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CORK Bibliography: Brief Treatment

58 citations. July 2006 to present

Prepared: June 2007

Aalto M; Hyvonen S; Seppa K. Do primary care physicians' own AUDIT scores predict their use of brief alcohol intervention? A cross-sectional survey. Drug and Alcohol Dependence 83(2): 169-173, 2006. (15 refs.)

Background: To define whether the Alcohol Use Disorders Identification Test (AUDIT) scores of primary care physicians themselves predict their willingness to use brief alcohol intervention. Methods: Cross-sectional self-administered questionnaire survey to all 3193 physicians providing primary health care in Finland. The response rate was 1909 (59.8%). Odds ratios from multinomial regression analysis were calculated for self-reported frequency (never, occasionally or regularly) of conducting brief interventions by physicians with AUDIT scores of 0-1, 2, 3, 4, 5-7 or >= 8. Results: The prevalence of heavy drinkers based on AUDIT score (>= 8) was 14.5% among all physicians, 7.0% among females and 27.0% among males. Of the respondents 9.4% reported doing brief intervention regularly and 50.0% occasionally. AUDIT scores did not significantly predict either regular or occasional use of brief intervention. Instead, some other independent predictors for more frequent use of brief intervention were found. These included having a specialist licence in general practice or occupational health care and the location of the practice, but not gender or age. Conclusions: The present results indicate that in general heavy drinking among primary care physicians do not explain the low frequency with which brief intervention is used in primary health care.

Akers L; Gordon JS; Andrews JA; Barckley M; Lichtenstein E; Severson HH. Cost effectiveness of changing health professionals' behavior: Training dental hygienists in brief interventions for smokeless tobacco cessation. Preventive Medicine 43(6): 482-487, 2006. (21 refs.)

Objective. Disseminating effective interventions to health care professionals is a critical step in ensuring that patients receive needed advice and materials. This cost effectiveness analysis compared two methods of disseminating an effective protocol for smokeless tobacco cessation intervention. Method. Interested dental hygienists (N=1051) were recruited in 20 Western and Midwestern U.S. communities and randomized by community to receive workshop training, self-study with mailed materials, and delayed self-study training, in 1996-98. Hygienists were surveyed about their smokeless tobacco-related activities with patients at baseline and post-intervention. Data on intervention costs were collected, and incremental costs per unit of behavior change were calculated. Results. Self-study was more cost effective than workshop training under a wide range of assumptions: change in group versus individual behavior, hygienists' time and travel costs included or excluded, and hygienist wage rates at the national median or substantially lower. However, workshops may be as cost effective in producing behavior change among hygienists earning wages substantially higher than the national median. Conclusion. Self-study may be a more cost effective method than workshops to achieve behavior change among motivated health professionals.

Babor TF; Higgins-Biddle JC; Dauser D; Burleson JA; Zarkin GA; Bray J. Brief interventions for at-risk drinking: Patient outcomes and cost-effectiveness in managed care organizations. Alcohol and Alcoholism 41(6): 624-631, 2006. (23 refs.)

Aims: Evaluate effectiveness and costs of brief interventions for patients screening positive for at-risk drinking in managed health care organizations (MCOs). Methods: A pre-post, quasi-experimental, multi-site evaluation conducted at 15 clinic sites within five MCO settings. At-risk drinkers (N = 1329) received either: (i) brief intervention delivered by licensed practitioners; or (ii) brief intervention delivered by mid-level professional specialists (nurses); or (iii) usual care (comparison condition). Clinics were randomly assigned to three study conditions. Data were collected on the cost of screening and brief intervention. Follow-up interviews were conducted at 3 and 12 months. Results: Participants in all three study conditions were drinking significantly less at 3-month follow-up, but the decline was significantly greater in the two intervention groups than in the control group. There were no significant differences between the two intervention conditions. Of the patients in the intervention conditions 60% reduced their alcohol consumption by >= 1 drink per week, compared with 53% of those in the control condition. No differences were found on a measure of the quality of life. Differential reductions in weekly alcohol consumption between intervention and control groups were significant at 12-month follow-up. Average incremental costs of the interventions were $4.16 USD per patient using licensed practitioners and $2.82 USD using mid-level specialists. Conclusion: Alcohol screening and brief intervention when implemented in managed care organizations produces modest, statistically significant reductions in at-risk drinking. Interventions delivered to a common protocol by mid-level specialists are as effective as those delivered by licensed practitioners at about two-thirds the cost.

Baez A. Development of an objective structured clinical examination (OSCE) for practicing substance abuse intervention competencies: An application in social work education. Journal of Social Work Practice in the Addictions 5(3): 3-20, 2005. (38 refs.)

The substance abuse skills OSCE (Objective Structured Clinical Examination) was developed by an interdisciplinary faculty team at New York University from 2001 to 2003. The aims of the project were to teach medical, nursing, and social work students screening and brief intervention skills, provide a practice opportunity and feedback to students on their ability to demonstrate substance abuse skills, and to expose students to interdisciplinary collaboration. After students were educated and participated in the OSCE, the mean score on their substance abuse knowledge questionnaires increased from 6.24 (SD = 1.522) at pretest to 8.06 (SD = 1.600) at post test (t(16) = -6.080, p < .002). According to the faculty observer performance checklists, students manifested the fifteen competencies on the checklist at an average rate of 79.0%. Students rated the overall experience of participating in the OSCE highly favorably, at 4.9 on a five-point scale. While the OSCE proved to be highly compatible with the teaching and practicing of substance abuse intervention skills, it is a tool that also has relevance and applicability for the practicing and assessing of many other social work skills, and can be a powerful addition to the ways in which the field approaches the challenge of assessing competence in more direct ways.

Baldwin JA; Johnson RM; Gotz NK; Wayment HA; Elwell K. Perspectives of college students and their primary health care providers on substance abuse screening and intervention. Journal of American College Health 55(2): 115-119, 2006. (32 refs.)

The authors conducted a needs assessment among students and health-care providers of a southwestern university health center with the goal of developing health-care-provider training addressing substance-abuse screening and intervention. They collected data from focus groups of undergraduate students and structured interviews and questionnaires with health-care providers. They identified gaps in provider and student perspectives on the extent of substance abuse on campus and the perceived roles of health-care providers and patients in screening and conducting interventions for substance abuse. These findings suggest that training for college health-care providers regarding substance-abuse brief screening and intervention should emphasize confidentiality of student medical records, the importance of nonjudgmental attitudes toward students, and the role of the provider as one who is competent and appropriate to address substance abuse. Such training should also educate providers about the types of substances students are using.

Belenko SR. The Economic Benefits of Drug Treatment: A Critical Review of the Evidence for Policy Makers. Philadelphia: Treatment Research Institute, 2005. (143 refs.)

Executive Summary. Nearly two decades of treatment research, represented by hundreds of studies, finds that substance abuse treatment, especially when it incorporates evidence-based practice, results in clinically significant reductions in alcohol and drug use,crime and improvement in health and social function for many clients. Economic studies across settings, populations, methods, and time periods consistently find positive net economic benefits of alcohol and other drug treatment that are relatively robust. The primary economic benefits occur from reduced crime (including incarceration and victimization costs) and post-treatment reduction in health care costs. In general, outpatient programs achieve reductions in substance use at a lower cost than residential programs, although the latter services may be more effective for higher risk populations. Enhanced outpatient programs tend to be more cost effective than standard outpatient programs. However, studies of brief interventions for alcohol-involved clients suggest that less intensive interventions may be more cost effective in certain settings. Residential prison treatment is cost effective but only in conjunction with post-release aftercare services. In addition, cost effectiveness is greater for high-risk inmates who receive prison treatment plus aftercare, compared with low-risk inmates. Better controlled and designed studies are needed to determine the long-term economic impact of treatment, and the specific components of treatment that are cost-effective or produce positive economic benefits.

