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CORK Bibliography: Brief Treatment

69 citations. September 2010 to present

Prepared: June 2011

Adey GE; Moore SC; Chestnutt IG. Dose-response expectancies for alcohol: Validation and implications for brief interventions. Drug and Alcohol Review 29(6): 662-668, 2010. (34 refs.)

Introduction and Aims. Brief interventions for alcohol problems are informed by elements of behavioural motivation theories and behaviour change models. However, motivations across drinking occasions have yet to be explored. This paper addresses this need and presents initial validity statistics for a new construct, Dose Response Expectancies for Alcohol Metrics (DREAM) that can be used to investigate expectancies across the drinking session and thus inform novel interventions. Design and Methods. Twenty-seven participants completed a test-retest reliability assessment. Hypothesised systematic relationships between the hypothetical number of drinks consumed across a drinking session and anticipated affective responses were assessed. Results. The DREAM questionnaire yielded good test-retest statistics for anticipated happiness and nausea in the hours following drinking. Consistent with hypotheses, DREAM yielded a systematic relationship between anticipated alcohol dose and affective response. Discussion and Conclusions. DREAM offers a novel means to investigate alcohol dose-response expectancies across drinking sessions and to therefore provide a theoretical platform that can be used to inform effective brief interventions for young people.

Ahacic K; Allebeck P; Thakker KD. Being questioned and receiving advice about alcohol and smoking in health care: Associations with patients' characteristics, health behavior, and reported stage of change. Substance Abuse Treatment, Prevention and Policy 5: e-article 30, 2010. (43 refs.)

Background: Alcohol habits are more rarely addressed than other health behavior topics in Swedish health care. This study examined whether differences between topics could be explained by their different associations with patient characteristics or by the differences in the prevalence of the disadvantageous health behavior, i.e., excessive alcohol use and smoking. The study moreover examined whether simply being asked questions about behavior, i.e., alcohol use or smoking, was associated with reported change. Methods: The study was based on a cross-sectional postal survey (n = 4 238, response rate 56.5 percent) representative of the adult population in Stockholm County in 2003. Retrospective self-reports were used to assess health care visits during the past 12 months, the questions and advice received there, patients characteristics, health behavior, and the present stage of change. Logistic regression analysis was used to estimate the associations among the 68 percent who had visited health care. Results: Among the health care visitors, 23 percent reported being asked about their alcohol habits, and 3 percent reported receiving advice or/and support to modify their alcohol use -fewer than for smoking, physical exercise, or diet. When regression models adjusted for patient characteristics, the differences between health behaviors in the extent of questioning and advice remained. However, when the models also adjusted for smoking and alcohol consumption there was no difference between smoking and alcohol-related advice. In fact one-third of the present smokers and two-fifths of the persons dependent on alcohol reported having receiving advice the previous 12 months. Those who reported being asked questions or receiving advice more often reported a decreased alcohol use and similarly intended to cease smoking within 6 months. Questions about alcohol use were moreover related to a later stage of stage of change independently of advice among women but not among men. Conclusions: While most patients are never addressed, many in the target groups seem to be reached anyway. Besides advice, already addressing alcohol habits appears to be associated with change. The results also indicate that gender possibly plays a role in the relationship between advice and the stage of change.

Baggett TP; Rigotti NA. Cigarette smoking and advice to quit in a national sample of homeless adults. American Journal of Preventive Medicine 39(2): 164-172, 2010. (64 refs.)

Background: Cigarette smoking is common among homeless people, but its characteristics in this vulnerable population have not been studied at a national level. Whether homeless smokers receive advice to quit from healthcare providers is also unknown. Purpose: To determine the prevalence and predictors of current cigarette smoking, smoking cessation, and receipt of clinician advice to quit in a national sample of homeless adults. Methods: This study analyzed data from 966 adult respondents to the 2003 Health Care for the Homeless User Survey, representing more than 436,000 people nationally. Using multivariable logistic regression, the independent predictors of smoking, quitting, and receiving advice to quit were identified. Analyses were conducted in 2008-2009. Results: The prevalence of current smoking was 73%. The lifetime quit rate among ever smokers was 9%. Among past-year smokers, 54% reported receiving clinician advice to quit. Factors independently associated with current smoking included out-of-home placement in childhood (AOR=2.79, 95% CI=1.03, 7.52); victimization while homeless (AOR=2.36, 95% CI=1.15, 4.83); past-year employment (AOR=2.52, 95% CI=1.13, 5.58); and prior illicit drug use (AOR=7.21, 95% CI=3.11, 16.7) or problem alcohol use (AOR=7.42, 95% CI=2.51, 21.9). Respondents with multiple homeless episodes had higher odds of receiving quit advice (AOR=2.51, 95% CI=1.30, 4.83) but lower odds of quitting (AOR=0.47, 95% CI=0.29, 0.78). Conclusions: Compared to the general population, homeless people are far more likely to smoke and much less likely to quit, even though more than half of smokers received quit advice in the past year. Interventions for homeless smokers should address the unique comorbidities and vulnerabilities of this population.

Bernstein JA; Bernstein E; Heeren TC. Mechanisms of change in control group drinking in clinical trials of brief alcohol intervention: Implications for bias toward the null. Drug and Alcohol Review 29(5): 498-507, 2010. (89 refs.)

Issues. Reductions in control group consumption over time that are possibly related to research design affect the impact of brief alcohol interventions (BAI) in clinical settings. Approach. We conducted a systematic review to identify research design factors that may contribute to control group change, strategies to limit these effects and implications for researchers. Studies with control group n > 30 were selected if they published baseline and outcome consumption data, conducted trials in clinical settings in Anglophone countries and did not censor gender or age. Key Findings. Among 38 studies cited in 20 reviews through October 2009, 16 met criteria (n = 31-370). In 54%, controls received alcohol specific handouts, advice and/or referral. Both the number and depth of assessments were highly variable. The percentage change in consumption ranged from -0.10 to -0.84 (mean -0.32), and effect size from 0.04 to 0.70 (mean 0.37). Published data were insufficient for meta-analysis. Implications. Researchers should consider strategies to reduce the impact of research design factors, such as procedures to enhance sample diversity, blind subjects to study purpose to limit social desirability bias, reduce the number and depth of instruments (assessment reactivity), and finally, analytic techniques to decrease the impact of outliers and regression to the mean. Conclusions. This review identifies problems with retrospective analysis of predictors of control group change, and underscores the need to design prospective studies to permit identification, quantification and adjustment for potential sources of bias in BAI trials.

Bernstein E; Bernstein J; Feldman J; Fernandez W; Hagan M; Mitchell P et al. The impact of screening, brief intervention and referral for treatment in emergency department patients' alcohol use: A 3-, 6-and 12-month follow-up. Alcohol and Alcoholism 45(6): 514-519, 2010. (40 refs.)

Aims: This study aims to determine the impact of Screening, Brief Intervention and Referral for Treatment (SBIRT) in reducing alcohol consumption in emergency department (ED) patients at 3, 6, and 12 months following exposure to the intervention. Methods: Patients drinking above the low-risk limits (at-risk to dependence), as defined by National Institute of Alcohol Abuse and Alcoholism (NIAAA), were recruited from 14 sites nationwide from April to August 2004. A quasi-experimental comparison group design included sequential recruitment of intervention and control patients at each site. Control patients received a written handout. The Intervention group received the handout and participated in a brief negotiated interview with direct referral for treatment if indicated. Follow-up surveys were conducted at 3, 6, and 12 months by telephone using an Interactive Voice Response (IVR) system. Results: Of the 1132 eligible patients consented and enrolled (581 control, 551 intervention), 699 (63%), 575 (52%) and 433 (38%) completed follow-up surveys via IVR at 3, 6, and 12 months, respectively. Regression analysis adjusting for the clustered sampling design and using multiple imputation procedures to account for subject attrition revealed that those receiving SBIRT reported roughly three drinks less per week than controls (B = -3.00, SE = 1.06, P < 0.05) and the level of maximum drinks per occasion was approximately three-fourths of a drink less than controls (B = -0.76, SE = 0.29, P < 0.05) at 3 months. At 6 and 12 months post-intervention, these effects had weakened considerably and were no longer statistically or substantively significant. Conclusion: SBIRT delivered by ED providers appears to have short-term effectiveness in reducing at-risk drinking, but multi-contact interventions or booster programs may be necessary to maintain long-term reductions in risky drinking.

Bernstein J; Heeren T; Edward E; Dorfman D; Bliss C; Winter M et al. A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking. Academic Emergency Medicine 17(8): 890-902, 2010. (49 refs.)

Objectives: Adolescents in their late teens and early 20s have the highest alcohol consumption in the United States; binge drinking peaks at age 21-25 years. Underage drinking is associated with many negative consequences, including academic problems and risk of intentional and unintentional injuries. This study tested the effectiveness of pediatric emergency department (PED) screening and brief intervention to reduce alcohol consumption and associated risks. Methods: A three-group randomized assignment trial was structured to test differences between intervention (I) and standard assessed control (AC) groups in alcohol consumption and alcohol-related behaviors from baseline to 12 months and to compare the AC group with a minimally assessed control (MAC) group to adjust for the effect of assessment reactivity on control group behavior. Patients aged 14-21 years were eligible if they screened positive on the Alcohol Use Disorders Identification Test (AUDIT) or for binge drinking or high-risk behaviors. The MAC group received a resource handout, written advice about alcohol-related risks, and a 12-month follow-up appointment. Patients in the AC group were assessed using standardized instruments in addition to the MAC protocol. The I group received a peer-conducted motivational intervention, referral to community resources and treatment if indicated, and a 10-day booster in addition to assessment. Measurements included 30-day self-report of alcohol consumption and alcohol-related behaviors, screens for depression and posttraumatic stress disorder, and self-report of attempts to quit, cut back, or change conditions of use, all repeated at follow-up. Motor vehicle records and medical records were also analyzed for changes from baseline to 1-year follow-up. Results: Among 7,807 PED patients screened, 1,202 were eligible; 853 enrolled (I, n = 283; AC, n = 284; MAC, n = 286), with a 12-month follow-up rate of 72%. At 12 months, more than half of enrollees in Reaching Adolescents for Prevention (RAP) attempted to cut back on drinking, and over a third tried to quit. A significantly larger proportion of the I group made efforts to quit drinking and to be careful about situations when drinking compared to AC enrollees, and there was a numerically but not significantly greater likelihood (p = 0.065) among the I group for efforts to cut back on drinking. At 3 months, the likelihood of the I group making attempts to cut back was almost triple that of ACs. For efforts to quit, it was double, and for trying to be careful about situations when drinking, there was a 72% increase in the odds ratio (OR) for the I group. Three-month results for attempts were sustained at 12 months for quit attempts and efforts to be careful. Consumption declined in both groups from baseline to 3 months to 12 months, but there were no significant between-group differences in alcohol-related consequences at 12 months or in alcohol-related risk behaviors. We found a pattern suggestive of assessment reactivity in only one variable at 12 months: the attempt to cut back (73.3% for the I group vs. 64.9% among the AC group and 54.8% among the MAC group). Conclusions: Brief motivational intervention resulted in significant efforts to change behavior (quit drinking and be careful about situations while drinking) but did not alter between-group consumption or consequences.

