Effects of brief counselling among male heavy drinkers identified on general hospital wards

Although the prevalence of heavy alcohol consumption among patients of general hospitals is well documented, no study has yet reported an effect of counselling on the ward in reducing the level of consumption among such patients after discharge. This study was designed to evaluate brief counselling to reduce alcohol consumption among male heavy drinkers identified on general hospital wards. Male patients were screened on wards of four teaching hospitals in Sydney, Australia. Identified heavy drinkers (n = 174) showing predominantly low levels of alcohol dependence were allocated to one of two forms of brief counselling (skills-based counselling or brief motivational interviewing) or to a non-intervention control group. Blind follow-up for 123 patients (71%) was carried out approximately 6 months after discharge from hospital and self-reports of alcohol consumption were compared with collateral sources of information. Patients who received counselling showed a significantly greater mean reduction in a quantity-frequency measure of weekly alcohol consumption than controls but there were no significant differences in reduced consumption between the two intervention groups. However, patients who were deemed “not ready to change” showed greater reductions if they had received brief motivational interviewing than if they had received skills-based counselling. The implications of these findings for counselling male in-patients to reduce alcohol consumption are discussed.     

Predictors of motivation to change alcohol use among referred college students

The current study investigated motivation and its relationship with alcohol use and life satisfaction. Participants were 49 undergraduates referred to a university-based clinic to participate in a brief alcohol intervention. All participants completed measures assessing readiness to change drinking, frequency of alcohol use and related problems, and life satisfaction. As hypothesized, higher levels of motivation to change drinking were related to higher frequency and quantity of alcohol use, alcohol-related problems, and lower levels of life satisfaction. Results indicate the importance of assessing motivation in students referred to receive alcohol interventions.     

Alcohol dependent inpatients who receive general hospital care vs. detoxification in psychiatric care and alcohol problem 1 year later

Aim

The aims were to investigate differences between alcohol dependent inpatients who seek alcohol treatment and those who do not seek alcohol specific but general hospital treatment, and to investigate problem drinking 12 months after hospitalization.

Methods

Two samples of alcohol dependent inpatients were recruited: N = 571 at general hospitals and N = 473 at psychiatric alcohol detoxification units, and were followed-up 12 months later.

Results

Multivariate logistic regression analyses revealed that higher age, living alone, being employed, previous help-seeking, increased severity of dependence, increased adverse consequences from drinking and increased motivation were significant predictors of receiving alcohol detoxification vs. general hospital treatment. A composite assessment of motivation to change and to seek help was the strongest predictor of positive outcome 12 months later.

Conclusions

Alcohol dependent individuals who receive detoxification in psychiatric care have a more severe alcohol problem and fewer social resources than those treated in general hospitals. Interventions targeting at enhancing motivation to change and to seek help should be part of routine general hospital care and of detoxification treatment in psychiatric care.     

Communication during brief intervention, intention to change, and outcome.

OBJECTIVES: To explore the relationship between patient's intention to change regarding future alcohol consumption following brief alcohol intervention (BAI) and changes in alcohol consumption 12-months later and the communication characteristics between patient and counselor during BAI. DESIGN, SETTING AND SUBJECTS: Data from 367 patients (experimental arm) of a pragmatic randomized controlled trial were used to assess the effectiveness of BAI among hazardous drinkers attending an Emergency Department (Lausanne University Hospital, Lausanne, Switzerland). Alcohol outcome measures at baseline and 12 months follow-up included usual number of drinks per week, monthly frequency of heavy episodic drinking (5 or more standard drinks for men; 4 or more for women), and the Alcohol Use Disorders Identification Test (AUDIT) score. In addition, the communication characteristics between patient and counselor were analyzed via tape recordings using the Motivational Interviewing Skill Code (MISC) from 97 participants. Patient readiness and importance to change on a 10-point Likert scale (readiness/importance to change ruler) was asked during BAI, and patient intention to change alcohol consumption (yes/no) was asked at the last step. Differences in alcohol outcome at follow-up between the 367 patients who did or did not have an intention to change consumption at baseline were compared, as were differences between these two groups in communication characteristics for the 97 who completed tape recordings. RESULTS: Patients with an intention to decrease alcohol consumption reduced alcohol use and related problems more often, and reported higher levels of importance and readiness to change than did their counterparts. Analyses of MISC-coded data showed a significantly higher use of MI-consistent skills among those with a moderation intention, but no group differences on the 8 other counselor communication skills measures were found. Analyses of patient speech during the intervention indicated that those with an intention to change their alcohol consumption significantly more often self-explored personal ambivalence towards alcohol, expressed more intensely their ability, commitment, desire, need and reason to change their alcohol use than did those in the no decrease group. CONCLUSIONS: The intention expressed by hazardous drinkers when concluding BAI is associated with both patient change talk during BAI and drinking outcome 12 months later, but is mainly independent of counselor communication skills. This intention may be an important clinical indicator of which hazardous drinkers are most likely to improve after BAI.     

