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CORK Bibliography: Brief Treatment

78 citations. July 2009 to present

Prepared: June 2010

Allamani A; Pili I; Cesario S; Centurioni A; Fusi G. Client/general medical practitioner interaction during brief intervention for hazardous drinkers: A pilot study. Substance Use & Misuse 44(6): 775-793, 2009

Brief Intervention (BI) for hazardous drinkers at a Primary Health Care (PHC) level can be implemented during the interaction between a GP and his/her client in a range of contexts and opportunities, the GP's office being a primary context. Communication skills are needed for professionals in order to deliver the BI and they should be familiar with motivational interviewing. This pilot study, carried out during 2006-2007, observed how GPs are able to effectively communicate with their hazardous drinking clients when implementing BI. Four GPs have voluntarily participated in the study, altogether interviewing 13 clients in their office in the province of Florence (Italy). Two types of questionnaires were used: a questionnaire on the quality of BI and a questionnaire on the reformulation and summarizing skills. At the end of each interview both questionnaires were independently completed by both the GP and an attending research psychologist. Also, 12 interviews were videotaped and subsequently evaluated by two clinicians. On the whole, GPs scored high regarding their effective communication skills as well as in terms of the quality of BI implemented during the interviews at their offices. The study's limitations are noted and research needed in the future is suggested.

Amaro H; Ahl M; Matsumoto A; Prado G; Mule C; Kemmemer A et al. Trial of the university assistance program for alcohol use among mandated students. Journal of Studies on Alcohol and Drugs Supplement 16: 45-56, 2009. (68 refs.)

Objective: The aim of this study was to investigate the effectiveness of a brief intervention for mandated students in the context of the University Assistance Program, a Student Assistance Program developed and modeled after workplace Employee Assistance Programs. Method: Participants were 265 (196 males and 69 females) judicially mandated college students enrolled in a large, urban university in the northeast United States. All participants were sanctioned by the University's judicial office for all alcohol- or drug-related violation. Participants were randomized to one of two intervention conditions (the University Assistance Program or services as usual) and were assessed at baseline and 3 and 6 months after intervention. Results: Growth curve analyses showed that relative to services as usual, the University Assistance Program was more efficacious in reducing past-90-day weekday alcohol consumption and the number of alcohol-related consequences while increasing past-90-day use of protective behaviors and coping skills No significant differences in growth trajectories were found between the two intervention conditions on past-90-day blood alcohol concentration, total alcohol consumption, or weekend consumption. Conclusions: The University Assistance Program may have a possible advantage over service as usual for mandated students.

Amaro H; Reed E; Rowe E; Picci J; Mantella P; Prado G. Brief screening and intervention for alcohol and drug use in a college student health clinic: Feasibility, implementation, and outcomes. Journal of American College Health 58(4): 357-364, 2010. (34 refs.)

Objective: Evaluation of the Brief Alcohol Screen and Intervention in College Students (BASICS) in a university primary care setting. Participants/Methods: Undergraduates (N = 449) participated in BASICS and electronic surveys assessing frequency/quantity of alcohol and drug use, psychosocial and mental health outcomes, and demographic information. Data were collected at baseline and 6-month follow-up between August 2006 and August 2008. Results: Drinking and drug use decreased between baseline and 6 months. Participants reported an increase in protective factors and in readiness to change alcohol-related behaviors, and a decrease in alcohol-related consequences and in distress symptoms. Heavy episodic drinking at baseline significantly moderated the changes in number of drinks in a typical week and in it typical weekend, and number of drinks on the occasion drank most on a weekend. Conclusions: BASICS can be implemented in a primary health care setting and university students may reduce their alcohol and/or drug use.

Andersson C; Johnsson KO; Berglund M; Ojehagen A. Intervention for hazardous alcohol use and high level of stress in university freshmen: A comparison between an intervention and a control university. Brain Research 1305, special issue: s61-s71, 2009. (59 refs.)

Background: The first year of university studies is associated with increased levels of alcohol drinking and stress. This study examines the one-year outcome of both primary and secondary interventions of one alcohol programme and one stress intervention programme at an intervention university in comparison with a control university. Methods: At the intervention university all freshmen were offered a primary prevention programme for hazardous alcohol use and stress management and, in addition, those who had high ratings for stress and/or hazardous alcohol use were offered a secondary intervention programme for alcohol consumption and/or stress management. Freshmen still attending the two universities one year later responded to follow-up questionnaires. Results: The primary alcohol and stress interventions were associated with lower alcohol expectancies and mental symptoms, but no differences in AUDIT scores (-0.2, CI 95% -0.5 to 0.1), estimated blood alcohol concentrations or stress in comparison to freshmen at the control university. The secondary alcohol interventions were associated with decreased AUDIT (-1.1, CI 95% -2.0 to -0.2) as well as alcohol expectancies, blood alcohol concentrations, stress and mental symptoms in comparison to high-risk freshmen at the control university. The secondary stress interventions were associated with decreased mental symptoms and alcohol expectancies, but not stress, AUDIT scores (-0.6, Cl 95% -1.4 to 0.2) and blood alcohol concentrations in comparison to high-risk freshmen at the control university. Conclusion: This study suggests that both primary and secondary alcohol and stress interventions have 1-year effects in university freshmen and could be implemented in university settings.

Annemans L; Nackaerts K; Bartsch P; Prignot J; Marbaix S. Cost effectiveness of Varenicline in Belgium, compared with bupropion, nicotine replacement therapy, brief counselling and unaided smoking cessatio: A BENESCO Markov cost-effectiveness analysis. Clinical Drug Investigation 29(10): 655-665, 2009. (38 refs.)

Background and Objective: Varenicline is a nicotinic acetylcholine receptor partial agonist that is approved for use as an aid to smoking cessation. Randomized clinical trials show that its efficacy is superior to that of other current smoking cessation therapies. This study set out to determine the cost effectiveness of varenicline relative to other smoking cessation interventions (bupropion and nicotine replacement therapy [NRT]) as well as brief counselling alone and unaided cessation in a cohort of Belgian adult smokers making a one-time quit attempt, from the perspective of the healthcare payer (public and private). Methods: A Markov model, the Benefits of Smoking Cessation on Outcomes (BENESCO) model, was applied to calculate the long-term health and economic benefits of smoking cessation. Cost effectiveness was expressed as cost per life-year (LY) gained and cost per quality-adjusted life-year (QALY) gained. Clinical and economic model inputs were obtained from the literature and public healthcare databases. Costs were discounted at 3% and health outcomes at 1.5%. A probabilistic sensitivity analysis and a one-way sensitivity analysis were performed to test the robustness of the results. Results: Varenicline is associated with a reduction of smoking-related morbidity and mortality as well as with a decrease in healthcare costs compared with the pharmacological agents bupropion and NRT. Varenicline also leads to additional LYs and QALYs compared with brief counselling alone and unaided cessation over a lifetime period. Varenicline is a dominant strategy compared with bupropion and NRT. Compared with brief counselling alone and unaided cessation, varenicline presents a cost/QALY of (sic)240 and (sic)1656, respectively. Conclusion: Varenicline is a cost-effective alternative to brief counselling and unaided cessation, and is a cost-saving treatment in comparison with bupropion and NRT, in a Belgian population of smokers willing to quit.

Babor TF; Caetano R; Casswell S; Edwards G; Giesbrecht N; Graham K et al. Alcohol: No Ordinary Commodity: A summary of the second edition. Addiction 105(5): 769-779, 2010. (64 refs.)

This article summarizes the contents of "Alcohol: No Ordinary Commodity" (2nd edn). The first part of the book describes why alcohol is not an ordinary commodity, and reviews epidemiological data that establish alcohol as a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. This section also documents how international beer and spirits production has been consolidated recently by a small number of global corporations that are expanding their operations in Eastern Europe, Asia, Africa and Latin America. In the second part of the book, the scientific evidence for strategies and interventions that can prevent or minimize alcohol-related harm is reviewed critically in seven key areas: pricing and taxation, regulating the physical availability of alcohol, modifying the drinking context, drink-driving countermeasures, restrictions on marketing, education and persuasion strategies, and treatment and early intervention services. Finally, the book addresses the policy-making process at the local, national and international levels and provides ratings of the effectiveness of strategies and interventions from a public health perspective. Overall, the strongest, most cost-effective strategies include taxation that increases prices, restrictions on the physical availability of alcohol, drink-driving countermeasures, brief interventions with at risk drinkers and treatment of drinkers with alcohol dependence.

Baker A; Turner A; Kay-Lambkin FJ; Lewin TJ. The long and the short of treatments for alcohol or cannabis misuse among people with severe mental disorders. Addictive Behaviors 34(10, Special Issue): 852-858, 2009. (45 refs.)

Substance misuse among people with severe mental disorders is very common and has been associated with a number of adverse outcomes. Most trials among people with severe mental disorders have reported general substance misuse outcomes and have argued that longer treatments are likely to be more effective. Such studies have not specifically compared intervention effectiveness for alcohol vs. cannabis misuse. The present paper reports findings from a synthesis of datasets from three randomized controlled trials (N=248) comparing brief (1-session advice or motivational interviewing, MI) and extended (10 sessions MI/cognitive-behaviour therapy; CBT) interventions for substance misuse among people with psychosis or major depression and outcomes are reported separately for alcohol and cannabis use. Whilst there were comparable rates of reduction in alcohol consumption for the BI and intensive MI/CBT, BI tended to be associated with less reduction in cannabis use. A stepped care approach for substance misuse in people with severe mental disorders may help to improve cannabis outcomes, including monitoring of both mental health and substance misuse domains. with interventions stepped up or down according to treatment response. Future studies should evaluate the effectiveness of stepped care approaches.

Barnett NP; Apodaca TR; Magill M; Colby SM; Gwaltney C; Rohsenow DJ et al. Moderators and mediators of two brief interventions for alcohol in the emergency department. Addiction 105(3): 452-465, 2010. (77 refs.)

Objective: To evaluate moderators and mediators of brief alcohol interventions conducted in the emergency department. Methods: Patients (18-24 years; n = 172) in an emergency department received a motivational interview with personalized feedback (MI) or feedback only (FO), with 1- and 3-month booster sessions and 6- and 12-month follow-ups. Gender, alcohol status/severity group [ALC+ only, Alcohol Use Disorders Identification Test (AUDIT+) only, ALC+/AUDIT+], attribution of alcohol in the medical event, aversiveness of the event, perceived seriousness of the event and baseline readiness to change alcohol use were evaluated as moderators of intervention efficacy. Readiness to change also was evaluated as a mediator of intervention efficacy, as were perceived risks/benefits of alcohol use, self-efficacy and alcohol treatment seeking. Results: Alcohol status, attribution and readiness moderated intervention effects such that patients who had not been drinking prior to their medical event, those who had low or medium attribution for alcohol in the event and those who had low or medium readiness to change showed lower alcohol use 12 months after receiving MI compared to FO. In the AUDIT+ only group those who received MI showed lower rates of alcohol-related injury at follow-up than those who received FO. Patients who had been drinking prior to their precipitating event did not show different outcomes in the two interventions, regardless of AUDIT status. Gender did not moderate intervention efficacy and no significant mediation was found. Conclusions: Findings may help practitioners target patients for whom brief interventions will be most effective. More research is needed to understand how brief interventions transmit their effects.

Becker SJ; Curry JF; Yang CM. Longitudinal association between frequency of substance use and quality of life among adolescents receiving a brief outpatient intervention. Psychology of Addictive Behaviors 23(3): 482-490, 2009. (34 refs.)

Recognition of the broad consequences of adolescent substance abuse has led to increased emphasis on balancing traditional measures of treatment effectiveness, such as frequency of substance use, with measures of patient functioning and quality of life (QOL). This study evaluated the longitudinal association between frequency of use and QOL among adolescent substance abusers receiving a brief outpatient intervention. Participants were 106 adolescents, aged 13 to 21 years, who met criteria for substance abuse or dependence and completed 4 assessments over a 12 month period. Results of a parallel-process latent growth curve model indicated a moderate longitudinal association, such that reduced frequency of use was associated with QOL improvement. Elaboration of the temporal ordering of this association via a cross-lagged panel model revealed that frequency of substance use predicted subsequent QOL, but that QOL did not predict subsequent frequency of use. Implications pertaining to the assessment of comprehensive outcomes and the setting of treatment expectations are discussed.

Bernstein SL. Screening, brief intervention, referral, and treatment, references. Academic Emergency Medicine 16(11): 1054-1059, 2009. (33 refs.)

Modifiable health behaviors are an important cause of visits to emergency departments (EDs). Substance use, unsafe sexual behavior, interpersonal violence, unintentional injury, and other risky behaviors account for a large proportion of ED volume, as well as up to 40% of all deaths in the United States. While emergency physicians commonly treat the illnesses and injuries caused by these behaviors, additional opportunities exist to screen, intervene, refer, and initiate treatment for patients with these health risks. This article reviews the epidemiology and clinical impact of risky health behaviors on ED visits and suggests strategies for creating a research agenda in these areas.

Bernstein E; Topp D; Shaw E; Girard C; Pressman K; Woolcock E et al. A preliminary report of knowledge translation: Lessons From taking screening and brief intervention techniques from the research setting into regional systems of care. Academic Emergency Medicine 16(11): 1225-1233, 2009. (30 refs.)

