Associations Between a Primary Care-Delivered Alcohol-Related Brief Intervention and Subsequent Opioid-Related Outcomes.

OBJECTIVE: The co-occurrence of unhealthy alcohol use and opioid misuse is high and associated with increased rates of overdose, emergency health care utilization, and death. The current study examined whether receipt of an alcohol-related brief intervention is associated with reduced risk of negative downstream opioid-related outcomes. METHODS: This retrospective cohort study included all VISN-6 Veterans Affairs (VA) patients with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening results (N=492,748) from 2014 to 2019. Logistic regression was used to examine the association between documentation of an alcohol-related brief intervention and probability of a new 1) opioid prescription, 2) opioid use disorder (OUD) diagnosis, or 3) opioid-related hospitalization in the following year, controlling for demographic and clinical covariates. RESULTS: Of the veterans, 13% (N=63,804) had "positive" AUDIT-C screen results. Of those, 72% (N=46,216) had a documented alcohol-related brief intervention. Within 1 year, 8.5% (N=5,430) had a new opioid prescription, 1.1% (N=698) had a new OUD diagnosis, and 0.8% (N=499) had a new opioid-related hospitalization. In adjusted models, veterans with positive AUDIT-C screen results who did not receive an alcohol-related brief intervention had higher odds of new opioid prescriptions (adjusted odds ratio [OR]=1.10, 95% CI=1.03-1.17) and new OUD diagnoses (adjusted OR=1.19, 95% CI=1.02-1.40), while new opioid-related hospitalizations (adjusted OR=1.19, 95% CI=0.99-1.44) were higher although not statistically significant. Removal of medications for OUD (MOUD) did not impact associations. All outcomes were significantly associated with an alcohol-related brief intervention in unadjusted models. CONCLUSIONS: The VA's standard alcohol-related brief intervention is associated with subsequent lower odds of a new opioid prescription or a new OUD diagnosis. Results suggest a reduction in a cascade of new opioid-related outcomes from prescriptions through hospitalizations.

Sleep and Alcohol Use Among Veterans Living With Long COVID.

OBJECTIVES: Study objectives were to: (1) better understand sleep experiences and unhealthy alcohol use among Veterans with long COVID and (2) explore providers' perceptions of barriers and facilitators to delivering evidence-based care for sleep problems and unhealthy alcohol use in patients with long COVID. METHODS: VA electronic health records were used to conduct chart reviews (n = 57) of patients evaluated in a VA COVID-19 Recovery Clinic during 1 calendar year; semi-structured interviews were completed with Veterans (n = 5) and clinicians (n = 7) recruited from the clinic. Veteran participants also completed quantitative, self-report measures assessing sleep- and alcohol-related experiences and behaviors. RESULTS: Data from chart reviews and interviews suggested that Veterans with long COVID often had pre-existing sleep problems that were exacerbated during long COVID. Patients and providers agreed that sleep interventions would be beneficial and acceptable in the COVID-19 Recovery clinic. Conversely, few Veterans with long COVID had a pre-existing alcohol use disorder (AUD) diagnosis; alcohol use occurred less frequently and was less often discussed between patients and providers. Providers had mixed viewpoints on delivering alcohol-related care in the clinic; some were highly amenable, others were unsure whether patients would be receptive. CONCLUSIONS: This study is among the first to take a mixed-method approach to understanding experiences of sleep-wake behaviors and unhealthy alcohol use in Veterans with long COVID. Characterizing sleep and alcohol-related experiences, examining associations with functioning, and exploring perspectives on treatment approaches is critical to support efforts to refine, personalize, and optimize evidence-based sleep and alcohol care for Veterans living with long COVID.

Perspectives of clinical stakeholders and patients from four VA liver clinics to tailor practice facilitation for implementing evidence-based alcohol-related care.

