Factors Associated with Favorable Drinking Outcome 12Months After Hospitalization in a Prospective Cohort Study of Inpatients with Unhealthy Alcohol Use

BACKGROUND: Prevalence of unhealthy alcohol use among medical inpatients is high. OBJECTIVE: To characterize the course and outcomes of unhealthy alcohol use, and factors associated with these outcomes. DESIGN: Prospective cohort study. PARTICIPANTS: A total of 287 medical inpatients with unhealthy alcohol use. MAIN MEASURES: At baseline and 12months later, consumption and alcohol-related consequences were assessed. The outcome of interest was a favorable drinking outcome at 12months (abstinence or drinking "moderate” amounts without consequences). The independent variables evaluated included demographics, physical/sexual abuse, drug use, depressive symptoms, alcohol dependence, commitment to change (Taking Action), spending time with heavy-drinking friends and receipt of alcohol treatment (after hospitalization). Adjusted regression models were used to evaluate factors associated with a favorable outcome. KEY RESULTS: Thirty-three percent had a favorable drinking outcome 1 year later. Not spending time with heavy-drinking friends [adjusted odds ratio (AOR) 2.14, 95% CI: 1.14-4.00] and receipt of alcohol treatment [AOR (95% CI): 2.16(1.20-3.87)] were associated with a favorable outcome. Compared to the first quartile (lowest level) of Taking Action, subjects in the second, third and highest quartiles had higher odds of a favorable outcome [AOR (95% CI): 3.65 (1.47, 9.02), 3.39 (1.38, 8.31) and 6.76 (2.74, 16.67)]. CONCLUSIONS: Although most medical inpatients with unhealthy alcohol use continue drinking at-risk amounts and/or have alcohol-related consequences, one third are abstinent or drink "moderate” amounts without consequences 1 year later. Not spending time with heavy-drinking friends, receipt of alcohol treatment and commitment to change are associated with this favorable outcome. This can inform efforts to address unhealthy alcohol use among patients who often do not seek specialty treatmen

Mechanisms of action of brief alcohol interventions remain largely unknown - a narrative review.

A growing body of evidence has shown the efficacy of brief intervention (BI) for hazardous and harmful alcohol use in primary health care settings. Evidence for efficacy in other settings and effectiveness when implemented at larger scale are disappointing. Indeed, BI comprises varying content; exploring BI content and mechanisms of action may be a promising way to enhance efficacy and effectiveness. Medline and PsychInfo, as well as references of retrieved publications were searched for original research or review on active ingredients (components or mechanisms) of face-to-face BIs [and its subtypes, including brief advice and brief motivational interviewing (BMI)] for alcohol. Overall, BI active ingredients have been scarcely investigated, almost only within BMI, and mostly among patients in the emergency room, young adults, and US college students. This body of research has shown that personalized feedback may be an effective component; specific MI techniques showed mixed findings; decisional balance findings tended to suggest a potential detrimental effect; while change plan exercises, advice to reduce or stop drinking, presenting alternative change options, and moderation strategies are promising but need further study. Client change talk is a potential mediator of BMI effects; change in norm perceptions and enhanced discrepancy between current behavior and broader life goals and values have received preliminary support; readiness to change was only partially supported as a mediator; while enhanced awareness of drinking, perceived risks/benefits of alcohol use, alcohol treatment seeking, and self-efficacy were seldom studied and have as yet found no significant support as such. Research is obviously limited and has provided no clear and consistent evidence on the mechanisms of alcohol BI. How BI achieves the effects seen in randomized trials remains mostly unknown and should be investigated to inform the development of more effective interventions

Use of mobile devices to answer online surveys: implications for research

BACKGROUND There is a growing use of mobile devices to access the Internet. We examined whether participants who used a mobile device to access a brief online survey were quicker to respond to the survey but also, less likely to complete it than participants using a traditional web browser. FINDINGS Using data from a recently completed online intervention trial, we found that participants using mobile devices were quicker to access the survey but less likely to complete it compared to participants using a traditional web browser. More concerning, mobile device users were also less likely to respond to a request to complete a six week follow-up survey compared to those using traditional web browsers. CONCLUSIONS With roughly a third of participants using mobile devices to answer an online survey in this study, the impact of mobile device usage on survey completion rates is a concern. TRIAL REGISTRATION ClinicalTrials.gov: NCT01521078

