Healthcare providers' perspectives on implementing a brief physical activity and diet intervention within a primary care smoking cessation program: a qualitative study.

BACKGROUND: Post-smoking-cessation weight gain can be a major barrier to quitting smoking; however, adding behavior change interventions for physical activity (PA) and diet may adversely affect smoking cessation outcomes. The "Picking up the PACE (Promoting and Accelerating Change through Empowerment)" study assessed change in PA, fruit/vegetable consumption, and smoking cessation by providing a clinical decision support system for healthcare providers to utilize at the intake appointment, and found no significant change in PA, fruits/vegetable consumption, or smoking cessation. The objective of this qualitative study was to explore the factors affecting the implementation of the intervention and contextualize the quantitative results. METHODS: Twenty-five semi-structured interviews were conducted with healthcare providers, using questions based on the National Implementation Research Network's Hexagon Tool. The data were analyzed using the framework's standard analysis approach. RESULTS: Most healthcare providers reported a need to address PA and fruit/vegetable consumption in patients trying to quit smoking, and several acknowledged that the intervention was a good fit since exercise and diet could improve smoking cessation outcomes. However, many healthcare providers mentioned the need to explain the fit to the patients. Social determinants of health (e.g., low income, food insecurity) were brought up as barriers to the implementation of the intervention by a majority of healthcare providers. Most healthcare providers recognized training as a facilitator to the implementation, but time was mentioned as a barrier by many of healthcare providers. Majority of healthcare providers mentioned allied health professionals (e.g., dieticians, physiotherapists) supported the implementation of the PACE intervention. However, most healthcare providers reported a need for individualized approach and adaptation of the intervention based on the patients' needs when implementing the intervention. The COVID-19 pandemic was found to impact the implementation of the PACE intervention based on the Hexagon Tool indicators. CONCLUSION: There appears to be a need to utilize a flexible approach when addressing PA and fruit/vegetable consumption within a smoking cessation program, based on the context of clinic, the patients' it is serving, and their life circumstances. Healthcare providers need support and external resources to implement this particular intervention. NAME OF THE REGISTRY: Clinicaltrials.gov. TRIAL REGISTRATION NUMBER: NCT04223336. DATE OF REGISTRATION: 7 January 2020 Retrospectively registered. URL OF TRIAL REGISTRY RECORD: https://classic. CLINICALTRIALS: gov/ct2/show/NCT04223336 .

AI Conversational Agent to Improve Varenicline Adherence: Protocol for a Mixed Methods Feasibility Study.

BACKGROUND: Varenicline is a pharmacological intervention for tobacco dependence that is safe and effective in facilitating smoking cessation. Enhanced adherence to varenicline augments the probability of prolonged smoking abstinence. However, research has shown that one-third of people who use varenicline are nonadherent by the second week. There is evidence showing that behavioral support helps with medication adherence. We have designed an artificial intelligence (AI) conversational agent or health bot, called "ChatV," based on evidence of what works as well as what varenicline is, that can provide these supports. ChatV is an evidence-based, patient- and health care provider-informed health bot to improve adherence to varenicline. ChatV has been programmed to provide medication reminders, answer questions about varenicline and smoking cessation, and track medication intake and the number of cigarettes. OBJECTIVE: This study aims to explore the feasibility of the ChatV health bot, to examine if it is used as intended, and to determine the appropriateness of proceeding with a randomized controlled trial. METHODS: We will conduct a mixed methods feasibility study where we will pilot-test ChatV with 40 participants. Participants will be provided with a standard 12-week varenicline regimen and access to ChatV. Passive data collection will include adoption measures (how often participants use the chatbot, what features they used, when did they use it, etc). In addition, participants will complete questionnaires (at 1, 4, 8, and 12 weeks) assessing self-reported smoking status and varenicline adherence, as well as questions regarding the acceptability, appropriateness, and usability of the chatbot, and participate in an interview assessing acceptability, appropriateness, fidelity, and adoption. We will use "stop, amend, and go" progression criteria for pilot studies to decide if a randomized controlled trial is a reasonable next step and what modifications are required. A health equity lens will be adopted during participant recruitment and data analysis to understand and address the differences in uptake and use of this digital health solution among diverse sociodemographic groups. The taxonomy of implementation outcomes will be used to assess feasibility, that is, acceptability, appropriateness, fidelity, adoption, and usability. In addition, medication adherence and smoking cessation will be measured to assess the preliminary treatment effect. Interview data will be analyzed using the framework analysis method. RESULTS: Participant enrollment for the study will begin in January 2024. CONCLUSIONS: By using predetermined progression criteria, the results of this preliminary study will inform the determination of whether to advance toward a larger randomized controlled trial to test the effectiveness of the health bot. Additionally, this study will explore the acceptability, appropriateness, fidelity, adoption, and usability of the health bot. These insights will be instrumental in refining the intervention and the health bot. TRIAL REGISTRATION: ClinicalTrials.gov NCT05997901; https://classic.clinicaltrials.gov/ct2/show/NCT05997901. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/53556.

