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Readiness to change, drinking, and negative consequences among Polish SBIRT patients
Korcha, Rachael A.
Cherpitel, Cheryl J.
Moskalewicz, Jacek
Swiatkiewicz, Grazyna
Bond, Jason
Ye, Yu
Addictive Behaviors
The aim of this study is to examine the longitudinal relationship of readiness to change, drinking pattern, amount of alcohol consumed, and alcohol-related negative consequences among at-risk and dependent drinkers enrolled in a Screening, Brief Intervention and Referral to Treatment (SBIRT) trial in an emergency department in southern Poland. The study examined 299 patients randomized to either an assessment or intervention condition and followed at 3 and 12 months after initial presentation. Patients indicating a readiness or were unsure of changing drinking behavior were significantly more likely to decrease the maximum number of drinks per occasion and the usual number of drinks in a sitting in the 3-months following study entry when compared to those that rated changing drinking behavior as unimportant. Readiness to change was not predictive of outcomes between the baseline and 12-month follow-up. Drinking outcomes and negative consequences by readiness and research condition were non-significant. This is the first Polish study utilizing SBIRT to enable patients to identify their hazardous drinking and reduce alcohol consumption. While some drinking outcomes improved with motivation, these improvements were not maintained at 12-months following SBIRT. Attention to additional constructs of readiness to change and drinking patterns may augment the effectiveness of SBIRT.
Related Articles
Feasibility of a computer-assisted alcohol SBIRT program in an urban emergency department: patient and research staff perspectives
Murphy, Mary K
Bijur, Polly E
Rosenbloom, David
Bernstein, Steven L
Gallagher, E John
Addiction Science & Clinical Practice
The study objective was to assess the feasibility of a computerized alcohol-screening interview (CASI) program to identify at-risk alcohol users among adult emergency department (ED) patients. The study aimed to evaluate the feasibility of implementing a computerized screening, brief intervention, and referral to treatment (SBIRT) program within a busy urban ED setting, to report on accurate deployment of alcohol screening results, and to assess comprehension and satisfaction with CASI from both patient and research staff perspectives.
Research assistants (RAs) screened a convenience sample of medically stable ED patients. The RAs brought CASI to patients' bedsides, and patients entered their own alcohol consumption data. The CASI intervention consisted of an alcohol use screening identification test, a personalized normative feedback profile, NIAAA low-risk drinking educational materials, and treatment referrals (when indicated).
Five hundred seventeen patients were enrolled. The median age of participants was 37 years (range, 21-85 years); 37% were men, 62% were Hispanic, 7% were Caucasian, 30% were African American, and 2% were multiracial. Eighty percent reported regular use of computers at home. Eighty percent of patients approached consented to participate, and 99% of those who started CASI were able to complete it. Two percent of interviews were interrupted for medical tests and procedures, however, no patients required breaks from using CASI for not feeling well. The CASI program accurately provided alcohol risk education to patients 100% of the time. Thirty-two percent of patients in the sample screened positive for at-risk drinking. Sixty percent of patients reported that CASI increased their knowledge of safe drinking limits, 39% reported some likeliness to change their alcohol use, and 28% reported some intention to consult a health care professional about their alcohol use as a result of their screening results. Ninety-three percent reported CASI was easy to use, 93% felt comfortable receiving alcohol education via computer, and 89% liked using CASI. Ninety percent of patients correctly identified their alcohol risk level after participating in CASI. With regard to research staff experience, RAs needed to provide standby assistance to patients during <1% of CASI administrations and needed to troubleshoot computer issues in 4% of interviews. The RAs distributed the correct alcohol risk normative profiles to patients 97% of the time and provided patients with treatment referrals when indicated 81% of the time. The RAs rated patients as "not bothered at all" by using CASI 94% of the time.
This study demonstrates that an ED-based computerized alcohol screening program is both acceptable to patients and effective in educating patients about their alcohol risk level. Additionally, this study demonstrates that few logistical problems related to using computers for these interventions were experienced by research staff: in most cases, staff accurately deployed alcohol risk education to patients, and in all cases, the computer provided accurate education to patients. Computer-assisted SBIRT may represent a significant time-saving measure, allowing EDs to reach larger numbers of patients for alcohol intervention without causing undue clinical burden or interruptions to clinical care. Future studies with follow-up are needed to replicate these results and assess drinking reductions post-intervention.
Computerized alcohol screening; Brief intervention; Emergency department; SBIRT
Related Articles
An Evidence-Based Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) Curriculum for Emergency Department (ED) Providers Improves Skills and Utilization
Bernstein, Edward
Bernstein, Judith
Feldman, James
Fernandez, William
Hagan, Melissa
Mitchell, Patricia
Safi, Clara
Woolard, Robert
Mello, Mike
Baird, Janette
Lee, Cristina
Bazargan-Hejazi, Shahrzad
Broderick, Kerry
LaPerrier, Kathryn A.
Kellermann, Arthur
Wald, Marlena M.
Taylor, Robert E.
Walton, Kim
Grant-Ervin, Michelle
Rollinson, Denise
Edwards, David
Chan, Theodore
Davis, Dan
Marshall, Jean Buchanan
Aseltine, Robert
James, Amy
Abu-Hasaballah, Khamis
Schilling, Elizabeth
Baumann, Brigitte M.
Boudreaux, Edwin D.
Maio, Ronald
Cunningham, Rebecca
Murrell, Teresa
Doezema, David
Bauer, Michael J.
Anglin, Deirdre
Eliassen, Adriana
Martin, Marcus
Pines, Jesse
Buchanan, Leslie
Turner, James
D'Onofrio, Gail
Degutis, Linda C.
Owens, Patricia
Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse
Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience improves provider beliefs and practices.
ED faculty, residents, nurses, physician extenders, social workers, and Emergency Medical Technicians (EMTs) were surveyed prior to participating in either a two hour interactive workshops with case simulations, or a web-based program (www.ed.bmc.org/sbirt). A pre-post repeated measures design assessed changes in provider beliefs and practices at three and 12 months post-exposure.
Among 402 ED providers, 74% reported < 10 hours of prior professional alcohol-related education and 78% had < 2 hours exposure in the previous year. At 3-month follow-up, scores for self-reported confidence in ability, responsibility to intervene, and actual utilization of SBIRT skills all improved significantly over baseline. Gains decreased somewhat at 12 months, but remained above baseline. Length of time in practice was positively associated with SBIRT utilization, controlling for gender, race and type of profession. Persistent barriers included time limitations and lack of referral resources.
ED providers respond favorably to SBIRT. Changes in utilization were substantial at three months post-exposure to a standardized curriculum, but less apparent after 12 months. Booster sessions, trained assistants and infrastructure supports may be needed to sustain changes over the longer term.
Brief intervention; alcohol screening; substance abuse; alcohol education
Related Articles
Emergency Department–Based Brief Intervention to Reduce Risky Driving and Hazardous/Harmful Drinking in Young Adults: A Randomized Controlled Trial
Sommers, Marilyn S.
Lyons, Michael S.
Fargo, Jamison D.
Sommers, Benjamin D.
McDonald, Catherine C.
Shope, Jean T.
Fleming, Michael F.
Alcoholism, clinical and experimental research
Risky driving and hazardous drinking are associated with significant human and economic costs. Brief interventions for more than one risky behavior have the potential to reduce health-compromising behaviors in populations with multiple risk-taking behaviors such as young adults. Emergency department (ED) visits provide a window of opportunity for interventions meant to reduce both risky driving and hazardous drinking.
We determined the efficacy of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocol addressing risky driving and hazardous drinking. We used a randomized controlled trial design with follow-ups through 12 months. ED patients aged 18 to 44 who screened positive for both behaviors (n = 476) were randomized to brief intervention (BIG), contact control (CCG), or no-contact control (NCG) groups. The BIG (n = 150) received a 20-minute assessment and two 20-minute interventions. The CCG (n = 162) received a 20-minute assessment at baseline and no intervention. The NCG (n = 164) were asked for contact information at baseline and had no assessment or intervention. Outcomes at 3, 6, 9, and 12 months were self-reported driving behaviors and alcohol consumption.