Public Domain

Bendtsen P; Johansson K; Akerlind I. Feasibility of an email-based electronic screening and brief intervention (e-SBI) to college students in Sweden. Addictive Behaviors 31(5): 777-787, 2006. (22 refs.)

An email-based electronic screening and brief intervention (e-SBI) with personalized normative feedback on alcohol habits was offered to all 3875 second term students at Linkoping University, Sweden. The students received an email with a link to a computerized alcohol habit test and were offered personalized feedback directly on the computer screen. The students evaluated the test and were asked to state whether they were going to consider changing or actually change their alcohol habits. The response rate was 44%, with 742 female and 843 male students participating. The students displayed a strong gender difference in drinking pattern. A three-fold higher percentage of males than females were risky drinkers with regard to a high average weekly volume consumption. The gender differences were less pronounced regarding heavy episodic drinking that was reported by 51% of the females and 70.5% of the males. The email-based computerized non-native feedback was appreciated by the students and one-third of the females and one-fifth of the males believed that they would benefit from the normative feedback; 8% of the females and 3% of the males believed that they would actually change their habits after the feedback. Students with a risky drinking, pattern, previous experiences of blackouts, being dissatisfied with their current drinking and students that had considered to change their habits before the e-SBI, yielded a stronger motivation to change their drinking after having performed the intervention compared to students without such characteristics. The e-SBI with non-native feedback was simple to administer and has the potential to be used repeatedly and on a large scale with minimum effort in terms of cost and time.

Blow FC; Barry KL; Walton MA; Maio RF; Chermack ST; Bingham CR et al. The efficacy of two brief intervention strategies among injured, at-risk drinkers in the emergency department: Impact of tailored messaging and brief advice. Journal of Studies on Alcohol 67(4): 568-578, 2006. (59 refs.)

Objective: This study used a randomized controlled trial design to compare the effectiveness of four interventions at reducing alcohol consumption, consequences, and heavy episodic drinking among injured, at-risk drinkers in the emergency department (ED). Method: Injured patients (n = 4,476) completed a computerized survey; 575 at risk drinkers were randomly assigned to one of four intervention conditions: tailored message booklet with brief advice, tailored message booklet only, generic message booklet with brief advice, and generic message booklet only. Regression models using the generalized estimating equation approach were constructed comparing the intervention conditions at baseline, 3-month follow-up, and 12-month follow-up. Gender and age were entered in models along with their interaction. Results: Each of the intervention groups significantly decreased their alcohol consumption from baseline to 12-month follow-up; subjects in the tailored message booklet with brief advice group significantly decreased their average weekly alcohol consumption by 48.5% (p < .0001). Those in the brief advice conditions (tailored or generic) significantly decreased their average consumption during the 12 months of the study compared with the no brief advice conditions. Younger adult women (ages 19-22) who received some brief advice were the most likely to decrease their heavy episodic drinking. Conclusions: This was the first large-scale, brief intervention trial that included development and testing of computerized, highly tailored interventions with injured drinkers in the ED. ED-based interventions for alcohol problems would benefit from computerized screening, brief advice, and booklets to positively impact risky drinking practices.

Buffels J; Degryse J; Decramer M; Heyrman J. Spirometry and smoking cessation advice in general practice: A randomised clinical trial. Respiratory Medicine 100(11): 2012-2017, 2006. (30 refs.)

Rationale: To assess the success rate of smoking cessation with the "minimal intervention strategy" in general practice, and to determine the influence of spirometry on this success rate. Methods: Training in smoking cessation advice was given to 16 general practitioners (GPs). During 12 weeks, these GPs screened their practice population for smoking habits, the degree of dependence on nicotine, and the motivation to quit smoking. Patients willing to stop were randomised to a group that underwent a single office spirometry, or to a control group. The GPs were asked to support the attempts with the minimal intervention strategy. Success rates were compared after 6, 12 and 24 months. Results: On a population of 5590 patients, 1206 smokers were identified (22%). To the vulnerable group, identified following the Prochaska and Di Clemente scheme, the proposal was made to change smoking behaviour. Two hundred and twenty-one patients undertook an attempt of smoking cessation. Nicotine replacement therapy (NRT) or bupropion was prescribed in 51% of the attempts. Sixty-four sustained quitters were counted after 6 months (29%), 43 after 1 year (19%) and 33 after 2 years (15%). We found a small but statistically non-significant difference in success rate in favour of the group that underwent office spirometry. Conclusion: GPs can motivate almost 20% of their smoking population to quit smoking. The success rate with the minimal intervention strategy was 19% after 1 year and 15% after 2 years. We found no arguments in favour of confronting smokers with their lung function as a tool for enhancing smoking cessation.

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

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

Carey KB; Carey MP; Maisto SA; Henson JM. Brief motivational interventions for heavy college drinkers: A randomized controlled trial. Journal of Consulting and Clinical Psychology 74(5): 943-954, 2006. (39 refs.)

In this randomized controlled trial, the authors evaluated brief motivational interventions (BMIs) for at-risk college drinkers. Heavy drinking students (N = 509; 65% women, 35% men) were randomized into I of 6 intervention conditions formed by crossing the baseline Timeline Followback (TLFB) interview (present versus absent) and intervention type (basic BMI, BMI enhanced with a decisional balance module, or none). Assessments completed at baseline, 1, 6, and 12 months measured typical and risky drinking as well as drinking-related problems. Relative to controls, the TLFB interview reduced consumption but not problems at I month. The basic BMI improved all drinking outcomes beyond the effects of the TLFB interview at I month, whereas the enhanced BMI did not. Risk reduction achieved by brief interventions maintained throughout the follow-up year.

Chang G; McNamara TK; Orav EJ; Wilkins-Haug L. Brief intervention for prenatal alcohol use: The role of drinking goal selection. Journal of Substance Abuse Treatment 31(4): 419-424, 2006. (25 refs.)

The behavioral problems and cognitive deficits resulting from even small amounts of prenatal alcohol exposure can be significant and enduring but completely preventable. The purpose of this study was to examine the impact of a prenatal drinking goal selected during a brief intervention for 115 pregnant women and their partners on subsequent consumption. Higher proportions of women having their first pregnancy chose abstinence as a goal over drinking reduction. Goal selection was highly predictive of subsequent drinking behavior. Interestingly, the participants who were abstinent at enrollment and who chose to remain abstinent had the highest rates of abstinence. In contrast, the women who chose cutting down on drinking were the least likely to drink less subsequently, despite recognizing more situations putting them at risk for drinking and identifying more alternatives to consumption. We conclude that goal choice in behavioral self-management of alcohol use by pregnant women is critical.

Cherpitel CJ. Screening and brief intervention for alcohol problems in the emergency room: Is there a role for nursing? (editorial). Journal of Addictions Nursing 17(2): 79-82, 2006. (28 refs.)

