alcoholism

Background: Cognitive behavioural therapy (CBT) has been shown to be effective for several psychiatric and somatic conditions; however, most randomized controlled trials (RCTs) have administered treatment in person and whether remote delivery is similarly effective remains uncertain. We sought to compare the effectiveness of therapist-guided remote CBT and in-person CBT.

Methods: We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to July 4, 2023, for RCTs that enrolled adults (aged ≥ 18 yr) presenting with any clinical condition and that randomized participants to either therapist-guided remote CBT (e.g., teleconference, videoconference) or in-person CBT. Paired reviewers assessed risk of bias and extracted data independently and in duplicate. We performed random-effects model meta-analyses to pool patient-important primary outcomes across eligible RCTs as standardized mean differences (SMDs). We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance to assess the certainty of evidence and used the Instrument to Assess the Credibility of Effect Modification Analyses (ICEMAN) to rate the credibility of subgroup effects.

Results: We included 54 RCTs that enrolled a total of 5463 patients. Seventeen studies focused on treatment of anxiety and related disorders, 14 on depressive symptoms, 7 on insomnia, 6 on chronic pain or fatigue syndromes, 5 on body image or eating disorders, 3 on tinnitus, 1 on alcohol use disorder, and 1 on mood and anxiety disorders. Moderate-certainty evidence showed little to no difference in the effectiveness of therapist-guided remote and in-person CBT on primary outcomes (SMD -0.02, 95% confidence interval -0.12 to 0.07).

Interpretation: Moderate-certainty evidence showed little to no difference in the effectiveness of in-person and therapist-guided remote CBT across a range of mental health and somatic disorders, suggesting potential for the use of therapist-guided remote CBT to facilitate greater access to evidence-based care. Systematic review registration: Open Science Framework (https://osf.io/7asrc).

Author/s:

Sara Zandieh, Seyedeh Maryam Abdollahzadeh, Behnam Sadeghirad, Li Wang, Randi E McCabe, Liam Yao, Briar E Inness, Ananya Pathak, Rachel J Couban, Holly Crandon, Kian Torabiardakani, Peter Bieling, Jason W Busse

NIAAA for Middle School

Erin Blanchette — Mon, 19 Feb 2024 16:29:17 +0000

Date Added:

February 19, 2024

Publisher:

National Institute of Health

URL:

NIAAA for Middle School

Type:

Patient Education Materials

Format:

Web Page

Keywords

MeSH

national institute on alcohol abuse and alcoholism (U.S.)

alcoholism

Parents

caregivers

Guidance for families with middle school children regarding prevention of alcohol use and abuse. James W. Mold, MD, MPH

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Underage drinking is a significant public health problem in the United States.

This webpage contains interactive activities to help parents, caregivers, and teachers introduce and reinforce key messages about peer pressure, resistance skills, and other important topics related to underage drinking.

These engaging activities are designed for middle schoolers ages 11 to 13. They can be used at home, in classrooms, or in after-school programs.

The content is based on a curriculum for grades 6–8 developed by the University of Michigan. The curriculum was created for the Alcohol Misuse Prevention Study (AMPS), a large-scale project supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

One goal of AMPS was to give students a clearer picture about alcohol use among their peers. Many middle schoolers tend to overestimate how much other students their age really drink. When they learn more accurate information, some of the pressure to drink can subside. Other goals of AMPS were to help students learn skills to resist pressure to drink and to give them reasons not to drink. This site incorporates AMPS goals in these and other features.

This website contains three sections focused on different aspects of alcohol, peer pressure, and resistance skills, followed by a resource list in section 4. The first three sections contain an overview, handouts, and role-playing exercises. The overviews provide background information to help you prepare to discuss alcohol and peer pressure with middle schoolers. The handouts are designed to be given to middle schoolers. The role-playing exercises are designed to be led by an adult and consist of two parts—a guide for the adult leader and a script for the middle schooler to read aloud.