Changes in self-reported cannabis use during the COVID-19 pandemic: a scoping review.

BACKGROUND: The COVID-19 pandemic is affecting mental health and substance use (MHSU) issues worldwide. The purpose of this study was to characterize the literature on changes in cannabis use during the pandemic and the factors associated with such changes. METHODS: We conducted a scoping review by searching peer-reviewed databases and grey literature from January 2020 to May 2022 using the Arksey and O'Malley Framework. Two independent reviewers screened a total of 4235 documents. We extracted data from 129 documents onto a data extraction form and collated results using content analytical techniques. RESULTS: Nearly half (48%) of the studies reported an increase/initiation of cannabis use, while 36% studies reported no change, and 16% reported a decrease/cessation of cannabis use during the pandemic. Factors associated with increased cannabis use included socio-demographic factors (e.g., younger age), health related factors (e.g., increased symptom burden), MHSU factors (e.g., anxiety, depression), pandemic-specific reactions (e.g., stress, boredom, social isolation), cannabis-related factors (e.g., dependence), and policy-related factors (e.g., legalization of medical/recreational cannabis). CONCLUSION: Public health emergencies like the COVID-19 pandemic have the potential to significantly impact cannabis use. The pandemic has placed urgency on improving coping mechanisms and supports that help populations adapt to major and sudden life changes. To better prepare health care systems for future pandemics, wide-reaching education on how pandemic-related change impacts cannabis use is needed.

Cocreation of a conversational agent to help patients adhere to their varenicline treatment: A study protocol.

Objective: Varenicline is the most efficacious approved smoking cessation medication, making it one of the most cost-effective clinical interventions for reducing tobacco-related morbidity and mortality. Adhering to varenicline is strongly associated with smoking cessation. Healthbots have the potential to help people adhere to their medications by scaling up evidence-based behavioral interventions. In this protocol, we outline how we will follow the UK's Medical Research Council's guidance to codesign a theory-informed, evidence-based, and patient-centered healthbot to help people adhere to varenicline. Methods: The study will utilize the Discover, Design and Build, and Test framework and will include three phases: (a) a rapid review and interviews with 20 patients and 20 healthcare providers to understand barriers and facilitators to varenicline adherence (Discover phase); (b) Wizard of Oz test to design the healthbot and get a sense of the questions that chatbot has to be able to answer (Design phase); and (c) building, training, and beta-testing the healthbot (Building and Testing phases) where the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability framework will be used to develop the healthbot using the simplest sensible solution, and 20 participants will beta test the healthbot. We will use the Capability, Opportunity, Motivation-Behavior (COM-B) model of behavior change and its associated framework, the Theoretical Domains Framework, to organize the findings. Conclusions: The present approach will enable us to systematically identify the most appropriate features for the healthbot based on a well-established behavioral theory, the latest scientific evidence, and end users' and healthcare providers' knowledge.

Healthcare practitioner perceptions on barriers impacting cannabis prescribing practices.

