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CORK Bibliography: Brief Treatment

74 citations. 2008 to present

Prepared: June 2009

Aalto M; Seppa K. Primary health care physicians' definitions on when to advise a patient about weekly and binge drinking. Addictive Behaviors 32(7): 1321-1330, 2007. (28 refs.)

Objective: Little is known about the level of alcohol consumption at which physicians think that they should advise their patients to reduce drinking. This is especially true concerning the amounts consumed per one drinking occasion. The aim of the present study was to examine these issues and also characteristics of physicians possibly associated with their different opinions. Method: Cross-sectional self-administered questionnaire survey to all 3193 primary health care physicians in Finland. Response rate was 61.0%. Results: The physicians reported that on average 14.8 drinks (one drink = 12 g of absolute alcohol)/week for males and 10.6 drinks/week for females to be the threshold that would cause them to advise their patients. Corresponding figures for one drinking occasion were 6.6 and 4.9 drinks/week. In linear regression analyses physicians' AUDIT scores, use of brief intervention, experience as a physician and age explained the variance of all or some reported thresholds, but all the variables explained only about 10% of the phenomena. Conclusions: Compared to the official Finnish recommendations regarding the definition of heavy drinking, the physicians reported similar levels of drinking per occasion for deciding to advise their patients, but rather low levels concerning weekly drinking. This may lead to extra workload for physicians and thus hamper implementation of brief intervention. Physicians' characteristics seem to be a decidedly minor issue in implementing drinking limits in health care.

Anderson JF. Screening and brief intervention for hazardous alcohol use within indigenous populations: Potential solution or impossible dream? Addiction Research & Theory 15(5): 439-448, 2007. (37 refs.)

Despite the increasing popularity of screening and brief intervention (SBI) for hazardous drinking within the wider population, there is a paucity of SBI research directed at Indigenous populations. In Canada, Aboriginal drinkers are less than half as likely to drink on a weekly/daily basis but more than twice as likely to binge drink compared to the general drinking population. As a result, there is a high rate of alcohol related deaths and hospitalisations compared to the non-Aboriginal population. Modification of these patterns and levels of hazardous drinking - especially binge drinking - among Aboriginal drinkers should markedly improve health outcomes. Although the efficacy of SBI has been demonstrated across a range of health care settings and sociocultural groups, there are potential systemic and cultural barriers to implementation of SBI for Aboriginal hazardous drinkers including the historic impact of alcohol on Aboriginal communities. Implementation of SBI must address these barriers and be sensitive to the historic relationship between Aboriginals and alcohol.

Apodaca TR; Miller WR; Schermer CR; Amrhein PC. A pilot study of bibliotherapy to reduce alcohol problems among patients in a hospital trauma center. Journal of Addictions Nursing 18(4): 167-173, 2007. (37 refs.)

Because alcohol use plays a major role in many injuries that require hospital care, there is increasing interest in developing interventions to address alcohol problems among emergency department and trauma center patients. The aim of the current study was to extend past research on brief interventions by investigating the use of a self-help manual to treat problem drinkers in a hospital trauma center. Forty injured patients who were either intoxicated at the time of injury or screened positive for harmful drinking were randomly assigned to receive either a brief assessment and a self-help booklet with no more than 5 minutes clinician contact (bibliotherapy) or brief assessment only. Follow-up data obtained five months after hospital discharge indicated that patients in both conditions made significant reductions in drinking and associated negative consequences. There was a trend toward further treatment-seeking among those in the bibliotherapy condition (40% versus 13%). Results suggest that the provision of self-help materials to treat problem drinkers identified in a hospital trauma setting may not bring about behavior change beyond that observed following hospitalization and an assessment of drinking. Caution in the interpretation of results is warranted due to the small sample size.

Babor TF; McRee BG; Kassebaum PA; Grimaldi PL; Ahmed K; Bray J. Screening, Brief Intervention, and Referral to Treatment (SBIRT): Toward a public health approach to the management of substance abuse. Substance Abuse 28(3): 7-30, 2007

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive and integrated approach to the delivery of early intervention and treatment services through universal screening for persons with substance use disorders and those at risk. This paper describes research on the components of SBIRT conducted during the past 25 years, including the development of screening tests, clinical trials of brief interventions and implementation research. Beginning in the 1980s, concerted efforts were made in the US and at the World Health Organization to provide an evidence base for alcohol screening and brief intervention in primary health care settings. With the development of reliable and accurate screening tests for alcohol, more than a hundred clinical trials were conducted to evaluate the efficacy and cost effectiveness of alcohol screening and brief intervention in primary care, emergency departments and trauma centers. With the accumulation of positive evidence, implementation research on alcohol SBI was begun in the 1990s, followed by trials of similar methods for other substances (e.g., illicit drugs, tobacco, prescription drugs) and by national demonstration programs in the US and other countries. The results of these efforts demonstrate the cumulative benefit of translational research on health care delivery systems and substance abuse policy. That SBIRT yields short-term improvements in individuals' health is irrefutable; long-term effects on population health have not yet been demonstrated, but simulation models suggest that the benefits could be substantial.

Baird J; Longabaugh R; Lee CS; Nirenberg TD; Woolard R; Mello MJ et al. Treatment completion in a brief motivational intervention in the emergency department: The effect of multiple interventions and therapists' behavior. Alcoholism: Clinical and Experimental Research 31(10, Supplement S): 71S-75S, 2007. (18 refs.)

Background: The aim of this study was to identify therapist behaviors during a brief motivational intervention (BMI) given to injured emergency department patients that predicted participant return for a second BMI session and 12-month alcohol-related outcomes. Methods: This was a secondary data analysis of a randomized controlled trial (n = 539) previously demonstrating that random assignment to a BMI and booster session resulted in a significant reduction of 12-month postintervention alcohol-related injuries and negative consequences relative to standard care. Results: Participants who actually received 2 BMI sessions had significantly less alcohol-related negative consequences than those who received only 1 BMI session. Therapists who reported a higher focus on emotional support and low focus on participant drinking behaviors during the initial BMI session were more likely to have assigned participants return for the second BMI session. Conclusions: The results of these secondary analyses show that compliance with a 2-session therapeutic intervention (BIB) predicted fewer negative alcohol-related consequences, and that therapists' supportive emotional emphasis during the first BMI session was important in predicting participants returning for the second MI session.

Ball SA; Todd M; Tennen H; Armeli S; Mohr C; Affleck G et al. Brief motivational enhancement and coping skills interventions for heavy drinking. Addictive Behaviors 32(6): 1105-1118, 2007. (44 refs.)

Two brief (3-session) interventions were evaluated in a community sample of 98 non-dependent heavy drinking adults. Three weeks of intensive daily monitoring of drinking using a hand-held computer were completed before and after a 3-week intervention phase in which participants were randomly assigned to a brief coping skills, brief motivational enhancement, or waiting list condition. Waiting list participants drank more before, during, and after the brief intervention than brief intervention subjects, but all participants demonstrated reductions in drinking amount and frequency. No differences in drinking were found between the two brief interventions. The potential value of intensive daily monitoring as a tool for non-alcohol dependent individuals interested in reducing their drinking was considered.

Beich A; Gannik D; Saelan H; Thorsen T. Screening and brief intervention targeting risky drinkers in Danish general practice: A pragmatic controlled trial. Alcohol and Alcoholism 42(6): 593-603, 2007. (54 refs.)

Aims: Recommendations for routine alcohol screening and brief counselling intervention in primary health care rest on results from intervention efficacy studies. By conducting a pragmatic controlled trial (PCT), we aimed at evaluating the effectiveness of the WHO recommendations for screening and brief intervention (SBI) in general practice. Methods: A randomized PCT (brief counselling intervention vs no intervention) involving 39 Danish general practitioners (GPs). Systematic screening of 6897 adults led to inclusion of 906 risky drinkers, and research follow-up on 537 of these after 12-14 months. Outcome measures focused on patients acceptance of screening and intervention and their self-reported alcohol consumption. Results: Patient acceptance of screening and intervention 10.3% (N=794) of the target population (N=7, 691) explicitly refused screening. All intervention group subjects (N=442) were exposed to an instant brief counselling session while only 17.9% of them (79/442) attended a follow-up consultation that was offered by their GP. Consumption Changes: At one-year follow-up, average weekly consumption had increased by 0.7 drinks in both comparison groups. As secondary findings, we observed an indiscriminate absolute risk reduction (ARR=0.08 (95% CI: 0.02; 0.18)) in male binge drinking, but adverse intervention effects for women on the secondary outcomes (binge drinking ARR=0.30 (95% CI: 0.47; -0.09)). Conclusions: The results of brief interventions in everyday general practice performed on the basis of systematic questionnaire screening may fall short of theoretical expectations. When applied to non-selected groups in everyday general practice SBI may have little effect and engender diverse outcome. Women may be more susceptible to defensive reactions than men.

Bernstein E; Bernstein J; Feldman J; Fernandez W; Hagan M; Mitchell P et al. An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization. Substance Abuse 28(4): 79-92, 2007

OBJECTIVE: Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience improves provider beliefs and practices. METHODS: ED faculty, residents, nurses, physician extenders, social workers, and Emergency Medical Technicians (EMTs) were surveyed prior to participating in either a two hour interactive workshops with case simulations, or a web-based program (www.ed.bmc.org/sbirt). A pre-post repeated measures design assessed changes in provider beliefs and practices at three and 12 months post-exposure. RESULTS: Among 402 ED providers, 74% reported < 10 hours of prior professional alcohol-related education and 78% had < 2 hours exposure in the previous year. At 3-month follow-up, scores for self-reported confidence in ability, responsibility to intervene, and actual utilization of SBIRT skills all improved significantly over baseline. Gains decreased somewhat at 12 months, but remained above baseline. Length of time in practice was positively associated with SBIRT utilization, controlling for gender, race and type of profession. Persistent barriers included time limitations and lack of referral resources. CONCLUSIONS: ED providers respond favorably to SBIRT. Changes in utilization were substantial at three months post-exposure to a standardized curriculum, but less apparent after 12 months. Booster sessions, trained assistants and infrastructure supports may be needed to sustain changes over the longer term.

Boyle RG; Solberg LI; Asche SE; Maciosek MV; Boucher JL; Pronk NP. Proactive recruitment of health plan smokers into telephone counseling. Nicotine & Tobacco Research 9(5): 581-589, 2007. (22 refs.)

We tested whether a 3-month beneficial effect of telephone counseling as an adjunct to the use of medications for smoking cessation was maintained through 12 months. Health plan members filling a prescription for cessation medications were randomized either to a no-contact control group or to proactive recruitment into telephone counseling. An increased point-prevalence quit rate at 3 months (33.1% vs. 27.4%, p<. 05) among smokers randomized to proactive recruitment for telephone counseling was not maintained. Although at 12 months smokers in the proactive recruitment arm were more likely to report a 24-hr quit attempt, compared with control group smokers (86.7% vs. 80.8%, p=.027), we found no differences between the groups in repeated (3-month and 12-month) 7-day point-prevalence quit rates. In an analysis of predictors of quitting, age, marital status, making a lifestyle change, and the presence of household smokers were associated with repeated 3-month and 12-month point-prevalence abstinence. Offering telephone counseling to insured smokers who have filled prescriptions for cessation medications did not increase long-term quit rates. Although other variations of this approach might be tested, we suspect that it might be more useful to test innovative ways to influence the factors we identified as being most strongly predictive of lack of successful quitting.