Brief alcohol intervention in the emergency department: moderators of effectiveness

OBJECTIVE: Prior research supports the effectiveness of brief interventions for reducing alcohol misuse among patients in the emergency department (ED). However, limited information is available regarding the mechanisms of change, which could assist clinicians in streamlining or amplifying these interventions. This article examines moderators of outcomes among ED patients, ages 19 and older, who participated in a randomized controlled trial of a brief intervention for alcohol misuse. METHOD: Injured patients (N= 4,476) completed a computerized survey; 575 at-risk drinkers were randomly assigned to one of four brief intervention conditions, and 85% were interviewed again at 3-month and 12-month follow-ups. RESULTS: Regression models using the generalized estimating equations approach examined interaction effects between intervention condition (advice/no advice) and hypothesized moderator variables (stage of change, self-efficacy, acute alcohol use, attribution of injury to alcohol) on alcohol outcomes over time. Overall, participants who reported higher levels of self-efficacy had lower weekly consumption and consequences, whereas those with higher readiness to change had greater weekly consumption and consequences. Furthermore, individuals who attributed their injury to alcohol and received advice had significantly lower levels of average weekly alcohol consumption and less frequent heavy drinking from baseline to 12-month follow-up compared with those who attributed their injury to alcohol but did not receive advice. CONCLUSIONS: This study provides novel data regarding attribution for alcohol-related injury as an important moderator of change and suggests that highlighting the alcohol/injury connection in brief, ED-based alcohol interventions can augment their effectiveness.     

Readiness to change, drinking, and negative consequences among Polish SBIRT patients

The aim of this study is to examine the longitudinal relationship of readiness to change, drinking pattern, amount of alcohol consumed, and alcohol-related negative consequences among at-risk and dependent drinkers enrolled in a Screening, Brief Intervention and Referral to Treatment (SBIRT) trial in an emergency department in southern Poland. The study examined 299 patients randomized to either an assessment or intervention condition and followed at 3 and 12 months after initial presentation. Patients indicating a readiness or were unsure of changing drinking behavior were significantly more likely to decrease the maximum number of drinks per occasion and the usual number of drinks in a sitting in the 3-months following study entry when compared to those that rated changing drinking behavior as unimportant. Readiness to change was not predictive of outcomes between the baseline and 12-month follow-up. Drinking outcomes and negative consequences by readiness and research condition were non-significant. This is the first Polish study utilizing SBIRT to enable patients to identify their hazardous drinking and reduce alcohol consumption. While some drinking outcomes improved with motivation, these improvements were not maintained at 12-months following SBIRT. Attention to additional constructs of readiness to change and drinking patterns may augment the effectiveness of SBIRT.     

An Evaluation of the BASICS Alcohol Risk Reduction Model Among Predominantly Hispanic College Students

Although Hispanic college students consume alcohol in equal proportion to other ethnic groups, studies have not examined whether established alcohol-risk-reduction approaches are effective in this population. Accordingly, this study examined effectiveness of the Brief Alcohol Screening and Intervention for College Students (BASICS) risk-reduction model for reducing alcohol consumption and related problems in two samples of predominantly Hispanic college students (N = 206 and 405). The study also examined whether factors such as gender, baseline risk level, and readiness to change moderated program impact. Students first participated in an in-depth assessment of drinking patterns followed by relatively brief intervention including psychoeducation and personalized normative feedback. Behavioral outcomes were assessed six months after the intervention and included alcohol-risk scores, alcohol consumption-related problems, consumption, drinking and driving frequency, and stage of change. Supporting the effectiveness of BASICS, both samples showed significant improvement across all these outcomes. Moderator analyses suggested greater program impact among heavier drinkers and among high in change contemplation at assessment. Overall, the results strongly support use of the BASICS intervention model among Hispanic students. The study's limitations are noted.     

