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CORK Bibliography: Assessment

82 citations. October 2007 to present

Prepared: September 2008

Alexander JA; Nahra TA; Lemak CH; Pollack H; Campbell CI. Tailored treatment in the outpatient substance abuse treatment sector: 1995-2005. Journal of Substance Abuse Treatment 34(3): 282-292, 2008. (41 refs.)

Interest in improving the quality of addiction treatment has led to the development of clinical paradigms that emphasize the principle of tailored care-matching treatments to the specific needs of each client or client subgroup. This work analyzes how trends in the provision of tailored treatment practices (TTPs) have changed between 1995 and 2005 across outpatient substance abuse treatment (OSAT) programs in the United States. Categories of interest include measures to capture needs assessment and treatment planning activities, treatment offerings for special populations, and case management activities. Results show that TTPs have diffused in an uneven fashion in the population of OSAT programs between 1995 and 2005. Specifically, needs assessment/treatment planning and case management remain a relatively common practice among OSAT programs, while treatment for special populations (especially same-race therapy) is less widely practiced and, indeed, experienced some decline over the study period. This trend is troublesome given that minority clients constitute a large proportion of those utilizing OSAT programs.

Bajaj JS; Hafeezullah M; Thompson A; Kia SA; Franco J; Anderson RC. Deception during psychological evaluation for liver transplant in alcoholic cirrhosis: A DUI corroboration study. (meeting abstract). Hepatology 46(4, Supplement S): 489A-490A, 2007. (0 refs.)

Barry DT; Bernard MJ; Beitel M; Moore BA; Kerns RD; Schottenfeld RS. Counselors' experiences treating methadone-maintained patients with chronic pain: A needs assessment study. Journal of Addiction Medicine 2(2): 108-111, 2008. (24 refs.)

Purpose: This study was designed to conduct a needs assessment concerning methadone counselors' experiences working with methadone-maintained patients with chronic pain and measure counselors' interest in receiving specialized training to treat such patients. Methods: A survey, developed by the authors, was administered to 25 counselors with a combined caseload of 956 patients at 3 opioid agonist treatment programs. Results: Patients with chronic pain comprised 27% of counselors' overall caseloads. Counselors believed that, on average, 46% of these patients' pain had a psychologic component and 56% exhibited continued drug use, which patients attributed to ongoing pain. Twenty-three counselors reported an interest in receiving specialized training in treating chronic pain. A variety of management issues, including monitoring the use of pain medications and providing pain management referrals, were reported. Conclusions: Findings from this needs assessment study suggest specific targets, which may be important to consider, in prospective specialized methadone maintenance treatment (MMT) counselor training and counseling for MMT patients with chronic pain.

Bernhardt JM; Usdan S; Mays D; Arriola KJ; Martin RJ; Cremeens J et al. Alcohol assessment using wireless handheld computers: A pilot study. Addictive Behaviors 32(12): 3065-3070, 2007. (11 refs.)

The present study sought to test the feasibility of measuring quantity and frequency of self-reported alcohol consumption among college students using the Handheld Assisted Network Diary (HAND) by comparing results to a retrospective Timeline Followback (TLFB). A total of 40 undergraduate college students completed a HAND assessment during the two-week study period and completed a TLFB at follow-up. The HAND recorded similar levels of alcohol consumption compared to the TLFB. There were no significant differences in overall alcohol consumption, drinks per drinking day, or heavy drinking days between the two methods of assessment. Handheld computers may represent a useful tool for assessing daily alcohol use among college students.

Bernstein E; Bernstein J. Effectiveness of alcohol screening and brief motivational intervention in the emergency department setting. (editorial). Annals of Emergency Medicine 51(6): 751-754, 2008. (24 refs.)

Best D; Day E; Cantillano V; Gaston RL; Nambamali A; Sweeting R et al. Mapping heroin careers: Utilising a standardised history-taking method to assess the speed of escalation of heroin using careers in a treatment-seeking cohort. Drug and Alcohol Review 27(2): 165-170, 2008. (24 refs.)

Introduction and aims. Although there has been increasing research attention to the concept of addiction careers and treatment careers, there are few standardised measures for assessing illicit drug using careers. A new instrument for mapping lifetime drug use history (LDUH) was used to assess transitions in the initial stages of heroin use careers among illicit drug users. Design and Methods. 58 lifetime heroin users completed a researcher-administered interview in treatment settings in two English cities, London and Birmingham, about their histories of drug use, drug treatment and other key life events. Results. The sample reported initiating heroin use at a mean age of 21 years and escalated to daily use by 23 years. On average, there was a gap of nearly 8 years before seeking treatment and at the time of interview the cohort averaged one-third of their heroin careers in treatment. However, there was marked variability across the group, with three discernible groups identified based on use patterns. While one group (n=21) showed consistent escalation in total quantity of heroin used across the first year, the second group had an intermittent pattern of use and the third group reported an unchanging monthly heroin use pattern. These groups differed in the time taken to initiate treatment and in the proportion of their heroin careers in active use. Discussion and Conclusions. The instrument was acceptable to research participants and identified important variability in onset and escalation factors in heroin careers. The implications for therapeutic interventions and for clinical use of the instrument are discussed.

Burrow-Sanchez JJ; Lopez AL; Slagle CP. Perceived competence in addressing student substance abuse: A national survey of middle school counselors. Journal of School Health 78(5): 280-286, 2008. (20 refs.)

BACKGROUND: Student substance abuse is a serious concern for middle school personnel. School counselors are most likely to deliver mental health services, including substance abuse, in school settings. However, limited research is available on the perceived competence of middle school counselors for addressing student substance abuse concerns. The main purpose of this study was to determine how middle school counselors perceive their training in 9 competence areas related to student substance abuse. A secondary aim of this study was to identify which training areas counselors indicate as being most needed to address student substance abuse. METHODS: A survey study was conducted that included a national sample of 283 middle school counselors. Analysis of variance was used to determine differences between 9 competency areas rated by counselors. Further analysis was conducted to determine which training areas were most important to counselors. RESULTS: Counselors varied in their perceived competence depending on the specific area of student substance abuse; however, they were clearly able to identify the most important areas of training needed. CONCLUSIONS: Overall, the findings from this study indicate that middle school counselors require more training in the area of student substance abuse. Specifically, this study provides information on the most important areas of training as identified by counselors.

Cacciola JS; Alterman AI; McLellan AT; Lin YT; Lynch KG. Initial evidence for the reliability and validity of a "Lite" version of the Addiction Severity Index. Drug and Alcohol Dependence 87(2/3): 297-302, 2007. (25 refs.)

Purpose: To evaluate the psychometric properties of a shortened version of the baseline ASI-5, the ASI-L-VA. Method: Two samples were recruited from intensive outpatient treatment and a methadone maintenance clinic. For Sample A (n = 145), two versions of the Addiction Severity Index (i.e., ASI-5 and ASI-L-VA) were administered several days apart in counterbalanced order by different interviewers. Sample B (n = 50) was similarly administered the standard ASI-5 twice. Results: For Sample A, the internal consistency (coefficient alphas) of I I of 19 summary scores derived from the ASI-5 were good, 4 fair, and 4 unacceptable. The results for the ASI-L-VA Summary scores indicated that eight were good, six fair, and five unacceptable. The correlations between ASI problem areas were generally low for both versions (supporting the independence of the ASI areas), and none of the t-tests comparing corresponding correlations between the ASI-5 and ASI-L-VA approached statistical significance. The Sample A intraclass correlation coefficient (ICC) results evaluating agreement of the summary scores derived from the ASI-5 at one timepoint and those derived from ASI-L-VA at another point (i.e., concurrent validity) revealed at least fair agreement in all but one instance. Additionally, a comparison of the ICC results for Samples A and B (i.e., ASI-L-VA/ASI-5 versus ASI-5/AST-5, respectively) revealed that in 13 of 26 cases the ICCs were at the same level of agreement. When level of agreement was discordant, in nine cases the ICCs comparing the ASI-5 and ASI-L-VA exhibited greater agreement and in four cases the ICCs comparing two ASI-5 administrations exhibited greater agreement. Conclusions: The ASI-L-VA, a reduced item set from the ASI-5, yielded similar information on problem severity as the standard ASI-5.

Chick J; Kemppainen E. Estimating alcohol consumption. (review). Pancreatology 7(2/3): 157-161, 2007. (29 refs.)

Alcohol use is one of the two main aetiologies of acute pancreatitis. Detection of excessive alcohol consumption is problematic, illustrated by the fact that self-reports of alcohol consumption account for only approximately 50% of the reported sales of alcohol. To improve the reliability, structured questionnaires and various biochemical markers have been developed to estimate alcohol consumption objectively. Further, the pattern of drinking and level of consumption within the past 2 weeks may alter the clinical picture of the acute pancreatitis. The aim of this paper is to remind the clinician of the importance of accurate and complete history, the need to document the actual alcohol consumption, pattern of drinking, clinical signs of alcoholism and to use biochemical tests and sometimes questionnaires.

Chinet L; Plancherel B; Bolognini M; Holzer L; Halfon O. Adolescent substance-use assessment: Methodological issues in the use of the Adolescent Drug Abuse Diagnosis (ADAD). Substance Use & Misuse 42(10): 1505-1525, 2007. (34 refs.)

During the past twenty years, various instruments have been developed for the assessment of substance use in adolescents, mainly in the United States. However, few of them have been adapted to, and validated in, French- speaking populations. Consequently, although increasing alcohol and drug use among teenagers has become a major concern, the various health and social programs developed in response to this specific problem have received little attention with regard to follow- up and outcome assessment. A standardized multidimensional assessment instrument adapted for adolescents is needed to assess the individual needs of adolescents and assign them to the most appropriate treatment setting, to provide a single measurement within and across health and social systems, and to conduct treatment outcome evaluations. Moreover, having an available instrument makes it possible to develop longitudinal and transcultural research studies. For this reason, a French version of the Adolescent Drug Abuse Diagnosis (ADAD) was developed and validated at the University Child and Adolescent Psychiatric Clinic in Lausanne, Switzerland. This article aims to discuss the methodological issues that we faced when using the ADAD instrument in a 4- year longitudinal study including adolescent substance users. Methodological aspects relating to the content and format of the instrument, the assessment administration and the statistical analyses are discussed.

Christopher S; Dunnagan T; Haynes G; Stiff L. Determining client need in a multi-state fetal alcohol syndrome consortium: from training to practice. Behavioral and Brain Functions 3: article 10, 2007. (25 refs.)

Background: A multi-state consortium was developed in the US to conduct baseline data collection and intervention research on fetal alcohol syndrome. Each state employed support specialists whose job it was to reduce or eliminate alcohol consumption in women who were at high risk for drinking alcohol during their pregnancy. The purpose of this paper is to report how support specialists in three primarily rural/frontier states were trained to assess client need and how client need was actually assessed in the field. Methods: A qualitative process evaluation was conducted using semi-structured interviews. Interviews were conducted with state staff involved in support specialist training and consortium activities and the support specialists themselves. Inductive analyses were conducted with interview data. Results: Need determination varied by state and for one state within the state. How support specialists were trained to assess need and how need was assessed in the field was mostly congruent. Conclusion: Process evaluation is an effective method for providing practical and useful answers to questions that cannot be answered by outcome evaluation alone.

Clifford PR; Maisto SA; Davis CM. Alcohol treatment research assessment exposure subject reactivity effects: Part I. Alcohol use and related consequences. Journal of Studies on Alcohol and Drugs 68(4): 519-528, 2007. (21 refs.)