Outcomes were significantly lower in BIG compared with CCG through 6 or 9 months, but not at 12 months: Safety belt use at 3 months (adjusted odds ratio [AOR], 0.22; 95% confidence interval [CI], 0.08 to 0.65); 6 months (AOR, 0.13; 95% CI, 0.04 to 0.42); and 9 months (AOR, 0.18; 95% CI, 0.06 to 0.56); binge drinking at 3 months (adjusted rate ratio [ARR] 0.84; 95% CI, 0.74 to 0.97) and 6 months (ARR, 0.81; 95% CI, 0.67 to 0.97); and ≥ 5 standard drinks/d at 3 months (AOR, 0.43; 95% CI, 0.20 to 0.91) and 6 months (AOR, 0.41; 95% CI, 0.17 to 0.98). No substantial differences were observed between BIG and NCG at 12 months.
Our findings indicate that SBIRT reduced risky driving and hazardous drinking in young adults, but its effects did not persist after 9 months. Future research should explore methods for extending the intervention effect.
Brief Intervention; Hazardous Drinking; Risky Driving
Related Articles
Cherpitel, Cheryl J.
Korcha, Rachael A.
Moskalewicz, Jacek
Swiatkiewicz, Grazyna
Ye, Yu
Bond, Jason
Alcoholism, clinical and experimental research
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. Patients were recruited over a 23-week period (4:00 pm to 12:00 midnight) and randomized to one of three 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 three groups assessed at 12 months (screened only = 92, assessed = 99, intervention = 87). No difference was found across the three 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 three 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. Data suggest that improvements in drinking outcomes found in the assessment condition were not due to assessment reactivity, with both the screened and intervention conditions demonstrating greater (although non-significant) improvement than the assessed condition. Although group by time interaction effects were not found to be significant, findings show that declines in drinking measures for those receiving a brief intervention can be maintained at long-term follow-up.
Related Articles
Randomized clinical trial of the effects of screening and brief intervention for illicit drug use: the life shift/shift gears study
Woodruff, Susan I
Clapp, John D
Eisenberg, Kimberly
McCabe, Cameron
Hohman, Melinda
Shillington, Audrey M
Sise, C Beth
Castillo, Edward M
Chan, Theodore C
Sise, Michael J
Gareri, Joey
Addiction Science & Clinical Practice
Although screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals.
A total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite.
Of 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12).
In this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome.
Trial registration
ClinicalTrials.gov NCT01683227.
Screening and brief intervention; Drug use; Emergency department patients
Related Articles
The relationship between services delivered and substance use outcomes in New Mexico's Screening, Brief Intervention, Referral and Treatment (SBIRT) Initiative
Gryczynski, Jan
Mitchell, Shannon Gwin
Peterson, Thomas R.
Gonzales, Arturo
Moseley, Ana
Schwartz, Robert P.
Drug and alcohol dependence
Recent years have seen increased diffusion of the Screening, Brief Intervention, Referral and Treatment Initiative (SBIRT) in healthcare environments. This study examined the relationship between substance use outcomes and service variables within the SBIRT model.
Over 55,000 adult patients were screened for substance misuse at rural health clinics throughout New Mexico during the SBIRT Initiative. This naturalistic pre-post services study used administrative baseline, 6 month follow-up, and services data for adult participants in the New Mexico SBIRT evaluation (n=1,208). Changes in self-reported frequency of illicit drug use, alcohol use, and alcohol intoxication were examined as a function of service level (brief intervention– BI versus brief treatment/referral– BT/RT) and number of service sessions.
Participants reported decreased frequency of illicit drug use, alcohol use, and alcohol intoxication 6 months after receipt of SBIRT services (p<.001 for each). Compared to those who received BI, participants who received BT/RT had sharper reductions in frequency of drinking (IRR=.78; p<.05) and alcohol intoxication (IRR=.75; p<.05). Number of service sessions was associated with reduced frequency of alcohol use (IRR=.84; p<.01) and intoxication (IRR=.82; p<.05), but only among those who received BI.
Substance-using patients with disparate levels of use may benefit from SBIRT. In a real-world, multi-site rural SBIRT program, services of higher intensity and (within the BI modality) frequency were associated with greater magnitude of change in drinking behaviors. Reductions in illicit drug use, while substantial, did not differ significantly based on service variables. Future studies should identify the preferred service mix in the SBIRT model as it continues to expand.
Screening; Brief Intervention; Brief Treatment; SBIRT; Services; Rural Healthcare
Related Articles
Evaluation of California's Alcohol and Drug Screening and Brief Intervention Project for Emergency Department Patients
Woodruff, Susan I.
Eisenberg, Kimberly
McCabe, Cameron T.
Clapp, John D.
Hohman, Melinda
Western Journal of Emergency Medicine
Introduction: Visits to settings such as emergency departments (EDs) may present a "teachable moment" in that a patient may be more open to feedback and suggestions regarding their risky alcohol and illicit drug-use behaviors. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an 'opportunistic' public health approach that targets low-risk users, in addition to those already dependent on alcohol and/or drugs. SBIRT programs provide patients with comprehensive screening and assessments, and deliver interventions of appropriate intensity to reduce risks related to alcohol and drug use.
Methods: This study used a single group pre-post test design to assess the effect of the California SBIRT service program (i.e., CASBIRT) on 6 substance-use outcomes (past-month prevalence and number of days of binge drinking, illegal drug use, and marijuana use). Trained bilingual/bicultural Health Educators attempted to screen all adult patients in 12 EDs/trauma centers (regardless of the reason for the patient's visit) using a short instrument, and then delivered a brief motivational intervention matched to the patient's risk level. A total of 2,436 randomly selected patients who screened positive for alcohol and/or drug use consented to be in a 6-month telephone follow-up interview. Because of the high loss to follow-up rate, we used an intention-to-treat approach for the data analysis.
Results: Results of generalized linear mixed models showed modest reductions in all 6 drug-and alcohol-use outcomes. Men (versus women), those at relatively higher risk status (versus lower risk), and those with only one substance of misuse (versus both alcohol and illicit drug misuse) tended to show more positive change.
Conclusion: These results suggest that SBIRT services provided in acute care settings are associated with modest changes in self-reported recent alcohol and illicit drug use.
Related Articles
The Effectiveness of Community Action in Reducing Risky Alcohol Consumption and Harm: A Cluster Randomised Controlled Trial
Shakeshaft, Anthony
Doran, Christopher
Petrie, Dennis
Breen, Courtney
Havard, Alys
Abudeen, Ansari
Harwood, Elissa
Clifford, Anton
D'Este, Catherine
Gilmour, Stuart
Sanson-Fisher, Rob
PLoS Medicine
In a cluster randomized controlled trial, Anthony Shakeshaft and colleagues measure the effectiveness of a multi-component community-based intervention for reducing alcohol-related harm.
The World Health Organization, governments, and communities agree that community action is likely to reduce risky alcohol consumption and harm. Despite this agreement, there is little rigorous evidence that community action is effective: of the six randomised trials of community action published to date, all were US-based and focused on young people (rather than the whole community), and their outcomes were limited to self-report or alcohol purchase attempts. The objective of this study was to conduct the first non-US randomised controlled trial (RCT) of community action to quantify the effectiveness of this approach in reducing risky alcohol consumption and harms measured using both self-report and routinely collected data.