Readiness to change drinking among heavy-drinking college students

OBJECTIVE: The purpose of this study was to examine motivation to reduce alcohol consumption among heavy-drinking college students. Specific goals were to test the factor structure of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES); present normative SOCRATES data for collegiate heavy drinkers; present a heuristic, using SOCRATES scales to determine stage of readiness to change heavy-drinking; and compare students at different stages of change on demographic and drinking variables. METHOD: Participants were 278 (187 female) undergraduates who reported at least one episode of heavy drinking within the past 3 months. Students completed the SOCRATES and other questionnaires that assessed current and past drinking and demographics. RESULTS: Confirmatory factor analysis provided modest support for the SOCRATES factor structure. Students were classified according to the transtheoretical model of change (67% Precontemplation, 20% Contemplation and 13% Action). Contemplators drank more often, consumed more alcohol, reported more heavy drinking episodes and experienced more alcohol consequences than the other groups. CONCLUSIONS: Two thirds of the heavy-drinking college students did not recognize a need to reduce their alcohol consumption, despite evidence of tolerance and negative drinking consequences.     

An Evaluation of the BASICS Alcohol Risk Reduction Model Among Predominantly Hispanic College Students

Although Hispanic college students consume alcohol in equal proportion to other ethnic groups, studies have not examined whether established alcohol-risk-reduction approaches are effective in this population. Accordingly, this study examined effectiveness of the Brief Alcohol Screening and Intervention for College Students (BASICS) risk-reduction model for reducing alcohol consumption and related problems in two samples of predominantly Hispanic college students (N = 206 and 405). The study also examined whether factors such as gender, baseline risk level, and readiness to change moderated program impact. Students first participated in an in-depth assessment of drinking patterns followed by relatively brief intervention including psychoeducation and personalized normative feedback. Behavioral outcomes were assessed six months after the intervention and included alcohol-risk scores, alcohol consumption-related problems, consumption, drinking and driving frequency, and stage of change. Supporting the effectiveness of BASICS, both samples showed significant improvement across all these outcomes. Moderator analyses suggested greater program impact among heavier drinkers and among high in change contemplation at assessment. Overall, the results strongly support use of the BASICS intervention model among Hispanic students. The study's limitations are noted.     

Communication During Brief Intervention,Intention to Change,and Outcome

SUMMARY

Objectives: To explore the relationship between patient's intention to change regarding future alcohol consumption following brief alcohol intervention (BAI) and changes in alcohol consumption 12-months later and the communication characteristics between patient and counselor during BAI.

Design, Setting and Subjects: Data from 367 patients (experimental arm) of a pragmatic randomized controlled trial were used to assess the effectiveness of BAI among hazardous drinkers attending an Emergency Department (Lausanne University Hospital, Lausanne, Switzerland). Alcohol outcome measures at baseline and 12 months follow-up included usual number of drinks per week, monthly frequency of heavy episodic drinking (5 or more standard drinks for men; 4 or more for women), and the Alcohol Use Disorders Identification Test (AUDIT) score. In addition, the communication characteristics between patient and counselor were analyzed via tape recordings using the Motivational Interviewing Skill Code (MISC) from 97 participants. Patient readiness and importance to change on a 10-point Likert scale (readiness/importance to change ruler) was asked during BAI, and patient intention to change alcohol consumption (yes/no) was asked at the last step. Differences in alcohol outcome at follow-up between the 367 patients who did or did not have an intention to change consumption at baseline were compared, as were differences between these two groups in communication characteristics for the 97 who completed tape recordings.

