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CORK Bibliography: Brief Treatment

87 citations. 2011 to present

Prepared: June 2012

Amemori M; Michie S; Korhonen T; Murtomaa H; Kinnunen TH. Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers. Implementation Science 6(e-article 50), 2011. (32 refs.)

Background: Tobacco use adversely affects oral health. Clinical guidelines recommend that dental providers promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented, however. To improve guideline adherence and to develop effective interventions, it is essential to understand provider behaviour and challenges to implementation. This study aimed to develop a theoretically informed measure for assessing among dental providers implementation difficulties related to tobacco use prevention and cessation (TUPAC) counselling guidelines, to evaluate those difficulties among a sample of dental providers, and to investigate a possible underlying structure of applied theoretical domains. Methods: A 35-item questionnaire was developed based on key theoretical domains relevant to the implementation behaviours of healthcare providers. Specific items were drawn mostly from the literature on TUPAC counselling studies of healthcare providers. The data were collected from dentists (n = 73) and dental hygienists (n = 22) in 36 dental clinics in Finland using a web-based survey. Of 95 providers, 73 participated (76.8%). We used Cronbach's alpha to ascertain the internal consistency of the questionnaire. Mean domain scores were calculated to assess different aspects of implementation difficulties and exploratory factor analysis to assess the theoretical domain structure. The authors agreed on the labels assigned to the factors on the basis of their component domains and the broader behavioural and theoretical literature. Results: Internal consistency values for theoretical domains varied from 0.50 ('emotion') to 0.71 ('environmental context and resources'). The domain environmental context and resources had the lowest mean score (21.3%; 95% confidence interval [CI], 17.2 to 25.4) and was identified as a potential implementation difficulty. The domain emotion provided the highest mean score (60%; 95% CI, 55.0 to 65.0). Three factors were extracted that explain 70.8% of the variance: motivation (47.6% of variance, alpha = 0.86), capability (13.3% of variance, alpha = 0.83), and opportunity (10.0% of variance, alpha = 0.71). Conclusions: This study demonstrated a theoretically informed approach to identifying possible implementation difficulties in TUPAC counselling among dental providers. This approach provides a method for moving from diagnosing implementation difficulties to designing and evaluating interventions.

Anders ME; Sheffer CE; Barone CP; Holmes TM; Simpson DD; Duncan AM. Emergency department-initiated tobacco dependence treatment. American Journal of Health Behavior 35(5): 546-556, 2011. (41 refs.)

Objective: To examine the feasibility of a fax referral program to increase enrollment in tobacco dependence treatment in emergency department (ED) patients. Methods: The control group received quit advice and printed information; the intervention group also received a faxed referral that generated telephone contacts. Results: Treatment enrollment was higher in the intervention group (13.5% vs 2.7%). Only the faxed referral was associated with treatment enrollment. Conclusions: An ED intervention is feasible. Faxed referral resulted in a 5-fold increase in tobacco treatment enrollment. The ED may be an opportune setting to facilitate smoking-cessation behavior change among lower income, underserved patients.

Audrain-McGovern J; Stevens S; Murray PJ; Kinsman S; Zuckoff A; Pletcher J et al. The efficacy of motivational interviewing versus brief advice for adolescent smoking behavior change. Pediatrics 128(1): E101-E111, 2011. (50 refs.)

OBJECTIVE: In this study we sought to evaluate the efficacy of motivational interviewing (MI) compared with structured brief advice (SBA) for adolescent smoking behavior change. METHODS: Participants (N = 355) were randomly assigned to 5 sessions of either MI or SBA. The primary outcomes were attempts to reduce and to quit smoking, smoking reduction, and cotinine-validated 7-day point-prevalence smoking abstinence at the end of treatment (week 12) and the 24-week follow-up. RESULTS: White adolescents were similar to 80% less likely to attempt to cut back (odds ratio [OR]: 0.21; confidence interval [CI]: 0.08-0.53) and >80% less likely to attempt to quit smoking compared with black adolescents (OR: 0.17 [CI: 0.06-0.46]). Adolescents who were at least planning to cut back or quit smoking at baseline were almost 3 times more likely to attempt to cut back (OR: 2.87 [CI: 1.26-6.52]) and to attempt to quit smoking (OR: 3.13 [CI: 1.19-8.26]). Adolescents who received MI were similar to 60% less likely than adolescents who received SBA to try to quit smoking (OR: 0.41 [CI: 0.17-0.97]). However, adolescents who received MI showed a greater reduction in cigarettes smoked per day than adolescents who received SBA (5.3 vs 3.3 fewer cigarettes per day). There were no statistically significant differences between MI and SBA in smoking abstinence (5.7% vs 5.6%, respectively). CONCLUSIONS: The effects of MI on adolescent smoking behavior change are modest, and MI may best fit within a multicomponent smoking cessation treatment approach in which behavior change skills can support and promote smoking behavior change decisions.

Aveyard P; Raw M. Improving smoking cessation approaches at the individual level. (editorial). Tobacco Control 21(2): 252-257, 2012. (73 refs.)

Becker SJ; Curry JF; Yang CM. Factors that influence trajectories of change in frequency of substance use and quality of life among adolescents receiving a brief intervention. Journal of Substance Abuse Treatment 41(3): 294-304, 2011. (65 refs.)

This study aimed to identify factors influencing trajectories of change in two outcome domains, frequency of substance use and quality of life (QOL), among adolescents receiving a brief evidence-based intervention. Participants were 106 adolescents, aged 13 to 21 years, who met criteria for a substance use disorder. The adolescents received a five-session intervention and completed four assessments over 12 months. Based upon a theoretical and empirical review, five putative predictors were tested: gender, age, severity of conduct disorder, severity of depression, and peer substance involvement. Results of a parallel-process latent growth curve model indicated that higher peer substance involvement and conduct severity predicted higher frequency of use at baseline, whereas higher peer substance involvement and depression severity predicted poorer QOL at baseline. Counter to predictions, higher depression severity predicted greater improvements in QOL following substance use treatment. The implications of baseline risk factors on adolescents' response to intervention are discussed.

Bernstein J; Graczyk A; Lawrence D; Bernstein E; Strunin L. Determinants of drinking trajectories among minority youth and young adults: The interaction of risk and resilience. Youth & Society 43(4): 1199-1219, 2011. (61 refs.)

Adolescent drinking research has focused heavily on risks for alcohol-related consequences and on personality traits associated with adverse alcohol-related outcomes. A risk-based paradigm may inadvertently overemphasize risk when measures are applied to communities that experience discrimination and socioeconomic disadvantage. In this study we use qualitative methods to examine drinking motives and the relationship between motives and patterns of risk and resilience among a diverse group of 60 youth and young adults enrolled in an independent trial of brief intervention for alcohol use at an inner-city pediatric emergency department and report on their own understandings of their experiences, particularly their reasons for drinking. We found a clear distinction between drinking to "chill" and drinking to "cope" with very different projected life course trajectories despite similarities between groups in neighborhood and interpersonal stressors. Strategies to motivate "copers" to alter drinking behavior may need to be shored up with a network of support services.

Bingham CR; Barretto AI; Walton MA; Bryant CM; Shope JT; Raghunathan TE. Efficacy of a web-based, tailored, alcohol prevention/intervention program for college students: 3-month follow-up. Journal of Drug Education 41(4): 405-430, 2011. (62 refs.)

This study presents the results of an efficacy evaluation of a web-based brief motivational alcohol prevention/intervention program called Michigan Prevention and Alcohol Safety for Students (M-PASS). Four on-line sessions providing individually-tailored feedback were delivered to first-year college students over 9 weeks. Non-and low-risk drinking participants received risk prevention, while high-risk drinking participants received a risk-reduction intervention. Both intervention and control groups were surveyed at baseline and at a 3-month follow-up. Analysis showed positive effects for both men and women on stage of change, drinking behavior, drinking motivation and attitudes, and use of risk-reduction strategies. These results provided evidence of efficacy and found that M-PASS had both intervention and prevention effects, making it unique among currently developed brief alcohol interventions for college students.

Black JJ; Tran GQ; Goldsmith AA; Thompson RD; Smith JP; Welge JA. Alcohol expectancies and social self-efficacy as mediators of differential intervention outcomes for college hazardous drinkers with social anxiety. Addictive Behaviors 37(3): 248-255, 2012. (57 refs.)

The current pilot study examined the roles of two cognitive factors - positive alcohol expectancies of social anxiety reduction and drink refusal self-efficacy relevant to social situations - in mediating greater reduction in alcohol behaviors by the Brief Intervention for Socially Anxious Drinkers (BISAD; n = 21) compared to an alcohol psychoeducation (n = 20) in a sample of college hazardous drinkers with social anxiety. Mediation analysis results indicated that decreased positive alcohol expectancies and increased drink refusal self-efficacy relevant to social situations accounted for an average of 67% of the variance in treatment outcomes as measured by total quantity of alcohol consumption, heavy drinking days and problems related to alcohol use in the past month. Study results may enhance the understanding of cognitive factors' role in alcohol treatment outcomes, which could in turn improve the efficacy of interventions aimed to reduce hazardous drinking and comorbid social anxiety.

Bogenschutz MP; Donovan DM; Adinoff B; Crandall C; Forcehimes AA; Lindblad R et al. Design of National Institute on Drug Abuse CTN Protocol 0047: Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED). American Journal of Drug and Alcohol Abuse 37(5): 417-425, 2011. (53 refs.)

Background: Medical settings such as emergency departments (EDs) present an opportunity to identify and provide services for individuals with substance use problems who might otherwise never receive any form of assessment, referral, or intervention. Although screening, brief intervention, and referral to treatment models have been extensively studied and are considered effective for individuals with alcohol problems presenting in EDs and other medical settings, the efficacy of such interventions has not been established for drug users presenting in EDs. Objectives: This article describes the design of a National Institute on Drug Abuse Clinical Trials Network protocol testing the efficacy of an screening, brief intervention, and referral to treatment model in medical EDs, highlighting considerations that are pertinent to the design of other studies targeting substance use behaviors in medical treatment settings. Methods: The protocol is described, and critical design decisions are discussed. Results: Design challenges included defining treatment conditions, study population, and site characteristics; developing the screening process; choosing the primary outcome; balancing brevity and comprehensiveness of assessment; and selecting the strategy for statistical analysis. Conclusion: Many of the issues arising in the design of this study will be relevant to future studies of interventions for addictions in medical settings. Scientific Significance: Optimal trial design is critical to determining how best to integrate substance abuse interventions into medical care.

Borland R; Li L; Driezen P; Wilson N; Hammond D; Thompson ME et al. Cessation assistance reported by smokers in 15 countries participating in the International Tobacco Control (ITC) policy evaluation surveys. Addiction 107(1): 197-205, 2012. (19 refs.)

Aims: To describe some of the variability across the world in levels of quit smoking attempts and use of various forms of cessation support. Design Use of the International Tobacco Control Policy Evaluation Project surveys of smokers, using the 2007 survey wave ( or later, where necessary). Settings Australia, Canada, China, France, Germany, Ireland, Malaysia, Mexico, the Netherlands, New Zealand, South Korea, Thailand, United Kingdom, Uruguay and United States. Participants Samples of smokers from 15 countries. Measurements Self-report on use of cessation aids and on visits to health professionals and provision of cessation advice during the visits. Findings: Prevalence of quit attempts in the last year varied from less than 20% to more than 50% across countries. Similarly, smokers varied greatly in reporting visiting health professionals in the last year (< 20% to over 70%), and among those who did, provision of advice to quit also varied greatly. There was also marked variability in the levels and types of help reported. Use of medication was generally more common than use of behavioural support, except where medications are not readily available. Conclusions: There is wide variation across countries in rates of attempts to stop smoking and use of assistance with higher overall use of medication than behavioural support. There is also wide variation in the provision of brief advice to stop by health professionals.

Bottorff JL; Haines-Saah R; Oliffe JL; Sarbit G. Gender influences in tobacco use and cessation interventions. Nursing Clinics of North America 47(1): 55-70, 2012. (97 refs.)

Smoking rates among and between men and women are in large part a reflection of the influence of gender and its intersections with other social factors including ethnicity, age, and social class that influence tobacco use and, ultimately, tobacco reduction and cessation. In this article, opportunities for developing and delivering gender-sensitive (programs addressing gender) and gender-specific (programs designed for men or women) interventions in the context of tobacco dependence treatment are discussed.

Bradley KA; Johnson ML; Williams EC. Commentary on Nilsen et al. (2011): The importance of asking patients. The potential value of patient report of brief interventions (editorial). Addiction 106(10): 1757-1759, 2011. (19 refs.)

Brahms E; Ahl M; Reed E; Amaro H. Effects of an alcohol intervention on drinking among female college students with and without a recent history of sexual violence. Addictive Behaviors 36(12): 1325-1328, 2011. (24 refs.)

Objective: Alcohol misuse among college students is a significant public health problem that can have negative long-term implications. One important correlate of problem drinking among college female populations is sexual violence. The current study investigated: (1) past year sexual violence and its association with alcohol consumption and related psychosocial variables (stress, coping, and mental health); and (2) whether the impact of an alcohol intervention was different for college women with a history of sexual violence compared to those without such a history. Methods: Female undergraduate students (N = 351) who participated in the Brief Alcohol Screen in College Students (BASICS) completed web-based surveys measuring alcohol and drug use, psychosocial factors, and sexual violence at baseline and six-month follow-up. Results: At baseline, women who experienced sexual violence reported less use of protective alcohol strategies, more positive coping skills, and more mental health symptoms. Following the intervention, alcohol consumption decreased significantly among the entire sample; however no significant differences in consumption were identified based on a history of sexual violence. Yet, compared to women not reporting sexual violence, women who reported recent sexual violence showed greater improvements in mental health outcomes (p<0.05). Conclusions: Findings suggest that brief alcohol interventions may have a differential impact on alcohol-related outcomes based on whether or not women have experienced recent sexual violence.

Bredie SJH; Fouwels AJ; Wollersheim H; Schippers GM. Effectiveness of nurse based motivational interviewing for smoking cessation in high risk cardiovascular outpatients: A randomized trial. European Journal of Cardiovascular Nursing 10(3): 174-179, 2011. (27 refs.)

