Treatment Referrals Post-prohibition of Alcohol Exclusion Laws: Evidence from Colorado and Illinois.

BACKGROUND: Individuals with alcohol-related disorders often encounter barriers to accessing treatment. One potential barrier is the state alcohol exclusion laws (AELs) that allow insurers to deny coverage for injuries or illnesses caused by alcohol intoxication. Several states have repealed AELs by prohibiting them completely, including banning exclusions in health and accident insurance policies, limiting their scope, or creating exemptions. OBJECTIVES: To examine whether prohibiting alcohol exclusions in health and accident insurance policies is associated with alcohol-related treatment admissions. DESIGN: We used the 2002 to 2017 Treatment Episode Data Set and obtained data from several sources to control for state-level factors. We employed a heterogeneous difference-in-differences method and an event study to compare the treatment admissions in Colorado and Illinois, two states that uniquely repealed AELs, with control states that allowed or had no AELs. MAIN MEASURES: We used aggregated alcohol treatment admission for adults by healthcare referral: (i) with alcohol as the primary substance and (ii) with alcohol as the primary, secondary, or tertiary substance. KEY RESULTS: We found a significant relationship between AEL repeal and increased referrals. AEL repeal in Colorado and Illinois was associated with higher treatment admissions from 2008 to 2011 (average treatment effect on the treated: 2008 = 653, 2009 = 1161, 2010 = 1388, and 2011 = 2020). We also found that a longer duration of exposure to AEL repeal was associated with higher treatment admissions, but this effect faded after the fourth year post-treatment. CONCLUSIONS: Our study reveals a potential positive association between the repeal and prohibition of AELs and increased alcohol-related treatment admissions. These findings suggest that states could enhance treatment opportunities for alcohol-related disorders by reconsidering their stance on AELs. While our study highlights the possible public health benefits of repealing AELs, it also paves the way for additional studies in this domain.

Using the Cardiff model to reduce late-night alcohol-related presentations in regional Australia.

INTRODUCTION: The Cardiff model is a data sharing approach that aims to reduce the volume of intoxicated patients in emergency departments (EDs). This approach has not been tested in a rural setting. OBJECTIVE: This study assessed whether this approach would reduce the number of alcohol-associated presentations during high-alcohol hours (HAH) in a regional ED. DESIGN: From July 2017, people over the age of 18 attending the ED were asked by the triage nurse (1) whether they had consumed alcohol in the past 12 h, (2) their typical alcohol consumption level, (3) the location where most alcohol was purchased and (4) the location of the last drink. From April 2018, quarterly letters were sent to the top five venues reported within the ED. Deidentified, aggregated data were shared with local police, licensing authorities and local government, identifying the top five venues reported in the ED and providing a summary of alcohol-related attendances to the ED. Interrupted time series analyses were used to estimate the influence of the intervention on monthly injury and alcohol-related ED presentations. FINDINGS: ITS models found that there was a significant gradual decrease in the monthly rate of injury attendances during HAH (Coefficient = -0.004, p = 0.044). No other significant results were found. DISCUSSION: Our study found that sharing last drinks data collected in the ED with a local violence prevention committee was associated with a small, but significant reduction in the rate of injury presentations compared with all ED presentations. CONCLUSION: This intervention continues to have promise for reducing alcohol-related harm.

Binge Drinking and Alcohol Problems Among Moderate Average-Level Drinkers.

INTRODUCTION: A significant amount of binge drinking among adults escapes public health scrutiny because it occurs among individuals who drink at a moderate average level. This observational study examined the role of a binge pattern of drinking in predicting alcohol problems among moderate drinkers in a U.S. national sample of adults. METHODS: Participants were 1,229 current drinkers aged ≥30 years from 2 waves of the study of Midlife Development in the United States, with a 9-year time lag (2004-2015) (analyzed in 2021‒2022). Negative binomial regression analyses were used to examine the number of alcohol problems, and binary logistic regression analyses were used to examine multiple (≥2) alcohol problems. RESULTS: Independent of the average level of drinking, binge drinking was linked with an almost 3 times increase in the number of concurrent alcohol problems and a 40% increase in the number of alcohol problems prospectively 9 years later. Moderate average level drinkers accounted for most cases of binge drinking and multiple alcohol problems. Among moderate drinkers, binge drinking was linked with a close to 5 times increase in concurrent multiple alcohol problems and a >2 times increase in multiple alcohol problems prospectively 9 years later. CONCLUSIONS: These results substantially broaden an increasing recognition that binge drinking is a public health concern among adults. Moderate average-level drinkers should be included in efforts to reduce alcohol problems in adults. These findings are applicable to primary and secondary prevention of alcohol problems with the potential to advance population health.