This article describes a limited statewide dissemination of an evidence-based technology, screening, brief intervention, and referral to treatment (SBIRT), and evaluation of the effects on emergency department (ED) systems of care, utilizing the knowledge translation framework of reach, effectiveness, adoption, implementation, and maintenance (RE-AIM), using both quantitative and qualitative data sources. Screening and brief intervention (SBI) can detect high-risk and dependent alcohol and drug use in the medical setting, provide early intervention, facilitate access to specialty treatment when appropriate, and improve quality of care. Several meta-analyses demonstrate its effectiveness in primary care, and the federal government has developed a well-funded campaign to promote physician training and adoption of SBI. In the busy environment of the ED, with its competing priorities, researchers have tested a collaborative approach that relies on peer educators, with substance abuse treatment experience and broad community contact, as physician extenders. The ED-SBIRT model of care reflects clinician staff time constraints and resource limitations and is designed for the high rates of prevalence and increased acuity typical of ED patients. This report tracks services provided during dissemination of the ED-SBIRT extender model to seven EDs across a northeastern state, in urban, suburban, and rural community settings. Twelve health promotion advocates (HPAs) were hired, trained, and integrated into seven ED teams. Over an 18-month start-up period, HPAs screened 15,383 patients; of those, 4,899 were positive for high risk or dependent drinking and/or drug use. Among the positive screens, 4,035 (82%) received a brief intervention, and 57% of all positives were referred to the substance abuse treatment system and other community resources. Standardized, confidential interviews were conducted by two interviewers external to the program with 24 informants, including HPAs and their supervisors, clinicians, nurse managers, and ED directors across five sites. A detailed semistructured format was followed, and results were coded for thematic material. Barriers, challenges, and successes are described in the respondents' own words to convey their experience of this demonstration of SBIRT knowledge translation. Five of seven sites were sustained through the second year of the program, despite cutbacks in state funding. The dissemination process provided a number of important lessons for a large rollout. Successful implementation of the ED-SBIRT HPA model depends on 1) external funding for start-up; 2) local ED staff acting as champions to support the HPA role, resolve territorial issues, and promote a cultural shift in the ED treatment of drug and alcohol misuse from "treat and street" to prevention, based on a knowledge of the science of addiction; 3) sustainability planning from the beginning involving administrators, the billing and information technology departments, medical records coders, community service providers, and government agencies; and 4) creation and maintenance of a robust referral network to facilitate patient acceptance and access to substance abuse services.

Bingham CR; Barretto AI; Walton MA; Bryant CM; Shope JT; Raghunathan TE. Efficacy of a web-based, tailored, alcohol prevention/intervention program for college students: Initial findings. Journal of American College Health 58(4): 349-356, 2010. (46 refs.)

Objective: Reduce college student at-risk drinking (ARD) using a Web-based brief motivational alcohol prevention/intervention called Michigan Prevention and Alcohol Safety for Students (M-PASS). Participants: Participants included 1,137 randomly sampled first-year college students, including 59% female, 80% white, and averaged age 18.1 years. Methods: Intervention group participants (n = 616) attended 4 online M-PASS sessions, receiving feedback tailored to individual drinking patterns and concepts from 4 behavior change theories. Control group participants (n = 521) completed a mid-phase Survey, and both groups were Surveyed at baseline and posttest. Results: Evidence of M-PASS's efficacy was found. The intervention was associated with advanced stage of change, lower tolerance of drinking and drink/driving, fewer reasons to drink, and use of more strategies to avoid ARD. Preliminary evidence of behavioral change was also found. Efficacy was greater for women than men. Conclusions: Web-based programs may be useful in reducing alcohol-related risk among college students. Further evaluation is needed.

Blow FC; Ilgen MA; Walton MA; Czyz EK; McCammon R; Chermack ST et al. Severity of baseline alcohol use as a moderator of brief interventions in the emergency department. Alcohol and Alcoholism 44(5): 486-490, 2009. (30 refs.)

Aims: This study examines whether the severity of baseline alcohol consumption/consequences moderates the effect of an alcohol brief intervention (BI) in the emergency department (ED). Methods: Injured patients (N = 494) were recruited from an ED, randomly assigned to receive brief advice or not and completed a 12-month follow-up interview. Results: A significant interaction was found between severity of baseline alcohol consumption (i.e. average weekly, binge drinking) and receipt of a BI on alcohol consumption at 12 months. The form of this interaction indicates that the BI group tended to report lower alcohol consumption at follow-up than the untreated group especially in those who had reported high baseline consumption. Severity of alcohol consequences at baseline did not significantly impact the effect of the BI on 12-month outcomes. Conclusion: ED patients with higher alcohol consumption benefit from BI. In some cases, the BI's effects may be enhanced for patients who are heavier drinkers, perhaps due to a greater opportunity to develop a discrepancy between current behavior and future goals.

Brems C; Dewane SL; Johnson ME; Eldridge GD. Brief motivational interventions for HIV/STI risk reduction among individuals receiving alcohol detoxification. AIDS Education and Prevention 21(5): 397-414, 2009. (60 refs.)

This HIV/STI risk reduction clinical trial implemented in short-term alcohol detoxification employed a randomized block design to evaluate three intervention conditions for feasibility, safety, and potential for changing sexual risk attitudes, motivations, and behavior: (a) nonintervention control (standard HIV information dissemination), (b) brief motivational intervention (BMI) for resolution of ambivalence and sex risk reduction planning, and (c) BMI with biological feedback based on testing for sexually transmitted infections (STIs). Findings revealed that BMI can be feasibly implemented during detoxification treatment with individuals with significant substance impairment. BMI, whether coupled with biological feedback or not, enhanced motivation for increasing behaviors that protect from STI. Sexual risk behavior did not change in any of the groups to a statistically significant degree; however, additional analyses suggest negative biological feedback may have resulted in slightly increased level of sexual activity, undoing behavioral effects of increased motivation for sexual

Brown RA; Strong DR; Abrantes AM; Myers MG; Ramsey SE; Kahler CW. Effects on substance use outcomes in adolescents receiving motivational interviewing for smoking cessation during psychiatric hospitalization. Addictive Behaviors 34(10, Special Issue): 887-891, 2009. (39 refs.)

The purpose of this study was to compare substance involvement among psychiatrically hospitalized adolescent smokers who had received motivational interviewing (MI) versus brief advice (BA) for smoking cessation. One hundred and ninety-one (191) adolescent smokers (62.3% female; 15.4 years of age) were randomly assigned to MI (n = 116) or BA (n = 75). All patients were assessed at baseline, immediately after hospitalization, and at 1-. 3-, 6-. 9-, and 12-month follow-ups. Rates of substance use in the MI condition during follow-up increased from a low of 8.2% (SD = 18.5) to a high of 15.4% (SD = 30.0) substance use days, whereas in BA, substance use days increased from a low of 8.4% (SD = 20.8) to a high of 21.4% (SD = 35.2). The results of this study suggest that MI, relative to BA, for smoking cessation was associated with better substance use outcomes during the first 6 months following psychiatric hospitalization among adolescents. This finding is consistent with previous studies that have shown that smoking cessation does not have a detrimental effect on substance abuse treatment outcomes among youth.

Brown TG; Dongier M; Ouimet MC; Tremblay J; Chanut F; Legault L; Kin NMKNY. Brief motivational interviewing for DWI recidivists who abuse alcohol and are not participating in DWI intervention: A randomized controlled trial. Alcoholism: Clinical and Experimental Research 34(2): 292-301, 2010. (70 refs.)

Background: Driving while impaired (DWI) recidivists with unresolved alcohol use problems pose an ongoing risk for traffic safety. Following conviction, many do not participate in mandated alcohol evaluation and intervention programs, or continue to drink problematically after being relicensed. This study investigated if, in DWI recidivists with alcohol problems and not currently involved in DWI intervention, Brief Motivational Interviewing (BMI) produced greater reductions in risky drinking at 6- and 12-month follow-up compared to an information-advice control condition. Additional analyses explored whether BMI was associated with greater readiness to change, subsequent substance abuse treatment service utilization, and satisfaction compared to the control condition. Methods: Male and female recidivists with drinking problems and not currently engaged in DWI intervention were recruited, evaluated, and then randomly assigned to receive 1 of 2 manualized interventions: 30-minute BMI session or information-advice. Participants, interviewers, researchers, and statisticians were blind to assignment. Outcomes were changed in percent of risky drinking days (i.e., >= 3 standard drinks/d for males; >= 2 for females) in the previous 6 months derived from the Timeline Followback, biomarkers of alcohol abuse (GGT, AST, ALT, MCV) by blood assay, and alcohol abuse-related behaviors using the MMPI-Mac scale. Data from the Readiness to Change Questionnaire, a substance abuse service utilization questionnaire, and the Client Satisfaction Scale were also collected. Results: Analyses revealed significant declines in risky drinking with both interventions. BMI (n = 92) resulted in a 25% reduction in risky drinking days at 12-month follow-up, which compared to the control intervention (n = 92) represented a significant decline from 6-month levels. Exposure to BMI also produced significantly greater improvement at 6-month follow-up in a biomarker of alcohol abuse and a behavioral measure related to recidivism risk. Exploration of readiness to change, substance abuse service utilization, and satisfaction with intervention indicated a perception of BMI being more useful in coping with problems. Conclusions: Brief MI approaches warrant further implementation and effectiveness research as an opportunistic DWI intervention strategy to reduce risks associated with alcohol use outside of clinical and DWI relicensing settings.

Capone C; Wood MD. Thinking about drinking: Need for cognition and readiness to change moderate the effects of brief alcohol interventions. Psychology of Addictive Behaviors 23(4): 684-688, 2009. (36 refs.)

Research has demonstrated the efficacy of brief motivational interventions (BMI) and alcohol expectancy challenge (AEC) in reducing alcohol use and/or problems among college students. However, little is known about variables that may qualify the effectiveness of these approaches. The present analyses tested the hypothesis that need for cognition (NFC), impulsivity/sensation seeking (IMPSS) and readiness to change (RTC) would moderate the effects of BMI and AEC. Participants (N = 335) were heavy drinking college students enrolled in a randomized 2 X 2 factorial study of BMI and AEC. Latent growth curve analyses indicated significant interactions for BMI X NFC and AEC X RTC on alcohol use but not problems. Simple slopes analyses were used to probe these relationships and revealed that higher levels of NFC at baseline were associated with a stronger BMI effect on drinking outcomes over time. Similarly, higher levels of baseline RTC were associated with stronger AEC effects on alcohol use. Future preventive interventions with this population may profit by considering individual differences and targeting approaches accordingly.

Carey KB; Scott-Sheldon LAJ; Elliott JC; Bolles JR; Carey MP. Computer-delivered interventions to reduce college student drinking: A meta-analysis. (review). Addiction 104(11): 1807-1819, 2009. (74 refs.)

Aims: This meta-analysis evaluates the efficacy of computer-delivered interventions (CDIs) to reduce alcohol use among college students. Methods: We included 35 manuscripts with 43 separate interventions, and calculated both between-group and within-group effect sizes for alcohol consumption and alcohol-related problems. Effects sizes were calculated for short-term (< 5 weeks) and long-term (>= 6 weeks) intervals. All studies were coded for study descriptors, participant characteristics and intervention components. Results: The effects of CDIs depended on the nature of the comparison condition: CDIs reduced quantity and frequency measures relative to assessment-only controls, but rarely differed from comparison conditions that included alcohol-relevant content. Small-to-medium within-group effect sizes can be expected for CDIs at short- and long-term follow-ups; these changes are less than or equivalent to the within-group effect sizes observed for more intensive interventions. Conclusions: CDIs reduce the quantity and frequency of drinking among college students. CDIs are generally equivalent to alternative alcohol-related comparison interventions.

Chang FC; Hu TW; Lo SY; Yu PT; Chao KY; Hsiao ML. Quit smoking advice from health professionals in Taiwan: The role of funding policy and smoker socioeconomic status. Tobacco Control 19(1): 44-49, 2010. (41 refs.)

Objectives: In 2002, Taiwan launched a program to encourage doctors to provide brief cessation counselling to their patients during routine outpatient visits. This study is to compare and analyse the annual prevalence rate of receiving advice to quit smoking from health professionals before (2004) and after (2005, 2006) the increase in funding and the withdrawal of additional funding (2007). Methods: We analysed pooled data from 2004 to 2007 Taiwan Adult Tobacco Survey, an annual random digit dialling telephone survey, to estimate the prevalence of receiving quit advice among ever smokers across these years. Smoking characteristics and the socioeconomic factors of smokers associated with receipt of advice to quit smoking were also examined. Results: The prevalence rate of receiving quit advice increased from 21.1% in 2004 to 28.2% in 2006, and then decreased slightly to 27.6% in 2007 after the funds were cut. Multivariate analyses results indicated that increasing financing for smoking cessation services in 2005, being male, older, a daily cigarette user, having previously attempted to quit, perceiving oneself as having poor health and being aware of the benefits of smoking cessation services were significantly positively associated with receiving quit advice from health professionals. In contrast, smokers who were younger, female and occasional cigarette users were less likely to receive quit advice. Also, smokers with socioeconomic disadvantages were not less likely to receive quit advice. Conclusions: During the period of increased funding for smoking cessation services, the rates of receiving quit advice increased among all smokers and across different socioeconomic groups.