Objective: There has been increasing recognition among alcohol treatment researchers that research assessment exposure subject reactivity effects can contribute to clinical outcomes, decrease study design sensitivity, and confound research findings. The present study is an experimental investigation of two of the more salient components of the research assessment interview (i.e., frequency and comprehensiveness) and their effects on clinical outcomes (Part I: Alcohol Use and Related Consequences) and treatment participation (Part 11: Treatment Engagement and Involvement). Method: The study design was a 2 (Frequency of Assessment) x 2 (Comprehensiveness of Assessment) completely randomized factorial, and study participants were randomly assigned, using an urn randomization procedure, to one of the resulting four experimental research assessment exposure conditions: (1) frequent-comprehensive, (2) frequent-brief, (3) infrequent-comprehensive, and (4) infrequent-brief. Study participants were recruited from one of two hospital-based outpatient alcohol- and other substance-abuse clinics. Two hundred thirty-five subjects were randomly assigned to one of the four research assessment exposure conditions. Results: Research assessment exposure subject reactivity effects were related significantly to alcohol use and related negative consequences, such that subjects assigned to the infrequent-brief research assessment exposure condition reported the poorest outcomes. Conclusions: The research protocols used to study alcohol treatments have clinical efficacy and can alter the outcomes (e.g., alcohol use) under investigation. It is important for researchers to control/account for subject reactivity effects when conducting alcohol treatment outcome trials. Accurate interpretation of data derived from clinical trials of alcohol treatments necessitates taking research assessment exposure subject reactivity effects into consideration.

Corrigan MJ; Loneck B; Videka L; Brown MC. Moving the risk and protective factor framework toward individualized assessment in adolescent substance abuse prevention. Journal of Child & Adolescent Substance Abuse 16(3): 17-34, 2007. (43 refs.)

The field of substance abuse prevention has evolved towards a risk and protective factor paradigm in explaining the onset and escalation of adolescent substance use. This framework for understanding the problem has been develo ed and employed by researchers at the University of Washington, Under Doctors Hawkins and Catalano, to assess communities for high-risk and low protection. Currently, there are no individual instruments to assess adolescents on these risk and protective factors. This article argues for the need of such an instrument, one that is time manageable and comprehensive. It is suggested that using a two-step method for assessment could meet these goals.

Cronk C; Weiss M. Diagnosis, surveillance and screening for fetal alcohol syndrome spectrum disorders: Methods and dilemmas. (review). International Journal on Disability and Human Development 6(4): 343-359, 2007. (82 refs.)

Fetal Alcohol Spectrum Disorder (FASD) is a prevalent preventable disorder with a significant societal burden related to the cognitive and behavioral disabilities associated with this disorder. This paper reviews the published work on FASD diagnosis, surveillance, and screening programs. Challenges inherent to FASD diagnosis remain and complicate attempts to estimate FAS prevalence. In addition, the drive toward diagnostic accuracy has led to the formulation of screening children at school ages after many disabilities associated with FASD are established. We present the design and selected findings from a regional multi-stage screening project piloted in Wisconsin. Small for gestational age (SGA) newborns with birth head circumference less than 10(th) percentile were selected in the first screening stages. Those meeting these criteria were evaluated for growth, development and FAS facial features at about 2 years of age. Of newborns meeting the initial screening criteria, 30% demonstrated growth deficits and developmental delays at about 2 years of age. Children with any FAS facial feature (of 177 children assessed, n=13 with 2 or 3 facial findings, n=77 with one facial finding) showed greater deficits in growth and a greater proportion were developmentally delayed. The findings demonstrate the potential value of embedding screening for FAS within a multistage screening method to identify infants at risk for any developmental delay. Because this model would be a part of larger population screening for developmental delay, cost efficiencies could be achieved. Problems relating to protection and confidentiality that inevitably accompany screening to identify FASD would also be reduced.

Curran GM; Booth BM; Kirchner JE; Deneke DE. Recognition and management of depression in a substance use disorder treatment population. American Journal of Drug and Alcohol Abuse 33(4): 563-569, 2007. (25 refs.)

This study examines the association between depressive symptomatology and return to substance use among a sample of 126 veterans consecutively admitted to treatment at a VA intensive outpatient program for substance use disorders. Controlling for numerous demographic and health- related covariates, depressive symptomatology measured at treatment exit with a Beck Depression Inventory (BDI) was significantly predictive of substance use at three- months post- treatment (p <.05). Analysis with a recoded BDI showed that the moderately to severely symptomatic (BDI 20+) were 4.1 times more likely to have returned to substance use than those with a BDI score of under 20.

Daeppen JB; Gaume J; Bady P; Yersin B; Calmes JM; Givel JC; Gmel G. Brief alcohol intervention and alcohol assessment do not influence alcohol use in injured patients treated in the emergency department: A randomized controlled clinical trial. Addiction 102(8): 1224-1233, 2007. (39 refs.)

Aims: To evaluate the effectiveness of brief alcohol intervention (BAI) in reducing alcohol use among hazardous drinkers treated in the emergency department (ED) after an injury; in addition it tests whether assessment of alcohol use without BAI is sufficient to reduce hazardous drinking. Design: Randomized controlled clinical trial with 12-month follow-up conducted between January 2003 and June 2005. Setting: Urban academic emergency department (ED) of the Lausanne University Hospital, Lausanne, Switzerland. Participants A total of 5136 consecutive patients attending ED after an injury completed a seven-item general and a three-item alcohol screen and 1472 (28.7%) were positive for hazardous drinking according to the National Institute on Alcohol Abuse and Addiction definition; of these 987 (67.1%) were randomized into a BAI group (n = 310) or a control group with screening and assessment (n = 342) or a control group with screening only (n = 335) and then a total of 770 patients (78.0%) completed the 12-month follow-up procedures. Intervention: A single 10-15-minute session of standardized BAI conducted by a trained research assistant. Measurements: Percentage of participants who have changed to low-risk drinking at follow-up. Findings: Data obtained at 12 months indicated that similar proportions were low-risk drinkers in BAI versus control groups with and without assessment (35.6%, 34.0%, 37.0%, respectively, P = 0.71). Data also indicated similar reductions in drinking frequency, quantity, binge drinking frequency and Alcohol Use Disorders Identification Test (AUDIT) scores across groups. All groups reported similar numbers of days hospitalized and numbers of medical consults in the last 12 months. A model including age groups, gender, AUDIT and injury severity scores indicated that BAI had no influence on the main alcohol use outcome. Conclusions: This study provides the evidence that a 10-15-minute BAI does not decrease alcohol use and health resource utilization in hazardous drinkers treated in the ED, and demonstrates that commonly found decreases in hazardous alcohol use in control groups cannot be attributed to the baseline alcohol assessment. [Note: A correction/addendum is published in Addiction 102(12): 1224-1233.]

Day E; Best D; Cantillano V; Gaston RL; Nambamali A; Keaney F. Measuring the use and career histories of drug users in treatment: Reliability of the Lifetime Drug Use History (LDUH) and its data yield relative to clinical case notes. Drug and Alcohol Review 27(2): 171-177, 2008. (32 refs.)

Introduction and Aims. There is no generally accepted clinical or research instrument available for recording the longitudinal course of a drug-using 'career'. This paper reports on an initial examination of the properties of the Lifetime Drug Use History Questionnaire (LDUH), built around monthly mapping of drug use patterns in relation to other life events. Design and Methods. Forty heroin and cocaine users completed structured interviews at two treatment sites. Twenty subjects were interviewed on two occasions separated by a 3-day interval, using either the same interviewer (n=10) or two different interviewers (n=10) as assessments of inter-rater and test-retest reliability. Results. Very good inter-rater agreements were observed, demonstrated by Cronbach's alpha and intraclass correlation coefficients generally higher than 0.8 and 0.7, respectively. Additionally, concordance with clinical notes was assessed for four drug use history variables, resulting in poorer rates of agreement. An exact matching with clinical records was obtained for the variable 'age of first use of heroin' in 47.2% (n=17) of the heroin users, while a good agreement (only 1 or 2 years' difference) was found in 36.1% of cases (n=5). Discussion and Conclusions. The LDUH method resulted in high reliability for heroin and cocaine and suggests an effective, clinically applicable method for history-taking. The paucity and inconsistency of similar information in the clinical notes would further justify the use of a standardised method for recording drug histories.

Degenhardt L; Baker A; Maher L. Methamphetamine: Geographic areas and populations at risk, and emerging evidence for effective interventions. (editorial). Drug and Alcohol Review 27(3): 217-219, 2008. (15 refs.)

Del Boca FK; Darkes J. Enhancing the validity and utility of randomized clinical trials in addictions treatment research: II. Participant samples and assessment. Addiction 102(8): 1194-1203, 2007. (89 refs.)

Purpose: This paper is the second in a series that describes strategies for optimizing the validity and utility of randomized clinical trials (RCTs) in addictions treatment research. Whereas the first paper focused on treatment implementation and research design, here we address issues pertaining to participant samples and assessment methods. Scope With respect to participant samples, sections focus on the definition of study populations; informed consent; sample size and statistical power; recruitment and enrollment; sample retention; and participant tracking systems. Assessment topics include eligibility screening and baseline assessment; treatment-related variables; outcome measures; the frequency of follow-up evaluation; and assessment process. A final section highlights the importance of pilot testing. Conclusion Sample recruitment and retention strategies are needed that safeguard both internal and external validity. Daily estimation assessment procedures are recommended because of their versatility for creating a range of outcome measures. Assessment batteries should include measures that permit the investigation of treatment processes and mechanisms of action.

D'Onofrio G; Pantalon MV; Degutis LC; Fiellin DA; Busch SH; Chawarski MC et al. Brief intervention for hazardous and harmful drinkers in the emergency department. Annals of Emergency Medicine 51(6): 742-750, 2008. (31 refs.)

Study objective: To determine the efficacy of emergency practitioner-performed brief intervention for hazardous/harmful drinkers in reducing alcohol consumption and negative consequences in an emergency department (ED) setting. Methods: A randomized clinical trial (Project ED Health) was conducted in an urban ED from May 2002 to November 2003 for hazardous/harmful drinkers. Patients 18 years or older who screened above National Institute for Alcohol Abuse and Alcoholism guidelines for "low-risk" drinking or presented with an injury in the setting of alcohol ingestion were eligible. The mean number of drinks per week and binge-drinking episodes during the past 30 days were collected at 6 and 12 months; negative consequences and use of treatment services, at 12 months. A Brief Negotiation Interview performed by emergency practitioners was compared to scripted Discharge Instructions. Results: A total of 494 hazardous/harmful drinkers were studied. The 2 groups were similar with respect to baseline characteristics. In the Brief Negotiation Interview group, the mean number of drinks per week at 12 months was 3.8 less than the 13.6 reported at baseline. The Discharge Instructions group decreased 2.6 from 12.4 at baseline. Likewise, binge-drinking episodes per month decreased by 2.0 from a baseline of 6.0 in the Brief Negotiation Interview group and 1.5 from 5.4 in the Discharge Instructions group. For each outcome, the time effect was significant and the treatment effect was not. Conclusion: Among ED patients with hazardous/harmful drinking, we did not detect a difference in efficacy between emergency practitioner-performed Brief Negotiation Interview and Discharge Instructions. Further studies to test the efficacy of brief intervention in the ED are needed.