BACKGROUND: Canadians seeking medical cannabis (MC) may encounter difficulties in finding a healthcare provider (HCP) who authorizes their access to it. Barriers that HCPs face in authorizing MC are unclear. The objectives of this study were to evaluate HCP opinions, knowledge, comfort, and practice in MC prescribing and counseling on recreational cannabis use, and whether the COVID-19 pandemic affected MC prescribing practices. METHODS: Eligible participants included HCPs (e.g., attending physicians, nurses, pharmacists) in Canada. A questionnaire evaluating their knowledge, comfort, and practice in medical and recreational cannabis was designed based on instruments developed in previous studies. Between April 13th-December 13th 2021, ninety-one healthcare associations were asked to distribute the survey to their members, and an advertisement was placed in the online Canadian Medical Association Journal. Descriptive statistics were used to analyze the results. RESULTS: Twenty-four organizations agreed to disseminate the survey and 70 individuals completed it. Of respondents, 71% were attending physicians or medical residents, while the remainder were nurses, pharmacists or other HCPs. Almost none (6%) received training in MC in professional school but 60% did receive other training (e.g., workshops, conferences). Over half (57%) received more questions regarding MC since recreational cannabis was legalized, and 82% reported having patients who use MC. However, 56% felt uncomfortable or ambivalent regarding their knowledge of MC, and 27% were unfamiliar with the requirements for obtaining MC in Canada. The most common symptoms for recommending MC were pain and nausea, whereas the most common conditions for recommending it were cancer and intractable pain. The strongest barrier to authorizing MC was uncertainty in safe and effective dosage and routes of administration. The strongest barrier to recommending or authorizing MC was the lack of research evidence demonstrating its safety and efficacy. During the pandemic, many respondents reported that a greater number of their patients used cannabis to relieve anxiety and depression. CONCLUSIONS: Our results suggest that HCPs across Canada who responded to our survey are unfamiliar with topics related to MC. The strongest barriers appear to be lack of clinical research, and uncertainty in safe and effective MC administration. Increasing research, training, and knowledge may help HCPs feel more equipped to make informed treatment/prescribing decisions, which may help to improve access to MC.

Youth Perspectives on Seeking Psychotherapy: A Concurrent Mixed Methods Study.

OBJECTIVE: Psychotherapy is the recommended first line of treatment for depression among youth; however, few youth seek professional support. This study compares barriers and facilitators to seeking psychotherapy among both youth who have and have not seen a psychotherapist. The study further explores reasons youth discontinue psychotherapy. METHODS: A concurrent mixed methods study design was used. Eligible participants completed a survey (N=104) and a subset of participants completed a semi-structured interview (N=60). The survey and interview data were analyzed concurrently using a triangulation design. RESULTS: Surveys were conducted among youth who had experienced psychotherapy (N=53) and youth who had not (N=51). The majority of participants were female. Common reasons for not seeking psychotherapy included wanting to handle their problems on their own (87.6%), thinking their problems would improve on its own (87.6%), and not knowing who to see (74.3%). Several barriers were common across the two groups, including stigma, concerns about the therapeutic relationship, and a preference for self-management. Common facilitators included improving coping skills and addressing functional impairment. There was some overlap between the barriers to seeking psychotherapy and the reasons for discontinuing, although aging out of youth-oriented service also constituted a termination factor. CONCLUSIONS: : As this study highlights the multiple factors that influence youth's psychotherapy-seeking behavior, a widespread, multi-level approach is needed to address barriers and facilitators at the individual level, but also at the community, policy, and organizational levels. Strategies such as increasing service availability and quality are needed to increase service seeking and improve retention.

OBJECTIF: La psychothérapie est le traitement de première intention recommandé pour la dépression chez les jeunes, toutefois, peu de jeunes recherchent un soutien professionnel. La présente étude compare ce qui fait obstacle et ce qui facilite la recherche de psychothérapie chez les jeunes qui ont vu ou pas un psychothérapeute. L'étude explore en outre les raisons pour lesquelles les jeunes cessent la psychothérapie. MÉTHODES: Une étude concomitante à méthodes mixtes a été utilisée. Les participants admissibles ont rempli un sondage (N = 104) et un sous-ensemble de participants a répondu à une entrevue semi-structurée (N = 60). Les données du sondage et de l'entrevue ont été analysées simultanément à l'aide d'une méthode de triangulation. RÉSULTATS: Les sondages ont été menés auprès des jeunes qui avaient l'expérience de la psychothérapie (N = 53) et des jeunes qui ne l'avaient pas (N = 51). La majorité des participants était de sexe féminin. Les raisons communes de ne pas rechercher la psychothérapie étaient notamment vouloir régler leurs problèmes par eux-mêmes (87,6 %), croire que leurs problèmes allaient se régler d'eux-mêmes (87,6 %), et ne pas savoir qui consulter (74,3 %). Plusieurs obstacles étaient partagés par les deux groupes, dont les stigmates, des préoccupations quant à la relation thérapeutique, et une préférence pour la gestion autonome. Ce qui facilitait communément était notamment améliorer les compétences d'adaptation et remédier à la déficience fonctionnelle. Il y avait un chevauchement entre les obstacles à la recherche de psychothérapie et les raisons d'y mettre fin bien que le fait de vieillir hors de la zone des services pour les jeunes constitue un facteur d'abandon. CONCLUSIONS: Comme cette étude mentionne les multiples facteurs qui influencent la recherche de thérapie chez les jeunes, il faut une approche étendue multi-niveaux pour aborder obstacles et facilitateurs au niveau individuel, mais aussi à l'échelle communautaire, politique et organisationnelle. Des stratégies comme accroître la disponibilité et la qualité des services sont nécessaires pour hausser la recherche des services et améliorer le maintien en place.

