[Addiction: what's new in 2022]. / Addictions : ce qui a changé en 2022.

Addictions appear everywhere, mutate, transform with new products and behaviors, playing on our painstaking efforts to try to control them. Drawn into this current, the impression that dominates invites more to understand and to coax rather than to fight. Addictions are our condition, let's deal with it, rather than fight against them. It is therefore a question of knowing the products, that everyone can identify their level of risk, and of giving as many tools as possible, at any age, whatever the behavior or the product. This article shows us that there is a lot to do, from school benches to liver transplantation. There is also a lot to discover, in the recognition of the therapeutic virtues, of cannabinoids for example or even in their prescription, of pharmaceutical heroin for example, sometimes by far the best option.

Les addictions émergent de partout, mutent, se transforment avec des nouveaux produits et comportements, se jouant de nos efforts laborieux pour tenter de les contrôler. Entraînés dans ce courant, l'impression qui domine invite davantage à comprendre et à amadouer plutôt qu'à lutter. Les addictions sont notre condition, faisons avec, plutôt que contre. Il s'agit donc de connaître les produits, que chacun puisse identifier son niveau de risque, et de donner autant d'outils que possible, à tout âge, quel que soit le comportement ou le produit. Cet article nous montre qu'il y a beaucoup à faire, des bancs de l'école à la transplantation hépatique. Il y a aussi beaucoup à découvrir, dans la reconnaissance des vertus thérapeutiques, des cannabinoïdes par exemple, ou encore dans leur prescription, de l'héroïne pharmaceutique, parfois de loin la meilleure option.

Alcohol and falls among people with HIV infection: A view from Russia and the United States.

BACKGROUND: Both human immunodeficiency virus (HIV) infection and alcohol use predispose to autonomic/sensory neuropathy, imbalance symptoms, and cognitive impairment-conditions associated with a greater risk of falls-yet it is unclear how to identify people with HIV (PWH) whose drinking is associated with falls. Research on alcohol and falls using the same instruments in different countries could help to specify the level of alcohol use associated with fall risk. We examined whether a consumption-based measure (the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) and/or a symptom-based measure (DSM-5 criteria for alcohol use disorder [AUD]) are associated with sustaining a fall among PWH in St Petersburg, Russia and Boston, Massachusetts in the United States. METHODS: Separate multivariate logistic regressions were used for each cohort to examine cross-sectional associations for each alcohol measure predicting fall. Potential confounders included physical functioning, depressive symptoms, and other substance use (measured with the Addiction Severity Index). RESULTS: A fall was reported by 35% (87/251) of the sample in Boston and 12% (46/400) in St Petersburg. Each additional AUD criterion-but not higher AUDIT-C score-was significantly associated with a fall in both Boston (odds ratio [OR] = 1.10; 95% confidence interval [CI] 1.02, 1.18) and St Petersburg (adjusted OR AOR = 1.10; 95% CI 1.02, 1.18). Heavy alcohol use (>6 drinks/occasion, any vs. none) was associated with more than twice the odds of a fall (AOR = 2.24; 95% CI 1.21, 4.13) in Boston. CONCLUSIONS: These findings suggest that while fall risk may vary by setting and population, heavy alcohol use and AUD symptom severity are potential targets for interventions to prevent falls. Studies in diverse global settings advance our understanding of the relationship between alcohol and falls in PWH.

[Electronic screening and brief interventions]. / Dépistage et interventions brèves digitales.

Screening and brief interventions are among the evidence-based recommended practices to reduce the negative impact of substance use on the population. The digitization of these interventions makes it possible to disseminate them widely and to circumvent some of the barriers to the implementation of face-to-face interventions. Current evidence shows that electronic screening and brief interventions are effective in reducing alcohol and tobacco consumption. For other substances and for gambling, current evidence is more limited but promising and additional research is needed. These interventions can represent an alternative to face-to-face interventions.

Le dépistage et les interventions brèves font partie des interventions basées sur les preuves recommandées pour réduire l'impact négatif de la consommation de substances sur la population. La digitalisation de ces interventions permet de les diffuser largement et de contourner certaines barrières à l'implémentation des interventions en face à face. Les données actuelles montrent que le dépistage et l'intervention brève digitale sont efficaces sur la réduction de la consommation d'alcool et de tabac. Pour les autres substances et pour les jeux d'argent, les données sont plus limitées mais prometteuses et la recherche doit se poursuivre dans ce domaine. Ces interventions peuvent représenter une alternative aux interventions en face à face.

