mHealth Tool for Alcohol Use Disorders among Latinos in Emergency Department

Latino drinkers experience a disparate number of negative health and social consequences. Emergency Department Alcohol Screening Brief Intervention and Referral to Treatment (ED-SBIRT) is viable and effective at reducing harmful and hazardous drinking. However, barriers (e.g. readily available language translators, provider time burden, resources) to broad implementation remain and account for a major lag in adherence to national guidelines. We describe our approach to the design of a patient-centered bilingual Web-based mobile health ED-SBIRT App that could be integrated into a clinically complex ED environment and used regularly to provide ED-SBIRT for Spanish speaking patients.

Below:  AB-CASI Language Selection Screen

Below:  AB-CASI Frequency of Drinks Screen

Below:  Architecture of ED-SBIRT Mobile App Bilingual Text-to-Speech Generation

Below:  AB-CASI Ruler Screen

Full article at:   http://goo.gl/3r2GIa

By:  Fuad Abujarad and Federico E. Vaca

Department of Emergency Medicine Yale University, School of Medicine New Haven, Connecticut

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Gender Differences in the Life Concerns of Persons Seeking Alcohol Detoxification

Highlights

• Mental health, smoking, and finances are the most prevalent life concerns
• Gender affects the life concerns of persons with alcohol use disorders
• Men more concerned than women about money and drug use problems
• Men reported greater concern than women in most domains assessed

Background

This study explored the life concerns of persons seeking alcohol detoxification, a group with multiple life and psychosocial challenges. Gender may be an important contributor to the particular life concerns of persons with alcohol use disorders.

Methods

Using a 32-item, previously-validated life concerns survey that captures ten conceptual domains, we interviewed persons entering inpatient alcohol detoxification asking them to rate their level of concern about health and welfare items.

Results

Participants (n = 189) were 27% female, with a mean age of 43.5 years. Overall, concern about alcohol problems was perceived as the most serious, followed by mental health, cigarette smoking, financial, and relationship problems. Men were significantly more concerned than women about six of the ten domains including money, drug use, transmissible diseases, and physical illness.

Conclusions

Recognition of the daily worries of persons seeking inpatient alcohol detoxification persons could allow providers to better tailor their services to the context of their patients’ lives. Focusing on pressing life concerns such as mental health, financial, relationship problems, and other drug use may influence detoxification services and aftercare treatment choices.

Purchase full article at:   http://goo.gl/8YNKH0 

By:   Michael D. Stein, Megan M. Risi, Jessica N. Flori, Micah T. Conti, Bradley J. Anderson, Genie L. Bailey

Affiliations

General Medicine Research Unit, Butler Hospital, Providence, RI, 02906

Warren Alpert Medical School of Brown University, Providence, RI, 02912

Correspondence

Corresponding author at: Health Services, Policy & Practice, Alpert School of Medicine at Brown University, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906. Tel.: +401 455 6646; fax: +401 455 6685.

Michael_Stein@brown.edu

DOI: http://dx.doi.org/10.1016/j.jsat.2015.12.005

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Risks and Benefits of Nalmefene in the Treatment of Adult Alcohol Dependence: A Systematic Literature Review and Meta-Analysis of Published and Unpublished Double-Blind Randomized Controlled Trials

Background

Nalmefene is a recent option in alcohol dependence treatment. Its approval was controversial. We conducted a systematic review and meta-analysis of the aggregated data (registered as PROSPERO 2014:CRD42014014853) to compare the harm/benefit of nalmefene versus placebo or active comparator in this indication.