Objective: To evaluate the feasibility and effectiveness of Nurse Based Motivational Interviewing (NBMI) on top of a routine patient based Lifestyle Inventory with Feedback (LIFE) in a cardiovascular outpatient secondary prevention setting. Methods: All current smokers (n=112), identified in 619 successive patients with cardiovascular disease. were randomized for either care as usual (LIFE). or LIFE plus NBMI (intervention group). Cumulative time investment was recorded. Results: After 3 months of follow-up. the abstinence rate in the control group was 7%. and another 15% diminished the number of cigarettes. whereas 26% of intervention patients quit smoking (p < 0.017) and another 31% diminished smoking. On average. each completed motivational interviewing session took 63.5 min. Per guiltier, time investment was 3.8 h and NNT appeared 5.9. Conclusion: NBMI strategy on top of routinely administrated lifestyle self evaluation with professional feedback, significantly increases smoking cessation in an outpatient secondary prevention setting. Although cost effectiveness needs to be addressed. time investment per quitter in this approach appears low.

Brown ME; Swiggart WH; Dewey CM; Ghulyan MV. Searching for answers: Proper prescribing of controlled prescription drugs. Journal of Psychoactive Drugs 44(1): 79-85, 2012. (34 refs.)

Prescription drug abuse is increasing at alarming rates in this country. Most often drugs are obtained through relatives or friends. An important step in addressing this problem is educating healthcare providers in the proper prescribing of scheduled drugs. Physicians and other healthcare workers receive little training in proper screening for substance abuse, proper prescribing of scheduled drugs, and referral for those needing treatment. Continuing medical education is one venue for addressing this problem. However, screening, brief intervention and referral for treatment (SBIRT) should be taught in medical school and residency.

Broyles LM; Rosenberger E; Hanusa BH; Kraemer KL; Gordon AJ. Hospitalitalized patients' acceptability of nurse-delivered screening, brief intervention, and referral to treatment. Alcoholism: Clinical and Experimental Research 36(4): 725-731, 2012. (34 refs.)

Background: Inpatient healthcare providers in the United States may soon be required to offer alcohol screening, brief intervention, and referral to treatment (SBIRT) for hospital accreditation, but little is known about inpatient acceptability for SBIRT, particularly when performed by nonphysician providers such as nurses. The purpose of this study was to assess patient acceptability for and comfort with nurse-delivered SBIRT care among hospitalized patients and to identify factors associated with SBIRT acceptability. Methods: We conducted a cross-sectional survey of 370 hospitalized medical-surgical patients at a large university-affiliated medical center, which is part of the U.S. Department of Veterans Affairs. Results: Patient acceptability for 8 of 10 individual nurse-delivered SBIRT tasks was >84%. Patients were more accepting of SBIRT tasks if they felt able to determine their alcohol risk, able to reduce alcohol-related health risks, and expressed some degree of concern about their own use of alcohol. Approximately 20% of patients reported some degree of personal discomfort with alcohol-related discussions. Patients who were less comfortable with these discussions had lower perceived ability to reduce alcohol-related health risk, were >60 years old, had a positive AUDIT-C screening, and were of nonblack race. Conclusions: Among hospitalized patients, patient acceptability for nurse-delivered SBIRT is high, and alcohol-related risk perceptions appear to be important factors associated with acceptability for SBIRT tasks. Providers can proceed with greater confidence in SBIRT-related discussions with most hospitalized patients but may need particular sensitivity and skill addressing alcohol with patient subgroups such as older patients and those with positive alcohol screenings.

Chang G; Fisher NDL; Hornstein MD; Jones JA; Hauke SH; Niamkey N et al. Brief intervention for women with risky drinking and medical diagnoses: A randomized controlled trial. Journal of Substance Abuse Treatment 41(2): 105-114, 2011. (52 refs.)

This is a randomized controlled trial of 511 eligible women treated for diabetes, hypertension, infertility, or osteoporosis on an outpatient basis to test the hypothesis that those randomized to a brief intervention (BI) will drink less than those in the control condition 12 months later. A secondary goal was to identify the characteristics associated with changes in drinking outcome. All 511 completed the initial alcohol assessment, and 96% completed the 12-month follow-up interview. Those receiving the BI also had 3- and 6-month interviews. Four outcomes were assessed: (a) mean drinks per drinking day, (b) percent drinking days, (c) binge episodes defined as four or more drinks per occasion, and (d) weeks of drinking exceeding the National Institute on Alcohol Abuse and Alcoholism sensible drinking limits. Overall, there were no differences in drinking outcome by treatment group. Characteristics associated with changes in drinking, however, were identified to provide possible direction for future investigation.

Chen IC; Chie WC; Hwu HG; Chou SY; Yeh YC; Yu CY et al. Alcohol use problem among patients in methadone maintenance treatment in Taiwan. Journal of Substance Abuse Treatment 40(2): 142-149, 2011. (29 refs.)

Aims: To examine the prevalence rate and predictors of alcohol use problems among patients undergoing methadone maintenance treatment (MMT). Design: This was a prospective follow-up study. Participants: Study population included 438 patients who underwent more than 6 months of MMT. Measurements: Demographic and clinical characteristics were collected for each patient prior to treatment, and treatment-related variables were collected during treatment process. Hazardous drinking, alcohol abuse, and dependence were measured using a Chinese version of the Alcohol Use Disorders Identification Test (AUDIT) and by measuring breath alcohol concentration. Findings: The prevalence rates of alcohol use problems, indicated by hazardous drinking are 31.4%. The protective predictors of alcohol use problems among MMT patients include an attendance rate of more than 90% (odds ratio [OR] = 0.54,95% confidence interval [Cl] = 0.30-0.97) and being older than 36 years (OR = 0.48, 95% CI = 0.27-0.86), and alcohol drinking problem at intake of study is a risk factor (OR = 5.30, 95% Cl = 2.87-9.76). Conclusions: High attendance rate, which is regarded as a component of clinical policy and a key component of therapeutic context, should be incorporated with brief interventions to lower alcohol use problems among MMT patients.

Chun TH; Linakis JG. Interventions for adolescent alcohol use. (review). Current Opinion in Pediatrics 24(2): 238-242, 2012. (22 refs.)

Purpose of review: Adolescent alcohol use is a considerable public health problem, contributing to the leading causes of adolescent morbidity and mortality. Additionally, adolescent alcohol use is a major risk factor for adult alcohol use disorders. Successful prevention of and interventions for adolescent alcohol use may thus have significant public health impact. This article reviews the current literature on adolescent alcohol prevention and intervention strategies. Recent findings: Systematic reviews and meta-analyses find that a variety of adolescent alcohol interventions are effective at reducing adolescents' alcohol use, as well as harmful behaviors associated with alcohol use. Long-term treatment is not necessarily superior, as brief interventions have been found to have a large effect size. Additionally, universal interventions (i.e., those that target all families within a group) may be more successful than selective interventions (i.e., those that target only certain families within a group). Intervention effects tend to wane 6-12 months after the cessation of treatment. The results of prevention interventions are more mixed. Many different intervention modalities have been shown to be effective, particularly family-based interventions, as have both universal and targeted interventions. Summary: A wide range of interventions are effective at reducing the harm of adolescent alcohol use. It is unclear which intervention(s) is/are optimal or most efficacious. Additionally, further research is needed on how to maintain long-term intervention effects. It is less clear which prevention strategies are most efficacious. Family-based interventions appear to be most promising.

Clifford A; Shakeshaft A. Evidence-based alcohol screening and brief intervention in Aboriginal Community Controlled Health Services: Experiences of health-care providers. Drug and Alcohol Review 30(1): 55-62, 2011. (32 refs.)

Introduction and Aims. Alcohol screening and brief intervention (SBI) is a cost-effective treatment for reducing alcohol misuse in non-Indigenous populations. To increase the likelihood of alcohol SBI proving cost-effective for Indigenous Australians in practice, strategies to increase its uptake in Aboriginal Community Controlled Health Services (ACCHSs) should be implemented. The aim of this study is to describe the experiences of health-care providers supported to implement evidence-based alcohol SBI in two ACCHSs. Design and Methods. Pre- and post-surveys were administered to health staff (n = 32) participating in training workshops, followed by group interviews with health-care providers delivering alcohol SBI. Patient group interviews were also conducted. Survey results were summarised using descriptive statistics and interviews were analysed using a phenomenological approach. Results. Thirty-two per cent (n = 10) of workshop participants were confident or very confident at baseline to deliver alcohol SBI, increasing significantly to 81% (n = 25) post-training (McNemar Test, P < 0.05). Fifty-seven per cent (n = 16) of health-care providers attending workshops reported delivering alcohol SBI in the following 6 months. Group interviews with health-care providers elicited five themes relating to their experiences of alcohol SBI delivery. Patients in group interviews expressed a preference to be screened for alcohol as part of health assessments. Discussion and Conclusions. Training workshops appear to be an acceptable initial strategy for disseminating alcohol SBI to ACCHSs. Outreach support is required to assist health-care providers to tailor guidelines and resources, and optimally integrate their clinical skills with evidence-based practice. Patients' needs should inform the tailoring process. Tailored collaborative and supportive strategies are probably required to optimally disseminate alcohol SBI in ACCHSs.

Clifford A; Shakeshaft A; Deans C. How and when health-care practitioners in Aboriginal Community Controlled Health Services deliver alcohol screening and brief intervention, and why they don't: A qualitative study. Drug and Alcohol Review 31(1): 13-19, 2012. (32 refs.)

Introduction. Indigenous Australians experience a disproportionately high burden of alcohol-related harm. Alcohol screening and brief intervention (SBI) offers the potential to reduce this harm if barriers to its delivery in Aboriginal Community Controlled Health Services (ACCHSs) can be optimally targeted. Aims. Examine health-care practitioners' perceptions of, and practices in, alcohol SBI in ACCHSs. Methods. Semi-structured group interviews with 37 purposively selected health staff across five ACCHSs. Results. Alcohol screening independent of standard health assessments was generally selective. The provision of brief intervention was dependent upon factors related to the patient. Four key factors underlying health-care practitioners' perceptions of alcohol SBI were prominent: outcome expectancy; role congruence; utilisation of clinical systems and processes; and options for alcohol referral. Discussion. The influence of outcome expectancy and role congruence on health-care practitioners' alcohol SBI practices has been identified previously, as has to a lesser extent, their less than optimal use of clinical systems and processes. The influence of options for alcohol referral on health-care practitioners' willingness to deliver alcohol SBI primarily related to their misunderstanding of alcohol SBI and the lack of culturally appropriate alcohol referral options for their patients. Conclusion. An intervention combining interactive, supportive and reinforcing evidence-based dissemination strategies is most likely required to enhance health-care practitioners' knowledge and skills in alcohol SBI delivery, positively orientate them to their role in its delivery, and facilitate integration of evidence-based alcohol SBI into routine clinical processes and locally available systems.

Cobain K; Owens L; Kolamunnage-Dona R; Fitzgerald R; Gilmore I; Pirmohamed M. Brief Interventions in dependent drinkers: A comparative prospective analysis in two hospitals. Alcohol and Alcoholism 46(4): 434-440, 2011. (60 refs.)

Aims: To investigate whether brief interventions (BIs) delivered by a dedicated Alcohol Specialist Nurse (ASN) to non-treatment-seeking alcohol-dependent patients in an acute hospital setting are effective in reducing alcohol consumption and dependence. Methods: A prospective cohort control study in two acute NHS Hospital Trusts in the North West England, one of which provided BI (university teaching hospital-test site) while the other did not (district general hospital-control site), including follow-up BIs. Subjects were alcohol-dependent patients aged >= 18 years. Results: A total of 100 patients were recruited at each site. No differences were found between the groups in the baseline demographic parameters or medical co-morbidities. At the test site, further sessions were sometimes offered, and 46 patients received more than one intervention (median 4, mean 6.3 and maximum 20). At 6 months, alcohol consumption (P < 0.0001), Alcohol Use Disorders Identification Tool (AUDIT) score (P < 0.0001) and Severity of Alcohol Dependence Questionnaire score (P = 0.0001) were significantly lower at the test site than the control site. Outcomes were found to be independent of both the baseline level of dependence and medical co-morbidity. Conclusion: BI delivered by a dedicated ASN for non-treatment-seeking alcohol-dependent individuals, who often have significant medical co-morbidities, seem to be effective in an acute hospital setting. This study provides a framework to inform the design of a future randomized controlled trial.

Cooley ME; Emmons KM; Haddad R; Wang Q; Posner M; Bueno R et al. Patient-reported receipt of and interest in smoking-cessation interventions after a diagnosis of cancer. Cancer 117(13): 2961-2969, 2011. (52 refs.)

BACKGROUND: Smoking cessation is essential after the diagnosis of cancer to enhance clinical outcomes. Although effective smoking-cessation treatments are available, <50% of smokers with cancer report receiving treatment. Reasons for the low dissemination of such treatment are unclear. METHODS: Data were collected from questionnaires and medical record reviews from 160 smokers or recent quitters with lung or head and neck cancer. Descriptive statistics, Cronbach alpha coefficients, and logistic regression were used in the analyses. The median age of participants was 57 years, 63% (n = 101) were men, 93% (n = 149) were white, and 57% (n = 91) had lung cancer. RESULTS: Eight-six percent (n = 44) of smokers and 75% (n = 82) of recent quitters reported that healthcare providers gave advice to quit smoking. Sixty-five percent (n = 33) of smokers and 47% (n = 51) of recent quitters reported that they were offered assistance from their healthcare providers to quit smoking. Fifty-one percent (n = 26) of smokers and 20% (n = 22) of recent quitters expressed an interest in a smoking-cessation program. An individualized smoking-cessation program was the preferred type of program. Among smokers, younger patients with early stage disease and those with partners who were smokers were more interested in programs. CONCLUSIONS: Although the majority of patients received advice and were offered assistance to quit smoking, approximately 50% of smokers were interested in cessation programs. Innovative approaches to increase interest in cessation programs need to be developed and tested in this population.

Cowell AJ; Bray JW; Hinde JM. The cost of screening and brief intervention in employee assistance programs. Journal of Behavioral Health Services & Research 39(1): 55-67, 2012. (44 refs.)