[What's new in addiction medicine in 2021 ?] / Addictions.

Addiction medicine is influenced by societal changes and the environment has an impact on addictive behaviors and how they are experienced. The COVID-19 pandemic has had an impact on addictive behaviors, some of which could be favorable, and others highlight vulnerabilities to be considered by clinicians. Recent legislative changes open possibilities to limit the negative impact of electronic lotteries. In a context favorable to a better acceptance of people of LGBTQIA+ diversity, research and training in addiction medicine also have a role to play. In view of advances in understanding the harmful effects of alcohol, it is necessary to adapt the perception of the risk, in order not to provoke the incomprehension in the population.

La médecine des addictions est liée aux enjeux sociétaux actuels, et l'environnement joue un rôle important sur les comportements addictifs et comment ils sont vécus. La pandémie de Covid-19 a eu un impact sur les comportements addictifs, dont certains pourraient être positifs et d'autres mettent en lumière des vulnérabilités à prendre en compte en clinique. Les récents changements législatifs ouvrent des possibilités pour limiter l'impact négatif des loteries électroniques. Dans le contexte favorable à une meilleure acceptation des personnes issues de la diversité LGBTQIA+ (lesbienne, gay, bisexuel·le, transgenre, queer, intersexe et asexuel·le ou aromantique), la recherche et la formation en médecine des addictions ont aussi un rôle à jouer. Au vu des avancées dans la connaissance des effets nocifs de l'alcool, il est nécessaire d'adapter la perception du risque, afin de ne pas susciter l'incompréhension de la population.

Correlates of the use of electronic devices to vape cannabis in a cohort of young Swiss male reporting current cannabis use.

BACKGROUND: Information about correlates of cannabis vaping in Europe is scarce. METHODS: In a cohort of 1613 Swiss young males currently using cannabis, we used logistic regression, adjusting for age, linguistic region and education to assess the association between sensation seeking, substance use and sociodemographic variables with cannabis vaping. RESULTS: Mean age was 25.38 years, 60.4% had post-secondary education and 57.3% lived in French-speaking cantons; 26.3% met criteria for nicotine dependence, 16.0% met criteria for alcohol use disorder and 34.9% used illicit drugs other than cannabis; 27.4% used cannabis at least twice a week and 27.8% met criteria for cannabis use disorder (CUD). Ninety-four participants (5.8%) reported cannabis vaping (of them 87.4% reported infrequent cannabis vaping). In the adjusted analysis, using joints with no tobacco {adjusted odds ratio (aOR) [95% confidence interval (CI)] = 1.45 (1.02-1.76)}, water pipe with [aOR (95% CI) = 1.70 (1.29-2.24)] and without tobacco [aOR (95% CI) = 2.15 (1.60-2.87)], cannabis mixed with food [aOR (95% CI) = 1.61 (1.29-2.02)], using cannabis >2 times a week [aOR (95% CI) = 3.73 (2.40-5.81)], meeting criteria for CUD [aOR (95% CI) = 4.19 (2.70-6.50)], using illicit drugs other than cannabis [aOR (95% CI) = 1.88 (1.23-2.87)], weekly number of alcohol drinks [aOR (95% CI) = 1.01 (1.00-1.03)] and living in the German-speaking area of Switzerland [aOR (95% CI) = 2.70 (1.71-4.25)] were associated with higher odds of cannabis vaping; post-secondary schooling [aOR (95% CI) = 0.37 (0.16-0.86)] and vocational training [aOR (95% CI) = 0.41 (0.17-0.99)] (as opposed to primary schooling) were associated with lower odds of cannabis vaping. CONCLUSION: Cannabis vaping might be a marker of riskier behaviours among cannabis users.

Electronic screening and brief intervention for unhealthy alcohol use in primary care waiting rooms - A pilot project.