The Management of Substance Use Disorders: Synopsis of the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline

Saige Blanchard — Thu, 10 Mar 2022 06:00:00 +0000

Date Added:

March 22, 2022

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

March 22, 2022

URL:

The Management of Substance Use Disorders: Synopsis of the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M21-4011

Keywords

Substance Use

Department of Veterans Affairs

Department of Defense

Clinical Practice Guideline

PMID (1):

35313113

MeSH

Humans

Veterans

alcoholism

National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division

Algorithms

A synopsis of the VA guidelines for management of substance use disorders. James W. Mold, MD, MPH

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Description: In August 2021, leadership within the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved a joint clinical practice guideline (CPG) for the management of substance use disorders (SUDs). This synopsis summarizes key recommendations.

Methods: In March 2020, the VA/DoD Evidence-Based Practice Work Group assembled a team to update the 2015 VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy CPGs. The guideline panel developed key questions, systematically searched and evaluated the literature, created two 1-page algorithms, and distilled 35 recommendations for care using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. This synopsis presents the recommendations that were believed to be the most clinically impactful.

Recommendations: The scope of the CPG is broad; however, this synopsis focuses on key recommendations for the management of alcohol use disorder, use of buprenorphine in opioid use disorder, contingency management, and use of technology and telehealth to manage patients remotely.

Author/s:

Perry, C., Liberto, J., Milliken, C., Burden, J., Hagedorn, H., Atkinson, T., McKay, J. R., Mooney, L., Sall, J., Sasson, C., Saxon, A., Spevak, C., Gordon, A, J,, VA/DoD Guideline Development Group

Anticraving medication for moderate to severe alcohol use disorder

Saige Blanchard — Tue, 11 May 2021 05:00:00 +0000

Date Added:

May 11, 2021

Journal/Publication:

CMAJ Joule Inc.

Publisher:

CMAJ Joule Inc.

Publication Date:

May 10, 2021

URL:

Anticraving medication for moderate to severe alcohol use disorder

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

DOI (1):

10.1503/cmaj.200895

Keywords

MeSH

Cognitive Behavioral Therapy

A concise summary of treatment options for alcohol use disorders.

James W. Mold, MD, MPH

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Alcohol use disorder is characterized by compulsive use, lack of control and harmful consequences of alcohol. Men who have had more than 5 standard drinks and women who have had more than 4 standard drinks on 1 occasion within the past year should be assessed for alcohol use disorder.1 Anticraving medications can play an effective role in overcoming moderate to severe alcohol use disorder and can be prescribed by primary care physicians.

Author/s:

Mong, J., Ahamad, K., Bach, P.

Interventions for Substance Use Disorders in Adolescents: A Systematic Review

Brian Desmarais — Fri, 05 Jun 2020 18:28:32 +0000

Date Added:

June 5, 2020

Journal/Publication:

Comparative Effectiveness Review

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

May 21, 2020

Volume:

225

URL:

Interventions for Substance Use Disorders in Adolescents: A Systematic Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.23970/AHRQEPCCER225

Keywords

MeSH

Family Characteristics

An AHRQ systematic review of substance abuse disorders in adolescents. James W. Mold, MD, MPH

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Structured Abstract

Objectives. This systematic review (SR) synthesizes the literature on behavioral, pharmacologic, and combined interventions for adolescents ages 12 to 20 years with problematic substance use or substance use disorder. We included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms.

Data sources. We conducted literature searches in MEDLINE, the Cochrane CENTRAL Trials Registry, Embase, CINAHL, and PsycINFO to identify primary studies meeting eligibility criteria through November 1, 2019.

Review methods. Studies were extracted into the Systematic Review Data Repository. We categorized interventions into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. We conducted meta-analyses of comparative studies and evaluated the strength of evidence (SoE). The PROSPERO protocol registration number is CRD42018115388 .

Results. The literature search yielded 33,272 citations, of which 118 studies were included. Motivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month, and overall substance use problems by a standardized mean difference of 0.5, compared with treatment as usual. Brief MI did not reduce cannabis use days (net mean difference of 0). Across multiple intensive interventions, Fam was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual. No intensive interventions reduced cannabis use days. Pharmacologic treatment of opioid use disorder led to a more than 4 times greater likelihood of abstinence with extended courses (2 to 3 months) of buprenorphine compared to short courses (14 to 28 days).