Revision of the Australian guidelines to reduce health risks from drinking alcohol.

INTRODUCTION: The Australian guidelines to reduce health risks from drinking alcohol were released in 2020 by the National Health and Medical Research Council. Based on the latest evidence, the guidelines provide advice on how to keep the risk of harm from alcohol low. They refer to an Australian standard drink (10 g ethanol). RECOMMENDATIONS: •Guideline 1: To reduce the risk of harm from alcohol-related disease or injury, healthy men and women should drink no more than ten standard drinks a week and no more than four standard drinks on any one day. The less you drink, the lower your risk of harm from alcohol. •Guideline 2: To reduce the risk of injury and other harms to health, children and people under 18 years of age should not drink alcohol. •Guideline 3: To prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol. For women who are breastfeeding, not drinking alcohol is safest for their baby. CHANGES AS RESULT OF THE GUIDELINE: The recommended limit for healthy adults changed from two standard drinks per day (effectively 14 per week) to ten per week. The new guideline states that the less you drink, the lower your risk of harm from alcohol. The recommended maximum on any one day remains four drinks (clarified from previously "per drinking occasion"). Guidance is clearer for pregnancy and breastfeeding, and for people aged less than 18 years, recommending not drinking.

[The Danish Health Authority: prevention of alcohol intake and treatment of alcohol-related disorders].

Consumption of alcohol has major consequences for public health in Denmark, and many Danes still drink too much, given the health consequences. The Danish Health Authority supports the municipalities' effort with prevention of misuse of alcohol intake and treatment of alcohol-related disorders. Among other things, we monitor the prevalence of alcohol intake in the population, compose materials for counselling and financially support projects, which develop new methods for prevention and treatment in relation to alcohol. The Danish Health Authority withholds an ongoing focus on prevention of alcohol intake, especially among adolescents.

Drinking and alcohol-related problems among at-risk adolescents: The role of protective behavioral strategies.

INTRODUCTION: Protective Behavioral Strategies (PBS) are an alcohol-specific cognitive-behavioral strategies that may be employed before, during and/or after drinking, in order to reduce alcohol consumption and related consequences, particularly in the at-risk populations. Previous research on PBS was limited to North American college students. The purpose of this study was to examine the role of PBS use in a sample of Polish adolescents attending Special Educational Centers (SEC). METHOD: Data were collected from a nationwide sample of 12-19 year-old (Mean = 15.8; SD = 1.22) students attending SEC in Poland (N = 1585; about 33% female). The self-administered anonymous questionnaires were completed on-site in the SEC. PBS were measured by the authors adaptation of the PBSS-20. Alcohol-related problems were assessed by the Polish adaptation of the measures used in the MINI-KID tool. Alcohol use was measured by a single question on drinking frequency. These two latter variables were measured in the past year timeframe. Hierarchical regression models were used to test the main and interaction effects of employing PBS (total and subscales scores) on alcohol-related problems, after adjusting for demographics (gender, family composition and type of SEC) and alcohol use. RESULTS: The majority (about 94%) of study participants reported employment of some PBS. Regression analyses indicated that PBS use was associated with reduced risk of alcohol use and alcohol-related problems. We found that PBS significantly moderated the relationship between alcohol use and alcohol-related problems, for PBS total scale (F-change (1,1555) = 15.96, p < .001) and one of the PBS subscale: Limiting/Stopping Drinking (F-change (1,1555) = 4.80, p < .029). Findings were discussed within the results of PBS literature and resilience theory framework. CONCLUSION: The use of PBS helps to reduce alcohol-related problems among adolescents attending SEC. Implementation of tailored interventions that teach PBS among vulnerable adolescents may be an effective way to strengthen adolescent self-protection, reduce risky alcohol use and related negative consequences.