Dum M; Pickren J; Sobell LC; Sobell MB. Comparing the BDI-II and the PHQ-9 with outpatient substance abusers. Addictive Behaviors 33(2): 381-387, 2008. (22 refs.)

Because of the high co-occurrence of Axis-I mood disorders with primary substance use disorders (SUD), it is important to routinely assess substance abusers for evidence of a mood disorder. The primary goal of the present study was to examine the psychometric characteristics of two widely used self-report measures of depression (Beck Depression Inventory-II; Patient Health Questionnaire PRIME MD) with substance abusers (N=108) in an outpatient treatment setting. Using Cronbach's alpha, the reliabilities of the BDI-II and the PHQ-9 were 0.95 and 0.91, respectively. Principal component factor analyses of both measures were conducted to evaluate the relationship between a 3-factor solution (cognitive, affective, and somatic) for the BDI-II and a 1-factor solution for the PHQ-9 (depression). Both measures were correlated with severity levels of alcohol and drug use. Advantages and disadvantages of using both measures with substance abusers are discussed.

Edwards EM; Cheng DM; Levenson S; Bridden C; Meli S; Egorova VY et al. Behavioral assessments in Russian addiction treatment inpatients: A comparison of audio computer-assisted self-interviewing and interviewer-administered questionnaires. HIV Clinical Trials 9(4): 247-253, 2008. (23 refs.)

Purpose: Assess agreement between reported sex and drug use behaviors from audio computer-assisted self-interviewing (ACASI) and interviewer-ad ministered questionnaire (IAQ). Method: Participants (N = 180) enrolled in an HIV intervention trial in Russia completed ACASI and IAQ on the same day. Agreement between responses was evaluated. Results: Of the 13 sex behavior questions, 10 items had excellent agreement (kappas/ICC 0.80-0.95) and 3 items had moderate agreement (kappas/ICC 0.59-0.75). The 3 drug behavior questions had excellent agreement (kappas/ICC 0.94-0.97). Among HIV-specific questions asked of HIV-positive participants (n = 21) only, 2 items had excellent agreement (kappas 1.0) and 3 items had moderate agreement (kappas 0.40-0.71). Conclusions: Assessment of drug and sex. risk behaviors by ACASI and IAQ had generally strong agreement for the majority of items. The lack of discrepancy may result from these Russian subjects' perception that computers do not ensure privacy. Another potential explanatory factor is that both interviews were delivered on the same day. These data raise questions as to whether use of ACASI is uniformly beneficial in all settings, and what influence cultural factors have on its utility.

Galanter M; Dermatis H; Bunt G; Williams C; Trujillo M; Steinke P. Assessment of spirituality and its relevance to addiction treatment. Journal of Substance Abuse Treatment 33(3): 257-264, 2007. (43 refs.)

The prominence of Twelve-Step programs has led to increased attention on the putative role of spirituality in recovery from addictive disorders. We developed a 6-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and we demonstrated here its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers. This scale and the measures related to recovery from addiction and treatment response were applied in three diverse treatment settings: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs. Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees. These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery. Furthermore, the relevance of this issue may be underestimated in the way treatment is framed in a range of clinical facilities.

Graham AW; Schultz TK; Mayo-Smith MF; Ries RK; Wilford BB, eds. Principles of Addiction Medicine. Chevy Chase MD: American Society of Addiction Medicine, 2003. (Chapter refs.)

This volume is a comprehensive text on addictions. It is organized into 14 major sections, each of which has multiple chapters. There are over 200 contributors. The sections deal with the following themes: basic science and core concepts; pharmcology; diagnosis, assessment and early intervention; overview of addiction treatment; management of intoxication and withdrawal; pharmacologic interventions; behavioral interventions; 12-step programs and other recovery-oriented interventions; alcohol and drug problems in the workplace; medical disorders and complications of addiction; co-occurring addictive and psychiatric disorders; pain and addiction; and children and adolescents. There are also six appendices.

Green AI; Drake RE; Brunette MF; Noordsy DL. Schizophrenia and co-occurring substance use disorder. American Journal of Psychiatry 164(3): 402-408, 2007. (41 refs.)

Nearly 50% of patients with schizophrenia develop a substance use disorder in their lifetime, and this co-occurring disorder substantially worsens the course of schizophrenia by destabilizing the illness, impeding treatment adherence, and adding the problems of psychosocial instability, legal entanglements, and medical illnesses to the challenge of managing psychotic symptoms. While the basis of the high rate of substance abuse in this patient group is uncertain, it appears that these patients are highly vulnerable to the effects of alcohol and other drugs and that they suffer from an accumulation of known risk factors for the development of substance abuse disorder. Following the presentation of a case vignette, the article provides an overview of schizophrenia and co-occurring substance use disorders, theories of the possible basis for co-occurrence, detection of substance abuse problems in patients with schizophrenia, integrated treatment and drug therapies.

Grella CE; Greenwell L. Treatment needs and completion of community-based aftercare among substance-abusing women offenders. Women's Health Issues 17(4): 244-255, 2007. (72 refs.)

Background. Women offenders with substance abuse problems typically have many treatment needs on reentry to the community from prison. This paper explores the correlates of treatment needs among a sample of women offenders with substance-abuse problems (n = 1,404), and the relationship between their treatment needs and other background characteristics with completion of community-based treatment after parole. Methods. Treatment needs were assessed at admission into prison-based substance abuse treatment; participants were admitted into community-based treatment upon parole. Descriptive statistics and multiple regression were used to examine their treatment needs; logistic regression analysis was used to determine the factors related to completion of the aftercare program. Analysis of variance was used to examine ethnic differences in treatment needs. Results. Greater treatment needs were associated with unstable housing before incarceration, a history of sexual or physical abuse, mental health problems, alcohol or drug dependence, and first arrest at age < 19; lower treatment needs were associated with having been mandated to prison-based treatment (versus volunteering). Mental health problems and earlier age at first arrest predicted treatment noncompletion. Drug dependence was associated with higher treatment needs and a greater likelihood of treatment completion, whereas African American and Hispanic ethnicity were both associated with lower treatment needs (compared with Whites) and a lower likelihood of treatment completion. Conclusions. Interventions are needed to engage substance-abusing women offenders in community treatment after parole to address their treatment needs, improve their retention in treatment, and reduce the likelihood of recidivism.

Guinier D; Hubert N; Chopard JL. Surgical and forensic problems of body-packing. (review). Journal de Chirurgie 144(6): 481-485, 2007. (33 refs.)

Body-packing has increased as a means of illicit drug transportation, particularly since the intensification of customs control and luggage inspection which followed the terrorist attacks of September 11, 2001. This mode of drug transport may result in intestinal obstruction or systemic intoxication; diagnostic measures are discussed; management may require specific precautions and occasionally surgical intervention. The problem of how to handle and dispose of large quantities of drugs removed from or passed by a patient who may not be under arrest presents specific medicolegal considerations.

Gustafson DL; Goodyear L; Keough F. When the dragon's awake: A needs assessment of people injecting drugs in a small urban centre. International Journal of Drug Policy 19(3): 189-194, 2008. (27 refs.)

Background: St. John's, Newfoundland and Labrador is one of the smallest Canadian provincial capitals. Like other Canadian coastal communities, St. John's has been affected by dramatic economic and institutional restructuring that negatively impacted community health. Marginalized populations including people who inject drugs are more negatively affected by the gap between health needs and available services. Methods: A mixed methods needs assessment began with a survey and key informant and focus group interviews to determine attitudes, knowledge, and practices of people with current or previous experience injecting drugs. An environmental scan of programmes and services was conducted followed by a community consultation with key stakeholders, community agencies, study participants, the media, and members of the public to share and validate findings, solicit feedback, and gather data about future knowledge transfer activities. Results: This paper examines two of the five barriers to health and health services for people injecting drugs: First, there was a discrepancy amongst people injecting drugs between awareness and use of safer practices, and second, there was a limited formalized network of health and social programmes and services. Conclusion: Accurate and timely information about safer practices, whilst an essential component of a harm reduction approach, is insufficient to reduce the risk of negative health outcomes for people injecting drugs. Funding new programmes and services, although desirable, is not always feasible in small urban centres with limited human and material resources. Recommendations for promoting health, reducing harm, and building local capacity must consider these limitations. Registered nurses are well positioned to provide leadership through collaborative community-based research, education and advocacy.

Heimer R. Community coverage and HIV prevention: Assessing metrics for estimating HIV incidence through syringe exchange. International Journal of Drug Policy 19(Supplement 1): s65-s73, 2008. (41 refs.)

Background: Evaluations of syringe-exchange programme effectiveness that attempt to measure "coverage" by determining the percentage of the at-risk population reached by a programme are insufficient since programmes must provide syringes on a continual basis. Determining the relationship between the extent of programme coverage and its impact (i.e., reductions in disease risk or incidence) is complicated by the lack of controlled trials with cohorts of drug users and instead has to be estimated by imputation, mathematical modelling, or ecological data analysis. This report offers an approach to determine community-wide impact and discusses the limitations of that approach. Methods: Easily created programme tracking data were maintained by exchanges in New Haven, CT, USA and Chicago, IL, USA. Data compiled by month quantified the number of unique participants visiting syringe-exchange programmes and the number of syringes distributed. "Coverage", defined either as the percentage of individuals reached or percentage of community syringe need met, was estimated by incorporating measures of the size of the injector population or injection frequency. These measures of coverage are placed in the context of changing programme operations to estimate the effect of these changes on coverage. Finally, data on AIDS cases from New Haven and Chicago were used to estimate the community-wide impact of syringe exchange. Results: Two mobile syringe-exchange programmes operated with very different exchange policies. Programme data revealed that coverage of individuals rarely exceeded 10% and was higher in New Haven than in Chicago. On the other hand, coverage measured as the percentage of syringe need met was higher at the Chicago exchange that employed the less restrictive policy. The impact of syringe exchange in the two cities was measured by comparing subsequent AIDS cases. The relative reduction in injection-related AIDS cases as a function of all new AIDS diagnoses was 21.7% in New Haven and 41.4% in Chicago. Conclusions: A modest investment in the collection of programme data can yield reliable and interpretable information on the extent of programme reach and retention. Limitations to the approach result from the ecological nature of the data and from the need to use data from outside the programme that may be less reliable. For the cases presented here, coverage rates will vary as a function of the programme policies; however, even modest coverage rates - well below those recommended by UNAIDS - can have significant impacts on HIV epidemics. Restrictive policies appeared to increase the coverage if measured only by the proportion of monthly participants and not by the proportion of syringe need met by a programme. More generally, programmes can collect programmatic data and some rapid assessment data (estimates of IDU population and injection frequency) to estimate of the impact of their programmes.

Holmqvist M; Bendtsen P; Spak F; Rommelsjo A; Geirsson M; Nilsen P. Asking patients about their drinking: A national survey among primary health care physicians and nurses in Sweden. Addictive Behaviors 33(2): 301-314, 2008. (41 refs.)

Aims: To investigate the extent to which Swedish primary health care (PHC) general practitioners (GPs) and nurses discuss alcohol issues with their patients, their reasons for and against addressing alcohol issues, their perceived importance of these issues, and factors that could facilitate increased alcohol intervention activity among the PHC professionals. Methods: All Swedish GPs and nurses who have the authority to issue prescriptions were surveyed with a postal questionnaire. The questionnaire was returned by 1821 GPs (47% response rate) and 3125 nurses (55% response rate). Results: Fifty percent of the GPs and 28% of the nurses stated that they "frequently" discussed alcohol with their patients. The two most common reasons for asking patients about their drinking were that the GPs and nurses considered it part of their routines and the belief that the patient had alcohol-related symptoms. GPs said that improved opportunities for referral to specialists and provision of more knowledge about counselling techniques for use when alcohol-related symptoms are evident were the most important facilitators to increased intervention activity. Concerning the nurses, 93% stated that more time devoted to health-oriented work could facilitate increased alcohol intervention activity. Conclusions: The findings highlight a considerable gap between the recognition of the significance of the alcohol problem and Swedish PHC intervention activity.