Teaching About Partnerships Between Patients and the Team: Exploring Student Perceptions.

Health profession educators are responding to shifting approaches where patients are increasingly recognized as partners in an interprofessional care process. To foster competencies related to partnerships between patients and the team, educators have advanced the role of patient partners; however, an appreciation of resulting student learning is in its early stages. First-year students from 9 programs interacted with patient partners and participated in a Reader's Theater that explored partnerships with patients in an interprofessional team. Students completed reflective assignments; an inductive thematic analysis explored student learning. The following 4 overarching themes were recognized: developing insights through patient perspective, promoting partnerships with patients, recognizing attitudes that promote therapeutic relationships, and advocating for the patient to be a team member. Accompanying subthemes provide enhancement of each of the identified themes. Students discussed the effect of poor collaboration, identified attitudes that promote collaboration, and expressed the value of advocacy for patient partnership. An enriched appreciation of student learning will guide educator engagement of patient partners in both health professional and interprofessional curricula.

From Planning to Implementation of the YouthCan IMPACT Project: a Formative Evaluation.

In order to improve the youth mental health system, there is an international movement toward developing community-based service hubs that provide integrated, collaborative care to youth. However, the implementation of multisystem collaboration is complex and can be hampered by barriers. This paper presents a formative evaluation of the YouthCan IMPACT integrated youth services project based on the Consolidated Framework for Implementation Research (CFIR), to identify facilitators and barriers to successful implementation. Results highlight that previous positive working relationships along with collaborative investment of resources from partnering organizations are essential to implement an integrated youth service model. In addition, it is important that representative members of all key stakeholder groups, including staff, youth, and caregivers, be involved in the development and execution of the project to ensure effective implementation. Attention to the facilitators and barriers to implementation may help teams seeking to implement highly collaborative, integrated models of service delivery for youth in the community.

Service provision for depressed children and youth: a survey of the scope and nature of services in Ontario.

BACKGROUND: The worldwide prevalence of depressive disorders among children and youth has been reported in ranges from just under 3% to over 10%. In Canada, 7% of youth report past year depression, which is higher than any other age demographic. Yet, many of these youth do not receive evidence based interventions, increasing their risk for serious lifetime consequences. To better understand low service use, it is crucial to map and evaluate current services. This study aimed to determine the scope and nature of services available to depressed children and youth, and compare services to best evidence treatment guidelines. METHODS: Several government and non-government resources were utilized to develop a new multi-sectoral database of depression services for children and youth across Ontario. An online survey was sent to program managers serving children/youth with depression, examining agency characteristics, populations served, services provided, patterns of service use, evaluation activities, and research priorities. RESULTS: 413 agencies with 869 program managers participated, representing mental health, addictions and other sectors. Age groups served included children up to 12 years of age (31%), adolescents aged 13-17 (70%) and transition aged youth (18-25 years) (81%). Over half of respondents worked in the mental health (43.4%) or mental health and addiction (24.4%) sectors. The most frequently provided services were assessment, psychotherapy, case management, and psychoeducation; the most common types of psychotherapy provided included cognitive behavioral therapy, social skills training, and solution-focused therapy. Psychotherapies are offered in widely varying formats, frequencies and durations. Discontinuation rates varied, with higher discontinuation among transition aged youth as compared to children. Respondents identified effective treatment, improving access, and reducing service gaps as top future research priorities. CONCLUSIONS: This study provides important new data on service provision and uptake for depressed children and youth. Comparing these results with best-evidence practice guidelines raises significant concerns about the services most commonly offered and their delivery formats. In addition, high early discontinuation rates raise questions about the service experiences of children, youth and their families. Other factors which may contribute to ongoing treatment engagement challenges include access barriers, service or client characteristics, and unintentional treatment impacts.

Key attributes of integrated community-based youth service hubs for mental health: a scoping review.