Methods and Findings

Three reviewers searched for published and unpublished studies in Medline, the Cochrane Library, Embase, ClinicalTrials.gov, Current Controlled Trials, and bibliographies and by mailing pharmaceutical companies, the European Medicines Agency (EMA), and the US Food and Drug Administration. Double-blind randomized clinical trials evaluating nalmefene to treat adult alcohol dependence, irrespective of the comparator, were included if they reported (1) health outcomes (mortality, accidents/injuries, quality of life, somatic complications), (2) alcohol consumption outcomes, (3) biological outcomes, or (4) treatment safety outcomes, at 6 mo and/or 1 y. Three authors independently screened the titles and abstracts of the trials identified. Relevant trials were evaluated in full text. The reviewers independently assessed the included trials for methodological quality using the Cochrane Collaboration tool for assessing risk of bias. On the basis of the I2 index or the Cochrane’s Q test, fixed or random effect models were used to estimate risk ratios (RRs), mean differences (MDs), or standardized mean differences (SMDs) with 95% CIs. In sensitivity analyses, outcomes for participants who were lost to follow-up were included using baseline observation carried forward (BOCF); for binary measures, patients lost to follow-up were considered equal to failures (i.e., non-assessed patients were recorded as not having responded in both groups). Five randomized controlled trials (RCTs) versus placebo, with a total of 2,567 randomized participants, were included in the main analysis. None of these studies was performed in the specific population defined by the EMA approval of nalmefene, i.e., adults with alcohol dependence who consume more than 60 g of alcohol per day (for men) or more than 40 g per day (for women). No RCT compared nalmefene with another medication. Mortality at 6 mo (RR = 0.39, 95% CI [0.08; 2.01]) and 1 y (RR = 0.98, 95% CI [0.04; 23.95]) and quality of life at 6 mo (SF-36 physical component summary score: MD = 0.85, 95% CI [−0.32; 2.01]; SF-36 mental component summary score: MD = 1.01, 95% CI [−1.33; 3.34]) were not different across groups. Other health outcomes were not reported. Differences were encountered for alcohol consumption outcomes such as monthly number of heavy drinking days at 6 mo (MD = −1.65, 95% CI [−2.41; −0.89]) and at 1 y (MD = −1.60, 95% CI [−2.85; −0.35]) and total alcohol consumption at 6 mo (SMD = −0.20, 95% CI [−0.30; −0.10]). An attrition bias could not be excluded, with more withdrawals for nalmefene than for placebo, including more withdrawals for safety reasons at both 6 mo (RR = 3.65, 95% CI [2.02; 6.63]) and 1 y (RR = 7.01, 95% CI [1.72; 28.63]). Sensitivity analyses showed no differences for alcohol consumption outcomes between nalmefene and placebo, but the weight of these results should not be overestimated, as the BOCF approach to managing withdrawals was used.

Conclusions

The value of nalmefene for treatment of alcohol addiction is not established. At best, nalmefene has limited efficacy in reducing alcohol consumption.

Below:  Forest plots for health outcomes at 6 mo

Full article at:   http://goo.gl/39dTbp

By:   

Clément Palpacuer, Bruno Laviolle, Jean Michel Reymann, Eric Bellissant, Florian Naudet

INSERM Centre d’Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Rennes, France

Bruno Laviolle, Jean Michel Reymann, Eric Bellissant, Florian Naudet

Laboratoire de Pharmacologie Expérimentale et Clinique, Faculté de Médecine, Université de Rennes 1, Rennes, France

Rémy Boussageon

Département de Médecine Générale, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France

  

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Personality Traits & Psychiatric Comorbidities in Alcohol Dependence

Non-adaptive personality traits may constitute risk factors for development of psychiatric disorders such as depression and anxiety. We aim to evaluate associations and the predictive value of personality traits among alcohol-dependent individuals, with or without psychiatric comorbidities. 

The convenience sample comprised two groups of males over 18 years of age: one with subjects who had an alcohol dependence diagnosis (AG, n=110), and a control group without abuse and/or alcohol dependence diagnosis (CG, n=110). The groups were assessed by means of the Structured Clinical Interview DSM-IV (SCID-IV). AG participants were recruited among outpatients from the university hospital, whereas CG participants were recruited from a primary healthcare program. Data collection was done individually with self-assessment instruments. Parametric statistics were performed, and a significance level of P=0.05 was adopted. 

A positive correlation was observed between openness and the length of time that alcohol has been consumed, as were significant and negative correlations between conscientiousness and both the length of time alcohol has been consumed and the number of doses. For alcoholics, extraversion emerged as a protective factor against depression development (P=0.008) and tobacco abuse (P=0.007), whereas openness worked as a protective factor against anxiety (P=0.02). 

The findings point to specific deficits presented by alcoholics in relation to personality traits with or without psychiatric comorbidities and to the understanding that therapeutic approaches should favor procedures and/or preventive measures that allow more refined awareness about the disorder.

Below:  Table 2 highlights the statistically significant differences between AG and CG for all of the five assessed personality factors; all factors were less evident in AG.

Full article at:  http://goo.gl/xzTLeW

By:  Donadon MF1, Osório FL1.

1Departamento de Neurociência e Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil

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"Coming Out" as an Alcoholic: How Former Problem Drinkers Negotiate Disclosure of Their Nondrinking Identity

Although communication is critical for former problem drinkers to reject drinks, socialize with others, minimize stigma, and maintain their health and sobriety, recovering alcoholics' communication has not been examined beyond alcohol self-help groups. 

Using a Communication Privacy Management framework and in-depth, semistructured interviews, this study examined how former problem drinkers negotiate the disclosure of their nondrinking status. As participants perceived not drinking in the United States as deviant and socially risky, the investigation found participants primarily concealed their nondrinking status in order to fit in. Participants enacted specific communicative behaviors to regulate their privacy boundaries, only disclosing their struggles with alcohol when benefits outweighed costs (e.g., inspiring others, maintaining sobriety, or building relationships). 

This study offers practical disclosure strategies for former problem drinkers to protect their private information, manage social interactions, and stay sober.

Via: http://ht.ly/Sph2g 

By: Romo LK1, Dinsmore DR2, Watterson TC1.

• 1a Department of Communication , North Carolina State University.
• 2b Department of Communication Studies , Texas State University.

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