Methods and Findings
We conducted a cluster RCT comprising 20 communities in Australia that had populations of 5,000–20,000, were at least 100 km from an urban centre (population ≥ 100,000), and were not involved in another community alcohol project. Communities were pair-matched, and one member of each pair was randomly allocated to the experimental group. Thirteen interventions were implemented in the experimental communities from 2005 to 2009: community engagement; general practitioner training in alcohol screening and brief intervention (SBI); feedback to key stakeholders; media campaign; workplace policies/practices training; school-based intervention; general practitioner feedback on their prescribing of alcohol medications; community pharmacy-based SBI; web-based SBI; Aboriginal Community Controlled Health Services support for SBI; Good Sports program for sports clubs; identifying and targeting high-risk weekends; and hospital emergency department–based SBI. Primary outcomes based on routinely collected data were alcohol-related crime, traffic crashes, and hospital inpatient admissions. Routinely collected data for the entire study period (2001–2009) were obtained in 2010. Secondary outcomes based on pre- and post-intervention surveys (n = 2,977 and 2,255, respectively) were the following: long-term risky drinking, short-term high-risk drinking, short-term risky drinking, weekly consumption, hazardous/harmful alcohol use, and experience of alcohol harm. At the 5% level of statistical significance, there was insufficient evidence to conclude that the interventions were effective in the experimental, relative to control, communities for alcohol-related crime, traffic crashes, and hospital inpatient admissions, and for rates of risky alcohol consumption and hazardous/harmful alcohol use. Although respondents in the experimental communities reported statistically significantly lower average weekly consumption (1.90 fewer standard drinks per week, 95% CI = −3.37 to −0.43, p = 0.01) and less alcohol-related verbal abuse (odds ratio = 0.58, 95% CI = 0.35 to 0.96, p = 0.04) post-intervention, the low survey response rates (40% and 24% for the pre- and post-intervention surveys, respectively) require conservative interpretation. The main limitations of this study are as follows: (1) that the study may have been under-powered to detect differences in routinely collected data outcomes as statistically significant, and (2) the low survey response rates.
This RCT provides little evidence that community action significantly reduces risky alcohol consumption and alcohol-related harms, other than potential reductions in self-reported average weekly consumption and experience of alcohol-related verbal abuse. Complementary legislative action may be required to more effectively reduce alcohol harms.
Trial registration
Australian New Zealand Clinical Trials Registry ACTRN12607000123448
Please see later in the article for the Editors' Summary
Editors' Summary
People have consumed alcoholic beverages throughout history, but alcohol use is now an increasing global public health problem. According to the World Health Organization's 2010 Global Burden of Disease Study, alcohol use is the fifth leading risk factor (after high blood pressure and smoking) for disease and is responsible for 3.9% of the global disease burden. Alcohol use contributes to heart disease, liver disease, depression, some cancers, and many other health conditions. Alcohol also affects the well-being and health of people around those who drink, through alcohol-related crimes and road traffic crashes. The impact of alcohol use on disease and injury depends on the amount of alcohol consumed and the pattern of drinking. Most guidelines define long-term risky drinking as more than four drinks per day on average for men or more than two drinks per day for women (a "drink" is, roughly speaking, a can of beer or a small glass of wine), and short-term risky drinking (also called binge drinking) as seven or more drinks on a single occasion for men or five or more drinks on a single occasion for women. However, recent changes to the Australian guidelines acknowledge that a lower level of alcohol consumption is considered risky (with lifetime risky drinking defined as more than two drinks a day and binge drinking defined as more than four drinks on one occasion).
Why Was This Study Done?
In 2010, the World Health Assembly endorsed a global strategy to reduce the harmful use of alcohol. This strategy emphasizes the importance of community action–a process in which a community defines its own needs and determines the actions that are required to meet these needs. Although community action is highly acceptable to community members, few studies have looked at the effectiveness of community action in reducing risky alcohol consumption and alcohol-related harm. Here, the researchers undertake a cluster randomized controlled trial (the Alcohol Action in Rural Communities [AARC] project) to quantify the effectiveness of community action in reducing risky alcohol consumption and harms in rural communities in Australia. A cluster randomized trial compares outcomes in clusters of people (here, communities) who receive alternative interventions assigned through the play of chance.
What Did the Researchers Do and Find?
The researchers pair-matched 20 rural Australian communities according to the proportion of their population that was Aboriginal (rates of alcohol-related harm are disproportionately higher among Aboriginal individuals than among non-Aboriginal individuals in Australia; they are also higher among young people and males, but the proportions of these two groups across communities was comparable). They randomly assigned one member of each pair to the experimental group and implemented 13 interventions in these communities by negotiating with key individuals in each community to define and implement each intervention. Examples of interventions included general practitioner training in screening for alcohol use disorders and in implementing a brief intervention, and a school-based interactive session designed to reduce alcohol harm among young people. The researchers quantified the effectiveness of the interventions using routinely collected data on alcohol-related crime and road traffic crashes, and on hospital inpatient admissions for alcohol dependence or abuse (which were expected to increase in the experimental group if the intervention was effective because of more people seeking or being referred for treatment). They also examined drinking habits and experiences of alcohol-related harm, such as verbal abuse, among community members using pre- and post-intervention surveys. After implementation of the interventions, the rates of alcohol-related crime, road traffic crashes, and hospital admissions, and of risky and hazardous/harmful alcohol consumption (measured using a validated tool called the Alcohol Use Disorders Identification Test) were not statistically significantly different in the experimental and control communities (a difference in outcomes that is not statistically significantly different can occur by chance). However, the reported average weekly consumption of alcohol was 20% lower in the experimental communities after the intervention than in the control communities (equivalent to 1.9 fewer standard drinks per week per respondent) and there was less alcohol-related verbal abuse post-intervention in the experimental communities than in the control communities.
What Do These Findings Mean?
These findings provide little evidence that community action reduced risky alcohol consumption and alcohol-related harms in rural Australian communities. Although there was some evidence of significant reductions in self-reported weekly alcohol consumption and in experiences of alcohol-related verbal abuse, these findings must be interpreted cautiously because they are based on surveys with very low response rates. A larger or differently designed study might provide statistically significant evidence for the effectiveness of community action in reducing risky alcohol consumption. However, given their findings, the researchers suggest that legislative approaches that are beyond the control of individual communities, such as alcohol taxation and restrictions on alcohol availability, may be required to effectively reduce alcohol harms. In other words, community action alone may not be the most effective way to reduce alcohol-related harm.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001617.
The World Health Organization provides detailed information about alcohol; its fact sheet on alcohol includes information about the global strategy to reduce the harmful use of alcohol; the Global Information System on Alcohol and Health provides further information about alcohol, including information on control policies around the world
The US National Institute on Alcohol Abuse and Alcoholism has information about alcohol and its effects on health
The US Centers for Disease Control and Prevention has a website on alcohol and public health that includes information on the health risks of excessive drinking
The UK National Health Service Choices website provides detailed information about drinking and alcohol, including information on the risks of drinking too much, tools for calculating alcohol consumption, and personal stories about alcohol use problems
MedlinePlus provides links to many other resources on alcohol
More information about the Alcohol Action in Rural Communities project is available
Related Articles
Mobile phone text message intervention to reduce binge drinking among young adults: study protocol for a randomized controlled trial
Suffoletto, Brian
Callaway, Clifton W
Kristan, Jeffrey
Monti, Peter
Clark, Duncan B
Heavy episodic (binge) drinking is common among young adults and can lead to injury and illness. Young adults who seek care in the Emergency Department (ED) may be disproportionately affected with binge drinking behavior, therefore provide an opportunity to reduce future risk through screening, brief intervention and referral to treatment (SBIRT). Mobile phone text messaging (SMS) is a common form of communication among young adults and has been shown to be effective at providing behavioral support to young adult drinkers after ED discharge. Efficacy of SMS programs to reduce binge drinking remains unknown.
We will conduct a three parallel arm, randomized trial. A convenience sample of adults aged 18 to 25 years attending three EDs in Pittsburgh, PA and willing to participate in the study will be screened for hazardous alcohol consumption. Participants identified as hazardous drinkers will then be allocated to either 12 weeks of weekly SMS drinking assessments with feedback (SA+F), SMS drinking assessments without feedback (SA), or a control group. Randomization will be via an independent and remote computerized randomization and will be stratified by study site. The SA+F group will be asked to provide pre-weekend drinking intention as well as post-weekend consumption via SMS and will receive feedback messages focused on health consequences of alcohol consumption, personalized normative feedback, protective drinking strategies and goal setting. Follow-up data on alcohol use and injury related to alcohol will be collected through a password-protected website three, six and nine months later. The primary outcome for the study is binge drinking days (≥4 drinks for women; ≥5 drinks for men) during the previous month, and the main secondary outcome is the proportion of participants who report any injury related to alcohol in the prior three months.