BACKGROUND: Unhealthy alcohol use (UAU) is particularly dangerous for people with chronic liver disease. Liver clinics may be an important setting in which to provide effective alcohol-related care by integrating evidence-based strategies, such as brief intervention and medications for alcohol use disorder. We conducted qualitative interviews with clinical stakeholders and patients at liver clinics in four Veterans Health Administration (VA) medical centers to understand barriers and facilitators of integrating alcohol-related care and to support tailoring of a practice facilitation implementation intervention. METHODS: Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed and qualitatively analyzed using a Rapid Assessment Process (RAP) guided by the CFIR. RESULTS: We interviewed 46 clinical stakeholders and 41 patient participants and analyzed findings based on the CFIR. Clinical stakeholders described barriers and facilitators that ranged from operations/clinic resource-based (e.g., time and capacity, desire for additional provider types, referral processes) to individual perspective and preference-based (e.g., supportiveness of leadership, individual experiences/beliefs). Patient participants shared barriers and facilitators that ranged from relationship-based (e.g., trusting the provider and feeling judged) to resource and education-based (e.g., connection to a range of treatment options, education about impact of alcohol). Many barriers and facilitators to integrating alcohol-related care in liver clinics were similar to those identified in other clinical settings (e.g., time, resources, role clarity, stigmatizing beliefs). However, some barriers (e.g., fellow-led care and lack of integration of liver clinics with addictions specialists) and facilitators (e.g., presence of quality improvement staff in clinics and integrated pharmacists and behavioral health specialists) were more unique to liver clinics. CONCLUSIONS: These findings support the possibility of integrating alcohol-related care into liver clinics but highlight the importance of tailoring efforts to account for variation in provider beliefs and experiences and clinic resources. The barriers and facilitators identified in these interviews were used to tailor a practice facilitation implementation intervention in each clinic setting.

Unhealthy alcohol use and brief intervention rates among high and low complexity veterans seeking primary care services in the Veterans Health Administration.

INTRODUCTION: Brief intervention (BI) is recommended for all primary care (PC) patients who screen positive for unhealthy alcohol use; however, patients with multiple chronic health conditions who are at high-risk of hospitalization (i.e., "high complexity" patients) may face disparities in receiving BIs in PC. The current study investigated whether high complexity and low complexity patients in the Veterans Health Administration (VHA) differed regarding screening positive for unhealthy alcohol use, alcohol-use severity, and receipt of BI for those with unhealthy alcohol use. METHODS: Patients were veterans receiving PC services at the VHA in a mid-Atlantic region of the United States. The study extracted VHA administrative and clinical data for a total of 282,242 patients who had ≥1 PC visits between 1/1/2014 and 12/31/2014, during which they were screened for unhealthy alcohol use by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). The study defined high complexity patients as those within and above the 90th percentile of risk for hospitalization per the VHA's Care Assessment Need Score. Logistic regression models assessed if being a high complexity patient was associated with screening positive for unhealthy alcohol use (AUDIT-C ≥ 5), severity of unhealthy alcohol use in those who screened positive (AUDIT-C score range 5-12), and receipt of BI in those who screened positive. RESULTS: Our sample was 94.5% male, 83% White, 13% Black, 4% other race, and 1.7% Hispanic. A total of 10,813 (3.8%) patients screened positive for unhealthy alcohol use from which we identified 569 (5.3%) high complexity and 10,128 (93.6%) low complexity patients (n = 116 removed due to missing complexity data). Relative to low complexity patients, high complexity patients were less likely to screen positive for unhealthy alcohol use (3.3% vs. 4.1%, AOR = 0.59, p < .001); however, in patients who screened positive, high complexity patients had higher AUDIT-C scores (Mean AUDIT-C = 7.75 vs. 6.87, AOR = 1.46, p < .001) and were less likely to receive a BI (78.0% vs. 92.6%, AOR = 0.42, p < .001). CONCLUSIONS: Disparities in BI exist for highly complex patients despite having more severe unhealthy alcohol use. Future research should examine the specific patient- and/or clinic-level factors impeding BI delivery for complex patients.

Insomnia symptoms and postoperative healthcare utilization in veterans undergoing decompressive laminectomy for lumbar spinal stenosis.