Conclusions. Brief interventions: MI reduces heavy alcohol use (low SoE), alcohol use days (moderate SoE), and substance use–related problems (low SoE) but does not reduce cannabis use days (moderate SoE). Nonbrief interventions: Fam may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Intensive interventions did not appear to decrease cannabis use (low SoE). Some interventions (CBT, CBT+MI, and CBT+MI+CM) were associated with increased cannabis use (low SoE). Both MI and CBT reduce combined alcohol and other drug use (low SoE). Combined CBT+MI reduces illicit drug use (low SoE). Subgroup analyses of interest (male vs. female, racial and ethnic minorities, socioeconomic status, and family characteristics) were sparse, precluding conclusions regarding differential effects. Pharmacological interventions: longer courses of buprenorphine (2–3 months) are more effective than shorter courses (14–28 days) to reduce opioid use and achieve abstinence (low SoE). SRs in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for opioid, alcohol, and cannabis use disorders.

Citation

Suggested citation: Steele DW, Becker SJ, Danko KJ, Balk EM, Saldanha IJ, Adam GP, Bagley SM, Friedman C, Spirito A, Scott K, Ntzani EE, Saeed I, Smith B, Popp J, Trikalinos TA. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225. (Prepared by the Brown Evidence-based Practice Center under Contract No. 290-2015-00002-I.) AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCCER225 .

Author/s:

Steele, D.W., Becker, S.J., Danko, K.J., Balk, E.M., Saldanha, I.J., Adam, G.P., Bagley, S.M., Friedman, C., Spirito, A., Scott, K., Ntzani, E.E., Saeed, I., Smith, B., Popp J., Trikalinos, T.A.

Evidenced-Based Pharmacotherapies for Alcohol Use Disorder

John Bayhi — Thu, 21 May 2020 16:22:32 +0000

Date Added:

May 21, 2020

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Elsevier Inc / Mayo Foundation for Medical Education and Research

Publication Date:

May 20, 2020

Volume:

Article in Press

URL:

Evidenced-Based Pharmacotherapies for Alcohol Use Disorder

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2020.01.030

Keywords

MeSH

Pharmacogenomic Testing

united states food and drug administration

A review of pharmacological approaches to the treatment of alcoholism with some clinical pearls from Mayo physicians. James W. Mold, MD, MPH

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Pathologic alcohol use affects more than 2 billion people and accounts for nearly 6% of all deaths worldwide. There are three medications approved for the treatment of alcohol use disorder by the US Food and Drug Administration (FDA): disulfiram, naltrexone (oral and long-acting injectable), and acamprosate. Of growing interest is the use of anticonvulsants for the treatment of alcohol use disorder, although currently none are FDA approved for this indication. Baclofen, a γ-aminobutyric acid B receptor agonist used for spasticity and pain, received temporary approval for alcohol use disorder in France. Despite effective pharmacotherapies, less than 9% of patients who undergo any form of alcohol use disorder treatment receive pharmacotherapies. Current evidence does not support the use of pharmacogenetic testing for treatment individualization. The objective of this review is to provide knowledge on practice parameters for evidenced-based pharmacologic treatment approaches in patients with alcohol use disorder.

Author/s:

Fairbanks, J, Umbreit, A, Kolla, BP, Karpyak, VM, Schneekloth, TD, Loukianova, LL, Sinha, S

Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal Symptoms: A Randomized Clinical Trial

Brian Desmarais — Tue, 24 Mar 2020 16:09:01 +0000

Date Added:

March 24, 2020

Journal/Publication:

JAMA International Medicine

Publication Date:

March 9, 2020

URL:

Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal Symptoms: A Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2020.0249

MeSH

gabapentin

substance withdrawal syndrome

This RCT found that gabapentin helped patients with heavy alcohol reduce their use of alcohol (compared to placebo). James W. Mold, MD, MPH

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OBJECTIVE:

To examine whether gabapentin would be useful in the treatment of AUD, especially in those with the most alcoholwithdrawal symptoms.