This study will test the hypothesis that a mobile phone text-messaging program will result in immediate and durable reductions in binge drinking among at-risk young adults. By testing an intervention group to an assessment-only and control group, we will be able to separate the effect of assessment reactivity. By collecting pre-weekend drinking intentions and post-weekend consumption data in the SA+F group, we will be able to better understand mechanism of change.
Trial registration
Clinicaltrials.gov NCT01688245
Alcohol misuse; Intervention; Randomized controlled trial; Effectiveness
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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
Bernstein, Judith
Heeren, Timothy
Edward, Erika
Dorfman, David
Bliss, Caleb
Winter, Michael
Bernstein, Edward
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
Adolescents in their late teens and early twenties have the highest alcohol consumption in the United States; binge drinking peaks at age 21 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.
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 group (MAC) 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 intervention group received a peer-conducted motivational intervention, erral to community resources and treatment if indicated, and a ten-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 one year follow-up.
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 RAP (Reaching Adolescents for Prevention) 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 three 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 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).
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.
youth drinking; brief intervention; SBIRT; motivational interviewing; alcohol consequences
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Screening, brief intervention, and referral to treatment (SBIRT) for offenders: protocol for a pragmatic randomized trial
Prendergast, Michael L
Cartier, Jerome J
Addiction Science & Clinical Practice
Although screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based technique that, in some health-care settings, has been shown to cost-effectively reduce alcohol and drug use, research on the efficacy of SBIRT among criminal offender populations is limited. Such populations have a high prevalence of drug and alcohol use but limited access to intervention, and many are at risk for post-release relapse and recidivism. Thus, there exists a need for treatment options for drug-involved offenders of varying risk levels to reduce risky behaviors or enter treatment.
This protocol describes an assessment of SBIRT feasibility and effectiveness in a criminal justice environment. Eight-hundred persons will be recruited from a large metropolitan jail, with the experimental group receiving an intervention depending on risk level and the control group receiving minimal intervention. The intervention will assess the risk level for drug and alcohol misuse by inmates, providing those at low or medium risk a brief intervention in the jail and referring those at high risk to community treatment following release. In addition, a brief treatment (eight-session) option will be available. Using data from a 12-month follow-up interview, the primary study outcomes are a reduction in drug and alcohol use, while secondary outcomes include participation in treatment, rearrest, quality of life, reduction in HIV risk behaviors, and costs of SBIRT.
Expected value
Individual reductions in alcohol and drug use can have significant effects on public health and safety when observed over a large population at risk for substance-use problems. With wider dissemination statewide or nationwide, a relatively low-cost intervention such as SBIRT could offer demonstrated benefits in this population.
Trial registration
Clinical Trials Government Identifier, NCT01683643.
Screening, brief intervention, and referral to treatment (SBIRT); Offenders; Jail; Protocol; Pragmatic randomized trial
Related Articles
Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use in a School-based Program: Services and Outcomes
Mitchell, Shannon Gwin
Gryczynski, Jan
Gonzales, Arturo
Moseley, Ana
Peterson, Thomas
O'Grady, Kevin E.
Schwartz, Robert P.
The American journal on addictions / American Academy of Psychiatrists in Alcoholism and Addictions
Despite the advantages of using high schools for conducting school-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs for adolescent substance misuse, there have been very few studies of brief interventions in these settings.
This multi-site, repeated measures study examined outcomes of adolescents who received SBIRT services and compared the extent of change in substance use based on the intensity of intervention received.
Participants consisted of 629 adolescents, ages 14 to 17, who received SBIRT services across 13 participating high schools in New Mexico. The level of service received and number of sessions were collected through administrative records, while the number of self-reported days in the past month of drinking; drinking to intoxication; and drug use were gathered at baseline and 6-month follow-up.
Brief Intervention (BI) was provided to 85.1% of adolescents, while 14.9% received brief treatment or referral-to-treatment (BT/RT). Participants receiving any intervention reported significant reductions in frequency of drinking to intoxication (p<.05) and drug use (p<.001), but not alcohol use, from baseline to 6-month follow-up. The magnitude of these reductions did not differ based on service variables. Controlling for baseline frequency of use, a BT/RT service level was associated with more days of drinking at 6 month follow-up (p<.05), but was no longer significant when controlling for number of service sessions received.
Conclusions and Scientific Significance
These findings support school-based SBIRT for adolescents, but more research is needed on this promising approach.
Related Articles
Enhancing screening, brief intervention, and referral to treatment among socioeconomically disadvantaged patients: study protocol for a knowledge exchange intervention involving patients and physicians
Salvalaggio, Ginetta
Dong, Kathryn
Vandenberghe, Christine
Kirkland, Scott
Mramor, Kelsey
Brown, Taryn
Taylor, Marliss
McKim, Robert
Cummings, Greta G
Wild, T Cameron
BMC Health Services Research
Screening, Brief Intervention, and Referral for Treatment (SBIRT) is an effective approach for managing alcohol and other drug misuse in primary care; however, uptake into routine care has been limited. Uptake of SBIRT by healthcare providers may be particularly problematic for disadvantaged populations exhibiting alcohol and other drug problems, and requires creative approaches to enhance patient engagement. This knowledge translation project developed and evaluated a group of patient and health care provider resources designed to enhance the capacity of health care providers to use SBIRT and improve patient engagement with health care.
A nonrandomized, two-group, pre-post, quasi-experimental intervention design was used, with baseline, 6-, and 12-month follow-ups. Low income patients using alcohol and other drugs and who sought care in family medicine and emergency medicine settings in Edmonton, Canada, along with physicians providing care in these settings, were recruited. Patients and physicians were allocated to the intervention or control condition by geographic location of care. Intervention patients received a health care navigation booklet developed by inner city community members and also had access to an experienced community member for consultation on health service navigation. Intervention physicians had access to online educational modules, accompanying presentations, point of care resources, addiction medicine champions, and orientations to the inner city. Resource development was informed by a literature review, needs assessment, and iterative consultation with an advisory board and other content experts. Participants completed baseline and follow-up questionnaires (6 months for patients, 6 and 12 months for physicians) and administrative health service data were also retrieved for consenting patients. Control participants were provided access to all resources after follow-up data collection was completed. The primary outcome measure was patient satisfaction with care; secondary outcome measures included alcohol and drug use, health care and addiction treatment use, uptake of SBIRT strategies, and physician attitudes about addiction.
Effective knowledge translation requires careful consideration of the intended knowledge recipient's context and needs. Knowledge translation in disadvantaged settings may be optimized by using a community-based participatory approach to resource development that takes into account relevant patient engagement issues.
Trial registration
Northern Alberta Clinical Trials and Research Centre #30094
Addiction; Screening; Brief intervention; Family medicine; Emergency medicine; Underserved patients; Patient engagement
Related Articles
Cherpitel, Cheryl J.
Bernstein, Edward
Bernstein, Judith
Moskalewicz, Jacek
Swiatkiewicz, Grazyna
Journal of addictions nursing
A randomized clinical controlled trial of screening, brief intervention and referral to treatment (SBIRT) for drinking and related problems among at-risk and dependent drinkers, using nurse interventionists, was undertaken in an emergency room (ER) in Sosnowiec, Poland, the first level-one trauma center in that country. This study was the first outside of the U.S. to test protocols developed in a 14-site collaborative SBIRT study. Because Poland has both a pattern of heavy drinking and a highly accessible specialized alcohol treatment system, it offered a key setting for cultural translation of SBIRT to the international context of a new and emerging health care system. It also offered the opportunity to test the effectiveness of SBIRT with both at-risk and dependent drinkers, and to test the feasibility of using ER nursing staff to provide the brief intervention, serving as a potential model for ongoing implementation of SBIRT in ER settings. Findings suggest that the U.S.-based SBIRT protocols can be successfully translated to other cultures, and that nurses can be successfully trained to provide brief intervention for problem drinking in the ER setting.