Cunningham JA; Humphreys K; Kypri K; van Mierlo T. Formative evaluation and three-month follow-up of an online personalized assessment feedback intervention for problem drinkers. Journal of Medical Internet Research 8(2): article 5, 2006. (39 refs.)

Background: In recent years, online services for problem drinkers have been developed. This paper describes ongoing efforts to improve one of these services, the Alcohol Help Center. Objective: This report summarizes new modules added to the Check Your Drinking (CYD) screener, a component of the Alcohol Help Center, to make the CYD screener more useful to periodic heavy drinkers, as well as to regular alcohol consumers. Participants' initial reactions to the CYD screener and the changes in their drinking habits at a three-month follow-up are presented. Methods: The CYD screener provides a free personalized Final Report that compares the user's drinking to that of others in the general population of the same age, gender, and country of origin. Current alcohol consumption and demographic characteristics are collected as part of the CYD screening process. After users were presented with a customized Final Report, they were hot-linked to a volunteer feedback survey The voluntary feedback survey asked about impressions of the CYD Final Report. Respondents agreeing to participate were sent a follow-up survey after three months. Results: We recruited 388 volunteers (69% female) who were registered users of another free-to-consumer online cHealth service. Of the 343 respondents agreeing to participate in the three-month follow-up, 138 accessed the survey, and 97 provided complete data (participation rate = 40%; completion rate 70%). Compared to moderate drinkers, current problem drinkers judged the Final Report to be more useful (34% vs. 69%, chi(2) = 41.5, P <.001) and accurate (43% vs. 76%, chi(2) (1) =36.0,P <.001). Respondents who participated in the three-month follow-up displayed reductions in drinking compared to baseline (F-4,F-76 = 12.2, P=.001). Conclusions: Improvements can still be made to make the CYD screener more relevant to specific populations, particularly periodic heavy drinkers. There is a need to further tailor algorithms that can present questions only relevant to specific populations. There also appears to be a need to further customize the Final Report for respondents who identify themselves as infrequent heavy drinkers. These improvements will be made, and a randomized controlled trial is planned to conduct a rigorous evaluation of the CYD screener as an intervention to help problem drinkers.

Dolan K; Rees V; Peters R; Wodak A. A Brief Cognitive Behavioural Intervention for Alternatives to Injecting: Therapist's Manual. NDARC Technical Report No. 154. Sydney: National Drug and Alcohol Research Centre (Australia), 2003. (17 refs.)

This is a manual intended to assist therapistis in working with clients to reduce injection drug use, and its associated harms. Preventing or reducing injecting is an important method for reducing the transmission of blood borne infection, as well as contributing to improvement in other health, social and psychological problems. Inclusion and exclusion criteria are also discussed, and assessment tools described. The protocol here is designed for outpatient, individual therapy with the goal of changing the route of drug administration. There is a detailed, session-by-session outline for each of five, sixty-minute meetings, including recommendations for the allocation of time within each session. Session I deals with an introduction to therapy, feedback from the assessment, self-efficacy, reasons for injecting drugs, motivational enhancement, the identification of personal high risk situations and triggers, and client goals. Session II deals with plans to change. All sessions begins with a review of assigned homework; this session involves an exploration of different routes of administration. Session III addresses a review of drug using behavior, with attention to non-injection experience, cognitive restructuring excercises. Session IV addresses specific non-injecting skills - dealing with urges, "decatastrophising," identifying a support system and training its members in how to be supportive. Session V is devoted to relpase prevention. Accompanying work sheets and handouts are included.

Doran CM; Duszynski KM; Beilby JJ; Mattick RP. Use of pharmacotherapies for the management of addictive behaviours in Australian clinical practice. Addictive Behaviors 31(11): 1947-1958, 2006. (20 refs.)

Aims: To collect data on the behaviours associated with the prescription of pharmacotherapies (bupropion, acamprosate and naltrexone) for nicotine and alcohol dependence in Australian clinical practice. Design: Self-administered questionnaire. Setting: Australian clinical practice. Participants: Three specialties, psychiatrists, gastroenterologists and general practitioners (GPs) were defined by the Health Insurance Commission's derived major specialty classification codes and stratified by state (and territory) as well as rural and remote metropolitan area classification. A total of 2680 surveys were sent (670 psychiatrists, 82 gastroenterologists and 1928 GPs) with 1291 surveys used in the final analysis (329 psychiatrists, 37 gastroenterologists and 925 GPs). Interventions: A 10-page, 46-item survey was distributed by the HIC. The initial survey was sent in March 2003 and sent a subsequent two times to non-responding physicians. Measurements: Characteristics of physicians and their therapeutic preferences in managing patients with nicotine or alcohol dependence. Findings: The majority of physicians identified and provided advice to patients who smoked and consumed alcohol at levels harmful to health. Fourteen percent used a formal alcohol-screening instrument, 4% were familiar with the 5 As' of a smoking cessation strategy and less than a third had undertaken any formal training in providing brief advice. The majority of physicians perceived pharmacotherapies to be an effective treatment strategy and indicated adjuncts improved likelihood of behaviour modification. Predictors of pharmacotherapy prescribing included working in a large clinical practice, having an additional mental health qualification and training in provision of brief advice. Conclusions: Physicians are in a strong position, and are encouraged to, manage additive disorders. Scope exists to improve prescribing of pharmacotherapies for nicotine and alcohol dependence by enhancing appropriate counselling skills and making explicit the nature of a comprehensive treatment regime as an adjunct to medicines.

Fitzpatrick JJ, ed. Alcohol Use, Misuse, Abuse and Dependence. Annual Review of Nursing Research, Vol 23. New York: Springer, 2005

This annual review, with 11 chapters and 15 contributors, addresses alcohol use and alcohol disorders relevant to nursing practice. It assembles the essential research to underpin efforts to define evidenced-based clinical practice. The volume is organized into four section. Section I provides perspectives on alcohol use research and measurement issues. The challenges to measuring alcohol consumption are discussed, the relationship of different drinking levels and cardiovascular disease is used as an example of measuremeent challenges. Also, a case is made for alcohol research as a focus for nursing research. Part II examines research in different age-based populations. These include pregnancy, children and adolescents, college students, young and middle adulthood, and the elderly. Part III considers alcohol use among lesbians and gay men, and the relationship of alcohol use to behavior that can compromise health. Part IV considers the research on brief treatment, well suited to a number of clinical settings, especially in primary care.

Floyd RL; O'Connor MJ; Bertrand J; Sokol R. Reducing adverse outcomes from prenatal alcohol exposure: A clinical plan of action. Alcoholism: Clinical and Experimental Research 30(8): 1271-1275, 2006. (51 refs.)

Fetal alcohol spectrum disorders (FASDs) are among the leading preventable causes of developmental disorders in the United States; however, recognition and prevention of these conditions cannot be achieved without informed and educated health providers. This commentary addresses the importance of recognition and prevention of FASDs through the use of well-established standardized practices of diagnosis, screening, and brief alcohol reduction counseling. It is hoped that more knowledge on currently available procedures will encourage their use in the provision of routine health care to all women of childbearing age.

Friedmann PD; Rose J; Hayaki J; Ramsey S; Charuvastra A; Dube C et al. Training primary care clinicians in maintenance care for moderated alcohol use. Journal of General Internal Medicine 21(12): 1269-1275, 2006. (45 refs.)