Cherpitel CJ; Bernstein E; Bernstein J; Moskalewicz J; Swiatkiewicz G. Screening, Brief Intervention and Referral to Treatment (SBIRT) in a Polish emergency room: Challenges in cultural translation of SBIRT. Journal of Addictions Nursing 20(3): 127-U10, 2009. (28 refs.)

A randomized clinical controlled trial of Screening, Brief Intervention and Referral to Treatment (SBIRT) for drinking and related problems among at-risk and dependent drinkers, using nurse interventionists, was undertaken in an emergency room (ER) in Sosnowiec, Poland, the first level-one trauma center in that country. This study was the first outside of the US to test protocols developed in a 14-site collaborative SBIRT study. Because Poland has both a pattern of heavy drinking and a highly accessible specialized alcohol treatment system, it offered a key setting for cultural translation of SBIRT to the international context of a new and emerging health care system. It also offered the opportunity to test the effectiveness of SBIRT with both at-risk and dependent drinkers, and to test the feasibility of using ER nursing staff to provide the brief intervention, serving as a potential model for ongoing implementation of SBIRT in ER settings. Findings suggest that the US-based SBIRT protocols can be successfully translated to other cultures, and that nurses can be successfully trained to provide brief intervention for problem drinking in the ER setting.

Cimini MD; Martens MP; Larimer ME; Kilmer JR; Neighbors C; Monserrat JM. Assessing the effectiveness of peer-facilitated interventions addressing high-risk drinking among judicially mandated college students. Journal of Studies on Alcohol and Drugs Supplement 16: 57-66, 2009. (78 refs.)

Objective: This study examined the effectiveness of three peer-facilitated brief alcohol interventions -- small group motivational interviewing, motivationally enhanced peer theater, and an interactive alcohol-education program -- with students engaging in high-risk drinking who were referred for alcohol policy violations. Method: Undergraduate students referred for alcohol policy violations (N = 695) at a large northeastern public university were randomized to one of the three conditions. Six-month follow-up data were collected on drinking frequency and quantity, negative consequences, use of protective behaviors, and perceptions of peers' drinking norms. Results: There were no statistically significant overall pre-post effects or treatment effects. However, exploratory analyses indicated that decreases in perceived norms and increases in use of protective behavioral strategies were associated with reductions in alcohol use and alcohol-related problems at follow-up (p < .01). Conclusions: The presence of nonsignificant pre-post or main effects is, in part, consistent with recent research indicating that sanctioned college Students may immediately reduce drinking in response to citation and that brief interventions may not contribute to additional behavioral change. The presence of statistically significant correlations between alcohol use and related problems with corrections in norms misperceptions and increased use of protective behaviors at the individual level holds promise for both research and practice. The integration of elements addressing social norms and use of protective behaviors within brief cognitive-behavioral intervention protocols delivered by trained peer facilitators warrants further study using randomized clinical trials.

Clark DB; Gordon AJ; Ettaro LR; Owens JM; Moss HB. Screening and brief intervention for underage drinkers. Mayo Clinic Proceedings 85(4): 380-391, 2010. (59 refs.)

In a 2007 report, the US Surgeeon General called for health care professionals to renew efforts to reduce underage drinking. Focusing on the adolescent patient, this review provides health care professionals with recommendations for alcohol-related screening, brief intervention, and referral to treatment. MEDLINE and published reviews were used to identify relevant literature. Several brief screening methods have been shown to effectively identify underage drinkers likely to have alcohol use disorders. After diagnostic assessment when germane, the initial intervention typically focuses on education, motivation for change, and consideration of treatment options. Internet-accessible resources providing effective brief interventions are available, along with supplemental suggestions for parents. Recent changes in federal and commercial insurance reimbursement policies provide some fiscal support for these services, although rate increases and expanded applicability may be required to prompt the participation of many practitioners. Nevertheless, advances in clinical methods and progress on reimbursement policies have made screening and brief intervention for underage drinking more feasible In general health care practice.

Cobiac L; Vos T; Doran C; Wallace A. Cost-effectiveness of interventions to prevent alcohol-related disease and injury in Australia. Addiction 104(10): 1646-1655, 2009. (23 refs.)

Aims: To evaluate cost-effectiveness of eight interventions for reducing alcohol-attributable harm and determine the optimal intervention mix. Methods: Interventions include volumetric taxation, advertising bans, an increase in minimum legal drinking age, licensing controls on operating hours, brief intervention (with and without general practitioner telemarketing and support), drink driving campaigns, random breath testing and residential treatment for alcohol dependence (with and without naltrexone). Cost-effectiveness is modelled over the life-time of the Australian population in 2003, with all costs and health outcomes evaluated from an Australian health sector perspective. Each intervention is compared with current practice, and the most cost-effective options are then combined to determine the optimal intervention mix. Measurements: Cost-effectiveness is measured in 2003 Australian dollars per disability adjusted life year averted. Findings: Although current alcohol intervention in Australia (random breath testing) is cost-effective, if the current spending of $71 million could be invested in a more cost-effective combination of interventions, more than 10 times the amount of health gain could be achieved. Taken as a package of interventions, all seven preventive interventions would be a cost-effective investment that could lead to substantial improvement in population health; only residential treatment is not cost-effective. Conclusions: Based on current evidence, interventions to reduce harm from alcohol are highly recommended. The potential reduction in costs of treating alcohol-related diseases and injuries mean that substantial improvements in population health can be achieved at a relatively low cost to the health sector.

Conrod PJ; Castellanos-Ryan N; Strang J. Brief, personality-targeted coping skills interventions and survival as a non-drug user over a 2-year period during adolescence. Archives of General Psychiatry 67(1): 85-93, 2010. (37 refs.)

Context: Selective interventions targeting personality risk are showing promise in the prevention of problematic drinking behavior, but their effect on illicit drug use has yet to be evaluated. Objective: To investigate the efficacy of targeted coping skills interventions on illicit drug use in adolescents with personality risk factors for substance misuse. Design: Randomized controlled trial. Setting: Secondary schools in London, United Kingdom. Participants: A total of 5302 students were screened to identify 2028 students aged 13 to 16 years with elevated scores on self-report measures of hopelessness, anxiety sensitivity, impulsivity, and sensation seeking. Seven hundred thirty-two students provided parental consent to participate in this trial. Intervention: Participants were randomly assigned to a control no-intervention condition or a 2-session group coping skills intervention targeting 1 of 4 personality profiles. Main Outcome Measures: The trial was designed and powered to primarily evaluate the effect of the intervention on the onset, prevalence, and frequency of illicit drug use over a 2-year period. Results: Intent-to-treat repeated-measures analyses on continuous measures of drug use revealed time X intervention effects on the number of drugs used (P<.01) and drug use frequency (P<.05), whereby the control group showed significant growth in the number of drugs used as well as more frequent drug use over the 2-year period relative to the intervention group. Survival analysis using logistic regression revealed that the intervention was associated with reduced odds of taking up the use of marijuana (beta=-0.3; robust SE=0.2; P=.09; odds ratio=0.7; 95% confidence interval, 0.5-1.0), cocaine (beta=-1.4; robust SE=0.4; P<.001; odds ratio=0.2; 95% confidence interval, 0.1-0.5), and other drugs (beta=-0.7; robust SE=0.3; P=.03; odds ratio=0.5; 95% confidence interval, 0.3-0.9) over the 24-month period. Conclusion: This study extends the evidence that brief, personality-targeted interventions can prevent the onset and escalation of substance misuse in high-risk adolescents.

Coups EJ; Dhingra LK; Heckman CJ; Manne SL. Receipt of provider advice for smoking cessation and use of smoking cessation treatments among cancer survivors. Journal of General Internal Medicine 24(Supplement 2): 480-486, 2009. (35 refs.)

As the number of cancer survivors increases, the assessment and intervention for smoking among survivors are increasingly important. This study examined the extent to which cancer survivors reported being asked and advised about smoking by health-care providers and their use of smoking cessation treatments during quit attempts. The data were drawn from the 2005 National Health Interview Survey, an annual health survey of US adults. The participants were 1,825 individuals who reported being diagnosed with cancer at least 1 year previously and provided data regarding their current smoking status. Participants completed items assessing demographics, health and health-care factors, and smoking-related variables. More than three-quarters of participants (81.0%) reported that their smoking status was known by a health-care provider. Among current smokers (17.6%) who visited a health-care provider in the past year, 72.2% reported being advised to quit smoking by a provider. Factors associated with a higher rate of receiving advice to quit included greater cigarette consumption (P=0.008), more medical comorbidities (P= 0.001), high psychological distress (P= 0.003), and lack of health-care insurance (P = 0.03). Among current smokers who tried to quit in the last year, 33.5% used pharmacotherapy cessation treatment and 3.8% used an evidence-based behavioral treatment. This study reveals considerable missed opportunities for health-care providers to advise cancer survivors about smoking and provide evidence-based interventions. Systematic efforts are needed to increase the provision of smoking cessation advice and use of cessation treatments among cancer survivors.

Cunningham RM; Bernstein SL; Walton M; Broderick K; Vaca FE; Woolard R et al. Alcohol, tobacco, and other drugs: Future directions for screening and intervention in the emergency department. (review). Academic Emergency Medicine 16(11): 1078-1088, 2009. (129 refs.)

This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on "Public Health in the ED: Screening, Surveillance, and Intervention." The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening-develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention-conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups-conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategies-a) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and follow-up; and d) examine alternatives to specialized treatment referral. 5) Translation-conduct translational and cost-effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice.

Danaher BG; Seeley JR. Methodological Issues in research on web-based behavioral interventions. Annals of Behavioral Medicine 38(1): 28-39, 2009. (83 refs.)

Web-based behavioral intervention research is rapidly growing. We review methodological issues shared across Web-based intervention research to help inform future research in this area. We examine measures and their interpretation using exemplar studies and our research. We report on research designs used to evaluate Web-based interventions and recommend newer, blended designs. We review and critique methodological issues associated with recruitment, engagement, and social validity. We suggest that there is value to viewing this burgeoning realm of research from the broader context of behavior change research. We conclude that many studies use blended research designs, that innovative mantling designs such as the Multiphase Optimization Strategy and Sequential Multiple Assignment Randomized Trial methods hold considerable promise and should be used more widely, and that Web-based controls should be used instead of usual care or no-treatment controls in public health research. We recommend topics for future research that address participant recruitment, engagement, and social validity.

Deckter L; Mahabee-Gittens EM; Gordon JS. Are pediatric ed nurses delivering tobacco cessation advice to parents? Journal of Emergency Nursing 35(5): 402-405, 2009. (22 refs.)

Introduction: Due to the adverse health effects of environmental tobacco smoke exposure in children, pediatric registered nurses (RNs) have frequent encounters with parents who smoke. RNs have a unique opportunity to provide tobacco cessation counseling to parental smokers during their child's ED or hospital visit. The purpose of this study was to assess pediatric RNs' levels of knowledge, attitudes, and behaviors regarding provision of tobacco cessation advice to parents who smoke. Methods: An anonymous electronic self-administered survey of current tobacco cessation practices and attitudes was sent to ED RNs (N = 130) at a tertiary care pediatric hospital in Ohio. Results: A total of 87 RNs (67%) completed the survey. Approximately 22% of respondents indicated that they assess parental smoking status, 14% encouraged parents who smoke to quit, and even fewer indicated that they provided specific counseling or assistance to their patients' parents. Perceived barriers to delivering tobacco cessation counseling included parent resistance, parent complaints, parent anger, and lack of parent materials. More than 60% of respondents agreed that they should learn new ways to help parents quit and advise parents who use tobacco to quit and that RNs can be effective in helping parents quit. Discussion: Pediatric ED nurses are unlikely to engage in tobacco cessation activities but express interest in learning new ways to help patients' parents quit smoking. Future education could promote tobacco cessation advice and assistance, thus improving the health of parents and patients in the pediatric setting.

Dieperink E; Ho SB; Heit S; Durfee JM; Thuras P; Willenbring ML. Significant reductions in drinking following brief alcohol treatment provided in a hepatitis C clinic. Psychosomatics 51(2): 149-156, 2010. (39 refs.)

Background: Although the hepatitis C virus (HCV) alone increases the risk of cirrhosis, alcohol use is thought to act synergistically with HCV to significantly hasten the development of fibrosis. Objective: The authors assessed the impact of brief medical counseling or integrated-care approaches to lessen or eliminate alcohol use in these vulnerable patients. Method: This retrospective study describes the effect of brief alcohol treatment delivered in a hepatitis clinic on drinking outcomes and antiviral treatment eligibility: 47 heavy-drinking chronic hepatitis C patients received a brief intervention performed by medical clinicians, with follow-up by a psychiatric nurse-specialist. Results: At the last follow-up, 62% of patients reported >50% drinking reduction; these included 36% who achieved abstinence. Only 6% of patients were excluded from antiviral therapy. Discussion: Brief treatment addressing heavy drinking delivered by hepatitic clinicians with psychiatric-specialist follow-up was associated with abstinence or a significant reduction in alcohol consumption in over 50% of patients.