Bewick BM; West R; Gill J; O'May F; Mulhern B; Barkham M; Hill AJ. Providing web-based feedback and social norms information to reduce student alcohol intake: A multisite investigation. Journal of Medical Internet Research 12(5): e-article 59, 2010. (37 refs.)

Background: Unhealthy alcohol use among university students is cause for concern, yet the level of help seeking behavior for alcohol use is low within the student population. Electronic brief interventions delivered via the Internet present an alternative to traditional treatments and could enable the delivery of interventions on a population basis. Further evidence is needed of the effectiveness of Internet-delivered interventions and of their generalizability across educational institutions. Objective: Our objective was to evaluate the effectiveness across 4 UK universities of a Web-based intervention for student alcohol use. Methods: In total, 1112 participants took part. Participants were stratified by educational institution, gender, age group, year of study, and self-reported weekly consumption of alcohol and randomly assigned to either the control arm or to the immediate or delayed intervention arms. Intervention participants gained access to the intervention between weeks 1 to 7 or weeks 8 to 15, respectively. The intervention provided electronic personalized feedback and social norms information on drinking behavior accessed by logging on to a website. Participants registered interest by completing a brief screening questionnaire and were then asked to complete 4 further assessments across the 24 weeks of the study. Assessments included a retrospective weekly drinking diary, the Alcohol Use Disorders Identification Test (AUDIT), and a readiness-to-change algorithm. The outcome variable was the number of units of alcohol consumed in the last week. The effect of treatment arm and time on units consumed last week and average units consumed per drinking occasion were investigated using repeated measures multivariate analysis of covariance (MANCOVA). In addition, the data were modeled using a longitudinal regression with time points clustered within students. Results: MANCOVA revealed a main effect of time on units of alcohol consumed over the last week. A longitudinal regression model showed an effect of assessment across time predicting that participants who completed at least 2 assessments reduced their drinking. The model predicted an additional effect of being assigned to an intervention arm, an effect that increased across time. Regression analysis predicted that being male or being assigned to an intervention arm increased the odds of not completing all assessments. The number of units of alcohol consumed over the last week at registration, age, university educational institution, and readiness to change were not predictive of completion. Conclusions: Delivering an electronic personalized feedback intervention to students via the Internet can be effective in reducing weekly alcohol consumption. The effect does not appear to differ by educational institution. Our model suggested that monitoring alone is likely to reduce weekly consumption over 24 weeks but that consumption could be further reduced by providing access to a Web-based intervention. Further research is needed to understand the apparent therapeutic effect of monitoring and how this can be utilized to enhance the effectiveness of brief Web-based interventions.

Bischof G; Reinhardt S; Freyer-Adam J; Coder B; Grothues JM et al. Severity of unhealthy alcohol consumption in medical inpatients and the general population: Is the general hospital a suitable place for brief interventions? International Journal of Public Health 55(6): 637-643, 2010. (35 refs.)

Evidence for brief interventions in general hospital (GH) settings is scarce, probably due to higher rates of dependent drinkers. The present study aims to compare unhealthy drinking patterns in GH patients with the general population (GP). Sample 1 consisted of 4,075 individuals randomly drawn from registration office files, representing the non-institutionalised GP of a northern mixed rural-urban German area. Sample 2 consisted of 2,949 consecutively admitted patients from a GH covering the same area. Compared to individuals from the GP, GH patients revealed higher prevalence rates of alcohol dependence (1.3 vs. 5.5%) and alcohol abuse (1.2 vs. 2.8%), but did not differ significantly concerning at-risk drinking (5.1 vs. 6.2%). Multinomial logistic regression analysis controlling for age, sex and smoking using unrisky alcohol consumption as reference category belonging to the GH group was predictive for alcohol use disorders but not for at-risk drinking. Data show that a substantial number of individuals with unhealthy drinking patterns without alcohol use disorders can easily be accessed in GH settings if appropriate screening measures are conducted.

Blow FC; Walton MA; Murray R; Cunningham RM; Chermack ST; Barry KL et al. Intervention attendance among emergency department patients with alcohol- and drug-use disorders. Journal of Studies on Alcohol and Drugs 71(5): 713-719, 2010. (46 refs.)

Objective: The emergency department (ED) visit provides a window of opportunity for screening and linkage to services for innercity adults with substance-use disorders (SUDs). This article examines predictors of intervention attendance among ED patients who screen positive for an SUD (alcohol or other drug). Method: As part of a large randomized control trial, medical and injured patients (ages 19-60) in an inner-city ED completed a computerized screening survey. Based on random assignment, those screening positive for an SUD either were scheduled to attend a post-discharge intervention or received a referral brochure. Interventions (brief motivational intervention vs. case management intervention) focused on linking participants to substance-use treatment. Independent variables assessed included demographics, ED visit reason, health functioning, readiness to change, self-efficacy, and substance use. Intervention attendance (yes/no) was the dependent variable. Results: Overall, 957 (62.3% male; 58.3% African-American; M-age = 33.2 years) were randomized to interventions (brief motivational intervention/case management intervention) and are the focus of subsequent analyses. There were no differences in the pattern of predictors of intervention attendance for brief motivational intervention versus case management intervention. Bivariate analyses compared those who attended the post-ED intervention with those who did not attend. Participants who attended the intervention (50%) were significantly more likely to be older, unmarried, insured, unemployed, and in the "action" stage of change. Conclusions: The present findings highlight the relative importance of assessing and attending to readiness to change as well as demographic factors such as insurance and employment (and potentially associated barriers) in ED-based screening, brief intervention, and referral to treatment protocols.

Brown N; Newbury-Birch D; Mcgovern R; Phinn E; Kaner E. Alcohol screening and brief intervention in a policing context: A mixed methods feasibility study. Drug and Alcohol Review 29(6): 647-654, 2010. (30 refs.)

Introduction and Aims. There is a strong association between alcohol and offending behaviour and 25% of police time involves alcohol-related incidents. This pilot study aimed to investigate the feasibility of delivering alcohol screening and brief intervention (ASBI) to individuals arrested for offences linked to drinking behaviour. Design and Methods. Participants were detainees arrested for public order or assault offences in one North East police station in England. Following a 2 h training session, 10 Detention Officers (DOs) conducted ASBI over 3 months during routine police work. In-depth interviews with the DOs provided further details about the acceptability of ASBI procedures. Results. Of 704 target arrestees, 229 (33%) agreed to participate in the study. Most were male (81%), white British (95%) and under the age of 30 (62%). Fifty-nine per cent screened positively for an alcohol use disorder (50% were hazardous, 15% harmful and 35% dependent drinkers), although 23% detainees either refused or were unable to complete the screening tool. Of the 134 participants that screened positively, 98% were willing to receive brief intervention. DOs reported mixed views about ASBI; while half were positive about the process the remaining DOs expressed reservations about the appropriateness of the policing context for ASBI. Discussion and Conclusions. Despite limited training, DOs were able to deliver ASBI during routine police work. These findings provide a promising platform for future evaluative research on brief intervention outcomes in this setting. However, the issue of coercion needs to be explored more fully with both detainees and DOs.

Broyles LM; Gordon AJ. SBIRT implementation: Moving beyond the interdisciplinary rhetoric. (editorial). Substance Abuse 31(4): 221-223, 2010. (12 refs.)

Bryant J; Bonevski B; Paul C; O'Brien J; Oakes W. Delivering smoking cessation support to disadvantaged groups: A qualitative study of the potential of community welfare organizations. Health Education Research 25(6): 979-990, 2010. (43 refs.)

Reaching disadvantaged groups for smoking cessation represents a significant challenge. Not-for-profit community service organizations (CSOs) represent a promising setting for the delivery of quit smoking support to disadvantaged smokers. However, their potential has not yet been explored. This qualitative study examined the acceptability of community service-delivered smoking cessation care. In-depth interviews and focus groups were conducted with 8 managers, 35 staff and 32 clients of CSOs between December 2008 and March 2009 in New South Wales, Australia. Discussions were audiotaped, transcribed and analysed using thematic analysis techniques. Quantitative surveys were also conducted to explore preferences for cessation support. Results: showed that the acceptability of providing and receiving cessation support in the community service setting was high. Staff perceived the provision of quit support to be compatible with their role but reported barriers to providing care including competing priorities, insufficient resources and inadequate staff training. Brief intervention approaches were preferred by managers and staff, while financial incentives and access to free or subsidized nicotine replacement therapy (NRT) were desired by clients. The community service setting represents a promising access point for engaging disadvantaged smokers for cessation and further research exploring the effectiveness of support delivered in this setting is clearly warranted.

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

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

Cherpitel CJ; Korcha RA; Moskalewicz J; Swiatkiewicz G; Ye Y; Bond J. Screening, brief intervention, and referral to treatment (SBIRT): 12-Month outcomes of a randomized controlled clinical trial in a Polish emergency department. Alcoholism: Clinical and Experimental Research 34(11): 1922-1928, 2010. (23 refs.)

Background: A randomized controlled trial of screening, brief intervention, and referral to treatment (SBIRT) among at-risk (based on average number of drinks per week and drinks per drinking day) and dependent drinkers was conducted in an emergency department (ED) among 446 patients 18 and older in Sosnowiec, Poland. Methods: Patients were recruited over a 23-week period (4:00 pm to 12:00 midnight) and randomized to 1 of 3 conditions: screened-only (n = 147), assessed (n = 152), and intervention (n = 147). Patients in the assessed and intervention conditions were blindly reassessed via a telephone interview at 3 months, and all 3 groups were assessed at 12 months (screened-only = 92, assessed = 99, and intervention = 87). Results: No difference was found across the 3 conditions in at-risk drinking at 12 months, as the primary outcome variable, or in decrease in the number of drinks per drinking day, with all 3 groups showing a significant reduction in both. Significant declines between baseline and 12 months in secondary outcomes of the RAPS4, number of drinking days per week, and the maximum number of drinks on an occasion were seen only for the intervention condition, and in negative consequences for both the assessment and intervention conditions. Conclusions: Data suggest that improvements in drinking outcomes found in the assessment condition were not because of assessment reactivity, with both the screened and intervention conditions demonstrating greater (although nonsignificant) improvement than the assessed condition. Only those in the intervention condition showed significant improvement in all outcome variables from baseline to 12-month follow-up. Although group by time interaction effects were not found to be significant, these findings suggest that declines in drinking measures for those receiving a brief intervention can be maintained at long-term follow-up.

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

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

Corrigan JD; Bogner J; Hungerford DW; Schomer K. Screening and brief intervention for substance misuse among patients with traumatic brain injury. (review). Journal of Trauma, Injury, Infection and Critical Care 69(3): 722-726, 2010. (52 refs.)