Background: In primary care, electronic self-administered screening and brief interventions for unhealthy alcohol may overcome some of the implementation barriers of face-to-face intervention. We developed an anonymous electronic self-administered screening brief intervention device for unhealthy alcohol use and assessed its feasibility and acceptability in primary care practice waiting rooms. Two modes of delivery were compared: with or without the presence of a research assistant (RA) to make patients aware of the device's presence and help users. Using the device was optional. Methods: The devices were placed in 10 participating primary care practices waiting rooms for 6 weeks, and were accessible on a voluntary basis. Number of appointments by each practice during the course of the study was recorded. Access to the electronic brief intervention was voluntary among those who screened positive. Screening and brief intervention rates and characteristics of users were compared across the modes of delivery. Results: During the study, there were 7270 appointments and 1511 individuals used the device (20.8%). Mean age of users was 45.3 (19.5), and 57.9% screened positive for unhealthy alcohol use. Of them, 53.8% accessed the brief intervention content. The presence of the RA had a major impact on the device's usage (59.6% vs 17.4% when absent). When the RA was present, participants were less likely to screen positive (49.4% vs 60.7%, P = 0.0003) but more likely to access the intervention (62.7% vs 51.4%, P = 0.009). Results from the satisfaction survey indicated that users found the device easy to use (93.5%), questions useful (89-95%) and 77.2% reported that their friends would be willing to use it. Conclusions: This pilot project indicates that the implementation of an electronic screening and brief intervention device for unhealthy alcohol is feasible and acceptable in primary care practices but that, without human support, its use is rather limited.

Outcomes of two randomized controlled trials, employing participants recruited through Mechanical Turk, of Internet interventions targeting unhealthy alcohol use.

BACKGROUND: Two randomized controlled trials (RCTs) were conducted to explore the utility of the Mechanical Turk (MTurk) crowdsourcing platform to conduct rapid trials evaluating online interventions for unhealthy alcohol use. METHODS: Both trials employed a staged recruitment procedure where participants who drank in an unhealthy fashion were identified using a baseline survey and then invited to take part in a 6-month follow-up. Participants in both trials were randomized to receive one of several different online interventions or to a no intervention control condition. In study 1, the online interventions were password protected and only those who accessed the study portal were randomized to condition. In study 2, participants were directed to free-of charge interventions and asked to send a screenshot of the intervention to demonstrate that they had complied. RESULTS: Participants reporting unhealthy alcohol use were recruited fairly rapidly. Large numbers of screeners were completed (Study 1: n = 4910; Study 2: n = 5812), found eligible (Study 1: n = 3741; Study 2: n = 4095), and randomized to condition (Study 1: n = 511; Study 2: n = 878). Fair follow-up rates were observed at 6 months for each study (Study 1: 82%; Study 2: 66%). Neither trial was able to clearly demonstrate that providing access to the online interventions lead to increased reductions in alcohol use as compared to the control group. CONCLUSIONS: While recruitment through a crowdsourcing platform is rapid and relatively low cost, it is possible that the lack of impact of the online websites employed in these trials could be due to the source of participants rather than the lack of efficacy of the interventions. TRIAL REGISTRATION: ClinicalTrials.gov # NCT02977026 and NCT03060135 .

[Use of clear and nonstigmatizing language is necessary in addiction medicine]. / L'emploi d'un langage non stigmatisant et précis est nécessaire en médecine des addictions.

The language used has an impact on clinician attitudes and behaviors. In particular, the use of stigmatizing language or language reducing individuals in treatment to a given behavior has a negative impact on clinician attitudes, perception of people, perception of the disorders and treatment options. In addiction medicine, using clear, non-stigmatizing and scientifically appropriate language aims at delivering better care, increases treatment access, improves communication between health care professionals and improves knowledge transfer towards health care system users and their families, health care providers and society. The use of clear, slang-free, people-first language is crucial.

Le langage influence les attitudes et le comportement des clinicien·ne·s. Notamment l'emploi d'un langage stigmatisant et amalgamant les personnes en traitement et leur comportement a une influence négative sur les attitudes des clinicien·ne·s, leur perception des personnes, des troubles et des soins proposés. En médecine des addictions, employer un langage non stigmatisant, précis et scientifiquement approprié vise à améliorer la prise en charge et l'entrée en soins ainsi que la communication entre professionnel·le·s, diffuser les connaissances actuelles auprès des usager·ère·s du système de soins et de leur entourage, des professionnel·le·s de la santé et de la société en général. L'utilisation d'un langage centré sur la personne, précis, non argotique est crucial.