Study Objectives: Lumbar spinal stenosis is an age-related spine condition that contributes to pain and disability. Decompressive laminectomy (DL) is regularly performed to alleviate symptoms. Insomnia symptoms are common among people living with chronic pain and may affect key DL outcomes, such as healthcare utilization. We examined associations of insomnia symptom severity with post-DL healthcare utilization in veterans with lumbar spinal stenosis. Methods: Veterans (N = 200) with lumbar spinal stenosis undergoing DL were recruited into a prospective cohort study and self-reported insomnia symptom severity on the Insomnia Severity Index prior to DL. Post-DL, veterans reported on pain and non-pain-related monthly healthcare office visits, emergency room visits, hospitalizations, and mental health visits for 1 year. Incident rate ratios (IRRs) obtained via negative binomial regression evaluated associations of insomnia symptom severity with healthcare utilization rates. Results: Approximately 51% of participants endorsed insomnia symptoms of at least mild severity. Participants who reported at least mild insomnia symptoms had more healthcare office visits (IRR = 1.23, p = .04), general mental health visits (IRR = 3.98, p < .0001), and pain-related mental health visits (IRR = 9.55, p = .01) than those without insomnia symptoms. Adjusting for covariates, rates of mental health visits, overall (IRR = 3.13, p = .001) and pain-related (IRR = 6.93, p = .02), remained statistically significantly higher. Conclusions: Insomnia symptoms are associated with postoperative healthcare utilization lending support for future work to examine the value of assessing and intervening on insomnia symptoms prelaminectomy.

The role of gender and veteran status in healthcare access among a national sample of U.S. adults with unhealthy alcohol use.

Background: Routine healthcare access is critical to reduce drinking and its effects, yet little is known about Veteran and gender differences in routine healthcare access among unhealthy drinkers. The current study examined differences in routine healthcare access, stratified by Veteran status and gender, among a national sample of adults endorsing unhealthy drinking. Method: Using data from the Centers for Disease Control and Prevention's 2019 Behavioral Risk Factor Surveillance System National Survey, we identified adults who endorsed unhealthy drinking over the past month (N = 58,816; 41.4% female; 2.7% female Veterans). Bivariate and multivariable analyses modeled associations between gender, Veteran status, and their interaction in predicting routine healthcare access. All multivariable models adjusted for sociodemographic characteristics. Results: Veterans with unhealthy alcohol use reported high rates of routine healthcare access (e.g., >86% sought care in the past 2 years) and were less likely to experience a cost barrier to care (aOR = 0.75, 95% CI = 0.62-0.92). Females were more likely than males to report better access to care but also to experience a cost barrier (aOR = 1.2, 95% CI = 1.10-1.37). The interaction between Veteran status and gender was non-significant. Conclusions: Overall, healthcare access was better for Veterans and females with unhealthy alcohol use compared to civilians and males with unhealthy alcohol use. However, given that females were more likely to report a cost barrier, future implementation research aiming to improve equity in care may want to explore reasons for cost barriers and develop strategies to help reduce these barriers in order to eliminate gender disparities in primary care-based alcohol-related care.

A Reexamination of Drinking Motives in Young Adults: The Development and Initial Validation of the Young Adult Alcohol Motives Scale.

This study reexamined the factor structure of drinking motives using 205 unique items from 18 drinking motives scales with the inclusion of social tension reduction motives, which have been largely neglected in the literature. A new scale was created and compared with the Drinking Motives Questionnaire-Revised (DMQ-R) to predict alcohol use/problems. Young adults (N = 1,049) completed questionnaires assessing drinking motives and alcohol use/problems. A subset (N = 368) of participants completed a 6-month follow-up. Hierarchical factor analyses informed the creation of a four-factor (i.e., coping, social, enhancement, and social tension reduction) scale (i.e., the Young Adult Alcohol Motives Scale [YAAMS]). In general, the YAAMS performed similarly to the DMQ-R in predicting concurrent and prospective alcohol consumption (i.e., typical drinking quantity and frequency) and alcohol problems (i.e., Alcohol Use Disorder Identification Test [AUDIT] and Brief Young Adult Alcohol Consequences Questionnaire [B-YAACQ] scores), but there were some notable differences, including that the novel social tension reduction scale of the YAAMS was particularly relevant in predicting drinking frequency in those with social anxiety. Results suggest that drinking motives can be described by multiple factor structures and predict alcohol-related outcomes.