Few studies examine the costs of conducting screening and brief intervention (SBI) in settings outside health care. This study addresses this gap in knowledge by examining the employer-incurred costs of SBI in an employee assistance program (EAP) when delivered by counselors. Screening was self-administered as part of the intake paperwork, and the brief intervention (BI) was delivered during a regular counseling session. Training costs were $83 per counselor. The cost of a screen to the employer was $0.64; most of this cost comprised the cost of the time the client spent completing the screen. The cost of a BI was $2.52. The cost of SBI is lower than cost estimates of SBI conducted in a health care setting. The low costs for the current study suggest that only modest gains in outcomes would likely be needed to justify delivering SBI in an EAP setting.

Croff JM; Clapp JD; Chambers CD; Woodruff SI; Strathdee SA. Brief field-based intervention to reduce alcohol-related problems among men who have sex with men. Journal of Studies on Alcohol and Drugs 73(2): 285-289, 2012. (20 refs.)

Objective: This study evaluated the utility of a brief field-based intervention to reduce alcohol use and alcohol-related problems among men who have sex with men. Method: A randomized control trial was designed to test a brief alcohol intervention against an attention-placebo control intervention. Over a 13-week period in fall 2009, a sample (n = 152) of men who have sex with men was recruited at a local gay bar in San Diego, CA, and were randomized to a brief alcohol intervention or an attention-placebo control group. Sober bar patrons were recruited before bar entrance and asked to undergo a brief survey and give a breath alcohol sample at exit from the bar. Results: Breath alcohol concentrations at exit from the bar were not significantly different between those in the experimental alcohol feedback condition and those in the attention-placebo control condition. However, among participants in the experimental condition, those categorized as high risk for alcohol-related problems at entrance drank significantly less than planned as compared with participants categorized as low risk for alcohol-related problems. Conclusions: Brief, venue-based interventions may be appropriate for men who have sex with men who plan to drink at rates that would put them at higher risk of alcohol-related problems. Additional studies exploring the utility of brief intervention in risk settings are warranted.

Cucciare MA; Darrow M; Weingardt KR. Characterizing binge drinking among U.S. military veterans receiving a brief alcohol intervention. Addictive Behaviors 36(4): 362-367, 2011. (28 refs.)

Background: Brief web-based alcohol interventions (BAIs) are effective for reducing binge drinking in college students and civilian adults, and are increasingly being applied to U.S. military populations. However, little is known about factors associated with binge drinking in Veteran populations and therefore some concern remains on the generalizability of studies supporting BAIs for addressing binge drinking in this population. This study sought to better understand the characteristics (e.g., demographic, coping related mental health factors, prior exposure to traumatic events, and factors assessing motivation to change alcohol use) of a predominantly male sample of binge drinking Veterans receiving a BAI from a VA provider. Methods: A primarily male (93.5%) sample (N = 554) of Veterans completed a BAI consisting of brief assessment and personalized feedback. Results: We found that Veterans who were younger, used drugs/alcohol to cope with symptoms of PTSD and depression (e.g., nightmares and flashbacks and sleep difficulties), and had experienced sexual assault, had higher self-reported peak blood alcohol concentration and a higher likelihood for a binge drinking episode in the last 90 days. Conclusions: BAIs may be a promising approach for addressing binge drinking in Veterans. However, binge drinking among a sample of mostly male Veterans receiving a BAI may be associated with a complex set of factors that are less prevalent in the college student population and thus studies demonstrating the efficacy of BAIs with Veterans are needed.

Dalum P; Paludan-Muller G; Engholm G; Kok G. A cluster randomised controlled trial of an adolescent smoking cessation intervention: Short and long-term effects. Scandinavian Journal of Public Health 40(2): 167-176, 2012. (20 refs.)

Background: There is a lack of effective smoking cessation interventions which have a high reach among adolescent smokers. Method: We conducted a randomised controlled trial of an adolescent smoking cessation intervention for students aged 15-21 at 22 continuation schools in Denmark. The intervention was a minimal intervention based on events with short counselling and a range of self-help materials. Our 1-month follow up consisted of 514 baseline daily smokers and the 14-month follow up of 369 daily smokers. Results: We found positive short-term effects regarding smoking cessation (adjusted OR 4.50, 95% CI 1.20-16.86), self-efficacy (p=0.01), and intentions to quit (p=0.004). However, none of these effects were maintained at 1-year follow up. The intervention was successful in reaching more than half of all daily smokers in the target group with more than 30% receiving counselling at least once in the intervention period. Conclusions: This trial shows that a "minimal" intervention can produce short-term effects but that this approach is insufficient in producing long-term effects.

Darker CD; Sweeney BP; El Hassan HO; Smyth BP; Ivers JHH; Barry JM. Brief interventions are effective in reducing alcohol consumption in opiate-dependent methadone-maintained patients: Results from an implementation study. Drug and Alcohol Review 31(3): 348-356, 2012. (35 refs.)

Introduction and Aims. An implementation study to test the feasibility and effectiveness of brief interventions (BIs) to reduce hazardous and harmful alcohol consumption in opiate-dependent methadone-maintained patients. Methods. Before and after intervention comparison of Alcohol Use Disorders Identification Test (AUDIT-C) scores from baseline to 3 month follow up. Seven hundred and ten (82%) of the 863 eligible methadone-maintained patients within three urban addiction treatment clinics were screened. A World Health Organization protocol for a clinician-delivered single BI to reduce alcohol consumption was delivered. The full AUDIT questionnaire was used at baseline (T1) to measure alcohol consumption and related harms; and in part as a screening tool to exclude those who may be alcohol-dependent. AUDIT-C was used at 3 month follow up (T2) to assess any changes in alcohol consumption. Results. One hundred and sixty (23% of overall sample screened) 'AUDIT-positive' cases were identified at baseline screening with a mean total full AUDIT score of 13.5 (SD 6.7). There was a statistically significant reduction in AUDIT-C scores from T1 (((x) over bar = 6.74, SD = 2.35) to T2 ((x) over bar = 5.74, SD = 2.66) for the BI group (z = -3.98, P < 0.01). There was a statistically significant decrease in the proportion of men who were AUDIT-positive from T1 to T2 (chi(2) = 8.25, P < 0.003). Discussion and Conclusions. It is feasible for a range of clinicians to screen for problem alcohol use and deliver BI within community methadone clinics. Opiate-dependent patients significantly reduced their alcohol consumption as a result of receiving a BI.

Dembo R; Briones-Robinson R; Ungaro RA; Karas L; Gulledge LM; Greenbaum PE et al. Problem profiles of at-risk youth in two service programs: A multigroup exploratory latent class analysis. Criminal Justice and Behavior 38(10): 988-1008, 2011. (66 refs.)

Baseline data collected in two brief intervention projects (BI-Court and Truancy Project) were used to assess similarities and differences in subgroups of at-risk youth. Classifications of these subgroups were based on their psychosocial characteristics (e. g., substance use). Multigroup latent class analysis identified two BI-Court subgroups of youth and three truant subgroups. These classes can be viewed as differing along two dimensions, substance use involvement and emotional and behavioral issues. Equality tests of means across the latent classes for BI-Court and Truancy Project youths found significant differences that were consistent with their problem group classification. These findings highlight the importance of quality assessments and allocating appropriate services on the basis of problem profiles of at-risk youth.

Dembo R; Gulledge L; Robinson RB; Winters KC. Enrolling and engaging high-risk youths and families in community-based, brief intervention services. Journal of Child & Adolescent Substance Abuse 20(4): 330-350, 2011. (44 refs.)

Increasing interest has been shown in brief interventions for troubled persons, including those with substance abuse problems. Most of the published literature on this topic has focused on adults, and on the efficacy of these interventions. Few of these studies have examined the critical issues of enrollment and engagement in brief intervention services. The present article seeks to address the shortcomings in the current literature by reporting on our experiences implementing National Institute on Drug Abuse (NIDA)-funded brief intervention projects involving truant and diversion program youths.

Demirkol A; Conigrave K; Haber P. Problem drinking: Management in general practice. Australian Family Physician 40(8): 576-+, 2011. (25 refs.)

Background: Management of problem drinking presents the general practitioner with similar challenges and rewards to those associated with the management of other chronic conditions. Objective: This article presents a framework for managing alcohol problems in general practice based on national guidelines for the treatment of alcohol problems. Discussion: General practitioners are well placed to undertake the management of drinking problems following an assessment of the amount of alcohol taken and the risks this poses for the individual and the people around them. This assessment starts the process of engagement and reflection on drinking habits and will inform the appropriate management approach. Brief interventions can result in reduction in drinking in nondependent drinkers. For dependent drinkers, treatment steps include assessing need for withdrawal management and developing a comprehensive management plan, which includes consideration of relapse prevention pharmacotherapy and psychosocial interventions. The patient's right to choose what they drink must be respected, and those who continue to drink in a problematic way can still be assisted, with compassion, within a harm reduction framework.

DiClemente CC; Delahanty JC; Kofeldt MG; Dixon L; Goldberg R; Lucksted A. Stage movement following a 5A's intervention in tobacco dependent individuals with serious mental illness (SMI). Addictive Behaviors 36(3): 261-264, 2011. (20 refs.)

Smoking among individuals with serious mental illness (SMI) creates significant health problems. This study explored stage of change transitions over time among smokers with serious mental illness (SMI) and how dose of a brief intervention and other psychosocial variables were related to stage transitions. Participants were a subsample of 110 patients who participated in a larger controlled trial (Dixon, et al., 2009) examining whether psychiatrists in mental health clinics implementing the "5A's" (Ask, Advise, Assess, Assist, and Arrange) significantly reduced smoking among persons with SMI. Participants were classified into one of the Transtheoretical Model (TTM) Stages of Change for Smoking Cessation as well as classified into groups based upon the pattern of stage status transitions over time (i.e., Regressors, Stable, Inconsistent, Progressors with and without a successful quit). Modest quit rates for this brief intervention were found at one-year (6.4%) and the dose of the intervention was meaningfully related to positive stage transitions. Cessation outcomes from the controlled trial (Dixon,et al., 2009) indicated a small effect on smoking cessation, which is confirmed in this stage transition secondary analysis with a subset of these smokers. However, these results suggest that a brief intervention delivered by psychiatrists in a mental health treatment setting does seem to make an impact on these smokers.

Dunn KE; Saulsgiver KA; Sigmon SC. Contingency management for behavior change: Applications to promote brief smoking cessation among opioid-maintained patients. Experimental and Clinical Psychopharmacology 19(1): 20-30, 2011. (86 refs.)

Cigarette smoking is highly prevalent among patients who are being treated for opioid-dependence, yet there have been limited scientific efforts to promote smoking cessation in this population. Contingency management (CM) is a behavioral treatment that provides monetary incentives contingent upon biochemical evidence of drug abstinence. This paper discusses the results of two studies that utilized CM to promote brief smoking cessation among opioid-maintained patients. Participants in a pilot study were randomly assigned for a 2-week period to a Contingent group that earned monetary vouchers for providing biochemical samples that met criteria for smoking abstinence, or a Noncontingent group that earned monetary vouchers independent of smoking status (Dunn et al, 2008). Results showed Contingent participants provided significantly more smoking-negative samples than Noncontingent participants (55% vs. 5%, respectively). A second randomized trial that utilized the same 2-week intervention and provided access to the smoking cessation pharmacotherapy bupropion replicated the results of the pilot study (55% and 17% abstinence in Contingent and Noncontingent groups, respectively; Dunn et al, 2010). Relapse to illicit drug use was also evaluated prospectively and no association between smoking abstinence and relapse to illicit drug use was observed (Dunn et al, 2009). It will be important for future studies to evaluate participant characteristics that might predict better treatment outcome, to assess the contribution that pharmacotherapies might have alone or in combination with a CM intervention on smoking cessation and to evaluate methods for maintaining the abstinence that is achieved during this brief intervention for longer periods of time.

Fildes EE; Wilson MAT; Crawford BJ; Kapella-Mshigeni S; Wilson LA; Henkelman W. Tobacco quitlines in the United States. Nursing Clinics of North America 47(1): 97-108, 2012. (33 refs.)

Tobacco use is the number one preventable cause of death and disability in the United States today. In 2003, the Interagency Committee on Smoking and Health recommended to establish a federally funded national tobacco quitline network by 2005. Quitlines are telephone-based programs that assist tobacco users to quit. The combination of health professionals referring patients to an accessible, evidence-based, cost-effective cessation resource can produce a substantial reduction in the number of tobacco users in the United States. Initiatives to increase knowledge and working relationships between nurses and quitlines need to be created, implemented, and evaluated.

Furr-Holden CD; Voas RB; Lacey J; Romano E; Jones K. The prevalence of alcohol use disorders among night-time weekend drivers. Addiction 106(7): 1251-1260, 2011. (36 refs.)

Aims: The objective of this study was to establish the extent of alcohol use disorders (AUDs) among drivers at risk for alcohol-related crashes. The prevalence of drivers with AUDs on US roads on weekend evenings when alcohol-related crashes are most frequent is unknown. This study will inform laws and programs designed to reduce alcohol-involved crashes. Design: Interviews using a 15-item AUD questionnaire with a stratified random sample of non-commercial drivers at 60 primary sampling locations in the 48 contiguous states on Fridays and Saturdays between 10 p. m. and 3 a. m. from July to November 2007. Setting Off-road locations into which a police officer directed a random selection of motorist passing the site. Participants A total of 4614 drivers of non-commercial vehicles. Measurements AUDs, including heavy drinking, alcohol abuse, and alcohol dependence. Findings: Of the participating drivers, 73.7% were current drinkers (reported drinking in the last year). Among those drinkers, 14% were classifiable either as dependent drinkers or as abusive drinkers based on self-reports of drinking. Another 10% of the drivers were classified as heavy drinkers. Nearly half of the drivers in the survey who had blood alcohol concentrations (BACs) at or higher than the 0.08 g per deciliter legal limit fell into one of those three AUD categories. Conclusions: Survey data suggest that the majority of high-blood alcohol concentration drivers on US roads show no clinical signs of an alcohol use disorder, but they are categorized as heavy drinkers. This suggests that environmental programs directed at reducing heavy drinking and brief behavioral interventions aimed at reducing episodes of excessive consumption have promise for reducing alcohol-related crashes.