Hussey DL; Drinkard AM; Falletta L; Flannery DJ. Understanding clinical complexity in delinquent youth: Comorbidities, service utilization, cost, and outcomes. Journal of Psychoactive Drugs 40(1): 85-95, 2008. (49 refs.)

This study describes the extent and severity of multiple comorbidities in a juvenile detention center population, and explores how these numerous problems impact the utilization of treatment services, costs, and outcomes including those for substance abuse, mental illness, and criminal activity. Cluster analyses of the outcome scales at intake yielded two groups: youth high (42%) and youth lower (58%) on all factors. Girls experienced the most significant impairments across emotional problems, behavior complexity, internal mental distress, and victimization domains, utilized significantly more units of residential treatment, individual counseling and case management, and had the highest treatment costs. The total cost of services ($1,171,290, N = 114) was significantly related to substance problems in the past year (r = .219, p <.05), emotional problems (r = .237, p <.05), behavior complexity (r = .318, p <.05), internal mental distress (r = .263,p <.05), environmental risk (r = .205,p <.05), and conflict tactics (r =.240, p <.05). Despite initial differences in measures of baseline severity, high and low cluster youth, and boys and girls in general, achieved similar results on the key outcome variables 12 months later. Study implications include a need for co-occurring, integrated treatment efforts that address family, emotional, and mental health problems of delinquent youth (especially females) in order to improve their ability to successfully attend to substance abuse problems and interpersonal conflicts.

Hymowitz N; Schwab JV; Haddock CK; Pyle SA; Schwab LM. The Pediatric Residency Training on Tobacco Project: Four-year resident outcome findings. Preventive Medicine 45(6): 481-490, 2007. (46 refs.)

Objective. To evaluate the efficacy of a special program for training pediatric residents to address tobacco. Methods. In a study conducted at the New Jersey Medical School, sixteen pediatric residency training programs in the New York/New Jersey metropolitan area were assigned randomly to either special or standard training conditions. All of the residents were invited to take part in the training. Only second- and third-year residents participated in data collection activities (baseline and follow-up tobacco surveys and objective structured clinical examinations [OSCEs]). Baseline data were collected in the spring of 2001, and follow-up data were collected annually through the spring of 2005. Special training consisted of a hybrid website/CD-ROM training program on tobacco, a seminar series, companion intervention material, and clinic mobilization. Standard training residents participated in the seminar series and utilized standard educational and self-help material. Results. The percent of residents in special training, but not of those in standard training, who provided assistance for modifying environmental tobacco smoke, preventing use, and helping patients and parents stop smoking increased significantly from baseline to year 4 of training, as did the percent who felt prepared to address tobacco. Performance on the OSCEs was consistent with survey outcomes as special training residents revealed mastery of key interviewing and intervention skills. Conclusion. The special training program, with Solutions for Smoking as its centerpiece, was found to be effective for training pediatric residents to address tobacco, and it may serve as a model for pediatric residency training programs. Ways of improving the program are discussed.

Johnson ME; Brems C; Mills ME; Fisher DG. Psychiatric symptomatology among individuals in alcohol detoxification treatment. Addictive Behaviors 32(8): 1745-1752, 2007. (16 refs.)

The coexistence of psychiatric symptomatology among individuals receiving longer-term treatment for alcohol use disorders has been well-established; however, less is known about comorbidity among individuals receiving alcohol detoxification. Using the Brief Symptom Inventory [BSI; Derogatis, L. R. (1992). BSI: Administration, scoring, and procedures manual-II. Towson, NID: Clinical Psychometric Research], we compared psychiatric symptomatology among 815 individuals receiving short-term detoxification services with normative data from non-patients, psychiatric patients, and out-of-treatment individuals using street drugs. Findings revealed that individuals in the current sample reported a wide range of psychiatric symptoms with over 80% meeting BSI criteria for diagnosable mental illness. These BSI scores were significantly more severe than those reported by out-of-treatment individuals using street drugs and most closely resembled BSI scores reported for adult psychiatric inpatients. Findings suggest that routine screening for severe mental health symptoms appears warranted in detoxification units. Such screening would greatly increase the chance that coexistence of substance use and other psychiatric disorders would be properly addressed in ongoing treatment.

Johnson JL; Gryczynski J; Wiechelt SA. HIV/AIDS, substance abuse, and hepatitis prevention needs of Native Americans living in Baltimore: In their own words. AIDS Education and Prevention 19(6): 531-544, 2007. (22 refs.)

A needs assessment funded by the Center of Substance Abuse Prevention was conducted in 2005-2006 to determine the HIV/AIDS, substance abuse, and hepatitis prevention needs of Native Americans living in Baltimore, Maryland. We used a community-based participatory approach to gain an in-depth understanding of local Native American health service needs. Community stakeholders and key informants embedded in the local Native American population were consulted at each stage of the research planning process. Two complementary methodologies (focus groups and surveys) produced a holistic assessment of the population's needs, risks, and strengths and uncovered the social and cultural contexts in which health risk behaviors unfold. The use of these methods within a participatory framework produced a more complete portrait of the service needs of the Native American population in Baltimore. Findings from this study support the necessity for future HIV/AIDS, substance abuse, and hepatitis prevention programming for urban Native Americans.

Juhnke GA; Coll KM; Peters SW. An interview with Frank Miller about the Substance Abuse Subtle Screening Inventory. Journal of Addictions & Offender Counseling 26(2): 123-128, 2006. (5 refs.)

This interview is with the head of the organization that publishes the prepriortory instrument, the Substance Abuse Subtle Screening Inventory. This instrument is one of the most widely used of all standardized alcohol and other drug (AOD) use screening tools and considered effective for initial screening. Some of the topics under discussed here are the Inventory, its use with diverse populations, and the Miller's background.

Juhnke G; Hagedorn WB. Counseling Addicted Families: An Integrated Assessment and Treatment Model. New York: Brunner-Routledge, 2006

One of the major assumptions of this book is that treatment needs to pay attention to pre-existing family dynamics, be they dysfunctional or supportive. To ignore family factors, is seen as failing to capitalize upon a major support, or failing to recognize a significant obstacle. The book is divided into three sections. Part One discusses the prevalence of addictions, their negative impact upon families, and the major existing addiction treatment models, including their limitations and benefits. Part Two discusses the assessment process. Part Three outlines the Integrated Family Addictions Model. This model represents a step-based approach to family interventions and treatment. It consists of six progressive treatment levels representing a graduated, beginning with the briefest and least costly forms of therapy. More advanced and intensive forms of therapy are only used if one that is less intensive does not adequately deal with the client and family's problems. Two special situations are addressed in particular detail, families dealing with violence and families with a member having a co-occurring psychiatric disorder. An epilogue discusses the process of professional training, and the major professional associations that may be relevant to practitioners.

Kalberg WO; Buckley D. FASD: What types of intervention and rehabilitation are useful? (review). Neuroscience and Biobehavioral Reviews 31(2): 278-285, 2007. (27 refs.)

Fetal alcohol spectrum disorders (FASD) occurs worldwide when children are prenatally exposed to alcohol. This paper discusses recent findings regarding the neuropsychological and behavioral effects of prenatal alcohol exposure and how it impacts the developmental and functional abilities of children with FASD. Specifically, recent research focus has concentrated on studies to elucidate a neurobehavioral phenotype for the alcohol-exposed population. As a result, the FASD field has learned what types of neurobehavioral issues occur most frequently with these children. This paper discusses how that information can be used to inform school assessment, intervention planning, and support. Strategies for functional assessment, individualized planning, structured teaching, and developments in cognitive-behavioral methods are described.

Katz G; Lazcano-Ponce E. Intellectual disability: Definition, etiological factors, classification, diagnosis, treatment and prognosis. (review). Salud Publica de Mexico 50(Supplement 2): s132-s141, 2008. (57 refs.)

Etiology and classification: Causal factors related with cognitive disability are multiples and can be classified as follows: Genetic, acquired (congenital and developmental), environmental and sociocultural. Likewise, in relation to the classification, cognitive disability has as a common denominator a subnormal intellectual functioning level; nevertheless, the extent to which an individual is unable to face the demands established by society for the individual's age group has brought about four degrees of severity: Mild, moderate, severe and profound. Diagnostic: The clinical history must put an emphasis on healthcare during the prenatal, perinatal and postnatal period and include the results of all previous studies, including a genealogical tree for at least three generations and an intentional search for family antecedents of mental delay, psychiatric illnesses and congenital abnormalities. The physical exam should focus on secondary abnormalities and congenital malformations, somatometric measurements and neurological and behavioral phenotype evaluations. If it is not feasible to establish a clinical diagnosis, it is necessary to conduct high-resolution cytogenetic studies in addition to metabolic clinical evaluations. In the next step, if no abnormal data are identified, submicroscopic chromosomal disorders are evaluated. Prognosis: Intellectual disability is not curable; and yet, the prognostic in general terms is good when using the emotional wellbeing of the individual as a parameter. Conclusions: Intellectual disability should be treated in a comprehensive manner. Nevertheless, currently, the fundamental task and perhaps the only one that applies is the detection of the limitation and abilities as a function of subjects' age and expectations for the future, with the only goal being to provide the support necessary for each one of the dimensions or areas in which the person's life is expressed and exposed.

Institute Nacional Salud Publica

Labrie JW; Pedersen ER; Tawalbeh S. Classifying risky-drinking college students: Another look at the two-week drinker-type categorization. Journal of Studies on Alcohol and Drugs 68(1): 86-90, 2007. (26 refs.)

Objective: The present study examined the effectiveness of the 2-week period currently used in the categorization of heavy episodic drinking among college students. Two-week drinker-type labels included the following: nonbinge drinker, binge drinker, and frequent binge drinker. Method: Three samples of college student drinkers (104 volunteers, 283 adjudicated students, and 238 freshmen male students) completed the 3-month Timeline Followback assessment of drinking. Drinking behavior during the last 2 weeks of the month before the study was compared with drinking behavior during the first 2 weeks of the same month to compare behavior and resulting labels during both 2-week periods. Results: Inconsistencies existed in drinker-type labels during the first 2 weeks of the month and the last 2 weeks of the month for all three samples. Between 40% and 50% of participants in the three samples were classified as a different drinker type across the month. Nonbinge drinkers experienced a wide range of alcohol-related problems, and much variation existed among the frequent-binge-drinker label. Conclusions: The results suggest that the current definition needs to be modified to accurately identify risky-drinking college students. Expanding the assessment window past 2 weeks of behavior, as well as developing different classification schemes, might categorize risky drinkers more accurately.

Laudet AB. What does recovery mean to you? Lessons from the recovery experience for research and practice. Journal of Substance Abuse Treatment 33(3): 243-256, 2007. (71 refs.)