Assistência de enfermagem na síndrome de abstinência alcoólica: fluxograma de atendimento / Cuidados de enfermería en el síndrome de abstinencia de alcohol: diagrama de cuidado / Nursing care in alcohol withdrawal syndrome: care flowchart

RESUMO Objetivo: realizar revisão da literatura e pela síntese de evidências elaborar um fluxograma de assistência de Enfermagem na síndrome de abstinência alcoólica (SAA). Método: foram executadas as primeiras etapas de elaboração de um protocolo clínico de Enfermagem. Na etapa "a" definiu-se o objetivo do protocolo; na etapa "b" realizou-se pesquisa da literatura científica para levantamento de evidências; e na etapa "c", a partir das evidências, elaborou-se um fluxograma de assistência de Enfermagem na SAA. A coleta de dados ocorreu em janeiro de 2019 nas bases de dados: Biblioteca Virtual em Saúde, PubMed, CINAHL, PSYINFO e MEDLINE. Os resultados foram apresentados em tabelas e figuras. Resultados: oito estudos foram incluídos na revisão. As evidências subsidiaram a elaboração do fluxograma de assistência de Enfermagem na SAA sistematizado nas seguintes fases: acolhimento e abordagem dos usuários de álcool com manifestação de sinais e sintomas de SAA; rastreio; intervenções; e encaminhamento. Conclusão: com a síntese das evidências foi possível a elaboração de um fluxograma de assistência de Enfermagem na SAA, o qual pode contribuir para o aprimoramento das respostas em saúde a esse problema, bem como é suficiente para dar seguimento às etapas de validação de um protocolo clínico.

RESUMEN Objetivo: revisar la literatura y, a través de la síntesis de evidencia, elaborar un diagrama de flujo de los cuidados de enfermería en el síndrome de abstinencia alcohólica (SAA). Método: se realizaron los primeros pasos para desarrollar un protocolo clínico de enfermería. En el paso "a" se definió el objetivo del protocolo; en el paso "b" se realizó una búsqueda de la literatura científica para recolectar evidencia; y en el paso "c", con base en la evidencia, se elaboró un diagrama de flujo de la atención de enfermería en la SAA. La recolección de datos se realizó en enero de 2019 en las siguientes bases de datos: Biblioteca Virtual en Salud, PubMed, CINAHL, PSYINFO y MEDLINE. Los resultados se presentaron en tablas y figura. Resultados: se incluyeron ocho estudios en la revisión. La evidencia apoyó la elaboración del diagrama de flujo de cuidados de enfermería en el SAA sistematizado en las siguientes fases: recepción y abordaje de consumidores de alcohol con manifestación de signos y síntomas de SAA; Seguimiento; intervenciones; y reenvío. Conclusión: con la síntesis de evidencias, fue posible desarrollar un diagrama de flujo de cuidados de enfermería en el SAA, que puede contribuir a la mejora de las respuestas de salud a esta problemática, además de ser suficiente para dar seguimiento a los pasos de validación de un protocolo clínico.

ABSTRACT Objective: to review the literature and, through the synthesis of evidence, elaborate a flowchart of Nursing care in the alcohol withdrawal syndrome (AWS). Method: the first steps of elaboration of a clinical Nursing protocol were carried out. In step "a" the objective of the protocol was defined; in step "b" a search of the scientific literature was carried out to gather evidence; and in step "c", based on the evidence, a flowchart of Nursing care in the AWS was elaborated. Data collection took place in January 2019 in the following databases: Virtual Health Library, PubMed, CINAHL, PSYINFO and MEDLINE. The results were presented in tables and figures. Results: eight studies were included in the review. The evidence supported the elaboration of the Nursing care flowchart in the AWS systematized in the following phases: reception and approach to alcohol users with manifestation of AWS signs and symptoms; Tracking; interventions; and forwarding. Conclusion: with the synthesis of evidence, it was possible to develop a flowchart of Nursing care in the SAA, which can contribute to the improvement of health responses to this problem, as well as being sufficient to follow up on the steps of validation of a clinical protocol.