Bradley KA; Williams EC; Achtmeyer CE; Hawkins EJ; Harris AH; Frey MS et al. Measuring performance of brief alcohol counseling in medical settings: A review of the options and lessons from the Veterans Affairs (VA) health care system. Substance Abuse 28(4): 133-149, 2007

Brief alcohol counseling is a top US prevention priority but has not been widely implemented. The lack of an easy performance measure for brief alcohol counseling is one important barrier to implementation. The purpose of this report is to outline important issues related to measuring performance of brief alcohol counseling in health care settings. We review the strengths and limitations of several options for measuring performance of brief alcohol counseling and describe three measures of brief alcohol counseling tested in the Veterans Affairs (VA) Health Care System. We conclude that administrative data are not well-suited to measuring performance of brief alcohol counseling. Patient surveys appear to offer the optimal approach currently available for comparing performance of brief alcohol counseling across health care systems, while more options are available for measuring performance within health care systems. Further research is needed in this important area of quality improvement.

Brown RL; Saunders LA; Bobula JA; Mundt MP; Koch PE. Randomized-controlled trial of a telephone and mail intervention for alcohol use disorders: Three-month drinking outcomes. Alcoholism: Clinical and Experimental Research 31(8): 1372-1379, 2007. (57 refs.)

Bakcground: Alcohol screening, brief intervention, and referral to specialized treatment (ASBIR) reduce drinking and related harms. Unanswered questions are how to manage nondependent patients with poor response to brief interventions, how to manage dependent patients who do not obtain treatment, and how to ensure population-wide delivery of ASBIR. Telephone-administered counseling may provide answers. Methods: We conducted a 12-month randomized controlled trial of a telephone and mail intervention for non-treatment-seeking primary care patients with alcohol use disorders. We enrolled 897 subjects after systematic screening in 18 primary care clinic waiting rooms in and around Madison and Milwaukee, Wisconsin, and subsequent telephone-administered diagnostic interviews. Experimental subjects received up to six sessions of protocol-driven telephone counseling based on principles of motivational interviewing and stages of readiness to change. Control subjects received a pamphlet on healthy lifestyles. The paper reports on 3-month drinking outcomes for men and women with alcohol abuse and dependence. Results: Male experimental subjects (N=199) manifested a 30.6% decline in risky drinking days, compared with a 8.3% decline in controls (N=201, p < 0.001). The total consumption declined by 17.3% compared with 12.9% by controls (p=0.001). Female experimental subjects (N=246) manifested a 17.2% decrease in risky drinking days compared with an 11.5% decrease by controls (N=251; p=NS) and a 13.9% decline in total consumption compared with 11.0% by controls (p=NS). Greater numbers of telephone counseling sessions were associated with greater declines in drinking. Conclusion: Following systematic screening, a six-session telephone and mail intervention is more effective than a pamphlet in reducing drinking at 3 months for non-treatment-seeking men with alcohol abuse and dependence. An intervention effect of the enrollment procedures may have obscured further intervention effectiveness. Telephone counseling shows promise for non-treatment-seeking primary care patients with alcohol use disorders.

Burleson JA; Kaminer Y. Aftercare for adolescent alcohol use disorder: Feasibility and acceptability of a phone intervention. American Journal on Addictions 16(3): 202-205, 2007. (23 refs.)

A lack of continuity of care for adolescents with alcohol and other substance use disorders (AOSUD) is common. The objectives of this brief report are to present the rationale for the use of manualized, individual brief therapeutic phone contacts (IBTPC) integrating motivational interviewing and cognitive behavioral therapies for aftercare in youth with AOSUD; and report the results and discuss the implications of a study on the feasibility and acceptability of IBTPC in youths with AOSUD. Four therapists and forty-three adolescents who completed IBTPC responded to a questionnaire concerning the acceptability, feasibility, and confidentiality of the IBTPC. In general, both subjects and therapists were positively consistent in their endorsement of the common items. In conclusion, aftercare for adolescents with AOSUD utilizing a brief phone intervention is perceived as feasible and acceptable.

Campbell J; Mays MZ; Yuan NP; Muramoto ML. Who are health influencers? Characterizing a sample of tobacco cessation interveners. American Journal of Health Behavior 31(2): 181-192, 2007. (32 refs.)

Objectives: To describe characteristics of health influencers (HIs) prior to training in brief tobacco cessation interventions. Methods: HIs (n=910) in Arizona were recruited for a randomized controlled trial comparing training modalities. Results:Typically middle-aged (M=43, SD=14), non-Hispanic white (68%), female (77%), non-tobacco users (93%), most identified personal (89%) rather than job-related (3%) motivators for becoming cessation interveners. Confidence about intervention ability was high (93%); knowledge scores, however, were low (M=55%, SD=13%). Conclusions: HIs exhibiting high motivation to intervene but, lacking knowledge about BI strategies may be an untapped resource for tobacco cessation and a variety of other health promotion interventions.

Carey KB; Henson JA; Carey MP; Maisto SA. Which heavy drinking college students benefit from a brief motivational intervention? Journal of Consulting and Clinical Psychology 75(4): 663-669, 2007. (22 refs.)

Heavy drinking among college students is common and is often harmful. A previously reported randomized trial revealed that a brief motivational intervention (BMI) reduced the alcohol consumption of heavy drinking college students (K. B. Carey, M. P. Carey, S. A. Maisto, & J. M. Henson, 2006). For this study, the reseachers conducted supplemental analyses of hypothesized predictors of change using the same sample (N = 495). Greater readiness to change, higher levels of self-regulation, and less engagement in social comparison all independently predicted reductions in drinking outcomes. Furthermore, self-regulation, social comparison, and future time perspective interacted with BMI and predicted drinks per week. As expected, greater self-regulation skills enhanced response to the BMI; the remaining interaction effects were unexpected. Overall, these findings suggest that BMIs produce relatively robust effects.

Chossis I; Lane C; Gache P; Michaud PA; Pecoud A; Rollnick S et al. Effect of training on primary care residents' performance in brief alcohol intervention: A randomized controlled trial. Journal of General Internal Medicine 22(8): 1144-1149, 2007. (39 refs.)

Background: Brief alcohol interventions (BAI) reduce alcohol use and related problems in primary care patients with hazardous drinking behavior. The effectiveness of teaching BAI on the performance of primary care residents has not been fully evaluated. Methods: A cluster randomized controlled trial was conducted with 26 primary care residents who were randomized to either an 8-hour, interactive BAI training workshop (intervention) or a lipid management workshop (control). During the 6-month period after training (i.e., from October 1, 2003 to March 30, 2004), 506 hazardous drinkers were identified in primary care, 260 of whom were included in the study. Patients were interviewed immediately and then 3 months after meeting with each resident to evaluate their perceptions of the BAI experience and to document drinking patterns. Results: Patients reported that BAI trained residents: conducted more components of BAI than did controls (2.4 vs 1.5, p=.001); were more likely to explain safe drinking limits (27% vs 10%, p=.001) and provide feedback on patients' alcohol use (33% vs 21%, p=.03); and more often sought patient opinions on drinking limits (19% vs 6%, p=.02). No between-group differences were observed in patient drinking patterns or in use of 9 of the 12 BAI components. Conclusions: The BAI-trained residents did not put a majority of BAI components into practice, thus it is difficult to evaluate the influence of BAI on the reduction of alcohol use among hazardous drinkers.

Christenhusz L; Marcel P; Erwin S; van der Palen J. Prospective determinants of smoking cessation in COPD patients within a high intensity or a brief counseling intervention. Patient Education and Counseling 66(2): 162-166, 2007. (16 refs.)

Objectives: The aims of this study were to identify prospective determinants of smoking cessation in COPD patients, and to assess whether prospective determinants vary between two different cessation interventions. Methods: Two hundred and twenty-five moderate to severe COPD patients were randomly allocated to two smoking cessation interventions. One-year cotinine-validated continuous abstinence rates were 9% for the minimal intervention strategy for lung patients (LMIS) and 19% for the SmokeStopTherapy (SST). The baseline characteristics that showed a significant univariate relationship with 1-year continuous abstinence (p < .20) were included in the logistic regression model. This procedure was performed for each intervention separately. Variables that did not remain independent predictors were removed. Results: For the SST separately, no independent significant predictor remained. For the LMIS, attitude towards smoking cessation (OR: 11.8; 95% CI: 1.7-81.5; p = .013) and cotinine level (OR: 2.1; 95% CI: 1.08-3.93; p = .028) remained significant predictors. Within the LMIS, 31% of the variance in continuous abstinence was explained by these variables (p = .003). Conclusion: This study suggests that a moderately intensive intervention (LMIS) is primarily suitable for COPI) patients with a positive attitude regarding smoking cessation. The more intensive SST can be an alternative for patients without such baseline characteristic. Practice implications: This stepped-care approach in smoking cessation counseling may be useful in clinical practice and will enable health care providers to match interventions to individual needs and increase efficiency.

Daeppen JB; Bertholet N; Gmel G; Gaume J. Communication during brief intervention, intention to change, and outcome. Substance Abuse 28(3): 43-51, 2007

OBJECTIVES: To explore the relationship between patient's intention to change regarding future alcohol consumption following brief alcohol intervention (BAI) and changes in alcohol consumption 12-months later and the communication characteristics between patient and counselor during BAI. DESIGN, SETTING AND SUBJECTS: Data from 367 patients (experimental arm) of a pragmatic randomized controlled trial were used to assess the effectiveness of BAI among hazardous drinkers attending an Emergency Department (Lausanne University Hospital, Lausanne, Switzerland). Alcohol outcome measures at baseline and 12 months follow-up included usual number of drinks per week, monthly frequency of heavy episodic drinking (5 or more standard drinks for men; 4 or more for women), and the Alcohol Use Disorders Identification Test (AUDIT) score. In addition, the communication characteristics between patient and counselor were analyzed via tape recordings using the Motivational Interviewing Skill Code (MISC) from 97 participants. Patient readiness and importance to change on a 10-point Likert scale (readiness/importance to change ruler) was asked during BAI, and patient intention to change alcohol consumption (yes/no) was asked at the last step. Differences in alcohol outcome at follow-up between the 367 patients who did or did not have an intention to change consumption at baseline were compared, as were differences between these two groups in communication characteristics for the 97 who completed tape recordings. RESULTS: Patients with an intention to decrease alcohol consumption reduced alcohol use and related problems more often, and reported higher levels of importance and readiness to change than did their counterparts. Analyses of MISC-coded data showed a significantly higher use of MI-consistent skills among those with a moderation intention, but no group differences on the 8 other counselor communication skills measures were found. Analyses of patient speech during the intervention indicated that those with an intention to change their alcohol consumption significantly more often self-explored personal ambivalence towards alcohol, expressed more intensely their ability, commitment, desire, need and reason to change their alcohol use than did those in the no decrease group. CONCLUSIONS: The intention expressed by hazardous drinkers when concluding BAI is associated with both patient change talk during BAI and drinking outcome 12 months later, but is mainly independent of counselor communication skills. This intention may be an important clinical indicator of which hazardous drinkers are most likely to improve after BAI.

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.]

Davidson D; Gulliver SB; Longabaugh R; Wirtz PW; Swift R. Building better cognitive-behavioral therapy: Is broad-spectrum treatment more effective than motivational-enhancement therapy for alcohol-dependent patients treated with naltrexone? Journal of Studies on Alcohol and Drugs 68(2): 238-247, 2007. (33 refs.)