Estee S; Wickizer T; He LJ; Shah MF; Mancuso D. Evaluation of the Washington State Screening, Brief Intervention, and Referral to Treatment project cost outcomes for medicaid patients screened in hospital emergency departments. Medical Care 48(1): 18-24, 2010. (47 refs.)

Background: Substance abuse is a major determinant of morbidity, mortality, and health care resource consumption. We evaluated a screening, brief intervention, and referral to treatment (SBIRT) program, implemented in 9 hospital emergency departments (ED) in Washington State. Methods: Working-age, disabled Medicaid patients who were screened and received a brief intervention (BI) from April 12, 2004 through September 30, 2006 were included in the study's intervention group (N = 1557). The comparison group (N = 1557), constructed using (one-to-one) propensity score matching, consisted of Medicaid patients who received care in one of the counties in which an intervention hospital ED was located but who did not receive a BI. We estimated difference-in-difference (DiD) regression models to assess the effects of the SBIRT program for different patient groups. Results: The SBIRT program was associated with an estimated reduction in Medicaid costs per member per month of $366 (P = 0.05) for all patients, including patients who received a referral for chemical dependency (CD) treatment. For patients who received a BI only and had no CD treatment in the year before or the year after the ED visit, the estimated reduction in Medicaid per member per month costs was $542 (P = 0.06). The SBIRT program was also associated with decreased inpatient utilization (P = 0.04). Conclusion: SBIRT programs have potential to limit resource consumption among working-age, disabled Medicaid patients. The hospital ED seems especially well suited for SBIRT programs given the large number of injured patients treated in the ED and the fact that many conditions treated are related to substance abuse.

Etter JF. Comparing computer-tailored, internet-based smoking cessation counseling reports with generic, untailored reports: A randomized trial. Journal of Health Communication 14(7): 646-657, 2009. (37 refs.)

To assess and compare the impact on quit attempts of online computer-tailored smoking cessation counseling reports and untailored reports, we performed a randomized controlled trial on a smoking cessation website in 2007-2008. After answering a questionnaire, current and former smokers were randomly assigned to immediately receiving either an online, individually tailored counseling report or a personalized but untailored generic report. Participants were invited by e-mail to report any smoking in the previous 24 hours, 48 hours after baseline. We used an intention-to-treat analysis, where nonrespondents at follow-up were counted as smokers. There were 2,872 participants at baseline and 2,226 at follow-up (78%). At baseline, there were 76% of current smokers (mean=18 cigarettes/day) and 24% of recent quitters (median=7 days of abstinence). The same proportion of smokers in both study groups had made a 24-hour quit attempt at follow-up (12.1%, P=1.0). In baseline recent quitters, lapse/relapse rates at follow-up were similar in both groups (tailored: 25.1%, untailored: 23.5%, P=0.64). We conclude that untailored reports were as effective as tailored reports in the short term. Even though these particular computer-tailored reports were not more effective than untailored reports, meta-analyses show that computer-tailored documents are in general more effective than untailored ones.

Field CA; Caetano R; Harris TR; Frankowski R; Roudsari B. Ethnic differences in drinking outcomes following a brief alcohol intervention in the trauma care setting. Addiction 105(1): 62-73, 2010. (54 refs.)

Background: Evidence suggests that brief interventions in the trauma care setting reduce drinking, subsequent injury and driving under the influence (DUI) arrest. However, evidence on the effectiveness of these interventions in ethnic minority groups is lacking. The current study evaluates the efficacy of brief intervention among whites, blacks and Hispanics in the United States. Methods: We conducted a two-group parallel randomized trial comparing brief motivational intervention (BMI) and treatment as usual with assessment (TAU+) to evaluate treatment differences in drinking patterns by ethnicity. Patients were recruited from a level 1 urban trauma center over a 2-year period. The study included 1493 trauma patients, including 668 whites, 288 blacks and 537 Hispanics. Hierarchical linear modeling was used to evaluate ethnic differences in drinking outcomes including volume per week, maximum amount consumed in 1 day, percentage days abstinent and percentage days heavy drinking at 6- and 12-month follow-up. Analyses controlled for age, gender, employment status, marital status, prior alcohol treatment, type of injury and injury severity. Special emphasis was given to potential ethnic differences by testing the interaction between ethnicity and BMI. Results: At 6- and 12-month follow-up, BMI significantly reduced maximum amount consumed in 1 day (P < 0.001; P < 0.001, respectively) and percentage days heavy drinking (P < 0.05; P < 0.05, respectively) among Hispanics. Hispanics in the BMI group also reduced average volume per week at 12-month follow-up (KH2 = 6.8, df = 1, P < 0.01). In addition, Hispanics in TAU+ reduced maximum amount consumed at 6- and 12-month follow-up (P < 0.001; P < 0.001) and volume per week at 12-month follow-up (P < 0.001). Whites and blacks in both BMI and TAU+ reduced volume per week and percentage days heavy drinking at 12-month follow-up (P < 0.001; P < 0.01, respectively) and decreased maximum amount at 6- (P < 0.001) and 12-month follow-up (P < 0.001). All three ethnic groups In both BMI and TAU+ reduced volume per week at 6-month follow-up (P < 0.001) and percentage days abstinent at 6- (P < 0.001) and 12-month follow-up (P < 0.001). Conclusions: All three ethnic groups evidenced reductions in drinking at 6- and 12-month follow-up independent of treatment assignment. Among Hispanics, BMI reduced alcohol intake significantly as measured by average volume per week, percentage days heavy drinking and maximum amount consumed in 1 day.

Field C; Caetano R. The role of ethnic matching between patient and provider on the effectiveness of brief alcohol interventions with Hispanics. Alcoholism: Clinical and Experimental Research 34(2): 262-271, 2010. (78 refs.)

Background: Evaluating the effectiveness of treatments such as brief alcohol interventions among Hispanics is essential to effectively addressing their treatment needs. Clinicians of the same ethnicity as the client may be more likely to understand the culture-specific values, norms, and attitudes and, therefore, the intervention may be more effective. Thus, in cases in which Hispanic patients were provided intervention by a Hispanic clinician improved drinking outcomes were expected. Methods: Patients were recruited from an urban Level I Trauma following screening for an alcohol-related injury or alcohol problems. Five hundred thirty-seven Hispanics were randomly assigned to brief intervention or treatment as usual. Hierarchical linear modeling was used to determine the effects of ethnic match on drinking outcomes including volume per week, maximum amount, and frequency of 5 or more drinks per occasion. Analyses controlled for level of acculturation and immigration status. Results: For Hispanics who received brief motivational intervention, an ethnic match between patient and provider resulted in a significant reduction in drinking outcomes at 12-month follow-up. In addition, there was a tendency for ethnic match to be most beneficial to foreign-born Hispanics and less acculturated Hispanics. Conclusions: As hypothesized, an ethnic match between patient and provider significantly enhanced the effectiveness of brief intervention among Hispanics. Ethnic concordance between patient and provider may have impacted the effectiveness of the intervention through several mechanisms including cultural scripts, ethnic-specific perceptions pertaining to substance abuse, and ethnic-specific preferred channels of communication.

Fleming MF; Balousek SL; Grossberg PM; Mundt MP; Brown D; Wiegel JR et al. Brief physician advice for heavy drinking college students: A randomized controlled trial in college health clinics. Journal of Studies on Alcohol and Drugs 71(1): 23-31, 2010. (36 refs.)

Objective: The aim of this study was to test the efficacy of brief physician advice in reducing alcohol use and related harm in college students. Method: The College Health Intervention Projects (CHIPs) is a randomized, controlled clinical trial with 12-month follow-up conducted in five college health clinics in Wisconsin; Washington state; and Vancouver, Canada. Of the 12,900 students screened for high-risk drinking, 484 men and 502 women met inclusion criteria and were randomized into a control (n = 493) or intervention (n = 493) group. Ninety-six percent of students participated in the follow-up procedures. The intervention consisted of two 15-minute counseling visits and two follow-up phone calls, and used motivational interviewing, contracting, diary cards, and take-home exercises. Results: No significant differences were found between groups at baseline on alcohol use, age, socioeconomic or smoking status, rates of depression, or measures of alcohol-related harm. At 12 months, the experimental subjects reduced their 28-day drinking totals by 27.2%, and the control group reduced their totals by 21%. A mixed effects repeated measures model found a statistical difference in favor of the brief-intervention group (beta = 4.7, SE = 2.0, p = .018) in 28-day drinking totals. The total Rutgers Alcohol Problem Index score was also significantly different during the 12-month follow-up period (beta = 0.8, SE = 0.4, p = .033). There was no difference on the other outcome measures of interest, such as frequency of excessive heavy drinking, health care utilization, injuries, drunk driving, depression, or tobacco use. Conclusions: The study supports resource allocation and implementation of alcohol screening and brief physician advice in primary care-based college health clinics.

Frigon AP; Krank MD. Self-coded indirect memory associations in a brief school-based intervention for substance use suspensions. Psychology of Addictive Behaviors 23(4): 736-742, 2009. (35 refs.)

This study assessed the concurrent validity of self-generated and self-coded substance use associations for marijuana and alcohol use. Grades seven to twelve students were assessed as part of a brief intervention program in lieu of suspension for substance use infractions in school. During the cognitive assessment, students generated memory associations to probes for high-risk situations and desirable outcomes. Later, the participant rated their responses according to categories including both non-risk and substance use. Three different coding methods were compared: (1) conservative codes using clearly unambiguous responses, (2) liberal scores adding ambiguous, but likely responses, and (3) self-coded. Self-coded scores were higher, had stronger correlations with substance use, and were better predictors of substance use and problems than either conservative or liberal coded scores. These findings suggest that self-coding may be used to improve concurrent validity, decrease ambiguities in coding, and reduce the cost of measuring memory associations. The present method promises a cost effective and valid measure of indirect substance use cognitions that can be readily adapted for interventions.

Gaume J; Gmel G; Faouzi M; Daeppen JB. Counselor skill influences outcomes of brief motivational interventions. Journal of Substance Abuse Treatment 37(2): 151-159, 2009. (38 refs.)

The aim of this study was to estimate the influence of counselor skills during brief motivational interventions (BMIs) on patient alcohol use 12 months later. Ninety-five BMIs delivered by five counselors of similar background and training were recorded and coded using the Motivational Interviewing Skills Code (MISC). Baseline alcohol measures and sociodemographics of patients did not differ across counselors, whereas MISC scores and outcome at 12 months did. Multilevel models showed that counselors with better motivational interviewing (MI) skills achieved better outcomes overall and maintained efficacy across all levels of an important predictor (patient ability to change), whereas counselors with poorer MI skills were effective mostly at high levels of ability to change. Findings indicated that avoidance of MI-inconsistent skills was more important than frequency of using MI-consistent skills and that training and selection of counselors should be based more on the overall MI-consistent gestalt than on particular MI techniques.

Haller DM; Meynard A; Lefebvre D; Tylee A; Narring F; Broers B. Brief intervention addressing excessive cannabis use in young people consulting their GP: a pilot study. British Journal of General Practice 59(560): 166-172, 2009. (49 refs.)

Background: When excessive cannabis consumption occurs in adolescence, the adverse consequences extend into adulthood. Interventions by GPs are effective in preventing harm associated with alcohol use. Similar interventions have potential in addressing cannabis use. Aim: To develop and pilot test a brief intervention targeting excessive cannabis use (defined as >= 1 x/week) in young people in primary care. Design of the study Pilot intervention trial. Setting Seven family practices in Switzerland. Method: The team collaborated with GPs and young people to develop the intervention. Seven GPs piloted its use in their consultations. Patients aged 15 to 24 years consulting for any health problem were recruited before the consultation. Cannabis use, other substance use, and their psychosocial correlates were assessed with a short confidential questionnaire administered before the consultation and 1 month later. GPs, staff, and patients were asked to comment on the study and its feasibility. Results: Of 81 young people invited to participate, 78 (70% female) agreed (participation rate: 96%). One in seven (13.2%, 95% confidence interval = 7.5% to 18.9%) used cannabis at least once a week. Data at 1 month were available for 42% who had provided email contact details and 91% of those who had provided their mobile phone number (63% overall). In most cases, the intervention lasted no more than 5 minutes. Comments from participants added favourable data towards the feasibility of the study. Conclusion: This pilot study provides a solid base on which to build a randomised trial of a brief intervention addressing cannabis use in young people consulting in family practice.

Hodgins DC; Currie SR; Currie G; Fick GH. Randomized trial of brief motivational treatments for pathological gamblers: More is not necessarily better. Journal of Consulting and Clinical Psychology 77(5): 950-960, 2009. (37 refs.)

The efficacy of brief treatments for media-recruited pathological gamblers was tested in a randomized clinical trial design (N = 314). Two self-directed motivational interventions were compared with a 6-week waiting list control and a workbook only control. Brief motivational treatment involved a telephone motivational interview and a mailed self-help workbook. Brief motivational booster treatment involved a telephone motivational interview, a workbook, and 6 booster telephone calls over a 9-month period. Primary outcomes were gambling frequency and dollar losses. As hypothesized, brief and brief booster treatment participants reported less gambling at 6 weeks than those assigned to the control groups. Brief and brief booster treatment participants gambled significantly less often over the first 6 months of the follow-up than workbook only participants. However, the workbook only participants were as likely to have significantly reduced their losses over the year and to have not met criteria for pathological gambling. Contrary to the hypothesis, participants in the brief booster treatment group showed no greater improvement than brief treatment participants. These results provide further support for the value of brief motivational treatments for pathological gambling.