Results: Patients with an intention to decrease alcohol consumption reduced alcohol use and related problems more often, and reported higher levels of importance and readiness to change than did their counterparts. Analyses of MISC-coded data showed a significantly higher use of MI-consistent skills among those with a moderation intention, but no group differences on the 8 other counselor communication skills measures were found. Analyses of patient speech during the intervention indicated that those with an intention to change their alcohol consumption significantly more often self-explored personal ambivalence towards alcohol, expressed more intensely their ability, commitment, desire, need and reason to change their alcohol use than did those in the no decrease group.

Conclusions: The intention expressed by hazardous drinkers when concluding BAI is associated with both patient change talk during BAI and drinking outcome 12 months later, but is mainly independent of counselor communication skills. This intention may be an important clinical indicator of which hazardous drinkers are most likely to improve after BAI.     

The motivational context for mandated alcohol interventions for college students by gender and family history

Objective

Alcohol interventions to reduce drinking for college students sanctioned for alcohol use reduce drinking and/or problems. However, intrinsic motivation to change cannot be assumed if students are mandated to receive interventions. The purpose of this study was to explore the influence of both gender and family history on motivational variables prior to a mandated intervention.

Method

Participants were 677 students (63% male) who violated residence hall alcohol policy and were mandated to participate in an alcohol abuse prevention intervention. During a baseline assessment, students described their drinking patterns and completed an assessment of biological risk for alcohol problems; they also reported attitudes regarding the sanction event, perceived peer norms regarding sanctions, resistance to influences on their alcohol use, motivation to change alcohol use, and decisional balance regarding current alcohol use.

Results

Many gender differences emerged on the motivational variables suggestive of more motivation to change among female students; family history was related only to drinking patterns and decisional balance.

Conclusions

If motivational factors influence receptivity and response to mandated interventions, then these finding suggest that greater attention to enhancing motivation to change in male students is warranted.     

Does readiness to change predict subsequent alcohol consumption in medical inpatients with unhealthy alcohol use?

We studied whether readiness to change predicts alcohol consumption (drinks per day) 3 months later in 267 medical inpatients with unhealthy alcohol use. We used 3 readiness to change measures: a 1 to 10 visual analog scale (VAS) and two factors of the Stages of Change Readiness and Treatment Eagerness Scale: Perception of Problems (PP) and Taking Action (TA). Subjects with the highest level of VAS-measured readiness consumed significantly fewer drinks 3 months later [Incidence rate ratio (IRR) and 95% confidence interval (CI): 0.57 (0.36, 0.91) highest vs. lowest tertile]. Greater PP was associated with more drinking [IRR (95%CI): 1.94 (1.02, 3.68) third vs. lowest quartile]. Greater TA scores were associated with less drinking [IRR (95%CI): 0.42 (0.23, 0.78) highest vs. lowest quartile]. Perception of Problems' association with more drinking may reflect severity rather than an aspect of readiness associated with ability to change; high levels of Taking Action appear to predict less drinking. Although assessing readiness to change may have clinical utility, assessing the patient's planned actions may have more predictive value for future improvement in alcohol consumption.     

Motives for drinking, alcohol consumption, and alcohol-related problems among British secondary-school and university students

Relationships among reasons for drinking, alcohol consumption, and drinking-related problems were assessed among secondary-school students (N=328) and university students (N=74) in North Wales, United Kingdom, and results were compared with results from North America. The ability of drinking reasons to predict drinking problems was tested in both age groups. Khavari Alcohol Test, Quantity-Frequency-Variability Index, Reasons for Drinking Questionnaire, and Rutgers Alcohol Problems Index were used to measure the variables of interest. Regression and mediational analyses indicated that negative reasons were stronger predictors of drinking problems than were positive reasons among both secondary-school and university students. Results also showed that the effect of both positive and negative drinking reasons on alcohol-related problems was partially mediated by alcohol consumption among both secondary-school students and university students. There were different correlates of problematic drinking among younger and older students, which suggest that different types of intervention should be used with the two age groups.     