Background: Research on screening and brief interventions (SBI) for substance misuse has demonstrated efficacy in a variety of medical settings including emergency departments and trauma centers. However, SBI has not yet been evaluated for persons who incur traumatic brain injury (TBI)-a substantial patient subpopulation for whom substance-related problems are frequent. To examine whether research on SBI efficacy and effectiveness can be generalized to persons with TBI, a systematic review of the literature was conducted to analyze how TBI populations were included in previous studies and whether there was evidence of differential outcomes. Methods: Peer-reviewed studies that investigated SBI for misuse of alcohol or other drugs, that were implemented in emergency departments or trauma centers, and that were published in English since 1985 were examined. From 174 articles initially identified, 28 studies were determined to meet inclusion criteria. Results: The review revealed that research conducted on SBI for injury populations systematically neglected patients with more severe TBI and those who presented with sufficient confusion that they could not provide informed consent. Conclusions: Future effectiveness studies should examine barriers to routine clinical use of SBI and evaluate the generalizability of expected benefits to the full spectrum of injured patients. Researchers should also develop and evaluate systematic accommodations for persons with neurobehavioral impairments who would benefit from brief interventions for substance misuse.

Crawford MJ; Csipke E; Brown A; Reid S; Nilsen K; Redhead J et al. The effect of referral for brief intervention for alcohol misuse on repetition of deliberate self-harm: An exploratory randomized controlled trial. Psychological Medicine 40(11): 1821-1828, 2010. (31 refs.)

Background. Referral for brief intervention among people who misuse alcohol is reported to be effective but its impact among those who present to services following deliberate self-harm (DSH) has not been examined. Method. Consecutive patients who presented to an Emergency Department (ED) following an episode of DSH were screened for alcohol misuse. Those found to be misusing alcohol were randomly assigned to brief intervention plus a health information leaflet or to a health information leaflet alone. The primary outcome was whether the patient reattended an ED following a further episode of DSH during the subsequent 6 months. Secondary outcomes were alcohol consumption, mental health and satisfaction with care measured 3 and 6 months after randomization. Results. One hundred and three people took part in the study. Follow-up data on our primary outcome were obtained for all subjects and on 63% for secondary outcomes. Half those referred for brief intervention received it. Repetition of DSH was strongly associated with baseline alcohol consumption, but not influenced by treatment allocation. There was a non-significant trend towards the number of units of alcohol consumed per drinking day being lower among those randomized to brief intervention. Conclusions. Referral for brief intervention for alcohol misuse following an episode of DSH may not influence the likelihood of repetition of self-harm. Longer-term interventions may be needed to help people who deliberately harm themselves and have evidence of concurrent alcohol misuse.

Daeppen JB; Bertholet N; Gaume J. What process research tells us about brief intervention efficacy. (review). Drug and Alcohol Review 29(6): 612-616, 2010. (13 refs.)

Issue. This article explores mechanisms of the efficacy of brief intervention (BI). Approach. We conducted a BI trial at the emergency department of the Lausanne University Hospital, of whom 987 at-risk drinkers were randomised into BI and control groups. The overall results demonstrated a general decrease in alcohol use with no differences across groups. The intention to change was explored among 367 patients who completed BI. Analyses of 97 consecutive tape-recorded sessions explored patient and counsellor talks during BI, and their relationship to alcohol use outcome. Key Findings. Evaluation of the articulation between counsellor behaviours and patient language revealed a robust relationship between counsellor motivational interviewing (MI) skills and patient change talk during the intervention. Further exploration suggested that communication characteristics of patients during BI predicted changes in alcohol consumption 12 months later. Moreover, despite systematic training, important differences in counsellor performance were highlighted. Counsellors who had superior MI skills achieved better outcomes overall, and maintained efficacy across all levels of patient ability to change, whereas counsellors with inferior MI skills were effective mostly with patients who had higher levels of ability to change. Finally, the descriptions of change talk trajectories within BI and their association with drinking 12 months later showed that final states differed from initial states, suggesting an impact resulting from the progression of change talk during the course of the intervention. Implication. These findings suggest that BI should focus on the general MI attitude of counsellors who are capable of eliciting beneficial change talk from patients.

Davoudi M; Rawson RA. Screening, brief intervention, and referral to treatment (SBIRT) initiatives in California: Notable trends, challenges, and recommendations. Journal of Psychoactive Drugs Supplement 6: 239-248, 2010. (41 refs.)

It is estimated that most substance users are not substance-dependent, yet they misuse alcohol and/or other drugs on a regular basis and are at risk in terms of health and further dependency. Screening, brief intervention, and referral to treatment (SBIRT) is an intervention model that identifies at-risk substance users and then provides them a patient-centered intervention. A review of selected SBIRT initiatives in California revealed a number of positive trends: the involvement of healthcare settings in substance use prevention; an increase in the number of providers trained in substance use screening; greater use of standardized screening tools; indications of reduced substance use by individuals receiving SBIRT; and the establishment of statewide policy initiatives. Despite these positive trends, SBIRT projects continue to face challenges related to leadership support, staff resources, integration into ongoing protocols, screening, client retention, client confidentiality, and data collection. To assist projects to overcome these challenges and to ensure future adoption and sustainability of SBIRT, state and local authorities can benefit from (a) promoting SBIRT among healthcare leaders, (b) identifying and sharing successful SBI RT "models," (c) providing tailored trainings and ongoing technical assistance, (d) educating providers about patient confidentiality and reimbursement laws and regulations, and (e) creating benchmark measures and data collection protocols.

Desy PM; Howard PK; Perhats C; Li SL. Alcohol screening, brief intervention, and referral to treatment conducted by emergency nurses: An impact evaluation. Journal of Emergency Nursing 36(6): 538-545, 2010. (30 refs.)

Introduction: In a quasi-experimental study, control and intervention group outcomes were compared following implementation of alcohol screening, brief intervention, and referral to treatment (SBIRT) by emergency nurses. The primary hypothesis was: Trauma patients who participate in nurse-delivered ED SBIRT will have greater reductions in alcohol consumption and fewer alcohol-related incidents than those who do not. Methods: Patients were screened for alcohol use and those with risky drinking were randomly assigned to either the intervention or usual care group. Those in the intervention group received a brief motivational intervention and referral to appropriate follow-up services. Using medical and driving history records, subjects' alcohol consumption, alcohol-related traffic incidents, repeat injuries, and repeat ED visits were compared between groups at baseline and three-month follow-up. Results: Alcohol consumption decreased by 70% in the intervention group compared to 20% in the usual care group. Drinking frequency also decreased in both groups. Fewer patients from the intervention group (20%) had recurring ED visits compared to patients in the usual care group (31%). Discussion: The SBIRT procedure can impact alcohol consumption and potentially reduce injuries and ED visits when successfully implemented by staff nurses in the emergency department environment. Further research is needed to improve follow-up methods in this hard to reach, mobile patient population.

Dhital R; Whittlesea CM; Norman IJ; Milligan P. Community pharmacy service users' views and perceptions of alcohol screening and brief intervention. Drug and Alcohol Review 29(6): 596-602, 2010. (28 refs.)

Introduction and Aims. Community pharmacists have the potential to deliver alcohol screening and brief interventions (SBI) to pharmacy users. However, little is known if SBI would be utilised and views of people who might use the service. Therefore, the aim was to investigate potential barriers and enablers of pharmacy SBI. Design and Methods. Purposive sampling was used to select four pharmacies within the London borough of Westminster, UK. Semistructured interview schedule recorded participants' views of pharmacy SBI. The Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) was incorporated to record views of high and low-risk drinkers. Categorical data were analysed and content analysis undertaken. Results. Of the 237 participants (149 female) approached 102 (43%) agreed to be interviewed (63 female). Of these 98 completed AUDIT-C, with 51 (52%) identified as risky drinkers. Risky drinkers were significantly identified among the younger age group (chi 2 = 11.03, P = 0.004), professional occupations (chi 2 = 10.41, P = 0.015), with higher qualifications (chi 2 = 10.46, P = 0.033), were least frequent visitors to a pharmacy (chi 2 = 11.58, P = 0.021) and more frequently identified in multiple pharmacy establishments than independents (chi 2 = 8.52, P = 0.004). Most were willing to discuss drinking (97, 96%) and accept written information (99, 98%). Accessibility and anonymity were reported as positive aspects and concerns were expressed about lack of privacy and time (pharmacist and user). Discussion and Conclusions. This study reports the first results of pharmacy users' views on SBI. Regardless of drinking status, most were willing to utilise the service and positive about pharmacists' involvement.

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

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

DiStefano G; Hohman M. Selecting strategic counseling interventions for DUI clients. Journal of Social Work Practice in the Addictions 10(2): 180-196, 2010

Multiple driving under the influence (DUI) offenders present to DUI programs with a variety of needs, including alcohol and other drug use disorders, mood disorders, and psychosocial stressors. This article describes the paradigm developmental model of treatment (PDMT), developed for use with multiple DUI offenders along with accompanying scale and manualized brief interventions. Psychometrics of the PDMT scale are reported elsewhere, but this article describes a PDMT scale revalidation and application to 162 DUI clients. Four case examples are presented regarding the use of the scale by counselors in client assessment and intervention, demonstrating treatment matching for individual client counseling sessions.

D'Onofrio G; Degutis LC. Integrating Project ASSERT: A screening, intervention, and referral to treatment program for unhealthy alcohol and drug use into an urban emergency department. Academic Emergency Medicine 17(8): 903-911, 2010. (40 refs.)

Objectives: The objective was to evaluate the effects of Project Alcohol and Substance Abuse Services Education and Referral to Treatment (ASSERT), an emergency department (ED)-based screening, brief intervention, and referral to treatment program for unhealthy alcohol and other drug use. Methods: Health promotion advocates (HPAs) screened ED patients for alcohol and/or drug problems 7 days a week using questions embedded in a general health questionnaire. Patients with unhealthy drinking and/or drug use received a brief negotiation interview (BNI), with the goal of reducing alcohol/drug use and/or accepting a referral to a specialized treatment facility (STF), depending on severity of use. Patients referred to an STF were followed up at 1 month by phone or contact with the STF to determine referral completion and enrollment into the treatment program. Results: Over a 5-year period (December 1999 through December 2004), 22,534 adult ED patients were screened. A total of 10,246 (45.5%) reported alcohol consumption in the past 30 days, of whom 5,533 (54%) exceeded the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for low-risk drinking. Use of at least one illicit drug was reported by 3,530 patients (15.7%). Over one-fourth of screened patients received BNIs (6,266, or 27.8%). Of these, 3,968 (63%) were referred to an STF. Eighty-three percent of patients were followed at 1 month, and 2,159 (65%) had enrolled in a program. Patients who received a direct admission to an STF were 30 times more likely to enroll than those who were indirectly referred (odds ratio = 30.71; 95% confidence interval = 18.48 to 51.04). After 3 years, funding for Project ASSERT was fully incorporated into the ED budget. Conclusions: Project ASSERT has been successfully integrated into an urban ED. A direct, facilitated referral for patients with alcohol and other drug problems results in a high rate of enrollment in treatment programs.

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

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

Field CA; Baird J; Saitz R; Caetano R; Monti PM. The mixed evidence for brief intervention in emergency departments, trauma care centers, and inpatient hospital settings: What should we do? (review). Alcoholism: Clinical and Experimental Research 34(12): 2004-2010, 2010. (38 refs.)