OBJECTIVES: To evaluate whether training primary care clinicians in maintenance care for patients who have changed their drinking influences practice behavior. DESIGN: We randomized 15 physician and 3 mid-level clinicians in 2 primary care offices in a 2:1 design. The 12 intervention clinicians received a total of 2 1/4 hours of training in the maintenance care of alcohol problems in remission, a booster session, study materials and chart-based prompts at eligible patients' visits. Six controls provided usual care. Screening forms in the waiting rooms identified eligible patients, defined as those who endorsed: 1 or more items on the CAGE questionnaire or that they had an alcohol problem in the past; that they have "made a change in their drinking and are trying to keep it that way"; and that they drank < 15 (men) or < 10 (women) drinks per week in the past month. Exit interviews with patients evaluated the clinician's actions during the visit. RESULTS: Of the 164 patients, 62% saw intervention clinicians. Compared with patients of control clinicians, intervention patients were more likely to report that their clinician asked about their alcohol history (odds ratio, 2.8; 95% confidence interval, 1.3, 5.8). Intervention clinicians who asked about the alcohol history were more likely to assess prior and planned alcohol treatment, assist through offers for prescriptions and treatment referral, and receive higher satisfaction ratings for the visit. CONCLUSIONS: Systemic prompts and training in the maintenance care of alcohol use disorders in remission might increase primary care clinicians' inquiries about the alcohol history as well as appropriate assessment and intervention after an initial inquiry.

Friend KB; Colby S. Healthcare providers' use of brief clinical interventions for adolescent smokers. Drugs: Education, Prevention and Policy 13(3): 263-280, 2006

Aims: Numerous studies document the effectiveness of intensive clinical interventions to treat tobacco dependence in adult smokers. Empirical studies have provided limited support for the efficacy of such interventions among adolescent smokers, yet participation, retention, and quit rates associated with these interventions tend to be relatively low. Brief clinical interventions may be a promising alternative for promoting smoking cessation in adolescents. The purpose of this paper is to examine the efficacy and use of brief clinical interventions for adolescent smokers, healthcare providers' provision of such treatment, barriers to adoption, and policies to increase brief clinical intervention provision. Methods: Studies were collected from the Centers for Disease Control and Prevention's Office of Smoking and Health, Medline, Psychinfo, PubMed, and the Cochrane Library. We also examined references identified from pertinent articles and books and elicited suggestions from experts in the field of tobacco control. Investigations were primarily confined to those conducted in the USA to allow ease of comparisons among studies. In addition, we chose to concentrate on research conducted in the USA because differences between the USA healthcare system and that of other countries would result in different barriers to adoption and policy recommendations. Findings: Results showed that, although healthcare professionals appear to be screening adolescents for their smoking status, rates of counseling and follow-up are disappointingly low. Obstacles to brief clinical intervention adoption include clinicians' lack of knowledge and confidence regarding brief intervention delivery, lack of understanding regarding the unique use patterns of adolescent smokers, and focus on prevention instead of treatment. Clinician training can increase the confidence with which healthcare providers interact with their adolescent patients. Organizational changes include chart reminders, reimbursement for counseling, and staff behavior monitoring. Conclusions: Additional studies on efficacious methods to help adolescent smokers quit smoking are critically needed. Research on ways in which to increase brief clinical intervention provision are also warranted to prevent teenage smokers from carrying this habit, along with its associated morbidity and mortality risks, into adulthood.

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

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

Hall SM; Tsoh JY; Prochaska JJ; Eisendrath S; Rossi JS; Redding CA et al. Treatment for cigarette smoking among depressed mental health outpatients: A randomized clinical trial. American Journal of Public Health 96(10): 1808-1814, 2006. (32 refs.)

Objectives. Using a brief contact control, we tested the efficacy of a staged care intervention to reduce cigarette smoking among psychiatric patients in outpatient treatment for depression. Methods. We conducted a randomized clinical trial that included assessments at baseline and at months 3, 6, 12, and 18. Three hundred twenty-two patients in mental health outpatient treatment who were diagnosed with depression and smoked 11 cigarette per day participated. The desire to quit smoking was not a prerequisite for participation. Staged care intervention participants received computerized motivational feedback at baseline and at 3, 6, and 12 months and were offered a 6-session psychological counseling and pharmacological cessation treatment program. Brief contact control participants received a self-help guide and referral list of local smoking-treatment providers. Results. As we hypothesized, abstinence rates among staged care intervention participants exceeded those of brief contact control participants at months 12 and 18. Significant differences favoring staged care intervention also were found in occurrence of a quit attempt and stringency of abstinence goal. Conclusion. The data suggest that individuals in psychiatric treatment for depression can be aided in quitting smoking through use of staged care interventions and that smoking cessation interventions used in the general population can be implemented in psychiatric outpatient settings.

Haro G; Ramirez N; Lopez N; Barea J; Mateu C; Cervera G. Effectiveness of a step-stage psychotherapeutic approach between hospital detoxification and outpatient treatment of drug dependencies. Addictive Disorders and their Treatment 5(2): 87-98, 2006. (42 refs.)

Evaluate the effectiveness of a therapy such as step-stage approach between hospital detoxification treatment and outpatient treatment of drug dependencies. Experimental study with a sampling of persons dependent on substances, divided randomly into experimental group (52 patients) and control group (26 patients), who were admitted to a Hospital Detoxification Unit (HDU). An intervention known as Brief Motivational Psycho-educational Therapy (BMPT) was applied to the experimental group, structured in 3 sessions. A questionnaire designed ad hoc, which was intended to measure the level of knowledge about drug dependency and the patient's motivation to receive psychotherapy, was administered upon admittance and before release from the hospital. For patients who received the therapy, questions designed to measure satisfaction in respect to the therapy were included in the questionnaire they were given before release from the hospital. After the intervention, patients belonging to the experimental group showed improvement of 19% in the area of previous knowledge, in respect to 10 basic concepts about drug dependency; this percentage was lower in those with a dependency on legal opiates or in the Program of Maintenance with Methadone (R=-0.36; P=0.009). Seventy-six percent of the patients in the experimental group considered the experience as being quite positive or very positive, with this satisfaction being greater in those who finished the therapy (from R=0.30 to 0.47 according to the aspect evaluated, P<0.05) and less in the Program of Maintenance with Methadone (R=-0.46; P=0.02). The patients who received BMPT improved in respect to their motivation to receive outpatient psychotherapy, especially the females. BMPT would appear to be an adequate approach for those patients admitted to an HDU to improve their knowledge about drug dependencies and their motivation to receive psychotherapy, besides generating high levels of satisfaction. The effectiveness, however, varied depending on the sex of the patients and the substance on which they were dependent.

Hoving EF; Mudde AN; de Vries H. Predictors of smoking relapse in a sample of Dutch adult smokers: The roles of gender and action plans. Addictive Behaviors 31(7): 1177-1189, 2006. (40 refs.)

Background: The object of this study was to investigate the influence of gender and the additional protective quality of action plans on the occurrence of relapse in smokers after a pharmacy-based minimal intervention strategy. Methods: Respondents received a written baseline questionnaire, based on the I-Change Model, and were contacted 3 months after baseline by telephone. Results: A total of 223 respondents were included in relapse analyses. Relapse was predicted by intention, the use of pharmacotherapy and action plans. Predictors differed for men and women. Conclusions: Action plans provide a protective value against smoking relapse. Men and women did not differ in relapse rates, but predictors differed. Developers of relapse prevention activities should consider developing programmes based on gender. These programmes could also benefit from making use of action plans as a method for preventing relapse.