DESIGN, SETTING, AND PARTICIPANTS:

This double-blind randomized clinical trial conducted between November 2014 and June 2018 evaluated gabapentin vs placebo in community-recruited participants screened and treated in an academic outpatient setting over a 16-week treatment period. A total of 145 treatment-seeking individuals who met Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for AUD and were not receiving other AUD intervention were screened, and 96 who also met recent alcohol withdrawalcriteria were randomized to treatment after 3 abstinent days. Daily drinking was recorded, and percentage of disialo carbohydrate-deficient transferrin in the blood, a heavy drinking marker, was collected at baseline and monthly during treatment.

INTERVENTIONS:

Gabapentin up to 1200 mg/d, orally, vs placebo along with 9 medical management visits (20 minutes each).

MAIN OUTCOMES AND MEASURES:

The percentage of individuals with no heavy drinking days and those with total abstinence were compared between treatment groups and further evaluated based on prestudy alcohol withdrawal symptoms.

RESULTS:

Of 96 randomized individuals, 90 were evaluable (44 in the gabapentin arm and 46 in the placebo arm), with a mean (SD) age of 49.6 (10.1) years; 69 were men (77%) and 85 were white (94%). The evaluable participants had 83% baseline heavy drinking days (4 or more drinks/day for women, 5 or more for men) and met 4.5 alcohol withdrawal criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). More gabapentin-treated individuals had no heavy drinking days (12 of 44 participants [27%]) compared with placebo (4 of 46 participants [9%]), a difference of 18.6% (95% CI, 3.1-34.1; P = .02; number needed to treat [NNT], 5.4), and more total abstinence (8 of 44 [18%]) compared with placebo (2 of 46 [4%]), a difference of 13.8% (95% CI, 1.0-26.7; P = .04; NNT, 6.2). The prestudy high-alcohol withdrawal group had positive gabapentin effects on no heavy drinking days (P < .02; NNT, 3.1) and total abstinence (P = .003; NNT, 2.7) compared with placebo, while within the low-alcohol withdrawal group, there were no significant differences. These findings were similar for other drinking variables, where gabapentin was more efficacious than placebo in the high-alcohol withdrawal group only. Gabapentin caused more dizziness, but this did not affect efficacy.

CONCLUSIONS AND RELEVANCE:

These data, combined with others, suggest gabapentin might be most efficacious in people with AUD and a history of alcohol withdrawal symptoms. Future studies should evaluate sleep changes and mood during early recovery as mediators of gabapentin efficacy.

TRIAL REGISTRATION:

ClinicalTrials.gov Identifier: NCT02349477.

Author/s:

Anton, R.F., Latham, P., Voronin, K., Book, S., Hoffman, M., Bristol, E., Prisciandaro, J.

Naltrexone for the treatment of alcoholism: A meta-analysis of randomized controlled trials

Jeffrey Wilson — Wed, 02 Jan 2019 14:38:22 +0000

Date Added:

January 2, 2019

Journal/Publication:

International Journal of Neuropsychopharmacology

Publisher:

Oxford University Press

Publication Date:

June 1, 2005

Issue:

Volume:

Pages:

267-280

URL:

Naltrexone for the treatment of alcoholism: A meta-analysis of randomized controlled trials

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1017/S1461145704004997

Keywords

alcohol

alcoholism

naltrexone

PMID (1):

15850502

MeSH

alcohol

alcoholism

naltrexone

This Meta-analysis involving 2861 subjects in 24 RCTs found that, in short-term treatment, naltrexone significantly decreased relapses [relative risk (RR) 0.64, 95% confidence interval (CI) 0.51-0.82], but not return to drinking (RR 0.91, 95% CI 0.81-1.02). Short-term treatment of naltrexone significantly increased nausea, dizziness, and fatigue in comparison to placebo [RRs (95% CIs) 2.14 (1.61-2.83), 2.09 (1.28-3.39), and 1.35 (1.04-1.75)].