Background: This qualitative review is based on a symposia presented at the 2009 annual conference of the Research Society on Alcoholism (Baird et al., 2009; Field et al., 2009; Monti et al., 2009; Saitz et al., 2009a). The purpose is to describe the mixed evidence supporting brief interventions in the emergency department, trauma care, and in-patient medical care settings; examine potential moderators of treatment outcome in light of the mixed evidence; and identify methods to move the research and practice of brief interventions beyond their current state. Methods: By drawing upon existing reviews and selected individual studies, we provide examples that reflect the current complexity of research in this area and propose steps for advancing the field. Results: Emergency departments, inpatient hospital settings, and trauma care settings represent three unique contexts within which brief interventions have been tested. While the general efficacy of brief alcohol interventions in these settings has been recognized, the evidence is increasingly mixed. Recent studies investigating potential moderators of treatment outcomes suggest that a more sophisticated approach to evaluating the effectiveness of brief interventions across varying patient populations is needed to further understand its effectiveness. Conclusions: Current dissemination efforts represent a significant advance in broadening the base of treatment for alcohol problems by providing an evidence-based intervention in health care settings and should not be curtailed. However, additional research is required to enhance treatment outcomes, refine current practice guidelines, and continue to bridge the gap between science and practice. Given the current state of research, a multisetting clinical trial is recommended to account for potential contextual differences while controlling for study design.

Field CA; Caetano R. The effectiveness of brief intervention among injured patients with alcohol dependence: Who benefits from brief interventions? Drug and Alcohol Dependence 111(1-2): 13-20, 2010. (60 refs.)

Background: Research investigating the differential effectiveness of Brief Motivational Interventions (BMIs) among alcohol-dependent and non-dependent patients in the medical setting is limited. Clinical guidelines suggest that BMI is most appropriate for patients with less severe alcohol problems. As a result, most studies evaluating the effectiveness of BMI have excluded patients with an indication of alcohol dependence. Methods: A randomized controlled trial of brief intervention in the trauma care setting comparing BMI to treatment as usual plus assessment (TAU+) was conducted. Alcohol dependence status was determined for 1336 patients using DSM-IV diagnostic criteria. The differential effectiveness of BMI among alcohol-dependent and non-dependent patients was determined with regard to volume per week, maximum amount consumed, percent days abstinent, alcohol problems at 6 and 12 months follow-up. In addition, the effect of BMI on dependence status at 6 and 12 months was determined. Results: There was a consistent interaction between BMI and alcohol dependence status, which indicated significantly higher reductions in volume per week at 6 and 12 months follow-up (beta = -.56, p = .03, beta = -.63, p = .02, respectively), maximum amount at 6 months (beta = -.31, p = .04), and significant decreases in percent days abstinent at 12 months (beta = .11, p = .007) and alcohol problems at 12 months (beta = -2.7, p(12) = .04) among patients with alcohol dependence receiving BMI. In addition, patients with alcohol dependence at baseline that received BMI were .59 (95% CI = .39-.91) times less likely to meet criteria for alcohol dependence at six months. Conclusions: These findings suggest that BMI is more beneficial among patients with alcohol dependence who screen positive for an alcohol-related injury.

Gibbons CJ; Nich C; Steinberg K; Roffman RA; Corvino J; Babor TF et al. Treatment process, alliance and outcome in brief versus extended treatments for marijuana dependence. Addiction 105(10): 1799-1808, 2010. (49 refs.)

Aims: The Marijuana Treatment Project, a large multi-site randomized clinical trial, compared a delayed treatment control condition with a brief (two-session) and extended (nine-session) multi-component treatment among 450 marijuana-dependent participants. In this report we present treatment process data, including the fidelity of treatment delivery in the three community-based treatment settings as well as the relationships between treatment process and outcome. Design: Independent evaluations of clinician adherence and competence ratings were made based on 633 videotaped sessions from 163 participants. Relationships between clinician adherence and competence, ratings of the working alliance and marijuana treatment outcomes were evaluated. Findings: Protocol treatments were implemented with strong fidelity to manual specifications and with few significant differences in adherence and competence ratings across sites. In the brief two-session treatment condition, only the working alliance was associated significantly with frequency of marijuana use, but in the extended treatment therapist ratings of working alliance predicted outcomes, as did the interaction of alliance and curvilinear adherence. Conclusions: Behavioral treatments for marijuana use were delivered in community settings with good fidelity. Participant and therapist working alliance scores were associated significantly with improved marijuana use outcomes in a brief behavioral treatment for adults with marijuana dependence. In extended treatment the therapist ratings of working alliance were associated with more positive outcome. However, in that treatment there was also a significant interaction between alliance and curvilinear adherence.

Gordon JS; Andrews JA; Crews KM; Payne TJ; Severson HH; Lichtenstein E. Do faxed quitline referrals add value to dental office-based tobacco-use cessation interventions? Journal of The American Dental Association 141(8): 1000-1007, 2010. (24 refs.)

Background. The Ask, Advise, Refer (AAR) model of intervening with patients who use tobacco promotes a brief office-based intervention plus referral to a tobacco quitline. However, there is little evidence that this model is effective. The primary aim of this study was to evaluate the effects on patients' tobacco use of two levels of a dental office-based intervention compared with usual care. Methods. The, authors randomly assigned 68 private dental clinics to one of three conditions: 5 As (Ask, Advise, Assess, Assist, Arrange); 3 As (AAR model); or usual care, and they enrolled 2,160 participants. Results. At the 12-month assessment, compared with those in usual care, participants in the two intervention conditions combined were more likely to report cessation of tobacco use, as measured by nine-month prolonged abstinence (3 percent versus 2 percent; F-1,F-66 = 3.97, P < .10) and 12-month point prevalence (12 percent versus 8 percent; F-1,F-66 = 7.32, P < .01). There were no significant differences between participants in the clinics using the 5 As and 3 As strategies. Conclusions. The results of this study are inconclusive as to whether referrals to a quitline add value to brief dental office based interventions. Patients receiving telephone counseling quit tobacco use at higher rates, but only a small percentage of those proactively referred actually received counseling. Clinical Implications. The results confirm those of previous research: that training dental practitioners to provide brief tobacco-use cessation advice and assistance results in a change in their behavior, and that these practitioners are effective in helping their patients to quit using tobacco.

Graham LJC; Mackinnon D. Grasping the thistle: The role of alcohol brief interventions in Scottish alcohol policy. (review). Drug and Alcohol Review 29(6): 603-607, 2010. (35 refs.)

Issue. Scotland has experienced a substantial rise in alcohol-related harm, which is now one of the biggest public health challenges it faces. Approach. Alcohol problems in Scotland are described along with national alcohol policy response in addressing them. The role of a program of Alcohol Brief Interventions is discussed therein. Key Findings. In Scotland, considerable proportions of the population are drinking hazardously or harmfully, common across different age and socioeconomic groups. Rising consumption has been set in wider environmental changes with alcohol becoming more available and affordable. Scotland has had one of the fastest growing chronic liver disease mortality rates in the world at a time when rates in most of Western Europe are falling. Scotland's alcohol policy has an explicit aim to reduce population consumption and includes legislative measures to tackle price and availability. A national program to deliver Alcohol Brief Interventions for hazardous drinkers is a key plank of this wider strategy. A portfolio of studies will monitor and evaluate national policy and, through contribution analysis, describe the role Alcohol Brief Interventions play in reducing alcohol misuse. Implications. Effective alcohol policy recognises that determinants of health not only lie at individual level, but include wider social, environmental and economic factors. Scotland's policy is addressing these determinants with both population-based and population-targeted interventions. Conclusion. Scotland has a serious problem with alcohol. A comprehensive, evidence-based, resourced alcohol policy is being implemented, which will need continual review to ensure it remains anchored in evidence while maintaining its ambition.

Griffiths M; Kidd SA; Pike S; Chan J. The tobacco addiction recovery program: Initial outcome findings. Advances in Psychiatric Nursing 24(4): 239-246, 2010. (28 refs.)

Tobacco addiction is a major cause of excess mortality among individuals with severe mental illness (SMI). This study examined the impact of a brief group intervention developed for individuals with SMI that integrates evidence-based and recovery-oriented strategies to address tobacco addiction. The intervention was found to significantly decrease tobacco use and dependence and increase participants' sense of self-efficacy with respect to resisting the urge to smoke. These preliminary findings indicate that the Tobacco Addiction Recovery Program intervention is an effective, recovery-oriented intervention for tobacco addiction.

Grossbard JR; Mastroleo NR; Kilmer JR; Lee CM; Turrisi R; Larimer ME et al. Substance use patterns among first-year college students: Secondary effects of a combined alcohol intervention. Journal of Substance Abuse Treatment 39(4): 384-390, 2010. (32 refs.)

This study explored secondary effects of a multisite randomized alcohol prevention trial on tobacco, marijuana and other illicit drug use among a sample of incoming college students who participated in high school athletics. Students (n = 1,275) completed a series of Web-administered measures at baseline during the summer before starting college and 10 months later. Students were randomized to one of four conditions a parent-delivered intervention, a brief motivation enhancement intervention (Brief Alcohol Screening and Intervention for College Students [BASICS]) a condition combining the parent intervention and BASICS, and assessment-only control A series of analyses of variance evaluating drug use outcomes at the 10-month follow-up assessment revealed significant reductions in marijuana use among students who received the combined intervention compared to the BASICS-only and control groups. No other significant differences between treatment conditions were found for tobacco or other illicit drug use Our findings suggest the potential utility of targeting both alcohol and marijuana use when developing peer- and parent-based interventions for students transitioning to college. Clinical implications and future research directions are considered.

Grossberg P; Halperin A; Mackenzie S; Gisslow M; Brown D; Fleming M. Inside the physician's black bag: Critical ingredients of brief alcohol interventions. Substance Abuse 31(4): 240-250, 2010. (30 refs.)

Brief primary care interventions structured around patient workbooks have been shown to be effective in modifying hazardous drinking behavior. However, the critical ingredients of such interventions are not well understood, possibly contributing to their underutilization. Seventeen campus-based clinicians trained in a brief, workbook-based alcohol intervention participated in a qualitative study to identify the most promising clinician-patient interaction components within this shared approach, utilizing a focus group with the clinicians and ranking of the 24 workbook ingredients. Based on the clinicians' collective experience, consensus emerged around the perceived strength of 5 main components: (1) providing a summary of the patient's drinking level, (2) discussing drinking likes and dislikes, (3) discussing life goals, (4) encouraging a risk-reduction agreement, and (5) asking patients to track their drinking (on cards provided for this purpose). This is the first paper to examine primary care physician perspectives on potentially critical components of effective brief alcohol intervention.

Hartzler B; Beadnell B; Rosengren DB; Dunn C; Baer JS. Deconstructing proficiency in motivational interviewing: Mechanics of skilful practitioner delivery during brief simulated encounters. Behavioural and Cognitive Psychotherapy 38(5): 611-628, 2010. (59 refs.)

