Two to three brief training sessions can significantly increase pediatricians’ use of screening and brief interventions to help their patients with substance use and mental health problems, according to a large, 2-year trial supported by NIAAA. The study also found that pediatric practices can increase delivery of these services by adding behavioral health clinicians to their teams.
Mounting evidence supports the use of screening, brief intervention, and referral to treatment (SBIRT) in pediatric practices to reduce underage drinking and its harmful consequences. Pediatricians often report barriers to conducting SBIRT, however, including time constraints and a lack of training.
Researchers at Kaiser Permanente Northern California compared two practical ways to overcome these barriers and increase the delivery of SBIRT services in a trial involving about 50 pediatricians and 1,900 adolescents. One group of pediatricians was offered three 60-minute SBIRT training sessions then encouraged to conduct assessments and brief interventions when needed. A second group had one 60-minute training session, then was encouraged to assess and refer patients as needed for interventions by clinical psychologists “embedded” in their practices. For comparison, a third, “usual care” group had access to the same clinical guidelines and tools but no SBIRT training or psychologists in their practices.
The researchers found that, following SBIRT training, the pediatrician-only group was about 10 times more likely to conduct brief interventions with patients deemed at risk, compared with usual care pediatricians (16 percent for the trained group vs. 1.5 percent for usual care). In the pediatrician-plus-psychologist group, 24 percent of at-risk patients received brief interventions.
Although overall pediatrician attention to behavioral health concerns was still low following training, the researchers indicated that embedding behavioral health clinicians in primary care could be a cost-effective way to increase SBIRT delivery. Future analyses will examine patient outcomes and the cost-effectiveness of the two SBIRT delivery options.
Sterling, S.; Kline-Simon, A.H.; Satre, D.D.; Jones, A.; Mertens, J.; Wong, A.; and Weisner, C. Implementation of screening, brief intervention, and referral to treatment for adolescents in pediatric primary care: A cluster randomized trial. JAMA Pediatrics 169(11):e153145, 2015. PMID: 26523821
Reprinted from the NIAAA Spectrum, Volume 8, Issue 1, February 2016.
Adults drank more alcohol in 2012–2013 than they did in 2001–2002, according to the most recent National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). NESARC–III is a cross-sectional survey sponsored, designed, and directed by NIAAA and is the largest study ever conducted on the co-occurrence of alcohol use, drug use, and related psychiatric conditions.
To assess how drinking patterns have changed over time, researchers compared the NESARC–III data with that from Wave 1 NESARC. In both surveys, which had similar objectives and content areas, researchers assessed a large sample of U.S. adults through personal interviews conducted in participants’ homes. However, unlike Wave 1 NESARC, NESARC–III researchers collected saliva samples from participants for future DNA analyses.
Data analysis revealed that between 2001–2002 and 2012–2013, past-year drinking prevalence increased from 65.4 percent to 72.7 percent, and the prevalence of monthly binge drinking increased from 21.5 percent to 25.8 percent. Likewise, overall frequency of drinking increased from 83.5 days per year to 87.9 days per year. The authors of the study observed that these statistics, along with the increase in daily alcohol consumption (from 0.628 ounces to 0.751 ounces), indicate “a wetter drinking climate.”
One particularly striking finding was that African Americans experienced disproportionate increases in past-year drinking prevalence (from 53.2 percent to 66.1 percent) and past-month binge drinking prevalence (from 19 percent to 27.7 percent), as well as average daily volume (from 0.751 ounces to 1.033 ounces), compared with Caucasians. The authors suggest this may indicate disparities in treatment availability and/or treatment seeking.
Another notable finding was that percent increases in prevalence and overall drinking frequency were about twice as high for women as for men, prior to adjustment for sociodemographic differences. Adjusting for these differences, women demonstrated larger increases than men in all consumption measures. According to the authors, this finding may contribute to evidence of a closing gender gap in heavy drinking.
Looking ahead, scientists will continue to analyze the various waves of NESARC data to advance our understanding of drinking trends through comparison of survey results over time.
Dawson, D.A.; Goldstein, R.B.; Saha, T.D.; and Grant, B.F. Changes in alcohol consumption: United States, 2001-2002 to 2012-2013. Drug and Alcohol Dependence 148:56–61, 2015. PMID: 25620731
Reprinted from the NIAAA Spectrum, Volume 8, Issue 1, June 2016.
In a recent study, Cindy L. Ehlers, Ph.D., and colleagues examined the clinical course of alcohol use disorder (AUD)—as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5)—in a sample of young adult (ages 18–30) individuals of Mexican American (MA) and Native American (NA) descent.
Face-to-face interviews using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) were conducted with 619 MA and 510 NA community-based participants recruited in southwest California. Of the total sample of 1,129 participants, 634 (56 percent) met criteria for a lifetime diagnosis of DSM–5 AUD. Mild AUD was found in 22 percent of participants, moderate AUD in 14 percent, and severe AUD in 20 percent. Further data analysis revealed that 70 percent of the NA men, 64 percent of the NA women, 56 percent of the MA men, and 42 percent of the MA women met the lifetime diagnostic criteria for AUD.
The researchers examined the clinical course of AUD, as defined by order and progression of 36 alcohol-related life events, within their MA and NA young adult sample. A comparison of these alcohol-related life experiences and their order of occurrence over time was made between male and female and between MA and NA participants. NAs reported more alcohol-related life events and at an earlier age than MAs. Otherwise, a high degree of similarity in clinical course was found between men and women and between MA and NA individuals. The researchers also analyzed their data across severity of DSM–5 AUD disorder (mild, moderate, or severe). The high degree of similarity in the clinical course for moderate and severe AUD and across genders was not found for mild AUD. This information suggests that mild AUD may not be part of the same clinical continuum as moderate and severe AUD for NA and MA populations.
It should be noted that this study was limited by the specificity of the participant sample, which means the results may not be generalizable to the population as a whole. However, the findings are significant because they are informative for understanding health disparities in the groups studied and because they provide some early insights into the new DSM–5 mild, moderate, and severe AUD categories.
Ehlers, C.L.; Stouffer, G.M.; Corey, L.; and Gilder, D.A. The clinical course of DSM-5 alcohol use disorders in young adult native and Mexican Americans. American Journal of Addiction 24(8):713–721, 2015. PMID: 26346282
Reprinted from the NIAAA Spectrum, Volume 8, Issue 1, February 2016.
Witkiewitz, K.; McCallion, E.; Vowles, K.E.; Kirouac, M.; Frohe, T.; Maisto, S.A.; Hodgson, R.; Heather, N. Association between physical pain and alcohol treatment outcomes: The mediating role of negative affect. Journal of Consulting and Clinical Psychology 83(6)1044–1057, 2015. PMID: 2609837
Reprinted from the NIAAA Spectrum, Volume 8, Issue 2, June 2016.