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Many trials of naltrexone have been carried out in alcohol-dependent patients. This paper is aimed to systematically review its benefits, adverse effects, and discontinuation of treatment. We assessed and extracted the data of double-blind, randomized controlled trials (RCTs) comparing naltrexone with placebo or other treatment in people with alcoholism. Two primary outcomes were subjects who relapsed (including heavy drinking) and those who returned to drinking. Secondary outcomes were time to first drink, drinking days, number of standard drinks for a defined period, and craving. All outcomes were reported for the short, medium, and long term. Five common adverse effects and dropout rates in short-term treatment were also examined. A total of 2861 subjects in 24 RCTs presented in 32 papers were included. For short-term treatment, naltrexone significantly decreased relapses [relative risk (RR) 0.64, 95% confidence interval (CI) 0.51-0.82], but not return to drinking (RR 0.91, 95% CI 0.81-1.02). Short-term treatment of naltrexone significantly increased nausea, dizziness, and fatigue in comparison to placebo [RRs (95% CIs) 2.14 (1.61-2.83), 2.09 (1.28-3.39), and 1.35 (1.04-1.75)]. Naltrexone administration did not significantly diminish short-term discontinuation of treatment (RR 0.85, 95% CI 0.70-1.01). Naltrexone should be accepted as a short-term treatment for alcoholism. As yet, we do not know the appropriate duration of treatment continuation in an alcohol-dependent patient who responds to short-term naltrexone administration. To ensure that the real-world treatment is as effective as the research findings, a form of psychosocial therapy should be concomitantly given to all alcohol-dependent patients receiving naltrexone administration.

Author/s:

Srisurapanont, Manit, Jarusuraisin, Ngamwong

Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices

Jeffrey Wilson — Wed, 02 Jan 2019 14:31:45 +0000

Date Added:

January 2, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

April 1, 1997

Issue:

Volume:

277

Pages:

1039-1045

URL:

Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.1997.03540370029032

Keywords

PMID (1):

9091691

MeSH

In this RCT conducted in primary care settings, two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information was sufficient to reduce 7-day alcohol use from 19.1 to 11.5 at 12 months in the experimental group vs 18.9 at baseline to 15.5 at 12 months in controls (P<.001); episodes of binge drinking from 5.7 at baseline to 3.1 at 12 months in the experimental group vs 5.3 at baseline to 4.2 at 12 months in controls (P<.001), and percentage drinking excessively in previous 7 days from 47.5% at baseline to 17.8% at 12 months in the experimental group vs 48.1% at baseline to 32.5% at 12 months in controls (P<.001) at one year.

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OBJECTIVE:

Project TrEAT (Trial for Early Alcohol Treatment) was designed to test the efficacy of brief physician advice in reducing alcohol use and health care utilization in problem drinkers.

DESIGN:

Randomized controlled clinical trial with 12-month follow-up.

SETTING:

A total of 17 community-based primary care practices (64 physicians) located in 10 Wisconsin counties.

PARTICIPANTS:

Of the 17695 patients screened for problem drinking, 482 men and 292 women met inclusion criteria and were randomized into a control (n=382) or an experimental (n=392) group. A total of 723 subjects (93%) participated in the 12-month follow-up procedures.

INTERVENTION:

The intervention consisted of two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information.

MAIN OUTCOME MEASURES:

Alcohol use measures, emergency department visits, and hospital days.

RESULTS:

There were no significant differences between groups at baseline on alcohol use, age, socioeconomic status, smoking status, rates of depression or anxiety, frequency of conduct disorders, lifetime drug use, or health care utilization. At the time of the 12-month follow-up, there were significant reductions in 7-day alcohol use (mean number of drinks in previous 7 days decreased from 19.1 at baseline to 11.5 at 12 months for the experimental group vs 18.9 at baseline to 15.5 at 12 months for controls; t=4.33; P<.001), episodes of binge drinking (mean number of binge drinking episodes during previous 30 days decreased from 5.7 at baseline to 3.1 at 12 months for the experimental group vs 5.3 at baseline to 4.2 at 12 months for controls; t=2.81; P<.001), and frequency of excessive drinking (percentage drinking excessively in previous 7 days decreased from 47.5% at baseline to 17.8% at 12 months for the experimental group vs 48.1% at baseline to 32.5% at 12 months for controls; t=4.53; P<.001). The chi2 test of independence revealed a significant relationship between group status and length of hospitalization over the study period for men (P<.01).