Perception of the Amount of Drinking by Others in A Sample of 20-Year-Old Men: The More I Think You Drink, The More I Drink

Background: The amount a person drinks can be influenced by their perception of drinking by others. Aim: We studied whether perception of the amount of drinking by others (same age and sex) is associated with one's own current drinking, and the factors that are related to this perception. Methods: A random sample of drinkers (n=404) from a census of 20-year-old Swiss men (n=9686) estimated the percentage of others who drink more than they do. Using weekly alcohol consumption data of the census, we computed for each subject the percentage of individuals drinking more than they do. We compared the ‘perceived' to the ‘computed' percentage and classified the drinkers as overestimating or not drinking by others. We compared the alcohol consumption of those who overestimated drinking by others to those who did not, using analyses of variance/covariance. We used logistic regression models to evaluate the impact of age, education level, occupation, living environment and family history of alcohol problems on estimations of drinking by others. Results: Among the 404 drinkers, the mean (SD) number of drinks/week was 7.95(9.79); 45.5% overestimated drinking by others, while 35.2% underestimated it and 19.3% made an accurate estimation. The likelihood of overestimating increased as individual alcohol use increased. Those overestimating consumed more alcohol than those who did not; the adjusted mean number of drinks/week (SE) 11.45 (1.12) versus 4.50 (1.08), P<0.0001. Except for current drinking, no other variables were significantly associated with overestimating. Conclusion: This study confirms prior findings within selective student populations. It sets the stage for preventive actions, such as normative feedback based on social norms theor

Drinking Patterns and Their Predictive Factors in CONTROL: a 12-Month Prospective Study in a Sample of Alcohol-Dependent Patients Initiating Treatment

Aims: To describe the drinking patterns and their baseline predictive factors during a 12-month period after an initial evaluation for alcohol treatment. Methods CONTROL is a single-center, prospective, observational study evaluating consecutive alcohol-dependent patients. Using a curve clustering methodology based on a polynomial regression mixture model, we identified three clusters of patients with dominant alcohol use patterns described as mostly abstainers, mostly moderate drinkers and mostly heavy drinkers. Multinomial logistic regression analysis was used to identify baseline factors (socio-demographic, alcohol dependence consequences and related factors) predictive of belonging to each drinking cluster. ResultsThe sample included 143 alcohol-dependent adults (63.6% males), mean age 44.6 ± 11.8 years. The clustering method identified 47 (32.9%) mostly abstainers, 56 (39.2%) mostly moderate drinkers and 40 (28.0%) mostly heavy drinkers. Multivariate analyses indicated that mild or severe depression at baseline predicted belonging to the mostly moderate drinkers cluster during follow-up (relative risk ratio (RRR) 2.42, CI [1.02-5.73, P = 0.045] P = 0.045), while living alone (RRR 2.78, CI [1.03-7.50], P = 0.044) and reporting more alcohol-related consequences (RRR 1.03, CI [1.01-1.05], P = 0.004) predicted belonging to the mostly heavy drinkers cluster during follow-up. Conclusion In this sample, the drinking patterns of alcohol-dependent patients were predicted by baseline factors, i.e. depression, living alone or alcohol-related consequences and findings that may inform clinicians about the likely drinking patterns of their alcohol-dependent patient over the year following the initial evaluation for alcohol treatmen

Lights and Siren Transport and the Need for Hospital Intervention in Nontrauma Patients: A Prospective Study