Objective: The current study investigated the treatment effectiveness, during treatment, of a second-generation cognitive-behavioral therapy for alcoholism-broad-spectrum treatment (BST)-compared with motivational -enhancement therapy (MET), when both were offered in conjunction with a therapeutic dose of naltrexone (Revia). Method: One hundred forty-nine alcohol-dependent patients completed a 3-month randomized, controlled trial of BST and naltrexone versus MET and naltrexone. Results: Patients receiving BST had a significantly higher percentage of days abstinent than patients receiving MET. The superior effect of BST is particularly strong in interaction with support for drinking, suggesting that the advantage of BST is worth the additional cost for patients whose psychosocial networks are supportive of continued drinking. This effect remains significant when controlling for pretreatment percentage of days abstinent. Conclusions: In aggregate, these findings suggest that it is either the combination of naltrexone and BST or the unique properties of BST that account for BST's superiority to MET and naltrexone. The results of this initial phase of the trial suggest that a second-generation cognitive-behavioral therapy such as BST may have a meaningful clinical advantage over brief interventions such as MET, at least when combined with naltrexone.

Dawe S; Harnett P. Reducing potential for child abuse among methadone-maintained parents: Results from a randomized controlled trial. Journal of Substance Abuse Treatment 32(4): 381-390, 2007. (55 refs.)

High rates of child abuse and neglect occur in many families in which either or both parents abuse illicit drugs. This study reports on the results of a randomized controlled trial with families having a parent on methadone maintenance (N = 64), in which an intensive, home-based intervention, the Parents Under Pressure (PUP) program, was compared to standard care. A second brief intervention control group of families received a two-session parenting education intervention. The PUP intervention draws from the ecological model of child development by targeting multiple domains of family functioning including the psychological functioning of individuals in the family, parent-child relationships, and social contextual factors. Mindfulness skills were included to address parental affect regulation, a significant problem for this group of parents. At 3- and 6-rnonth follow-up, PUP families showed significant reductions in problems across multiple domains of family functioning, including a reduction in child abuse potential, rigid parenting attitudes, and child behavior problems. Families in the brief intervention group showed a modest reduction in child abuse potential but no other changes in family function. There were no improvements found in the standard care group and some significant worsening was observed. Results are discussed in terms of their implications for improved treatment.

Freyer J; Coder B; BIschof G; Baumeister SE; Rumpf HJ; John U; Hapke U. Intention to utilize formal help in a sample with alcohol problems: A prospective study. Drug and Alcohol Dependence 87(2/3): 210-216, 2007. (43 refs.)

Background: Studies investigating factors of treatment entry have predominantly focussed on persons that have already taken an initial step in the process of help-seeking. With particular emphasis on intention to utilize help, this study aims to detect predictors for alcohol-related help-seeking among a non-help-utilizing sample. Methods: Using 312 individuals with diverse alcohol problems (dependence, abuse, at-risk drinking), intention to utilize help was assessed in addition to evidence based predictors for utilization of help (e.g. severity of alcohol problem, prior help-seeking). Results: In addition to prior utilization of help (OR = 9.76, CI: 4.60-20.74) and adverse consequences from drinking (OR = 1.13, CI: 1.02-1.25), intention to utilize help (OR = 4.84, CI: 2.04-11.51) was a central predictor for help-seeking. Among individuals who had not obtained prior help, individuals intending to seek help were 8.7 times more likely to utilize help than those not intending to seek help (CI: 1.05-72.2). Conclusions: In the past, intention to utilize help has been neglected from models investigating treatment entry. This study's findings show that intention is a central factor for utilization of alcohol-specific formal help. Consequently, brief interventions focusing on enhancing motivation are expected to improve early help-seeking among general hospital patients with diverse alcohol problems. Ireland Ltd.

Funderburk JS; Maisto SA; Sugarman D. Brief alcohol interventions and multiple risk factors in primary care. Substance Abuse 28(4): 93-105, 2007

Early identification and intervention of harmful/hazardous drinking in primary care are U.S. healthcare priorities. Traditionally, research has focused on designing interventions for patients in primary care who report hazardous/harmful alcohol use, even though it is likely for a patient to be at risk for multiple problems. This article has three major goals: (1) to present data highlighting the prevalence and co-variation of other risk factors with hazardous/harmful drinking, including data from a small descriptive study; (2) to review the literature on brief alcohol interventions designed to address multiple risk factors; and (3) to provide recommendations for future research. Despite data indicating primary care patients present with multiple risk factors, only a limited number of studies in the literature have investigated brief interventions addressing alcohol use and other risk factors. It is important for future research to expand brief alcohol interventions to include other risk factors as well.

Geisner IM; Neighbors C; Lee CM; Larimer ME. Evaluating personal alcohol feedback as a selective prevention for college students with depressed mood. Addictive Behaviors 32(12): 2776-2787, 2007. (53 refs.)

Objective: This research evaluated a brief mailed intervention for alcohol use as an adjunct to a brief treatment for college students with depression symptoms. The intervention aimed to correct normative misperceptions and reduce students' drinking and related consequences. Method: One hundred seventy seven college students (70% Female) with elevated scores on the Beck Depression Inventory were randomly assigned to intervention or control group. Participants in the intervention were mailed feedback and information detailing their reported alcohol use, moderation strategies, and accurate normative information regarding student drinking. Results: Results indicated no main effects of the intervention on drinking or related problems but students receiving feedback showed significant reductions in their perception of drinking norms compared to the control group. Furthermore, students whose normative perceptions reduced showed significant reductions in total drinks per week and total alcohol related problems compared to those whose norms did not reduce. Conclusions: Results support the importance of correcting normative perceptions and provide direction for selective prevention of alcohol use and related problems among college students with depressed mood.

Gibson A; Shanahan M. Costs and outcomes of treatments for excessive alcohol consumption: Making policy decisions with the available data. Drugs: Education, Prevention and Policy 14(1): 1-17, 2007. (75 refs.)

AIM: To determine which treatments for risky or dependent alcohol consumption provide the best health outcomes for a given expenditure. Methods: Economic evaluation expressing results in cost per unit outcome, from the perspective of the Australian healthcare system. Interventions considered include brief interventions; psychosocial interventions (motivational approaches, cognitive-behavioural approaches and self-guided materials); and pharmacotherapies (acamprosate and naltrexone). Treatment outcomes and standard treatment costs were measured for selected studies, and costs per unit outcome were calculated. Findings: Twenty-nine studies were selected for the analysis. As treatment outcomes were not consistently expressed in a single unit across interventions, two outcomes were used in the analysis: percentage change in alcohol consumption and percentage change in the proportion of abstinent days. Brief interventions provided the best cost per unit outcome, followed by psychosocial interventions, then pharmacotherapies. Conclusions: By using two treatment outcomes instead of one we demonstrated that some treatments for alcohol dependence provide better value for money, but as a result we were unable to complete a formal health economic evaluation. Consistent measurement of alcohol consumption outcomes in research studies would facilitate similar economic evaluations in the future. This work illustrates the difficulties of using research studies with non-comparable outcomes to inform policy on the cost-effectiveness of different treatments.

Hjalmarson A; Boethius G. The effectiveness of brief advice and extended smoking cessation counseling programs when implemented routinely in hospitals. Preventive Medicine 45(2/3): 202-207, 2007. (21 refs.)

Objective. To evaluate the effectiveness of two in-hospital smoking cessation interventions - brief advice and extended counseling with follow-up. Methods. The subjects (n = 770) were in-patients who were daily smokers or had stopped smoking 30 days preceding admission to 15 wards in five Swedish hospitals. All wards started with a control period. Thereafter, eight wards treated patients with brief advice by a nurse and seven provided bedside support by a trained counselor plus telephone support for up to 30 days after discharge. Results. The one-year point prevalence self-reported cessation rate of 22% for brief advice and 28% for extended counseling was not significantly better than usual care. The odds ratios were 1.12 (95% CI 0.63, 2.01) and 1.25 (95% CI 0.80, 1.98) respectively. The response rate was 79%. Brief advice was refused by 17% of the patients and extended counseling by 34%. Only half of the brief advice and one third of counseled patients received the complete program, and cessation rates among them were 25% and 38% respectively. Conclusion. In a hospital setting, neither brief advice nor extended counseling significantly increased cessation rates. However, patients who received the entire intervention were more successful at quitting. Effective implementation of current interventions may be more productive in reducing smoking than a search for better treatments.

Holloway AS; Watson HE; Arthur AJ; Starr G; McFadyen AK; McIntosh J. The effect of brief interventions on alcohol consumption among heavy drinkers in a general hospital setting. Addiction 102(11): 1762-1770, 2007. (43 refs.)

Aims (i) To evaluate the effect of receiving one of two brief interventions in reducing alcohol consumption among general hospital patients compared with usual care. (ii) To assess whether a brief intervention of self-efficacy enhancement was superior to a self-help booklet in reducing alcohol consumption. Design A three-arm cluster randomized controlled trial. Setting: Seven general medical, six general surgical, one dermatology and two otolaryngology wards of a large teaching hospital covering a large urban and rural area. Participants: A total of 215 of 789 in-patients aged 18-75 years, who screened positive for alcohol consumption in excess of national recommended limits according to a 7-day retrospective drinking diary. Interventions Participants were allocated to receive one of three interventions: (i) face-to-face self-efficacy enhancement; (ii) a self-help booklet; or (iii) usual care. Measurements: The primary outcome measure was change in reported alcohol consumption at 6-month follow-up as measured by a 7-day retrospective drinking diary. Secondary outcomes were change in: number of alcohol drinking days in last week; the maximum units of alcohol consumed on any one day in last week; and Drinking Refusal Self-efficacy Expectancy Questionnaire score. Findings: Compared to the usual care group the self-efficacy enhancement group (-10.1 units 95% CI -16.1 to -4.1) and the self-help booklet group (-10.0 units 95% CI -16.0 to -3.9) had greater reductions in self-reported weekly alcohol consumption. There was no evidence that self-efficacy enhancement was superior to the self-help booklet (P = 0.96). Conclusions: Brief interventions delivered in hospital offer simple means of helping heavy drinkers to reduce their alcohol consumption.

Jungerman FS; Andreoni S; Laranjeira R. Short term impact of same intensity but different duration interventions for cannabis users. Drug and Alcohol Dependence 90(2/3): 120-127, 2007. (33 refs.)

The present study evaluates the efficacy of a brief intervention for cannabis users. A randomized controlled trial compared 3 conditions: 4 weekly individual sessions of motivational interviewing and relapse prevention over 1 month (1MIRP); the same 4 sessions over 3 months (3MIRP), and delayed treatment control (DTC). The short term impact of each intervention was followed up 4 months after randomization. Participants were 160 highly educated adults with a long history of frequent cannabis use. Both treatments showed better results than the DTC, and for primary outcomes (i.e., cannabis consumption) there was no difference between treatments, while the 3MIRP scheme showed greater efficacy in reducing dependence. symptoms and other drug use according to the ASI drug subscale. There was a tendency for the longer treatment to have better outcomes, regardless of intensity, although the waiting list did have some positive effect. The cohort needs to be followed up for a longer period in order to ascertain whether changes are maintained over time.

Kemp R; Harris A; Vurel E; Sitharthan T. Stop Using Stuff: Trial of a drug and alcohol intervention for young people with comorbid mental illness and drug and alcohol problems. Australasian Psychiatry 15(6): 490-493, 2007. (19 refs.)

Objective: Substance abuse is a significant problem in the treatment of young people with their first psychosis. This study reports a randomized trial of a brief manualized cognitive behavioural therapy for substance abuse in young people with psychosis. Method: Subjects were randomized between the study treatment and a group treated as usual. Treatment was a four to six session brief cognitive behavioural therapy (CBT) intervention developed specifically for this patient group - Stop Using Stuff (SUS). Results: Both groups improved across the trial. However, those exposed to the active treatment improved significantly on measures of the frequency of cannabis and alcohol abuse. Conclusions: Brief interventions in substance abuse in young people with psychosis can help moderate substance use in this difficult to treat group.

