Brief alcohol interventions: Do counsellors' and patients' communication characteristics predict change?

Aims: To identify communication characteristics of patients and counsellors during brief alcohol intervention (BAI) which predict changes in alcohol consumption 12 months later. Methods: Tape-recordings of 97 BAI sessions with hazardous drinkers were analysed using the Motivational Interviewing Skill Code (MISC). Outcome measures were (i) baseline to a 12-month difference in the weekly drinking quantity, and (ii) baseline to a 12-month difference in heavy drinking episodes per month. Bivariate analyses were conducted for all MISC measures, and significant variables were included in multiple linear regression models. Results: Patient communication characteristics (ability to change) during BAI significantly predicted the weekly drinking quantity in the multiple linear regression model. There were significant differences for some of the counsellor skills in bivariate analyses but not in the multiple regression model adjusting for patients' talk characteristics. Changes in heavy drinking showed no significant association with patient or counsellor skills in the multiple linear regression model. Conclusion: Findings indicate that the more the patient expresses ability to change during the intervention, the more weekly alcohol use decreases. The role of the counsellor during the interaction, and influence on the outcomes was not clearly established. Implications for BAI and related research are discusse

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

Who Drinks Most of the Total Alcohol in Young Men—Risky Single Occasion Drinking as Normative Behaviour

Aims: The objectives of this study were to analyse (a) the distribution of risky single-occasion drinking (RSOD) among 19-year-old men in Switzerland and (b) to show the percentage of all alcohol consumption in the form of RSOD. Methods: The study was based on a census of Swiss francophone 19-year-old men consecutively reporting for processing. The study was conducted at Army Recruitment Center. The participants were 4116 recruits consecutively enrolling for mandatory army recruitment procedures between 23 January and 29 August in 2007. The measures were alcohol consumption measured in drinks of ∼10 g of pure alcohol, number of drinking occasions with six or more drinks (RSOD) in the past 12 months and a retrospective 1 week drinking diary. Results: 264 recruits were never seen by the research staff, 3536 of the remaining 3852 conscripts completed a questionnaire which showed that 7.2% abstained from alcohol and 75.5% of those drinking had an RSOD day at least monthly. The typical frequency of drinking was 1-3 days per week on weekends. The average quantity on weekends was about seven drinks, 69.3% of the total weekly consumption was in the form of RSOD days, and of all the alcohol consumed, 96.2% was by drinkers who had RSOD days at least once a month. Conclusion: Among young men, RSOD constitutes the norm. Prevention consequently must address the total population and not only high-risk drinker

A Health Behaviour Cross-Sectional Study of Immigrants and Non-immigrants in a Swiss Urban General-Practice Setting

Background Little is known about smoking, unhealthy use of alcohol, and risk behaviours for sexually transmitted diseases (STDs) in immigrants from developed and developing countries. Method We performed a cross-sectional study of 400 patients who consulted an academic emergency care centre at a Swiss university hospital. The odds ratios for having one or more risk behaviours were adjusted for age, gender, and education level. Results Immigrants from developing countries were less likely to use alcohol in an unhealthy manner (OR=0.35, 95% CI 0.22-0.57) or practise risk behaviours for STDs (OR=0.31, 95% CI 0.13-0.74). They were also less likely to have any of the three studied risk behaviours (OR=2.5, 95% CI 1.5-4.3). Discussion In addition to the usual determinants, health behaviours are also associated with origin; distinguishing between immigrants from developing and developed countries is useful in clinical settings. Surprisingly, patients from developing countries tend to possess several protective characteristic