Background: Proficient delivery of motivational interviewing (MI) is often determined by global rating of relational elements or cumulative tallies of technical elements. Yet limited empirical evidence exists to clarify how relational and technical elements are associated, or if rates of skill indices and their constituent technical elements vary within a clinical encounter. Aims: This study sought to document temporal variance in rates of MI skill indices and their constituent technical elements during brief clinical encounters with a standardized patient wherein delivery was "MI-proficient", and to distinguish those temporal patterns from those observed in encounters with "MI-inconsistent" delivery. Method: Data were accessed from a large MI training trial wherein relational and technical elements of MI delivery were scored for 503 recordings of a simulated 20-minute clinical encounter. Notably, independent raters tallied technical elements in 5-minute segments, allowing evaluation of potential variance among the encounter's quartile intervals. Global ratings of MI spirit identified subsets of recordings with MI-proficient (n = 49) and MI-inconsistent (n = 43) delivery for stratified analyses. Results: Analyses contrast temporal trajectories of technical aspects of MI-proficient and MI-inconsistent delivery, with the former characterized by: 1) elicitation and reflective listening as primary opening strategies; 2) increased depth of reflective listening as a predominant strategy in subsequent, focused therapeutic discussion; and 3) increased use of elicitation and information provision in change planning as the encounter approached conclusion. Conclusions: Findings are generally consistent with seminal descriptions of MI (Miller and Rollnick, 1991, 2002), and document temporal aspects of skilful MI delivery in brief encounters.

Haug S; Meyer C; Ulbricht S; Gross B; Rumpf HJ; John U. Need for cognition as a predictor and a moderator of outcome in a tailored letters smoking cessation intervention. Health Psychology 29(4): 367-373, 2010. (28 refs.)

Objective: To analyze whether baseline need for cognition (NFC) was a predictor or a moderator of treatment outcome in a tailored letters intervention for smoking cessation. Design: A total of 1,499 daily smokers were recruited from general medical practices in Germany within a quasi-randomized trial testing the efficacies of two brief interventions for smoking cessation: (a) computer-generated tailored letters and (b) physician-delivered brief counseling versus assessment-only. For this study, we used data from 1,097 daily smokers who were assigned to the tailored letters or the assessment-only condition. Main Outcome Measures: self-reported 6-month prolonged abstinence from tobacco smoking assessed at 12-, 18-, and 24-month follow-ups, and smoking cessation self-efficacy assessed at 6- and 24-month follow-ups. Results: Baseline NFC predicted 6-month prolonged smoking abstinence (p = .01) and smoking cessation self-efficacy (p < .01). When compared to assessment only, NFC did not moderate the effect of the tailored letters intervention on smoking abstinence (p > .05) but on smoking cessation self-efficacy (p = .05). Tailored letters resulted in higher smoking cessation self-efficacy only for persons with higher NFC. Conclusion: Higher levels of NFC are required to increase smoking cessation self-efficacy in computer-tailored interventions for smoking cessation. Considering an individual's NFC might improve the efficacy of written interventions for smoking cessation.

Hayes-Roth B; Saker R; Amano K. Automating individualized coaching and authentic role-play practice for brief intervention training. Methods of Information In Medicine 49(4): 406-411, 2010. (16 refs.)

Objectives: Brief intervention helps to reduce alcohol abuse, but there is a need for accessible, cost-effective training of clinicians. This study evaluated STAR Workshop, a web-based training system that automates efficacious techniques for individualized coaching and authentic role-play practice. Methods: We compared STAR Workshop to a web-based, self-guided e-book and a no-treatment control, for training the Engage for Change (E4C) brief intervention protocol. Subjects were medical and nursing students. Brief written skill probes tested subjects' performance of individual protocol steps, in different clinical scenarios, at three test times: pre-training, post-training, and post-delay (two weeks). Subjects also did live phone interviews with a standardized patient, post-delay. Results: STAR subjects performed significantly better than both other groups. They showed significantly greater improvement from pre-training probes to post-training and post-delay probes. They scored significantly higher on post-delay phone interviews. Conclusion: STAR Workshop appears to be an accessible, cost-effective approach for training students to use the E4C protocol for brief intervention in alcohol abuse. It may also be useful for training other clinical interviewing protocols.

Heather N. Breaking new ground in the study and practice of alcohol brief interventions. Drug and Alcohol Review 29(6): 584-588, 2010. (40 refs.)

This article amplifies the decision to subtitle the INEBRIA2009 Conference 'Breaking New Ground'. The effectiveness of screening and brief intervention (SBI) for hazardous and harmful drinking is now well-established for primary health care and is promising for other medical settings. In addition, significant advances in the implementation of SBI are being made in various parts of the world. But, because of the need to establish efficacy and effectiveness, and perhaps too because of a preoccupation with meta-analysis of existing research findings, progress in other aspects of the theory and practice of SBI has been slower than ideal. There may also be a risk of complacency in the SBI field of study. For these reasons and others, the Conference Organizing Committee decided to focus the conference and invite presentations on a number of specific topics in the field of alcohol SBI and these are listed here followed by a discussion of other areas in which new ground needs to be broken.

Heather N; Kaner E. Special issue on alcohol brief interventions: Breaking new ground. Introduction. Drug and Alcohol Review 29(6): 581-583, 2010. (17 refs.)

Hedman E; Riis U; Gabre P. The impact of behavioural interventions on young people's attitudes toward tobacco use26. Oral Health & Preventive Dentistry 8(1): 23-32, 2010. (26 refs.)

Purpose: The objective of the present study was to study the ability to influence young at-risk patients attitudes toward tobacco use through two intervention methods that were performed by dental health professionals. Materials and Methods: Two inteiventions, a brief individual motivational interview and an adapted school lecture, were studied, and both were compared with a control group. Before and after interventions, a questionnaire was used. Patients born in 1989 and 1992 who were judged by the dental personnel as potentially at risk for dental diseases, a total of 301 individuals, were included. Results: Both before and after interventions, the results showed a generally negative attitude towards tobacco use. A majority of the participants were positive towards measures that were taken to control the spread of tobacco use, younger participants (born 1992) to a greater extent (73%) than the older participants (born 1989) (54%) Important factors that kept the participants away from tobacco use were the harmful effects and the approaches of parents and friends. The older participants believed to a greater extent that they would try smoking as adults. No change in tobacco use was registered after intervention, although the participants reported an increased use among friends. Conclusions: The two pedagogical methods that were used in the present study influenced the young people's attitudes towards tobacco use only to a small extent. However, the period between 12 and 15 years old seems to provide a good opportunity to influence attitudes towards tobacco. The adolescents' demand for interactive learning and their development of attitudes and tobacco use habits in relation to family and friends provide opportunities to use new pedagogical models.

Kaner E. NICE work if you can get it: Development of national guidance incorporating screening and brief intervention to prevent hazardous and harmful drinking in England. Drug and Alcohol Review 29(6): 589-595, 2010. (54 refs.)

This paper describes the development of the first set of national guidance focused on the prevention of alcohol problems in England. These guidelines were produced by the National Institute for Health and Clinical Excellence (NICE) working with a multidisciplinary program development group of scientists, practitioners and lay members. In this work, screening and brief alcohol interventions represent a key element of a comprehensive public health strategy to prevent alcohol-related risk and harm across the population. The first controlled trials of brief alcohol intervention were published in the mid to late 1980's and there are now around 60 published trials in this field. After 25 years of accumulated evidence in this field, brief alcohol interventions have yet to make a significant impact on routine clinical practice. While it is imperative to have good science to make the case for brief intervention delivery, this work is in vain if practitioners are unwilling or unable to use these interventions with their patients. Evidence from the alcohol field and other clinical areas indicates that national prioritisation of brief alcohol intervention activity, by a body, such as NICE, is likely to be a key driver of implementation by practitioners. This paper summarises a suite of complementary system-level and practice recommendations, which were published by NICE in June 2010, and considers their likely impact on screening and brief alcohol in England.

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

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

Kim JS; Smock S; Trepper TS; McCollum EE; Franklin C. Is solution-focused brief therapy evidence-based? Families In Society 91(3): 300-306, 2010. (66 refs.)

This article describes the process of having solution-focused brief therapy (SFBT) be evaluated by various federal registries as an evidence-based practice (EBP) intervention. The authors submitted SFBT for evaluation for inclusion on three national EBP registry lists in the United States: the Substance Abuse and Mental Health Services Administration (SAMHSA), What Works Clearinghouse (WWC), and Office of Juvenile Justice and Delinquency Prevention (OJJDP). Results of our submission found SFBT was not reviewed by SAMHSA and WWC because it was not prioritized highly enough for review, but it was rated as "promising" by OJJDP. Implications for practitioners and recommendations regarding the status of SFBT as an EBP model are discussed.

Klein B; White A; Kavanagh D; Shandley K; Kay-Lambkin F; Proudfoot J et al. Content and functionality of alcohol and other drug websites: Results: of an online survey. Journal of Medical Internet Research 12(5): e-article 51, 2010. (23 refs.)

Background: There is a growing trend for individuals to seek health information from online sources. Alcohol and other drug (AOD) use is a significant health problem worldwide, but access and use of AOD websites is poorly understood. Objective: To investigate content and functionality preferences for AOD and other health websites. Methods: An anonymous online survey examined general Internet and AOD-specific usage and search behaviors, valued features of AOD and health-related websites (general and interactive website features), indicators of website trustworthiness, valued AOD website tools or functions, and treatment modality preferences. Results: Surveys were obtained from 1214 drug (n = 766) and alcohol website users (n = 448) (mean age 26.2 years, range 16-70). There were no significant differences between alcohol and drug groups on demographic variables, Internet usage, indicators of website trustworthiness, or on preferences for AOD website functionality. A robust website design/navigation, open access, and validated content provision were highly valued by both groups. While attractiveness and pictures or graphics were also valued, high-cost features (videos, animations, games) were minority preferences. Almost half of respondents in both groups were unable to readily access the information they sought. Alcohol website users placed greater importance on several AOD website tools and functions than did those accessing other drug websites: online screening tools (chi(2)(2) = 15.8, P < .001, n = 985); prevention programs (chi(2)(2) = 27.5, P < .001, n = 981); tracking functions (chi(2)(2) = 11.5, P = .003, n = 983); self help treatment programs (chi(2)(2) = 8.3, P = .02, n = 984); downloadable fact sheets for friends (chi(2)(2) = 11.6, P = .003, n = 981); or family (chi(2)(2) = 12.7, P = .002, n = 983). The most preferred online treatment option for both the user groups was an Internet site with email therapist support. Explorations of demographic differences were also performed. While gender did not affect survey responses, younger respondents were more likely to value interactive and social networking features, whereas downloading of credible information was most highly valued by older respondents. Conclusions: Significant deficiencies in the provision of accessible information on AOD websites were identified, an important problem since information seeking was the most common reason for accessing these websites, and, therefore, may be a key avenue for engaging website users in behaviour change. The few differences between AOD website users suggested that both types of websites may have similar features, although alcohol website users may more readily be engaged in screening, prevention and self-help programs, tracking change, and may value fact sheets more highly. While the sociodemographic differences require replication and clarification, these differences support the notion that the design and features of AOD websites should target specific audiences to have maximal impact.

Klein G; Ulbricht S; Haug S; Gross B; Rumpf HJ; John U; Meyer C. Effects of practitioner-delivered brief counseling and computer-generated tailored letters' on cigarettes per day among smokers who do not quit-A quasi-randomized controlled trial. Drug and Alcohol Dependence 112(1-2): 81-89, 2010. (49 refs.)