Hyman Z. Brief interventions for high-risk drinkers. Journal of Clinical Nursing 15(11): 1383-1396, 2006. (75 refs.)

Aims and objectives. The purpose of this paper is to explore the literature on brief alcohol intervention and to review the literature that examines the status of the clinic nurse in the delivery of these interventions. The objective is to review critically the literature on brief intervention to create links for nurse developed and delivered brief intervention to high-risk drinkers. Background. Population estimates suggest that more than one-third of North Americans drink excessively with even higher rates for individuals treated in primary care settings. Alcohol use has been identified as the third leading cause of mortality in the United States. This problem is not unique to the US and, worldwide, agencies and governmental offices and ministries have issued recommendations to screen patients for alcohol misuse and deliver brief interventions to individuals considered to be high-risk drinkers. Numerous randomized controlled trials and recent meta-analyses have supported the use of screening and brief intervention for reducing alcohol consumption in primary healthcare settings. The vast majority of studies reporting on brief interventions have focused on the role of the physician with minimal if any involvement of the clinic nurse. A scant number of studies have been conducted that define and assess the role or potential role of the clinic nurse in providing screening and brief intervention to high-risk drinkers in the primary care setting. Methods. Systematic review. Results. Six systematic reviews and meta-analyses from an international base of studies support the use of brief intervention in the primary care setting. Three randomized control trials have highlighted the role of the staff or clinic nurse but there are no meta-analyses addressing nurse-delivered brief interventions. Numerous studies have explored factors effecting the implementation of brief intervention into the primary care setting. Conclusion. Brief intervention is recognized as a legitimate nursing role but little has been done to develop and define the role of the nurse in delivering brief interventions to high-risk drinkers. This represents a major lacuna in both the nursing and alcoholism literature, where only a handful of studies have investigated nurse-delivered brief intervention. Relevance to clinical practice. As health screening and health promotion are hallmarks of nursing care, nurses need to explore the use of brief intervention in their daily practice.

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

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

LaBrie JW; Lamb TF; Pedersen ER; Quinlan T. A group motivational interviewing intervention reduces drinking and alcohol-related consequences in adjudicated college students. Journal of College Student Development 47(3): 267-280, 2006. (34 refs.)

This study examines the effectiveness of a single-session group motivational enhancement intervention with college students adjudicated for violation of alcohol policy. The intervention consisted of a Timeline Followback assessment of drinking, social norms re-education, decisional balance for behavior change, relapse prevention, expectancy challenge, and the generation of behavioral goals. All participants evidenced significant reductions in drinking from baseline through one and three month follow-up. Male participants and frequent binge drinkers showed the largest and most sustained reductions in drinking behavior. The results of this study provide tentative evidence for the effectiveness of group motivational enhancement interventions with adjudicated students.

Littlejohn C. Does socio-economic status influence the acceptability of, attendance for, and outcome of, screening and brief interventions for alcohol misuse: A review. Alcohol and Alcoholism 41(5): 540-545, 2006. (59 refs.)

Aims: To determine whether socio-economic status (SES) influences (i) willingness to participate in brief intervention (BI) research, (ii) attendance to receive BI once allocated, and (iii) treatment outcome. Methods: Systematic review of published, randomised controlled trials of BI for non-dependent alcohol misuse in primary health care settings. Results: Eighteen papers met inclusion criteria. There is evidence that once recruited, and following attendance for intervention, participants' SES does not influence treatment outcome. However, the effect of choosing to participate remains unclear, and the generalizability of results to the whole primary care population remains equivocal. Socio-economic status may influence willingness to participate in BI treatment research, and may influence attendance to receive such interventions where allocated. Conclusion: Brief interventions should remain available to all non-dependent hazardous and harmful drinkers in primary care. However, fidelity to research design is suggested to allow for any participation effects to occur. Benefits of such an approach exist for both clinicians and patients. The characteristics of those who participate in BI trials, compared to those who do not, should be studied in detail. Socio-economic variables should be included as potentially important characteristics. The impact of BI on drinking style as well as consumption needs further attention.

Lopez-Bushnell K; Fassler C. Nursing care of hospitalized medical patients with addictions. (review). Journal of Addictions Nursing 15(3): 177-182, 2004. (56 refs.)

The purpose of this study is to discuss the literature regarding the development of a clinical pathway for substance abuse screening and brief intervention in an acute care facility for medical patients using Motivational Interviewing (MI). We reviewed the literature on the use of brief motivational interviewing for adult substance abuse treatment in hospitalized patients and we looked at the design and implementation of a clinical pathway that involves the screening and brief intervention for adult patients with substance abuse problems. Our research supports brief motivational interviewing techniques on adult hospitalized patients with substance abuse. The nursing literature identifies brief Motivational Interviewing as an evidence based approach to patients with substance abuse.

Marsden J; Stillwell G; Barlow H; Taylor C; Boys A. An evaluation of a brief intervention model for use with young non-injecting stimulant users. Drugs: Education, Prevention, and Policy 12(Supplement 1): 90-93, 2005. (0 refs.)

This report describes the rationale, implementation, and efficacy evaluation of a brief, motivational intervention for young users of cocaine, crack cocaine, and ecstasy not in contact with treatment services. It was developed so it could be used by peer and other drug workers. the evaluation was a two-condition, multi-site randomized controlled trial with a single 6-month follow-up. Both groups were administered an assessment tool, and the experimental group had an intervention built around motivational interviewing techniques that included Advice, Information, Motivation, and Support (AIMS). All participants were provided with informational pamphlets, and a list of local support services. This was the first study of such a model for this population. A "person-centered" approach was adopted. The methodology, procedures and sample are described, as well as the implementation results. A range of positive changes were found for both the experimental and control conditions. Among the findings are the following: for the experimental group, there was a significantly greater reduction in frequency of use of cocaine, crack, and ecstasy use. There were reductions in the typical intensity of use, and no differences between the two intervention conditions. there was a significant reduction in the self-rated health status for the experimental condition. There were significant reductions in offending in both the conditions and a greater reduction among primary ecstasy users in the experimental group. Those in the experimental condition were more aware of local services, and these clients more than twice as likely to apply for a job, or educational course and half times as likely to have begun a job or an educational course. Recommendations are set forth.

Marsden J; Stillwell G; Barlow H; Boys A; Taylor C; Hunt N; Farrell M. An evaluation of a brief motivational intervention among young ecstasy and cocaine users: No effect on substance and alcohol use outcomes. Addiction 101(7): 1014-1026, 2006. (40 refs.)