Amenable mortality within the New Zealand homeless population: we can do better!

AIM: To describe the context surrounding the deaths of homeless people in New Zealand and to determine the proportion of deaths that could be considered amenable to healthcare. METHOD: We used coroners' findings related to 171 deaths of persons with "no fixed abode" at the time of death, from 2008 to 2019. Recent lists of amenable mortality from the New Zealand Ministry of Health and the Office of National Statistics in the UK were combined to determine the rate of amenable mortality. RESULTS: The life expectancy of homeless persons identified in this sample was 30 years shorter than in the housed population, with a mean age of death of 45.7 years. Deaths occurred mainly alone, in public spaces (56.1%) or in private vehicles (14%). Three-quarters (75.8%) of homeless persons died from conditions amenable to timely and effective healthcare interventions, mostly from natural causes (45.7%) and suicide (41.5%). CONCLUSION: Homeless people experience considerable challenges when accessing the healthcare system, as uncovered by the dramatic rate of amenable mortality. Our findings highlight the urgent need to implement specific models of care that are designed to meet the social and healthcare needs of homeless persons and address the significant health inequalities they experience.

The Fast Track intervention's impact on behaviors of despair in adolescence and young adulthood.

How to mitigate the dramatic increase in the number of self-inflicted deaths from suicide, alcohol-related liver disease, and drug overdose among young adults has become a critical public health question. A promising area of study looks at interventions designed to address risk factors for the behaviors that precede these -often denoted-"deaths of despair." This paper examines whether a childhood intervention can have persistent positive effects by reducing adolescent and young adulthood (age 25) behaviors that precede these deaths, including suicidal ideation, suicide attempts, hazardous drinking, and opioid use. These analyses test the impact and mechanisms of action of Fast Track (FT), a comprehensive childhood intervention designed to decrease aggression and delinquency in at-risk kindergarteners. We find that random assignment to FT significantly decreases the probability of exhibiting any behavior of despair in adolescence and young adulthood. In addition, the intervention decreases the probability of suicidal ideation and hazardous drinking in adolescence and young adulthood as well as opioid use in young adulthood. Additional analyses indicate that FT's improvements to children's interpersonal (e.g., prosocial behavior, authority acceptance), intrapersonal (e.g., emotional recognition and regulation, social problem solving), and academic skills in elementary and middle school partially mediate the intervention effect on adolescent and young adult behaviors of despair and self-destruction. FT's improvements to interpersonal skills emerge as the strongest indirect pathway to reduce these harmful behaviors. This study provides evidence that childhood interventions designed to improve these skills can decrease the behaviors associated with premature mortality.

[Policies to prevent the harm caused by alcohol: priorities for Spain.] / Políticas para prevenir los daños causados por el alcohol: prioridades para España.

This paper presents a strategic analysis of the prevention of the harm caused by alcohol in Spain. The alcohol action plan of the European Office of the WHO offers a guide for the development of the most effective control policies. Following its scheme, the current situation and the prevention policies are reviewed with data available in 2020. Strategies and key actions for the future are proposed, considering as major goals to curb the early abuse of alcohol by adolescents and to reduce the risk consumption of the population at large. Besides helping persons with abuse criteria from health services, key actions for prevention include public policies such as fiscal, marketing and availability regulations, and drink driving measures. Some have followed a favorable evolution in Spain, but for others there is wide room for improvement.