Indirect effects of personality on high-intensity drinking: The role of drinking motives.

BACKGROUND: Researchers have long been interested in identifying risk factors for binge drinking behavior (4+/5+ drinks/occasion for females/males), but many studies have demonstrated that a substantial proportion of young adults are drinking at levels far beyond (often 2 to 3 times) the standard binge threshold. The consumption of such large quantities of alcohol, typically referred to as high-intensity drinking (HID), can cause severe alcohol-related problems, such as blackouts, unintended sexual experiences, and death. This study is the first to investigate whether personality is indirectly associated with the likelihood of HID via drinking motives in a large (N = 999) sample of underage young adult drinkers. We hypothesized that trait neuroticism would be indirectly associated with the likelihood of HID via coping motives and that extraversion would be indirectly associated with the likelihood of HID via social and enhancement motives. METHODS: To investigate these hypotheses, we used two archival data sets that recruited current underage (18- to 20-year-old) adult drinkers residing in the United States from online panel services. Participants completed self-report survey items assessing constructs of interest. To investigate the role of drinking motives in the association between personality and HID, both the direct and indirect effects were calculated via three path analyses. RESULTS: Findings revealed that neuroticism was partially indirectly associated with the likelihood of HID via coping motives (b = 0.02, SE = 0.004, p < 0.01). In addition, extraversion was indirectly associated with the likelihood of HID via social (b = 0.031, SE = 0.002, p < 0.01) and enhancement motives (b = 0.01, SE = 0.002, p = 0.01). CONCLUSIONS: These findings are an initial step in examining the interplay among personality traits, drinking motives, and HID in underage drinkers and point to the need for longitudinal studies assessing these associations.

Assessment of Alcohol and Other Substance Use in Patients With Chronic Liver Disease.

Content available: Audio Recording.

Using practice facilitation to improve alcohol-related care in primary care: a mixed-methods pilot study protocol.

BACKGROUND: Alcohol use is a significant risk factor for disability and death in U.S. adults, and approximately one out of every six Veterans seen in primary care (PC) report unhealthy alcohol use. Unhealthy alcohol use is associated with increased risk for poor medical outcomes, substantial societal costs, and death, including suicide. Based on substantial evidence from randomized controlled trials and the U.S. Preventive Services Task Force, VA/DoD clinical guidelines stipulate that all Veterans screening positive for unhealthy alcohol use should receive evidence-based alcohol care in PC, including brief counseling interventions (BI) and additional treatment (e.g., pharmacotherapy) for those with alcohol use disorders (AUD). The VA pioneered implementing alcohol screening and BI in PC, yet substantial implementation gaps remain. To improve alcohol-related care, this study will conduct a pilot study to assess whether a multi-faceted evidence-based implementation strategy-practice facilitation-has the potential to improve PC-based alcohol-related care at a single VA clinic. METHODS: We will first recruit and conduct qualitative interviews with Veterans with unhealthy alcohol use (n = 20-25) and PC stakeholders (N = 10-15) to understand barriers and facilitators to high-quality alcohol care and use results to refine and hone the multifaceted practice facilitation intervention. Qualitative interviews, analysis, and refinement of the intervention will be guided by the Consolidated Framework for Implementation Research (CFIR). Focus groups with a small sample of PC providers and staff (n = 5-7) will be used to further refine the practice facilitation intervention and assess its acceptability and feasibility. The refined practice facilitation intervention will then be offered in the PC clinic to assess implementation (e.g., reach) and effectiveness (reduced drinking) outcomes based on the RE-AIM framework. DISCUSSION: This research directly addresses one of the largest public health crises of our time, as alcohol kills more people than opioids and is associated with increased risk of suicide. If successful, this pilot may generate an intervention with far-reaching effects on adverse outcomes experienced by Veterans with unhealthy alcohol use, including increased access to care and suicide prevention. Trial registration Clinicaltrials.gov identifier: NCT04565899; Date of registration: 9/25/2020.