CONCLUSIONS:

This study provides the first direct evidence that physician intervention with problem drinkers decreases alcohol use and health resource utilization in the US health care system.

Author/s:

Fleming, Michael F., Barry, Kristen L., Manwell, Linda B., Johnson, Kristen, London, Richard

Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations

Jeffrey Wilson — Wed, 02 Jan 2019 14:20:26 +0000

Date Added:

January 2, 2019

Journal/Publication:

Journal of Addiction Medicine

Publisher:

American Society of Addiction Medicine

Publication Date:

September 1, 2015

Issue:

Volume:

Pages:

343-351

URL:

Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1097/ADM.0000000000000150

Keywords

alcohol

alcoholism

SBIRT

PMID (1):

26428359

MeSH

community health services

substance-related disorders

alcoholism

alcohol drinking

motivational interviewing

This is a systematic review that provides guidance regarding use of the SBIRT process in culturally diverse patient populations.

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OBJECTIVES:

To review the literature on the screening, brief intervention, and referral to treatment (SBIRT) approach to alcohol and drug use with racial and ethnic subgroups in the United States and to develop recommendations for culturally competent SBIRT practice.

METHODS:

Articles reporting on the use of SBIRT components (screening, brief intervention, referral to treatment) for alcohol and drug use were identified through a comprehensive literature search of PubMed from 1995 to 2015.

RESULTS:

A synthesis of the published literature on racial and ethnic considerations regarding SBIRT components (including motivational interviewing techniques) was created using evidence-based findings. Recommendations on culturally competent use of SBIRT with specific ethnic groups are also described.

CONCLUSIONS:

On the basis of the literature reviewed, SBIRT offers a useful set of tools to help reduce risky or problematic substance use. Special attention to validated screeners, appropriate use of language/literacy, trust building, and incorporation of patient and community health care preferences may enhance SBIRT acceptability and effectiveness.

PRACTICE IMPLICATIONS:

Providers should consider the implications of previous research when adapting SBIRT for diverse populations, and use validated screening and brief intervention methods. The accompanying case illustration provides additional information relevant to clinical practice.

Author/s:

Manuel, Jennifer K., Satre, Derek D., Tsoh, Janice, Moreno-John, Gina, Ramos, Jacqueline S., McCance-Katz, Elinore F., Satterfield, Jason M.

Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness

Jeffrey Wilson — Wed, 02 Jan 2019 14:14:52 +0000

Date Added:

January 2, 2019

Journal/Publication:

American Journal of Preventative Medicine

Publisher:

American College of Preventative Medicine and Association for Prevention Teaching and Research

Publication Date:

February 1, 2008

Issue:

Volume:

Pages:

143-152

URL:

Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.amepre.2007.09.035

Keywords

alcohol

alcohol abuse

PMID (1):

18201645

MeSH

This systematic review concluded that screening, brief interventions, and treatment of alcohol use disorders was one of the highest-ranking preventive services among the 25 effective services evaluated.

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BACKGROUND:

The U.S. Preventive Services Task Force (USPSTF) has recommended screening and behavioral counseling interventions in primary care to reduce alcohol misuse. This study was designed to develop a standardized rating for the clinically preventable burden and cost effectiveness of complying with that recommendation that would allow comparisons across many recommended services.

METHODS:

A systematic review of the literature from 1992 through 2004 to identify relevant randomized controlled trials and cost-effectiveness studies was completed in 2005. Clinically preventable burden (CPB) was calculated as the product of effectiveness times the alcohol-attributable fraction of both mortality and morbidity (measured in quality-adjusted life years or QALYs), for all relevant conditions. Cost effectiveness from both the societal perspective and the health-system perspective was estimated. These analyses were completed in 2006.

RESULTS:

The calculated CPB was 176,000 QALYs saved over the lifetime of a birth cohort of 4,000,000, with a range in sensitivity analysis from -43% to +94% (primarily due to variation in estimates of effectiveness). Screening and brief counseling was cost-saving from the societal perspective and had a cost-effectiveness ratio of $1755/QALY saved from the health-system perspective. Sensitivity analysis indicates that from both perspectives the service is very cost effective and may be cost saving.