Recovery is a ubiquitous concept but remains poorly understood and ill defined, hindering the development of assessment tools necessary to evaluate treatment effectiveness. This study examines recovery definitions and experiences among persons who self-identify as "in recovery." Two questions are addressed: (a) Does recovery require total abstinence from all drugs and alcohol? (b) Is recovery defined solely in terms of substance use or does it extend to other areas of functioning as well? Inner-city residents with resolved dependence to crack or heroin were interviewed yearly three times (N = 289). Most defined recovery as total abstinence. However, recovery goes well beyond abstinence; it is experienced as a bountiful "new life," an ongoing process of growth, self-change, and reclaiming the self. Implications for clinical and assessment practice are discussed, including the need to effect paradigmatic shifts from pathology to wellness and from acute to continuing models.

Lee JD; Triola M; Gillespie C; Gourevitch MN; Hanley K; Truncali A. Working with patients with alcohol problems: A controlled trial of the impact of a rich media web module on medical student performance. Journal of General Internal Medicine 23(7): 1006-1009, 2008. (15 refs.)

INTRODUCTION/AIMS: We designed an interactive web module to improve medical student competence in screening and interventions for hazardous drinking. We assessed its impact on performance with a standardized patient (SP) vs. traditional lecture. SETTING: First year medical school curriculum. PROGRAM DESCRIPTION: The web module included pre/posttests, Flash (R), and text didactics. It centered on videos of two alcohol cases, each contrasting a novice with an experienced physician interviewer. The learner free-text critiqued each clip then reviewed expert analysis. PROGRAM EVALUATION: First year medical students conveniently assigned to voluntarily complete a web module (N = 2) or lecture (N = 81) were rated by a SP in a later alcohol case. Participation trended higher (82% vs. 72%, p < .07) among web students, with an additional 4 lecture-assigned students crossing to the web module. The web group had higher mean scores on scales of individual components of brief intervention (assessment and decisional balance) and a brief intervention composite score (1-13 pt.; 9 vs. 7.8, p < .02) and self-reported as better prepared for the SP case. CONCLUSIONS: web module for alcohol use interview skills reached a greater proportion of voluntary learners and was associated with equivalent overall performance scores and higher brief intervention skills scores on a standardized patient encounter.

Leslie K. Youth substance use and abuse: Challenges and strategies for identification and intervention. (editorial). Canadian Medical Association Journal 178(2): 145-148, 2008. (20 refs.)

Maisto SA; Clifford PR; Davis CM. Alcohol treatment research assessment exposure subject reactivity effects: Part II. Treatment engagement and involvement. Journal of Studies on Alcohol and Drugs 68(4): 529-533, 2007. (4 refs.)

Objective: This is the second of two articles in this issue on participant reactivity to alcohol treatment research assessment protocols. In the first article, Clifford et al. presented experimental evidence that the combination of less frequent and less comprehensive assessment results in the least assessment reactivity, as measured by alcohol use and related consequences at 1 year after admission for adult outpatient treatment for alcohol problems. In addition, Part I revealed that the presence of either frequent or comprehensive research assessment tends to result in a greater degree of reactivity. This article extends the analyses by Clifford et al. to treatment for substance use-disorders engagement and involvement across a 1-year follow-up. Method: The design, participants, and procedures were identical to those described in Clifford et al. Treatment data were obtained from hospital records and participants' self-reports as part of the Timeline Followback interview. Results: Analyses revealed several effects of frequency of assessment and comprehensiveness of assessment on treatment engagement or involvement. The reactivity effect observed varied with the dependent variable, which included if a participant presented for out- patient treatment (more likely in the comprehensive groups), the number of days of outpatient substance use-disorders treatment during follow-up (no reactivity effects), if a participant engaged in intensive treatment for substance-use disorders during follow-up (more likely for the frequent groups in Months 1 6, but the reverse in Months 7-12, and overall more likely in the brief conditions), and the number of days of intensive treatment for substance -use disorders during follow-up (more days in the frequent groups in Months 1-6, no frequency differences in Months 7-12, and overall more lays in the brief groups), respectively. Additional analyses showed that treatment participation did not mediate the reactivity effects on alcohol use and related consequences reported by Clifford et al. Conclusions: Data provide experimental evidence for a causal relationship between frequency of assessment and comprehensiveness of assessment on substance abuse-treatment engagement and involvement. Future research should be directed at understanding the factors in the assessment process that determine reactivity effects.

Malliarakis KD; Lucey P. Social determinates of health: Focus on substance use and abuse. Nursing Economics 25(6): 368-+, 2007. (15 refs.)

Addiction is a progressive, chronic, and relapsing disorder of the brain that cannot be cured but can be treated. It is imperative to recognize the social overlay when planning to meet the health care needs of clients with addiction care needs. The implications for society are significant as addiction is a multifarious disease that costs the individual as well as the taxpayers. Administrators have the opportunity to provide education for all health personnel on early intervention and screening. Denial is a hallmark of the disease of addiction. Health care personnel must not be in denial about addiction because they can take action to prevent and treat addictions.

Manning MA; Hoyme HE. Fetal alcohol spectrum disorders: A practical clinical approach to diagnosis. Neuroscience and Biobehavioral Reviews 31(2): 230-238, 2007. (39 refs.)

In utero exposure to alcohol can have numerous adverse effects on a developing fetus. These effects represent a spectrum of structural anomalies and neurocognitive and behavioral disabilities that have recently been termed fetal alcohol spectrum disorders (FASD). Children at the most severe end of this spectrum and displaying the complete phenotype of characteristic facial anomalies, growth retardation and developmental abnormalities of the central nervous system are defined as having fetal alcohol syndrome (FAS). While FAS is the most readily clinically recognized form of FASD, other categories within the continuum of adverse effects due to prenatal alcohol exposure are becoming better defined. These include partial fetal alcohol syndrome (PFAS), alcohol-related birth defects (ARBD) and alcohol-related neurodevelopmental disorder (ARND). As more is learned regarding the exact manifestations of alcohol on brain development, these classifications may be expanded and/or refined. Because FASD represents a major public health concern, early recognition of at-risk children is important for initiating interventional strategies. Thus, the purpose of this report is to educate practicing physicians about the recognizable phenotypes of FASD in order to accurately identify these children and implement the most appropriate management plans.

Marsh A; DaleA. Addiction Counselling: Content and Process. Melbourne: IP Communications, 2006

Both the "content" of addiction counselling and the "process" of working with addiction clients are addressed. Part I addresses the effects, harms, and etiology of drug use. Part II, in 18 chapters, addresses content, focusing on the therapeutic alliance, assessment, suicide assessment and management, motivational interviewing, harm reduction, treatment planning, problem solving, cognitive restructuring, anger management, assertiveness training, grief and loss, drug therapies, referral and supervision. Part III deals with process. In 8 chapters it addresses developmental needs, transference and counter-transference, client ambivalence, core themes, and termination. Part IV considers special populations -- the coerced client, adolescents and young people, and working with co-occurring substance abuse and mental health disorders. Case studies illustrate addiction counselling principles and challenges. 'Tip-sheet' summaries of core material are provided. In addition, client handouts and work sheets are provided.

Matto H; Miller KA; Spera C. Examining the relative importance of social context referents in predicting intention to change substance abuse behavior using the EASE. Addictive Behaviors 32(9): 1826-1834, 2007. (12 refs.)

There is growing consensus across literatures that more than individual motivation and "will to change" influence whether a client will be able to make and sustain recovery-related changes to prevent drug relapse post-treatment. New areas of inquiry in the substance abuse field have proposed conceptual models that promote an integration of both individual and social context factors, which offer the opportunity for important developments in clinical practice. This study examined the influence of social context referents on clients' intention to change substance abusing behaviors. The Ecological Assessment of Substance abuse Experiences (EASE), an instrument that measures the influence of social context referents on addiction and recovery behaviors, was administered to 302 inpatient and outpatient adults in treatment for substance abuse. Results showed that the number of people in his/her social network favorable towards recovery (Beta=.222); the extent to which one personally identifies with being in recovery (Beta=.339); the perceived importance of people in the client's social network encouraging recovery-related behaviors (Beta=.369); weak beliefs that drugs will lead to positive outcomes (Beta=-.220); and strong beliefs that recovery will lead to positive outcomes (Beta=.307) were all associated with intention to change substance abusing behavior.

McGovern MP; Clark RE; Samnaliev M. Co-occurring psychiatric and substance use disorders: A multistate feasibility study of the quadrant model. Psychiatric Services 58(7): 949-954, 2007. (28 refs.)

Objective: The quadrant model was developed to organize the heterogeneous group of persons with co-occurring psychiatric and substance use disorders and to anticipate differential use of systems of care. The purpose of the study presented here was to test the feasibility of applying the model to classify persons with co-occurring disorders, examine the reliability of quadrant prevalence and distribution, and test the validity of differential service use by quadrant. Methods: Medicaid claims data from 1999 from six states were analyzed, and 22,912 individuals with co-occurring disorders were classified into quadrants, by severity of substance use and psychiatric disorders. Distribution by quadrant and the utilization of emergency and inpatient services were analyzed. Results: A majority of cases were classified in quadrant IV (52.5%) (high severity of psychiatric and substance use disorders), and fewest were classified in quadrant I (8.2%) (low severity of psychiatric and substance use disorders). There was equivalence in distribution for quadrant III (19.8%) (high severity of substance use disorders and low severity of psychiatric disorders) and quadrant II (19.4%) (high severity of psychiatric disorders and low severity of substance use disorders). Distribution was consistent across states, and service utilization was most associated with quadrant IV. Persons with the more severe psychiatric problems (quadrants II and IV) were more likely to be female, to be older, and to have been hospitalized or to have visited an emergency department. Another important finding is the high rate of persons with substance dependence disorders (quadrants III and IV). Conclusions: The feasibility of applying the quadrant model was supported. The quadrant model has been well adopted conceptually by community providers and policy makers. The consistency of the findings across six state Medicaid systems supports the potential utility of the model to articulate patient characteristics and service use patterns. Further application and research with this model is proposed.

Mitchell AM; Dewey CM. Chronic pain in patients with substance abuse disorder: General guidelines and an approach to treatment. Postgraduate Medicine 120(1): 75-79, 2008. (29 refs.)

Treating pain may be difficult in patients with a coexisting substance abuse disorder. Opioids can be used successfully to control pain in such a patient population, but the physician must have a general understanding of addictive behavior and early signs of abuse. The challenge is not in treating pain, but identifying true pain from drug-seeking behaviors. Furthermore, several myths of opioid usage, such as iatrogenic addiction and risk of disciplinary action, may be unfounded. General guidelines and open communication between patient and physician may aid in controlling pain. With better understanding and a systematic treatment approach, patients with substance abuse disorders can receive adequate symptomatic pain relief.

Moos RH. Context and mechanisms of reactivity to assessment and treatment. (editorial). Addiction 103(2): 249-250, 2008. (18 refs.)

This is a commentary on the report by McCambridge and Day (this issue) on changes in drinking behavior which occured following the administration of the AUDIT.

Nace EP; Tinsley JA. Patients with Substance Abuse Problems: Effective Identification, Diagnosis, and Treatment. New York: W.W. Norton, 2007. (Chapter refs.)