Gaume J; Gmel G; Faouzi M; Bertholet N; Daeppen JB. Is brief motivational intervention effective in reducing alcohol use among young men voluntarily receiving it? A randomized controlled trial. Alcoholism: Clinical and Experimental Research 35(10): 1822-1830, 2011. (32 refs.)

Background: Heavy drinking is one of the leading causes of morbidity and mortality in young men. Brief motivational intervention (BMI) has shown promising results for young people, but has never been tested in young men in the community who volunteered to receive an intervention. Methods: We evaluated the effectiveness of BMI in reducing alcohol use among heavy episodic users and in maintaining low-risk drinking among nonheavy episodic users. Participants were French-speaking young men attending the mandatory Swiss army conscription process. They were offered the opportunity to receive a 20-minute BMI, and those interested were randomized into an intervention group (BMI immediately) or into a control group (BMI after the 6-month follow-up assessment, in a waiting list design). Analyses were conducted separately for heavy and nonheavy episodic users (separated using baseline heavy episodic use frequency) as the hypotheses tested were different between both groups (primary vs. secondary prevention intervention). Results: From a pool of 6,085 young men invited to receive BMI, 727 (11.9%) showed up and 572 were included in the study (after exclusions related to organizational aspects of the conscription process). Among nonheavy episodic users, there was a protective effect of BMI on weekly alcohol use (p < 0.05). Among heavy episodic users, there were no significant effects of BMI. Conclusions: About 12% of young men were interested in addressing their drinking within the BMI framework, suggesting that there is some need for easily accessible alcohol intervention. The present intervention did have a preventive effect among low-risk young drinkers in helping them maintain their patterns of alcohol use. An explanation for the lack of effectiveness among heavy episodic users might be that those individuals interested in BMI had patterns of more severe alcohol use, thereby making change more difficult.

Gual A; Sabadini MBD. Implementing alcohol disorders treatment throughout the community. (review). Current Opinion in Psychiatry 24(3): 203-207, 2011. (35 refs.)

Purpose of review: Alcohol is the world's third leading cause of ill-health and premature death. Alcohol has been found to be the most harmful drug, when considering harm to the individual and to others. With a prespecified search strategy we looked for relevant articles concerning screening, brief interventions and referral to treatment of patients with hazardous or harmful alcohol use, with a special focus on the primary healthcare implementation of these effective interventions. Recent findings: The evidence on the efficacy and effectiveness of brief interventions in primary care continues to grow and is confirmed by many recent studies, even in specific populations. The implementation of those effective interventions continues to be difficult, but successful experiences have been reported. The use of brief interventions in other healthcare settings and to address problems other than risky drinking is promising, but the evidence is far from conclusive. Some specific age groups (elderly, women and youth below 16) may deserve specifically tailored interventions. Summary: Alcohol is a major public health problem and brief interventions are one of the cost-effective measures that can be taken at a community level. Nevertheless, implementation of those measures is difficult. Further research is needed to identify the best implementation strategies.

Havard A; Shakeshaft AP; Conigrave KM; Doran CM. Randomized controlled trial of mailed personalized feedback for problem drinkers in the emergency department: The short-term impact. Alcoholism: Clinical and Experimental Research 36(3): 523-531, 2012. (73 refs.)

Background: Evidence exists for the efficacy of emergency department (ED)-based brief alcohol interventions, but attempts to incorporate face-to-face interventions into routine ED practice have been hampered by time, financial, and attitudinal constraints. Mailed personalized feedback, which is likely to be more feasible, has been associated with reduced alcohol consumption in other settings, but its cost-effectiveness in the ED has not been examined. Methods: The intervention was evaluated with a randomized controlled trial of patients presenting to 5 rural EDs in New South Wales, Australia. Patients aged 14 years and older were screened using the Alcohol Use Disorders Identification Test, and those scoring 8 or more were randomly allocated to the intervention or control group. Participants in the intervention group received mailed personalized feedback regarding their alcohol consumption. The control group received no feedback. Results: Two hundred and forty-four (80%) participants were successfully followed up at 6 weeks. A significant effect of the mailed feedback was observed only in patients with an alcohol-involved ED presentation. Among this subgroup of participants, those in the intervention group consumed 12.2 fewer drinks per week than the control group after controlling for baseline consumption and other covariates (effect size d = 0.59). The intervention was associated with an average cost of Australian $ 5.83 per patient, and among participants with an alcohol-involved ED presentation, an incremental cost-effectiveness ratio of 0.48. Conclusions: Mailed personalized feedback is efficacious in reducing quantity/frequency of alcohol consumption among patients with alcohol-involved ED presentations. Mailed feedback has high cost-efficacy and a low absolute cost, making it a promising candidate for integration into ED care.

Higashi H; Barendregt JJ. Cost-effectiveness of tobacco control policies in Vietnam: The case of personal smoking cessation support. Addiction 107(3): 658, 2012. (49 refs.)

Aims: To examine the cost-effectiveness of personal smoking cessation support in Vietnam. Design, setting and participants We followed-up the population aged 15 years and over in 2006 to model the costs and health gains associated with five interventions: physician brief advice; nicotine replacement therapy (patch and gum); bupropion; and varenicline. Threshold analysis was undertaken to determine the price levels of pharmaceuticals for the interventions to be cost-effective. A multi-state life table model was constructed such that the interventions affect the smoking cessation behaviour of the age cohorts, and the resulting smoking prevalence defines their health outcomes. A health-care perspective was employed. Measurements Cost-effectiveness is measured in 2006 Vietnamese Dong (VND) per disability-adjusted life year (DALY) averted. We adopted theWorld Health Organization thresholds of being ` cost-effective' if less than three times gross domestic product (GDP) per capita (VND 34 600 000) and ` very cost effective' if less than GDP per capita (VND 11 500 000). Findings: The cost-effectiveness result of physician brief advice was VND 1 742 000 per DALY averted (international dollars 543), which was 'very cost-effective'. Varenicline dominated bupropion and nicotine-replacement therapies, although it did not fall within the range of being 'costeffective' under different scenarios. The threshold analysis revealed that prices of pharmaceuticals must be substantially lower than the levels from other countries if pharmacological therapies are to be cost-effective in Vietnam. Conclusions: Physician brief advice is a cost-effective intervention and should be included in the priority list of tobacco control policy in Vietnam. Pharmacological therapies are not cost-effective, and so they are not recommended in Vietnam at this time unless pharmaceuticals could be produced locally at substantially lower costs in the future.

Huang YS; Tang TC; Lin CH; Yen CF. Effects of Motivational Enhancement Therapy on readiness to change MDMA and methamphetamine use behaviors in Taiwanese adolescents. Substance Use & Misuse 46(4): 411-416, 2011. (28 refs.)

The aim of this study was to examine the effect of brief modified motivational enhancement therapy (MET) on readiness to change patterns of methylenedioxymethamphetamine (MDMA) and methamphetamine (MAMP) use behaviors in adolescents. A total of 94 adolescents who used MDMA or MAMP were consecutively recruited from a juvenile abstinence center; 46 received a three-session MET intervention (intervention group), and 48 received educational materials only and no MET intervention (control group). Analysis of covariance was performed to examine the effect of motivational interviewing on the readiness of change scores on the University of Rhode Island Change Assessment and on the scores of its subscales. By using the pretreatment scores as covariates, the intervention group demonstrated higher posttreatment scores of readiness to change and of the contemplation subscale on the University of Rhode Island Change Assessment than the control group. The results of this study support the finding that brief modified MET is effective in promoting readiness to change MAMP and MDMA use behaviors in adolescents who receive short-term treatment programs.

Humeniuk R; Ali R; Babor T; Souza-Formigoni MLO; de Lacerda RB; Ling W et al. A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health-care settings in four countries. Addiction 107(5): 957-966, 2012. (28 refs.)

Aims: This study evaluated the effectiveness of a brief intervention (BI) for illicit drugs (cannabis, cocaine, amphetamine-type stimulants and opioids) linked to the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST screens for problem or risky use of 10 psychoactive substances, producing a score for each substance that falls into either a low-, moderate- or high-risk category. Design: Prospective, randomized controlled trial in which participants were either assigned to a 3-month waiting-list control condition or received brief motivational counselling lasting an average of 13.8 minutes for the drug receiving the highest ASSIST score. Setting Primary health-care settings in four countries: Australia, Brazil, India and the United States. Participants A total of 731 males and females scoring within the moderate-risk range of the ASSIST for cannabis, cocaine, amphetamine-type stimulants or opioids. Measurements: ASSIST-specific substance involvement scores for cannabis, stimulants or opioids and ASSIST total illicit substance involvement score at baseline and 3 months post-randomization. Findings: Omnibus analyses indicated that those receiving the BI had significantly reduced scores for all measures, compared with control participants. Country-specific analyses showed that, with the exception of the site in the United States, BI participants had significantly lower ASSIST total illicit substance involvement scores at follow-up compared with the control participants. The sites in India and Brazil demonstrated a very strong brief intervention effect for cannabis scores ( P < 0.005 for both sites), as did the sites in Australia ( P < 0.005) and Brazil ( P < 0.01) for stimulant scores and the Indian site for opioid scores ( P < 0.01). Conclusions: The Alcohol, Smoking and Substance Involvement Screening Test-linked brief intervention aimed at reducing illicit substance use and related risks is effective, at least in the short term, and the effect generalizes across countries.

Kaminer Y; Winters KC, eds. Clinical Manual of Adolescent Substance Abuse Treatment. Washington DC: American Psychiatric Association, 2011. (Chapter refs.)

This book in 16 chapters with a total of 45 contributors is a comprehensive work on adolescent substance use problems and treatment. It begins with consideration of adolescent substance use, with data on the prevalence and natural history of substance use and substance use disorders. In respect to etiology and prevention, both protective and risk factors are discussed. Attention then turns to screening, assessment and brief interventions, and includes a chapter on the use of biomarker testing in adolescents. In turning to treatment, there are chapters dealing with treatment planning and placement criteria for different treatment settings, discussion of adolescent behavioral changed, and the use of pharmacotherapy in treatment of substance use disorders. A chapter is directed to club drugs, prescription drugs, and over-the-counter medication, and the diagnosis of treatment and intervention. Individual chapters are directed to specific treatment approaches: brief motivational interventions, cognitive-behavioral therapy, and contingency management; adolescents community reinforcement approach and mutidimensional family therapy, as well as relapse prevention; and twelve-step programs. Several chapters consider co-occurring problems: attention deficit/hyperactivity; internalizing disorders (depression, anxiety disorders, and PTST; assessment and treatment of suicidal behavior; and assessment and treatment of psychotic disorders and bipolar disorder. The final chapter addresses the care of adolescents in the juvenile system with substance use problems.

2011, American Psychiatric Association

Kerr S; Whyte R; Watson H; Tolson D; McFadyen AK. A mixed-methods evaluation of the effectiveness of tailored smoking cessation training for healthcare practitioners who work with older people. Worldviews on Evidence-Based Nursing 8(3): 177-186, 2011. (48 refs.)

Background: Older people who smoke derive significant health benefits from stopping smoking in later life. Healthcare practitioners have an important role to play in raising the issue of smoking cessation with this client group; however, they often fail to do so. Aim: To assess the effectiveness of smoking cessation training for healthcare practitioners who have regular contact with older adults. Methods: Mixed-methods were used to explore satisfaction with the training, the participants' learning and any resultant changes in behaviour. The effectiveness of the training was assessed using a two-group parallel design randomised controlled trial, followed by semistructured qualitative interviews. Participants (n = 57) were recruited from a cohort of community nurses and allied health professionals (e. g., occupational therapists) working in Scotland. The intervention was 1-day brief intervention smoking cessation training. Validated measures of knowledge, attitudes and practice, were used to assess learning and behaviour at baseline, 1 week and 3 months post training. Data were analysed using two-factor repeated measure analysis of variance, where the factors were "group" and "time." Qualitative data were gathered from members of the intervention group during semistructured interviews (n = 8) and were analysed thematically. Results/Findings: Levels of satisfaction with the training were high. There was a statistically significant improvement in the knowledge and attitudes of the intervention group following the training, with a noticeable, but nonsignificant, improvement in practice. The qualitative findings demonstrate how the training impacted positively on practice. Conclusions: Smoking cessation interventions in later life are important, as older smokers generally have long-term conditions caused or complicated by smoking. The delivery of brief smoking cessation interventions is known to be highly cost-effective; however, research demonstrates that practitioners often fail to raise the issue of smoking cessation with older adults. This study has demonstrated the effectiveness of a 1-day training course for practitioners. Further research is recommended.

Khadjesari Z; Murray E; Hewitt C; Hartley S; Godfrey C. Can stand-alone computer-based interventions reduce alcohol consumption? A systematic review (review). Addiction 106(2): 267-282, 2011. (76 refs.)

Aim: To determine the effects of computer-based interventions aimed at reducing alcohol consumption in adult populations. Methods: The review was undertaken following standard Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for systematic reviews. The literature was searched until December 2008, with no restrictions on language. Randomized trials with parallel comparator groups were identified in the form of published and unpublished data. Two authors independently screened abstracts and papers for inclusion. Data extraction and bias assessment was undertaken by one author and checked by a second author. Studies that measured total alcohol consumption and frequency of binge drinking episodes were eligible for inclusion in meta-analyses. A random-effects model was used to pool mean differences. Results: Twenty-four studies were included in the review (19 combined in meta-analyses). The meta-analyses suggested that computer-based interventions were more effective than minimally active comparator groups (e.g. assessment-only) at reducing alcohol consumed per week in student and non-student populations. However, most studies used the mean to summarize skewed data, which could be misleading in small samples. A sensitivity analysis of those studies that used suitable measures of central tendency found that there was no difference between intervention and minimally active comparator groups in alcohol consumed per week by students. Few studies investigated non-student populations or compared interventions with active comparator groups. Conclusion: Computer-based interventions may reduce alcohol consumption compared with assessment-only; the conclusion remains tentative because of methodological weaknesses in the studies. Future research should consider that the distribution of alcohol consumption data is likely to be skewed and that appropriate measures of central tendency are reported.