Kraemer KL. The cost-effectiveness and cost-benefit of screening and brief intervention for unhealthy alcohol use in medical settings. Substance Abuse 28(3): 67-77, 2007

Economic evaluation can be a valuable tool for assessing the efficiency and value of health care programs. To examine the literature on the economic evaluation of alcohol screening and brief intervention in medical settings, relevant studies were identified in the MEDLINE database (1966 through November 2006) and by hand-searching the references of identified articles and relevant journals. The 15 identified studies used a range of economic evaluation methods, including cost analysis, cost-benefit, cost-effectiveness, and cost-utility. Nearly all of the studies supported the use of alcohol screening and brief intervention. The studies that prospectively collected cost and effect data and/or conformed closely to methodological guidelines demonstrated a strong economic benefit of alcohol screening and brief intervention when compared to usual care. Overall, the reviewed studies support alcohol SBI in medical settings as a wise use of health care resources and illustrate the usefulness of economic evaluation for assessing alcohol prevention and treatment programs.

Kypri K. Methodological issues in alcohol screening and brief intervention research. Substance Abuse 28(3): 31-42, 2007

The research literature on screening and brief intervention (SBI) for unhealthy alcohol use is large and diverse. More than 50 clinical trials and 9 systematic reviews have been published on SBI in a range of healthcare settings, and via a variety of delivery approaches, in general practice, hospital wards, emergency departments, addiction treatment centres, and more recently, via computers and the Internet. The aim of this paper was to discuss methodological issues which arise in the design, analysis, interpretation, and reporting of SBI trials. Principal among these are the challenge of detecting small effects, standards of analysis, reporting, and interpretation, the risks of bias arising from self-report of outcomes, and the need to ensure that results have the potential to be applied in practice to reduce the burden of disease and injury attributable to unhealthy alcohol use.

Kypri K; Langley JD; Saunders JB; Cashell-Smith ML. Assessment may conceal therapeutic benefit: Findings from a randomized controlled trial for hazardous drinking. Addiction 102(1): 62-70, 2007. (30 refs.)

The concept that assessment of a person's health status without subsequent intervention has beneficial effects in itself has stimulated much interest in underlying psychological mechanisms, methodological implications and its public health potential. There have, however, been few experimental studies of assessment effects. To test the hypothesis that assessment in itself produces a reduction in hazardous drinking. Two conditions (group A, leaflet only and group B, leaflet and assessment but no intervention) of a four-arm randomized controlled trial with enrolment in March-April 2003. A total of 975 students (17-29 years) attending a primary health-care clinic completed a web-based Alcohol Use Disorders Identification Test (AUDIT) questionnaire. Of 599 who scored >= 8 or more, 576 consented to follow-up and were included in the full four-arm trial, of whom 293 (153 women) were assigned to groups A and B. Group A received an information leaflet at baseline. Group B received the information leaflet and 10 minutes of web-based assessment 4 weeks later. Drinking frequency, typical quantity, heavy episode frequency, personal problems and academic problems. Baseline mean AUDIT scores were 15.0 (SD = 5.4) and 14.9 (SD = 5.0) in groups A and B, respectively. Twelve months after baseline, relative to group A, group B reported lower overall consumption (geometric means ratio 0.82, 95% CI: 0.68-0.98), fewer heavy drinking episodes (0.66, 0.47-0.91), fewer problems (0.81, 0.67-0.99) and lower AUDIT scores (beta = -1.63, -0.62 to -2.65). Brief assessment appeared to reduce hazardous drinking. Controlled trials that rely on assessment may therefore underestimate treatment effects. Limitations include the possibility of measurement artefact due to social desirability bias.

Lee CS; Longabaugh R; Baird J; Abrantes AM; Borrelli B; Stein LAR et al. Do patient intervention ratings predict alcohol-related consequences? Addictive Behaviors 32(12): 3136-3141, 2007. (7 refs.)

Little is known about treatment process for behavior change for brief interventions. Patient ratings of treatment process during a patient-centered brief intervention for alcohol were used to predict post-treatment alcohol use and consequences. We use data from a randomized clinical trial that compared the effects of BI (1 session) to BI and booster (BIB, 2 sessions) to reduce harmful drinking and alcohol consequences. Subjects were n = 167 (BI) and n = 82 (BIB). Five of the 12 ratings were rated significantly higher by those in the BIB condition compared to BI. The only predictor of reduced alcohol consequences at 12-months was higher ratings of, "I have obtained some new understanding," for BIB participants t=-2.50,p<.05). Patient perspectives on treatment may have a role in patient outcomes and should be explored as a dimension of treatment process.

Lewis MA; Neighbors C. Optimizing personalized normative feedback: The use of gender-specific referents. Journal of Studies on Alcohol and Drugs 68(2): 228-237, 2007. (48 refs.)

Objective: Many brief interventions include personalized normative feedback (PNF) using gender-specific or gender-neutral referents. Several theories suggest that information pertaining to more socially proximal referents should have greater influence on one's behavior compared with more socially distal referents. The current research evaluated whether gender specificity of the normative referent employed in PNF related to intervention efficacy. Method: Following baseline assessment, 185 college students (45.2% women) were randomly assigned to one of three intervention conditions: gender-specific feedback, gender-neutral feedback, or assessment-only control. Immediately after completing measures of perceived norms, alcohol consumption, and gender identity, participants in the gender-neutral and gender-specific intervention conditions were provided with computerized information detailing their own drinking behavior, their perceptions of student drinking, and actual student drinking. Results: After a 1-month follow-up, the results indicated that normative feedback was effective in changing perceived norms and reducing alcohol consumption for both intervention groups for women and men. The results provide support, however, for changes in perceived gender-specific norms as a mediator of the effects of normative feedback on reduced drinking behavior for women only. Additionally, gender-specific feedback was found to be more effective for women higher in gender identity relative to the gender-neutral feedback. A post-assessment follow-up telephone survey administered to assess potential demand characteristics corroborated the intervention effects. Conclusions: Results extend previous research documenting efficacy of computer delivered PNF Gender specificity and gender identity appear to be important elements to consider for PNF intervention efficacy for women.

Lewis MA; Neighbors C; Oster-Aaland L; Kirkeby BS; Larimer ME. Indicated prevention for incoming freshmen: Personalized normative feedback and high-risk drinking. Addictive Behaviors 32(11): 2495-2508, 2007. (39 refs.)

This research evaluated the efficacy of a computerized, freshmen-specific personalized normative feedback (PNF) intervention on reducing alcohol consumption among high-risk drinking freshmen. Students (N=316; 53.8% female) completed measures of perceived drinking norms and drinking behavior. After completing the baseline assessment, students were randomly assigned to receive either freshmen-specific PNF that was gender-specific or gender-neutral, or to assessment only control. Findings demonstrated that students exhibited normative misperceptions for typical freshmen drinking behavior and that perceptions of typical same-sex freshmen drinking were positively associated with riskier drinking behavior. At follow-up, students randomly assigned to receive PNF reduced perceptions of typical freshmen drinking behavior and personal drinking behavior relative to those who did not receive PNF. Findings extend previous evaluations of computer-based PNF and suggest that computer-based PNF for incoming freshmen utilizing freshmen-specific norms that are gender-specific may constitute a promising prevention strategy.

Lopez ML; Iglesias JM; del Valle MO; Comas A; Fernandez JM; de Vries H; CA FAPACAN Grpup. Impact of a primary care intervention on smoking, drinking, diet, weight, sun exposure, and work risk in families with cancer experience. Cancer Causes and Control 18(5): 525-535, 2007. (59 refs.)

Background: Modifying multiple behavior risks is a promising approach to reduce cancer risk. Primary prevention advices of the European Code against Cancer were included in an educational intervention (EI) using social cognitive theories for motivating families with cancer experiences to adopt six cancer prevention behaviors. Methods: A randomized clinical controlled trial recruited 3,031 patients from Primary Care among cancer patients' relatives. The experimental group (EG) received four EI, one EI every six months, focused on tobacco, alcohol, diet, weight, sun and work, and based on social cognitive models. The impact of the first three EI was calculated measuring at baseline and 18 months later: (a) The percentage of people with each risk behavior; (b) The score reached in a Total Cancer Behavioral Risk (TCBR) indicator; (c) The Odds Ratios at the post-test. Results Five risk behaviors decreased significantly more (p < 0.01) in the EG than in the CG: Smoking (OR = 0.662), drinking (OR = 0.504), diet (OR = 0.542), weight (OR = 0.698), and sun (OR = 0.389). The TCBR indicator also decreased an average of nearly 5 points (28.42 vs. 23.82), significantly more (p < 0.001) in the EG. Conclusion: Families with cancer experiences changed five cancer risk behaviors when approached in Primary Care with interventions based on social cognitive models.

MacKillop J; Murphy JG. A behavioral economic measure of demand for alcohol predicts brief intervention outcomes. Drug and Alcohol Dependence 89(2/3): 227-233, 2007. (46 refs.)

Considerable basic and clinical research supports a behavioral economic conceptualization of alcohol and drug dependence. One behavioral economic approach to assess motivation for a drug is the use of demand curves, or quantitative representations of drug consumption and drug-reinforced responding across a range of prices. This study used a hypothetical alcohol purchase task to generate demand curves, and examined whether the resulting demand curve parameters predicted drinking outcomes following a brief intervention. Participants were 51 college student drinkers (67% female; 94% Caucasian; drinks/week: M = 24.57, S.D. = 8.77) who completed a brief alcohol intervention. Consistent with predictions, a number of demand curve indices significantly predicted post-intervention alcohol use and frequency of heavy drinking episodes, even after controlling for baseline drinking and other pertinent covariates. Most prominently, O-max, (i.e., maximum alcohol expenditure) and breakpoint (i.e., sensitivity of consumption to increasing price) predicted greater drinking at 6-month post-intervention follow-up. These results indicate that a behavioral economic measure of alcohol demand may have utility in characterizing the malleability of alcohol consumption. Moreover, these results support the utility of translating experimental assays of reinforcement into clinical research.

Mahabee-Gittens EM; Huang B; Slap GB; Gordon JS. An emergency department intervention to increase parent-child tobacco communication: A pilot study. Journal of Child & Adolescent Substance Abuse 17(2): 71-83, 2007. (34 refs.)

We conducted a randomized trial of parents and their 9- to 16-year-old children to pilot test an emergency department (ED)-based intervention designed to increase parent-child tobacco communication. Intervention group (IG) parents received verbal/written instructions on how to relay anti-tobacco messages to their children; control group (CG) parents received no specific instructions. Of the 540 subjects, 268 (49.6%) were randomized to the IG; both groups were similar at baseline. At one-month follow-up, IG children, were more likely to report that they would definitely not smoke in the next 6 months (96.3% and 88.4%, p =0.01), that there were an increased number of child-initiated tobacco conversations (F(1,386) = 5.7, p = 0.02), times parents talked to them about: refusing cigarettes (F(1,380) = 7.6, p = 0.006), and reasons not to smoke (F(1,377) = 6.0, p = 0.015). Our pilot study has shown increases in parent-child tobacco communication after an ED-based intervention, suggesting that the ED may be an appropriate setting to encourage parent-child tobacco communication.

Martens MP; Cimini MD; Barr AR; Rivero EM; Vellis PA; Desemone GA; Horner KJ. Implementing a screening and brief intervention for high-risk drinking in university-based health and mental health care settings: Reductions in alcohol use and correlates of success. Addictive Behaviors 32(11): 2563-2572, 2007. (39 refs.)

The purpose of this study was to assess the efficacy of a screening and brief intervention program for college students in a naturally occurring university-based primary health and mental health care setting. One-hundred seventy five students who met our screening criteria (> 8 for men or > 7 for women on the Alcohol Use Disorders Identification Test) enrolled in the project, and six-week follow-up data were collected from 120 (69%) of them. Results indicated that after receiving the intervention students reported decreased alcohol use, more accurate perceptions of other students' drinking, and increased use of protective behavioral strategies. Results also indicated that the individual-level changes in alcohol use were positively correlated with changes in the students' perceptions of drinking among their peers. Implications of the findings for clinicians, administrators, and researchers in the college drinking intervention and prevention field are discussed.