Background: It is still unclear how brief counseling for smoking cessation, combined with proactive recruitment of participants, impacts on those smokers not reaching the primary treatment goal of tobacco abstinence. Thus, within a quasi-randomized controlled trial, we examined the effects of (1) practitioner-delivered brief advice and (2) computer-generated tailored letters on cigarettes per day (CPD) among participants not succeeding in quitting. Methods: A total of 34 general practices (participation rate 87%) were randomly selected in a German region. Within these practices, 1499 daily smoking patients aged 18-70 years (participation rate 80%) agreed to participate in a smoking cessation intervention trial. Allocation to study condition was based on time of practice attendance. Latent growth analyses were performed on the subsample of 1334(89%) smokers who did not reach 6-month prolonged abstinence within the 2-year follow-up period. CPD was assessed at baseline and at 6-, 12-, 18-, and 24-month follow-ups. Results: Both interventions led to small but significant reductions in CPD, and they did not differ in efficacy. Treatment effects occurred within the first 6 months and could be sustained by the continuing smokers until the 24-month follow-up. Conclusions: Present results complement earlier findings of increased abstinence rates in the total sample. It can be concluded that, even if applied to unselected samples of smokers, from which only a minority initially intends to change, both brief counseling strategies are able to significantly decrease tobacco consumption. They hence appear to provide a means to reducing tobacco-related disease among general medical practice patients.

Lavoie D. Alcohol identification and brief advice in England: A major plank in alcohol harm reduction policy. (review). Drug and Alcohol Review 29(6): 608-611, 2010. (14 refs.)

Screening and brief interventions form a vital plank in England's plans to reduce alcohol-related harm. This article clarifies the use of terminology in England to describe various drinking categories and screening and brief interventions. It details efforts to implement these interventions, including recent incentive packages that have been put in place to encourage primary care to implement these interventions. It describes the Screening and Intervention Programme for Sensible Drinking research program that is underway to clarify tools and methods to introduce and support these interventions.

Lee CS; Baird J; Longabaugh R; Nirenberg TD; Mello MJ; Woolard R. Change plan as an active ingredient of brief motivational interventions for reducing negative consequences of drinking in hazardous drinking emergency-department patients. Journal of Studies on Alcohol and Drugs 71(5): 726-733, 2010. (44 refs.)

Objective: Few studies have examined the effects of brief motivational intervention components, such as change-plan completion, on treatment outcomes. This secondary analysis of an opportunistically recruited emergency-department sample of hazardous injured drinkers examines the potential predictive role of an alcohol-related change plan on treatment outcomes after accounting for pretreatment readiness. Written change plans were independently rated. Method: A mediational analysis framework tested directional hypotheses between pretreatment readiness, change plan, and treatment outcomes using linear regressions. The baseline total Drinker Inventory of Consequences (DrInC) score was covaried on 12-month DrInC total score, in all analyses. Participants who completed a brief motivational intervention and a change plan were included (N = 333). Results: Pretreatment readiness was negatively associated with alcohol consequences at 12 months, beta = -.09, t(254) = -2.07, p < .05, and good-quality change plans, beta = .18, t(320) = 4.37, p < .001. With change plan and readiness in the same model, the relationship between readiness and treatment outcomes became nonsignificant, but change plan remained a significant predictor of treatment outcomes in the expected direction, beta = -.17, t(254) = -2.89, p < .01. Follow-up generalized linear modeling including an interaction term (change plan and pretreatment readiness) revealed that those with high readiness and a good-quality change plan versus those with low readiness and a poor-quality change plan had better-than-predicted outcomes for either readiness or change plan alone. Conclusions: Study findings suggest that the change plan in brief motivational intervention may be an active ingredient of treatment associated with better outcomes over and above the influence of pretreatment readiness.

Lin JC; Karno MP; Barry KL; Blow FC; Davis JW; Tang LQ et al. Determinants of early reductions in drinking in older at-risk drinkers participating in the intervention arm of a trial to reduce at-risk drinking in primary care. Journal of the American Geriatrics Society 58(2): 227-233, 2010. (31 refs.)

OBJECTIVES: To describe differences between older at-risk drinkers, as determined using the Comorbidity Alcohol Risk Evaluation Tool, who reduced drinking and those who did not after an initial intervention and to determine factors associated with early reductions in drinking. DESIGN: Secondary analyses of data from a randomized controlled trial. SETTING: Seven primary care sites. PARTICIPANTS: Subjects randomized to the intervention group who completed the first health educator call approximately 2 weeks after enrollment (n = 239). INTERVENTION: Personalized risk reports, booklets on alcohol-associated risks, and advice from physicians, followed by a health educator call. MEASURMENTS: Reductions in number of alcoholic drinks. RESULTS: Thirty-nine percent of the sample had reduced drinking within 2 weeks of receiving the initial intervention. According to the final multiple logistic regression model, those who were concerned about alcohol-related risks (odds ratio (OR) = 2.03, 95% confidence interval (CI) = 1.01-4.07), read through the educational booklet (OR = 2.97, 95% CI = 1.48-5.95), or perceived that their physicians discussed risks and advised changing drinking behaviors (OR = 4.1, 95% CI = 2.02-8.32) had greater odds of reducing drinking by the first health educator call. CONCLUSION: Concern about risks, reading educational material, and perception of physicians providing advice to reduce drinking were associated with early reductions in alcohol use in older at-risk drinkers. Understanding these factors will enable development of better intervention strategies to reduce unhealthy alcohol use.

Magill M; Mastroleo NR; Apodaca TR; Barnett NP; Colby SM; Monti PM. Motivational interviewing with significant other participation: Assessing therapeutic alliance and patient satisfaction and engagement. Journal of Substance Abuse Treatment 39(4): 391-398, 2010. (35 refs.)

Inclusion of concerned significant others (SOs) in alcohol use treatment has demonstrated efficacy but has not been tested in the context of brief interventions. In this study, individual motivational interviewing (MI) sessions were compared with MI sessions including a significant other on within-treatment outcomes (alliance fidelity, client satisfaction, and engagement). Participants (N = 382) were adult alcohol users recruited in a Level I trauma center Perceived alliance did not differ across conditions, but patients and SOs reported higher alliance satisfaction, and engagement than was perceived by the therapist. The occurrence of MI components, or discussion areas, was consistent across conditions. Higher baseline SO drinking was associated with lower patient engagement, whereas higher baseline SO acceptance of patient drinking was associated with lower SO engagement Results suggest that individual MI sessions can be adapted to include an SO with minimal impact on patient acceptability and treatment fidelity. Research should, however consider SOs influence on participant outcomes and the relevance of specific SO characteristics.

Mc Carthy PM; O'Sullivan D. Efficacy of a brief cognitive behavioral therapy program to reduce excessive drinking behavior among new recruits entering the Irish navy: A pilot evaluation. Military Medicine 175(11): 841-846, 2010. (28 refs.)

This pilot study evaluated the efficacy of a brief cognitive behavioral therapy (CBT) intervention program designed to reduce excessive pre-enlistment drinking behaviors in a sample of Irish Navy recruits undergoing a 16-week basic training course. Participants were randomly allocated to either a treatment (TG) or control group (CG) (N = 13 each). The program was conducted over four consecutive 1.5-hour weekly sessions. Data were collected at pre and post intervention as well as at a 2-month follow-up. In comparison to those in the control group, participants who received the intervention reported increased scores (p < 0.05) in readiness to change drinking at time 2 and reduced scores in binge drinking (p < 0.05) at time 3. There were also marginal changes in self-efficacy and risky drinking behavior. This work adds to the evidence of the emerging efficacy of a workplace CBT intervention for unhealthy drinking.

McClure JB; Ludman EJ; Grothaus L; Pabiniak C; Richards J. Impact of spirometry feedback and brief motivational counseling on long-term smoking outcomes: A comparison of smokers with and without lung impairment26. Patient Education and Counseling 80(2): 280-283, 2010. (26 refs.)

Objective: We compared long-term outcomes among smokers with and without impaired lung functioning who received brief counseling highlighting their spirometric test results. Methods: Participants in this analysis all received a brief motivational intervention for smoking cessation including spirometric testing and feedback (similar to 20 min), were advised to quit smoking, offered free access to a phone-based smoking cessation program, and followed for one year. Outcomes were analyzed for smokers with (n = 99) and without (n = 168) impaired lung function. Results: Participants with lung impairment reported greater use of self-help cessation materials at 6 months, greater use of non-study-provided counseling services at 6 and 12 months, higher 7-day PPA rates at 6 months, and were more likely to talk with their doctor about their spirometry results. Conclusion: Further research is warranted to determine if spirometry feedback has a differential treatment effect among smokers with and without lung impairment. Practice implications: It is premature to make practice recommendations based on these data.

McCormick R; Docherty B; Segura L; Colom J; Gual A; Cassidy P et al. The research translation problem. Alcohol screening and brief intervention in primary care: Real world evidence supports theory. Drugs: Education, Prevention and Policy 17(6): 732-748, 2010. (33 refs.)

Translational research projects based in England, New Zealand and Catalonia are described. In combination they provide real world evidence in support of the evolving discourse on translating the evidence on screening and brief intervention for problem use of alcohol so that it is acceptable and fit for routine practice. Acceptance and uptake was enhanced by encouraging primary health clinicians to use evidence-based screening and brief intervention processes which fit with the context in which they work and which build on the skills they already have and use in practice. Emerging general principles included: tailoring procedures to fit with local circumstances; breaking the process down into clinically acceptable steps and negotiating where there is flexibility. Key issues explored in each case study included how 'screening' is best conducted, what is a brief intervention best suited to which provider and which providers should run the process.

Omole OB; Ngobale KNW; Ayo-Yusuf OA. Missed opportunities for tobacco use screening and brief cessation advice in South African primary health care: a cross-sectional study. BMC Family Practice 11: e-article 94, 2010. (34 refs.)

Background: Primary health care (PHC) settings offer opportunities for tobacco use screening and brief cessation advice, but data on such activities in South Africa are limited. The aim of this study was to determine the extent to which participants were screened for and advised against tobacco use during consultations. Methods: This cross-sectional study involved 500 participants, 18 years and older, attended by doctors or PHC nurses. Using an exit-interview questionnaire, information was obtained on participants' tobacco use status, reason (s) for seeking medical care, whether participants had been screened for and advised about their tobacco use and patients' level of comfort about being asked about and advised to quit tobacco use. Main outcome measures included patients' self-reports on having been screened and advised about tobacco use during their current clinic visit and/or any other visit within the last year. Data analysis included the use of chi-square statistics, t-tests and multiple logistic regression analysis. Results: Of the 500 participants, 14.9% were current smokers and 12.1% were smokeless tobacco users. Only 12.9% of the participants were screened for tobacco use during their current visit, indicating the vast majority were not screened. Among the 134 tobacco users, 11.9% reported being advised against tobacco use during the current visit and 35.1% during any other visit within the last year. Of the participants not screened, 88% indicated they would be 'very comfortable' with being screened. A pregnancy-related clinic visit was the single most significant predictor for being screened during the current clinic visit (OR = 4.59; 95% CI = 2.13-9.88). Conclusion: Opportunities for tobacco use screening and brief cessation advice were largely missed by clinicians. Incorporating tobacco use status into the clinical vital signs as is done for pregnant patients during antenatal care visits in South Africa has the potential to improve tobacco use screening rates and subsequent cessation.

Ortega G; Castella C; Martin-Cantera C; Ballve JL; Diaz E; Saez M et al. Passive smoking in babies: The BIBE study (Brief Intervention in Babies. Effectiveness). BMC Public Health 10: e-article 772, 2010. (39 refs.)