Aims: To investigate whether a stimulant- and alcohol-focused brief motivational intervention induces positive behaviour change among young, regular users of MDMA ('ecstasy'), cocaine powder and crack cocaine. Design and measurements: A randomized trial of the intervention versus a control group who received written health risk information materials only. All participants completed a baseline self-assessment questionnaire before randomization. Outcome measures were self-reported period prevalence abstinence from ecstasy, cocaine powder and crack cocaine and the frequency and amount of stimulant and alcohol use in the previous 90 days, recorded at 6-month follow-up via self-completion questionnaire and personal interview. Participants and setting: A total of 342 adolescent and young adult stimulant users (aged 16-22 years) were recruited and 87% were followed-up. The intervention was delivered by a team of 12 agency youth drug workers and two researchers at five locations in Greater London and south-east England. Findings: There were no significant differences in abstinence for ecstasy, cocaine powder or crack cocaine use between the experimental and control groups. Contrasting follow-up with baseline self-reports, there were no between-group effects for changes in the frequency or amount of stimulant or alcohol use. Participant follow-up data suggested that the baseline assessment was a contributing factor in within-group behaviour change among experimental and control condition participants. Conclusions: Our brief motivational intervention was no more effective at inducing behaviour change than the provision of information alone. We hypothesize that research recruitment, baseline self-assessment and contact with study personnel are influences that induce positive reactive effects on stimulant use.

Martino S; Carroll KM; Nich C; Rounsaville BJ. A randomized controlled pilot study of motivational interviewing for patients with psychotic and drug use disorders. Addiction 101(10): 1479-1492, 2006. (64 refs.)

Aims: This pilot study examined the efficacy of a two-session motivational interview adapted for dually diagnosed psychotic and drug-related disordered patients (DDMI) in comparison to a two-session standard psychiatric interview (SI). Design: The study used a randomized controlled trial design. Participants received either DDMI or SI and were assessed at baseline, 4-, 8- and 12-week follow-up points. The principal analysis for examination of treatment effects across time was a random effects regression model. Setting Both DDMI and SI interviews served as pre-admission intake interventions to an ambulatory specialty dual diagnosis intensive out-patient and partial hospital program. Partcipants Forty-four treatment-seeking participants (DDMI = 24; SI = 20) who had co-occurring psychotic and drug-related disorders were assigned randomly to the treatment conditions. Measurements: Primary outcomes were days of primary drug use, secondary drug use, alcohol use and psychotropic medication adherence, proportion of participants admitted into the program and days of attendance. Findings and conclusions: DDMI and SI resulted in improved treatment outcomes, but there were no main effects for the sample as a whole. Separate examination of primary cocaine and primary marijuana using subsamples, however, suggested that DDMI resulted in significantly better primary drug treatment outcomes for the cocaine-using group, whereas SI resulted in significantly better primary drug treatment outcomes for the marijuana-using group. These findings indicate that MI may not work equally well for all types of psychotic disordered dually diagnosed patients and that alternative approaches may be as effective in fostering improved substance use treatment outcomes for subgroups of these individuals.

May C; Rapley T; Kaner E. Clinical reasoning, clinical trials and risky drinkers in everyday primary care: A qualitative study of British general practitioners. Addiction Research & Theory 14(4): 387-397, 2006. (32 refs.)

Alcohol and other substance misuse problems have historically been seen as refractory in primary care, but in the past 20 years brief interventions have come to be seen as an important and effective response to a range of problems around 'risky drinking'. Proponents of brief interventions have argued that these interventions are best accomplished in the community, but that primary health care professionals resist using them. This qualitative study investigated responses to alcohol problems in a maximum variation sample of 28 primary care professionals in and around a northern English city. We found clinicians negotiating alcohol problems using interactional techniques that integrated elements of brief interventions, and which fitted these to the interactional and temporal order of clinical encounters and physician-patient relationships in primary care. Central to these accounts was the problem of finding an interactional solution that drew together notions of what was both ethically and practically possible in any given encounter.

McArdle PA. Cannabis use by children and young people. (review). Archives of Disease in Childhood 91(8): 692-695, 2006. (61 refs.)

The rate of cannabis use by young people approximately doubled in the 1990s. Use in Western Europe and North America (30-40% having used by mid-adolescence) may have plateaued. Although it remains illegal, occasional cannabis use has been considered a normal activity of youth and is not strongly associated with emotional or behavioural disorder. Athough the exact location of the threshold is not clear, approximately half of those who use cannabis more than monthly exhibit behavioural or emotional difficulties. Some argue that adverse effects linked to cannabis have increased in recent times -- potentially attributed to an earlier onset of use, the use of water pipes or bongs to achieve more efficient delivery, preferential use by chronic users of the stronger preparations available, or use by more vulnerable individuals. As occasional use does not appear to be damaging, in the absence of any other difficulties enquired for, the clinician's role may include reassurance of anxious teachers or parents. However, more intensive use, or use by very young or pre-adolescents may be associated with a range of antecedent and concurrent difficulties. This "misuse" tends to occur in the context of antecedent behaviour disorder, substance using parents, family breakdown, and loss of trusting attachments to key adults. Clarifying the potential harm associated with cannabis use requires distinguishing between the effects of the drug itself from other co-occurring antecedent or persistent adversities. Indeed, regular use "...could be a marker, rather than a cause, of a life trajectory more likely to involve adverse outcomes". The author discusses screening, assessment, markers of harmful use, brief interventions, as well as reviewing the current research on more formal family based, cognitive behavioural, or group interventions for those with more complex presentations. The data on the relationship of marijuana use and schizophrenia is also summarized.

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

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

Moller AM. Preoperative smoking intervention. (editorial). Journal of Clinical Anesthesia 18(8): 561-562, 2006. (10 refs.)

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

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

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

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

Nygaard P. Focus on secondary prevention: Implications of a study on intervention in social networks. Substance Use & Misuse 41(13): 1719-1733, 2006. (26 refs.)

Screening and brief intervention (SBI) as a method within secondary prevention of alcohol use-related problems has experienced enormous attention and interest over the past 20 years. Initial results were very promising and great effort was put into designing screening instruments and developing different kinds of interventions. However, at the same time, the approach has generated problems in its own right. Some of these problems relate to standardization of instruments and some to criteria of inclusion into samples; others relate to the focus on the individual drinking style independent from social influences. In light of these problems, it is necessary to elaborate on the theoretical foundation, as well as on the methods used in SBI. This article introduces a method for intervening in social networks with important implications for SBI. By putting emphasis on the motivational part of SBI and including social networks in the field of intervention, it may be assumed that the approach will produce better results than heretofore. The results from a Danish qualitative study on intervening into the social network of social drinkers are presented. This study was carried out between 1991 and 1999 and involved 13 adult Danes between 35 and 45 years of age. They all had a weekly alcohol consumption of 120 to 360 g of pure alcohol and they all considered themselves to be social drinkers. The results of this study show that enhanced awareness of the person's own drinking, as well as that of peers, may influence decisions about specific drinking situations. These findings and the perspectives for SBI are discussed. Recommendations for further research are also presented.

Okuyemi KS; Nollen NL; Ahluwalia JS. Interventions to facilitate smoking cessation. American Family Physician 74(2): 262-271, 2006. (43 refs.)

Tobacco use, primarily cigarette smoking, is the leading cause of preventable morbidity and mortality in the United States, and nearly one third of those who try a cigarette become addicted to nicotine. Family physicians, who see most of these patients, in their offices every year, have an important opportunity to decrease smoking rates with office-based interventions. The U.S. Public Health Service recommends that primary care physicians use the five A's (Ask, Advise, Assess, Assist, and Arrange) model when treating patients with nicotine addiction. Physicians can improve screening and increase cessation rates by asking patients about tobacco use at every office visit. Behavioral modification can improve long-term smoking cessation success; even brief (five minutes or less) advice on smoking cessation during an office visit can increase cessation rates. The effectiveness of nonpharmacologic treatments generally is lower; therefore, pharmacotherapy is recommended for smokers who are willing to attempt cessation, unless medical contraindications exist. The pharmacologic agents approved by the U.S. Food and Drug Administration for treatment of tobacco dependence include bupropion (a non-nicotine therapy) and nicotine replacement therapies in the form of a gum, patch, nasal spray, inhaler, and lozenge. These agents have similar long-term success rates.