Mezzani L; Patussi V; Rossi A; Russo R; Scafato E. Establishing an Italian general practitioner brief intervention pilot project for problem drinkers. Substance Use & Misuse 42(12-13): 1979-1989, 2007. (23 refs.)

This national pilot project commenced in 2004. It was promoted by the Istituto Superiore di Sanita and financed by the Italian Ministry of Health. The Italian Society of General practitioners supported implementation of the study in general medical practitioner settings and coordination was under-taken by the Alcohol Centre of the University Hospital of Florence. The objectives of the study are to create a brief intervention package, suitable for use within the Italian primary health care system for screening and treating "hazardous drinkers"; to survey alcohol consumption in a sample of the population aged 18 or over, who the general practitioners assessed as suitable for brief intervention using the project's instruments; to conduct an experimental trial of brief intervention procedures, with "hazardous drinkers" randomly allocated to intervention or control conditions; to assess the effectiveness of brief intervention as a primary preventive measure. The early stage of this study concentrated on creating a strong research partnership to foster the involvement of general medical practitioners on a national scale. Subsequently, resources were devoted to the creation of the brief intervention package, including support material and the training of the general medical practitioners in its implementation.

Milne B; Towns S. Do paediatricians provide brief intervention for adolescents who smoke? Journal of Paediatrics and Child Health 43(6): 464-468, 2007. (24 refs.)

Aims: This study aimed to describe the self-reported practice of paediatricians in brief interventions for adolescents who smoke. We also aimed to compare practice with confidence, skills and knowledge of brief intervention and nicotine replacement therapy after a targeted training programme. Methods: Medical staff at The Children's Hospital at Westmead completed a questionnaire of clinical practice and confidence in brief intervention for smoking cessation. Data were analysed comparing self-reported practice with confidence, skill and knowledge of brief interventions, based on Fiore's 5A's approach (Ask about smoking at every opportunity, Assess willingness to quit, Advise patients to quit smoking, Assist quit attempts and Arrange follow up). Results: Fifty-seven clinicians completed questionnaires, 55 (96%) recognised the importance of asking adolescents about smoking. Thirty-one (54%) identified adolescent smokers all or most of the time, increasing to 50 (88%) if their presenting condition was associated with smoking. Twenty-five (44%) clinicians assessed the stage of change, 33 (58%) advised the adolescent to quit smoking, nine (16%) assisted quit attempts and 10 (17.5%) arranged follow up. Clinicians more confident in brief intervention skills, motivational interviewing and relapse prevention were more likely to use the 5A's (P < 0.05). Training increased clinician's confidence in brief intervention skills and knowledge of nicotine replacement therapy (P < 0.01); however, there was no statistically significant change in clinical practice 1 month post training. Conclusion: Training paediatricians in brief intervention skills, motivational interviewing and relapse prevention can increase the use of 5A's brief intervention in clinical practice, potentially increasing quit attempts in adolescents who smoke.

Mitcheson L; McCambridge J; Byrne S. Pilot cluster-randomised trial of adjunctive motivational interviewing to reduce crack cocaine use in clients on methadone maintenance. European Addiction Research 13(4): 6-10, 2007. (28 refs.)

This pilot trial explored the effectiveness of an adjunctive single session of motivational interviewing (MI) to reduce crack cocaine use in a methadone maintenance treatment population. Twenty-nine participants were cluster randomised by clinician to MI or a crack information control condition as part of treatment as usual. The intervention had a modest impact on one crack cocaine measure but was not statistically significant in this small sample. A large and statistically significant reduction in heroin use amongst those in the MI condition was observed. This pilot study demonstrated that it was feasible to incorporate a psychosocial intervention within a busy outpatient methadone maintenance programme and the findings support the value of undertaking a larger trial.

Monti PM; Barnett NP; Colby SM; Gwaltney CJ; Spirito A; Rohsenow DJ et al. Motivational interviewing versus feedback only in emergency care for young adult problem drinking. Addiction 102(8): 1234-1243, 2007. (36 refs.)

Aim: To establish the efficacy of a brief motivational intervention compared to feedback only when delivered in an emergency department for reducing alcohol use and problems among young adults. Design: Two-group randomized controlled trial with follow-up assessments at 6 and 12 months. Setting: Level I Trauma Center. Participants A total of 198 18-24-year-old patients who were either alcohol positive upon hospital admission or met screening criteria for alcohol problems. Intervention Participants were assigned randomly to receive a one-session motivational intervention (MI) that included personalized feedback, or the personalized feedback report only (FO). All participants received additional telephone contact 1 month and 3 months after baseline. Measurements: Demographic information, alcohol use, alcohol problems and treatment seeking. Findings: Six months after the intervention MI participants drank on fewer days, had fewer heavy drinking days and drank fewer drinks per week in the past month than did FO patients. These effects were maintained at 12 months. Clinical significance evaluation indicated that twice as many MI participants as FO participants reliably reduced their volume of alcohol consumption from baseline to 12 months. Reductions in alcohol-related injuries and moving violations, and increases in alcohol treatment-seeking were observed across both conditions at both follow-ups with no differences between conditions. Conclusions: This study provides new data supporting the potential of the motivational intervention tested to reduce alcohol consumption among high-risk youth.

Murgraff V; Abraham C; McDermott M. Reducing friday alcohol consumption among moderate, women drinkers: Evaluation of a brief evidence-based intervention. Alcohol and Alcoholism 42(1): 37-41, 2007. (22 refs.)

Aims: A randomized controlled trial was used to evaluate a brief research-based intervention designed to promote drinking within recommended limits on Fridays and Saturdays among moderate drinkers. Methods: The two-page, leaflet-like intervention included persuasive communication targeting motivational and volitional antecedents of behaviour as specified by an extended theory of planned behaviour (TPB) and implementation intention theory. Participants were randomly allocated to a control group (TPB questionnaire only) or to a group receiving the TPB questionnaire plus leaflet-like intervention. Cognitions and drinking behaviour were measured immediately before the intervention and at 8-weeks follow-up. The pre-intervention questionnaire was distributed to 573 participants of whom 347 (61%) responded at follow-up. Results: Significantly greater reduction in risky drinking on Fridays was observed among women (but not men) in the intervention group at 8-weeks follow-up. No other post-intervention differences were found. Conclusions: A low-cost, readily-produced, written intervention focusing on recommended daily limits reduced risky drinking amongst women on Fridays. Further work on similar interventions is warranted.

Neuner B; Fleming M; Born R; Weiss-Gerlach E; Neumann T; Rettig J et al. Predictors of loss to follow-up in young patients with minor trauma after screening and written intervention for alcohol in an urban emergency department. Journal of Studies on Alcohol and Drugs 68(1): 133-140, 2007. (39 refs.)

Objective: In health promotion studies, young age, male gender. low education, and substance use have been found to be relevant predictors of loss to follow-up. The purpose of this study was to assess factors of loss to follow-up after screening and tailored brief advice for alcohol problems in an emergency department setting. Method: A randomized controlled intervention study was conducted and followed up at 12 months. At baseline (TO), 2,562 consecutive trauma patients (62.1% male) were screened for substance use (smoking, alcohol consumption, and illicit drug use) and for socioeconomic factors (income, relationship status, an education). Patients with five points or more in the Alcohol Use Disorders Identification Test randomly received tailored brief advice on alcohol and were followed up at 3 (T3), 6 (T6), 9 (T9), and 12 months (T12). Results: At baseline, median age was 32 years (range: 18-89). There was a loss of 950 participants (37.1%) from T0 to T12. Loss to follow-up was strongly dependent on social factors. In participants with a high school diploma, only smoking was predictive of loss to follow-up (odds ratio [OR] = 1.81, 95% confidence interval [CI] = 1.43-2.29). In participants with no high school diploma, alcohol problems alone predicted loss to follow-up (medium level of alcohol problems, OR = 1.57, 95% CI = 1.09-2.27; high level of alcohol problems, OR = 1.62, 95% CI = 0.96-2.76; p = .017). Smoking (OR = 1.35, 95% CI = 0.97-1.89) and, for smokers, age 18-31 years (OR = 1.65, 95% CI = 0.98-2.78) showed a tendency toward an increased risk of loss to follow-up. Conclusions: After screening and a brief intervention in an emergency department, substance use and differences in education level predicted loss to follow-up. Patients with alcohol problems and no high school diploma are at increased risk of becoming lost to follow-up.

O'Farrell TJ; Murphy M; Alter J; Fals-Stewart W. Brief family treatment intervention to promote aftercare among male substance abusing patients in inpatient detoxification: A quasi-experimental pilot study. Addictive Behaviors 32(8): 1681-1691, 2007. (18 refs.)

We developed a brief family treatment (BFT) intervention for substance abusing patients in inpatient detoxification to promote aftercare treatment post-detox. BFT consisted of meeting with the patient and a family member (spouse or parent) with whom the patient lived to review and recommend potential aftercare plans for the patient. A phone conference was used when logistics prevented an in-person family meeting. Results indicated that male substance abusing patients who received BFT (N= 14), as compared with a matched treatment as usual (TAU) comparison group (N= 14) that did not, showed a trend toward being more likely to enter an aftercare program and to attend more days of aftercare in the 3 months after detoxification. The magnitude of these differences favoring BFT over TAU was midway between a medium and a large effect size. Days using alcohol or drugs in the 3 months after detox were lower for treatment-exposed BFT patients who had an in-person family meeting than TAU counterparts (trend, medium effect), and for patients who entered aftercare regardless of treatment condition (significant large effect).

Pal HR; Yadav D; Mehta S; Mohan I. A comparison of brief intervention versus simple advice for alcohol use disorders in a North India community-based sample followed for 3 months. Alcohol and Alcoholism 42(4): 328-332, 2007. (23 refs.)

Aim: To examine the change in alcohol use parameters following a brief intervention (BI) based on the FRAMES protocol, compared to simple advice (SA), in a community setting in North India. Method: Ninety male subjects, 20-45 years old, with an AUDIT score between 8 and 24, consented to participate in this study. They were recruited from an earlier study on treatment, non-seeking, and allocated alternatively to the BI or SA protocols. The subjects were compared on drinking parameters, Addiction Severity Index (ASI), WHO Quality of Life (WHOQOL-Bref) and readiness to change (RCQ) after I month and 3 months post intervention. The assessments were made by an investigator blind to the intervention status of the subject. Results: Of the 90 subjects, 87 (96.7%) were available for follow up in the first month and 86 (95.6%) in the third month. There was significant improvement across many drinking and QOL parameters in both the BI and SA groups, Significant differences were noticed across interventions, with a decrease in severity of dependence as measured by alcohol use in the last 30 days, composite ASI scores & improvement in physical and psychological quality of life, in those who received BI compared to those who received SA. Changes in motivation toward action were documented at first follow up, but were not sustained in either of the interventions. Conclusions: BI had a slight advantage over SA in excessive users of alcohol in this community setting in India. It is probable that booster sessions would be needed to achieve sustained effect.

Parker DR; Windsor RA; Roberts MB; Hecht J; Hardy NV; Strolla LO et al. Feasibility, cost, and cost-effectiveness of a telephone-based motivational intervention for underserved pregnant smokers. Nicotine & Tobacco Research 9(10): 1043-1051, 2007. (41 refs.)