Role of pregaming motives in accounting for links between maladaptive personality traits and drinking consequences.

College students are at heightened risk of engaging in unhealthy alcohol use that leads to negative consequences (e.g., motor vehicle accidents, poor academic performance). Understanding how individual differences, such as maladaptive personality traits, contribute to that risk could improve intervention efforts. A potential pathway through which personality confers risk for consequences is by influencing students' motivation to drink. In this study of 441 college students, we investigated whether different motivations to pregame, a particularly risky and common drinking practice on college campuses, accounts for links between maladaptive traits and alcohol-related consequences. Results of bivariate analyses showed that all pregaming motives and maladaptive traits (except detachment) were strongly correlated with negative consequences. In path analytic models that adjusted for shared variance between pregaming motives and between maladaptive traits, results showed that traits had indirect effects on total drinking consequences via individual differences in pregaming motives as well as direct effects that were independent of motives. Specifically, antagonism, disinhibition, and negative affectivity predicted more drinking consequences via stronger motives to pregame for instrumental reasons over and above the general motivation to pregame, whereas detachment predicted fewer consequences via weaker instrumental pregaming motives. Antagonism and disinhibition were also associated with more drinking consequences, and detachment with fewer consequences, over and above pregaming motives and general personality problems. Our study indicates that one way maladaptive personality traits may shape alcohol-related consequences in college students is by associations with their motivations to pregame. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The influence of negative mood on solitary drinking preference: An experiment with young adult solitary drinkers.

Solitary drinking is a risk marker for alcohol use disorder; thus, it is important to identify why individuals drink alone and for whom this association is particularly relevant. Evidence suggests the desire to ameliorate negative affect (NA) motivates solitary drinking, with some individuals particularly likely to drink alone to cope, but all past studies are cross-sectional. The present study therefore aimed to determine whether 1) experimentally induced NA increased preferences to drink alcohol alone, and 2) whether the relationship between NA and choosing to drink alcohol alone was moderated by neuroticism, drinking to cope motives, and social anxiety. Current drinkers (ages 21-29) with a solitary drinking history (N=126) were randomly assigned to either NA, positive affect [PA], or no affect change (control) conditions via differing cognitive task feedback. After the mood manipulation, participants chose between drinking alcoholic or nonalcoholic beverages in one of two contexts: alone or socially. Evidence regarding effectiveness of the mood manipulation was mixed, and few chose non-alcoholic beverages in either context. Condition did not influence outcome choice. Across conditions, increases in NA and the importance placed on receiving one's context choice were associated with solitary (versus social) alcohol preference. Neuroticism and its interaction with NA change also influenced choice; individuals high in neuroticism chose more solitary (versus social) drinking contexts while the opposite was true for those low in neuroticism, and among the latter, the preference difference was more pronounced with relatively smaller NA increases. Findings are discussed based on the existing solitary drinking literature.

Moderators of Substance Use Disorder Treatment for Adolescents.

Objective: This brief review covers the current state of the literature on moderators of adolescent substance use disorder (SUD) treatment. These moderators provide information on "for whom" a specific treatment may work best.Method: We used Google Scholar, PubMed, PsycInfo, and manual search of relevant reference lists to identify eligible peer-reviewed publications from January 2005 to December 2019.Results: We summarize 21 published studies (including meta-analyses, randomized clinical trials, and correlational work) testing moderators and/or predictors of adolescent SUD treatment outcomes. Conclusions are, thus, limited by the relatively small number of studies. Results suggest that, for adolescents with co-occurring externalizing pathology or those higher in SUD severity, more intensive treatment appears to be more effective. Other findings were often inconsistent (e.g., examining sex or race/ethnicity as a moderator) between studies, making it challenging to provide clear recommendations for personalizing SUD treatment choice.Conclusions: Future research may need to shift focus from exploring often unchangeable moderators (e.g., race/ethnicity) to factors that are potentially modifiable with treatment. Additionally, testing models that include mediators of treatment effects-that is, factors that help to explain "how" treatment works-along with moderators (moderated-mediation) may provide the most benefit in understanding both "for whom" and "how" to tailor SUD treatment to optimally meet an adolescent's personal needs.