[New biomarkers of alcohol use]. / Nouveaux marqueurs biologiquesde la consommation d'alcool.

Estimating alcohol consumption using biomarkers raises interpretation problems. The biomarkers currently used in clinical settings have limited performances to identify unhealthy alcohol use (e.g. CDT, AST, ALT). New direct biomarkers, ethylglucuronide (EtG) and phosphatydilethanol (PEth) are available and offer better sensitivity and specificity compared to indirect biomarkers. In forensic medicine, EtG and PEth are replacing indirect biomarkers. However, in clinical routine practice these markers are usually not considered. Still, for specific purposes such in pre-liver transplant evaluations, direct markers may help specialists in the decision process.

Estimer la consommation d'alcool en se basant sur des tests biologiques pose des problèmes d'interprétation. Les marqueurs actuellement utilisés en clinique (CDT et transaminases) présentent des performances limitées pour l'identification du mésusage d'alcool. Des nouveaux marqueurs directs, l'éthylglucuronide (EtG) et le phosphatidyléthanol (PEth), sont à disposition et offrent de meilleures performances en termes de sensibilité et spécificité que les marqueurs indirects. Ils sont principalement utilisés dans le cadre de suivis médico-légaux et remplacent les marqueurs indirects. En pratique clinique, l'EtG et le PEth ne sont que peu utilisés. On voit apparaître l'utilisation de ces tests dans le cadre d'évaluations spécifiques, par exemple avant transplantation hépatique.

[Addictions]. / Addictions.

New drugs available in a click, plethora of games, new regulations on cannabis, addiction medicine has a lot to do ! In 2018, Switzerland recognized a training certificate in addiction medicine, pathological gambling entered into ICD-11 and vaping, first considered with suspicion, found a place in the pharmacopoeia of the fight against tobacco. That's not all, on the alcohol front, we realized that even a small glass can hurt and the medicine of addictions evolved towards models of recovery that aim to improve quality of life with chronic diseases. Finally, the American opioid prescription epidemic is worrying in Switzerland, even if the situation and the context are very different.

Nouvelles drogues disponibles en un clic, pléthore de l'offre de jeux, nouvelles réglementations sur le cannabis, la médecine de l'addiction a bien à faire ! En 2018, nous voyons apparaître en Suisse une reconnaissance de la formation en médecine de l'addiction, les jeux font leur entrée dans la CIM-11 et le vapotage d'abord considéré avec méfiance trouve une place dans la pharmacopée de la lutte contre le tabac. Mais ce n'est pas tout, sur le front de l'alcool on s'aperçoit que même un petit verre peut faire mal et la médecine des addictions évolue vers des modèles de soins qui visent à mieux vivre avec la maladie plutôt que de s'en défaire. Finalement, l'épidémie américaine de prescription détournée d'opioïdes inquiète en Suisse, même si la situation et le contexte sont très différents.

Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials.