This study reports on the evaluation of the feasibility, cost, and cost-effectiveness of a proactively provided telephone-based motivational smoking cessation intervention to an underserved population of pregnant smokers who may or may not receive ongoing prenatal care. As part of the New England SCRIPT randomized clinical trial comparing the efficacy of three types of smoking cessation interventions for pregnant smokers, one-third of the women (n=358) received a motivational telephone counseling intervention (MI) delivered by trained counselors using a semistructured protocol. Although this population was very mobile, the MI counselors were able to reach 86% of the women with at least one call and 46% received all three calls. The group receiving three MI calls had a cotinine-confirmed quit rate of 23%. Cost-effectiveness analyses for those women receiving telephone counseling supported the net benefit in favor of the three phone calls compared with the women who did not receive any telephone calls, with an effectiveness to cost ratio of 1:$84. Our results suggest that telephone-based motivational smoking cessation counseling may be a feasible and cost-effective method for low-income pregnant smokers enrolled in prenatal care.

Patel V; Aroya R; Chatterjee S; Chisholm D; Cohen A; De Silva M et al. Global Mental Health 3 - Treatment and prevention of mental disorders in low-income and middle-income countries. (review). Lancet 370(9591): 991-1005, 2007. (179 refs.)

We review the evidence on effectiveness of interventions for the treatment and prevention of selected mental disorders in low-income and middle-income countries. Depression can be treated effectively in such countries with low-cost antidepressants or with psychological interventions (such as cognitive-behaviour therapy and interpersonal therapies). Stepped-care and collaborative models provide a framework for integration of drug and psychological treatments and help to improve rates of adherence to treatment. First-generation antipsychotic drugs are effective and cost effective for the treatment of schizophrenia; their benefits can be enhanced by psychosocial treatments, such as community-based models of care. Brief interventions delivered by primary-care professionals are effective for management of hazardous alcohol use, and pharmacological and psychosocial interventions have some benefits for people with alcohol dependence. Policies designed to reduce consumption, such as increased taxes and other control strategies, can reduce the population burden of alcohol abuse. Evidence about the efficacy of interventions for developmental disabilities is inadequate, but community-based rehabilitation models provide a low-cost, integrative framework for care of children and adults with chronic mental disabilities. Evidence for mental health interventions for people who are exposed to conflict and other disasters is still weak-especially for interventions in the midst of emergencies. Some trials of interventions for prevention of depression and developmental delays in low-income and middle-income countries show beneficial effects. Interventions for depression, delivered in primary care, are as cost effective as antiretroviral drugs for HIV/AIDS. The process and effectiveness of scaling up mental health interventions has not been adequately assessed. Such research is needed to inform the continuing process of service reform and innovation. However, we recommend that policyrnakers should act on the available evidence to scale up effective and cost-effective treatments and preventive interventions for mental disorders.

Patton R; Strang J; Birtles C; Crawford MJ. Alcohol: A missed opportunity. A survey of all accident and emergency departments in England. Emergency Medicine Journal 24(8): 529-531, 2007. (24 refs.)

Aim: To determine the extent to which the recommendations of the alcohol harm reduction strategy for England and the Choosing Health white paper for the provision of screening and brief interventions for hazardous and harmful drinkers have been adopted by accident and emergency departments. Method: Telephone/postal survey of all 191 Type 1 departments in England. The survey was part of a larger study investigating the impact of the changes in the licensing act (2004) on alcohol-related attendances. Results: 4 departments use formal screening tools and 24 ask general questions about consumption (98.9% response rate). Blood alcohol levels were measured as required by 100 departments. No departments routinely measure blood alcohol, and 84 departments never assess blood alcohol levels. Alcohol-related attendances were formally recorded by 131 departments. Access to an alcohol health worker or a clinical nurse specialist was reported by 32 departments. Discussion: Although departments may be willing to address hazardous alcohol consumption, the low numbers of departments utilising formal screening tools suggests that patients who may benefit from help or advice remain undetected.

Rabius V; Pike KJ; Hunter J; Wiatrek D; McAlister AL. Effects of frequency and duration in telephone counselling for smoking cessation. Tobacco Control 16(Supplement 1): 171-174, 2007. (9 refs.)

Objective: This study evaluates alternative protocols in telephone counselling for smoking cessation. Design: The American Cancer Society enrolled 6322 clients in a randomised trial comparing three counselling formats of varying duration and frequency of contact, with or without booster sessions, and mailed self help booklets without telephone counselling. Setting and participants: Participants were drawn from callers to the American Cancer Society's National Cancer Information Center seeking assistance with smoking cessation who provided informed consent and were adult daily smokers, ready to make a quit attempt within two weeks, and from states not served by an evidence based proactive telephone counselling programme. Outcomes: Six-month cessation rates (30-day point prevalence) were measured in telephone interviews. Results: There was a significant counselling effect. The overall cessation rates that were yielded by a brief protocol including booster sessions were equivalent to those obtained with the American Cancer Society's standard protocol with boosters. Conclusions: Based on these findings, the abbreviated protocol with five sessions and two boosters is considered to be an option for improving cost efficiency in the delivery of this service.

Rodriguez-Martos A; Castellano Y; Salmeron JM; Domingo G. Simple advice for injured hazardous drinkers: An implementation study. Alcohol and Alcoholism 42(5): 430-435, 2007. (24 refs.)

Aim: To evaluate the implementation of a screening and intervention procedure for hazardous drinkers in the routine praxis of an emergency service, without increasing the ED (emergency department) staff. Methods: Four stages of the implementation process were undertaken: exploration and adoption, programme installation, and initial implementation. Two hospitals participated, with a coordinator, four trainers and all the emergency nursing staff. Eligible patients were males over age 15 presenting at the weekend with a traffic injury. Screening was performed with five questions (the three items of alcohol use disorders identification test (AUDIT-C) plus two questions about drinking within 6 h before the crash). Hazardous drinkers and drivers who had driven while intoxicated were offered simple advice. The programme implementation was evaluated by reviewing the patients forms and by interviews and surveys of the nursing staff. Results: The study lasted for 27 weeks. Knowledge and compliance with the programme were good. However, only 25% of the eligible patients were identified. Simple advice was accomplished by 94.7% of those in need of it. Although the majority of nurses felt at ease performing the intervention, 75% considered the programme as a work overload and only 21% reckoned that it was feasible for the emergency service. Conclusion: The emergency setting poses important barriers to the implementation of brief interventions.

Saitz R. Introduction: Screening and brief intervention. Substance Abuse 28(3): 1-2, 2007

Saitz R. Screening and brief intervention enter their 5th decade. Substance Abuse 28(3): 3-6, 2007

About 40 years since the first controlled study, screening and brief intervention (SBI) are being disseminated into practice. But many unanswered questions remain. Studies in this special issue address what we know and don't know about alcohol and drug SBI, cost-effectiveness, patient preferences, education for clinicians, quality performance measures, 'no-contact' SBI, predictors of behavior change, and methodological concerns with the SBI literature. The best evidence for efficacy of SBI is that it can lead to decreased consumption in primary care patients with non-dependent unhealthy alcohol use. But further research is needed on brief drug screening tools, efficacy of SBI for drugs, effectiveness in real world settings, integration of SBI for alcohol and drugs with other health behaviors, effects of SBI on alcohol and drug consequences, effects on dependence among those not seeking help, and on how to best disseminate the efficacious elements of SBI into practice.

Saitz R; Palfai TP; Freedner N; Winter MR; MacDonald A; Lu J et al. Screening and brief intervention online for college students: The ihealth study. Alcohol and Alcoholism 42(1): 28-36, 2007. (51 refs.)

Aims: To test the feasibility of online alcohol screening and brief intervention by comparing (i) two approaches to inviting all students to be screened, and (ii) a minimal versus a more extensive brief intervention. Methods: Freshmen students at one university were randomized to receive one of two types of email invitations to an online anonymous: (i) general health assessment, or (ii) alcohol-specific assessment. All were linked to the same alcohol screening survey. Those with unhealthy alcohol use (AUDIT >= 8) were randomly assigned to minimal or more extensive online alcohol brief intervention. Results: In both invitation groups (4008 students), 55% of students completed the online screening. Overall, 37% of men and 26% of women had unhealthy alcohol use. Compared to minimal brief intervention, more extensive brief intervention was associated with intention to seek help among men and with a greater increase in readiness to change among women. One month after brief intervention, 75% of students completed another assessment, 33% of women and 15% of men with unhealthy alcohol use at baseline no longer had unhealthy alcohol use. There were no significant differences on drinking measures by brief intervention randomization group. Conclusions: Over half of an entire freshman class of college students were reached by email and completed alcohol screening and brief intervention. Even an alcohol-specific invitation did not deter students. Although brief interventions that differed had some gender specific effects on readiness to change and intention, in general, unhealthy alcohol use decreased after brief intervention. Web screening and brief intervention show promise for addressing unhealthy alcohol use by college students.

Slama K; Chiang CY; Enarson DA. Tobacco cessation and brief advice. International Journal of Tuberculosis and Lung Disease 11(6): 612-616, 2007. (14 refs.)

Patients who are enrolled on tuberculosis (TB) treatment are often ill and are seeking ways to get better. They are more likely at that time to adopt risk-reducing health behaviours. Interventions that are neither complicated nor time-consuming are available to health service personnel to help patients undertake smoking cessation. Brief advice to patients repeated at various times throughout their TB care can increase cessation rates. All tobacco use needs to be identified and reasons for quitting enunciated. Patients are thus given a framework for considering smoking cessation. If patients then choose not to stop currently, they can be asked to reconsider at a later visit, and also be cautioned to avoid smoking in the presence of others. Smokers who want to stop can discuss strategies for avoiding craving and withdrawal, and pharmacological agents can be recommended if they are available. Because the brief advice is repeated, patients are reinforced either for having stopped or for their progress towards stopping.

Soderstrom CA; DiClemente CC; Dischinger PC; Hebel JR; McDuff DR; Auman KM; Kufera JA. A controlled trial of brief intervention versus brief advice for at-risk drinking trauma center patients. Journal of Trauma, Injury, Infection and Critical Care 62(5): 1102-1111, 2007. (41 refs.)

Background: Numerous reports document that preinjury alcohol use is associated with all modes of injury requiring treatment in a trauma center, with 25% to 50% or more of patients testing positive for alcohol at the time of admission. There is evidence that in trauma patients unaddressed alcohol use problems result in recurrent injury requiring readmission to a trauma center and/or death. Methods: A randomized clinical trial was conducted to assess the effectiveness of two types of brief interventions to reduce drinking and the consequences of drinking. Trauma patients defined as at-risk alcohol users (n = 497) were randomized into two treatment options: a brief personalized motivational intervention (PMI), or brief information and advice (BIA). After a brief assessment, PMI subjects received a motivational session, feedback letter, and two postdischarge telephone contacts, whereas the BIA group received a brochure and one postdischarge telephone contact. Both groups were reassessed at 6 and 12 months postinjury. Results: Both the PMI and BIA groups had statistically significant reductions in drinking, binge episodes, and consequences related to drinking that persisted from the 6- to the 12-month follow-up. However, although not statistically significant, for those classified as lower-level drinkers (<= 1 drink per day), there was a consistent pattern of maintaining reductions for the PMI group at 12 months compared with the BIA group. Conclusion: our results suggest that brief interventions (PMI and BIA) that link alcohol consumption with trauma injury and consequences of drinking can be effective in reducing drinking and consequences related to drinking in a significant portion of at-risk nondependent drinkers.

Srisurapanont M; Sombatmai S; Boripuntakul T. Brief intervention for students with methamphetamine use disorders: A randomized controlled trial. American Journal on Addictions 16(2): 111-116, 2007. (18 refs.)

