícitas e ilícitas

Se trata de un estudio cuantitativo, descriptivo y transversal que buscó caracterizar el uso de drogas entre estudiantes del segundo año de la carrera de Licenciatura en Enfermería. Se aplicó un cuestionario autoadministrado a 119 estudiantes, el que se dividió en información: general, sociodemográfica, económica, personal, familiar, sociocultural y, sobre el consumo de drogas. El estudio evidenció que los estudiantes poseen factores protectores para la prevención del consumo o el avance del uso problemático de drogas; pero, por otro lado poseen también factores de riesgo importantes que deben ser tomados en cuenta en programas de prevención, por ejemplo: estilos de vida no saludables, consumo de drogas de personas cercanas a ellos (familiares, amigos o compañeros). A pesar de que el alcohol y tabaco ocupan el primer lugar de consumo, tanto en el entorno inmediato del grupo de estudiantes seleccionados como en el ámbito nacional, ellos no lo consideran un problema tan grande si comparado con las drogas ilícitas.

Sustainable Play

This article suggests a revisit of the New Games movement, formed by Stewart Brand and others in the early 1970s in the United States as a response to the Vietnam War, against a backdrop of dramatic social and economic change fueled by a looming energy crisis, civil rights, feminism, and unhealthy widespread drug abuse. Like-minded contemporaries R. Buckminster Fuller (World Game), Robert Smithson (Spiral Jetty), and Christo and Jean-Claude (Valley Curtain) responded in kind to these environmental and sociopolitical quandaries with their “earthworks.” As digital game designers and theorists embark on developing new methods to address the creative crisis in mainstream game production, against a similar backdrop of global climate change, a controversial war, political upheaval, and complex gender issues, the authors propose a reexamination of the New Games movement and its methods as a means of constructing shared contexts for meaningful play in virtual and real-world spaces.

Unhealthy drug donations

Unhealthy drug donations

YOUNG WOMEN'S DISORDERED EATING AND DRUG USE: DO MIDDLE AND HIGH SCHOOL STUDENTS DIFFER? 1668

Adolescent girls have a high prevalence of disordered eating and use of laxatives and diuretics. The natural history of the development of these behaviors is not well defined. We surveyed 867 middle and 1218 high school aged female adolescents, using a 118-item questionnaire. Our survey combined established correlates of disordered eating and drug use with risk factors in the domains of personal variables: knowledge, skills, beliefs, psychological factors and demographics; peer effects; and non-peer influences of parents, media and society. Middle and high school groups were similar on many items: prevalence use of tobacco, alcohol, cocaine, diet pills and self-induced vomiting; use of diet supplements and vitamins; and intent toward future disordered eating and drug use. The younger girls, however, had less knowledge of adverse effects from disordered eating and drug use (p<0.001), lower perceived prevalence of these behaviors among peers (p<0.001), less belief in the media (p<0.001) and less belief that smoking helps control weight(p<0.001). These findings of comparable prevalence rates for drug use and disordered eating are concerning and underscore the need for effective programs to combat these unhealthy behaviors at a young age. While prevention programs for high school girls may be too late to deter experimentation with unhealthy eating behaviors and drug use, for younger girls, certain critical knowledge items and attitudes are not yet firmly established. Including these items as components of a drug prevention program may result in interventions that effectively prevent initiation and continuation of disordered eating and drug use.