Kishore V; Lynch S; Pichon J; Theall K; Johnson S; Roberson E et al. Knowledge, attitudes and practice relating to hazardous alcohol use across the continuum of care in a community healthcare centre. Drugs: Education, Prevention and Policy 18(1): 60-68, 2011. (20 refs.)

Alcohol screening and intervention in community health settings places a great time demand on practitioners. Thus, implementation of practitioner-delivered intervention is challenging. Aims: The aim of this study was to assess the feasibility of incorporating a brief alcohol intervention into daily practices of a community health care centre by utilizing assistance from non-practitioners and administrative staff. Methods: In regard to alcohol use, the knowledge, attitudes and practice (KAP) of the staff of a health care centre were assessed using a self-administered survey. The 57-item survey consisted of alcohol-relevant questions in four domains: clinical practice, knowledge and self-assessment of skills and available resources. Findings: The sample consisted of 70 individuals-23 practitioners, 21 medical assistants and 26 administrative staff from two New Orleans' clinics. Practitioners were observed to be most confident in assessing alcoholism as well as in implementing interventions for alcohol abuse. Medical assistants exhibited high self-rated scores, second to practitioners, in survey items regarding attitudes towards patients, alcohol knowledge and alcohol-related clinical skills. Conclusions: Based on KAP, it appears that healthcare workers other than practitioners, particularly medical assistants, may serve as a useful resource to practitioners in providing alcohol screening and prevention services. Educationation and empowerment of medical assistants will however be needed to achieve this goal.

Korcha RA; Cherpitel CJ; Moskalewicz J; Swiatkiewicz G; Bond J; Ye Y. Readiness to change, drinking, and negative consequences among Polish SBIRT patients. Addictive Behaviors 37(3): 287-292, 2012. (39 refs.)

The aim of this study is to examine the longitudinal relationship of readiness to change, drinking pattern, amount of alcohol consumed, and alcohol-related negative consequences among at-risk and dependent drinkers enrolled in a Screening, Brief Intervention and Referral to Treatment (SBIRT) trial in an emergency department in southern Poland. The study examined 299 patients randomized to either an assessment or intervention condition and followed at 3 and 12 months after initial presentation. Patients indicating a readiness or were unsure of changing drinking behavior were significantly more likely to decrease the maximum number of drinks per occasion and the usual number of drinks in a sitting in the 3-months following study entry when compared to those that rated changing drinking behavior as unimportant. Readiness to change was not predictive of outcomes between the baseline and 12-month follow-up. Drinking outcomes and negative consequences by readiness and research condition were non-significant. This is the first Polish study utilizing SBIRT to enable patients to identify their hazardous drinking and reduce alcohol consumption. While some drinking outcomes improved with motivation, these improvements were not maintained at 12-months following SBIRT. Attention to additional constructs of readiness to change and drinking patterns may augment the effectiveness of SBIRT.

Lapham GT; Achtmeyer CE; Williams EC; Hawkins EJ; Kivlahan DR; Bradley KA. Increased documented brief alcohol interventions with a performance measure and electronic decision support. Medical Care 50(2): 179-187, 2012. (50 refs.)

Background: Alcohol screening and brief interventions (BIs) are ranked the third highest US prevention priority, but effective methods of implementing BI into routine care have not been described. Objectives: This study evaluated the prevalence of documented BI among Veterans Affairs (VA) outpatients with alcohol misuse before, during, and after implementation of a national performance measure (PM) linked to incentives and dissemination of an electronic clinical reminder (CR) for BI. Methods: VA outpatients were included in this study if they were randomly sampled for national medical record reviews and screened positive for alcohol misuse (Alcohol Use Disorders Identification Test-Consumption score >= 5) between July 2006 and September 2008 (N = 6788). Consistent with the PM, BI was defined as documented advice to reduce or abstain from drinking plus feedback linking drinking to health. The prevalence of BI was evaluated among outpatients who screened positive for alcohol misuse during 4 successive phases of BI implementation: baseline year (n = 3504), after announcement (n = 753) and implementation (n = 697) of the PM, and after CR dissemination (n = 1834), unadjusted and adjusted for patient characteristics. Results: Among patients with alcohol misuse, the adjusted prevalence of BI increased significantly over successive phases of BI implementation, from 5.5% (95% CI 4.1%-7.5%), 7.6% (5.6%-10.3%), 19.1% (15.4%-23.7%), to 29.0% (25.0%-33.4%) during the baseline year, after PM announcement, PM implementation, and CR dissemination, respectively (test for trend P < 0.001). Conclusions: A national PM supported by dissemination of an electronic CR for BI was associated with meaningful increases in the prevalence of documented brief alcohol interventions.

Makela P; Havio M; Seppa K. Alcohol-related discussions in health care: A population view. Addiction 106(7): 1239-1248, 2011. (41 refs.)

Aims: The present study aimed to evaluate the frequency and the target group of alcohol screening and brief interventions in health-care settings and how well this level of activity reflects public opinion. Design A general population survey. Setting and participants: A random sample of Finns aged 15-69 years with a 74% response rate (n = 2725). Measurements: Frequency counts were used to evaluate the level of activity. Logistic regression models were used to examine which groups were asked and advised about alcohol use and which groups considered it useful. Findings: More than 90% had positive attitudes towards being asked about their alcohol use. Of those who had been in contact with health care (n = 2062) in the 12 months before the survey, 33.3% had been asked about their alcohol use, being most often men, young, heavy drinkers and those of high socio-economic status. Thirty-seven per cent of those who had been asked were given advice, being most often heavy drinkers and those with a normal body mass index. However, 50% of heavy drinkers who had been asked about their alcohol use had not been advised about it. Of those who had been advised, 71.9% considered it useful, especially older subjects, and also including heavy episodic drinkers, although less than others. Conclusions: In Finland, the frequency of health-care professionals asking and giving advice on alcohol is relatively low. However, public opinion towards these discussions is positive. Our results encourage the support and uptake of systematic screenings and brief interventions in health-care settings.

Mason M; Pate P; Drapkin M; Sozinho K. Motivational interviewing integrated with social network counseling for female adolescents: A randomized pilot study in urban primary care. Journal of Substance Abuse Treatment 41(2): 148-155, 2011. (47 refs.)

This study tested the efficacy of a brief preventive intervention for substance use and associated risk behaviors among female adolescent patients of an urban primary care health clinic. We integrated an evidenced-based motivational interviewing (MI) approach with a social network component to develop a 20-minute session, a social network intervention delivered in an MI-consistent style. Female adolescents (N = 28) 14 to 18 years old were recruited, provided consent/assent, were screened, and were randomly assigned to the treatment or control (no treatment) condition. The sample was 82% African American and 18% mixed race, with 32% living below the U.S. poverty line. At 1-month follow-up, teens in the treatment condition reported less trouble due to alcohol use, less substance use before sexual intercourse, less social stress, less offers for marijuana use, and increased readiness to start counseling compared with the teens in the control condition. Results provide support for socially based brief interventions with at-risk urban adolescents.

McCance-Katz EF; Satterfield J. SBIRT: A key to integrate prevention and treatment of substance abuse in primary care. American Journal on Addictions 21(2): 176-177, 2012. (10 refs.)

The 2009 National Survey on Drug Use and Health reported that 21.8 million, or 8%, of those over age 12 had used illicit substances in the past month, 23.7% (59.6 million) reported binge drinking, and 6.8% (17.1 million) reported regular heavy drinking. This makes substance abuse one of the most common medical disorders in the United States. Furthermore, at best only 10% of those in need of treatment, actual receiving treatment. A single screening question is recommended for primary care, community health settings, and emergency departments. The question is "in the past year, have you had any times when you had 5 (for women, 4) or more drinks at one sitting?" The authors discusses efforts by SAMHSA has launched a 17 site, medical residency training program to promote the core SBIRT clinical skills among physicians, with the goal of bringing one of the most common medical disorders into the medical mainstream.

McQueen J; Howe TE; Allan L; Mains D; Hardy V. Brief interventions for heavy alcohol users admitted to general hospital wards. (review). Cochrane Database of Systematic Reviews 8: e-article CD005191, 2011. (98 refs.)

Background: Brief interventions involve a time-limited intervention focusing on changing behaviour. They are often motivational in nature using counselling skills to encourage a reduction in alcohol consumption. Objectives: To determine whether brief interventions reduce alcohol consumption and improve outcomes for heavy alcohol users admitted to general hospital inpatient units. Search strategy We searched the Cochrane Drug and Alcohol Group Register of Trials (March 2011) the Cochrane Central Register of Controlled Trials (The Cochrane Library March 2011), MEDLINE January 1966-March 2011, CINAHL 1982-March 2011, EMBASE 1980-March 2011 and www.clinicaltrials.gov to April 2011 and performed some relevant handsearching. Selection criteria: All prospective randomised controlled trials and controlled clinical trials were eligible for inclusion. Participants were adults and adolescents (16 years or older) admitted to general inpatient hospital care for any reason other than specifically for alcohol treatment and received brief interventions (of up to 3 sessions) compared to no or usual care. Data collection and Three reviewers independently selected the studies and extracted data. Where appropriate random effects meta-analysis and sensitivity analysis were performed. Main results: Forteen studies involving 4041 mainly male participants were included. Our results demonstrate that patients receiving brief interventions have a greater reduction in alcohol consumption compared to those in control groups at six month, MD -69.43 (95% CI -128.14 to -10.72) and nine months follow up, MD -182.88 (95% CI -360.00 to -5.76) but this is not maintained at one year. Self reports of reduction of alcohol consumption at 1 year were found in favour of brief interventions, SMD -0.26 (95% CI -0.50 to -0.03). In addition there were significantly fewer deaths in the groups receiving brief interventions than in control groups at 6 months, RR 0.42 (95% CI 0.19 to 0.94) and one year follow up, RR 0.60 (95% CI 0.40 to 0.91). Furthermore screening, asking participants about their drinking patterns, may also have a positive impact on alcohol consumption levels and changes in drinking behaviour. Authors' conclusions: The main results of this review indicate that there are benefits to delivering brief interventions to heavy alcohol users admitted to general hospital wards in terms of reduction in alcohol consumption and death rates. However, these findings are based on studies involving mainly male participants. Further research is required determine the optimal content and treatment exposure of brief interventions within general hospital settings and whether they are likely to be more successful in patients with certain characteristics.

Meyer C; Ulbricht S; Gross B; Kastel L; Wittrien S; Klein G et al. Adoption, reach and effectiveness of computer-based, practitioner delivered and combined smoking interventions in general medical practices: A three-arm cluster randomized trial. Drug and Alcohol Dependence 121(1-2): 124-132, 2012. (43 refs.)

Background: Brief advice for smoking patients has not been sufficiently integrated in routine care. Computer-based interventions emerged as a time saving option that might help to exhaust the potential population impact of the general practice setting. Method: 151 practices were randomly assigned to one of three intervention programs consisting in the delivery of: (1) brief advice by the practitioner; (2) individually tailored computer-generated letters; or (3) a combination of both interventions. We assessed three dimensions of population impact: (1) adoption, i.e., the rate of practices participating in the program; (2) reach, measured as the number of interventions provided within 7 months; (3) effectiveness, measured as smoking abstinence at 12-months follow-up. Results: Among the practices, 70% adopted the program with no significant differences across study groups. Treatment was provided to 3086 adult smokers. Negative binomial regression analysis revealed that the number of interventions provided was higher in practices allocated to the tailored letter and combination intervention groups by 215% (p<.01) and 127% (p=.02), respectively, compared to the brief advice intervention group. Among the patients who received the combination of both intervention, the odds of point abstinence from smoking was increased by 65% (p=.02) and 32% (p=.01) compared to the brief advice and tailored letters intervention respectively. Comparing the number of abstinent patients at follow-up revealed that the tailored letter and combination interventions were superior to the brief advice intervention. Conclusions: Computer-based interventions alone or in addition to conventional practitioner-delivered advice can foster the participation of general medical practices in tobacco control.

Miller PM; Book SW; Stewart SH. Medical treatment of alcohol dependence: A systematic review. (review). International Journal of Psychiatry in Medicine 42(3): 227-266, 2011. (103 refs.)

Objective: To summarize published data on pharmacologic treatments for alcohol dependence alone and in combination with brief psychosocial therapies that may be feasible for primary care and specialty medical settings. Methods: We conducted electronic searches of published original research articles and reviews in MEDLINE, SCOPUS, CINAHL, Embase, and PsychINFO. In addition, hand searches of reference lists of review articles, supplemental searches of internet references and contacts with experts in the field were conducted. Randomized controlled studies published between January 1960 and August 2010 that met our inclusion/exclusion criteria were included. Results: A total of 85 studies, representing 18,937 subjects, met our criteria for inclusion. The evidence base for oral naltrexone (6% more days abstinent than placebo in the largest study) and topiramate (prescribed off-label) (e.g., 26.2% more days abstinent than placebo in a recent study) is positive but modest. Acamprosate shows modest efficacy with recently abstinent patients, with European studies showing better results than U.S. ones. The evidence-base for disulfiram is equivocal. Depot naltrexone shows efficacy (25% greater reduction in rate of heavy drinking vs. placebo, in one of the largest studies) in a limited number of studies. Some studies suggest that patients do better with extensive psychosocial treatments added to medications while others show that brief support can be equally effective. Conclusions: Although treatment effects are modest, medications for alcohol dependence, in conjunction with either brief support or more extensive psychosocial therapy, can be effective in primary and specialty care medical settings.

Moore BA; Fazzino T; Garnet B; Cutter CJ; Barry DT. Computer-based interventions for drug use disorders: A systematic review. (review). Journal of Substance Abuse Treatment 40(3): 215-223, 2011. (35 refs.)

A range of innovative computer-based interventions for psychiatric disorders have been developed and are promising for drug use disorders due to reduced cost and greater availability compared to traditional treatment. Electronic searches were conducted from 1966 to November 19, 2009, using MEDLINE, Psychlit, and EMBASE. Four hundred sixty-eight nonduplicate records were identified. Two reviewers classified abstracts for study inclusion, resulting in 12 studies of moderate quality. Eleven studies were pilot or full-scale trials compared to a control condition. Interventions showed high acceptability despite substantial variation in type and amount of treatment. Compared to treatment-as-usual, computer-based interventions led to less substance use and higher motivation to change, better retention, and greater knowledge of presented information. Computer-based interventions for drug use disorders have the potential to dramatically expand and alter the landscape of treatment. Evaluation of Internet- and telephone-based delivery that allows for treatment-on-demand in patients' own environment is needed.