The diagnosis and treatment of substance-abuse disorders are gaining the attention of physicians, with, in a given year, approximately 9% of the U.S. population is found to be dependent on or to abuse alcohol, and almost 4% are dependent on illicit drugs. Nicotine dependence affects some 20% of the population. The book is intended to provide a relatively brief concise overview of the field of substance abuse for the busy practitioner. It reviews the medical literature concerning the basics of addiction and details specific procedures such as detoxification schedules for alcohol, anxiolytic and hypnotic agents, and opioids. Each chapter uses brief vignettes to illustrate concepts, and tables or figures to clarify material. Two special populations are featured in this book: adolescence and late life. It is organized into 10 chapters: (1) Facing the Challenge: Patients with Substance Abuse Problems; (2) Addiction: A Disease of the Reward Pathway; (3) Does the Patient Know Something is Wrong?; (4) Steps to Identification; (5) Making a Diagnosis; (6) Treatment Options; (7) Adolescence (8) Substance Abuse in Late Life; (9) Smoking; and (10) Pharmacologic Treatment.

Nanda S; Konnur N. Adolescent drug & alcohol use in the 21st century. Pediatric Annals 36(10): 706-712, 2006. (33 refs.)

Screening for drug abuse should be a part of adolescent health maintenance visits. Good interviewing skills using open-ended, nonjudgmental questions in a private setting may elicit a history of drug abuse. A detailed and comprehensive history is important to recognize family dynamics, early behavioral changes (NB outlined in a table), comorbid psychiatric conditions, and the adolescent's attitude toward substances of abuse. A good physical exam may reveal clinical sequelae of drug abuse. Testing for drug abuse should be done with the patient's consent except in cases where judgment is impaired. Periodic screening for drugs is a part of drug treatment and rehabilitation. The typical pediatrician is not equipped to provide drug counseling and treatment to the abusing adolescent. Specialized referral centers would be ideal, and clinicians need to be aware of local resources in their communities. Anticipatory guidance explaining the ill effects of drugs is mandatory. Prevention should be aimed at increasing public awareness of the consequences of drug abuse, improving parenting techniques, and introducing school-based drug prevention programs. The fight against substance abuse needs to be a community effort in which the individual, the family and the primary care physician play important roles.

National Quality Forum. National Quality Consensus Standards for the Treatment of Substance Use Conditions: Evidence-Based Treatment Practices. Washington DC: National Quality Forum, 2007

This report grew out of a consensus conference convened by the National Quality Forum. The Executive Summary notes that over the past 15 years, scientific knowledge has substantially increased in respect to treating substance use conditions and that there is growing recognition of substance abuse/dependence as a chronic medical condition. This report assembles a set of 11 detailed, fully specified, evidence-based practices. For each practice the target outcomes are identified, the procedures involved specified, as well as for whom it is intended, the settings in which it is provided, and the personnel involved in providing the services. The practices outlined are applicable across a range of populations, diverse settings, and providers. They fall into four domains - identification of substance use conditions, initiation and engagement in treatment, therapeutic interventions, and continuing care management . These practices include: (1) screening and case finding; (2) adoption of systematic methods and procedures to accomplish case finding; (3) diagnosis and assessment for those with positive screening; (4) brief interventions by a trained clinician; (5) provision of support and other services to promotion initiation of care; (6) management of withdrawal, a necessary precursor of treatment of the substance abuse condition; (7) psychosocial interventions; (8-10) pharmacotherapy for opiate, alcohol and nicotine dependence as an adjunct to psychosocial service; and (11) continuing care management and monitoring. For each of these elements the practice domain is identified, as well as the target outcome, and specification of what is involved. A series of appendices set forth the Members and Board of Directors (drawn from major medical centers, representatives of all major medical professional societies as well as private foundations, and governmental agencies), the members of the Steering Committee and Technical Advisory Panel, selected references, and a summary of the consensus development process.

Niv N; Hser YI. Women-only and mixed-gender drug abuse treatment programs: Service needs, utilization and outcomes. Drug and Alcohol Dependence 87(2/3): 194-201, 2007. (31 refs.)

Objectives: This prospective longitudinal study examined service needs, utilization and outcomes for 189 women in women-only (WO) programs and 871 women in mixed-gender (MG) programs. Methods: The Addiction Severity Index was administered at both intake and the 9-month follow-up interview to assess clients' problem severity and outcomes, and the Treatment Service Review was given at the 3-month interview to measure service utilization. Treatment completion and arrests were based on official records. Results: Compared to women in MG programs, women in WO programs were more likely to be White, less educated, physically abused in the past 30 days and in residential treatment (as opposed to outpatient treatment). Women in WO programs also had greater problem severity in a number of domains including alcohol, drug, family, medical and psychiatric. They utilized more treatment services and had better drug and legal outcomes at follow-up compared to women in MG programs. Program type was not predictive of treatment retention/completion or outcomes in other domains (i.e., alcohol, employment, family, medical and psychiatric). Conclusions: The greater problem severity of women treated in WO programs and their better drug and legal outcomes suggest that these specialized services are filling an important gap in addiction services.

Niv N; Wong EC; Hser YI. Asian Americans in community-based substance abuse treatment: Service needs, utilization, and outcomes. Journal of Substance Abuse Treatment 33(3): 313-319, 2007. (19 refs.)

The objectives of this study were to examine differences in substance abuse treatment needs, treatment utilization, and outcomes between Asian Americans/Pacific Islanders (AAPI) and others. Data were collected from 452 AAPI and a matched sample of 403 non-AAPI who were admitted to 43 drug treatment programs across California. A subset of these participants was assessed at 3 months (n = 112) and 9 months (n = 140) after treatment admission. Differences in pretreatment characteristics, treatment retention and completion, services received, and treatment outcomes were examined. AAPI presented to treatment with lower alcohol and drug severity lower than the comparison group and similar problem severity in other domains. There were no group differences in treatment retention, but AAPI received a greater number of legal services and fewer medical and psychiatric services than the comparison group. AAPI also received fewer total services within their treatment program. Treatment outcomes were similar between the two groups, with one exception: AAPI demonstrated better alcohol outcomes than those in the comparison group.

Niveau G; Ritter C. Route of administration of illicit drugs among remand prison entrants. European Addiction Research 14(2): 92-98, 2008. (30 refs.)

Aims: To describe the self-reported routes of administration of illicit drugs among subjects entering a remand prison and the different drugs used by this population. Methods: A cross-sectional study, with a sample of 770 subjects, was conducted in Geneva ( Switzerland). Participants were assessed with the semi-structured interview from the Council of Europe Pompidou Group multi-city study. Results: 428 (55.6%) subjects admitted to having used illicit drugs during the 3 months prior to entry. Amongst these illicit drug users, 54.7% took several drugs. Injectable drugs ( heroin, cocaine or illicit benzodiazepines) were taken by 75.7% of drug users but the majority (84.1%) declared that they had not injected drugs during the 3 months prior to entering prison. 68 subjects (8.8% of the total sample) declared that they had injected drugs during the 3 months prior to entering prison, either alone or in association with other methods. Conclusion: By extrapolation it is possible to suggest that about 200 intravenous drug users entered the remand prison in Geneva in 1 year. This confirms the need for prison health services to implement a policy of treatment, prevention and education adapted to patterns of drug use in the local context.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report. Health Insurance and Substance Use Treatment Need. (February 23, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (7 refs.)

Health insurance and the need for and receipt of substance abuse treatment among adults aged 18 or older was examined based on combined 2004 and 2005 SAMHSA National Surveys on Drug Use and Health. Types of health insurance included Medicare, Medicaid/CHIP, military health care, and private insurance. An annual average of 85.4% adults had some type of health insurance in the past year and 70.5% had private health insurance. Adults needing substance abuse treatment in the past year were less likely to have some type of health insurance coverage in the past year than adults not needing treatment (74.4% vs. 86.6%). About half (51.2%) of the adults needing treatment whose last treatment in the past year was at a specialty substance abuse treatment reported that some type of health insurance (private insurance, Medicare, Medicaid, military health care, or other insurance) paid for the services.

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report. Substance Use Treatment among Women of Childrearing Age. (October 7, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (6 refs.)

Combined data from SAMHSA's National Surveys on Drug Use & Health conducted from 2004 to 2006 indicate that an annual average of 6.3 million women (9.4%) aged 18 to 49 needed treatment for a substance use problem. Of the women aged 18 to 49 who met criteria for needing substance use treatment in the past year, 84.2% neither received it nor perceived the need for substance use treatment. Only 5.5% of women in this age group had a perceived unmet treatment need (i.e., did not receive substance use treatment even though they thought they needed it). The reasons for not receiving substance use treatment among the women with an unmet treatment need were as follows: 36.1% were not ready to stop using alcohol or illicit drugs, 34.4% could not cover their treatment costs because of no or inadequate health insurance coverage, and 28.9% did not seek substance use treatment because of social stigma.

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. State Estimates of Substance Use from the 2005-2006 National Surveys on Drug Use and Health. NHSDUH Series H-33. Rockville MD: Substance Abuse and Mental Health Services Administration, 2008. (22 refs.)

This report presents State estimates for 23 measures of substance use or mental health problems based on the 2005 and 2006 National Surveys on Drug Use and Health (NSDUHs), an ongoing survey of the civilian, noninstitutionalized population. Past month use of illicit drugs in 2005-2006 ranged from a low of 5.7 percent in North Dakota to a high of 11.2 percent in Rhode Island. Nationally i10.4 percent of all persons aged 12 or older reported marijuana use in the past year. Young adults aged 18 to 25 reported the highest rate of past year use of marijuana, 28.0 percent. Vermont had the highest rates of past year and past month marijuana use among persons 12 or older (15.5 and 9.7 percent, respectively). Vermont also had the highest rates of past year and past month marijuana use among persons aged 18 to 25 (41.9 and 28.3 percent, respectively). Utah had the lowest rates of past year and past month marijuana use. The rate of past month use of illicit drugs other than marijuana increased between 2004-2005 and 2005-2006 among all persons aged 12 or older (from 3.6 to 3.8 percent). In 2005-2006, North Dakota had the lowest rate (2.5 percent) of past month use of an illicit drug other than marijuana among persons 12 or older, and Tennessee had the highest rate (4.7 percent). The rate of past month alcohol use ranged from a low of 32.4 percent in Utah to a high of 63.1 percent in Wisconsin. Six States showed significant increases from 2004-2005 to 2005-2006: Arkansas (39.6 to 42.6 percent), Maine (51.5 to 54.8 percent), Michigan (54.2 to 56.2 percent), Nevada (48.2 to 52.0 percent), Utah (30.1 to 32.4), and Wyoming (53.0 to 56.4 percent). The rate of binge alcohol use among youths aged 12 to 17 decreased from 10.5 percent in 2004-2005 to 10.1 percent in 2005-2006; however, the rates among young adults aged 18 to 25 and persons aged 26 or older did not change. There is also data provided on tobacco use, and rates of substandce dependence, abuse, and treatment need.

Public Domain

Paley B; O'Connor MJ. Neurocognitive and neurobehavioral impairments in individuals with fetal alcohol spectrum disorders: Recognition and assessment. International Journal on Disability and Human Development 6(2): 127-142, 2007. (146 refs.)

Fetal Alcohol Spectrum Disorders (FASDs) represent a continuum of development disabilities associated with maternal consumption of alcohol during pregnancy. This spectrum of disorders, which includes the Fetal Alcohol Syndrome (FAS), is characterized by a wide range of physical, cognitive, and behavioral impairments. Estimates of the number of live births in the United States meeting criteria for a diagnosis of FAS range from .5 to 2 infants per 1,000, with the prevalence of the entire continuum of FASDs estimated to be I in 100. This paper discusses some of the complexities involved in diagnosing individuals affected by prenatal alcohol exposure, provides a review of the neurocognitive and neurobehavioral deficits commonly seen in this population, and examines how such deficits may manifest during different developmental periods across the life span. Additionally, strategies for assessing these deficits are described, and specific measures that are appropriate for alcohol-exposed individuals are presented. The challenges of working with this under-identified and underserved population are highlighted, as well as the importance of early diagnosis and intervention.