BACKGROUND: Face-to-face brief interventions for problem drinking are effective, but they have found limited implementation in routine care and the community. Internet-based interventions could overcome this treatment gap. We investigated effectiveness and moderators of treatment outcomes in internet-based interventions for adult problem drinking (iAIs). METHODS AND FINDINGS: Systematic searches were performed in medical and psychological databases to 31 December 2016. A one-stage individual patient data meta-analysis (IPDMA) was conducted with a linear mixed model complete-case approach, using baseline and first follow-up data. The primary outcome measure was mean weekly alcohol consumption in standard units (SUs, 10 grams of ethanol). Secondary outcome was treatment response (TR), defined as less than 14/21 SUs for women/men weekly. Putative participant, intervention, and study moderators were included. Robustness was verified in three sensitivity analyses: a two-stage IPDMA, a one-stage IPDMA using multiple imputation, and a missing-not-at-random (MNAR) analysis. We obtained baseline data for 14,198 adult participants (19 randomised controlled trials [RCTs], mean age 40.7 [SD = 13.2], 47.6% women). Their baseline mean weekly alcohol consumption was 38.1 SUs (SD = 26.9). Most were regular problem drinkers (80.1%, SUs 44.7, SD = 26.4) and 19.9% (SUs 11.9, SD = 4.1) were binge-only drinkers. About one third were heavy drinkers, meaning that women/men consumed, respectively, more than 35/50 SUs of alcohol at baseline (34.2%, SUs 65.9, SD = 27.1). Post-intervention data were available for 8,095 participants. Compared with controls, iAI participants showed a greater mean weekly decrease at follow-up of 5.02 SUs (95% CI -7.57 to -2.48, p < 0.001) and a higher rate of TR (odds ratio [OR] 2.20, 95% CI 1.63-2.95, p < 0.001, number needed to treat [NNT] = 4.15, 95% CI 3.06-6.62). Persons above age 55 showed higher TR than their younger counterparts (OR = 1.66, 95% CI 1.21-2.27, p = 0.002). Drinking profiles were not significantly associated with treatment outcomes. Human-supported interventions were superior to fully automated ones on both outcome measures (comparative reduction: -6.78 SUs, 95% CI -12.11 to -1.45, p = 0.013; TR: OR = 2.23, 95% CI 1.22-4.08, p = 0.009). Participants treated in iAIs based on personalised normative feedback (PNF) alone were significantly less likely to sustain low-risk drinking at follow-up than those in iAIs based on integrated therapeutic principles (OR = 0.52, 95% CI 0.29-0.93, p = 0.029). The use of waitlist control in RCTs was associated with significantly better treatment outcomes than the use of other types of control (comparative reduction: -9.27 SUs, 95% CI -13.97 to -4.57, p < 0.001; TR: OR = 3.74, 95% CI 2.13-6.53, p < 0.001). The overall quality of the RCTs was high; a major limitation included high study dropout (43%). Sensitivity analyses confirmed the robustness of our primary analyses. CONCLUSION: To our knowledge, this is the first IPDMA on internet-based interventions that has shown them to be effective in curbing various patterns of adult problem drinking in both community and healthcare settings. Waitlist control may be conducive to inflation of treatment outcomes.

Effectiveness of brief alcohol interventions in primary care populations.

BACKGROUND: Excessive drinking is a significant cause of mortality, morbidity and social problems in many countries. Brief interventions aim to reduce alcohol consumption and related harm in hazardous and harmful drinkers who are not actively seeking help for alcohol problems. Interventions usually take the form of a conversation with a primary care provider and may include feedback on the person's alcohol use, information about potential harms and benefits of reducing intake, and advice on how to reduce consumption. Discussion informs the development of a personal plan to help reduce consumption. Brief interventions can also include behaviour change or motivationally-focused counselling.This is an update of a Cochrane Review published in 2007. OBJECTIVES: To assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and 12 other bibliographic databases to September 2017. We searched Alcohol and Alcohol Problems Science Database (to December 2003, after which the database was discontinued), trials registries, and websites. We carried out handsearching and checked reference lists of included studies and relevant reviews. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. The comparison group was no or minimal intervention, where a measure of alcohol consumption was reported. 'Brief intervention' was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 minutes. Any more was considered an extended intervention. Digital interventions were not included in this review. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We carried out subgroup analyses where possible to investigate the impact of factors such as gender, age, setting (general practice versus emergency care), treatment exposure and baseline consumption. MAIN RESULTS: We included 69 studies that randomised a total of 33,642 participants. Of these, 42 studies were added for this update (24,057 participants). Most interventions were delivered in general practice (38 studies, 55%) or emergency care (27 studies, 39%) settings. Most studies (61 studies, 88%) compared brief intervention to minimal or no intervention. Extended interventions were compared with brief (4 studies, 6%), minimal or no intervention (7 studies, 10%). Few studies targeted particular age groups: adolescents or young adults (6 studies, 9%) and older adults (4 studies, 6%). Mean baseline alcohol consumption was 244 g/week (30.5 standard UK units) among the studies that reported these data. Main sources of bias were attrition and lack of provider or participant blinding. The primary meta-analysis included 34 studies (15,197 participants) and provided moderate-quality evidence that participants who received brief intervention consumed less alcohol than minimal or no intervention participants after one year (mean difference (MD) -20 g/week, 95% confidence interval (CI) -28 to -12). There was substantial heterogeneity among studies (I² = 73%). A subgroup analysis by gender demonstrated that both men and women reduced alcohol consumption after receiving a brief intervention.We found moderate-quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD -0.08, 95% CI -0.14 to -0.02; 15 studies, 6946 participants); drinking days per week (MD -0.13, 95% CI -0.23 to -0.04; 11 studies, 5469 participants); or drinking intensity (-0.2 g/drinking day, 95% CI -3.1 to 2.7; 10 studies, 3128 participants).We found moderate-quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (-14 g/week, 95% CI -37 to 9; 6 studies, 1296 participants). There was little difference in binges per week (-0.08, 95% CI -0.28 to 0.12; 2 studies, 456 participants; moderate-quality evidence) or difference in days drinking per week (-0.45, 95% CI -0.81 to -0.09; 2 studies, 319 participants; moderate-quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI -26 to 9; 1 study, 158 participants; low-quality evidence).Extended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI -42 to 45; 3 studies, 552 participants; low-quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (-0.5, 95% CI -1.2 to 0.2; 147 participants; low-quality evidence). Results from this trial also suggested very little impact on drinking intensity (-1.7 g/drinking day, 95% CI -18.9 to 15.5; 147 participants; very low-quality evidence).Only five studies reported adverse effects (very low-quality evidence). No participants experienced any adverse effects in two studies; one study reported that the intervention increased binge drinking for women and two studies reported adverse events related to driving outcomes but concluded they were equivalent in both study arms.Sources of funding were reported by 67 studies (87%). With two exceptions, studies were funded by government institutes, research bodies or charitable foundations. One study was partly funded by a pharmaceutical company and a brewers association, another by a company developing diagnostic testing equipment. AUTHORS' CONCLUSIONS: We found moderate-quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness.