Drinking beyond the binge threshold in a clinical sample of adolescents.

BACKGROUND AND AIMS: Nearly all the research conducted on high-intensity drinking has focused on college and school-based samples, with recent calls for research to understand this risky drinking pattern in non-school-based samples and across time. This study aimed to characterize predictors and consequences of non-binge drinking, age- and gender-adjusted binge drinking (level I) and drinking at levels representing two or more times (level II) and three or more times the level I binge threshold (level III) in a clinical sample of adolescents followed into young adulthood. DESIGN: Cross-sectional associations between non-binge drinking, binge levels, and negative alcohol-related consequences were examined during adolescence; prospective analyses tested whether adolescent non-binge drinking and binge levels predicted alcohol use disorder (AUD) symptoms in young adulthood and whether changes in drinking motives over time were associated with binge levels in young adulthood. SETTING: US clinical settings. PARTICIPANTS: A total of 432 adolescents (aged 12-18 years) with alcohol-related problems followed into young adulthood (aged 19-25 years). MEASUREMENTS: Life-time drinking history, Structured Clinical Interview for DSM AUDs, and Inventory of Drinking Situations. FINDINGS: Results were generally consistent with a distinction between binge level I versus levels II-III on various negative alcohol-related consequences in adolescence (Ps < 0.05) that were maintained in young adulthood (Ps < 0.01). The maintenance of relatively high endorsement of enhancement and social motives over time was associated with binge levels II-III in young adulthood (Ps < 0.001); decreases in coping motives were associated with less risky drinking in adulthood (P = 0.003). CONCLUSIONS: Among US adolescents with alcohol-related problems who were followed-up in young adulthood (aged 19-25 years), standard threshold binge drinking (five or more drinks per occasion; level I) was generally associated with fewer alcohol-related consequences and problem behaviors than binge drinking at two or more times (level II) or three or more times (level III) the standard binge threshold.

The registration continuum in clinical science: A guide toward transparent practices.

Clinical scientists can use a continuum of registration efforts that vary in their disclosure and timing relative to data collection and analysis. Broadly speaking, registration benefits investigators by offering stronger, more powerful tests of theory with particular methods in tandem with better control of long-run false positive error rates. Registration helps clinical researchers in thinking through tensions between bandwidth and fidelity that surround recruiting participants, defining clinical phenotypes, handling comorbidity, treating missing data, and analyzing rich and complex data. In particular, registration helps record and justify the reasons behind specific study design decisions, though it also provides the opportunity to register entire decision trees with specific endpoints. Creating ever more faithful registrations and standard operating procedures may offer alternative methods of judging a clinical investigator's scientific skill and eminence because study registration increases the transparency of clinical researchers' work. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Predicting Engagement With Mental Health Peer Specialist Services.

OBJECTIVE: Peer specialists are individuals with behavioral disorders who complete training to use their experiences to help others with similar disorders. Recent analyses have suggested that greater engagement with peer specialist services is associated with fewer psychiatric symptoms. This study assessed predictors of engagement with peer specialist services. METHODS: Using the Andersen model of health service utilization with a sample of veterans (N=71) receiving housing support, investigators constructed a negative binomial regression model to evaluate the association between peer specialist service engagement and the model's three factors assessed at baseline of a larger trial: predisposing (personal demographic and social variables); enabling (support variables), and need (perceived and evaluated health problems). Demographic characteristics and behavioral health service use six months before baseline were also predictors. RESULTS: Greater hope (predisposing), psychiatric symptoms (need), and service utilization significantly predicted greater peer specialist engagement. CONCLUSIONS: These results suggest subpopulations with whom peer specialists would be most likely to engage successfully, perhaps improving their efficiency.