Background: There is evidence that exposure to passive smoking in general, and in babies in particular, is an important cause of morbimortality. Passive smoking is related to an increased risk of pediatric diseases such as sudden death syndrome, acute respiratory diseases, worsening of asthma, acute-chronic middle ear disease and slowing of lung growth. The objective of this article is to describe the BIBE study protocol. The BIBE study aims to determine the effectiveness of a brief intervention within the context of Primary Care, directed to mothers and fathers that smoke, in order to reduce the exposure of babies to passive smoking (ETS). Methods/Design: Cluster randomized field trial (control and intervention group), multicentric and open. Subject: Fathers and/or mothers who are smokers and their babies (under 18 months) that attend pediatric services in Primary Care in Catalonia. The measurements will be taken at three points in time, in each of the fathers and/or mothers who respond to a questionnaire regarding their baby's clinical background and characteristics of the baby's exposure, together with variables related to the parents' tobacco consumption. A hair sample of the baby will be taken at the beginning of the study and at six months after the initial visit (biological determination of nicotine). The intervention group will apply a brief intervention in passive smoking after specific training and the control group will apply the habitual care. Discussion: Exposure to ETS is an avoidable factor related to infant morbimortality. Interventions to reduce exposure to ETS in babies are potentially beneficial for their health. The BIBE study evaluates an intervention to reduce exposure to ETS that takes advantage of pediatric visits. Interventions in the form of advice, conducted by pediatric professionals, are an excellent opportunity for prevention and protection of infants against the harmful effects of ETS.

Postel MG; de Haan HA; ter Huurne ED; Becker ES; de Jong CAJ. Effectiveness of a web-based intervention for problem drinkers and reasons for dropout: Randomized controlled trial. Journal of Medical Internet Research 12(4): 11-22, 2010. (42 refs.)

Background: Online self-help interventions for problem drinkers show promising results, but the effectiveness of online therapy with active involvement of a therapist via the Internet only has not been examined. Objective: The objective of our study was to evaluate an e-therapy program with active therapeutic involvement for problem drinkers, with the hypotheses that e-therapy would (1) reduce weekly alcohol consumption, and (2) improve health status. Reasons for dropout were also systematically investigated. Method: In an open randomized controlled trial, Dutch-speaking problem drinkers in the general population were randomly assigned (in blocks of 8, according to a computer-generated random list) to the 3-month e-therapy program (n = 78) or the waiting list control group (n = 78). The e-therapy program consisted of a structured 2-part online treatment program in which the participant and the therapist communicated asynchronously, via the Internet only. Participants in the waiting list control group received "no-reply" email messages once every 2 weeks. The primary outcome measures were (1) the difference in the score on weekly alcohol consumption, and (2) the proportion of participants drinking under the problem drinking limit. Intention-to-treat analyses were performed using multiple imputations to deal with loss to follow-up. A dropout questionnaire was sent to anyone who did not complete the 3-month assessment. Reasons for dropout were independently assessed by the first and third author. Results: Of the 156 individuals who were randomly assigned, 102 (65%) completed assessment at 3 months. In the intention-to-treat analyses, the e-therapy group (n = 78) showed a significantly greater decrease in alcohol consumption than those in the control group (n = 78) at 3 months. The e-therapy group decreased their mean weekly alcohol consumption by 28.8 units compared with 3.1 units in the control group, a difference in means of 25.6 units on a weekly basis (95% confidence interval 15.69-35.80, P < .001). The between-group effect size (pooled SD) was large (d = 1.21). The results also showed that 68% (53/78) of the e-therapy group was drinking less than 15 (females) or 22 (males) units a week, compared with 15% (12/78) in the control group (OR 12.0, number needed to treat 1.9, P < .001). Dropout analysis showed that the main reasons for dropouts (n = 54) were personal reasons unrelated to the e-therapy program, discomfort with the treatment protocol, and satisfaction with the positive results achieved. Conclusions: E-therapy for problem drinking is an effective intervention that can be delivered to a large population who otherwise do not seek help for their drinking problem. Insight into reasons for dropout can help improve e-therapy programs to decrease the number of dropouts. Additional research is needed to directly compare the effectiveness of the e-therapy program with a face-to-face treatment program.

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

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

Saitz R. Alcohol screening and brief intervention in primary care: Absence of evidence for efficacy in people with dependence or very heavy drinking. (review). Drug and Alcohol Review 29(6): 631-640, 2010. (75 refs.)

Issues. Although screening and brief intervention (BI) in the primary-care setting reduces unhealthy alcohol use, its efficacy among patients with dependence has not been established. This systematic review sought to determine whether evidence exists for BI efficacy among patients with alcohol dependence identified by screening in primary-care settings. Approach. We included randomised controlled trials (RCTs) extracted from eight systematic reviews and electronic database searches published through September 2009. These RCTs compared outcomes among adults with unhealthy alcohol use identified by screening who received BI in a primary-care setting with those who received no intervention. Key Findings. Sixteen RCTs, including 6839 patients, met the inclusion criteria. Of these, 14 excluded some or all persons with very heavy alcohol use or dependence; one in which 35% of 175 patients had dependence found no difference in an alcohol severity score between groups; and one in which 58% of 24 female patients had dependence showed no efficacy. Conclusion and Implications. Alcohol screening and BI has efficacy in primary care for patients with unhealthy alcohol use, but there is no evidence for efficacy among those with very heavy use or dependence. As alcohol screening identifies both dependent and non-dependent unhealthy use, the absence of evidence for the efficacy of BI among primary-care patients with screening-identified alcohol dependence raises questions regarding the efficiency of screening and BI, particularly in settings where dependence is common. The finding also highlights the need to develop new approaches to help such patients, particularly if screening and BI are to be disseminated widely.

Saitz R; Alford DP; Bernstein J; Cheng DM; Samet J; Palfai T. Screening and brief intervention for unhealthy drug use in primary care settings: Randomized clinical trials are needed. (review). Journal of Addiction Medicine 4(3): 123-130, 2010. (106 refs.)

The efficacy of screening and brief intervention (SBI) for drug use in primary care patients is largely unknown. Because of this lack of evidence, US professional organizations do not recommend it. Yet, a strong theoretical case can be made for drug SBI. Drug use is common and associated with numerous health consequences, patients usually do not seek help for drug abuse and dependence, and SBI has proven efficacy for unhealthy alcohol use. On the other hand, the diversity of drugs of abuse and the high prevalence of abuse and dependence among those who use them raise concerns that drug SBI may have limited or no efficacy. Federal efforts to disseminate SBI for drug use are underway, and reimbursement codes to compensate clinicians for these activities have been developed. However, the discrepancies between science and policy developments underscore the need for evidence-based research regarding the efficacy of SBI for drug use. This article discusses the rationale for drug SBI and existing research on its potential to improve drug-use outcomes and makes the argument that randomized controlled trials to determine its efficacy are urgently needed to bridge the gap between research, policy, and clinical practice.

Sanson-Fisher R; Brand M; Shakeshaft A; Haber P; Day C; Conigrave K et al. Forming a national multicentre collaboration to conduct clinical trials: Increasing high-quality research in the drug and alcohol field. Drug and Alcohol Review 29(5): 469-474, 2010. (40 refs.)

Issues. There is a shortage of high-quality intervention-based evidence in the drug and alcohol misuse field. That is, evidence based on replicated effects using rigorous methodology, to establish a causal knowledge base around ethical, cost-effective methods relevant to clinical practice. The knowledge base in this field is limited participant recruitment challenges; difficulty generalising results from single-centre studies; lack of research culture; issues in managing research teams; incentives for descriptive research; and limited expertise in research design and working in multidisciplinary teams. Approach. An Australian national multicentre collaboration is proposed to overcome these barriers, and reduce the burden of drug and alcohol misuse by increasing the number of high-quality clinical trials in this field. It would involve: selecting a representative sample of centres nation-wide with expertise in specific drug and alcohol issues; creating an expert multidisciplinary team to facilitate clinical trials; simultaneous recruitment and implementation of clinical trials across centres; establishing a virtual infrastructure; forming an independent data-integrity and methodology review panel; and attracting and allocating funding for clinical trials. Implications. The ability to allocate funding, the involvement of multidisciplinary experts in drug and alcohol research, and the establishment of infrastructure and procedures are likely to result in the national multicentre group's capacity to prescribe the type of research conducted under its auspices. Conclusion. The proposed initiative is likely to increase the volume of high-quality clinical trials in the Australian drug and alcohol field, a key step towards reducing the burden of drug and alcohol misuse.

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

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

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

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

Spijkerman R; Roek MAE; Vermulst A; Lemmers L; Huiberts A; Engels RCME. Effectiveness of a web-based brief alcohol intervention and added value of normative feedback in reducing underage drinking: A randomized controlled trial. Journal of Medical Internet Research 12(5): e-article 65, 2010. (55 refs.)

Background: Current insights indicate that Web-based delivery may enhance the implementation of brief alcohol interventions. Previous research showed that electronically delivered brief alcohol interventions decreased alcohol use in college students and adult problem drinkers. To date, no study has investigated the effectiveness of Web-based brief alcohol interventions in reducing alcohol use in younger populations. Objective: The present study tested 2 main hypotheses, that is, whether an online multicomponent brief alcohol intervention was effective in reducing alcohol use among 15- to 20-year-old binge drinkers and whether inclusion of normative feedback would increase the effectiveness of this intervention. In additional analyses, we examined possible moderation effects of participant's sex, which we had not a priori hypothesized. Method: A total of 575 online panel members (aged 15 to 20 years) who were screened as binge drinkers were randomly assigned to (1) a Web-based brief alcohol intervention without normative feedback, (2) a Web-based brief alcohol intervention with normative feedback, or (3) a control group (no intervention). Alcohol use and moderate drinking were assessed at baseline, 1 month, and 3 months after the intervention. Separate analyses were conducted for participants in the original sample (n = 575) and those who completed both posttests (n = 278). Missing values in the original sample were imputed by using the multiple imputation procedure of PASW Statistics 18. Results: Main effects of the intervention were found only in the multiple imputed dataset for the original sample suggesting that the intervention without normative feedback reduced weekly drinking in the total group both 1 and 3 months after the intervention (n = 575, at the 1-month follow-up, beta = -.24, P = .05; at the 3-month follow-up, beta = -.25, P = .04). Furthermore, the intervention with normative feedback reduced weekly drinking only at 1 month after the intervention (n=575, beta = -.24, P = .008). There was also a marginally significant trend of the intervention without normative feedback on responsible drinking at the 3-month follow-up (n = 575, beta = .40, P = .07) implying a small increase in moderate drinking at the 3-month follow-up. Additional analyses on both datasets testing our post hoc hypothesis about a possible differential intervention effect for males and females revealed that this was the case for the impact of the intervention without normative feedback on weekly drinking and moderate drinking at the 1-month follow-up (weekly drinking for n = 278, beta = -.80, P = .01, and for n = 575, beta = -.69, P = .009; moderate drinking for n = 278, odds ratio [OR] = 3.76, confidence interval [CI] 1.05 - 13.49, P = .04, and for n = 575, OR = 3.00, CI = 0.89 - 10.12, P = .08) and at the 3-month follow-up (weekly drinking for n = 278, beta = -. 58, P = .05, and for n = 575, beta = -. 75, P = .004; moderate drinking for n = 278, OR = 4.34, CI = 1.18 - 15.95, P = .04, and for n = 575, OR = 3.65, CI = 1.44 - 9.25, P = .006). Furthermore, both datasets showed an interaction effect between the intervention with normative feedback and participant's sex on weekly alcohol use at the 1-month follow-up (for n = 278, beta = -. 74, P = .02, and for n = 575, beta = -. 64, P =. 01) and for moderate drinking at the 3-month follow-up (for n = 278, OR = 3.10, CI = 0.81 - 11.85, P = .07, and for n = 575, OR = 3.00, CI = 1.23 - 7.27, P = .01). Post hoc probing indicated that males who received the intervention showed less weekly drinking and were more likely to drink moderately at 1 month and at 3 months following the intervention. For females, the interventions yielded no effects: the intervention without normative feedback even showed a small unfavorable effect at the 1-month follow-up. Conclusion: The present study demonstrated that exposure to a Web-based brief alcohol intervention generated a decrease in weekly drinking among 15- to 20-year-old binge drinkers but did not encourage moderate drinking in the total sample. Additional analyses revealed that intervention effects were most prominent in males resulting in less weekly alcohol use and higher levels of moderate drinking among 15- to 20-year-old males over a period of 1 to 3 months.