Related Articles
Performance Measurement: A Proposal to Increase Use of SBIRT and Decrease Alcohol Consumption during Pregnancy
O'Brien, Peggy L.
Maternal and child health journal
Alcohol consumption during pregnancy has negative implications for maternal and child health. Appropriate early universal Screening, Brief Intervention and Referral to Treatment (SBIRT) for pregnant women is necessary to identify women at risk and reduce the likelihood of continued drinking. Because SBIRT is not consistently used, the development and use of performance measures to assure implementation of SBIRT are key steps towards intervention and reduction of alcohol consumption during pregnancy.
Practice guidelines provide ample support for specific instruments designed for SBIRT in prenatal care. An examination of existing performance measures related to alcohol consumption during pregnancy, however, reveals no comprehensive published performance measure designed to quantify the use of SBIRT for alcohol use in prenatal care.
Process performance measures were developed that can determine the proportion of pregnant women who are screened during the course of prenatal care and the proportion of women requiring either brief intervention or referral to substance use disorder treatment who received those interventions. The measures require use of screening instruments validated for use with pregnant women.
The two proposed measures would represent a significant step in efforts to assure appropriate intervention for women who drink during pregnancy, hold accountable providers who do not employ SBIRT, and provide a basis from which necessary systemic changes might occur. Pregnancy is a time when many women are motivated to stop drinking. That opportunity should be seized, with timely intervention offering assistance for pregnant women who have not stopped drinking of their own accord.
Related Articles
Increased Detection of Alcohol Consumption and At-risk Drinking with Computerized Alcohol Screening
Lotfipour, Shahram
Howard, James
Roumani, Samer
Hoonpongsimanont, Wirachin
Chakravarthy, Bharath
Anderson, Craig L
Weiss, Jie
Cisneros, Victor
Dykzeul, Brad
The Journal of emergency medicine
The impact of alcohol use has been widely studied and is considered a public health issue. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends Screening and Brief Intervention and Referral Treatment (SBIRT) but the actual practice in the Emergency Department (ED) is constrained due to limited provider time and financial resources.
To assess the effectiveness of alcohol screening using Computerized Alcohol Screening and brief Intervention (CASI) compared to alcohol screening by triage nurse during Medical Screening Examination (MSE) in the ED.
Retrospective review of CASI/MSE database from January 2008 through December 2009, collected in the tertiary, level I Trauma ED was performed. Inclusion criteria included age ≥18, and completion of both the MSE and CASI. We analyzed the database by comparing age, gender, primary language (English, Spanish), and Alcohol Use Disorders Identification Test (AUDIT) scores using McNemar's analysis.
Data was available for 5,835 patients. CASI showed a significant increase in detection of at-risk drinking over MSE across all ages, gender, and primary language (p<.05). MSE found 2.5% at-risk drinkers while CASI found 11.5% at risk drinkers (Odds ratio 8.88, 95%CI 6.89–11.61). Similar results were found in 18 to 20 year-old patients. MSE identified 1.7% at-risk drinkers and CASI reported 15.94%. (Odds ratio 19.33, 95% CI 6.29–96.74)
CASI increased detection of at-risk alcohol drinkers compared with MSE across all ages, gender, and primary language. CASI is a promising innovative method for alcohol screening in the ED for the adult population including under-aged drinkers.
tablet computer; bilingual alcohol screening; CASI; injury prevention; AUDIT
Related Articles
The Basics of Alcohol Screening, Brief Intervention and Referral to Treatment in the Emergency Department
Vaca, Federico E.
Winn, Diane
Western Journal of Emergency Medicine
Nearly eight million emergency department (ED) visits are attributed to alcohol every year in the United States. A substantial proportion is due to trauma. In 2005, 16,885 people were killed as a result of alcohol-related motor vehicle crashes. Patients with alcohol-use problems (AUPs) are not only more likely to drive after drinking but are also at greater risk for serious alcohol-related illness and injury. Emergency departments have an important and unique opportunity to identify these patients and intervene during the "teachable moment" of an ED visit. The American College of Emergency Physicians, Emergency Nurses Association, American College of Surgeons-Committee on Trauma, American Public Health Association, and the National Highway Traffic Safety Administration, have identified Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) as a pivotal injury- and illness-prevention strategy to improve the health and well-being of ED patients. We provide a general overview of the basis and need for integrating SBIRT into EDs. Models of SBIRT, as well as benefits and challenges to its implementation, are also discussed.
Related Articles
Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and six months
Madras, Bertha K.
Compton, Wilson M.
Avula, Deepa
Stegbauer, Tom
Stein, Jack B.
Clark, H. Westley
Drug and alcohol dependence
Alcohol screening and brief interventions in medical settings can significantly reduce alcohol use. Corresponding data for illicit drug use is sparse. A Federally funded Screening, Brief Intervention, Referral to Treatment (SBIRT) service program, the largest of its kind to date, was initiated by the Substance Abuse and Mental Health Services Administration (SAMHSA) in a wide variety of medical settings. We compared illicit drug use at intake and six months after drug screening and interventions were administered.
SBIRT services were implemented in a range of medical settings across six states. A diverse patient population (Alaska Natives, American Indians, African-Americans, Caucasians, Hispanics), was screened and offered score-based progressive levels of intervention (brief intervention, brief treatment, referral to specialty treatment). In this secondary analysis of the SBIRT service program, drug use data was compared at intake and at a six month follow-up, in a sample of a randomly selected population (10%) that screened positive at baseline.
Of 459,599 patients screened, 22.7% screened positive for a spectrum of use (risky/problematic, abuse/addiction). The majority were recommended for a brief intervention (15.9%), with a smaller percentage recommended for brief treatment (3.2%) or referral to specialty treatment (3.7%). Among those reporting baseline illicit drug use, rates of drug use at 6 month follow-up (4 of 6 sites), were 67.7% lower (p < 0.001) and heavy alcohol use was 38.6% lower (p < 0.001), with comparable findings across sites, gender, race/ethnic, age subgroups. Among persons recommended for brief treatment or referral to specialty treatment, self-reported improvements in general health (p < 0.001), mental health (p < 0.001), employment (p < 0.001), housing status (p < 0.001), and criminal behavior (p < 0.001) were found.
SBIRT was feasible to implement and the self-reported patient status at six months indicated significant improvements over baseline, for illicit drug use and heavy alcohol use, with functional domains improved, across a range of health care settings and a range of patients.
services; treatment; prescription drug abuse; preventive medicine; marijuana; cocaine; heroin; methamphetamine; CPT® codes; primary health care; trauma centers
Related Articles
Self-reported alcohol and drug use six months after brief intervention: do changes in reported use vary by mental-health status?
Krupski, Antoinette
Sears, Jeanne M
Joesch, Jutta M
Estee, Sharon
He, Lijian
Huber, Alice
Dunn, Chris
Roy-Byrne, Peter
Ries, Richard
Addiction Science & Clinical Practice
Although brief intervention (BI) for alcohol and other drug problems has been associated with subsequent decreased levels of self-reported substance use, there is little information in the extant literature as to whether individuals with co-occurring hazardous substance use and mental illness would benefit from BI to the same extent as those without mental illness. This is an important question, as mental illness is estimated to co-occur in 37% of individuals with an alcohol use disorder and in more than 50% of individuals with a drug use disorder. The goal of this study was to explore differences in self-reported alcohol and/or drug use in patients with and without mental illness diagnoses six months after receiving BI in a hospital emergency department (ED).
This study took advantage of a naturalistic situation where a screening, brief intervention, and referral to treatment (SBIRT) program had been implemented in nine large EDs in the US state of Washington as part of a national SBIRT initiative. A subset of patients who received BI was interviewed six months later about current alcohol and drug use. Linear regression was used to assess whether change in substance use measures differed among patients with a mental illness diagnosis compared with those without. Data were analyzed for both a statewide (n = 828) and single-hospital (n = 536) sample.