This study evaluated the short-term (eight-week) benefits of brief intervention (BI) in students aged 14-19 years old who met the DSMIV diagnostic criteria for methamphetamine (MA) dependence or abuse. The participants were randomly assigned to receive two 20-minute sessions of BI or one 15-minute session of psychoeducation (PE). Primary outcomes of interest were the decrease of MA use in days of use (per week) units and MA tablets used (per day when used). All outcomes were assessed at baseline (week 0), week 4, and week 8 (endpoint). A total of 48 participants were enrolled in the study (24 on BI and 24 on PE treatment). At week 4, the numbers of dropouts in the BI and PE groups were 7 and 5, respectively. The frequency and amount of MA use decreased significantly in both groups. At week 8, the days of MA use had decreased in the BI group by a significantly larger number than in the PE group (t = 2, df = 34, p = 0.04). BI appears to have some minimal short-term benefits for adolescents with MA use disorders. It may decrease the number of days that MA is used.

Stahlbrandt H; Johnsson KO; Berglund M. Two-year outcome of alcohol interventions in Swedish university halls of residence: A cluster randomized trial of a brief skills training program, twelve-step-influenced intervention, and controls. Alcoholism: Clinical and Experimental Research 31(3): 458-466, 2007. (36 refs.)

Background: High-risk alcohol consumption among university students is well documented. Several types of intervention have proved to be effective in reducing alcohol consumption. This study examines the 2-year outcome of 2 different alcohol intervention programs at university halls of residence. Methods: Ninety-eight university halls of residence (with 556 students) were cluster randomized to 2 different intervention groups: a brief skills training program (BSTP) with interactive lectures and discussions, a twelve-step-influenced (TSI) program with didactic lectures by therapists trained in the 12-step approach, and a control group. All students completing the baseline assessment received personalized feedback by mail. Students responded to mailed follow-up questionnaires after 1, 2, and 3 years, including alcohol use disorders identification test (AUDIT; years 2 and 3), short index of problems (SIP), and estimated blood alcohol concentration (eBAC). Results: All groups significantly reduced their AUDIT scores from baseline to the second year follow-up, with no significant differences between the groups. Seventy-seven percent of the students belonged to a population with high-risk consumption, using the AUDIT cut-off scores of 8 and 4 for men and women, respectively. Students with high-risk alcohol consumption showed significant differences in AUDIT score reduction in favor of the BSTP compared with controls, and had a tendency to show better results than the TSI intervention (p=0.06). Similar trends could be seen using SIP and eBAC. The TSI did not differ significantly from the control group within the group of students with high-risk alcohol consumption. Conclusions: This study suggests that a BSTP is effective as an intervention in students with high-risk alcohol consumption.

Stein MD; Anderson BJ; Niaura R. Smoking cessation patterns in methadone-maintained smokers. Nicotine & Tobacco Research 9(3): 421-428, 2007. (48 refs.)

To determine predictors of smoking cessation duration in a randomized clinical trial, we assigned participants to nicotine patch (8-12 weeks) plus either (a) a baseline tailored brief motivational intervention, a quit date behavioral skills counseling session, and a relapse prevention follow-up session, or (b) brief advice using the National Cancerer Institute's 4A's model. A total of 383 smokers from five methadone maintenance treatment centers in Rhode Island were enrolled, of whom 312 (82%) completed 6-month follow-up assessments. The primary outcome was longest period of self-reported abstinence during follow-up. Participants were on average 40.5 years of age; 51.9% were male, and 77.6% were White. In multivariate analysis controlling for demographics, nicotine dependence, depressive symptoms, and smoking-related symptoms, we found longer periods of abstinence in persons reporting at least one 24-hr quit attempt in the year prior to baseline (OR=1.97, p=.003), in those anticipating success in cessation (OR=1.33, p=.024), and in those with a greater percentage of nicotine patch use days (OR=2.78, p,. 001). Past quit attempts, self-efficacy, and constant nicotine replacement were associated with duration of abstinence among methadone-maintained smokers. Attention to these domains in future intervention studies may improve treatment success.

Stephens RS; Roffman RA; Fearer SA; Williams C; Burke RS. The Marijuana Check-up: Promoting change in ambivalent marijuana users. Addiction 102(6): 947-957, 2007. (34 refs.)

Aims: To evaluate the efficacy of a two-session assessment and feedback intervention designed to reach and increase motivation for change in marijuana users who were experiencing negative consequences but were ambivalent about change. Design Random assignment to one of two types of feedback conditions or a delayed feedback control (DFC) with follow-up assessments at 7 weeks, 6 months and 12 months. Setting: University of Washington research center in Seattle, Washington. Participants A total of 188 adult male and female marijuana users who responded to advertisements. Interventions A personalized feedback (PF) condition utilizing motivational interviewing was compared to an educational control condition labeled multi-media feedback (MMF). Measurements Marijuana use, dependence symptoms, other associated negative consequences and motivational constructs were assessed at all time-points. Findings PF participants reported fewer days of use per week, fewer periods of use per day and fewer dependence symptoms at 7 weeks than those in the MMF and DFC conditions. PF participants also reported fewer days of use per week compared to MMF participants at the 12-month follow-up and fewer dependence symptoms at both the 6- and 12-month follow-ups compared to MMF participants. Conclusions: The PF intervention, delivered in the context of a check-up, shows potential as a way of reaching and motivating change in marijuana users with a diagnosable disorder who otherwise are not ready to approach treatment. Ways of augmenting the modest absolute levels of change are discussed.

Stern SA; Meredith LS; Gholson J; Gore P; D'Amico EJ. Project CHAT: A brief motivational substance abuse intervention for teens in primary care. Journal of Substance Abuse Treatment 32(2): 153-165, 2007. (64 refs.)

Many adolescents use alcohol and drugs; however, most do not seek help because of stigma or confidentiality concerns. Providing services in settings that teens frequent may decrease barriers. We examined the feasibility of adapting a brief motivational intervention for high-risk adolescents age 12-18 years) in a primary care setting by conducting small feedback sessions with adolescents, parents, and clinic staff, and pilot testing the motivational intervention with adolescents. Findings from feedback sessions indicated that clinic staff thought teens would not talk about alcohol and drugs use. In contrast, adolescents reported that they would talk about their alcohol and drugs use, however, they were afraid of being judged. Parents were also concerned that the PC provider might be judgmental. Feedback from the motivational intervention pilot indicated that teens were willing to talk about their alcohol and drug use and indicated readiness to change. Findings suggest that providing a brief motivational intervention in a primary care setting is a viable approach for working with high-risk youth.

Sturk H; Kavanagh D; Gallois C; King D; Turpin M; Kina R et al. Should mental health issues be addressed in primary care, and can it be done? Views of rural general practitioners in Queensland. Australasian Psychiatry 15(Supplement S): S90-S94, 2007. (16 refs.)

Objective: The aim or this paper was to examine self-efficacy and perceived appropriateness among rural general practitioners (GPs) in regards to screening and intervention for physical, lifestyle and mental health issues. Method: Fifty GPs from 25 Practices in eight rural Queensland towns completed a written survey designed for the study. Results: General practitioners rated opportunistic screening or assessment for smoking and for detection of relapse of mental disorders as the most appropriate, with even cardiovascular and diabetes risk falling behind these. Self-efficacy was highest for medical disorders for smoking assessment. It was significantly lower for alcohol, mental health issues, and addressing risks of physical disorder in people with mental disorders. Conclusions: High appropriateness ratings suggest that current strategies to boost self-efficacy of GPs in addressing mental health issues are timely.

Templeton LJ; Zohhadi SE; Velleman RDB. Working with family members in specialist drug and alcohol services: Findings from a feasibility study. Drugs: Education, Prevention and Policy 14(2): 137-150, 2007. (31 refs.)

Background: Family members can be affected by a relative's substance misuse, but service provision is limited. A brief intervention in primary care has been shown to be effective. The application of such an intervention in other settings requires investigation. Aims: To assess the feasibility of the development and implementation of a brief intervention. for family members of substance misusers, within Specialist Drug and Alcohol Services. Method: A before and after mixed methodology design. Findings: Thirteen staff, from seven teams across one Mental Health NHS Trust area, worked with twenty family members. It was shown that it was feasible to: adapt the intervention for use within a specialist setting; recruit and train specialist service staff to deliver the intervention; have these staff recruit and work with family members; and for this intervention to be seen by both staff and family members as a positive and useful addition to service delivery. However, although feasible, there are still difficulties in integrating this work into routine clinical practice. Conclusions: It is feasible, and beneficial, for specialist drug and alcohol services to deliver a brief intervention to family members. However, organizational and commissioning issues mean that routine delivery of such an intervention may not yet be possible, until full recognition is given to the view that addiction problems are best dealt with in a more holistic way that takes into account the family context within which most people live.

Unrod M; Smith M; Spring B; DePue J; Redd W; Winkel G. Randomized controlled trial of a computer-based, tailored intervention to increase smoking cessation counseling by primary care physicians. Journal of General Internal Medicine 22(4): 478-484, 2007. (39 refs.)

OBJECTIVE: The primary care visit represents an important venue for intervening with a large population of smokers. However, physician adherence to the Smoking Cessation Clinical Guideline (5As) remains low. We evaluated the effectiveness of a computer-tailored intervention designed to increase smoking cessation counseling by primary care physicians. METHODS: Physicians and their patients were randomized to either intervention or control conditions. In addition to brief smoking cessation training, intervention physicians and patients received a one-page report that characterized the patients' smoking habit and history and offered tailored recommendations. Physician performance of the 5As was assessed via patient exit interviews. Quit rates and smoking behaviors were assessed 6 months post-intervention via patient phone interviews. Intervention effects were tested in a sample of 70 physicians and 518 of their patients. Results were analyzed via generalized and mixed linear modeling controlling for clustering. MEASUREMENTS AND MAIN RESULTS: Intervention physicians exceeded controls on "Assess" (OR 5.06; 95% CI 3.22, 7.95), "Advise" (OR 2.79; 95% CI 1.70, 4.59), "Assist-set goals" (OR 4.31; 95% CI 2.59, 7.16), "Assist provide written materials" (OR 5.14; 95% CI 2.60, 10.14), "Assist-provide referral" (OR 6.48; 95% CI 3.11, 13.49), "Assist-discuss medication" (OR 4.72; 95% CI 2.90, 7.68), and "Arrange" (OR 8.14; 95% CI 3.98, 16.68), all p values being < 0.0001. Intervention patients were 1.77 (CI 0.94, 3.34, p = 0.078) times more likely than controls to be abstinent (12 versus 8%), a difference that approached, but did not reach statistical significance, and surpassed controls on number of days quit (18.4 versus 12.2, p < .05) but not on number of quit attempts. CONCLUSIONS: The use of a brief computer-tailored report improved physicians' implementation of the 5As and had a modest effect on patients' smoking behaviors 6 months postintervention.

Versland A; Rosenberg H. Effect of brief imagery interventions on craving in college student smokers. Addiction Research & Theory 15(2): 177-187, 2007. (21 refs.)

This study examined the comparative impact of three types of imagery interventions (olfactory, visual, and olfactory-plus-visual imagery) and a distracting cognitive task (serial sevens) on self-reported craving for cigarettes by 54 university students who had been smoking at least a pack of cigarettes per day for the past 3 to 6 months. Using the 10-item, self-report questionnaire of smoking urges, we assessed participants' experience of craving prior to cue exposure, following 2 min of lab-based cue-exposure, during a 2 min imagery or distraction intervention, and immediately following the intervention. Reported craving during intervention was significantly lower in all three imagery conditions compared to the distracting cognitive task condition, but there was not a significant difference in craving among the imagery conditions. Despite explicit instructions to focus on the designated form(s) of imagery, a majority of participants in each of the imagery conditions also reported experiencing other forms of sensory imagery. Brief imagery interventions hold promise to interrupt, at least temporarily, cue- induced craving in daily smokers.