Rigole H; Perney P; Bismuth M; Navarro F; Larrey D; Blanc F et al. Assessment of liver transplant candidates by an addiction medicine specialist: A prospective study. (meeting abstract). Hepatrology 46(4, Supplement S): 506A-506A, 2007. (0 refs.)

Rounds-Bryant JL; Baker L. Substance dependence and level of treatment need among recently-incarcerated prisoners. American Journal of Drug and Alcohol Abuse 33(4): 557-561, 2007. (7 refs.)

This study assessed both prevalence rates of substance dependence and level of treatment need among recently- incarcerated prisoners in a southeastern state. Participants were 752 consecutive admissions to the state prison system in 2002. They were administered the 93 item Substance Abuse Subtle Screening Inventory (SASSI). The results indicated that approximately 72% of participants met criteria for substance dependence and 46% of participants met criteria for prison-based residential treatment. The results of this study can be used to inform allocation of prison-based treatment resources.

Rowan-Szal GA; Greener JM; Joe GW; Simpson D. Assessing program needs and planning change. Journal of Substance Abuse Treatment 33(2): 121-129, 2007. (34 refs.)

Assessments of treatment staff training needs, preferences, and barriers can help guide and improve training activities and transfer evidence-based technologies into clinical practice. The Texas Christian University (TCU) Program Training Needs (PTN) assessment consists of 54 items organized into seven domains: Program Facilities and Climate, Program Computer Resources, Staff Training Needs, Preferences for Training Content, Preferences for Training Strategy, Training Barriers, and Satisfaction With Training. Data collected from 589 counselors representing 194 treatment programs showed that the PTN was psychometrically sound and predictably associated with results from a more comprehensive assessment of organizational functioning. Importantly, fewer barriers to training and greater staff satisfaction with training were reported for programs with higher levels of organizational functioning. In addition to representing an efficient source of staff's perceptions about organizational operations and needs, the PTN empowers staff with a '' voice '' through which they can contribute to strategic planning and priority setting for organizational actions.

Schifano F; Corkery J. Cocaine/crack cocaine consumption, treatment demand, seizures, related offences, prices, average purity levels and deaths in the UK (1990-2004). Journal of Psychopharmacology 22(1): 71-79, 2008. (59 refs.)

A recent trend of escalating use of cocaine/crack cocaine was observed in the UK. The number of mentions on death certificates; last year use of cocaine; treatment demand, number of drug offenders, seizures, prices and average purity levels were the indicators used for this descriptive and correlational study. Figures ( 1990-2004) were taken from official UK sources. A total of 1022 cocaine/crack cocaine death mentions ( i.e. deaths from any cause where the presence of cocaine/ crack cocaine was also detected) were identified, with cocaine/ crack cocaine being the sole drug mentioned in 36% of cases. The number of cocaine/ crack cocaine death mentions showed a year-on-year increase and correlated positively with the following cocaine ( powder) figures: last year use ( p < 0.001); number of offenders ( p < 0.001) and number of seizures ( p < 0.001), but correlated negatively with price ( p < 0.001). Furthermore, the number of cocaine/ crack cocaine death mentions correlated positively with the number of crack offenders ( p < 0.001) and seizures ( p < 0.001), but correlated negatively with both crack purity ( p < 0.001) and price ( p < 0.05). With conditions of increasing drug availability having been met in the UK, decrease in cocaine prices were associated with higher consumption levels and this, in turn, contributed to the increase in number of cocaine-related fatalities. There are limitations with the information collected, since no distinction is usually made on medical death certificates between cocaine and crack cocaine. The present study being an ecological one, it proved difficult to address the role of confounding variables that may well explain some of the associations observed.

Schockett ER. Risky business: Assessing operative risk in the cocaine-positive patient. (meeting abstract). Journal of General Internal Medicine 23(Supplement 2): 169-169, 2008. (0 refs.)

Shamblen SR; Springer JF. Improving the sensitivity of needs assessment for substance abuse prevention planning: The measurement of differential severity of consequences for individual substance types. Journal of Drug Education 37(3): 295-316, 2007. (22 refs.)

There is an absence of systematic, comparative research examining the negative consequences that are experienced as a result of using specific substances. Further, techniques typically used for needs assessment (i.e., prevalence proportions) do not take into account the probability of experiencing a negative consequence as a result of using specific substances. An approximated severity index is proposed that: a) takes into account the probability of experiencing negative consequences as a result of using specific substances; and b) is comparable across substances. Data from the NSDUH and the ADSS are used to demonstrate these techniques. The findings suggest that substances typically considered priorities based on prevalence proportions are not the same substances that have a high probability of causing negative consequences. The policy implications of these findings are discussed.

Shourie S; Conigrave KM; Proude EM; Ward JE; Wutzke SE; Haber PS. Pre-operative screening for excessive alcohol consumption among patients scheduled for elective surgery. Drug and Alcohol Review 26(2): 119-125, 2007. (18 refs.)

Pre- operative intervention for excessive alcohol consumption among patients scheduled for elective surgery has been shown to reduce complications of surgery. However, successful intervention depends upon an effective and practical screening procedure. This study examines current screening practices for excessive alcohol consumption amongst patients scheduled for elective surgery in general hospitals. It also examines the appropriateness of potential sites and staff for pre- operative screening. Forms used routinely to assess alcohol consumption in the pre-admission clinics ( PAC) of eight Sydney hospitals were examined. In addition, the appropriateness of six staff categories (surgeons, surgeons' secretaries, junior medical officer, anaesthetists, nurses and a research assistant) and of two sites (surgeons' office and PAC) in conducting additional screening was assessed at two hospitals. Outcomes included observed advantages and disadvantages of sites and personnel, and number of cases with excessive drinking identified. There was duplication in information collected routinely on alcohol use in the PACs in eight Sydney Hospitals. Questions on alcohol consumption in patient self-completion forms were not validated. The PAC provided for efficient screening but time to surgery was typically too short for successful intervention in many cases. A validated tool and efficient screening procedure is required to detect excessive drinking before elective surgery. Patients often present to the PAC too close to the time of surgery for any change in drinking to reverse alcohol's effects. The role of the referring general practitioner and of printed advice from the surgeon in preparing patients for surgery needs further investigation.

Sindelar-Manning H; Lewander W; Chun T; Barnett N; Spirito A. Emergency department detection of adolescents with a history of alcohol abuse and alcohol problems. Pediatric Emergency Care 24(7): 457-461, 2008. (26 refs.)

Objective: To compare the characteristics of adolescents with and without a history of problematic alcohol use, who are treated in the emergency department (ED) for an alcohol-related problem. Methods: Three hundred seventeen adolescents presenting to the ED after an alcohol-related incident were divided into 2 groups based on whether their score on the Adolescent Drinking Inventory reached the clinical cutoff on problematic drinking, and compared regarding current drinking, depression, and risk-taking behaviors. Results: Adolescents who reached the clinical cutoff on the Adolescent Drinking Inventory were older and reported more frequent drinking, greater depressed mood, and more risk-taking behaviors. Conclusions: Of the adolescents presenting to the ED with an alcohol-related incident, those with a positive history of problematic drinking represent a particularly high-risk subgroup.

Sirri L; Potena L; Masetti M; Tossani E; Grigioni F; Magelli C et al. Prevalence of substance-related disorders in heart transplantation candidates. Transplantation Proceedings 39(6): 1970-1972, 2007. (22 refs.)

Substance abuse cessation is one of the leading factors in determining the eligibility for the heart transplantation waiting list, as noncompliance with this issue may seriously endanger posttransplantation outcomes. Yet, the prevalence of substance-related disorders among candidates for heart transplantation has not been evaluated enough. Eighty three heart transplantation candidates were assessed for prior or current substance-related disorders through the Structured Clinical Interview for mental disorders according to DSM-IV. A prior history of at least one substance-related disorder was found in 64% of patients, with nicotine dependence as the most prevalent diagnosis (61.4% of the sample). Ten subjects were currently smokers, despite heart failure. A prior history of alcohol abuse and caffeine intoxication was found in 9.6% and 2.4% of patients, respectively. Substance abuse or dependence behaviors should be monitored during all the phases of heart transplantation program. Early identification of current substance-related disorders may allow better allocation of organ resources and proper lifestyle modification programs provision. A prior history of substance-related disorders should alert physicians to assess patients for possible relapse, especially after transplantation. The inclusion of a specialist in the assessment and treatment of substance-related disorders in the heart transplantation unit may reduce the risk of unsuccessful outcomes due to noncompliance with an adequate lifestyle.

Small NJK; Simons JS; Stricherz M. Assessing criterion validity of the Simple Screening Instrument for Alcohol and Other Drug abuse (SSI-AOD) in a college population. Addictive Behaviors 32(10): 2425-2431, 2007. (15 refs.)

Heavy drinking among college students is widespread, characterized by a unique pattern of heavy episodic drinking, and carries risk of negative consequences both immediate and long term. Because screening to detect high-risk student drinkers is of primary importance to insure early identification and appropriate levels of care, this study evaluated the criterion validity of the SSI-AOD. The SSI-AOD evidenced moderate to strong correlations with alcohol frequency, consumption, and problem indices. Sensitivity and specificity of the SSI-AOD and the AUDIT was determined by ROC analysis utilizing a range of possible cut-off scores using DSM-IV criteria for alcohol abuse as the reference standard. The SSI-AOD had very low sensitivity at the recommended cut-score of 4 and demonstrated poor ability to correctly classify participants overall. The AUDIT demonstrated significantly better performance, correctly classifying approximately 70% of participants using a cut-score of 8.

Stasiewicz PR; Nochajski TH; Homish DL. Assessment of alcohol use disorders among court-mandated DWI offenders. Journal of Addictions & Offender Counseling 27(2): 102-112, 2007. (35 refs.)

Convicted DWI offenders (N = 549) were assessed for alcohol use disorders. Repeat offenders had twice the rate of both lifetime and current alcohol use disorders compared with lst-time offenders. Guidelines for determining alcohol problems in DWI offenders are recommended.

Stitzer ML; Higgins ST. Behavioral treatment of drug and alcohol abuse. IN: Bloom FE; Kupfer DJ, eds. Psychopharmacology. The Fourth Generation of Progress. Nashville TN: American College of Neuropsychopharmacology, 2006. pp. unpaginated

The Smoking Cessation Manual is intended for a broad range of health professionals. It is organized into two parts. Part I, with two chapters sets forth the basic information, the demographics of smoking and the associated risks. Part II provides practical advice on implementing evidence-based interventions for smoking cessation. There is discussion of brief intervention, along with assessment tools and the process of referral. The next chapter deals with intensive one-to-one support and advice -- including assessment, pharmacotherapy, behavioral support, and monitoring -- followed by discussion of telephone counseling, and group interventions.

Turner AP; Kivlahan DR; Kazis LE; Haselkorn JK. Smoking among veterans with multiple sclerosis: Prevalence correlates, quit attempts, and unmet need for services. Archives of Physical Medicine and Rehabilitation 88(11): 1394-1399, 2007. (61 refs.)