What does it mean when people say that they have received expressions of concern about their drinking or advice to cut down on the AUDIT scale?

BACKGROUND: The Alcohol Use Disorders Identification Test (AUDIT) is a commonly used scale to measure severity of alcohol consumption that contains an item asking if anyone has expressed concern about your drinking or suggested you cut down. What does it mean when a participant says yes to this question? METHODS: Participants who were 18 or older and who drank at least weekly were recruited to complete a survey about their drinking from the Mechanical Turk platform. Comparisons were made between at risk (n = 2565) and high risk drinkers (n = 581) who said that someone had expressed concern about their drinking regarding who had expressed concern. If the person expressing concern was a health professional, the participant was also asked what type of support was provided. RESULTS: Expressions of concern about drinking were received more often by high risk than at risk drinkers. The most common type of person to have expressed concern was a relative, followed by a friend, or a marital partner. About one quarter of participants had received expressions of concern from a medical doctor or other health professional. All health professionals' expressions of concern were accompanied by a suggestion to cut down and about half provided some additional support (the most common type of support was brief advice). CONCLUSIONS: Expressions of concern come from a variety of sources and the likelihood of their occurrence is partially related to amount of alcohol intake.

Readiness to Change Predicts Drinking: Findings from 12-Month Follow-Up of Alcohol Use Disorder Outpatients.

AIM: To test whether measures of readiness to change (RTC) re-assessed every 3 months had predictive value for change in alcohol use over 12 months in a sample of adult outpatients with alcohol use disorder (AUD). METHODS: Of the case, 78 outpatients were followed monthly over one year and averaged 9.0 interviews each (total observations = 704). Alcohol abstinence days and heavy drinking days were assessed monthly using a 30-day timeline follow-back procedure. RTC was assessed using 3 'readiness rulers' (importance, readiness, and confidence to change, measured on a 0-10 visual analog scale). The effect of RTC on alcohol use over time was tested every 3 months using negative binomial generalized estimating equations (GEE), controlling for gender, age, baseline alcohol dependence severity and AUD treatment status (ongoing vs. ceased). RESULTS: GEE models showed highly significant effects of readiness and confidence to change on respective alcohol outcomes. Effects of importance to change were weaker. CONCLUSION: As hypothesized, higher RTC scores were associated with improved alcohol use outcomes in this longitudinal study. The strongest effects were for confidence to change. Finding significant predictive validity prospectively is consistent with a theoretical view of RTC as a dynamic construct. Further research might clarify how AUD treatment could actually elicit or increase RTC.