No significant differences were found between mentally ill and non-mentally ill subgroups in either sample with regard to self-reported hazardous substance use at six-month follow-up.
These results suggest that BI may not have a differing impact based on the presence of a mental illness diagnosis. Given the high prevalence of mental illness among individuals with alcohol and other drug problems, this finding may have important public health implications.
Brief intervention; Comorbid substance use and mental illness; Mental illness; Alcohol use; Binge drinking; Illicit drug use
Related Articles
Equipping Residents to Address Alcohol and Drug Abuse: The National SBIRT Residency Training Project
Pringle, Janice L.
Kowalchuk, Alicia
Meyers, Jessica Adams
Seale, J. Paul
Journal of Graduate Medical Education
The Screening, Brief Intervention and Referral to Treatment (SBIRT) service for unhealthy alcohol use has been shown to be one of the most cost-effective medical preventive services and has been associated with long-term reductions in alcohol use and health care utilization. Recent studies also indicate that SBIRT reduces illicit drug use. In 2008 and 2009, the Substance Abuse Mental Health Service Administration funded 17 grantees to develop and implement medical residency training programs that teach residents how to provide SBIRT services for individuals with alcohol and drug misuse conditions. This paper presents the curricular activities associated with this initiative.
We used an online survey delivery application (Qualtrics) to e-mail a survey instrument developed by the project directors of 4 SBIRT residency programs to each residency grantee's director. The survey included both quantitative and qualitative data.
All 17 (100%) grantees responded. Respondents encompassed residency programs in emergency medicine, family medicine, pediatrics, obstetrics-gynecology, psychiatry, surgery, and preventive medicine. Thirteen of 17 (76%) grantee programs used both online and in-person approaches to deliver the curriculum. All 17 grantees incorporated motivational interviewing and validated screening instruments in the curriculum. As of June 2011, 2867 residents had been trained, and project directors reported all residents were incorporating SBIRT into their practices. Consistently mentioned challenges in implementing an SBIRT curriculum included finding time in residents' schedules for the modules and the need for trained faculty to verify resident competence.
The SBIRT initiative has resulted in rapid development of educational programs and a cohort of residents who utilize SBIRT in practice. Skills verification, program dissemination, and sustainability after grant funding ends remain ongoing challenges.
Related Articles
Sex Differences in Alcohol Misuse and Estimated Blood Alcohol Concentrations Among Emergency Department Patients: Implications for Brief Interventions
Trillo, Alexis D.
Merchant, Roland C.
Baird, Janette R.
Liu, Tao
Nirenberg, Ted D.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
The objective was to assess the relationship between alcohol use and misuse and patient sex among emergency department (ED) patients by comparing self-reported estimates of quantity and frequency of alcohol use; estimated blood alcohol concentrations (eBACs) when typically drinking, and during heavy episodic drinking (binging); and alcohol misuse severity, to understand sex differences in alcohol use and misuse for this population.
The authors surveyed a random sample of non-intoxicated, sub-critically ill or injured, 18 to 64 year-old English- or Spanish-speaking patients on randomly selected dates and times at two EDs during July 2009 and August 2009. Participants self-administered a questionnaire about their self-reported alcohol use during a typical month within the past 12 months, and the Alcohol Use Disorders Identification Test (AUDIT). Using the formulae by Matthews and Miller, sex-specific eBACs were calculated for participants according to their reported weight and the number of reported alcoholic drinks consumed on days when typically drinking, and on days of heavy episodic (binge) drinking (≥ 5 drinks/occasion for men, ≥ 4 drinks for women). Sex-specific alcohol misuse severity levels (low-risk, harmful, hazardous, and dependence) were calculated using AUDIT scores. Wilcoxon rank-sum and Pearson's chi-square tests were used to compare outcomes by sex. Negative binomial regression was used to assess the relationship between sex and the number of drinks consumed on a typical day, the number of days spent drinking and binging, and estimated AUDIT scores. Logistic regression was used to assess the outcome of the presence of binging according to sex. Multinomial logistic regression was used to compare by sex the percentage of days spent drinking and binging in one month, eBACs when typically drinking and when binging, and AUDIT at-risk drinking levels. Incidence rate ratios (IRRs) and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. All models were adjusted for patient demographic characteristics.
Of the 513 participants, 52.1% were women, 55.8% were white non-Hispanic, and their median age was 34 years (IQR 25 to 46 years). Men reported greater mean alcohol consumption than women when typically drinking (4.3 vs. 3.3 drinks per day; p < 0.001), and during heavy episodic drinking (8.6 vs. 5.3/drinks per occasion; p < 0.001). Men spent more days drinking (IRR 1.41, 95% CI = 1.19 to 1.65) and engaging in heavy episodic drinking (IRR 1.68, 95% CI = 1.31 to 2.17) than women. Additionally, men were more likely to engage in heavy episodic drinking (AOR 1.72, 95% CI = 1.16 to 2.56) than women. However, the mean eBACs for men and women were similar when typically drinking (0.05 vs. 0.06; p < 0.13) and during heavy episodic drinking (0.13 vs. 0.12; p < 0.13). Mean AUDIT scores were greater for men than women (7.5 vs. 5.3; p < 0.001), although alcohol misuse severity levels were similar between men and women (24.4% vs. 26.6% for hazardous, 2.8% vs. 2.2% for harmful, and 6.5% vs. 3.4% for dependence; p < 0.38).
Although men drink more than women, women have similar eBACs with comparable levels of alcohol misuse. Women may benefit from recognizing that they are reaching similar levels of intoxication compared to men. Addressing these differences and possible health implications in future ED brief interventions may induce changes in problematic alcohol use among women.
Related Articles
A Text Message Alcohol Intervention for Young Adult Emergency Department Patients: A Randomized Clinical Trial
Suffoletto, Brian
Kristan, Jeffrey
Callaway, Clifton
Kim, Kevin H.
Chung, Tammy
Monti, Peter M.
Clark, Duncan B.
Annals of emergency medicine
Opportunistic brief in-person Emergency Department (ED) interventions can be effective at reducing hazardous alcohol use in young adult drinkers, but require resources frequently unavailable. Mobile phone text messaging (SMS) could sustainably deliver behavioral support to young adult patients, but efficacy remains unknown. We report 3-month outcome data of a randomized controlled trial testing a novel SMS-delivered intervention in hazardous drinking young adults.
We randomized 765 young adult ED patients who screened positive for past hazardous alcohol use to one of three groups: SMS Assessments + Feedback (SA+F) intervention who were asked to respond to drinking-related queries and received realtime feedback through SMS each Thursday and Sunday for 12 weeks (n=384); SMS Assessments (SA) who were asked to respond to alcohol consumption queries each Sunday but did not receive any feedback (N=196); and a control group who did not participate in any SMS (n=185). Primary outcomes were number of binge drinking days and number of drinks per drinking day in the past 30 days collected by web-based Timeline Follow-Back method and analyzed with regression models. Secondary outcomes were the proportion of participants with weekend binge episodes and most drinks consumed per drinking occasion over 12 weekends collected by SMS.
Using web-based data, there were decreases in the number of binge drinking days from baseline to 3 months in the SA+F group (-.51 [95% confidence interval {CI} -.10 to -.95]), whereas there were increases in the SA group (.90 [95% CI .23 to 1.6]) and the control group (.41 [95% CI -.20 to 1.0]). There were also decreases in the number of drinks per drinking day from baseline to 3 months in the SA+F group (-.31 [95% CI -.07 to -.55]), whereas there were increases in the SA group (.10 [95% CI -.27 to .47]) and the control group (.39 [95% CI .06 to .72]). Using SMS data, there was a lower mean proportion of SA+F participants reporting a weekend binge over 12 weeks (30.5% [95% CI 25% to 36%) compared to the SA participants (47.7% [95% CI 40% to 56%]). There was also a lower mean drinks consumed per weekend over 12 weeks in the SA+F group (3.2 [95%CI 2.6 to 3.7]) compared to the SA group (4.8 [95% CI 4.0 to 5.6]).