Este trabajo presenta un análisis estratégico de la prevención de los daños causados por el alcohol en España. El plan de acción sobre el alcohol de la Oficina Europea de la OMS ofrece una guía para el desarrollo de las políticas más efectivas de control. Siguiendo su esquema, se revisan la situación y las políticas de prevención con los datos disponibles en el año 2020. Se proponen unas estrategias y acciones clave para el futuro, considerando como grandes objetivos evitar el abuso precoz del alcohol en adolescentes y reducir el consumo de riesgo en el conjunto de la población. Además de ayudar a las personas con criterios de abuso desde los servicios sanitarios, destacan como acciones clave de prevención políticas públicas como la fiscal, la regulación de la publicidad y otras formas de promoción, la regulación de la disponibilidad de bebidas, y las medidas sobre alcohol y conducción. Algunas han seguido una evolución favorable en España, pero en otras hay amplio margen de mejora.

The research output on interventions for the behavioural risk factors alcohol & drug use and dietary risk is not related to their respective burden of ill health in countries at differing World Bank income levels.

BACKGROUND: Alcohol and drug use (A&D) and dietary risks are two increasingly important risk factors. This study examines whether there is a relationship between the burden of these risk factors in countries of specific income bands as defined by the World Bank, and the number of primary studies included in Cochrane Systematic Reviews (CSRs) conducted in those countries. METHODS: Data was extracted from primary studies included in CSRs assessing two risk factors as outcomes. For each risk factor, data was obtained on its overall burden in disability-adjusted life years (DALYs) by World Bank Income Levels and examined for a link between DALYs, the number of primary studies and participants. RESULTS: A total of 1601 studies from 95 CSRs were included. Only 18.3% of the global burden for A&D is in high income-countries (HICs) but they produced 90.5% of primary studies and include 99.5% of participants. Only 14.2% of the dietary risk burden is in HICs but they produced 80.5% of primary studies and included 98.1% of participants. CONCLUSIONS: This study demonstrates the unequal output of research heavily weighted towards HICs. More initiatives with informed contextual understanding are required to address this inequality and promote health research in low and middle-income countries.

Problematic substance use or problematic substance use policies? / Consommation problématique de substances ou politiques problématiques en la matière?

This special issue on substance use issues comes at a critical time for Canadian health policy makers and researchers. Most attention is currently focussed on the opioid crisis and the potential impacts of cannabis legalization. However, our most widely used and harmful substances continue to be alcohol and nicotine. Our policies to reduce harms from these substances are failing. While alcohol control policies are being gradually abandoned, opportunities to maximize the harm reduction potential of new, alternative and safer nicotine delivery devices are not being grasped. More generally, a greater focus is needed on harm reduction strategies that are informed by the experience of marginalized people with severe substance use-related problems so as to not exacerbate health inequities. In order to better inform policy responses, we recommend innovative approaches to monitoring and surveillance that maximize the use of multiple data sources, such as those used in the Canadian Substance Use Costs and Harms (CSUCH) project. Greater attention to precision in defining patterns of risky use and harms is also needed to support policies that more accurately reflect and respond to actual levels of substance use-related harm in Canadian society.

Substance use in Canada cost $46 billion in 2017, with the great majority of these costs resulting from the use of tobacco and alcohol. Substance use-related costs, harms and rates of use have been increasing in Canada over the past decades for both legal and illegal substances, including those for cannabis. Canadian policies to address our most harmful substances, i.e. alcohol, cannabis and tobacco, are largely failing, despite significant opportunities to improve policies on pricing, taxation and marketing of legal substances. Canada's monitoring and surveillance efforts can be improved by developing more discerning measures of risk and maximizing the use of multiple data sources.

Au Canada, la consommation de substances a coûté 46 milliards de dollars en 2017, la grande majorité de ces coûts découlant du tabagisme et de la consommation d'alcool. Au Canada, les taux de consommation de substances ainsi que les coûts et les méfaits connexes ont augmenté au cours des dernières décennies, que ce soit pour les substances légales ou illégales, en particulier le cannabis. Les politiques canadiennes en matière de lutte contre la consommation des substances les plus nocives, soit l'alcool, le cannabis et le tabac, sont en grande partie inefficaces, malgré d'importantes possibilités d'amélioration en matière de tarification, de taxation et de commercialisation des substances légales. Il est possible d'améliorer les efforts de contrôle et de surveillance au Canada en élaborant des mesures de risque bien pensées et en maximisant l'utilisation de multiples sources de données.