"I'll never drink like that again": characteristics of alcohol-related incidents and predictors of motivation to change in college students

OBJECTIVE: Alcohol use and its associated behaviors are among the most common reasons for medical treatment and disciplinary infractions among college students. The purpose of this study was to describe the characteristics of students who had recent serious alcohol-related incidents and to identify predictors of motivation to change alcohol use and heavy drinking in particular, with specific attention to gender. METHOD: Students (N = 227; 52% female) who had been mandated to attend a session of alcohol education following alcohol-related medical treatment and/or a disciplinary infraction were assessed on their alcohol use, alcohol problems, characteristics of their alcohol-related incident, reactions to the incident, attributions about the incident, and motivation to change drinking and heavy drinking. Path and regression analyses were used to identify the individual and incident-related characteristics that were related to motivation to change. RESULTS: Perceived aversiveness of the incident was directly and positively related to motivation to change drinking and heavy drinking. Alcohol consumption in the month before the incident and past-year alcohol problems were negatively related to motivation to change heavy drinking, and women were more motivated to change heavy drinking than men. The more students consumed in the incident, the more likely they were to feel responsible for it, and the more responsible they felt about the incident, the greater its aversiveness. CONCLUSIONS: Individual and incident-related characteristics are both directly and indirectly associated with motivation to change following an alcohol-related incident, and therefore have implications for interventions with college drinkers who have experienced an alcohol-related incident.     

Stress-motivated drinking in collegiate and postcollegiate young adulthood: life course and gender patterns

OBJECTIVE: This study examines stress-motivated drinking and its potential contribution to alcohol problems for young adults in college and subsequent postcollegiate contexts, specifically focusing on the simultaneous influences of life course stage and gender. METHOD: Data are drawn from a research project on health and well-being among multiple cohorts of college students and graduates from an undergraduate institution of higher education. Representative samples of students were surveyed in 1982 (n = 1,514), 1987 (n = 659) and 1991 (n = 926). Surveys were administered to graduates in 1987 (graduating classes of '79, '82 and '85; n = 860) and again in 1991 (graduating classes of '79, '82, '85 and '89; n = 1,151). Using this cross-sectional and longitudinal database, developmental aging effects are tested while checking for historical cohort and period effects. RESULTS: Stress-motivated drinking is somewhat more prevalent in the undergraduate years as are other drinking motivations, but stress-related reasons for drinking are relatively more prominent among motivations and relatively more problematic in terms of consumption levels and consequences in succeeding years after college. The prominence of stress-related drinking and its increased negative effects begin sooner for women than for men. CONCLUSION: Moving from college to stages of postcollegiate young adulthood is associated with substantial decreases in alcohol consumption and related problems. Drinking for stress-reduction, however, becomes increasingly prominent as the primary motivation for the drinking that does occur in postcollegiate life and this drinking motivation also becomes increasingly problematic in terms of negative consequences of alcohol use as each cohort ages. The problematic prominence of stress-motivated drinking is notable at earlier developmental points in this trajectory for women.     

The efficacy of two brief intervention strategies among injured, at-risk drinkers in the emergency department: impact of tailored messaging and brief advice

OBJECTIVE: This study used a randomized controlled trial design to compare the effectiveness of four interventions at reducing alcohol consumption, consequences, and heavy episodic drinking among injured, at-risk drinkers in the emergency department (ED). METHOD: Injured patients (n=4,476) completed a computerized survey; 575 at- risk drinkers were randomly assigned to one of four intervention conditions: tailored message booklet with brief advice, tailored message booklet only, generic message booklet with brief advice, and generic message booklet only. Regression models using the generalized estimating equation approach were constructed comparing the intervention conditions at baseline, 3-month follow-up, and 12-month follow-up. Gender and age were entered in models along with their interaction. RESULTS: Each of the intervention groups significantly decreased their alcohol consumption from baseline to 12-month follow-up; subjects in the tailored message booklet with brief advice group significantly decreased their average weekly alcohol consumption by 48.5% (p<.0001). Those in the brief advice conditions (tailored or generic) significantly decreased their average consumption during the 12 months of the study compared with the no brief advice conditions. Younger adult women (ages 19-22) who received some brief advice were the most likely to decrease their heavy episodic drinking. CONCLUSIONS: This was the first large-scale, brief intervention trial that included development and testing of computerized, highly tailored interventions with injured drinkers in the ED. ED-based interventions for alcohol problems would benefit from computerized screening, brief advice, and booklets to positively impact risky drinking practices.     