Hyman Z; Crosby F. Study of implementation of a guideline for brief alcohol intervention in primary care. Journal of Nursing Care Quality 25(1): 46-55, 2010. (22 refs.)

Application of research findings to clinical care has been advocated to improve quality of care and patient outcomes. This article discusses a method to evaluate the translation of research findings in support of evidence-based care. An exemplar of a brief intervention in primary care for high-risk drinkers is used.

Kaner E; Bland M; Cassidy P; Coulton S; Deluca P; Drummond C et al. Screening and brief interventions for hazardous and harmful alcohol use in primary care: A cluster randomised controlled trial protocol. BMC Public Health 9(article 287), 2009. (47 refs.)

Background: There have been many randomized controlled trials of screening and brief alcohol intervention in primary care. Most trials have reported positive effects of brief intervention, in terms of reduced alcohol consumption in excessive drinkers. Despite this considerable evidence-base, key questions remain unanswered including: the applicability of the evidence to routine practice; the most efficient strategy for screening patients; and the required intensity of brief intervention in primary care. This pragmatic factorial trial, with cluster randomization of practices, will evaluate the effectiveness and cost-effectiveness of different models of screening to identify hazardous and harmful drinkers in primary care and different intensities of brief intervention to reduce excessive drinking in primary care patients. Methods and design: GPs and nurses from 24 practices across the North East (n = 12), London and South East (n = 12) of England will be recruited. Practices will be randomly allocated to one of three intervention conditions: a leaflet-only control group (n = 8); brief structured advice (n = 8); and brief lifestyle counselling (n = 8). To test the relative effectiveness of different screening methods all practices will also be randomised to either a universal or targeted screening approach and to use either a modified single item (M-SASQ) or FAST screening tool. Screening randomisation will incorporate stratification by geographical area and intervention condition. During the intervention stage of the trial, practices in each of the three arms will recruit at least 31 hazardous or harmful drinkers who will receive a short baseline assessment followed by brief intervention. Thus there will be a minimum of 744 patients recruited into the trial. Discussion: The trial will evaluate the impact of screening and brief alcohol intervention in routine practice; thus its findings will be highly relevant to clinicians working in primary care in the UK. There will be an intention to treat analysis of study outcomes at 6 and 12 months after intervention. Analyses will include patient measures (screening result, weekly alcohol consumption, alcohol-related problems, public service use and quality of life) and implementation measures from practice staff (the acceptability and feasibility of different models of brief intervention.) We will also examine organisational factors associated with successful implementation.

Kaner EFS; Dickinson HO; Beyer F; Pienaar E; Schlesinger C; Campbell F et al. The effectiveness of brief alcohol interventions in primary care settings: A systematic review. (review). Drug and Alcohol Review 28(3): 301-323, 2009. (90 refs.)

Issues. Numerous studies have reported that brief interventions delivered in primary care are effective in reducing excessive drinking. However, much of this work has been criticised for being clinically unrepresentative. This review aimed to assess the effectiveness of brief interventions in primary care and determine if outcomes differ between efficacy and effectiveness trials. Approach. A pre-specified search strategy was used to search all relevant electronic databases up to 2006. We also hand-searched the reference lists of key articles and reviews. We included randomised controlled trials (RCT) involving patients in primary care who were not seeking alcohol treatment and who received brief intervention. Two authors independently abstracted data and assessed trial quality. Random effects meta-analyses, subgroup and sensitivity analyses and meta-regression were conducted. Key Findings. The primary meta-analysis included 22 RCT and evaluated outcomes in over 5800 patients. At 1 year follow up, patients receiving brief intervention had a significant reduction in alcohol consumption compared with controls [mean difference: -38 g week(-1), 95%CI (confidence interval): -54 to -23], although there was substantial heterogeneity between trials (I-2 = 57%). Subgroup analysis confirmed the benefit of brief intervention in men but not in women. Extended intervention was associated with a non-significantly increased reduction in alcohol consumption compared with brief intervention. There was no significant difference in effect sizes for efficacy and effectiveness trials. Conclusions. Brief interventions can reduce alcohol consumption in men, with benefit at a year after intervention, but they are unproven in women for whom there is insufficient research data. Longer counselling has little additional effect over brief intervention. The lack of differences in outcomes between efficacy and effectiveness trials suggests that the current literature is relevant to routine primary care.

Keough VA; Jennrich JA. Including a screening and brief alcohol intervention program in the care of the obstetric patient. Journal of Obstetric, Gynecologic and Neonatal Nursing 38(6): 715-722, 2009. (46 refs.)

Alcohol is the drug most commonly abused by pregnant women and the leading cause of preventable birth defects across the United States. Screening, brief intervention, and referral for treatment is a program developed by the Emergency Nurses Association that has demonstrated success in treating patients who have alcohol use disorders. This interventional program can be useful to perinatal nurses caring for pregnant women with alcohol use disorders in a variety of settings.

Koski-Jannes A; Cunningham J; Tolonen K. Self-assessment of drinking on the Internet, 6-and 12-month follow-ups. Alcohol and Alcoholism 44(3): 301-305, 2009. (26 refs.)

Aim: The aim of this work was to report on the results of a pilot study of a web-based self-assessment service (DHT) for Finnish drinkers (www.paihdelinkki.fi/testaa/juomatapatesti). Method: During the 7-month recruitment period in 2004 altogether 22,536 anonymous self-assessments were recorded in the database of this service. The study sample was recruited from the 1598 service users who also participated to a survey evaluating the DHT. Those who consented by providing required baseline data and their e-mail address (n = 343) were sent a message asking them to fill in the follow-up questions 3, 6 and 12 months later. Their self-reported use of alcohol and drinking-related problems served as the main outcome variables in this single-group follow-up study. Results: At 3, 6 and 12 months, 78%, 69% and 61% of the study participants, respectively, responded to the follow-up. The intention-to-treat (ITT) results revealed significant reductions (P < 0.001) in all the outcome measures. The reductions occurred during the first 3 months, after which the changes were non-significant. Conclusions: The results are in line with previous studies with mostly shorter follow-up periods suggesting that Internet-based self-assessment services can be useful tools in reducing excessive drinking. A randomized controlled trial would, however, increase our certainty about the causes of the observed changes.

Leontieva L; Horn K; Helmkamp J; Furbee M; Jarrett T; Williams J. Counselors' reflections on the administration of screening and brief intervention for alcohol problems in the emergency department and 3-month follow-up outcome. Journal of Critical Care 24(2): 273-279, 2009. (30 refs.)

Objectives: The purpose of this paper was to explore how events that counselors endorsed occurring during an emergency department-based screening and brief intervention (SBI) for drinking discriminate patients who reported change in Alcohol Use Disorder Identification Test (AUDIT) domains at follow-up from those who did not. Method: Patients who scored ">5" on the AUDIT were eligible for SBI. At the end of each intervention, counselors completed the questionnaire indicating which parts of the intervention they just used. Results: Discriminant function analyses indicated that "Referral made" discriminated for alcohol intake change (Wilks' lambda = 0.993, P < .05) "Did the patient set goals during intervention?" and "Referral made" discriminated for alcohol dependency change (Wilks' lambda = 0.940 and Wilks' lambda = 0.919, P < .05, respectively). "Intention to quit" (Wilks' lambda = 0.984, P < .05) discriminated for alcohol-related harm change. Conclusions: Making referrals to addiction treatment during motivational intervention discriminated for alcohol intake and dependency change. Working on intention to quit is an important point in changing alcohol-related harm. When conducting the SBI in ED, counselors may be mindful in making appropriate referrals to address alcohol use and examine intention to quit to maximize the efficacy of the harm-reduction approach.

Martin G; Copeland J. Brief intervention for regular ecstasy (MDMA) users: Pilot randomized trial of a check-up model. Journal of Substance Use 15(2): 131-142, 2010. (22 refs.)

The prevalence of ecstasy (MDMA) use has increased significantly in recent years, particularly amongst young people. Despite the existence of a sizable population of regular ecstasy users and emergent evidence of a range of associated harms, including dependence, to date no effective targeted intervention responses have been reported specifically for this group. The aim of this study was to evaluate the efficacy of a single session brief intervention in reducing ecstasy use and related problems among regular ecstasy users. In a randomized controlled trial conducted in Sydney, Australia, 50 adult ecstasy users were assigned to either a single session brief intervention or an assessment-only 3-month delayed treatment control condition. Primary outcome measures were days of ecstasy use and number of DSM-IV dependence symptoms reported. At 3-month follow-up significant differences were found in favour of the intervention group on measures of DSM-IV dependence symptoms reported and Severity of Dependence Scale score. No statistically significant differences were detected on measures of quantity and frequency of use. While abstinence rates differed between groups by a factor of 4 (16% vs. 4%), this difference did not achieve statistical significance. Between group effect sizes at follow-up, all in favour of the intervention group, were moderate on the main outcome measures. The approach is acceptable to participants and merits further evaluation.

Mason MJ; Malott K; Knoper T. Urban adolescents' reflections on brief substance use treatment, social networks, and self-narratives. Addiction Research & Theory 17(5): 453-468, 2009. (52 refs.)

The purpose of this study was to examine urban adolescents' experiences of completing a brief, substance use treatment protocol. Semi-structured interviews were conducted in 2006 with 23 patients to better understand their treatment experience, the subsequent impact on their social networks and self-narrative reflections. Results suggest common themes of new awareness of self in relation to substance use, utility of social networks in providing ongoing support, and hopeful future self-narratives. Participants named and evaluated all the substances that they could think of, with marijuana most frequently named and rated as good (65% of patients), indicating a positive attitude toward this drug. In general, we conclude that these qualitative data provide evidence of the effectiveness of brief substance abuse treatment for urban adolescents.

Mccambridge J. Research assessments: Instruments of bias and brief intervention of the future? Addiction 104(8): 1311-1312, 2009. (19 refs.)

McCullough A; Fisher M; Goldstein AO; Kramer KD; Ripley-Moffitt C. Smoking as a vital sign: Prompts to ask and assess increase cessation counseling. Journal of the American Board of Family Medicine 22(6): 625-632, 2009. (22 refs.)

Background: Strategies to improve smoking cessation counseling in clinical settings are critical to supporting smokers' attempts to quit. This study evaluates the impact of adding 2 smoking-related vital sign questions in an electronic medical records system on identification, assessment, and counseling for patients who smoke: "Current smoker?" and "Plan to quit?" Methods: Baseline data and data after intervention were collected through record review of 899 randomly selected patient visits across 3 outpatient clinics. Results: From before to after intervention, identification of smokers increased 18% (from 71% to 84%; P < .001), and assessment for a plan to quit increased 100% (from 25.5% to 51%; P < .005). Among all smokers, cessation counseling increased 26% (from 23.6% to 29.8%; P = .41). Significantly more smokers who received the assessment for a plan to quit received cessation counseling (46% vs. 14%, P < .001). Regression analysis showed that patients receiving an assessment for plan to quit were 80% more likely to receive cessation counseling (OR 0.209; 95% CI, 0.095-0.456). Conclusions: Physician-documented counseling rates are significantly higher when patients are asked about smoking and assessed for a plan to quit. Two questions that ask about smoking status and assess plans to quit may provide prompts to increase the likelihood that patients who smoke receive cessation counseling.

McQueen J; Howe TE; Allan L; Mains D. Brief interventions for heavy alcohol users admitted to general hospital wards. (review). Cochrane Database of Systemic Reviews 3: article CD005191, 2009. (83 refs.)

Background: Brief interventions involve a time-limited intervention focusing on changing behaviour. They are often motivational in nature using counselling skills to encourage a reduction in alcohol consumption. Objectives: To determine whether brief interventions reduce alcohol consumption and improve outcomes for heavy alcohol users admitted to general hospital inpatient units. Search strategy: We searched the Cochrane Drug and Alcohol Group Register of Trials (June 2008) the Cochrane Central Register of Controlled Trials (The Cochrane Library 2, 2008), MEDLINE January 1966-June 2008, CINAHL 1982-June 2008, EMBASE 1980-June 2008 using the search strategy developed by the Cochrane Drug and Alcohol Group. We hand searched relevant journals, conference proceedings and contacted experts in the field. Selection criteria: All prospective randomised controlled trials and controlled clinical trials were eligible for inclusion. Participants were adults (16 years or older) admitted to general inpatient hospital care for any reason other than specifically for alcohol treatment and received brief interventions (of up to 3 sessions) compared to no or regular treatment. Data collection and analysis Three reviewers independently selected the studies and extracted data. Where appropriate random effects meta-analysis and sensitivity analysis were performed. Main results: Eleven studies involving 2441 participants were included in this review. Three results were non significant and one result was significant mean alcohol consumption per week change scores from baseline (P0.02). Authors' conclusions: The evidence for brief interventions delivered to heavy alcohol users admitted to general hospital is still inconclusive. From data extracted from two studies it appears that alcohol consumption could be reduced at one year follow up though further research is recommended. Few studies have been retrieved and the results were difficult to combine because of the different measures used to assess alcohol consumption.