CONCLUSIONS:

These results make alcohol screening and counseling one of the highest-ranking preventive services among the 25 effective services evaluated using standardized methods. Since current levels of delivery are the lowest of comparably ranked services, this service deserves special attention by clinicians and care delivery systems.

Author/s:

Solberg, Leif I., Maciosek, Michael V., Edwards, Nichol M.

Helping Patients Who Drink Too Much: A Clinician's Guide

Jeffrey Wilson — Wed, 02 Jan 2019 13:58:54 +0000

Date Added:

January 2, 2019

Journal/Publication:

National Institutes of Health

Publisher:

U.S. Department of Health and Human Services

Publication Date:

July 1, 2016

Issue:

07-3769

URL:

Helping Patients Who Drink Too Much: A Clinician's Guide

Type:

Clinical Decision Aids

Format:

Article

Keywords

MeSH

referral and consultation

primary health care

alcoholism

This is a guidebook produced by the National Institute on Alcohol Abuse and Alcoholism for physicians who want to help patients reduce their alcohol consumption.

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Why screen for heavy drinking?

At-risk drinking and alcohol problems are common. About 3 in 10 U.S. adults drink at levels that elevate their risk for physical, mental health, and social problems. Of these heavy drinkers, about 1 in 4 currently has alcohol abuse or dependence.All heavy drinkers have a greater risk of hypertension, gastro - intestinal bleeding, sleep disorders, major depression, hemorrhagic stroke, cirrhosis of the liver, and several cancers.
Heavy drinking often goes undetected. In a recent study of primary care practices, for example, patients with alcohol dependence received the recommended quality of care, including assessment and referral to treatment, only about 10 percent of the time.
Patients are likely to be more receptive, open, and ready to change than you expect. Most patients don’t object to being screened for alcohol use by clinicians and are open to hearing advice afterward. In addition, most primary care patients who screen positive for heavy drinking or alcohol use disorders show some motivational readiness to change, with those who have the most severe symptoms being the most ready.
You’re in a prime position to make a difference. Clinical trials have demonstrated that brief interventions can promote significant, lasting reductions in drinking levels in at-risk drinkers who aren’t alcohol dependent.8 Some drinkers who are dependent will accept referral to addiction treatment programs. Even for patients who don’t accept a referral, repeated alcohol-focused visits with a health care provider can lead to significant improvement.
If you’re not already doing so, we encourage you to incorporate alcohol screening and intervention into your practice. With this Guide, you have what you need to begin.

Author/s:

National Institute on Alcohol Abuse and Alcoholism

Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use

Jeffrey Wilson — Thu, 27 Dec 2018 16:53:24 +0000

Date Added:

December 27, 2018

Publisher:

National Center on Birth Defects and Developmental Disabilities

Publication Date:

January 1, 2014

Type:

Meta-analyses, Reviews, and Guidelines, Practice Management Research Results

Format:

Slides

Keywords

MeSH

referral and consultation

This is a comprehensive set of recommendations from the CDC on how to establish a system for screening for and management of patients with unhealthy alcohol use.

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Like hypertension or tobacco screening, alcohol screening and brief intervention (alcohol SBI) is a clinical preventative service. It identifies and helps patients who may be drinking too much. It involves:

A validated set of screening questions to identify patients' drinking patterns,
A short conversation who are drinking to omuch, and for patients with severe risk, a referral to specialized treatment as warranted.

The entire service takes only a few minutes, is inexpensive, and may be reimbursable. Thirty years of resesarch has shown that alcohol SBI is effective at reducing the amount of alcohol consumed by those who are drinking too much. Based on this evidence the U.S. Preventative Services Task Force and many other organizations have recommended that alcohol SBI be implemented for all adults in primary health care settings.

Author/s:

Higgins-Biddle, John C., Hungerford, Daniel W., Baker, Susan D., Reynolds, Megan R., Cheal, Nancy E., Weber, Mary Kate, Dang, Elizabeth P.