Mulia N; Schmidt LA; Ye Y; Greenfield TK. Preventing disparities in alcohol screening and brief intervention: The need to move beyond primary care. Alcoholism: Clinical and Experimental Research 35(9): 1557-1560, 2011. (43 refs.)

The alcohol treatment field has focused on promoting screening and brief intervention (SBI) in medically based settings, particularly primary care. In this Commentary, we consider the potential unintended consequences for disparities in access to care for alcohol problems. National data show significant racial/ethnic and socioeconomic differences in the rates at which at-risk drinkers and persons with alcohol use disorders come into contact with primary care providers. This suggests that implementing SBI in mostly primary care settings could inadvertently widen the gap in alcohol-related health disparities. To ensure that all populations in need benefit from this evidence-based treatment, SBI should be considered and adapted for a wider range of service venues, including Federally Qualified Health Centers and venues frequented by racial/ethnic minorities and the uninsured.

Navarro HJ; Shakeshaft A; Doran CM; Petrie DJ. The potential cost-effectiveness of general practitioner delivered brief intervention for alcohol misuse: Evidence from rural Australia. Addictive Behaviors 36(12): 1191-1198, 2011. (65 refs.)

Objective: This paper aims to model General Practitioner (GP) delivered screening and brief intervention (BI), and to identify the costs per additional risky drinker who reduces alcohol consumption to low-risk levels, relative to current practice. Method: A decision model and nine different scenarios were developed to assess outcomes and costs of GP-delivered screening and BI on the potential number of risky drinkers who reduce their alcohol consumption to low-risk levels in 10 rural communities in New South Wales, Australia. Findings: Based on evidence from current practice, approximately 19% of all risky drinkers visiting GPs annually would reduce alcohol consumption to low-risk levels, of which 0.7% would do so because of GP-delivered screening and BI. If rates of screening and Blare increased to 100%, 36% of these risky drinkers would reduce their drinking to low risk-levels. Alternatively, increments of 10% and 20% in GP-delivered screening and BI would reduce the proportion of risky drinkers by 2.1% and 4.2% respectively. The most cost-effective outcome per additional risky drinker reducing their drinking relative to current practice would be if all of these risky drinkers are screened alone with an ICER of AUD$197. Conclusion: These findings indicate that increments in rates of screening and BI delivered by GPs can result in cost-effective reductions per additional risky drinkers reducing their drinking to low-risk levels, relative to current practice. They also imply that achieving substantial reductions in the prevalence of risky drinking in a community will require strategies other than opportunistic screening and BIs by GPs.

Nilsen P; McCambridge J; Karlsson N; Bendtsen P. Brief interventions in routine health care: A population-based study of conversations about alcohol in Sweden. Addiction 106(10): 1748-1756, 2011. (25 refs.)

Abstract: Aims To investigate how brief alcohol interventions are delivered in routine practice in the Swedish health-care system. Design, setting and participants: A cross-sectional sample of 6000 individuals representative of the adult population aged 18-64 years registered in the Swedish total population register was drawn randomly. Data were collected in 2010 by means of a mail questionnaire. The response rate was 54%. Measurements The questionnaire consisted of 27 questions, of which 15 variables were extracted for use in this study. Whether alcohol had been discussed and the duration, contents, experiences and effects of any conversations about alcohol, as reported by patients themselves, were assessed. Findings: Sixty-six per cent of the respondents had visited health-care services in the past 12 months and 20% of these had had one or more conversations about alcohol during these visits (13% of the population aged 18-64 years). The duration of the conversations was generally brief, with 94% taking less than 5 minutes, and were not experienced as problematic. The duration, contents, experiences and effects of these conversations generally varied between abstainers, moderate, hazardous and excessive drinkers. Twelve per cent of those having a conversation about alcohol reported that it led to reduced alcohol consumption. Reduced alcohol consumption was more likely when conversations lasted for 1-10 minutes rather than less than 1 minute and included advice on how to reduce consumption. Conclusions: Population survey data in Sweden suggest that when health-care professionals give brief advice to reduce alcohol consumption, greater effects are observed when the advice is longer and includes advice on how to achieve it.

Ondersma SJ; Grekin ER; Svikis D. The potential for technology in brief interventions for substance use, and during-session prediction of computer-delivered brief intervention response. Substance Use & Misuse 46(1): 77-86, 2011. (42 refs.)

We first provide an overview of the potential of technology in the area of brief interventions for substance use and describe recent projects from our lab that are illustrative of that potential. Second, we present data from a study of during-session predictors of brief intervention response. In a sample of postpartum women (N = 39), several variables showed promise as predictors of later drug use, and a brief index derived from them predicted abstinence with a sensitivity of .7 and a specificity of .89. This promising approach and initial study findings support the importance of future research in this area.

Perzynski AT; McCormick R; Webster NJ; Blixen CE; Kanuch S; Thomas CL et al. Psychosocial correlates of alcohol use and reduction for individuals with hepatitis C. Journal of Studies on Alcohol and Drugs 72(5): 787-798, 2011. (63 refs.)

Objective: Patients with hepatitis C virus (HCV) are advised to refrain from alcohol consumption. A questionnaire was developed to measure concepts associated with alcohol use for individuals with HCV. Method: Subjects with HCV (N = 527) completed a telephone survey. Eligible respondents had screened negative for current abuse/dependence disorders (Alcohol Use Disorders Identification Test [AUDIT] <= 10). Measures of personality, self-efficacy, knowledge, readiness, coping styles, stigma, and symptoms were examined for associations with alcohol use. Results: Factor analysis supported a measurement structure of 105 items in 35 subdomains. A total of 26 subdomains had significant bivariate associations with alcohol use. Higher self-efficacy for resisting drinking in social situations was associated with lower alcohol use (r = -.68, p < .001), as was knowledge of alcohol and HCV (r = -.27, p < .001). Although agreeableness and marital status are typically associated with lower current drinking in samples of those with alcohol use problems, in our study agreeableness (beta = .13, p < .01) and marital status (beta = .08,p < .05) were modestly associated with higher current drinking. The final multivariate R(2) was .55. Conclusions: The pattern of associations suggests the importance of the social aspects of drinking for drinking decisions. Existing brief interventions will need to be tailored to a contextualized psychosocial model for medical patients with HCV and AUDIT scores <= 10 to optimize effectiveness. Such future interventions should emphasize the potential medical hazards of drinking for persons with HCV, the maintenance of social relationships in the absence of alcohol use, and strategies for building confidence for resisting drinking in specific situations.

Rabius V; Wiatrek D; McAlister AL. African American participation and success in telephone counseling for smoking cessation. Nicotine & Tobacco Research 14(2): 240-242, 2012. (12 refs.)

Introduction: Quitlines that provide telephone counseling for smoking cessation have been proved to be effective. All 50 states currently provide free quitline access to their residents; however, little research has been published on African American utilization of quitlines or their success rates. Methods: This study evaluated how effectively African Americans are served by telephone counseling (quitline) for smoking cessation based on empirical data from 45,510 callers from Texas, Louisiana, Washington, and District of Columbia and randomized clinical trial data from 3,522 participants. Results: African Americans tended to use a quitline in proportions greater than their proportional representation in the smoking communities in both states and the District. African American quit rates were equivalent to those of non-Hispanic "Whites" as were their levels of satisfaction with the service and the number of counseling sessions they completed. African Americans were more likely to request counseling than non-Hispanic Whites. Conclusions: This study demonstrates that telephone counseling is a promising tool for addressing health disparities related to smoking among African Americans.

Regan D. The brief alcohol intervention. Psychologist 25(4): 286-288, 2012. (20 refs.)

Excessive alcohol use is common, and associated with many adverse social, economic, and mental and physical health consequences. But the next time you hear someone lecturing about the perils of the demon drink, stop them right there. Let them know that berating people with hard-hitting facts is no use. Point them in the direction of research on effective interventions to reduce harmful drinking, in which psychology plays a major role. This article considers one of the primary methods: to screen for harmful drinking, and then deliver specific brief interventions that are recognised as the primary effective strategy for reducing harmful drinking. The manner in which modern technology is impacting the delivery of these interventions is also discussed.

Ryb GE; Dischinger PC; DiClemente C; Auman KM; Kufera JA; Soderstrom CA. Impulsive or depressive personality traits do not impede behavioral change after brief alcohol interventions. Journal of Addictive Diseases 30(1): 54-62, 2011. (50 refs.)

The authors investigated whether impulsivity and depression affect the success of interventions to reduce alcohol use. Unadjusted and adjusted regression models were constructed to analyze the effect of impulsivity and depression on 12-month outcomes of participants of a trauma center based randomized trial of brief personalized motivational interventions versus information and advice. Of 497 problem drinkers enrolled in the program, 248 completed the 12-month follow-up. Impulsivity, male gender, being older than 35, and intentional mechanism of injury had a direct association with drinking. After interventions, a decrease in drinking was found that was unaffected by the presence of impulsivity or depression indicators.

Schimmel-Bristow A; Bricker JB; Comstock B. Can Acceptance & Commitment Therapy be delivered with fidelity as a brief telephone-intervention? Addictive Behaviors 37(4): 517-520, 2012. (24 refs.)

This study examined therapist adherence and competence of the first telephone-based Acceptance & Commitment Therapy (ACT) intervention for smoking cessation. An independent rater assessed 100% (n=54 sessions) of the recorded phone sessions for adherence and competence on a 1 (never addressed) to 5 (addressed extensively) scale. A separate 20% random sample was rated by both the same independent rater and a second independent rater. The two coders were in perfect agreement (kappa of 1.0). Overall adherence (x=4.61, SD=0.63) and competence (x=4.81, SD=0.39) was high. Except self-as-context, benchmark ratings (i.e., 4 or more) were between 93% and 100%. Results suggest ACT therapy can be delivered competently over the telephone, opening many options for future research on the potential uses of telephone-based ACT for smoking and other behaviors.

Schnoll RA; Cappella J; Lerman C; Pinto A; Patterson F; Wileyto EP et al. A novel recruitment message to increase enrollment into a smoking cessation treatment program: Preliminary results from a randomized trial. Health Communication 26(8): 735-742, 2011. (26 refs.)

Most smokers do not utilize approved interventions for nicotine dependence, reducing the probability of cessation. Smoking cessation programs typically use recruitment messages emphasizing the health threats of smoking. Augmenting this threat message by describing the genetic aspects of nicotine addiction may enhance enrollment into a cessation program. During telephone recruitment, 125 treatment-seeking smokers were randomized to receive by phone either a standard threat message or a threat plus genetic prime message and were offered open-label varenicline and counseling. There was a greater rate of enrollment into the cessation program for the threat plus genetic prime participants (51.7%) versus the threat-only participants (37.7%; p = .03). Smokers who self-identified from racial/ethnic minority groups were less likely to enroll in the cessation program (p = .01) versus smokers who self-identified as Caucasian. These preliminary data suggest that a simple, affordable, and transportable communication approach enhances enrollment of smokers into a smoking cessation program. A larger clinical trial to evaluate a genetic prime message for improving recruitment into smoking cessation programs is warranted.

Seigers DKL; Carey KB. Screening and brief interventions for alcohol use in college health centers: A review. (review). Journal of American College Health 59(3): 151-158, 2011. (59 refs.)

Objectives: To provide a critical review of the efficacy of brief interventions for alcohol use in college health centers. Methods: Studies were included if (a) they examined brief intervention trials that were conducted in college- or university-based student health centers or emergency departments, and (b) they provided pre-post data to estimate change. Results: Twelve studies suggested that screening and brief interventions in these settings are acceptable, feasible, and promote risk reduction. Conclusions: Findings support continued use of time-limited, single-session interventions with motivational interviewing and feedback components.

Seppa K. Primary health care and alcohol. (editorial). Zdravstveno Varstvo 50(3): 143-147, 2011. (39 refs.)

In his famous novel 'Anna Karenina' Konstantin Levin, a farmer who is commonly considered to represent the author Leo Tolstoy himself, listens to another farmer's opinions on the land reform. He highly respects these opinions which, as he says, 'had been brought not by a desire of finding some exercise for an idle brain, but a thought which had grown up out of the conditions of his life'. Researchers and policy makers, far from the realities of primary health care, seem to be more interested in brief alcohol interventions for hazardous drinkers than do general practitioners or other professionals working in this setting. Should brief intervention be removed to some other setting, buried forever as not being suitable for real life, or would it just now be perfect time for general practitioners and nurses in primary health care to take command of brief interventions and make it suitable for their own setting?

Sheffer CE; Barone C; Anders ME. Training nurses in the treatment of tobacco use and dependence: Pre- and post-training results. Journal of Advanced Nursing 67(1): 176-183, 2011. (36 refs.)

Aim. This paper is a report of a study conducted to examine the effects of a brief training in the treatment of tobacco use and dependence on the tobacco use intervention-related knowledge and attitudes of nurses. Background. Nurses are the largest group of healthcare providers and they have an extended reach into the population of tobacco users. Thus, increasing the number of nurses who deliver brief evidence-based interventions for tobacco use and dependence, such as that prescribed by the Public Health Service Clinical Practice Guideline in the United States of America, is likely to expose more tobacco users to evidence-based treatments and lead to more successful quit attempts. Effective training is key to improving provider proficiency in delivering evidence-based interventions for tobacco use and dependence. Method. A 1-hour didactic training was delivered to 359 nurses from 2006 to 2007, including 54 Advanced Practice Nurses, 250 Registered Nurses and 55 Licensed Practical Nurses. Pre- and post-training tests assessed attitudes, knowledge and behaviours. Paired samples t-tests were used to compare pre- and post-test results. Results. Statistically significant increases on nearly all measures were achieved, with Registered Nurses and Licensed Practical Nurses realizing the largest gains. Conclusion. Given the overwhelming impact of tobacco use on patients, all nurses should be provided with training in the delivery of brief, evidence-based interventions for tobacco use. As the most trusted healthcare provider group with an extended reach into the tobacco using population, nurses have a large potential impact on the prevalence of tobacco use.