Meader N; Li R; Des Jarlais DC; Pilling S. Psychosocial interventions for reducing injection and sexual risk behaviour for preventing HIV in drug users. (review). Cochrane Database of Systematic Reviews 1: CD007192, 2010. (67 refs.)

Background: Drug users (including both injection drug users and crack cocaine users), are at high levels of risk for contracting HIV. Therefore it is important to reduce the injection and/or sexual risk behaviours of these groups both for the benefit of themselves and for society as a whole. Objectives: To assess the efficacy of multi-session psychosocial interventions in comparison with standard education and minimal intervention controls for the reduction of injection and sexual risk behaviour. Search strategy: Electronic searches were conducted of a number of bibliographic databases (including Cochrane Library, CINAHL, MEDLINE, PsycINFO). In addition, other methods of locating papers were employed including contacting various authors working in the field of HIV risk reduction and examining reference lists of applicable papers identified in the electronic search. Selection criteria: The inclusion criteria consisted of randomised and quazi-randomised trials assessing the efficacy of psychosocial interventions in the reduction of injection and sexual risk behaviour for people who misused opiates, cocaine, or a combination of these drugs. Data collection and analysis: Two authors independently assessed the eligibility of studies identified by the search strategy, quality assessed these studies and extracted the data. A total of 35 trials met the eligibility criteria of the review providing data on 11,867 participants. Main results: There were minimal differences identified between multi-session psychosocial interventions and standard educational interventions for both injection and sexual risk behaviour. Although it should be noted there were large pre-post changes for both groups suggesting both were effective in reducing risk behaviours. In addition, there was some evidence of benefit for multi-session psychosocial interventions when compared with minimal controls. Subgroup analyses suggest that people in formal treatment are likely to respond to multi-session psychosocial interventions. It also appears single-gender groups may be associated with greater benefit. Authors' conclusions: There is limited support for the widespread use of formal multi-session psychosocial interventions for reducing injection and sexual risk behaviour. Brief standard education interventions appear to be a more cost-effective option. Further research is required to assess if there are particular groups of drug users more likely to respond to such interventions.

Moore MJ; Werch C. Efficacy of a brief alcohol consumption reintervention for adolescents. Substance Use & Misuse 44(7): 1009-1020, 2009. (27 refs.)

This article reports the efficacy of a brief substance use preventive reintervention for suburban high school students funded by NIAAA. Participants were randomly assigned to receive a brief consultation or control brochure in Fall 2002. Significant positive effects at the 3- and 12-month follow-up have been reported elsewhere. A total of 346 10th- and 12th-grade students were recruited from the original sample for the reintervention study in Fall 2003. Students remained in their originally assigned group and received a brief iterative consultation or control brochure. The same survey was used to collect information on ATOD use and risk/protective factors at all data points. MANCOVAs revealed no group differences 18 nionths after the initial study baseline. Analysis examining interactions between substance users and nonusers by treatment group indicated signficant positive effects for substance-using adolescents who received reintervention. Study limitations, implications, and suggestions for future research are discussed.

Neuner B; Weiss-Gerlach E; Miller P; Martus P; Hesse D; Spies C. Emergency department-initiated tobacco control: A randomised controlled trial in an inner city university hospital. Tobacco Control 18(4): 283-293, 2009. (32 refs.)

Objectives: Emergency department (ED) patients show high smoking rates. The effects of ED-initiated tobacco control (ETC) on 7-day abstinence at 12 months were investigated. Methods: A randomised controlled intention-to-treat trial (trials registry no.: ISRCTN41527831) was conducted with 1044 patients in an urban ED. ETC consisted of on-site counselling plus up to four telephone booster sessions. Controls received usual care. Analysis was by logistic regression. Results: In all, 630 (60.7%) participants were males, the median age was 30 years (range 18-81) and the median smoking intensity was 15 (range 1-60) cigarettes per day. Overall, 580 study participants (55.6%) were unmotivated, 331 (31.7%) were ambivalent and 133 (12.7%) were motivated smokers. ETC (median time 30 (range 1-99) min) was administered to 472 (91.7% out of 515) randomised study participants. At follow-up, 685 study participants (65.6% of 1044) could be contacted. In the ETC group, 73 out of 515 (14.2%) in the ETC group were abstinent, whereas 60 out of 529 (11.3%) controls were abstinent (OR adjusted for age and gender = 1.31 (95% CI 0.91 to 1.89, p = 0.15). Stratified for motivation to change behaviour, the adjusted ORs for ETC versus usual care were OR = 1.00 (95% CI 0.57 to 1.76) in unmotivated smokers, respectively OR = 1.37 (95% CI 0.73 to 2.58) in ambivalent smokers and OR = 2.19 (95% CI 0.98 to 4.89) in motivated smokers, p for trend = 0.29. Conclusions: ETC, in the form of on-site counselling with up to four telephone booster sessions, showed no overall effect on tobacco abstinence after 12 months. A nonsignificant trend for a better performance of ETC in more motivated smokers was observed.

Nilsen P; Holmqvist M; Bendtsen P; Hultgren E; Cedergren M. Is questionnaire-based alcohol counseling more effective for pregnant women than standard maternity care? Journal of Women's Health 19(1): 161-167, 2010. (25 refs.)

Objective: To compare current standard maternity care in Sweden concerning provision of alcohol advice with a more comprehensive questionnaire-based counseling model. Methods: The study population included pregnant women in Linkoping who were registered at a maternity care center during a 2-year period and whose pregnancies resulted in liveborn infants without birth defects, representing 93% of all pregnant women. Anonymous questionnaires were mailed to the women. The first cohort (registered April 2005 1, to March 31, 2006) received standard care according to a procedure that is common practice in Sweden. The second cohort (April 1, 2006 to March 31, 2007) received alcohol advice based on a comprehensive counseling model, incorporating the use of the three-item Alcohol Use Disorders Identification Test (AUDIT-C) questionnaire and tailored counseling based on the AUDIT-C score. Results: The response rate was 61% in the first cohort (standard care) and 70% in the second cohort (questionnaire-based counseling). The cohorts were similar in sociodemographic variables and prepregnancy drinking characteristics. The proportion of women who continued drinking alcohol during the pregnancy was 6.0% in cohort 1 and 5.8% in cohort 2. Women in cohort 2 were more favorable to the advice and, to a larger extent, perceived the main message to be abstinence from drinking during pregnancy. Conclusions: The questionnaire-based counseling model was more favorably perceived than the standard care model, but the new model was not more effective in terms of its impact on the proportion of women who abstained from drinking during pregnancy.

Nygaard P; Paschall MJ; Aasland OG; Lund KE. Use and barriers to use of screening and brief interventions for alcohol problems among Norwegian general practitioners. Alcohol and Alcoholism 45(2): 207-212, 2010. (14 refs.)

Aims: To investigate the use and the obstacles to use of screening and brief interventions (SBI) for alcohol misuse among Norwegian general practitioners (GP). Methods: A questionnaire with 68 questions about the use and barriers to use of SBI in general practice was mailed to 2000 randomly selected Norwegian GPs. Results: The survey response rate was 45%. There was a much higher prevalence of using interventions (mean = 4.47 on a seven-point Likert scale) than of screening for alcohol problems (mean = 2.10 on a seven-point Likert scale). Regression models showed that knowledge and self-efficacy were the main predictors for GPs' use of screening instruments and use of interventions, respectively, in particular with regard to use of screening. However, GPs' views of their relationship with their patients, and structural factors were significant predictors. Conclusions: (i) Norwegian GPs do not necessarily see the link between screening for alcohol problems and conducting interventions. (ii) Factors on at least three levels, i.e. personal, social and structural, play significant roles for understanding the problems related to implementing the use of SBI in general practice. (iii) Training GPs in the use of SBI is important but may not increase GPs' use of SBI due to social and structural barriers.

Ockene JK; Reed GW; Reiff-Hekking S. Brief patient-centered clinician-delivered counseling for high-risk drinking: 4-year results. Annals of Behavioral Medicine 37(3): 335-342, 2009. (19 refs.)

The purpose of this study is to determine the effect at 48 months of a screening and brief patient-centered physician- and nurse practitioner-delivered intervention implemented during a routine primary care visit on the reduction of alcohol consumption by high-risk drinkers. Participants seen in primary care practices previously randomized to special intervention (SI) or usual care (UC) were reconsented for long-term follow-up. From the initial cohort, 63% reconsented to participate and provided follow-up at 48 months between November 1996 and March 2002. The data for this paper were analyzed in June 2004. At 48 months, SI participants maintained significant reductions in drinks per week seen at 6 and 12 months. However, there were no longer significant differences in drinks per week, binges per month, percentage of low-risk drinking, relapse rates, and new quits between the SI and UC groups at 48 months that had been seen at earlier follow-up. There was a significant effect of prior low-risk drinking status at 12 months; those who were low-risk drinkers at 12 months were more likely to stay low-risk drinkers at 48 months regardless of treatment group. With a single brief intervention, SI participants had significantly greater reductions in their drinking levels at 6 and 12 months compared to UC participants and maintained the lower-risk levels at 48 months resulting in a reduction in health risk exposure time. However, the significant group differences in treatment effect seen in earlier follow-ups were not maintained.

O'Connor RM; Stewart SH. Brief motivational interventions for college drinkers: What we still need to know. (editorial). Clinical Psychology: Science and Practice 17(1): 72-76, 2010. (27 refs.)

Isolating the mechanisms of change that lead to reduced risk for heavy drinking by college students-a high-risk population-will permit development of succinct, targeted, and thereby more effective interventions. Examinations of currently used empirically supported brief interventions provide a starting point for identifying mediators (i.e., mechanisms) of change. Extrapolating from such work, it appears that there may be utility in using face-valid and possibly gender-specific interventions. In moving forward, it behooves clinical researchers to continue to draw on theory to identify potential proximal predictors of change. Continuing to think broadly will allow us to not only refine the current content of brief interventions but also open up the opportunity to introduce new components to treatment.

Roudsari B; Caetano R; Frankowski R; Field C. Do minority or white patients respond to brief alcohol intervention in trauma centers? A randomized trial. Annals of Emergency Medicine 54(2): 285-293, 2009. (389 refs.)

Study objective: The current study evaluates whether the effectiveness of brief alcohol intervention in reducing 6-and 12-month risk of injuries in a large Level I urban trauma center varies according to trauma patients' ethnicity. Methods: Eligible white, Hispanic, and black trauma patients aged 18 years or older were randomized to brief alcohol intervention or treatment as usual. The intervention was a "non-confrontational, patient-centered conversation" focused on patients' drinking pattern, with the purpose of encouraging them to change risky drinking. Study outcomes were patient-reported 6-and 12-month incidence of all-type injuries, alcohol-related injuries, and serious injuries (ie, injuries requiring emergency department visit or hospital admission). Results: A total of 1,493 trauma patients (668 whites, 537 Hispanics, 288 blacks) participated in this study. After 1 year of follow-up, we were not able to detect any important association between brief intervention and the risk of all-type injuries, alcohol-related injuries, or serious injuries among study participants. In addition, the association between brief intervention and the outcomes of interest was not modified by patients' ethnicity. Conclusion: Our study, congruent with some recent publications, implies that there are some patient-and provider-related impediments that could restrict the effectiveness of brief intervention programs in trauma centers, regardless of patient ethnicity. Unless those impediments are identified and eliminated, assuming that brief intervention will be an effective strategy for controlling future alcohol-related injuries among trauma patients and should be provided under any circumstances might not be reasonable.

Rubio G; Jimenez-Arriero MA; Martinez I; Ponce G; Palomo T. Efficacy of physician-delivered brief counseling intervention for binge drinkers. American Journal of Medicine 123(1): 72-78, 2010. (26 refs.)

BACKGROUND: Binge drinking is a common pattern of alcohol use in the US. However, no studies have evaluated the effectiveness of brief interventions targeting only binge drinkers. METHODS: Randomized controlled clinical trial with a 12-month follow-up period conducted from March 1, 2003 to March 1. 2006 in Spain. Of a screened population of 15,325 patients seeking routine medical care from their primary care providers, patients who met inclusion criteria were randomized into an experimental group (n = 371) or a control group (n = 381). The primary outcome measures were the frequency of binge drinking episodes and weekly alcohol intake. RESULTS: There were no significant differences at baseline between groups in alcohol use and demographic variables. At the end of the 12-month follow-up period, there were significant reductions in bin-e-drinking status (52.2% vs 67.2%, P < .001), number of episodes of binge drinking (1.14 vs 1.56, P < .001), number of drinks weekly (19.2 vs 22.4, P < .001), and frequency of excessive alcohol intake in 7 days (47.9% vs 66.6%, P > .001). CONCLUSIONS: This study provided evidence that screening and brief counseling delivered by a primary care physician as part of regular health care significantly reduced binge drinking episodes in binge drinkers.

Schaus JF; Sole ML; McCoy TP; Mullett N; O'Brien MC. Alcohol screening and brief intervention in a college student health center: A randomized controlled trial. Journal of Studies on Alcohol and Drugs Supplement 16: 131-141, 2009. (48 refs.)