A text message intervention can produce small reductions in binge drinking and the number of drinks consumed per drinking day in hazardous drinking young adults after ED discharge.
Related Articles
Study design to examine the potential role of assessment reactivity in the Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED) protocol
Donovan, Dennis M
Bogenschutz, Michael P
Perl, Harold
Forcehimes, Alyssa
Adinoff, Bryon
Mandler, Raul
Oden, Neal
Walker, Robrina
Addiction Science & Clinical Practice
Screening, brief intervention, and referral to treatment (SBIRT) approaches to reducing hazardous alcohol and illicit drug use have been assessed in a variety of health care settings, including primary care, trauma centers, and emergency departments. A major methodological concern in these trials, however, is "assessment reactivity," the hypothesized impact of intensive research assessments to reduce alcohol and drug use and thus mask the purported efficacy of the interventions under scrutiny. Thus, it has been recommended that prospective research designs take assessment reactivity into account. The present article describes the design of the National Institute on Drug Abuse Clinical Trials Network protocol, Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED), which addresses the potential bias of assessment reactivity.
The protocol employs a 3-arm design. Following an initial brief screening, individuals identified as positive cases are consented, asked to provide demographic and locator information, and randomly assigned to one of the three conditions: minimal screening only, screening + assessment, or screening + assessment + brief intervention. In a two-stage process, the randomization procedure first reveals whether or not the participant will be in the minimal-screening-only condition. Participants in the other two groups receive a more extensive baseline assessment before it is revealed whether they have been randomized to also receive a brief intervention. Comparing the screening only and screening + assessment conditions will allow determination of the incremental effect of assessment reactivity.
Assessment reactivity is a potential source of bias that may reduce and/or lead to an underestimation of the purported effectiveness of brief interventions. From a methodological perspective, it needs to be accounted for in research designs. The SMART-ED design offers an approach to minimize assessment reactivity as a potential source of bias. Elucidating the role of assessment reactivity may offer insights into the mechanisms underlying SBIRT as well as suggest clinical options incorporating assessment reactivity as a treatment adjunct.
ClinicalTrials.gov Identifier
Assessment reactivity; Brief intervention; SBIRT; Clinical trials; Research design
Related Articles
A Cost-Benefit Analysis of Wisconsin's Screening, Brief Intervention, and Referral to Treatment Program: Adding the Employer's Perspective
Quanbeck, Andrew
Lang, Katharine
Enami, Kohei
Brown, Richard L.
WMJ : official publication of the State Medical Society of Wisconsin
A previous cost-benefit analysis found Screening, Brief Intervention, and Referral to Treatment (SBIRT) to be cost-beneficial from a societal perspective. This paper develops a cost-benefit model that includes the employer's perspective by considering the costs of absenteeism and impaired presenteeism due to problem drinking.
We developed a Monte Carlo simulation model to estimate the costs and benefits of SBIRT implementation to an employer. We first presented the likely costs of problem drinking to a theoretical Wisconsin firm that does not currently provide SBIRT services. We then constructed a cost-benefit model in which the firm funds SBIRT for its employees. The net present value of SBIRT adoption was computed by comparing costs due to problem drinking both with and without the program.
When absenteeism and impaired presenteeism costs were considered from the employer's perspective, the net present value of SBIRT adoption was $771 per employee.
We concluded that implementing SBIRT is cost-beneficial from the employer's perspective and recommend that Wisconsin employers consider covering SBIRT services for their employees.
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Re: old m42 [screw mount?] on a k7 body?
In reply to Richard Ullakko2 • Nov 14, 2012
Thanks for replying, I know that on my nikon some of the really old lenses won't meter but they work if you use a hand held meter or "sunny 16"...........I wanted to give her the lens but didn't want to give her more problems. Again, thanks for the information.
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TOMTOM XXL 550M Automobile Portable Navigator – 1EP0.019.02
|List Price:
|Get it For $114.99 at Buy.com
|Expiry Date:
(click here to Enlarge)
|Outsmart road changes with the TomTom XXL 550M M complete 5.0 widescreen navigation plus Lifetime Map Updates. On average, 18 percent of road information changes each year, so it is important to have the most up-to-date maps. With Lifetime Map Updates, start fresh every few months by downloading a new edition of the industry's most accurate map. New editions are issued four times per year. Since TomTom has the industry's most accurate and dependable maps you'll have access to one million more miles of roads than you would using other GPS brands. Navigate to any location in the US, Canada or Mexico–or directly to one of 7 million preloaded points of interest. Finding your way has never been easier, using TomTom's new EasyMenu and spoken turn-by-turn instructions including street names.
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"Hello! I was born in Japan and I grew up in the States. I love nomikai and I am looking forward to making new friends. :)"
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Lung Cancer Health Center
Non-Small Cell Lung Cancer: When You Need More Than One Treatment
Treating Lung Cancer Is a Multidisciplinary Approach
"We work in a team when it comes to planning care for a lung cancer patient," says Steven E. Schild, MD, professor and chairman of the department of radiation oncology at the Mayo Clinic in Scottsdale, Ariz. This means that you will be working with one or more of the following specialists:
- Pulmonologist – a lung specialist
- Medical Oncologist – a doctor who specializes in cancer treatments
- Thoracic Surgeon – a doctor who specializes in chest surgery
- Radiation Oncologist – a doctor who specializes in radiation therapy
"Because of recent advances in all fields of cancer care, treatment for lung cancer has become more technical and nuanced," says Christopher Azzoli, MD, medical oncologist on the lung cancer service at the Memorial Sloan-Kettering Cancer Center in New York City. "We now take a multidisciplinary approach to fighting the disease. This allows us to work together to decide on the best approach for each patient."
Recommended Related to Lung Cancer
Most people who have lung cancer have NSCLC. Although it's serious, treatment can sometimes cure it or stop it from getting worse. There are things you can do to help you feel better, too. People who smoke or who breathe a lot of smoke are most likely to get NSCLC. Many of them are over 65. There are three kinds of NSCLC tumors: 1. Adenocarcinoma starts in cells in your air sacs that make mucus and other substances, often in the outer parts of your lungs. It's the most common kind of lung...
Read the Non-Small-Cell Lung Cancer article > >
Staging Non-Small Cell Lung Cancer
What type and combination of treatments you receive is based on several factors, which can include:
- The type of NSCLC cancer you have
- Your overall health and other conditions you may have
- Your lung function and any symptoms you are having, such as difficulty breathing
- How your cancer is staged
Staging lung cancer is usually done at the same time that you are diagnosed. Your doctors will perform physical exams, biopsies, and tests such as CT scans or X-rays to determine where the cancer is located. Cancers are staged according to:
- Size of the tumor
- Whether cancer has spread into nearby lymph nodes
- Whether cancer has spread, or metastasized, into other areas of the body
Cancers are staged into groups I, II, III, and IV, and are further subdivided within those groupings. Cancer tumors staged at a lower value tend to be smaller and haven't spread as far. Staging a cancer helps doctors plan your course of treatment. "How your cancer is staged will determine whether you get chemotherapy, radiation, or surgery," Azzoli says.
Treatment Options for Non-Small Cell Lung Cancer
Your medical team will plan a course of treatment that will provide the best option to cure your lung cancer, if possible, or to keep it in check for as long as possible. Because treatment is individualized, most lung cancer patients receive a combination of therapies.
- Surgery provides the best chance of a cure for lung cancer. This is the general approach for stages I and II, and sometimes for stage III and IV. Surgery may be followed by a course of radiation or chemotherapy.
- Radiation is used instead of surgery for lung cancer patients who aren't as healthy or whose tumors can't be removed surgically. Radiation combined with chemotherapy is generally used to treat Stage III lung cancers.
- Chemotherapy alone won't cure lung cancer. But used with radiation therapy and surgery, it improves the rates of cure. "Chemo is the icing on the cake when it comes to NSCLC treatment," says Azzoli. When chemotherapy is used in addition to surgery, it is called adjuvant therapy. The goal of adjuvant therapy is to lower the chance of cancer returning. For Stage IV lung cancers, the goal of chemotherapy usually is not to cure the lung cancer, but to relieve symptoms to make the patient more comfortable.