The Economic Burden of Alcohol Dependence in Europe

Aims: To determine the economic burden pertaining to alcohol dependence in Europe. Methods: Database searching was combined with grey literature searching to identify costs and resource use in Europe relating to alcohol dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or the World Health Organisation's International Classification of Diseases (ICD-10). Searches combined MeSH headings for both economic terms and terms pertaining to alcohol dependence. Relevant outcomes included direct healthcare costs and indirect societal costs. Main resource use outcomes included hospitalization and drug costs. Results: Compared with the number of studies of the burden of alcohol use disorders in general, relatively few focussed specifically on alcohol dependence. Twenty-two studies of variable quality were eligible for inclusion. The direct costs of alcohol dependence in Europe were substantial, the treatment costs for a single alcohol-dependent patient lying within the range €1591-€7702 per hospitalization and the annual total direct costs accounting for 0.04-0.31% of an individual country's gross domestic product (GDP). These costs were driven primarily by hospitalization; in contrast, the annual drug costs for alcohol dependence were low. The indirect costs were more substantial than the direct costs, accounting for up to 0.64% of GDP per country annually. Alcohol dependence may be more costly in terms of health costs per patient than alcohol abuse. Conclusions: This review confirms that alcohol dependence represents a significant burden for European healthcare systems and society. Difficulties in comparing across cost-of-illness studies in this disease area, however, prevent specific estimation of the economic burde

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

Non-medical prescription drug and illicit street drug use among young Swiss men and associated mental health issues

Non-medical use of prescription drugs (NMUPD) is increasing among the general population, particularly among teenagers and young adults. Although prescription drugs are considered safer than illicit street drugs, NMUPD can lead to detrimental consequences. The aim of the present study was to investigate the relationship between drug use (NMUPD on the one side, illicit street drugs on the other side) with mental health issues and then compare these associations. A representative sample of 5719 young Swiss men aged around 20 years filled in a questionnaire as part of the ongoing baseline Cohort Study on Substance Use Risk Factors (C-SURF). Drug use (16 illicit street drugs and 5 NMUPDs, including sleeping pills, sedatives, pain killers, antidepressants, stimulants) and mental health issues (depression, SF12) were assessed. Simple and multiple linear regressions were employed. In simple regressions, all illicit and prescription drugs were associated with poorer mental health. In multiple regressions, most of the NMUPDs, except for stimulants, were significantly associated with poorer mental health and with depression. On the contrary, the only associations that remained significant between illicit street drugs and mental health involved cannabis. NMUPD is of growing concern not only because of its increasing occurrence, but also because of its association with depression and mental health problems, which is stronger than the association observed between these problems and illicit street drug use, excepted for cannabis. Therefore, NMUPD must be considered in screening for substance use prevention purpose

Concurrent and simultaneous polydrug use among young Swiss males: use patterns and associations of number of substances used with health issues

Background: Simultaneous polydrug use (SPU) may represent a greater incremental risk factor for human health than concurrent polydrug use (CPU). However, few studies have examined these patterns of use in relation to health issues, particularly with regard to the number of drugs used. Methods: In the present study, we have analyzed data from a representative sample of 5734 young Swiss males from the Cohort Study on Substance Use Risk Factors. Exposure to drugs (i.e., alcohol, tobacco, cannabis, and 15 other illicit drugs), as well as mental, social and physical factors, were studied through regression analysis. Results: We found that individuals engaging in CPU and SPU followed the known stages of drug use, involving initial experiences with licit drugs (e.g., alcohol and tobacco), followed by use of cannabis and then other illicit drugs. In this regard, two classes of illicit drugs were identified, including first uppers, hallucinogens and sniffed drugs; and then "harder” drugs (ketamine, heroin, and crystal meth), which were only consumed by polydrug users who were already taking numerous drugs. Moreover, we observed an association between the number of drugs used simultaneously and social issues (i.e., social consequences and aggressiveness). In fact, the more often the participants simultaneously used substances, the more likely they were to experience social problems. In contrast, we did not find any relationship between SPU and depression, anxiety, health consequences, or health. Conclusions: We identified some associations with SPU that were independent of CPU. Moreover, we found that the number of concurrently used drugs can be a strong factor associated with mental and physical health, although their simultaneous use may not significantly contribute to this association. Finally, the negative effects related to the use of one substance might be counteracted by the use of an additional substanc