Objective: This study tested the effectiveness of brief primary care provider interventions delivered in a college student health center to a sample of college students who screened positive for high-risk drinking. Method: Between November 2005 and August 2006, 8,753 students who presented as new patients to the health service at a large public university were screened for high-risk drinking, and 2,484 students (28%) screened positive on the 5/4 gender-specific high-risk drinking question (i.e., five or more drinks per occasion for men and four or more for women). Students who screened positive for high-risk drinking and consented to participate (N = 363; 52% female) were randomly assigned either to a control group (n = 182) or to an experimental group (n = 181). Participants in the experimental group received two brief intervention sessions that were founded in motivational interviewing techniques and delivered by four specially trained providers within the student health center. Data on alcohol use and related harms were obtained from a Web-based Healthy Lifestyle Questionnaire, 30-day Time-line Followback alcohol-use diaries, the Rutgers Alcohol Problem Index (RAPI), and eight items from the Drinker Inventory of Consequences-2L. Results: Repeated measures analysis showed that, compared with the control group (C), the intervention group (1) had significant reductions in typical estimated blood alcohol concentration (BAC) (C = .071 vs I = .057 at 3 months; C = .073 vs I =.057 at 6 months), peak BAC (C=.142 vs I = .112 at 3 months; C = .145 vs I = 108 at 6 months). peak [lumber of drinks per silting (C = 8.03 vs I = 6.87 at 3 months; C = 7.98 vs I = 6.52 at 6 months), average number of drinks per week (C = 9.47 vs I = 7.33 at 3 months; C = 8.90 vs I = 6.16 at 6 months), number of drunk episodes in a typical week (C = 1.24 vs I = 0.85 at 3 months C = 1.10 vs I = 0.7 1 at 6 months), number of times taken foolish risks (C = 2.24 vs I = 1.12 at 3 months), and RAPI sum scores, (C = 6.55 vs I = 4.96 at 6 months C = 6.17 vs I = 4.58 at 9 months). Conclusions: Brief interventions delivered by primary care providers in a student health center to high-risk-drinking students may result in significantly decreased alcohol consumption, high-risk drinking, and alcohol-related harms.

Schonfeld L; King-Kallimanis BL; Duchene DM; Etheridge RL; Herrera JR; Barry KL et al. Screening and brief intervention for substance misuse among older adults: The Florida BRITE Project. American Journal of Public Health 100(1): 108-114, 2010. (25 refs.)

Objectives. We developed and examined the effectiveness of the Florida Brief Intervention and Treatment for Elders (BRITE) project, a 3-year, state-funded pilot program of screening and brief intervention for older adult substance misusers. Methods. Agencies in 4 counties conducted screenings among 3497 older adults for alcohol, medications, and illicit substance misuse problems and for depression and suicide risk. Screening occurred in elders' homes, senior centers, or other selected sites. Individuals who screened positive for substance misuse were offered brief intervention with evidence-based practices and rescreened at discharge from the intervention program and at follow-up interviews. Results. Prescription medication misuse was the most prevalent substance use problem, followed by alcohol, over-the-counter medications, and illicit substances. Depression was prevalent among those with alcohol and prescription medication problems. Those who received the brief intervention had improvement in alcohol, medication misuse, and depression measures. Conclusions. The BRITE program effectively shaped state policy by responding to legislative mandates to address the needs of an increasing, but underserved, elder population. The pilot paved the way for obtaining a federally funded grant to expand BRITE to 27 sites in 17 counties in Florida.

Shah LM; King AC; Basu A; Krishnan JA; Borden WB; Meltzer D. Effect of clinician advice and patient preparedness to quit on subsequent quit attempts in hospitalized smokers. Journal of Hospital Medicine 5(1): 26-32, 2010. (22 refs.)

BACKGROUND: Although smoking cessation counseling for cardiac inpatients is a quality measure, little data exist regarding postdischarge quit attempts in a primarily urban, African American, underserved population. This study aimed to assess preparedness to quit smoking and quit behaviors. METHODS: Smokers on the cardiology service were asked to rate preparedness using the 10-step Contemplation Ladder. During phone surveys given 30-days postdischarge, patients reported whether they made quit attempts, method and success of attempts, and recall of receiving advice to quit. RESULTS: From February 2006 through July 2007, 2906 of 3364 of inpatients were interviewed. Fifteen percent (436/2906) were current smokers and 415/436 completed the inpatient assessment. Of these, 75% (310/415) indicated they were prepared to quit. At the 1-month follow-up, 67% (276/415) were interviewed and 71% of those patients (195/276) reported making a quit attempt, with most (76%) reporting quitting "cold turkey" (without aid). Compared with less prepared patients, prepared patients were more likely to report making a quit attempt after discharge (77% [163/212] vs. 50% [32/64], P < 0.001) and were successful in that attempt (43% [90/212] vs. 25% [16/64], P = 0.010). CONCLUSIONS: The majority of smokers hospitalized with cardiac disease reported being prepared to quit smoking. Those prepared, and who received advice to quit, were more likely to make a quit attempt and report abstinence than those less prepared. However, most quit attempts were made using the least effective methods. Future studies in a population of primarily African American patients should assess preparedness to quit and target prepared patients with more effective interventions.

Shahab L; McEwen A. Online support for smoking cessation: A systematic review of the literature. (review). Addiction 104(11): 1792-1804, 2009. (65 refs.)

Aim: To examine the efficacy and acceptability of online, interactive interventions for smoking cessation and to identify treatment effect moderators and mediators. Methods: A systematic review and meta-analysis of the literature (1990-2008) was conducted, finding 11 relevant randomized controlled trials. Data were extracted and risk ratios and risk differences estimated with a random effects model. Results: There was no evidence of publication bias. Included trials were of variable methodological quality. Web-based, tailored, interactive smoking cessation interventions were effective compared with untailored booklet or e-mail interventions [rate ratio (RR) 1.8; 95% confidence interval (CI) 1.4-2.3] increasing 6-month abstinence by 17% (95% CI 12-21%). No overall effect of interactive compared with static web-based interventions was detected but there was significant heterogeneity, with one study obtaining a clear effect and another failing to find one. Few moderating or mediating factors were evaluated in studies and those that were had little effect. Pooled results suggest that only interventions aimed at smokers motivated to quit were effective (RR 1.3, 95% CI 1.0-1.7). Fully automated interventions increased smoking cessation rates (RR 1.4, 95% CI 1.0-2.0), but evidence was less clear-cut for non-automated interventions. Overall, the web-based interventions evaluated were considered to be acceptable and user satisfaction was generally high. Conclusion: Interactive, web-based interventions for smoking cessation can be effective in aiding cessation. More research is needed to evaluate the relative efficacy of interactive web-based interventions compared with static websites.

Spence R; Bohman T; Waters V; Velasquez M; Von Sternberg K; Wallisch L et al. SBIRT outcomes in Houston: Final report on InSight, a hospital district-based program for patients at risk for alcohol or drug use problems. Alcoholism: Clinical and Experimental Research 33(8): 1374-1381, 2009. (26 refs.)

Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) services have been implemented as the standard of care for patients in the Harris County Hospital District (HCHD). The present analysis addresses alcohol and drug use for patients admitted over a 39-month period from July 1, 2005 through September 30, 2008. Methods: Patients were screened for alcohol and drug use at medical admission. Those who were positive received further assessment and were transitioned to receive services as appropriate. A sample of consenting patients who were positive and received services was contacted at 6 months for a follow-up interview. Using an intent-to-treat (ITT) protocol, the analysis included all patients who were assigned for follow-up, including those with completed follow-ups as well as those who could not be contacted at follow-up. Patients not contacted at follow-up were assumed to have maintained their baseline drug and alcohol consumption levels. Results: Of 59,760 patients who were screened by generalists (primarily nurses, physicians, and medical care technicians), 15,241 (26%) were positive and received further assessment and services. The 6-month follow-up interview completion rate was 66%. The ITT sample consisted of all 1,937 patients who were assigned for follow-up. There was an overall reduction in the number of patients reporting any days of heavy drinking from 70% at intake to 37% at 6-month follow-up and a reduction in the mean number of days of heavy drinking from 7.8 days at intake to 4.1 days at follow-up. The number of patients reporting any days of drug use was 82% at intake versus 33% at follow-up, and the mean number of days of drug use declined from 8.3 days at intake to 4.2 days at follow-up. Conclusions: The results were consistent with but of greater magnitude than most other studies reporting positive outcomes for SBIRT patients. Drug use and heavy alcohol use were found to decrease substantially from admission to follow-up. This finding holds good for all levels of drug or alcohol misuse severity, with the highest severity patients showing the largest decreases. Future studies are needed to control for potential regression to the mean effects and to develop improved understanding of differences in outcomes by race/ethnicity.

Stein LAR; Minugh PA; Longabaugh R; Wirtz P; Baird J; Nirenberg TD et al. Readiness to change as a mediator of the effect of a brief motivational intervention on posttreatment alcohol-related consequences of injured emergency department hazardous drinkers. Psychology of Addictive Behaviors 23(2): 185-195, 2009. (52 refs.)

Brief motivational interventions (BMIs) are usually effective for reducing alcohol use and consequences in primary care settings. We examined readiness to change drinking as a mediator of the effects of BMI on alcohol-related consequences. Participants were randomized into three conditions: (a) standard care plus assessment (SC), (b) SC plus BMI (BI), and (c) BI plus a booster session (BIB). At 12-month follow-tip BIB patients had significantly reduced alcohol consequences more than had SC patients. Patients receiving BI or BIB maintained higher readiness scores 3 months after treatment than did patients receiving SC. However, readiness mediated treatment effects only for those highly motivated to change prior to the intervention but not for those with low pre-intervention motivation. BI and BIB for these patients decreased alcohol consequences in part because they enhanced and maintained readiness for those highly motivated prior to the intervention, but not for those with low motivation. Results are opposite of what would be expected from MI theory. An alternative explanation is offered as to why this finding occurred with this opportunistically recruited Emergency Department patient population.

Stein MD; Caviness CM; Anderson BJ; Hebert M; Clarke JG. A brief alcohol intervention for hazardously drinking incarcerated women. Addiction 105(3): 466-475, 2010. (34 refs.)

Objective: To test the hypothesis that among hazardously drinking incarcerated women who are returning to the community, a brief alcohol intervention will result in less alcohol use at follow-up relative to standard of care. Methods: Eligible participants endorsed hazardous alcohol consumption-four or more drinks at a time on at least 3 separate days in the previous 3 months or a score of 8 or above on the Alcohol Use Disorders Identification Test. Participants were randomized to either an assessment-only condition or to two brief motivationally focused sessions, the first delivered during incarceration, the second 1 month later after community re-entry. Participants recalled drinking behaviors at 3 and 6 months after the baseline interview using a 90-day time-line follow-back method. Results: The 245 female participants averaged 34 years of age, and were 71% Caucasian. The mean percentage of alcohol use days in the 3 months prior to incarceration was 51.7% and heavy alcohol use days was 43.9%. Intervention effects on abstinent days were statistically significant at 3 months (odds ratio = 1.96, 95% confidence interval 1.17, 3.30); the percentage of days abstinent was 68% for those randomized to intervention and 57% for controls. At 6 months the effect of the intervention was attenuated and no longer statistically significant. Conclusions: Among incarcerated women who reported hazardous drinking, a two-session brief alcohol intervention increased abstinent days at 3 months, but this effect decayed by 6 months. Study participants continued to drink heavily after return to the community. More intensive intervention pre-release and after re-entry may benefit hazardously drinking incarcerated women.

Sugarman DE; Carey KB. Drink less or drink slower: The effects of instruction on alcohol consumption and drinking control strategy use. Psychology of Addictive Behaviors 23(4): 577-585, 2009. (34 refs.)

Brief alcohol interventions often involve recommendations to use drinking control strategies. However, little is known about the functional effect of these strategies on alcohol use. This prospective study employed an experimental design to evaluate the relationship between strategy use and alcohol consumption. The differential effects of instructions to increase the use of strategies or to reduce alcohol consumption were compared to self-monitoring (SM) only. Undergraduate drinkers were randomized into 3 conditions: SM plus strategy increase (SI; n = 61), SM plus alcohol reduction (AR; n = 60), and SM control (SM; n = 56). Participants in the AR group reduced their alcohol use over 2 weeks, while those in the SI group did not drink less. Participants in the SI group increased strategy use over time, whereas the AR group increased use of some strategies but not others. These results indicate that increasing use of drinking control strategies does not necessarily result in reduced drinking. Furthermore, all strategies are not equal in their association with alcohol consumption; if the goal is alcohol reduction, type of strategy recommended may be important.

Terlecki MA; Larimer ME; Copeland AL. Clinical outcomes of a brief motivational intervention for heavy drinking mandated college students: A pilot study. Journal of Studies on Alcohol and Drugs 71(1): 54-60, 2010. (39 refs.)