text:
Criminal Justice Procedure / Edition 5by Taylor and Francis
Pub. Date: 01/01/1995
Publisher: Taylor & Francis
Carlson (University of Georgia) describes the U.S. adversary system of criminal justice, tracing the various steps that precede trial, as well as the trial process itself. The textbook covers bail, indictment, guilty pleas, rules of evidence, witnesses, sentencing, and appeals. The seventh edition addresses the challenge of dealing with terrorist suspects within the criminal justice framework. Annotation ©2004 Book News, Inc., Portland, OR
Product Details
- 9780870841361
- Publisher:
- Taylor & Francis
- Publication date:
- 01/01/1995
- Edition description:
- Older Edition
- Pages:
- 345
Table of Contents
1. An Overview of Criminal Justice in America
2. Arrest, Appearance and Preliminary Hearing
3. Bail
4. The Charging Instrument: Indictment or Information
5. Guilty Pleas
6. Criminal Trial
7. Sentencing, Crime and Corrections
8. Appeals and Habeas Corpus
9. Special Problems: Location of Trial and Double Jeopardy
10. Miscellaneous Proceedings: Juvenile Justice, Misdemeanor Trials, Damage Suits Against Police, Prisoner Rights
11. The Adversary System
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text:
Season 2, Episode 26 Hoedown in Motown
First Aired: May 8, 1994
Stan sells the radio station to a southerner (Brian Reddy)---who changes the format to country music. Stan: Garrett Morris. Agt. Ceasar: James A. Watson Jr. Sean: Jonathan Gries. Gina: Tisha Campbell. Tommy: Thomas Mikal Ford.
Guest Cast
James A. Watson Jr. James A. Watson Jr. Agt. Caesar
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- Premiered: August 27, 1992
- Rating: TV-PG
- Premise: Sassy humor about a hip though decidedly chauvinistic talk-show personality; his girlfriend, with whom he has a very adversarial relationship; and his two best friends, who spend most of their time hanging out at his apartment. (more)
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sony a700 2 recent shots
Started Jan 27, 2013 | Discussions thread
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ken71 OP • Contributing Member • Posts: 685
Re: sony a700 2 recent shots
In reply to brian14478 • Jan 28, 2013
thank you
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what: Fullmoon hike and mini Potluck at the turnaround (~3mile point). This will be a different route from the usual. It will also be a bit more challenging because of the extended distance and 3 additional hills added to the hike. The hill leading up to the turnaround is the steepest I've seen so far of all the trails I've hiked at Hulda Crooks Park. But don't worry, it's a short climb at this point. If you've been doing our weekday Blue Mountain hikes, pushing yourself, you'll be fine.
Plan to be at the turnaround for at least a half hour where we'll share in all the food and drinks under a well lit Fullmoon sky. Please go to the comment section below to indicate what food item you like to bring. I'm thinking finger foods, chips, salsa, a little wine, etc... This will not be a BBQ. So don't bring the steaks....LOL!
where: Hulda Crooks Park, 11800 Mountain View Ave, Loma Linda, Ca
when: Friday, April 26th, 7:15p.m.. The moon is scheduled to rise at 8:19p. providing us a well lit area by the time we get to the picnic area.
difficulty: semi strenuous - please know your limits
distance: ~5.5 miles
time: 3-3.5 hours
what: Look for me at the far left parking lot as you drive into the park at Mountain View and Beaumont Avenue. I will be driving the Silver Hyundai Elantra. If you need to call me or txt, my number is,[masked]-7132.
what to bring: plenty of water[masked] oz bottles, something to snack on, your food item for the potluck, running shoes or hiking boots, comfortable/warm clothing, flash light or headlamp.
If you bring a guest you must stay with them and are responsible for their safety
Disclaimer: The Organizer and Assistant Organizers in this group are not professional guides. The function of the organizer is only to organize the trip. Each person who signs up for a trip/meetup/or outing is responsible for his or her own safety. By signing up for a hike, or any other event organized by this group, you are acknowledging you are aware of the risks, dangers and hazards associated with any outdoor activity and freely accept and fully assume all such risks, dangers and hazards, and further agree to release and discharge the Organizer and Assistant Organizers of the inland empire hiking club Meetup Group from and against any and all liability arising from your participation in the group activities
Fun people, good food and wine, who could ask for more? Oh yea, nice evening hike!
0 · April 27, 2013
Thank you everyone for a great party hike under the full moon! Spectacular :p
0 · April 27, 2013
OMG, what a great time! This was the best fullmoon hike I've been on thus far. Thanks to everyone for making the evening so much fun! The food and wine was fantastic. I also enjoyed the champagne and Fetzer wine. Good choices for my cold vs. NyQuil...LOL! Also, happy the moon made it out.....Thanks again everyone. I enjoyed all of your company!
2 · April 27, 2013
Thanks God , we don't make friends with cayote , the full moon was amazing , the food all yummy ( burn 500 calorie and put back 1000 cal ... lol lol ) and a great company !! We have a good time !
1 · April 27, 2013
Got to see the full moon from on top of the hill, the potluck was amazing!, the trail was quite challenging at some spots but would love to do it again. Good to see everyone!
1 · April 26, 2013
Turkey Wrap Sandwich from Costco
0 · April 26, 2013
Just to let everyone know, the plan is to hike with our food up to an AWESOME look out area along the route. We'll have our potluck there not back at the parking lot. So I still like you to bring the watermelon Bruce...LOL! Also, if you like to sit down while we enjoy everyone's food or drink, I recommend bringing a beach towel or blanket. It will also be a great way to lay back and gaze at the moon above. The high will be 72 degrees at the start w/a low of 63 degrees finishing out the hike. See everyone tonite!
0 · April 26, 2013
Will everyone be bringing their own cup/plate/utensils like camping gear? Or should someone actually bring paper cups? If so, I have some. I'll bring crackers/cheese/grapes or maybe carrots/hummus and a bottle of wine. This will be fun!
0 · April 15, 2013
Yummy, Monja!
0 · April 14, 2013
Bringing seafood dip and champagne ;p looking forward to it!
0 · April 13, 2013
I'll bring veggies and dip.
0 · April 8, 2013
I will bring cheese, salami or something, and crackers.
0 · April 8, 2013
Sounds good Livia, Kristi, Bruce and Andy. We'll just indicate what food we'll bring in the comment section for this activity.
0 · April 7, 2013
I'll bring a bottle of wine.
1 · April 7, 2013
Hi Robert,
I don't know how to edit the spreadsheet, but I'll bring cheese and crackers :-)
0 · April 7, 2013
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Russell Brand on iPhone Window Attack: A Tribute to Steve Jobs!
Russell Brand has Tweeted a hilarious confession to recent allegations that he ganked some paparazzi dude's iPhone and hucked it through a window.
The zany British comedian is accused of ripping an iPhone right out of the hands of a paparazzo in New Orleans and firing it toward a local law firm.


text:
Array ( [cPath] => 61_69 [products_id] => 7341 [main_page] => product_info )
Handsfree Headset for Kyocera S2410 Tomo
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This 2.5 mm headset lets you listen to music, hear the other caller better, or listen to the audio on the Youtube video that you are secretly watching!
Works with the following models: Kyocera S2410 Tomo
Works with the following models: Kyocera S2410 Tomo
14.99 New Available online


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iPhone - iPad Games
Super Monkey Ball 2: Sakura Answers for iPhone - iPadHome / iPhone - iPad /
Game Questions & Answers (Q&A) service lets you ask questions about video games for game consoles or PC games. So ask your Super Monkey Ball 2: Sakura question for iPhone - iPad and get answers from real gamers or answer questions and share your insights and experience with the rest of the gaming community.
Question & Answers
How do you pass the calabration test?
I downloaded the game on my lg motion and i need to pass the calabration test i put the red dot in the middle but i doesnt let me continue? please help!
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