Addressing Alcohol Use: Practice Manual

Jeffrey Wilson — Thu, 27 Dec 2018 16:33:02 +0000

Date Added:

December 27, 2018

Publisher:

American Academy of Family Physicians

URL:

Alcohol Misuse

Type:

Meta-analyses, Reviews, and Guidelines, Practice Management Research Results

Format:

Slides

Keywords

MeSH

This is a useful set of recommendations from AAFP on how to develop a pathway for screening for and management of patients with unhealthy alcohol use.

Free full text

Risky alcohol use, defined as any level of alcohol consumption which increases the risk of harm to oneself or others, is both a substance use disorder and medical issue. Recognized as one of the leading preventable causes of death, risky alcohol use leads to over 88,000 deaths each year in the United States. Among adults in the U.S., approximately 58% of men and 46% of women report drinking in the last 30 days. National estimates also indicate that greater than 50% of the alcohol consumed by adults is during binge drinking, the most common pattern of excessive or risky alcohol use. More specifically, in the U.S., approximately 23% of adult men report binge drinking five times per month, while 11% of adult women report binge drinking three times per month. Furthermore, research indicates that more than one in two women of childbearing age drink alcohol. Among those that drink alcohol, 18% engage in binge drinking.

Family physicians and other primary care providers are in an ideal position to facilitate the prevention of morbidity and mortality associated with risky alcohol use. Many professional organizations recognize the importance of screening and behavioral counseling interventions to reduce alcohol misuse, including the American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (AGOG), and the U.S. Preventive Services Task Force (USPSTF).

Alcohol screening and brief intervention (SBI) is a USPSTF grade B recommendation that includes:

• Screening all adult primary care patients for risky alcohol use, at least yearly, using an evidence-based screening tool.

• Providing a brief behavioral intervention to patients screening positive for risky alcohol use, to help them make healthier choices around their drinking (e.g., to reduce alcohol use or quit drinking).

This practice manual provides a systems-change approach for implementing alcohol SBI into your practice.

Author/s:

Gonzalez, Sandra, Grubb, John, Kowalchuk, Alicia, Sidani, Mohamad, Spooner, Kiara, Zoorob, Roger

Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review

Jeffrey Wilson — Thu, 27 Dec 2018 16:24:11 +0000

Date Added:

December 27, 2018

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

August 28, 2018

Issue:

Volume:

320

Pages:

815-824

URL:

Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2018.11406

Keywords

alcohol

alcoholism

pharmacogenetics

PMID (1):

30167705

MeSH

This is a 5-part series of reviews pertaining to the treatment of patients with alcohol use disorders.

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IMPORTANCE:

Alcohol consumption is associated with 88 000 US deaths annually. Although routine screening for heavy alcohol use can identify patients with alcohol use disorder (AUD) and has been recommended, only 1 in 6 US adults report ever having been asked by a health professional about their drinking behavior. Alcohol use disorder, a problematic pattern of alcohol use accompanied by clinically significant impairment or distress, is present in up to 14% of US adults during a 1-year period, although only about 8% of affected individuals are treated in an alcohol treatment facility.

OBSERVATIONS:

Four medications are approved by the US Food and Drug Administration to treat AUD: disulfiram, naltrexone (oral and long-acting injectable formulations), and acamprosate. However, patients with AUD most commonly receive counseling. Medications are prescribed to less than 9% of patients who are likely to benefit from them, given evidence that they exert clinically meaningful effects and their inclusion in clinical practice guidelines as first-line treatments for moderate to severe AUD. Naltrexone, which can be given once daily, reduces the likelihood of a return to any drinking by 5% and binge-drinking risk by 10%. Randomized clinical trials also show that some medications approved for other indications, including seizure disorder (eg, topiramate), are efficacious in treating AUD. Currently, there is not sufficient evidence to support the use of pharmacogenetics to personalize AUD treatments.

CONCLUSIONS AND RELEVANCE:

Alcohol consumption is associated with a high rate of morbidity and mortality, and heavy alcohol use is the major risk factor for AUD. Simple, valid screening methods can be used to identify patients with heavy alcohol use, who can then be evaluated for the presence of an AUD. Patients receiving a diagnosis of the disorder should be given brief counseling and prescribed a first-line medication (eg, naltrexone) or referred for a more intensive psychosocial intervention.

Author/s:

Kranzler, Henry R., Soyka, Michael