Investigating the Degree of Reliable Change Among Persons Assigned to Receive Mental Health Peer Specialist Services.

OBJECTIVE: Peer specialists are individuals with mental illness and substance use disorders trained to use their experiences to help others with similar disorders. Evidence for the effectiveness of peer specialist services has been mixed in previous randomized trials using intent-to-treat analyses, possibly because of variation in the intensity of treatment delivered. This study, which was part of a larger randomized trial, assessed whether level of peer specialist engagement was associated with reliable positive change on measures of psychiatric symptoms and hope. METHODS: The Reliable Change Index was used to compute whether veterans (N=140) achieved reliable positive change on standardized baseline-to-posttest assessments of psychiatric symptoms and hope. Logistic regression analyses were conducted to predict positive change in symptoms and hope by level of peer specialist engagement, with controls for relevant demographic factors, several baseline mental health and substance abuse measures, and service use during the study. RESULTS: Logistic regression models showed that veterans with higher peer specialist engagement were more likely than those in a control group to show reliable positive change in psychiatric symptoms but not in hope. Compared with the control group, those with lower peer specialist engagement did not show positive change on either measure. White veterans were less likely than those from minority groups to exhibit positive change in psychiatric symptoms. CONCLUSIONS: Results suggest that peer specialists can benefit those with mental illnesses and substance use disorders who engage in more frequent interactions. Studies are needed to further assess the circumstances under which peer specialists can be effective.

Alcohol screening and brief intervention in a representative sample of veterans receiving primary care services.

AIMS: Unhealthy alcohol use is common among adults, and in particular, Veterans. Routine alcohol screening followed by brief intervention is recommended and considered a prevention priority in primary care settings. While previous studies have found that Veterans enrolled in the Veteran's Health Administration (VA) receive high rates of screening and brief intervention, less than 50% of Veterans receive VA health care. No study has evaluated receipt of these services in a general sample of Veterans. Therefore, in a nationally-representative sample, we examine whether Veteran status was associated with receiving alcohol screening and brief intervention in primary care. METHODS: Using the Centers for Disease Control and Prevention's 2014 Behavioral Risk Factor Surveillance System data, we identified adults who endorsed visiting a doctor for routine checkup at least once in the past two years and responded to an optional module assessing alcohol-related care (N = 92,206; 14.1% Veterans). Multivariable logistic regression was used to assess the association between Veteran status and screening and brief intervention outcomes. We also evaluate differences in alcohol-related care across Veteran status stratified by gender. Models were adjusted for sociodemographic and clinical characteristics likely to confound the association. RESULTS: Overall, Veterans were more likely than non-Veterans to be screened for alcohol quantity and heavy episodic drinking (ps < 0.05), and more likely to endorse receiving brief intervention advice about alcohol's harmful effects (p < .001). Veteran status predicted an increased likelihood of being screened and receipt of advice about alcohol's harmful effects, but did not predict the likelihood of receiving advice to reduce or abstain from drinking (AOR = 1.00, 95% C.I. [0.80-1.26]). Analyses stratified by gender indicated a similar pattern of results for males as the overall sample. Results among females indicated Veteran status predicted the likelihood of being asked about heavy episodic drinking (AOR = 1.47, 95% C.I. [1.09-1.99]) and being offered advice about the harmful effects of alcohol (AOR = 1.62, 95% C.I. [1.06-2.48]). Female Veterans were not more likely than female non-Veterans to be advised to reduce and/or abstain from drinking. CONCLUSIONS: Screening about any alcohol use was common while report of screening for quantity and heavy episodic drinking occurrence and report of brief intervention were less common. Veterans were more likely than non-Veterans to report receiving recommended care, though rates of advice to reduce or abstain from drinking did not differ across groups. Persistent gaps in delivery of recommended alcohol-related care, especially for particularly vulnerable subpopulations such as women Veterans, suggest a need for quality improvement.