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Early recognition and treatment of alcohol use disorders

We are focusing in our new topic on the early recognition and treatment of alcohol related problems. In primary care identifying the symptoms which can be related to alcohol use can help us to recognize drinking problems at an early stage – examples covered so far on our Resource Centre are the hypertension and depression topics. Another setting for early recognition and intervention is the Emergency Department, if patients present to the department with acute intoxication or alcohol related injuries.

As reported in our selection of articles, brief interventions and motivational interviewing are effective and low cost approaches for preventing or delaying the initiation of alcohol use, or intervening with heavier users before they progress to more problematic levels. Although originally, motivational interviewing was designed to be delivered by highly trained specialist counselors more recently there has been interest in training general medical practitioners – physicians and nurses – to use this intervention in routine practice. Motivational interviewing – 'change talk' – emphasizes developing a discrepancy between current behavior and future goals, increasing problem recognition, motivation, and self-efficacy. Learn more on how to talk change in the video Lectures presented by Dr Antoni Gual and in our interview with Professor Gerard Schippers.

  • Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: a randomized trial

    Walton MA et al. JAMA 2010

    Editorial comment
    A leading cause of mortality and morbidity in adolescents is violence, and adolescents seeking care in the emergency department are an important population for injury prevention based on increased risk for problems related to alcohol and violence. The objective of this US study was to assess the efficacy of single-session brief interventions addressing violence and alcohol among adolescents with self-reported alcohol use and aggression who sought acute general emergency department care. Data were collected for interventions delivered by a therapist or by stand-alone interactive animated program delivered by a computer. The authors found that brief interventions delivered by a therapist in this setting were associated with a clinically meaningful reduction in the occurrence of violence. To prevent severe peer aggression in 1 adolescent, only 8 at-risk adolescents (with past year alcohol use and aggression) would need to receive the brief intervention delivered by a therapist. At 6 months, participants in the therapist and computer conditions were less likely to report alcohol-related consequences than controls. Especially if designed to be easily incorporated into emergency department practice, these approaches can result in substantial public health benefits.

  • Patient-provider concordance with behavioral change goals drives measures of motivational interviewing consistency

    Laws MB et al. Patient Educ Couns 2015

    Editorial comment:
    There is an extensive evidence base for the effectiveness of motivational interviewing (MI) in behavioral counseling by trained practitioners. However, evaluation of MI techniques in regular medical practice has been more limited. The authors present data addressing the relationship between patient concordance with provider behavioral change goals and measured MI consistency from two studies of primary care, study participants were people with HIV. Studies of behavioral change counseling by trained MI practitioners have supported the effect of clinician talk in evoking client change talk. However, this may not be as feasible in the context of medical encounters with lightly trained providers. The study findings suggest that medical providers should be mindful that it is more difficult to maintain MI consistency with resistant patients, while this is precisely the situation in which MI technique is posited to be most useful. Training in MI for medical providers should emphasize this point. However, it may be that MI as such is not really applicable to very brief conversations with resistant patients, and that medical encounters require a modified approach.

  • Brief Alcohol Interventions for Adolescents and Young Adults: A Systematic Review and Meta-Analysis

    Tanner-Smith EE et al.

    J Subst Abuse Treat 2015

    Editorial comment:
    The authors performed a meta-analysis synthesizing findings from 185 experimental and quasi-experimental independent study samples that examined the effects of brief alcohol interventions on alcohol-related outcomes for adolescents and young adults who were not seeking treatment. The study results indicate that participants who received brief alcohol interventions reduced their alcohol consumption between 1.0 and 1.3 drinking days per month, relative to control participants, who reported an average of 6.2 drinking days per month at baseline. The effects of brief alcohol interventions persisted for up to 1 year after the end of the interventions. Although the magnitude of the effects is generally modest, the brevity and low cost of these interventions allow them to be applied on a relatively large scale where they may add incrementally to the influences that deter risky drinking among youth. Even modest reductions in alcohol consumption may have lasting benefits for youth during these critical developmental periods where progression to alcohol use disorders begins.

  • Motivational interviewing to reduce hazardous drinking and drug use among depression patients

    Satre DD et al. J Subst Abuse Treat 2013

    Editorial comment:
    The authors examined the efficacy of a motivational interviewing (MI) intervention to reduce hazardous drinking and drug use among depression patients as an adjunct to usual care in an outpatient psychiatry clinic setting. The intervention consisted of one 45-minute in-person motivational interviewing session followed by two 15-minute telephone “booster” sessions. At three months, patients who had received MI intervention were significantly less likely than controls to report any hazardous drinking in the prior 30 days: 60.0% vs. 81.8%. No impact was found for the intervention on cannabis use or depression symptoms. The study findings have implications for the development of appropriate alcohol interventions, which are integral to the delivery of effective psychiatric services, in which patients frequently present with alcohol and drug use in addition to major depression.

Presentation

  • Ambivalence and internal discrepancy

    Part 1 of lecture series Motivating patients with alcohol problems

    Patients often face two opposite strong feelings that are conflicting one against the other – to drink and to stay...
  • Values of life to explore

    Part 2 of lecture series Motivating patients with alcohol problems

    Asking patients about their values will get us closer to what is really important for them, and can help them...
  • Guiding the process of change

    Part 3 of lecture series Motivating patients with alcohol problems

    Just raising internal discrepancies in a motivational interview is not enough to bring about a change. Presentation: Antoni Gual Duration: 0:16:40
  • What is a good treatment outcome?

    Breakout session highlight, Anne Lingford-Hughes

    The key is to be individually tailored − success for one individual may not look like success for another.
  • Key messages about the management of relapse

    Breakout session highlight, Anne Lingford-Hughes

    If people are doing badly in diabetes, asthma or hypertension, we don’t tend to discharge them, whereas that is often exactly what happens to a person with an alcohol problem.
  • Key messages about motivational interviewing

    Breakout session highlight, Antoni Gual

    Motivation is also something we need to work on with the team. It doesn’t help that much if you are trying to be very motivating with the patient while the rest of your team is confronting them.