BACKGROUND: Community-based, integrated youth service hubs have the potential to address some of the longstanding issues with mental health services for youth, including problems with access and system fragmentation. Better understanding of these approaches, particularly efforts to create a single point of entry to comprehensive, evidence-based services through youth service hubs, is needed to help guide future implementation and evaluation. This scoping review identifies the key principles and characteristics of these models of care, as well as the state of the literature, particularly with regard to implementation and replicability. METHOD: Electronic databases and grey literature sources were searched for material from 2001 to 2019, with diverse search terms capturing the concept of "integrated" or "one-stop shop" youth mental health services. Title/abstract and full text review were conducted, as well as additional focused searching. After screening 4891 texts at the title/abstract level and 496 at the full-text level, 110 documents were included for data extraction. RESULTS: Several integrated care hub models for youth mental health services and related frameworks were identified internationally, largely in high-income countries. Common principles included an emphasis on rapid access to care and early intervention, youth and family engagement, youth-friendly settings and services, evidence-informed approaches, and partnerships and collaboration. Program characteristics also revealed similarities (e.g., providing evidence-informed or evidence-based services in youth-friendly spaces), with some differences (e.g., care coordination methods, types of service providers), potentially attributable to lack of available information about key ingredients. Outcome research was limited, with few rigorous evaluations of youth outcomes. Moreover, sufficient information for replication, community evaluation of feasibility or actual implementation was rarely provided. CONCLUSION: Internationally, integrated youth service hubs were found to share common key principles, while providing comprehensive services to youth with mental health difficulties. There is a great need for common language and measurement framework to facilitate replication, rigorous evaluation of outcomes, knowledge exchange, and dissemination of findings.

What makes mental health and substance use services youth friendly? A scoping review of literature.

BACKGROUND: There are increasing calls to make mental health and substance use services youth friendly, with hopes of improving service uptake, engagement and satisfaction. However, youth-friendliness in this area has not been clearly defined and there is a lack of information about the characteristics that make such services youth friendly. The purpose of this scoping review was to examine the literature available on youth-friendly mental health and substance use services in order to identify the characteristics, outline the expected impacts, and establish a definition. METHODS: A scoping review of seven databases and grey literature sources was conducted. Twenty-eight documents were retained as relevant to the research questions. Relevant data from these documents was extracted, analyzed and presented to stakeholders, including youth, caregivers and service providers to validate and refine the results. RESULTS: Youth-friendly mental health and substance use services include integrated, inclusive, confidential and safe organization and policy characteristics; bright, comfortable, environment with informational materials; welcoming and genuine service providers with appropriate communication and counselling skills; an accessible location; minimal wait times; and individualized and innovative approaches. All areas in which youth friendliness should be implemented in a mental health and substance use service organization had a core value of youth voice. CONCLUSION: Improving the youth friendliness of mental health and substance use services includes incorporating youth voice in organization, policy, environment, service providers, and treatment services, and has implications for treatment uptake, engagement and satisfaction. Further research is required to determine the impact of youth friendliness in such services.

Social Determinants of Health among Youth Seeking Substance Use and Mental Health Treatment.

OBJECTIVE: The extent to which social determinants of health problems occur among youth with mental health and addiction concerns and the impact of social determinants on their treatment is unknown. This study examined the prevalence of social determinants of health problems among treatment-seeking youth, their perceptions of interference with treatment, and the association between social determinants of health and mental health/addiction difficulties. METHOD: Youth ages 15-24 seeking out-patient treatment for substance use concerns, with or without concurrent mental health concerns, reported on substance use, mental health and social determinants of health. Descriptive statistics and logistic regression analyses were used to determine the extent of social determinant of health problems and their relationship with mental health, substance use, and crime or violence problems. RESULTS: In all, 80% of youth endorsed social determinants of health concerns in at least one domain; nearly 70% identified financial concerns, and many identified substantial problems in each domain and anticipated treatment impacts. Youth most frequently identified financial problems as likely to impact treatment. Cumulative number of social determinants of health problems and individual domains of social determinants of health problems were related to overall mental health and addiction concerns. CONCLUSIONS: Given their prevalence and association with mental health and addiction concerns, social determinants of health problems should be routinely assessed among treatment-seeking youth and integrative services that address these concerns in addition to symptomatology should be considered.