Smartphone application for unhealthy alcohol use: A pilot study.

BACKGROUND: Technology-delivered interventions are useful tools for addressing unhealthy alcohol use. Smartphones in particular offer opportunities to deliver interventions at the user's convenience. A smartphone application with 5 modules (personal feedback, self-monitoring of drinking, designated driver tool, blood alcohol content [BAC] calculator, information) was developed. Its acceptability and associations between use and drinking outcomes were assessed. METHODS: One hundred thirty adults with unhealthy alcohol use (>14 [men]/>7 [women] drinks/week or ≥1 episode/month with 6 or more drinks) recruited in Switzerland (n = 70) and Canada (n = 60) were offered to use the application. Follow-up occurred after 3 months. Appreciation, usefulness, and self-reported frequency of use of the modules, and drinking outcomes (drinks/week, binge drinking) were assessed. Associations between application use and drinking at 3 months were evaluated with negative binomial and logistic regression models, adjusted for baseline values and gender. RESULTS: Of the participants, 48% were women, mean (SD) age: 32.8 (10.0). Follow-up rate: 86.2%. There were changes from baseline (BL) to follow-up (FU) in number of drinks/week, BL: 15.0 (16.5); FU: 10.9 (10.5), P = .01, and binge drinking, BL: 95.4%; FU: 64.3%, P < .0001. All modules had median ratings between 6 and 8 (scale of 1-10). Among the participants, 77% used the application, 76% used the personal feedback module, 41% the self-monitoring of drinking, 22% the designated driver tool, 53% the BAC calculator, and 31% the information module. Participants using the application more than once reported significantly fewer drinks/week at follow-up: Incidence Rate Ratio (IRR), number of drinks per week = 0.70 (0.51; 0.96). CONCLUSIONS: A smartphone application for unhealthy alcohol use appears acceptable and useful (although there is room for improvement). Without prompting, its use is infrequent. Those who used the application more than once reported less weekly drinking than those who did not. Efficacy of the application should be tested in a randomized trial with strategies to increase frequency of its use.

Women and Men Admitted for Alcohol Intoxication at an Emergency Department: Alcohol Use Disorders, Substance Use and Health and Social Status 7 Years Later.

AIMS: To assess the prevalence of alcohol use disorder (AUD), substance use, mental health and social status 7 years following an Emergency Department (ED) admission for alcohol intoxication. To assess gender differences in these prevalences. METHODS: Cohort of 631 patients aged 18-30 years admitted for alcohol intoxication in 2006-2007 at a tertiary referral hospital in Switzerland, contacted for an interview in 2014. Assessment consisted of demography, Alcohol Use Disorders Identification Test-Consumption, Mini International Neuropsychiatric Interview for AUD, Patient Health Questionnaire (depression, anxiety) and lifetime/past year use of tobacco/illegal drugs. Gender differences were assessed with Chi-square tests, t-tests and Wilcoxon tests. RESULTS: In 2014, 318/631 (50.4%) completed the interview. Study completers were not different from non-completers on baseline characteristics (all P > 0.2). Of study completers, 36.8% were unemployed, 56.9% reported hazardous alcohol use, 15.1% alcohol dependence, 13.2% harmful use, 18.6% depression, 15.4% anxiety disorder. Prevalence of any use (lifetime/past year) was 93.4%/80.2% for tobacco, 86.6%/53.1% for cannabis, 54.7%/22.6% for cocaine, 25.6%/13.5% for sedatives, 40.9%/11.0% for stimulants, 21.7%/7.2% for opioids. Men reported significantly more binge drinking, AUD, cannabis use (past year) and more lifetime cannabis, cocaine and stimulants use (all P < 0.05). There was no gender difference in the prevalence of hazardous alcohol use and tobacco use. The prevalence of psychiatric disorders was significantly higher in women (P < 0.05). CONCLUSIONS: Seven years after being admitted for alcohol intoxication, young patients are likely to present substance misuse, mental health disorders and social problems, suggesting  that they should be offered secondary prevention measures while in the ED. SHORT SUMMARY: We studied a cohort of patients aged 18-30 and admitted for alcohol intoxication in 2006-2007 at a tertiary hospital. Participants were interviewed in 2014. Seven years after an admission for alcohol intoxication, patients are likely to present AUDs, substance misuse, mental health disorders and social problems.