Primary health care physicians' definitions on when to advise a patient about weekly and binge drinking

OBJECTIVE: Little is known about the level of alcohol consumption at which physicians think that they should advise their patients to reduce drinking. This is especially true concerning the amounts consumed per one drinking occasion. The aim of the present study was to examine these issues and also characteristics of physicians possibly associated with their different opinions. METHOD: Cross-sectional self-administered questionnaire survey to all 3193 primary health care physicians in Finland. Response rate was 61.0%. RESULTS: The physicians reported that on average 14.8 drinks (one drink=12 g of absolute alcohol)/week for males and 10.6 drinks/week for females to be the threshold that would cause them to advise their patients. Corresponding figures for one drinking occasion were 6.6 and 4.9 drinks/week. In linear regression analyses physicians' AUDIT scores, use of brief intervention, experience as a physician and age explained the variance of all or some reported thresholds, but all the variables explained only about 10% of the phenomena. CONCLUSIONS: Compared to the official Finnish recommendations regarding the definition of heavy drinking, the physicians reported similar levels of drinking per occasion for deciding to advise their patients, but rather low levels concerning weekly drinking. This may lead to extra workload for physicians and thus hamper implementation of brief intervention. Physicians' characteristics seem to be a decidedly minor issue in implementing drinking limits in health care.     

Intention to utilize formal help in a sample with alcohol problems: a prospective study

BACKGROUND: Studies investigating factors of treatment entry have predominantly focussed on persons that have already taken an initial step in the process of help-seeking. With particular emphasis on intention to utilize help, this study aims to detect predictors for alcohol-related help-seeking among a non-help-utilizing sample. METHODS: Using 312 individuals with diverse alcohol problems (dependence, abuse, at-risk drinking), intention to utilize help was assessed in addition to evidence based predictors for utilization of help (e.g. severity of alcohol problem, prior help-seeking). RESULTS: In addition to prior utilization of help (OR=9.76, CI: 4.60-20.74) and adverse consequences from drinking (OR=1.13, CI: 1.02-1.25), intention to utilize help (OR=4.84, CI: 2.04-11.51) was a central predictor for help-seeking. Among individuals who had not obtained prior help, individuals intending to seek help were 8.7 times more likely to utilize help than those not intending to seek help (CI: 1.05-72.2). CONCLUSIONS: In the past, intention to utilize help has been neglected from models investigating treatment entry. This study's findings show that intention is a central factor for utilization of alcohol-specific formal help. Consequently, brief interventions focusing on enhancing motivation are expected to improve early help-seeking among general hospital patients with diverse alcohol problems.     

Alcohol Use and Alcohol Consumption–Related Problems in Rural Vietnam: An Epidemiological Survey Using AUDIT

This study aimed to assess alcohol use and alcohol consumption–related problems in different sociodemographic groups in a rural district in Vietnam. Interviews were completed between March 2004 and July 2004. The Alcohol Use Disorder Identification Test (AUDIT) was applied to interview 3423 people, who were randomly selected in a rural district (1695 men and 1728 women). People who had an AUDIT score greater than 7 (in men) or greater than 5 (in women) were identified as having alcohol consumption–related problems. Prevalences and adjusted odds ratios of alcohol use and alcohol consumption–related problems were estimated for different subgroups of the population. Weekly and daily “binge drinking” among men were 5.7 and 3.6%, while binge drinking in women was virtually nonexistent. The prevalence of alcohol consumption–related problems was 25.5% among men and 0.7% among women. The differences between sociodemographic groups were not strong, but women who were separated, divorced, or widowed as well as those with higher education had significantly higher rates of alcohol consumption–related problems than married women and those with lower education. This study indicates an urgent need for alcohol intervention programs focused on men. However, further monitoring of alcohol use and problems among women is important to follow-up changes in consumption pattern. The study's limitations are discussed.