OBJECTIF: La mesure dans laquelle les déterminants sociaux des problèmes de santé sont présents chez les jeunes ayant des problèmes de santé mentale et de dépendance ainsi que l'impact des déterminants sociaux sur leur traitement sont inconnus. Cette étude a examiné la prévalence des déterminants sociaux des problèmes de santé chez les jeunes recherchant un traitement, leurs perceptions de l'interférence avec le traitement, et l'association entre les déterminants sociaux de la santé et les difficultés de santé mentale/dépendance. MÉTHODE: Des jeunes de 15 à 24 ans cherchant un traitement ambulatoire pour des problèmes d'utilisation de substances, avec ou sans problèmes de santé mentale co-occurrents, ont rapporté leur utilisation de substances, leur santé mentale et les déterminants sociaux de la santé. Des statistiques descriptives et des analyses de régression logistique ont servi à déterminer la portée des déterminants sociaux des problèmes de santé et leur relation avec les problèmes de santé mentale, d'utilisation de substances, et de criminalité ou de violence. RÉSULTATS: En tout, 80 % des jeunes ont reconnu l'action des déterminants sociaux des problèmes de santé dans au moins un domaine; près de 70 % ont identifié les ennuis financiers, et beaucoup ont identifié des problèmes substantiels dans chaque domaine et anticipé les impacts sur le traitement. Les jeunes estimaient très fréquemment que les problèmes financiers étaient susceptibles d'avoir un impact sur le traitement. Le nombre cumulatif de déterminants sociaux des problèmes de santé et les domaines individuels des déterminants sociaux des problèmes de santé étaient liés aux problèmes généraux de santé mentale et de dépendance. CONCLUSIONS: Étant donné leur prévalence et leur association aux problèmes de santé mentale et de dépendance, les déterminants sociaux des problèmes de santé devraient être régulièrement évalués chez les jeunes recherchant un traitement et des services intégratifs qui s'attaquent à ces problèmes en plus de la symptomatologie devaient être envisagés.

Evaluating moderators of beneficial effects of severity-based assignment to substance use treatments in impaired drivers.

Remedial programs for impaired driving offenders have proved valuable in reducing subsequent alcohol and other drug use and preventing recidivism in this population. Many of these programs are based on a severity-based assignment scheme, where individuals assessed to have greater problems or be at higher risk are assigned to longer, more intensive interventions. Recent research, using regression discontinuity analyses, provided support for severity-based assignment schemes in demonstrating that those with higher problem or risk levels assigned to longer and more intensive programming showed a significant reduction in drinking days over a follow-up interval, attributable to program assignment. Regression discontinuity analyses can also be used to assess moderators of this assignment benefit. We report an assessment of the impact of eight potential moderators of assignment benefit, derived from a factor analysis of the Research on Addictions Self-Inventory screening instrument. Five of the eight factors were found to moderate the assignment benefit: Negative Affect, Sensation Seeking, High Risk Lifestyle, Alcohol Problems, and Family History. The significance of these results for developing more effective program assignment procedures is discussed.

Multiple "Lower BAC" offenders: Characteristics and response to remedial interventions.

BACKGROUND: In recent years, there has been increasing attention to "lower BAC" drinking drivers, typically those whose blood alcohol content (BAC) is under the legal limits defined in criminal law. In 2009, legislation was enacted in Ontario, Canada that enabled police to issue roadside license suspensions to individuals caught driving with BAC between 0.05% and 0.08%, known as the "warn range". Multiple warn range (MWR) offenders are required to attend the Back on Track (BOT) remedial measures program. This study aimed to provide: (1) a preliminary characterization of MWR drivers charged under warn range legislation; and (2) an initial assessment of outcomes associated with BOT participation among MWR offenders. METHODS: A subsample of 727 MWR offenders was drawn from program records, and compared to samples of 3597 first-time Criminal Code (CC) offenders (those caught driving with a BAC of 0.08% or higher) and 359 second-time CC offenders. To provide an initial assessment of outcomes associated with BOT participation, another subsample consisted of 394 MWR participants from whom pre- and post-workshop questionnaires were collected and successfully matched using probabilistic matching processes. RESULTS: Similarities in demographic profile and driving history between MWR and first-time CC participants were apparent. MWR offenders scored higher on risk of problem drinking and drink-driving recidivism than either of the CC offender groups. Second-time CC offenders scored higher on these measures than first-time CC offenders. Following BOT participation, MWR participants demonstrated positive change including improved knowledge of and intentions to avoid drink-driving. CONCLUSIONS: MWR offenders share a similar demographic profile to that of first-time CC offenders and they report significantly higher risk of problem drinking and recidivism. MWR offenders may include high-functioning problem drinkers who are likely to continue drink-driving and who may escalate to a CC drink-driving offense. Like CC offenders, MWR offenders benefited from BOT participation.