Socioeconomic status and substance use among Swiss young men: a population-based cross-sectional study.

BACKGROUND: Socioeconomic status (SES) is often inversely related to health outcomes and is likely to play a role in the use of psychoactive substances among young individuals, although little consensus exists on the association between SES and substance use. The purpose of the study was to determine the association of three SES indicators (perceived family income, education level of participants, and parental education level) with past year use of alcohol, tobacco, cannabis, other illicit drugs and non-medical use of prescription drugs (NMPD) among Swiss young men. METHODS: Population-based cross-sectional study of 5,702 men at mean age twenty. Associations between SES indicators and substance use were assessed with regression models adjusted for age and linguistic region. RESULTS: Participants with average or below average perceived family income were less likely to report any use of alcohol (OR = O.75) but more likely to use tobacco daily (OR = 1.31) and cannabis weekly (OR = 1.27) compared to those with perceived above average family income. Participants whose parents had only achieved obligatory education were less likely to engage in any use of alcohol (OR = 0.30), monthly risky single occasion drinking (RSOD, defined as 6 or more drinks per occasion) (OR = 0.48), any use of cannabis (OR = 0.53) and other illicit drugs (OR = 0.58), whereas those whose parents had only achieved secondary education were less at risk of engaging in cannabis (OR = 0.66 for any use and OR = 0.77 for more than once a week use) and other illicit drugs (OR = 0.74) use, compared to those whose parents had achieved tertiary education. Compared to participants who completed secondary or tertiary education, those who completed only obligatory education reported a higher risk of tobacco (OR = 1.18 for any use, OR = 1.31 for daily use), cannabis (OR = 1.23 for any use, OR = 1.37 for more than once a week use), and other illicit drugs (OR = 1.48) use. No association was found between NMPD and the studied SES variables. CONCLUSION: The relationship between SES and substance use was complex in this sample. Higher socioeconomic status was associated with more alcohol and other illicit drugs use, while lower socioeconomic status was related to more tobacco use. Education level and perceived family income may have different impacts on substance use and may vary by substance.

Do brief alcohol motivational interventions work like we think they do?

BACKGROUND: Questions remain about how brief motivational interventions (BMIs) for unhealthy alcohol use work, and addressing these questions may be important for improving their efficacy. Therefore, we assessed the effects of various characteristics of BMIs on drinking outcomes across 3 randomized controlled trials (RCTs). METHODS: Audio recordings of 314 BMIs were coded. We used the global rating scales of the Motivational Interviewing Skills Code (MISC) 2.1: counselor's acceptance, empathy, and motivational interviewing (MI) spirit, and patient's self-exploration were rated. MI proficiency was defined as counselor's rating scale scores ≥5. We also used the structure, confrontation, and advice subscale scores of the Therapy Process Rating Scale and the Working Alliance Inventory. We examined these process characteristics in interventions across 1 U.S. RCT of middle-aged medical inpatients with unhealthy alcohol use (n = 124) and 2 Swiss RCTs of young men with binge drinking in a nonclinical setting: Swiss-one (n = 62) and Swiss-two (n = 128). We assessed the associations between these characteristics and drinks/d reported by participants 3 to 6 months after study entry. RESULTS: In all 3 RCTs, mean MISC counselor's rating scales scores were consistent with MI proficiency. In overdispersed Poisson regression models, most BMI characteristics were not significantly associated with drinks/d in follow-up. In the U.S. RCT, confrontation and self-exploration were associated with more drinking. Giving advice was significantly associated with less drinking in the Swiss-one RCT. Contrary to expectations, MI spirit was not consistently associated with drinking across studies. CONCLUSIONS: Across different populations and settings, intervention characteristics viewed as central to efficacious BMIs were neither robust nor consistent predictors of drinking outcome. Although there may be alternative reasons why the level of MI processes was not predictive of outcomes in these studies (limited variability in scores), efforts to understand what makes BMIs efficacious may require attention to factors beyond intervention process characteristics typically examined.