Pan W. Proactive telephone counseling as an adjunct to minimal intervention for smoking cessation: A meta-analysis. Health Education Research 21(3): 416-427, 2006. (79 refs.)

Proactive telephone counseling is an effective adjunct to minimal intervention for smoking cessation, but its effect has not been quantitatively synthesized thoroughly. The present meta-analysis reviewed 22 studies published between January 1990 and December 2003 and found that there was a heterogeneous, significant adjunct effect of proactive telephone counseling for smoking cessation. This meta-analytic review also found that the following study characteristics explained most of the variation in the adjunct effect: year of publication, follow-up time, mean age of participants, proportion of female participants, participants' readiness to quit smoking and number of cigarettes smoked per day before intervention. In other words, based on the 22 studies, proactive telephone counseling is effective as an adjunct to other minimal interventions for younger, male, light-smoking participants. The results of this meta-analytic review imply that researchers and health care providers may need to focus on participants as much as on intervention process to obtain more effective interventions.

Patten CA; Croghan IT; Meis TM; Decker PA; Pingree S; Colligan RC et al. Randomized clinical trial of an Internet-based versus brief office intervention for adolescent smoking cessation. Patient Education and Counseling 64(1-3): 249-258, 2006. (40 refs.)

Objective: Evaluation of novel treatment delivery methods, such as the Internet are notably absent from the adolescent smoking treatment literature. Methods: Adolescent smokers ages 11-18 years were randomized to a clinic-based, brief office intervention (1301; N = 69) consisting of four individual counseling sessions; or to Stomp Out Smokes (SOS), an Internet, home-based intervention (N = 70). Adolescents in SOS had access to the SOS site for 24 weeks. Results: The 30-day, point-prevalence smoking abstinence rates for BOI and SOS were 12% versus 6% at week 24 and 13% versus 6% at week 36, with no significant treatment differences. Among participants who continued to smoke, SOS was associated with a significantly greater reduction in average number of days smoked than BOI (P = 0.006). The BOI was found to be feasible with high session attendance rates. SOS participants accessed the site a mean +/- S.D. of 6.8 +/- 7.1 days. SOS use dropped to less than one-third of participants by week 3. Conclusion: Additional research is needed to tap the potential capabilities of the Internet for adolescent smoking cessation using proactive, personalized, patient-education components. Conclusion: Additional research is needed to tap the potential capabilities of the Internet for adolescent smoking cessation using proactive, personalized, patient-education components. Practice implications: Augmenting the SOS type of intervention with more structured, personal and proactive patient-education components delivered in-person or by telephone or electronic mail is recommended.

Pbert L; Fletcher KE; Flint AJ; Young MH; Druker S; DiFranza J. Smoking prevention and cessation intervention delivery by pediatric providers, as assessed with patient exit interviews. Pediatrics 118(3): E810-E824, 2006. (74 refs.)

OBJECTIVE. The goal was to evaluate the degree to which a smoking prevention and cessation intervention was delivered by providers to adolescents in the pediatric office setting. METHODS. Eight pediatric clinics in central Massachusetts were assigned randomly to either a special intervention (brief pediatric provider-delivered intervention plus peer counseling) or the usual care condition. Subjects (n = 2710) were adolescents 13 to 17 years of age, both smokers (smoked in the past 30 days) and nonsmokers/former smokers. The degree to which smoking prevention and treatment interventions were delivered by providers was assessed through patient exit interviews with adolescents after their clinic visits; interviews assessed the occurrence of 10 possible intervention steps. RESULTS. The percentage of providers engaging in the smoking interventions differed significantly between the special intervention and usual care conditions, according to adolescent reports in the patient exit interviews. For nonsmokers/former smokers, overall patient exit interview scores were 7.24 for the special intervention condition and 4.95 for the usual care condition. For current smokers, overall patient exit interview scores were 8.40 and 6.24 for the special intervention and usual care conditions, respectively. Intervention fidelity of special intervention providers was 72.2% and 84.0% for nonsmokers/former smokers and current smokers, respectively. CONCLUSIONS. Pediatric providers who receive training and reminders to deliver a brief smoking prevention and cessation intervention to adolescents in the context of routine pediatric primary care practice can do so feasibly and with a high degree of fidelity to the intervention protocol.

Peterson PL; Baer JS; Wells EA; Ginzler JA; Garrett SB. Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents. Psychology of Addictive Behaviors 20(3): 254-264, 2006. (58 refs.)

The short-term results of a randomized trial testing a brief feedback and motivational intervention for substance use among homeless adolescents are presented. Homeless adolescents ages 14-19 (N = 285) recruited from drop-in centers at agencies and from street intercept were randomly assigned to either a brief motivational enhancement (ME) group or I of 2 control groups. The I-session motivational intervention presented personal feedback about patterns of risks related to alcohol or substance use in a style consistent with motivational interviewing. Follow-up interviews were conducted at I and 3 months postintervention. Youths who received the motivational intervention reported reduced illicit drug use other than marijuana at I-month follow-up compared with youths in the control groups. Treatment effects were not found with respect to alcohol or marijuana. Post hoc analyses within the ME group suggested that those who were rated as more engaged and more likely to benefit showed greater drug use reduction than did those rated as less engaged. Limitations of the study are discussed as are implications for development of future substance use interventions for this high-risk group.

Quraishi SA; Orkin FK; Roizen MF. The anesthesia preoperative assessment: An opportunity for smoking cessation intervention. Journal of Clinical Anesthesia 18(8): 635-640, 2006. (56 refs.)

Smoking is the single most cause of preventable disease and premature death in the United States. In this paper, we discuss potential hazards that the anesthesiologist should be aware of when caring for patients who abuse tobacco. A review of recent preoperative smoking cessation initiatives is also provided in addition to recommendations on how anesthesiologists may use the preoperative visit as an opportunity to play a more active role in reducing the burden of tobacco-related disease.

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

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

Sharp D; Atherton SR. Out on the town: An evaluation of brief motivational interventions to address the risks associated with problematic alcohol use. International Journal of Offender Therapy and Comparative Criminology 50(5): 540-558, 2006. (28 refs.)

Alcohol has long been identified as a significant contributory factor in crime and antisocial behaviour, yet there is a dearth of effective treatment available for those individuals whose drinking contributes significantly to their criminality, and subsequently the health risks and the economic and wider social implications associated with it. The literature on treatment programmes is drawn almost exclusively from medical experience but indicates that brief interventions are at least as effective as more intensive programmes in reducing alcohol consumption in at-risk groups. This research was undertaken to evaluate projects based in the West Midlands, United Kingdom, providing brief motivational interventions to offenders arrested for offences where alcohol is identified as a significant contributory factor. The evaluation indicates that an arrest referral scheme as developed in the West Midlands can achieve good levels of identification and referral, acceptable attendance, retention rates, and effective outcomes in terms of attitude and behaviour change.