Thomsen T; Tonnesen H; Okholm M; Kroman N; Maibom A; Sauerberg ML et al. Brief smoking cessation intervention in relation to breast cancer surgery: A randomized controlled trial. Nicotine & Tobacco Research 12(11): 1118-1124, 2010. (27 refs.)

Smokers are more prone to develop postoperative complications. Smoking cessation intervention beginning 4-8 weeks prior to surgery improves the postoperative outcome. Cancer patients, however, often undergo surgery less than 4 weeks after diagnosis. The primary objective of this study was therefore to examine if a brief smoking cessation intervention shortly before breast cancer surgery would influence postoperative complications and smoking cessation. A randomized controlled multicentre trial with blinded outcome assessment conducted at 3 hospitals in Denmark. One hundred and thirty patients were randomly assigned to brief smoking intervention (n = 65) or standard care (n = 65). The intervention followed the principles of motivational interviewing and included personalized nicotine replacement therapy aimed at supporting smoking cessation from 2 days before to 10 days after surgery. The overall postoperative complication rate (including seroma requiring aspiration) was 61% in both groups risk ratio (RR) 1.00 (95% CI 0.75-1.33). The wound complication rate was 44% versus 45%. The effect on perioperative smoking cessation was modest, 28% intervention versus 11% control group patients, RR 2.49 (95% CI 1.10-5.60). There was no effect on smoking cessation at 12 months, 13% versus 9%. Brief smoking intervention administered shortly before breast cancer surgery modestly increased self-reported perioperative smoking cessation without having any clinical impact on postoperative complications. The study adds to the body of evidence indicating that brief intervention has no clinical importance for surgical patients in regard to postoperative morbidity. Future studies should be designed to determine the optimal time of smoking cessation before surgery.

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

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

Vaca F; Winn D; Anderson C; Kim D; Arcila M. Feasibility of emergency eepartment bilingual computerized alcohol screening, brief intervention, and referral to treatment. Substance Abuse 31(4): 264-269, 2010. (15 refs.)

The purpose of this study was to assess the feasibility of utilizing a computerized alcohol screening and intervention (CASI) kiosk in an emergency department (ED). An interactive English and Spanish audiographical computer program, developed for used on a mobile computer cart, was administered to 5103 patients. Patients who screened at risk (19%) also received a fully computer-guided brief negotiated interview (BNI) and a printed personal alcohol reduction plan. A higher percentage of younger patients, and males (31% versus 16% females), screened at risk or dependent. Patient surveys indicated CASI was easy to use and over 75% did not prefer a medical professional over the computer. The ED-based bilingual computerized alcohol screening, brief intervention, and referral to treatment required little time to administer, was acceptable to patients, identified at-risk and dependent drinkers, and was able to provide personalized feedback and brief intervention.

Walton MA; Chermack ST; Shope JT; Bingham CR; Zimmerman MA; Blow FC; Cunningham RM. Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: A randomized controlled trial. Journal of the American Medical Association 304(5): 527-535, 2010. (39 refs.)

Context: Emergency department (ED) visits present an opportunity to deliver brief interventions to reduce violence and alcohol misuse among urban adolescents at risk of future injury. Objective To determine the efficacy of brief interventions addressing violence and alcohol use among adolescents presenting to an urban ED. Design, Setting, and Participants: Between September 2006 and September 2009, 3338 patients aged 14 to 18 years presenting to a level I ED in Flint, Michigan, between 12 PM and 11 PM 7 days a week completed a computerized survey (43.5% male; 55.9% African American). Adolescents reporting past-year alcohol use and aggression were enrolled in a randomized controlled trial (SafERteens). Intervention: All patients underwent a computerized baseline assessment and were randomized to a control group that received a brochure (n = 235) or a 35-minute brief intervention delivered by either a computer (n = 237) or therapist (n = 254) in the ED, with follow-up assessments at 3 and 6 months. Combining motivational interviewing with skills training, the brief intervention for violence and alcohol included review of goals, tailored feedback, decisional balance exercise, role plays, and referrals. Main Outcome Measures: Self-report measures included peer aggression and violence, violence consequences, alcohol use, binge drinking, and alcohol consequences. Results: About 25% (n = 829) of screened patients had positive results for both alcohol and violence; 726 were randomized. Compared with controls, participants in the therapist intervention showed self-reported reductions in the occurrence of peer aggression (therapist, -34.3%; control, -16.4%; relative risk [RR], 0.74; 95% confidence interval [CI], 0.61-0.90), experience of peer violence (therapist, -10.4%; control, +4.7%; RR, 0.70; 95% CI, 0.52-0.95), and violence consequences (therapist, -30.4%; control, -13.0%; RR, 0.76; 95% CI, 0.64-0.90) at 3 months. At 6 months, participants in the therapist intervention showed self-reported reductions in alcohol consequences (therapist, -32.2%; control, -17.7%; odds ratio, 0.56; 95% CI, 0.34-0.91) compared with controls; participants in the computer intervention also showed self-reported reductions in alcohol consequences (computer, -29.1%; control, -17.7%; odds ratio, 0.57; 95% CI, 0.34-0.95). Conclusion: Among adolescents identified in the ED with self-reported alcohol use and aggression, a brief intervention resulted in a decrease in the prevalence of self-reported aggression and alcohol consequences.

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

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

White A; Kavanagh D; Stallman H; Klein B; Kay-Lambkin F; Proudfoot J et al. Online alcohol interventions: A systematic review. (review). Journal of Medical Internet Research 12(5): e-article 62, 2010. (57 refs.)

Background: There has been a significant increase in the availability of online programs for alcohol problems. A systematic review of the research evidence underpinning these programs is timely. Objectives: Our objective was to review the efficacy of online interventions for alcohol misuse. Systematic searches of Medline, PsycINFO, Web of Science, and Scopus were conducted for English abstracts (excluding dissertations) published from 1998 onward. Search terms were: (1) Internet, Web*; (2) online, computer*; (3) alcohol*; and (4) E\effect*, trial*, random* (where * denotes a wildcard). Forward and backward searches from identified papers were also conducted. Articles were included if (1) the primary intervention was delivered and accessed via the Internet, (2) the intervention focused on moderating or stopping alcohol consumption, and (3) the study was a randomized controlled trial of an alcohol-related screen, assessment, or intervention. Results: The literature search initially yielded 31 randomized controlled trials (RCTs), 17 of which met inclusion criteria. Of these 17 studies, 12 (70.6%) were conducted with university students, and 11 (64.7%) specifically focused on at-risk, heavy, or binge drinkers. Sample sizes ranged from 40 to 3216 (median 261), with 12 (70.6%) studies predominantly involving brief personalized feedback interventions. Using published data, effect sizes could be extracted from 8 of the 17 studies. In relation to alcohol units per week or month and based on 5 RCTs where a measure of alcohol units per week or month could be extracted, differential effect sizes to posttreatment ranged from 0.02 to 0.81 (mean 0.42, median 0.54). Pre-post effect sizes for brief personalized feedback interventions ranged from 0.02 to 0.81, and in 2 multi-session modularized interventions, a pre-post effect size of 0.56 was obtained in both. Pre-post differential effect sizes for peak blood alcohol concentrations (BAC) ranged from 0.22 to 0.88, with a mean effect size of 0.66. Conclusions: The available evidence suggests that users can benefit from online alcohol interventions and that this approach could be particularly useful for groups less likely to access traditional alcohol-related services, such as women, young people, and at-risk users. However, caution should be exercised given the limited number of studies allowing extraction of effect sizes, the heterogeneity of outcome measures and follow-up periods, and the large proportion of student-based studies. More extensive RCTs in community samples are required to better understand the efficacy of specific online alcohol approaches, program dosage, the additive effect of telephone or face-to-face interventions, and effective strategies for their dissemination and marketing.

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

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

Williams EC; Achtmeyer CE; Kivlahan DR; Greenberg D; Merrill JO; Wickizer TM et al. Evaluation of an electronic clinical reminder to facilitate brief alcohol-counseling interventions in primary care. Journal of Studies on Alcohol and Drugs 71(5): 720-725, 2010. (30 refs.)

Objective: Brief intervention for patients with unhealthy alcohol use is a prevention priority in the United States, but most eligible patients do not receive it. This study evaluated an electronic alcohol-counseling clinical reminder at a single Veterans Affairs general medicine clinic. Method: The systems-level intervention evaluated in this study consisted of making the clinical reminder, which facilitated medical record documentation of brief intervention among patients who screened positive for unhealthy alcohol use, available to providers on one (of two) randomly selected hallways. Secondary electronic data were extracted for all patients who visited the clinic (October 1, 2002, to September 30, 2005). The proportion of patients with clinical-reminder use was evaluated among patients who screened positive for unhealthy drinking and were assigned to intervention hallway providers ("descriptive cohort"). Adjusted logistic regression evaluated the association between the intervention and resolution of unhealthy drinking at follow-up among all screen-positive patients who completed a second Alcohol Use Disorders Identification Test Consumption questionnaire 18 months or longer after the first ("outcomes cohort"). Results: Eligible patients (N = 22,863) included 10,392 controls and 12,471 in the intervention group. Fifteen percent (398 of 2,640) of descriptive cohort patients with unhealthy drinking had clinical-reminder use, which varied by severity (14% [n = 302 of 2,165] with mild/moderate and 20% [n = 96 of 475] with severe unhealthy drinking, p = .001). Only 39% (156 of 398) of patients with clinical-reminder use had documented brief intervention; advice to abstain was most common. Access to the clinical reminder was not significantly associated with resolution of unhealthy drinking in 1,358 patients in the outcomes cohort. Conclusions: Availability of a clinical reminder to facilitate brief intervention did not, alone, result in substantial use of the clinical reminder. More active implementation efforts may be needed to get brief interventions onto the agenda of busy primary care providers.