How many alcohol-attributable deaths and hospital admissions could be prevented by alternative pricing and taxation policies? Modelling impacts on alcohol consumption, revenues and related harms in Canada. / Réduction des décès et des hospitalisations dus à l'alcool grâce à des politiques fiscales et d'établissement des prix différentes? Modélisation des effets sur la consommation d'alcool, les revenus et les méfaits liés à l'alcool au Canada.

INTRODUCTION: In 2017, Canada increased alcohol excise taxes for the first time in over three decades. In this article, we describe a model to estimate various effects of additional tax and price policies that are predicted to improve health outcomes. METHODS: We obtained alcohol sales and taxation data for 2016/17 for all Canadian jurisdictions from Statistics Canada and product-level sales data for British Columbia. We modelled effects of alternative price and tax policies - revenue-neutral taxes, inflation-adjusted taxes and minimum unit prices (MUPs) - on consumption, revenues and harms. We used published price elasticities to estimate impacts on consumption and revenue and the International Model for Alcohol Harms and Policies (InterMAHP) to estimate impacts on alcohol-attributable mortality and morbidity. RESULTS: Other things being equal, revenue-neutral alcohol volumetric taxes (AVT) would have minimal influence on overall alcohol consumption and related harms. Inflation-adjusted AVT would result in 3.83% less consumption, 329 fewer deaths and 3762 fewer hospital admissions. A MUP of $1.75 per standard drink (equal to 17.05mL ethanol) would have reduced consumption by 8.68% in 2016, which in turn would have reduced the number of deaths by 732 and the number of hospitalizations by 8329 that year. Indexing alcohol excise taxes between 1991/92 and 2016/17 would have resulted in the federal government gaining approximately $10.97 billion. We estimated this could have prevented 4000-5400 deaths and 43 000-56 000 hospitalizations. CONCLUSION: Improved public health outcomes would be made possible by (1) increasing alcohol excise tax rates across all beverages to compensate for past failures to index rates, and (2) setting a MUP of at least $1.75 per standard drink. While reducing alcohol-caused harms, these tax policies would have the added benefit of increasing federal government revenues.

Drinking patterns, alcohol-related harm and views on policies: results from a pilot of the International Alcohol Control Study in Canada. / Habitudes de consommation, méfaits liés à l'alcool et points de vue sur les politiques : résultats d'un projet pilote de l'étude internationale sur le contrôle de l'alcool (IAC) au Canada.

INTRODUCTION: We conducted a pilot assessment of the feasibility of implementing the International Alcohol Control (IAC) Study in Ontario, Canada, to allow for future comparisons on the impacts of alcohol control policies with a number of countries. METHODS: The IAC Study questionnaire was adapted for use in the province of Ontario, and a split-sample approach was used to collect data. Data were collected by computer-assisted telephone interviewing of 500 participants, with half the sample each answering a subset of the adapted IAC Study survey. RESULTS: Just over half of the sample (53.6%) reported high frequency drinking (once a week or more frequently), while 6.5% reported heavy typical occasion drinking (8 drinks or more per session). Self-reported rates of alcohol-related harms from one's own and others' drinking were relatively low. Attitudes towards alcohol control varied. A substantial majority supported more police spot checks to detect drinking and driving, while restrictions on the number of alcohol outlets and increases in the price of alcohol were generally opposed. CONCLUSION: This pilot study demonstrated that the IAC Study survey can be implemented in Canada with some modifications. Future research should assess how to improve participation rates and the feasibility of implementing the longitudinal aspect of the IAC Study. This survey provides additional insight into alcohol-related behaviours and attitudes towards alcohol control policies, which can be used to develop appropriate public health responses in the Canadian context.

Is another public health crisis brewing beneath the COVID-19 pandemic?