The use of lights and siren transport (LST) has been a matter of debate because of the short time savings and well-established increased risks for Emergency Medical Services (EMS) and bystanders. Time-critical hospital intervention (TCHI) denotes urgently needed procedures that cannot be performed properly in an out-of-hospital setting. Since 2013, rapid transportation from the field, fast-track, is currently used for patients with acute ST-elevation myocardial infarction, suspicion of acute stroke and out-of-hospital cardiac arrest. The aim of this study was to determine whether the use of LST was associated with the realization of TCHI for nontrauma cases within 15 minutes of hospital arrival, to quantify overtriage (LST without TCHI) and to identify the predictors of TCHI. This is a monocentric prospective observational study of nontrauma patients transported by ambulance. Based on Ross et al.'s work in 2016 on trauma patients, TCHI procedures were developed by the study team. Descriptive statistics were used to determine whether the use of LST was associated with the realization of TCHI. Multivariable analyses determined the predictors of TCHI and compared clinical outcomes. On the 324 patients included, 67 (20.7%) benefitted from LST, with 40 (59.7%) receiving TCHI (p &lt; 0.001). The overtriage rate was 40.3%. The most common medical TCHI was the fast-track (65.2% of all TCHI). LST was predictive of the need for TCHI (p &lt; 0.001), as was the clinical condition of the patient and also when EMS providers expected TCHI. A majority of the LST benefitted from TCHI with an overtriage rate of 40%. To reduce the rate of overtriage (LST without TCHI), LST should mainly be used for fast-track and when TCHI is expected by the EMS providers

Interpretation of DSM-5 alcohol use disorder criteria in self-report surveys may change with age. A longitudinal analysis of young Swiss men

Background: General population surveys using self-reported measures show alcohol use disorder (AUD) to be most prevalent in young adulthood, but this may be due to misinterpretations of AUD criteria among inexperienced drinkers. The present study investigated changes in prevalence of criteria during emerging adulthood. Methods: 4924 young Swiss men were followed across three waves (age at wave 1 (w1): 20; w2: 21; w3: 25 years). We measured AUD according to the 11 DSM-5 criteria and estimated Item Response Theory models for each wave and differential item functioning across waves, related to the cohort growing older. Results: Endorsement of several AUD criteria varied considerably as a function of age in a period of only five years: Five criteria showed differential item functioning between waves 1 and 3 (i.e. between the age of 20 and 25), including the three most frequently endorsed criteria. Prevalence of tolerance (w1, 57.8%; w3, 29.6%) decreased in relation to the AUD score (Mantel–Haenszel OR = 0.26), whereas the use of alcohol larger/longer than intended (w1, 73.7%; w3, 84.8%; OR = 1.93) and hazardous use (w1, 62.7%; w3, 68.4%; OR = 1.31) increased, resulting in an unchanged mean AUD score and prevalence, but changing combinations of criteria to qualify AUD. Conclusions: Considerable differential item functioning over five years among several of the most endorsed AUD criteria suggests shifts in the interpretation of DSM-5 criteria during emerging adulthood. Self-reported measures of DSM-5 AUD criteria may require reformulation to account for young people’s different perceptions and to yield comparable diagnoses over time and across age groups

Who benefits from brief motivational intervention among young adults presenting to the emergency department with alcohol intoxication : A latent-class moderation analysis

Background: Research has not identified which patients optimally benefit from brief Motivational Interviewing (bMI) for heavy drinking when delivered to young adults in the Emergency Department (ED). Methods: We conducted secondary analyses of data from a randomized controlled trial in which 344 young adults (18–35 years) presenting to the ED with alcohol intoxication received either bMI or Brief Advice (BA, control group). We used Latent Class Analysis to derive participants' profiles from baseline characteristics (i.e., sex, age, severity of alcohol use disorder, attribution of ED admission to alcohol use, importance, and confidence to change, cognitive discrepancy, anxiety, depression, and trait reactance). We then conducted a moderation analysis to assess the number of heavy drinking days at short-term (1-month) and long-term (12-month) follow-up using negative binomial regressions with interactions between the intervention and derived classes. Results: Fit statistics indicated that a 4-class solution best fit the data. Class 3 (high severity, importance and discrepancy, and low confidence and anxiety) benefitted more from bMI than BA at short- and long-term follow-up than Class 1 (younger; lowest severity, importance, discrepancy, reactance, anxiety and depression, and highest confidence). Class 2 (older; highest severity, importance, discrepancy, reactance, anxiety and depression, and lowest confidence) also benefitted more from bMI than BA than did Class 1 at short-term follow-up. In these significant contrasts, Class 1 benefitted more from BA than bMI. There were no significant interactions involving Class 4 (more likely to be women; low severity; high levels of anxiety, depression, and reactance). Conclusions: This study identified the patient profiles that benefitted more from bMI than BA among nontreatment-seeking young adults who present intoxicated to the ED. The findings have implications for intervention design and argue for the importance of research aimed at developing intervention content tailored to patient profiles