Sheridan J; Stewart J; Smart R; Mccormick R. Risky drinking among community pharmacy customers in New Zealand and their attitudes towards pharmacist screening and brief interventions. Drug and Alcohol Review 31(1): 56-63, 2012. (39 refs.)

Introduction and Aims. To estimate the prevalence of risky drinking among customers in community pharmacies and to explore customer attitudes towards screening and brief intervention (SBI). Design and Methods. Cross-sectional, anonymous survey, using random selection of community pharmacies in New Zealand to collect data using self-completion questionnaires and an opportunity to enter a prize draw. Participants were customers/patients attending the community pharmacy on a specific, randomly selected day (Monday to Friday) in one set week. Alcohol Use Disorder Identification Test (AUDIT)-C using a cut-off score of 5 was used to measure risky drinking. Attitudes towards pharmacists engaging in SBI for risky drinkers were measured. Results. 2384 completed customer/patient questionnaires from 43 participating pharmacies. Almost 84% ever drank alcohol and using a score of 5 or more as a cut-off, 30% of the sample would be considered as risky drinkers. Attitudes were generally positive to pharmacists undertaking SBI. Logistic regression with AUDIT-C positive or negative as the dependent variable found those taking medicines for mental health and liver disease being more likely to score negative on the AUDIT-C, and smokers and those purchasing hangover cures were more likely than average to have a positive AUDIT-C screen. Discussion and Conclusions. This study indicates there is scope for community pharmacists to undertake SBI for risky drinking, and that customers find this to be acceptable. Targeted screening may well be useful, in particular for smokers. Further research is required to explore the effectiveness of SBI for risky drinkers in this setting.

Spak F. Commentary on Makela et al. (2011): How many patients must be asked about alcohol before it is enough? (editorial). Addiction 106(7): 1249-1250, 2011. (9 refs.)

Strayer SM; Martindale JR; Pelletier SL; Rais S; Powell J; Schorling JB. Development and evaluation of an instrument for assessing brief behavioral change interventions. Patient Education and Counseling 83(1): 99-105, 2011. (49 refs.)

Objective: To develop an observational coding instrument for evaluating the fidelity and quality of brief behavioral change interventions based on the behavioral theories of the 5 A's, Stages of Change and Motivational Interviewing. Methods: Content and face validity were assessed prior to an intervention where psychometric properties were evaluated with a prospective cohort of 116 medical students. Properties assessed included the inter-rater reliability of the instrument, internal consistency of the full scale and sub-scales and descriptive statistics of the instrument. Construct validity was assessed based on student's scores. Results: Inter-rater reliability for the instrument was 0.82 (intraclass correlation). Internal consistency for the full scale was 0.70 (KR20). Internal consistencies for the sub-scales were as follows: MI intervention component (KR20 = .7); stage-appropriate MI-based intervention (KR20 = .55); MI spirit (KR20 = .5): appropriate assessment (KR20 = .45) and appropriate assisting (KR20 = .56). Conclusions: The instrument demonstrated good inter-rater reliability and moderate overall internal consistency when used to assess performing brief behavioral change interventions by medical students. Practice implications: This practical instrument can be used with minimal training and demonstrates promising psychometric properties when evaluated with medical students counseling standardized patients. Further testing is required to evaluate its usefulness in clinical settings.

Suffoletto B; Callaway C; Kristan J; Kraemer K; Clark DB. Text-message-based drinking assessments and brief interventions for young adults discharged from the emergency department. Alcoholism: Clinical and Experimental Research 36(3): 552-560, 2012. (36 refs.)

Background: Brief interventions have the potential to reduce heavy drinking in young adults who present to the emergency department (ED), but require time and resources rarely available. Text-messaging (TM) may provide an effective way to collect drinking data from young adults after ED discharge as well as to provide immediate feedback and ongoing support for behavior change. The feasibility of screening young adults in the ED, recruiting them for a TM-based interventional trial, collecting weekly drinking data through TM, and the variance in drinking outcomes remains unknown. Methods: Young adults in 3 urban EDs (n = 45; aged 18 to 24 years, 54% women) identified as hazardous drinkers by the Alcohol Use Disorders Identification Test-Consumption score were randomly assigned to weekly TM-based feedback with goal setting (Intervention), weekly TMbased drinking assessments without feedback (Assessment), or control. Participants in the Intervention group who reported 5 (for men) and 4 (for women) maximum drinks during any one 24-hour period were asked whether they would set a goal to reduce their drinking the following week. We describe the interaction with TM and goal setting. We also describe the heavy drinking days (HDDs), drinks per drinking day (DPDD) using timeline follow-back procedure at baseline and 3 months. Results: We screened 109 young adults over 157 hours across 24 unique days and 52 (48%; 95% CI 38 to 50) screened positive for hazardous drinking. Of these, 45 (87%; 95% CI 74 to 94) met inclusion criteria, were enrolled and randomized, and 6 (13%; 95% CI 5 to 27) did not complete 3-month web-based follow-up; 88% (95% CI 84 to 91) of weekly TM-based drinking assessments were answered, with 77% (95% CI 58 to 90) of participants responding to all 12 weeks. Agreeing to set a goal was associated with a repeat HDD 36% (95% CI 17 to 55) of the time compared with 63% (95% CI 44 to 81) when not willing to set a goal. At 3 months, participants that were exposed to the TM-based intervention had 3.4 (SD 5.4) fewer HDDs in the last month and 2.1 (SD 1.5) fewer DPDD when compared to baseline. Conclusions: TM can be used to assess drinking in young adults and can deliver brief interventions to young adults discharged from the ED. TM-based interventions have the potential to reduce heavy drinking among young adults but larger studies are needed to establish efficacy.

Sullivan LE; Tetrault JM; Braithwaite RS; Turner BJ; Fiellin DA. A meta-analysis of the efficacy of nonphysician brief interventions for unhealthy alcohol use: implications for the patient-centered medical home. American Journal on Addictions 20(4): 343-356, 2011. (47 refs.)

Brief physician interventions can reduce alcohol consumption. Physicians may not have the time to provide brief interventions, and it is unclear whether nonphysicians can do so effectively. We conducted a systematic review and meta-analysis to examine the efficacy of brief interventions by non-physician clinicians for unhealthy alcohol use. We searched the English-language literature in MEDLINE and other databases covering the domains of alcohol problems, primary care, nonphysician, and brief interventions. Studies of brief interventions delivered at least in part by nonphysicians in primary care and examining drinking outcomes were included. Sensitivity analyses examined the effect of excluding studies that contributed disproportionately to the heterogeneity of results. Thirteen studies, conducted 1996-2008, met our criteria. Seven studies with a total of 2,633 patients were included in the meta-analysis. Nonphysician interventions were associated with 1.7 (95% confidence interval [CI] = -.03 to -3.5) fewer standard drinks per week than control conditions (p = .054). Excluding the one study that increased heterogeneity, the effect was smaller but reached statistical significance; nonphysician counseling was associated with 1.4 (95% CI = .3-2.4) fewer standard drinks per week compared to control (p = .012). Nonphysician brief interventions are modestly effective at reducing drinking in primary care patients with unhealthy alcohol use.

Sutfin EL; McNamara RS; Blocker JN; Ip EH; O'Brien MC; Wolfson M. Screening and brief intervention for tobacco use by student health providers on college campuses. Journal of American College Health 60(1): 66-73, 2012. (36 refs.)

Objective: This study assessed college students' reports of tobacco screening and brief intervention by student health center providers. Participants: Participants were 3,800 students from 8 universities in North Carolina. Methods: Web-based survey of a stratified random sample of undergraduates. Results: Fifty-three percent reported ever visiting their student health center. Of those, 62% reported being screened for tobacco use. Logistic regression revealed screening was higher among females and smokers, compared to nonsmokers. Among students who were screened and who reported tobacco use, 50% reported being advised to quit or reduce use. Brief intervention was more likely among current daily smokers compared to current nondaily smokers, as well as at schools with higher smoking rates. Screening and brief intervention were more likely at schools with lower clinic caseloads. Conclusions: Results highlight the need to encourage college health providers to screen every patient at every visit and to provide brief intervention for tobacco users.

Truncali A; Lee JD; Ark TK; Gillespie C; Triola M; Hanley K et al. Teaching physicians to address unhealthy alcohol use: A randomized controlled trial assessing the effect of a Web-based module on medical student performance. Journal of Substance Abuse Treatment 40(2): 203-213, 2011. (40 refs.)

Background: The authors developed and evaluated an interactive, Web-based module to train medical students in screening and brief intervention (SBI) for unhealthy alcohol use. Methods: First-year students were randomized to module versus lecture. Change in knowledge, attitudes, and confidence were compared. Performance was assessed by objective structured clinical examination (OSCE) and analyzed by intention to treat and treatment received. Results: Of 141 consenting students, 64% (n = 90) completed an intervention (54% lecture vs. 70% Web assigned). Knowledge, confidence, and attitudes improved in both groups, with more improvement in Advise Assist knowledge for Web students (14% vs. -3%, p = .003). Web students outperformed their lecture peers in both general communication (65% vs. 51% items well done, p = .004);and alcohol-specific tasks (54% vs. 41%, p = .021) on OSCE. Analysis by treatment received enhanced between-group differences. Conclusion: Use of a Web-based module to teach SBI is associated with greater knowledge gain and skills performance compared with a lecture covering similar content. The module provides an efficient means for training in this area.

Tzilos GK; Sokol RJ; Ondersma SJ. A randomized phase I trial of a brief computer-delivered intervention for alcohol use during pregnancy. Journal of Women's Health 20(10): 1517-1524, 2011. (57 refs.)

Background: Drinking alcohol during pregnancy has a range of negative consequences for the developing fetus. Screening and brief intervention approaches have significant promise, but their population impact may be limited by a range of challenges to implementation. We, therefore, conducted preliminary acceptability and feasibility evaluation of a computer-delivered brief intervention for alcohol use during pregnancy. Methods: Participants were 50 pregnant women who screened positive for risky drinking during a routine prenatal clinic visit and were randomly assigned to computer-delivered brief intervention or assessment-only conditions. Results: Ratings of intervention ease of use, helpfulness, and other factors were high (4.7-5.0 on a 1-5 scale). Participants in both conditions significantly decreased alcohol use at follow-up, with no group differences; however, birth weights for infants born to women in the intervention group were significantly higher (p < 0.05, d = 0.62). Conclusions: Further development and study of computer-delivered screening and intervention for alcohol use during pregnancy are warranted.

Wallace P; Murray E; McCambridge J; Khadjesari Z; White IR; Thompson SG et al. On-line randomized controlled trial of an internet based psychologically enhanced intervention for people with hazardous alcohol consumption. PLoS ONE 6(3): article e14740, 2011. (39 refs.)

Background: Interventions delivered via the Internet have the potential to address the problem of hazardous alcohol consumption at minimal incremental cost, with potentially major public health implications. It was hypothesised that providing access to a psychologically enhanced website would result in greater reductions in drinking and related problems than giving access to a typical alcohol website simply providing information on potential harms of alcohol. DYD-RCT Trial registration: ISRCTN 31070347. Methodology/Principal Findings: A two-arm randomised controlled trial was conducted entirely on-line through the Down Your Drink (DYD) website. A total of 7935 individuals who screened positive for hazardous alcohol consumption were recruited and randomized. At entry to the trial, the geometric mean reported past week alcohol consumption was 46.0 (SD 31.2) units. Consumption levels reduced substantially in both groups at the principal 3 month assessment point to an average of 26.0 (SD 22.3) units. Similar changes were reported at 1 month and 12 months. There were no significant differences between the groups for either alcohol consumption at 3 months (intervention: control ratio of geometric means 1.03, 95% CI 0.97 to 1.10) or for this outcome and the main secondary outcomes at any of the assessments. The results were not materially changed following imputation of missing values, nor was there any evidence that the impact of the intervention varied with baseline measures or level of exposure to the intervention. Conclusions/Significance: Findings did not provide support for the hypothesis that access to a psychologically enhanced website confers additional benefit over standard practice and indicate the need for further research to optimise the effectiveness of Internet-based behavioural interventions. The trial demonstrates a widespread and potentially sustainable demand for Internet based interventions for people with hazardous alcohol consumption, which could be delivered internationally.

Werch CE; Bian H; Carlson JM; Moore MJ; DiClemente CC; Huang IC et al. Brief integrative multiple behavior intervention effects and mediators for adolescents. Journal of Behavioral Medicine 34(1): 3-12, 2011. (39 refs.)

This study evaluated the efficacy of a brief integrative multiple behavior intervention and assessed risk factors as mediators of behavioral outcomes among older adolescents. A randomized controlled trial was conducted with participants randomly assigned to either a brief intervention or standard care control with 3-month follow-up. A total of 479 students attending two public high schools participated. Participants receiving the intervention showed a significant reduction in quantity x frequency of alcohol use, and increases in fruit and vegetable consumption and frequency of relaxation activities, compared to those receiving the control, P's = .01. No effects were found on cigarette and marijuana use, exercise and sleep. Effect sizes were small with alcohol use cessation effects reaching medium size. Intervention effects were mediated by changes in peer influenceability for alcohol use, and self-efficacy and self-image for health promoting behaviors. Findings suggest that the brief intervention resulted in health risk and promoting behavior improvements for adolescents, with outcomes mediated by several risk factors.

Whittaker R; Dorey E; Bramley D; Bullen C; Denny S; Elley CR et al. A theory-based video messaging mobile phone intervention for smoking cessation: Randomized controlled trial. Journal of Medical Internet Research 13(1): 58-69, 2011. (45 refs.)