Objective: The aim of this study was to evaluate a brief motivational intervention (BMI) for reducing risky alcohol use and alcohol-related problems among mandated (M) and voluntary (V) student drinkers to determine (a) whether BMI-mandated students report greater decreases in alcohol use and related problems, relative to no treatment; (b) whether a BMI is comparably effective for mandated and voluntary students; and (c) whether a mandated control group shows greater changes in alcohol use and related problems relative to a voluntary control group. Method: Participants were undergraduate student research volunteers (62% male) who met heavy drinking criteria and completed measures of alcohol use and alcohol problems at baseline and 4 weeks after intervention. Participants (N = 84) were randomly assigned to treatment (T) or assessment-only control (C) conditions (mandated students were assigned to a brief wait list). Results: Participants assigned to treatment reported consuming fewer drinks after the intervention (MT: M = 14.11 drinks; VT: M = 14.05) relative to control groups (MC: M = 20.71; VC: M = 16.53). Evaluation of alcohol-related problems indicated a significant effect of referral status, such that mandated students reported significantly fewer problems at the follow-up assessment relative to volunteers. Conclusions: BMIs are comparably effective for mandated and voluntary students and may result in larger reductions in alcohol use than disciplinary attention alone. More longitudinal research is needed to evaluate the long-term impact of a BMI among mandated students.

Toft U; Pisinger C; Aadahl M; Lau C; Linneberg A; Ladelund S et al. The impact of a population-based multi-factorial lifestyle intervention on alcohol intake The Inter99 study. Preventive Medicine 49(2-3): 115-121, 2009. (47 refs.)

Purpose. To investigate the effect of screening and five years of multi-factorial lifestyle intervention on changes in alcohol intake in a general population. Methods. The study was a pre-randomized intervention study on lifestyle, Inter99 (1999-2006), Copenhagen, Denmark. Participants in the intervention group (n = 6 091) had at baseline a medical health examination and a face-to-face lifestyle counselling. Individuals at high risk of ischemic heart disease were repeatedly offered both individual and group-based counselling. The control group (n = 3 324) was followed by questionnaires. Alcohol intake was measured by questionnaires. Changes were analysed by multilevel analyses. Results . Binge drinking decreased both in men and women at three and five-year follow-ups (men: five-year: net-change:-0.13: p=0.03; women: five-year: net-change:-0.08; p=0.04). Furthermore, in women the ratio between wine and total alcohol was increased compared with the control group at five-year follow-up (net-change: 0.04; p<0.01). In men with a high intake of alcohol (>21 drinks per week) the effect on total alcohol intake was maintained at five-year follow-up (net-change: -3.7: p=0.01). No significant effects were found in women on total alcohol intake. Conclusion. Multi-factorial lifestyle intervention, including low intensity alcohol intervention, improved long-term alcohol habits in a general population.

Touquet R; Brown A. PAT. Revisions to the Paddington Alcohol Test for early identification of alcohol misuse and brief advice to reduce emergency department re-attendance. Alcohol and Alcoholism 44(3): 284-286, 2009. (12 refs.)

The Paddington Alcohol Test (PAT) has evolved over 15 years as a clinical tool to facilitate emergency physicians and nurses giving brief advice and the offer of an appointment for brief intervention by an alcohol nurse specialist. Previous work has shown that unscheduled emergency department re-attendance is reduced by 'making the connection' between alcohol misuse and resultant problems necessitating emergency care. The revised 'PAT (2009)' now includes education on clinical signs of alcohol misuse and advice on when to request a blood alcohol concentration.

Tran DT; Stone AM; Fernandez RS; Griffiths AMRD; Johnson M. Does implementation of clinical practice guidelines change nurses' screening for alcohol and other substance use? Contemporary Nurse 33(1): 13-19, 2009. (22 refs.)

Aim: To examine the effectiveness of the implementation of a clinical practice guideline on nurses screening patients for alcohol and other substance use, providing, brief interventions, and referring patients at risk for treatment. Method. Medical record audits were conducted in selected medical and surgical wards of two metropolitan hospitals in Sydney prior to and three months follow I rig the guideline implementation. Result. Seventy-nine (pre) and 84 (post) patient records were audited. There were no differences in screening rates for alcohol (28% and 29 9,6), tobacco (29% and 23%) and illicit drug use (16% and 8%) before and after implementation of the guideline. Practice implication: Factors which may have limited the effectiveness of the clinical practice guideline dissemination included design of the education program, existing level of nurses' knowledge and competence, and strategies in place to ensure sustainability of the program. We also provided suggestions for improvement of screening for alcohol and other substance use.

Turrisi R; Larimer ME; Mallett KA; Kilmer JR; Ray AE; Mastroleo NR et al. A randomized clinical trial evaluating a combined alcohol intervention for high-risk college students. Journal of Studies on Alcohol and Drugs 70(4): 555-567, 2009. (88 refs.)

Objective: The current study is a multisite randomized alcohol prevention trial to evaluate the efficacy of both a parenting handbook intervention and the Brief Alcohol Screening and Intervention for College Students (BASICS) intervention, alone and in combination, in reducing alcohol use and consequences among a high-risk population of matriculating college students (i.e., former high school athletes). Method: Students (n = 1,275) completed a series of Web-administered measures at baseline (in the summer before starting college) and follow-up (after 10 months). Students were randomized to one of four conditions: parent intervention only, BASICS only, combined (parent and BASICS), and assessment-only control. Intervention efficacy was tested on a number of outcome measures, including peak blood alcohol concentration, weekly and weekend, drinking, and negative consequences. Hypothesized mediators and moderators of intervention effect were tested. Results: The overall results revealed that the combined-intervention group had significantly lower alcohol consumption, high-risk drinking, and consequences at 10-month follow-up, compared with the control group, with changes in descriptive and injunctive peer norms mediating intervention effects. Conclusions: The findings of the present study suggest that the parent intervention delivered to students before they begin college serves to enhance the efficacy of the BASICS intervention, potentially priming students to respond to the subsequent BASICS session.

Walters ST; Vader AM; Harris TR; Jouriles EN. Reactivity to alcohol assessment measures: An experimental test. Addiction 104(8): 1305-1310, 2009. (27 refs.)

Aims: Previous research has suggested that alcohol screening and assessment may affect drinking. Design: This study was a randomized test of reactivity to alcohol assessment questionnaires among a group of heavy drinking college students. Setting and participants A total of 147 university students completed a screening questionnaire and were randomized to either immediate assessment or delayed assessment. The immediate assessment group completed a set of drinking questionnaires at baseline, 3, 6 and 12 months, while the delayed assessment group completed questionnaires only at 12 months. Measurements: Primary outcomes included overall volume of drinking, risky drinking and use of risk reduction behaviors. Findings: We found a significant effect of assessment on measures of risky drinking and risk reduction behaviors, but not on overall volume of drinking. Specifically, at 12 months, participants who had previously completed drinking assessments had a lower peak blood alcohol concentration (BAC) (d = -0.373), were more likely to report a low score on the Alcohol Use Disorders Identification Test (AUDIT; odds ratio = 2.55) and tended to use more strategies to moderate their alcohol consumption (d = 0.352). Risk reduction behaviors that were affected tended to be those that limited alcohol consumption, rather than those that minimized consequences. Conclusions: These results may have implications for the development of brief interventions.

Webb TL. Commentary on Shahab & McEwen (2009): Understanding and preventing attrition in online smoking cessation interventions: A self-regulatory (editorial) perspective. Addiction 104(11): 1805-1806, 2009. (19 refs.)

This commentary is on an article in this issue that reviews the literature on online support for smoking cessation.

Werch CE; Bian H; DiClemente CC; Moore MJ; Thombs D; Ames SC et al. A brief image-based prevention intervention for adolescents. Psychology of Addictive Behaviors 24(1): 170-175, 2010. (26 refs.)

The authors evaluated the efficacy of a brief image-based prevention intervention and assessed current drug use as a moderator of intervention effects. In a clinical trial, 416 high school-age adolescents were randomized to either the brief intervention or usual care control, with data collected at baseline and 3-month follow-up. The brief intervention consisted of a tailored in-person communication and a series of parent/guardian print materials based on the behavior-image model. Health behavior goal setting increased for participants receiving the brief intervention, with an effect size in the small range (d = 0.33). Overall effect sizes for cigarette smoking frequency and quantity and alcohol use frequency and quantity were small (ds = 0.16-0.21) and in favor of the brief intervention. However, adolescents reporting current substance use who received the brief intervention reduced their frequency and heavy use of alcohol, frequency and quantity of cigarette smoking, and reported fewer alcohol/drug problems, with larger effects ranging from small to approaching medium in size (ds = 0.32-0.43, ps < .01). This study suggests that brief image-based messages may increase health behavior goal setting and reduce substance use, particularly among drug-using older adolescents.

Werch CE; Moore MJ; Bian H; DiClemente CC; Huang IC; Ames SC et al. Are effects from a brief multiple behavior intervention for college students sustained over time? Preventive Medicine 50(1-2): 30-34, 2010. (43 refs.)

Objective. This study examined whether 3-month outcomes of a brief image-based multiple behavior intervention on health habits and health-related quality of life of college students were sustained at 12-month follow-up without further intervention. Methods. A randomized control trial was conducted with 303 undergraduates attending a public university in southeastern US. Participants were randomized to receive either a brief intervention or usual care control, with baseline, 3-month, and 12-month data collected during fall of 2007. Results. A significant omnibus MANOVA interaction effect was found for health-related quality of life, p = 0.01, with univariate interaction effects showing fewer days of poor spiritual health, social health, and restricted recent activity, p's<0.05, for those receiving the brief intervention. Significant group by time interaction effects were found for driving after drinking, p = 0.04, and moderate exercise, p = 0.04, in favor of the brief intervention. Effect sizes typically increased over time and were small except for moderate size effects for social health-related quality of life. Conclusion. This study found that 3-month outcomes from a brief image-based multiple behavior intervention for college students were partially sustained at 12-month follow-up.

Whiteside U; Cronce JM; Pedersen ER; Larimer ME. Brief motivational feedback for college students and adolescents: A harm reduction approach. Journal of Clinical Psychology 66(2): 150-163, 2010. (20 refs.)

Alcohol consumption and its attendant problems are prevalent among adolescents and young adult college students. Harm reduction has been found efficacious with heavy drinking adolescents and college students. These harm reduction approaches do not demand abstinence and are designed to meet the individual where he or she is in the change process. The authors present a case illustration of a harm reduction intervention, the Brief Alcohol Screening and Intervention for College Students (BASICS), with a heavy-drinking female college student experiencing significant problems as a result of her drinking. BASICS is conducted in a motivational interviewing style and includes cognitive-behavioral skills training and personalized feedback.

Williams EC; Lapham G; Achtmeyer CE; Volpp B; Kivlahan DR; Bradley KA. Use of an electronic clinical reminder for brief alcohol counseling is associated with resolution of unhealthy alcohol use at follow-up screening. Journal of General Internal Medicine 25(Supplement 1): 11-17, 2010. (50 refs.)

Brief alcohol counseling is a foremost US prevention priority, but no health-care system has implemented it into routine care. This study evaluated the effectiveness of an electronic clinical reminder for brief alcohol counseling ("reminder"). The specific aims were to (1) determine the prevalence of use of the reminder and (2) evaluate whether use of the reminder was associated with resolution of unhealthy alcohol use at follow-up screening. The reminder was implemented in February 2004 in eight VA clinics where providers routinely used clinical reminders. Patients eligible for this retrospective cohort study screened positive on the AUDIT-C alcohol screening questionnaire (February 2004-April 2006) and had a repeat AUDIT-C during the 1-36 months of follow-up (mean 14.5). Use of the alcohol counseling clinical reminder was measured from secondary electronic data. Resolution of unhealthy alcohol use was defined as screening negative at follow-up with a reduction in AUDIT-C scores. Logistic regression was used to identify adjusted proportions of patients who resolved unhealthy alcohol use among those with and without reminder use. Among 4,198 participants who screened positive for unhealthy alcohol use, 71% had use of the alcohol counseling clinical reminder documented in their medical records. Adjusted proportions of patients who resolved unhealthy alcohol use were 31% (95% CI 30-33%) and 28% (95% CI 25-30%), respectively, for patients with and without reminder use (p-value = 0.031). The brief alcohol counseling clinical reminder was used for a majority of patients with unhealthy alcohol use and associated with a moderate decrease in drinking at follow-up.

Wilton G; Moberg DP; Fleming MF. The effect of brief alcohol intervention on postpartum depression. American Journal of Maternal-Child Nursing 34(5): 297-302, 2009. (28 refs.)

Purpose: To report on secondary results from the Healthy Moms Study, a clinical trial to test the efficacy of brief intervention on reducing alcohol use and alcohol-related harms in postpartum women. Study Design and Methods: Data from a randomized clinical trial conducted between 2002 and 2005 with a sample of Wisconsin women was analyzed. This report presents comparison data on depressive symptomatology between postpartum women drinking above recommended levels who received a brief alcohol intervention and those who received no intervention. Results: At 6-month follow-up, there was a significant reduction in mean depression scores compared to baseline in the women who received the alcohol intervention (p < .001). There was no significant reduction in depressive symptomatology in the control group. Mean level of depression at 6 months was significantly predicted by baseline depression and the alcohol intervention (p = .018). Alcohol use at either baseline or follow-up was not a predictive factor in determining mean depressive symptomatology. Clinical Implications: The results of the Healthy Moms Study support the importance of both alcohol and depression screening during the postpartum period. Brief alcohol intervention during this time may also positively affect depressive symptomatology.