Walker DD; Roffman RA; Picciano JF; Stephens RS. The check-up: in-person, computerized, and telephone adaptations of motivational enhancement treatment to elicit voluntary participation by the contemplator. (review). Substance Abuse Treatment, Prevention, and Policy 2: article 2, 2007. (50 refs.)

Countless barriers come between people who are struggling with substance abuse and those charged with providing substance abuse treatment. The check-up, a form of motivational enhancement therapy, is a harm reduction intervention that offers a manner of supporting individuals by lowering specific barriers to reaching those who are untreated. The check-up was originally developed to reach problem drinkers who were neither seeking treatment nor self-initiating change. The intervention, marketed as an opportunity to take stock of one's experiences, involves an assessment and personalized feedback delivered with a counseling style termed motivational interviewing. Check-ups can be offered in care settings to individuals who, as a result of screening, manifest risk factors for specific disorders such as alcoholism. They can also be free-standing and publicized widely to the general public. This paper will discuss illustrations of in-person, computerized, in-school, and telephone applications of the free-standing type of check-up with reference to alcohol consumers, adult and adolescent marijuana smokers, and gay/bisexual males at risk for sexual transmission of HIV. The paper's major focus is to highlight how unique features of each application have the potential of reducing barriers to reaching specific at-risk populations. Also considered are key policy issues such as how check-up services can be funded, which venues are appropriate for the delivery of check-up interventions, pertinent competency criteria in evaluating staff who deliver this intervention, how marketing can be designed to reach contemplators in untreated at-risk populations, and how a check-up's success ought to be defined.

Watson B; Conigrave KM; Wallace C; Whitfield JB; Wurst F; Haber PS. Hazardous alcohol consumption and other barriers to antiviral treatment among hepatitis C positive people receiving opioid maintenance treatment. Drug and Alcohol Review 26(3): 231-239, 2007. (51 refs.)

Amongst people on opioid maintenance treatment (OMT), chronic hepatitis C (HCV) is common but infrequently treated. Numerous barriers, including misuse of alcohol may limit efforts at anti-viral treatment. The aim of this study was to define barriers, including alcohol misuse, to the effective treatment of HCV amongst OMT recipients. Ninety-four OMT patients completed the 3-item Alcohol Use Disorders Identification Test (AUDIT-C). A semi-structured interview was used in 53 subjects to assess alcohol use in detail, psychological health, discrimination and access to HCV treatment. Feasibility of brief intervention for alcohol misuse was assessed. Of the screening participants, 73% reported they were HCV positive. Of the detailed interview participants, 26% reported no drinking in the past month, but 53% scored 8 or more on AUDIT and 42% exceeded NHMRC drinking guidelines. Twenty subjects received brief intervention and among 17 re-interviewed at one month, alcohol consumption fell by 3.1 g/day (p = 0.003). Severe or extremely severe depression, stress and anxiety were found in 57%, 51% and 40% of interviewees respectively. Episodic heavy drinking, mental health problems, perceived discrimination, limited knowledge concerning HCV were all common and uptake of HCV treatment was poor. Brief intervention for alcohol use problems was acceptable to OMT patients, and warrants further study.

Weaver FM; LaVela SL; Miskevics S; Clemmons N; Janke EA; LaVela SL; Spring B. Smoking behavior and readiness to change in male veterans with spinal cord injuries. Rehabilitation Psychology 52(3): 304-310, 2007. (41 refs.)

Objectives: Little is known about psychological factors associated with tobacco use in persons with spinal cord injuries and disorders (SCI&D). Method. Veterans with SCI&D who were current or past smokers were mailed survey questions about physical dependence on nicotine, motivation to smoke, readiness to quit, and use of tobacco cessation methods. Results: Of 684 respondents, 19% were current smokers. They were younger (Ms = 56.4 vs. 63.3 years; p < .0001) and were more prone to alcohol use, depression, and posttraumatic stress than past smokers. Past smokers most frequently quit on their own. Most current smokers had low addiction levels; 15% had medium and 27% had high levels; one third were ready to make changes. Common smoking motives included relaxation, tension reduction, and psychological addiction. Discussion: More smokers than are offered may benefit from evidence-based, behavioral interventions. Treatment targeting self-efficacy enhancement is warranted for those ready to change; brief behavioral interventions, such as stress management, ongoing monitoring, and feedback regarding current smoking status are suggested for those not yet ready to quit.

White HR; Mun EY; Pugh L; Morgan TJ. Long-term effects of brief substance use interventions for mandated college students: Sleeper effects of an in-person personal feedback intervention. Alcoholism: Clinical and Experimental Research 31(8): 1380-1391, 2007. (44 refs.)

Background: It is known that brief interventions for mandated college students decrease alcohol use and/or related problems in the short term. However, none of the existing studies has followed students' past 6 months. Therefore, we compared the long-term efficacy of 2 brief substance use feedback interventions for mandated college students. Methods: We followed up mandated students (N=348) who were randomly assigned to either a brief motivational interview (BMI; n=180) or a written feedback-only (WF; n=168) intervention at 4 months and 15 months postintervention. Results: Long-term follow-up data revealed that students, at the aggregate level, decreased their peak blood alcohol concentration (BAC) levels, number of drinks per week, and number of alcohol-related problems at 15 months postintervention compared with their baseline levels. With the exception of peak BAC, the observed long-term reduction was mainly due to the positive change among students who received the BMI intervention. Students in the BMI intervention showed significantly lower levels of alcohol-related problems at 15 months than those in the WF intervention. The BMI intervention more effectively reduced within-individual alcohol-related problems during the initial 4 months, and more successfully curbed the subsequent increase in alcohol use frequency and number of drinks per week during the 11 months between the 2 follow-up assessments. Conclusions: The results suggest that brief substance use interventions reduce the riskiest type of alcohol use (e.g., peak BAC) among mandated college students over the long term, and that sleeper effects of in-person personal feedback interventions (PFIs) exist. In-person PFIs in the context of a motivational interview may be more efficacious in the long term than written feedback-only interventions for mandated students. Future studies comparing interventions for college students should extend follow-up for longer periods of time.

Wild, TC; Cunningham, JA; Roberts, AB. Controlled study of brief personalized assessment-feed back for drinkers interested in self-help. Addiction 102(2): 241-250, 2007. (61 refs.)

Aims: Brief alcohol interventions typically have been directed to heavy-drinking patients seeking primary health care and college students. This study examined the efficacy of mailing brief personalized assessment-feedback to interested drinkers recruited from the general public. We hypothesized that problem drinkers would benefit more from the intervention than individuals who were not problem drinkers. Design: A two-arm, double-blinded, community-based randomized controlled trial with 6-month follow-up. Setting and participants A screening interview was administered to a stratified random sample of 10 014 Canadians 18 years of age and older (5621 women and 4393 men; M age = 43.3 years, SD = 15.99; response rate = 65.4%). Intervention: Current drinkers interested in receiving alcohol self-help materials (n = 172 7) were assigned randomly to receive brief personalized assessment-feedback on male and female population drinking norms by mail, or to a delayed-treatment control group, and were contacted 6 months later (76% retention rate). Measurements Problem drinking status at baseline [using sex-specific Alcohol Use Disorders Identification Test (AUDIT) cut scores], and frequency and quantity of alcohol use at follow-up. Findings: Analysis of covariance identified the hypothesized interaction of baseline problem drinking status and treatment condition (P < 0.01). Among problem drinkers identified at baseline the intervention caused a 10.1% reduction in per-occasion binge drinking compared to controls, whereas there was no difference in binge drinking across conditions for nonproblem drinkers. Conclusions: The continuum of care for alcohol problems can be broadened by providing brief interventions to interested drinkers in the general population.

Winters KC; Leitten W. Brief intervention for drug-abusing adolescents in a school setting. Psychology of Addictive Behaviors 21(2): 249-254, 2007. (45 refs.)

This study evaluated the use of 2 brief interventions (BIs) to reduce drug use among 14- to 17-year-olds identified in a school setting as drug abusers. Students (N = 79) were randomly assigned to receive 1 of 3 target conditions: 2 sessions with the adolescent only (BI-A), 2 sessions with the adolescent and I with the parent (BI-AP), or an assessment-only control condition (CON). Follow-up assessments of 78 participants done 6 months postintervention showed that the adolescents in the BI-A and BI-AP conditions generally had superior outcomes on their drug use behaviors compared with the CON group. Also, those receiving the BI-AP had better outcomes on most outcome variables compared with adolescents receiving BI-A. The 6-month abstinence rates did not differ across groups. The potential value of a school-based BI for students with a substance abuse disorder is discussed.

Winters KC; Leitten W; Wagner E; Tevyaw TO. Use of brief interventions for drug abusing teenagers within a middle and high school setting. Journal of School Health 77(4): 196-206, 2007. (80 refs.)

BACKGROUND: Promising and encouraging results have been recently reported on the use of briefer interventions for adolescent drug abusers. Because middle- and high-school-based drug abuse intervention programs have grown in popularity over the past several decades, the use of brief interventions (BIs) in school settings merits consideration. METHODS: We review several clinical and school contextual issues pertaining to the scientific efficacy, feasibility, and application of BIs for students who are abusing drugs. RESULTS: Several advantages for employing BIs in a school setting are identified, including the relatively high base rate of students with mild-to-moderate drug involvement and the likelihood that school counselors can readily learn BI techniques. Caveats of implementing BIs include practical, systemic, and clinical barriers. CONCLUSIONS: Despite concerns, schools are a viable setting in which to screen youth for drug abuse problems and to conduct a BI.

Wood MD; Capone C; Laforge R; Erickson DJ; Brand NH. Brief motivational intervention and alcohol expectancy challenge with heavy drinking college students: A randomized factorial study. Addictive Behaviors 32(11): 2509-2528, 2007. (67 refs.)

This study is the first reported test of the unique and combined effects of Brief Motivational Intervention (BMI) and Alcohol Expectancy Challenge (AEC) with heavy drinking college students. Three hundred and thirty-five participants were randomly assigned in a 2 x 2 factorial design to either: BMI, AEC, BMI and AEC, and assessment only conditions. Follow-ups occurred at 1, 3, and 6 months. Unconditional latent curve analyses suggested that alcohol use (Q-F), heavy episodic drinking, and alcohol problems were best modeled as quadratic effects. BMI produced significant decreases in Q-F, heavy drinking, and problems, while AEC produced significant decreases in Q-F and heavy drinking. There was no evidence of an additive effect of combining the interventions. Intervention effects decayed somewhat for BMI and completely for AEC over 6 months. Multi-group analyses suggested similar intervention effects for men and women. BMI effects on alcohol problems were mediated by perceived norms. These findings extend previous research with BMI and AEC but do not support their utility as a combined preventive intervention to reduce collegiate alcohol abuse.

Zisserson RN; Palfai T; Saitz R. 'No-contact' interventions for unhealthy college drinking: Efficacy of alternatives to person-delivered intervention approaches. Substance Abuse 28(4): 119-131, 2007

Despite the development of brief efficacious interventions, they are not reaching a large proportion of college students who continue to drink in a manner that puts them at risk for harm. Recent efforts have attempted to address this issue through the development of brief alcohol interventions that may be more broadly disseminated to college students. Researchers have adapted a variety of approaches to print and computer-based modalities that do not require direct real-time contact with an interventionist. The goal of this paper is to review the empirical evidence for the utility of these brief alcohol interventions that are delivered without direct real-time contact. A systematic review of this research suggests that 'no-contact' interventions are feasible and may have efficacy. Further research is needed to understand the duration of these effects, mechanisms of change, moderators of outcome, and how to enhance the effectiveness of these approaches.