Background: Advances in technology allowed the development of a novel smoking cessation program delivered by video messages sent to mobile phones. This social cognitive theory-based intervention (called "STUB IT") used observational learning via short video diary messages from role models going through the quitting process to teach behavioral change techniques. Objective: The objective of our study was to assess the effectiveness of a multimedia mobile phone intervention for smoking cessation. Methods: A randomized controlled trial was conducted with 6-month follow-up. Participants had to be 16 years of age or over, be current daily smokers, be ready to quit, and have a video message-capable phone. Recruitment targeted younger adults predominantly through radio and online advertising. Registration and data collection were completed online, prompted by text messages. The intervention group received an automated package of video and text messages over 6 months that was tailored to self-selected quit date, role model, and timing of messages. Extra messages were available on demand to beat cravings and address lapses. The control group also set a quit date and received a general health video message sent to their phone every 2 weeks. Results: The target sample size was not achieved due to difficulty recruiting young adult quitters. Of the 226 randomized participants, 47% (107/226) were female and 24% (54/226) were Maori (indigenous population of New Zealand). Their mean age was 27 years (SD 8.7), and there was a high level of nicotine addiction. Continuous abstinence at 6 months was 26.4% (29/110) in the intervention group and 27.6% (32/116) in the control group (P = .8). Feedback from participants indicated that the support provided by the video role models was important and appreciated. Conclusions: This study was not able to demonstrate a statistically significant effect of the complex video messaging mobile phone intervention compared with simple general health video messages via mobile phone. However, there was sufficient positive feedback about the ease of use of this novel intervention, and the support obtained by observing the role model video messages, to warrant further investigation.

Williams JF; Ammerman SD; Levy SJL; Sims TH; Smith VC; Wunsch MJ. Policy Statement: Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians. Pediatrics 128(5): e1330-e1340, 2011. (53 refs.)

As a component of comprehensive pediatric care, adolescents should receive appropriate guidance regarding substance use during routine clinical care. This statement addresses practitioner challenges posed by the spectrum of pediatric substance use and presents an algorithm-based approach to augment the pediatrician's confidence and abilities related to substance use screening, brief intervention, and referral to treatment in the primary care setting. Adolescents with addictions should be managed collaboratively (or comanaged) with child and adolescent mental health or addiction specialists. This statement reviews recommended referral guidelines that are based on established patient-treatment-matching criteria and the risk level for substance abuse.

Williams M; Bowen A; Atkinson JS; Nilsson-Schonnesson L; Diamond PM; Ross MW et al. An assessment of brief group interventions to increase condom use by heterosexual crack smokers living with HIV infection. AIDS Care 24(2): 220-231, 2012. (64 refs.)

The purpose of this study was to assess the efficacy of brief group interventions, the positive choices intervention (PCI) and a standard intervention (SI), to increase condom use and intention to use condoms and to change condom use attitudes and beliefs. The design of the study was a randomized comparative trial. Participants were 347 heterosexual African American crack cocaine users living with HIV infection. Data were collected at intake and at three and nine months after intake. Behavioral and sociocognitive data were collected. Although both brief interventions achieved positive results, there were significant differences in outcomes between the interventions groups. The mean number of sex partners was significantly lower in the PCI group at three months. The proportion of those assigned to the PCI reporting sex with a paid partner significantly decreased, while the proportion disclosing their serostatus to their partners increased. There were no significant differences on these measures in the SI group. Significant time effects were found on measures of condom use, condom use attitudes, and self-efficacy beliefs. These measures significantly increased from intake to one month for both groups. One significant time-by-group effect was found. The measure of situational self-efficacy significantly increased in the PCI group, but not the SI group. Results also showed significant time-by-time effects. Mean condom use, intention to use condoms, attitudes, and condom use self-efficacy beliefs showed significant difference between three and nine months. However, there was no clear pattern of change. Findings suggest that brief group interventions designed to reduce HIV can help heterosexual drug users living with HIV infection increase condom use and intention to use condoms and change condom use attitudes and beliefs. A significant time-by-group effect was observed only for situational self-efficacy, suggesting limited additional efficacy of the PCI intervention. Given similar positive findings between groups, more research is needed to determine which components of brief interventions produce changes in motivations and risk behaviors.

Williams EC; Johnson ML; Lapham GT; Caldeiro RM; Chew L; Fletcher GS et al. Strategies to implement alcohol screening and brief intervention in primary care settings: A structured literature review. (review). Psychology of Addictive Behaviors 25(2): 206-214, 2011. (41 refs.)

Although alcohol screening and brief intervention (SBI) reduces drinking in primary care patients with unhealthy alcohol use, incorporating SBI into clinical settings has been challenging. We systematically reviewed the literature on implementation studies of alcohol SBI using a broad conceptual model of implementation, the Consolidated Framework for Implementation Research (CFIR), to identify domains addressed by programs that achieved high rates of screening and/or brief intervention (BI). Seventeen articles from 8 implementation programs were included; studies were conducted in 9 countries and represented 533,903 patients (127,304 patients screened), 2,001 providers, and 1,805 clinics. Rates of SBI varied across articles (2-93% for screening and 0.9-73.1% for BI). Implementation programs described use of 7-25 of the 39 CFIR elements. Most programs used strategies that spanned all 5 domains of the CFIR with varying emphases on particular domains and sub-domains. Comparison of SBI rates was limited by most studies' being conducted by 2 implementation programs and by different outcome measures, scopes, and durations. However, one implementation program reported a high rate of screening relative to other programs (93%) and could be distinguished by its use of strategies that related to the Inner Setting, Outer Setting, and Process of Implementation domains of the CFIR. Future studies could assess whether focusing on Inner Setting, Outer Setting, and Process of Implementation elements of the CFIR during implementation is associated with successful implementation of alcohol screening, as well as which elements may be associated with successful, sustained implementation of BI.

Wilson GB; Lock CA; Heather N; Cassidy P; Christie MM; Kaner EF. Intervention against excessive alcohol consumption in primary health care: A survey of GPs' attitudes and practices in England 10 years on. Alcohol and Alcoholism 46(5): 570-577, 2011. (48 refs.)

Aims: To ascertain the views of general practitioners (GPs) regarding the prevention and management of alcohol-related problems in practice, together with perceived barriers and incentives for this work; to compare our findings with a comparable survey conducted 10 years earlier. Methods: In total, 282 (73%) of 419 GPs surveyed in East Midlands, UK, completed a postal questionnaire, measuring practices and attitudes, including the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Results: GPs reported lower levels of post-graduate education or training on alcohol-related issues (< 4 h for the majority) than in 1999 but not significantly so (P = 0.031). In the last year, GPs had most commonly requested more than 12 blood tests and managed 1-6 patients for alcohol. Reports of these preventive practices were significantly increased from 1999 (P < 0.001). Most felt that problem or dependent drinkers' alcohol issues could be legitimately (88%, 87%) and adequately (78%, 69%) addressed by GPs. However, they had low levels of motivation (42%, 35%), task-related self-esteem (53%, 49%) and job satisfaction (15%, 12%) for this. Busyness (63%) and lack of training (57%) or contractual incentives (48%) were key barriers. Endorsement for government policies on alcohol was very low. Conclusion: Among GPs, there still appears to be a gap between actual practice and potential for preventive work relating to alcohol problems; they report little specific training and a lack of support. Translational work on understanding the evidence-base supporting screening and brief intervention could incentivize intervention against excessive drinking and embedding it into everyday primary care practice.

Winters KC; Fahnhorst T; Botzet A; Lee S; Lalone B. Brief intervention for drug-abusing adolescents in a school setting: Outcomes and mediating factors. Journal of Substance Abuse Treatment 42(3): 279-288, 2012. (50 refs.)

This randomized controlled trial evaluated the use of two brief intervention conditions for adolescents (aged 12-18 years) who have been identified in a school setting as abusing alcohol and other drugs. Adolescents and their parents (N = 315) were randomly assigned to receive either a two-session adolescent-only (BI-A), two-session adolescent and additional parent session (BI-AP), or assessment-only control condition (CON). Interventions were manually guided and delivered in a school setting by trained counselors. Adolescents and parents were assessed at intake and at 6 months following the completion of the intervention. Analyses of relative (change from intake to 6 months) and absolute (status at 6 months) outcome variables indicated that for the most part, adolescents in the BI-A and BI-AP conditions showed significantly more reductions in drug use behaviors compared with the CON group. In addition, youth receiving the BI-AP condition showed significantly better outcomes compared with the BI-A group on several variables. Problem-solving skills and use of additional counseling services mediated outcome. The value of a school-based brief intervention for students is discussed.

Wittchen HU; Hoch E; Klotsche J; Muehlig S. Smoking cessation in primary care - a randomized controlled trial of bupropione, nicotine replacements, CBT and a minimal intervention. International Journal of Methods in Psychiatric Research 20(1): 28-39, 2011. (38 refs.)

Background/aims: Smoking cessation has been shown to be effective in randomized controlled trials. It is unclear though, whether interventions also work in routine primary care. Methods: In 167 primary care settings we conducted a randomized four-armed smoking cessation trial to examine the efficacy of a minimal intervention (MI; n = 81), cognitive-behavioral therapy (CBT; n = 175), bupropion (BUP; n = 108) and nicotine replacements (NRT; n = 103). Overall, 467 current smokers were enrolled. Abstinence rates at the end of treatment (12 weeks) were 32.8% for MI patients, 34.8% for CBT, 35.3% for NRT, and 46.5% for BUP patients (ITT, intention to treat) (no differential effects). Retention rates were highest in the BUP group (59.3%) and lowest in the NRT group (50.5%). Completer findings were: MI, 56.4%; CBT, 64%; BUP, 79.3%; NRT, 69.2% (LOCF, lost to follow-up). No serious adverse events occurred during or after the medication phase. At 12-month follow-up continuous abstinence rates were: BUP, 29.0%; CBT, 20.9%; NRT, 29.6%; MI, 29.6%. Conclusion: Our findings suggest that established smoking cessation treatments are effective when applied by non-specialist primary care physicians. Our data supports a structured, multimodal treatment structure as core ingredient of successful smoking cessation in primary care.

World Health Organization. World Health Organization, Department of Mental Health and Substance Abuse. The ASSIST Project -- Alcohol, Smoking and Substance Involvement Screening Test. Geneva, Switzerland: World Health Organization, 2011

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was developed for the World Health Organization (WHO) by an international group of substance abuse researchers to detect and manage substance use and related problems in primary and general medical care settings. Primary health care professionals are well-positioned to provide interventions targeted to all substances irrespective of their legal status. The ASSIST Project was conducted in three phases. Phases I involved creation of an instrument and a feasibility study. Phase II focuses upon an international validity study and feasibility of brief interventions linked to the ASSIST screening instrument. Phase III involved an international multi-site collaborative project to evaluate the effectiveness of a brief intervention for illicit drugs (cannabis, opiates, cocaine and amphetamine-type stimulants) as linked to the ASSIST in a variety of primary health care settings and in a number of different cultural contexts; and to develop a manual of patient and clinician resources incorporating instructions for administering the ASSIST and Brief Intervention, self-help materials on specific drug information and generic self-help strategies to reduce drug use, information on injecting risk and a feedback card on current drug use. Manuals and associated instruments are available in 9 languages (English, Arabic, Chinese, Farsi, French, German, Hindi, Portuguese, and Spanish.

Public Domain

Zanis DA; Hollm RE; Derr D; Ibrahim JK; Collins BN; Coviello D et al. Comparing intervention strategies among rural, low SES, young adult tobacco users. American Journal of Health Behavior 35(2): 240-247, 2011. (20 refs.)

Objective: To evaluate 3-month tobacco quit rates of young adult tobacco users randomized to 2 intervention conditions. Methods: Overall 192 non-treatment-seeking 18-to-24-year-old tobacco users received educational information and advice to quit smoking. Participants were then block randomized to 2 brief intervention conditions: (1) a telephone quitline (TQ) N = 90; or (2) a brief direct treatment intervention (BDTI) N = 102. Results: A 90-day follow-up evaluation found that 19.6% of BDTI and 10.2% of TQ participants reported 30-day point prevalence tobacco quit rates (chisquare = 2.37, P = .09). Conclusions: BDTI can help non-treatment-seeking, low SES, young adult tobacco users quit smoking.

Zhu SH; Cummins SE; Wong SS; Gamst AC; Tedeschi GJ; Reyes-Nocon J. The effects of a multilingual telephone quitline for Asian smokers: A randomized controlled trial. Journal of the National Cancer Institute 104(4): 299-310, 2012. (47 refs.)

Background: Although telephone counseling services (quitlines) have become a popular behavioral intervention for smoking cessation in the United States, such services are scarce for Asian immigrants with limited English proficiency. In this study, we tested the effects of telephone counseling for smoking cessation in Chinese-, Korean-, and Vietnamese-speaking smokers. Methods: A culturally tailored counseling protocol was developed in English and translated into Chinese, Korean, and Vietnamese. We conducted a single randomized trial embedded in the California quitline service. Smokers who called the quitline's Chinese, Korean, and Vietnamese telephone lines between August 2, 2004, and April 4, 2008, were recruited to the trial. Subjects (N = 2277) were stratified by language and randomly assigned to telephone counseling (self-help materials and up to six counseling sessions; n = 1124 subjects) or self-help (self-help materials only; n = 1153 subjects) groups: 729 Chinese subjects (counseling = 359, self-help = 370), 848 Korean subjects (counseling = 422, self-help = 426), and 700 Vietnamese subjects (counseling = 343, self-help = 357). The primary outcome was 6-month prolonged abstinence. Intention-to-treat analysis was used to estimate prolonged abstinence rates for all subjects and for each language group. All statistical tests were two-sided. Results: In the intention-to-treat analysis, counseling increased the 6-month prolonged abstinence rate among all smokers compared with self-help (counseling vs self-help, 16.4% vs 8.0%, difference = 8.4%, 95% confidence interval [CI] = 5.7% to 11.1%, P < .001). Counseling also increased the 6-month prolonged abstinence rate for each language group compared with self-help (counseling vs self-help, Chinese, 14.8% vs 6.0%, difference = 8.8%, 95% CI = 4.4% to 13.2%, P < .001; Korean, 14.9% vs 5.2%, difference = 9.7%, 95% CI = 5.8% to 13.8%, P < .001; Vietnamese, 19.8% vs 13.5%, difference = 6.3%, 95% CI = 0.9% to 11.9%, P = .023). Conclusions: Telephone counseling was effective for Chinese-, Korean-, and Vietnamese-speaking smokers. This protocol should be incorporated into existing quitlines, with possible extension to other Asian languages.