Objective: To describe the prevalence and correlates of smoking as well as quit attempts and unmet need for smoking cessation services in a national sample of veterans with multiple sclerosis (MS). Design: Cross-sectional cohort study linking computerized medical record information to mailed survey data from 1999. Setting: Veterans Health Administration (VHA). Participants: Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires, as well as a 20% random subsample (n=569) who completed a more extensive assessment of smoking. Interventions: Not applicable. Main Outcome Measures: Items assessing smoking, quit attempts, and unmet need for smoking services. Results: Among all survey respondents with MS, 28.5% (95% confidence interval [CI], 26.9-30.2) endorsed current smoking. Of extended survey respondents, 54.5% (95% CI, 46.6 - 62. 1) reported a quit attempt in the past year, and 59.0% (95% CI, 51.1-66.4) reported not getting needed services for smoking in the past year. In fully adjusted logistic regression, smoking was associated with younger age, lower levels of education, being unmarried, higher levels of physical pain, and poorer mental health. A quit attempt was associated with higher levels of education and greater pain intensity. Conclusions: Smoking among veterans with NIS is common, with rates similar to those for other veterans. There is substantial need for cessation services. Cessation interventions should address correlates of smoking including pain, poorer mental health, and social isolation.

Urbanoski KA; Rush BR; Wild TC; Bassani DG; Castel S. Use of mental health care services by Canadians with co-occurring substance dependence and mental disorders. Psychiatric Services 58(7): 962-969, 2007. (55 refs.)

Objectives: This study contributes to knowledge of the processes underlying help seeking by those with mental and substance use disorders by examining relationships among need, service use, and satisfaction with mental health care in a population-based sample. Methods: Secondary data analyses were performed on responses to the 2002 Canadian Community Health Survey (N= 36,984). Diagnostic algorithms classified respondents by past-year diagnostic status, including substance dependence and selected mood and anxiety disorders. Logistic regressions examined associations between diagnostic status and service use, satisfaction, and unmet need for care. Results: Ten percent of Canadians and 39% of Canadians with a mental disorder or substance dependence sought services in the year preceding data collection. Although those with co-occurring substance dependence and mental disorders reported the poorest mental health and were most likely to seek care, the presence of a mental disorder, regardless of co-occurring substance dependence, contributed primarily to help seeking. Among those who sought services, the use of informal sources of care, including self-help groups, was more common among those with substance dependence. Those with co-occurring disorders reported the lowest satisfaction with care and the greatest prevalence of unmet need. Conclusions: The differential use of services, satisfaction, and unmet need across diagnostic status allowed for speculation on differing levels of disability and stigma in the help-seeking process for different types of disorders. The strong association between co-occurring disorders and unmet need for care, including a large proportion of respondents who stated they preferred to self-manage their symptoms, is particularly troubling and deserves future research attention.

Vakili S; Sobell LC; Sobell MB; Simco ER; Agrawal S. Using the Timeline Followback to determine time windows representative of annual alcohol consumption with problem drinkers. Addictive Behaviors 33(9): 1123-1130, 2008. (41 refs.)

When assessing individuals with alcohol use disorders, measurement of drinking can be a resource intensive activity, particularly because many research studies report data for intervals ranging from 6 to 12 months prior to the interview. This study examined whether data from shorter assessment intervals is sufficiently representative of longer intervals to warrant the use of shorter intervals for clinical and research purposes. Participants were 825 problem drinkers (33.1% female) who were recruited through media advertisements to participate in a community-based mail intervention in Toronto, Canada. Participants' Timeline Followback (TLFB) reports of drinking were used to investigate the representativeness of different time windows for estimating annual drinking behavior. The findings suggest that for aggregated reports of drinking and with large sample (e.g., surveys), a 1-month window can be used to estimate annual consumption. For individual cases (e.g., clinical use) and smaller samples, a 3-month window is recommended. These results suggest that shorter time windows, which are more time and resource efficient, can be used with little to no loss in the accuracy of the data.

Vinson DC; Kruse RL; Seale JP. Simplifying alcohol assessment: Two questions to identify alcohol use disorders. Alcoholism: Clinical and Experimental Research 31(8): 1392-1398, 2007. (43 refs.)

Background: Previous work has validated a single question to screen for hazardous or harmful drinking, but identifying those patients who have an alcohol use disorder (AUD) among those who screen positive is still time consuming. We therefore sought to develop and validate a brief assessment instrument using DSM-IV criteria for use in primary care medical practice. Methods: Four cross-sectional surveys of past-year drinkers. The developmental sample included patients presenting to emergency departments with an acute injury. The second sample, from the same study, was recruited by random-digit dialing. The third sample was recruited in 5 family medicine practices in Georgia. The fourth sample was the National Epidemiologic Survey on Alcohol and Related Conditions. Interviews with the first 3 samples used the Diagnostic Interview Schedule. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) used the Alcohol Use Disorder and Associated Disabilities Interview Schedule. Results: Two constructs with promising test characteristics were identified: recurrent drinking in hazardous situations and drinking more than intended. Among those who screened positive with the single question in the developmental sample (N=959), if either of the 2 items was positive, the sensitivity for current AUD was 95% and the specificity was 77%. In the second (N=494) and third (N=280) samples, the sensitivity was 94 and 95% and the specificity was 62 and 66%, respectively, among those with a positive screen. In the NESARC sample, including those with at least 1 occasion in the past year of drinking 5 or more drinks (N=7,890), the sensitivity and specificity were 77 and 86%, respectively. Conclusions: The sensitivity and specificity of these 2 items across 4 samples suggest that they could be formulated into 2 questions, potentially providing busy primary care clinicians with an efficient, reasonably accurate assessment instrument to identify AUD among those patients who screen positive with the single screening question.

Walker R; Cole JE; Logan TK; Corrigan JD. Screening substance abuse treatment clients for traumatic brain injury: Prevalence and characteristics. Journal of Head Trauma Rehabilitation 22(6): 360-367, 2007. (23 refs.)

Objectives: To examine clinical characteristics of clients in state-funded substance abuse treatment who report traumatic brain injury with loss of consciousness (TBI-LOC). Participants: Adult clients (N = 7784) entering state-funded substance abuse treatment in a rural state during a 12-month period. Measurement tools: Substance use and mental health problems were measured using the federal Substance Abuse and Mental Health Services Administration (SAMHSA) adaptation of the Addiction Severity index (ASI). A brain injury screening question was used to determine the number of TBI-LOCs in a client's lifetime. Design: Cross-sectional study of intake characteristics as part of a state-mandated treatment outcome study. Results: Almost one-third (31.7%) of substance abuse treatment clients reported 1 or more TBI-LOCs. The clients reporting 2 or more TBI-LOCs were more likely than clients with none or 1 TBI-LOC to have serious mental health problems (ie, depression, anxiety, hallucinations, and suicidal thoughts and attempts), trouble controlling violent behavior, trouble concentrating or remembering, and more months of use of most substances. When depression and anxiety were held constant, and controlling for race and gender, clients with TBI-LOC had more months of marijuana and tranquilizer use. Conclusions: Findings suggest that treatment providers may need to be attentive to the complex conditions that co-occur with TBI-LOC. Future research should examine whether there are differences in treatment outcome for clients reporting TBI-LOC.

Whitmore EA; Riggs PD. Developmentally informed diagnostic and treatment considerations in comorbid conditions. IN: Liddle HA; Rowe CL, eds. Adolescent Substance Abuse: Research and Clinical Advances. Cambridge: Cambridge University Press, 2006. pp. 264-283. (97 refs.)

This is one of four chapters dealing with comprehensive assessment and integrative treatment planning with adolescent substance abusers. The primary goals are to understand the clinical impact and treatment implications of comorbidity; to be familiar with the current standards for treatment of comorbid conditions; and to derive an algorithm for integrating the treatment of both substance use disorders and comorbid psychiatric disorders.

2006, Project Cork

Winters KC. Clinical perspectives on the assessment of adolescent drug abuse. IN: Liddle HA; Rowe CL, eds. Adolescent Substance Abuse: Research and Clinical Advances. Cambridge: Cambridge University Press, 2006. pp. 223-240. (64 refs.)

This is one of four chapters dealing with comprehensive assessment and integrative treatment planning with adolescent substance abusers. The purpose is to provide an overview of clinical bet practices for assessment of adolescent drug abuse. A multidimensional model of screening and assessment is proposed, applicable in most research and treatment settings, and suited for problem identification referral and treatment. In addition, the chapter highlights clinical challenges and approaches when the model is used. The model set forth describes three levels of evaluation: brief screening, taking 5-10 minutes, screening, taking 30-60 minutes, and comprehensive, taking 2 to 4 hours. Each of these uses different methods, ranging form a short questionnaire along to a comprehensive questionnaire, accompanied by a detailed interview, observations, and archival records. They also differ in terms of the sources of information, ranging from the client alone to client and parent, Finally, they differ from the nature of the focus, ranging from simply ascertaining the severity of abuse to the determining the severity, as well as psychiatric co-morbidity, and the psychosocial spheres. Specific instruments are described.

2006, Project Cork

Worden BL; McCrady BS; Epstein EE. Assessment reactivity to follow-up in a study of women's treatment for alcohol dependence. Addictive Behaviors 33(6): 831-835, 2008. (7 refs.)

Little research has been conducted on symptom reductions in response to assessments in clinical trials, despite the impact such reactivity may have on interpretation of outcomes. Reactivity to data collection procedures during post-treatment follow-up may obscure treatment effects. The current study examined whether female participants (n = 102) in a trial of cognitive-behavioral treatment for alcohol dependence had lower drinking quantity and frequency immediately after participating in follow-up assessments. Repeated measures ANOVAs were used to compare each participant's drinking among two-week time periods immediately before the follow-up, directly after the follow-up, and between follow-ups. No assessment reactivity was found for 9 or 15 month follow-up interviews, but was suggested at a 12 month in-person interview.

Yoast RA; Wilford BB; Hayashi SW. Encouraging physicians to screen for and intervene in substance use disorders: Obstacles and strategies for change. (review). Journal of Addictive Diseases 27(3): 77-97, 2008. (152 refs.)

The scientific literature was reviewed to identify obstacles and effective ways to improve primary care physician screening, interventions, and management of patient substance use disorders (SUDs). Major obstacles identified are physician lack of skills and self-efficacy in patient counseling, inadequate training at all levels of medical education, and lack of reimbursement and other health care systems support for services to patients. Physician abuse of drugs does not appear to be a major obstacle. Physician attitudes about patients with SUDS and the effectiveness of treatment services need to be addressed. Research points to the use of a multifaceted change strategy. Key components include practice-based training emphasizing screening and counseling skills throughout medical education, clinical systems to ensure regular SUD services (screening, intervention, and referral) to patients, and reimbursement and coverage systems to support physician interventions and patient services.

Yu J; Appel PW; Warren BE; Rubin S; Gutierrez R; Larson B; Robinson H. Substance abuse intervention services in public sexually transmitted disease clinics: A pilot experience. Journal of Substance Abuse Treatment 34(3): 356-362, 2008. (13 refs.)

Past research reported a gap in substance abuse treatment for patients in sexually transmitted disease (STD) clinics. Studies in New York City indicate that approximately 20% of patients with STD show symptoms of alcohol and substance abuse, but only 1% have ever received treatment services. This article reports findings from a pilot project that implemented early intervention service procedures in an STD clinic in New York City. Services implemented included screening for substance use problems, brief interventions, and referral for treatment. Four main issues were explored in this pilot study: the feasibility of implementing early intervention services in an STD clinic; the extent to which patients would accept such interventions; the extent to which STD staff would be ready to integrate substance abuse services into their primary care protocols; and the likelihood of sustaining such services in an STD environment. Results and recommendations are provided and discussed.