Shourie S; Conigrave KM; Proude EM; Ward JE; Wutzke SE; Haber PS. The effectiveness of a tailored intervention for excessive alcohol consumption prior to elective surgery. Alcohol and Alcoholism 41(6): 643-649, 2006. (29 refs.)

Aim: To assess the effectiveness of a tailored pre-operative intervention for excessive alcohol consumption in reducing post-operative complications and alcohol consumption thereafter. Methods: Patients scheduled for elective surgery requiring at least overnight hospitalisation were screened for alcohol misuse. Consenting, eligible participants with >= 7 days to surgery at the time of screening were offered an intervention and those with < 7 days to surgery were provided usual care. Results: Over a period of 2 years and 10 months, 3139 patients were screened to recruit 136 participants. Baseline analysis revealed a mean age of 53 (+/- 15.8) years and a mean consumption of 71 g/day (+/- 48.1). The intervention group (n = 45) did not differ significantly from controls (n = 91) in age, consumption, and number of current smokers, but there were significantly more women in the control group. There was no difference between the groups in major or minor complications experienced, or length of stay after controlling for age, gender, and baseline consumption. At 6-month follow-up there was a significant reduction in drinking for the entire study population. Conclusion: The study did not demonstrate any beneficial effect of the pre-operative intervention on post-operative complications. The relatively short time to surgery, intervention by a non-member of the surgical team, challenges to recruitment and reduced consumption in the control group may have limited the ability of the study to detect a significant effect of the intervention.

Sommers MS; Dyehouse JM; Howe SR; Fleming M; Fargo JD; Schafer JC. Effectiveness of brief interventions after alcohol-related vehicular injury: A randomized controlled trial. Journal of Trauma, Injury, Infection and Critical Care 61(3): 523-531, 2006. (28 refs.)

Background: Because 40% of motor vehicle fatalities in the United States are alcohol-related, interventions delivered by trauma clinicians targeted to reduce drinking are of particular importance to public health. The objective of this study was to test the effectiveness of hospital-based brief intervention strategies to reduce alcohol consumption and other health-related outcomes in the year after an alcohol-related vehicular injury. Brief interventions are clinically based strategies including assessment and direct feedback about drinking alcohol, goal setting, behavioral modification techniques, and the use of a self-help manual. Methods: The study was a randomized controlled trial of two types of brief intervention with a 12-month follow-up. Participants with alcohol-related vehicular injury who were admitted to Level I trauma centers were eligible for enrollment. Enrolled participants were randomized to a control, simple advice, or brief counseling condition. Primary outcome variables were alcohol consumption (standard drinks/month, binges/month), adverse driving events (driving citations, traffic crashes), and changes in health status (hospital and emergency department admissions). Results: The study enrolled 187 participants at baseline and retained 100 across 12 months. Participants had a significant decrease in alcohol consumption and traffic citations at 12 months as compared with baseline. Mean standard drinks/month declined from 56.80 (SD 63.89) at baseline to 32.10 (SD 53.20) at 12 months. Mean binges/month declined from 5.79 (SD 6.98) at baseline to 3.21 (SD 6.17) at 12 months. There were no differences in alcohol consumption, adverse driving events, or health status by condition. Conclusions: Whether the reductions in alcohol consumption and traffic citations were a result of the crash, hospitalization for injury, screening for alcohol use, or combination of these factors is difficult to determine. Further work is needed to understand the mechanisms involved in reductions of health-related outcomes and the role of brief intervention in this population.

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

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

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

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

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

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

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

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

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

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

Wiggers LCW; Smets EMA; Oort FJ; Peters RJG; Storm-Versloot MN; Vermeulen H et al. The effect of a minimal intervention strategy in addition to nicotine replacement therapy to support smoking cessation in cardiovascular outpatients: A randomized clinical trial. European Journal of Cardiovascular Prevention & Rehabilitation 13(6): 931-937, 2006. (30 refs.)

Background Smoking is an important risk factor for recurrent events in cardiovascular patients. Evidence exists that nicotine replacement therapy (NRT) approximately doubles smoking cessation rates. The minimal intervention strategy (MIS) has been used successfully to assist patients to quit smoking in general practice, and was recently adapted for cardiology inpatients (C-MIS). It is hypothesized that in cardiovascular outpatients the combination of C-MIS and NRT significantly increases the number of quitters compared to NRT alone. Methods A randomized clinical trial in 385 smoking patients who attended the cardiovascular outpatient departments in the Academic Medical Centre, Amsterdam for the treatment of atherosclerotic disease. Patients were allocated to either NRT+C-MIS or NRT alone. Self-reported and biochemically validated abstinence rates were measured at 12 months' follow-up. Results: Including patients with incomplete follow-up as smokers, abstinence was reported by 19% of the NRT+C-MIS group and 14% of the NRT group [absolute risk reduction (ARR)=0.05; 95% confidence interval (CI)= -0.02; 0.12]. According to biochemical markers, abstinence rates were 28 and 24%, respectively (ARR=0.04, 95% CI= -0.06; 0.14). Hence, no significant differences between groups were found. The number of cigarettes smoked a day decreased significantly at 12 months: from 21 to 15 a day in the experimental group, and from 21 to 14 in the control group (P < 0.001), but did not differ between groups (P = 0.32). Conclusions: The effectiveness of a minimal contact intervention was investigated in order to reach as many cardiovascular patients as possible in the setting of outpatient departments. This intervention was not found to be effective.

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

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

Williams EC; Kivlaban DR; Saitz R; Merrill JO; Achtmeyer CE; McCormick KA et al. Readiness to change in primary care patients who screened positive for alcohol misuse. Annals of Family Medicine 4(3): 213-220, 2006. (45 refs.)

PURPOSE Readiness to change drinking may influence the content or effectiveness of brief alcohol counseling. This study was designed to assess readiness to change and its relationship to alcohol misuse severity among primary care patients whose screening questionnaire was positive for alcohol misuse. METHODS This study was a cross-sectional analysis of data collected from 2 consecutive mailed questionnaires. Male outpatients at 7 Veterans Affairs (VA) general medicine clinics were eligible if they returned both questionnaires, screened positive for alcohol misuse (augmented CAGE Questionnaire >= 1 point), responded to 3 readiness-to-change questions, and completed the Alcohol Use Disorders Identification Test (AUDIT). A validated algorithm based on 3 standardized questions categorized participants into 3 readiness groups (precontemplation, contemplation, action). Measures of alcohol misuse severity included AUDIT, CAGE, and the 3 consumption questions from the AUDIT (AUDIT-C). Analyses were descriptive; linear-by-linear associations between alcohol misuse severity and readiness were tested with chi(2) statistics. RESULTS Response rates to the first and second surveys were 59% and 55%, respectively. Of the 6,419 eligible outpatients who screened positive for alcohol misuse, 4,797 (75%) reported any readiness to change (contemplation 24%, action 51%). Among patients with AUDIT scores > 8, more than 90% indicated that they drank more than they should and/or had contemplated drinking less. Greater readiness was significantly associated with greater alcohol misuse severity (P <.001 for all measures). CONCLUSIONS Most primary care patients who screen positive for alcohol misuse indicate some readiness to change. Contrary to stereotypes of denial, those with greater alcohol misuse severity are more likely to report readiness to change.

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

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