Evidence indicates associations between exposure to mass traumatic events and increased alcohol consumption and related harms following the crises. However, there is limited evidence available to inform alcohol policies during such events. In this commentary, we present the range of government actions to control public access to alcohol during the novel coronavirus disease 2019 pandemic in provinces and territories across Canada. Liquor retailers, including both private and government-run retailers, have been designated as essential services in all jurisdictions, operating under an evolving set of rules. From a public health perspective, keeping liquor retailers open during pandemic-related lockdown restrictions is a delicate decision which poses new risks and considerations about the best strategy for minimizing alcohol-related harms. We discuss the need to strike a balance between supplying public access to alcohol, particularly to those living with dependence, and unintentionally sending the message that alcohol is essential in our lives and encouraging consumption. Given the far-reaching effects of alcohol on health, social, psychological, economic, and work safety outcomes, we describe international guidance for minimizing alcohol-related harms and suggest that a nuanced and evidence-informed discussion about the considerations and impacts of alcohol control measures during a public health emergency should be undertaken.

Practice facilitation to promote evidence-based screening and management of unhealthy alcohol use in primary care: a practice-level randomized controlled trial.

BACKGROUND: Unhealthy alcohol use is the third leading cause of preventable death in the United States. Evidence demonstrates that screening for unhealthy alcohol use and providing persons engaged in risky drinking with brief behavioral and counseling interventions improves health outcomes, collectively termed screening and brief interventions. Medication assisted therapy (MAT) is another effective method for treatment of moderate or severe alcohol use disorder. Yet, primary care clinicians are not regularly screening for or treating unhealthy alcohol use. METHODS AND ANALYSIS: We are initiating a clinic-level randomized controlled trial aimed to evaluate how primary care clinicians can impact unhealthy alcohol use through screening, counseling, and MAT. One hundred and 25 primary care practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) will be engaged; each will receive practice facilitation to promote screening, counseling, and MAT either at the beginning of the trial or at a 6-month control period start date. For each practice, the intervention includes provision of a practice facilitator, learning collaboratives with three practice champions, and clinic-wide information sessions. Clinics will be enrolled for 6-12 months. After completion of the intervention, we will conduct a mixed methods analysis to identify changes in screening rates, increase in provision of brief counseling and interventions as well as MAT, and the reduction of alcohol intake for patients after practices receive practice facilitation. DISCUSSION: This study offers a systematic process for dissemination and implementation of the evidence-based practice of screening, counseling, and treatment for unhealthy alcohol use. Practices will be asked to implement a process for screening, counseling, and treatment based on their practice characteristics, patient population, and workflow. We propose practice facilitation as a robust and feasible intervention to assist in making changes within the practice. We believe that the process can be replicated and used in a broad range of clinical settings; we anticipate this will be supported by our evaluation of this approach. TRIAL REGISTRATION: ClinicalTrials.gov, ClinicalTrials.gov Identifier: NCT04248023, Registered 5 February 2020.

Smartphone-based secondary prevention intervention for university students with unhealthy alcohol use identified by screening: study protocol of a parallel group randomized controlled trial.

BACKGROUND: Unhealthy alcohol use is a leading cause of morbidity and mortality among young people, including university students. Delivering secondary prevention interventions against unhealthy alcohol use is challenging. Information technology has the potential to reach large parts of the general population. The present study is proposed to test a proactive secondary prevention smartphone-based intervention against unhealthy alcohol use. METHODS: This is a parallel-group, randomized controlled trial (1:1 allocation ratio) among 1696 university students with unhealthy alcohol use, identified by screening and followed up at 3, 6, and 12 months. Participants will be randomized to receive access to a smartphone-based intervention or to a no intervention control condition. The primary outcome will be self-reported volume of alcohol drunk over the past 30 days, reported as the mean number of standard drinks per week over the past 30 days, measured at 6 months. Secondary outcomes will be number of heavy drinking days over the past 30 days, at 6 months. Additional outcomes will be maximum number of drinks on any day over the past 30 days, alcohol-related consequences (measured using the Short Inventory of Problems (SIP-2R), and academic performance. DISCUSSION: The aim of this trial is to close the evidence gap on the efficacy of smartphone-based secondary prevention interventions. If proven effective, smartphone-based interventions have the potential to reach a large portion of the population, completing what is available on the Internet. TRIAL REGISTRATION: ISRCTN, 10007691. Registered on 2 December 2019. Recruitment will start in April 2020.