A1 Active components of a web-based personalised normative feedback: a dismantling
Andre Bedendo1,2, Jim McCambridge2, Jacques Gaume3, Altay A. L. Souza4, Maria L. O.
Souza‐Formigoni4, Ana R. Noto4
1Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil;
2Department of Health Sciences, University of York, York, United Kingdom; 3Alcohol
Treatment Centre, Lausanne University Hospital, Lausanne, Switzerland; 4Department
of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
Correspondence: Andre Bedendo - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A1
Background: Web-based Personalised Normative Feedback (PNF) show small to moderate
effects on alcohol use among college students. However, little is known about its
active components. This study evaluated the effectiveness of two components of PNF
in reducing alcohol use and consequences among Brazilian college students.
Methods: College students (18–30 years) who reported alcohol use in the last three
months (N = 5,476), were included in a three-arm pragmatic randomised controlled trial
with 1-, 3-, and 6-month follow-up. Participants were assigned to either: (1) full
PNF intervention; (2) Normative feedback (NF) only or (3) Consequences Feedback (CF)
only. The primary outcome was AUDIT score; secondary outcomes were number of alcohol-related
consequences, drinking frequency, and typical/maximum number of drinks. We used Mixed
Models with Multiple Imputation and Pattern-Mixture Model to account for attrition.
Post-hoc analysis considered participant interest in knowing more about their drinking.
Results: Single component interventions reduced AUDIT score compared to full PNF,
with significant effects for NF at 1-month (b = − 0.23, p = 0.048) and for CF at 3-month
(b = − 0.33, p = 0.03). Compared to PNF, NF reduced the number of consequences at
1-month (b = − 0.16, p = 0.001) and drinking frequency at 3-month (b = − 0.42, p = 0.03),
but increased the number of typical drinks at 6-month (b = 0.38, p = 0.03). CF reduced
drinking frequency at 3-month (b = − 0.37, p = 0.045). Attrition models confirmed
all results, except for the NF effect on typical drinks and drinking frequency. Post-hoc
analyses indicated the superiority of single components effects among those students
not interested in knowing more about drinking.
Conclusions: Findings suggest that individual components were superior to the full
PNF intervention, however this effect was mainly driven by a minority of students
(around 20%) who were not interested in receiving it.
Trial registration: NCT02058355.
A2 Optimising the alcohol reduction app, Drink Less
Claire Garnett1, Susan Michie2, Robert West1, Matt Field3, Felix Greaves4,5, Matthew
Hickman6, Eileen Kaner7, Marcus Munafo8, Robyn Burton9, Matthew Walmsley9, Jamie Brown1
1Department of Behavioural Science and Health, University College London, London,
UK; 2Department of Clinical, Educational and Health Psychology, University College
London, London, UK; 3Department of Psychology, University of Sheffield, Sheffield,
UK; 4Public Health England, London, UK; 5Department of Primary Care and Public Health,
Imperial College London, London, UK; 6School of Population Health Sciences, University
of Bristol, Bristol, UK; 7Institute of Health & Society, Newcastle University, Newcastle,
UK; 8School of Psychological Science, University of Bristol, Bristol, UK; 9Public
Health England, London, UK
Correspondence: Claire Garnett - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A2
Background: Drink Less is an evidence-based smartphone app for reducing excessive
drinking in the UK. The development and initial evaluation of Drink Less followed
the first two steps of the Multiphase Optimisation Strategy (MOST): (i) identification
of intervention components and (ii) randomised factorial screening trial to evaluate
the five individual components. The next step in MOST is to develop an optimised version
of Drink Less.
Methods: The optimisation will be informed by three work packages. First, use of Bayes
Factors to analyse additional data collected from extended recruitment of the randomised
factorial screening trial. Secondly, an update of the 2017 Cochrane review on digital
alcohol interventions and meta-regression of the intervention components associated
with effectiveness. Thirdly, a content analysis of Drink Less user feedback received
via emails and app store reviews.
Results: The Bayes Factors analysis of the factorial trial indicated that one of the
five the intervention components (‘Identity Change’) should be removed in the optimised
version of the app. The updated meta-regression of the Cochrane review indicated that
‘Behaviour substitution’ and ‘Information about antecedents’ should be introduced
into an optimised Drink Less. The content analysis of user feedback identified high
priority changes within existing components: customisable drink volumes; ability to
update normative feedback; drinking calendar to start on Monday; bug fix relating
to time zone changes; clarify how to edit drinks entries and how to navigate to the
Conclusions: Using a mixed methods approach to optimise Drink Less has provided us
with different insights: how to improve the likely effectiveness of the intervention
and also providing users with what they want from the intervention, which is crucial
for engagement with any intervention. This optimised version will undergo user testing
to improve its usability and then the optimised version will be evaluated in a definitive
A3 Skills training for reducing risky alcohol use in app form among internet help-seekers:
a pilot study
Anne H. Berman1, Olof Molander1, Miran Tahir2, Philip Törnblom2, Mikael Gajecki1,
Kristina Sinadinovic1, Claes Andersson3
1Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet,
& Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; 2Department
of Psychology/Centre for Psychiatry Research, Department of Clinical Neuroscience,
Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council,
Stockholm, Sweden; 3Department of Criminology, Malmö University, Malmö, Sweden
Correspondence: Anne H. Berman - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A3
Background: Problematic alcohol use in Sweden occurs among 16% of the adult population.
Digital interventions of varying intensity have shown positive effects in contributing
to reductions in problematic use, and the TeleCoach app has shown positive effects
in non-treatment-seeking university students with excessive drinking. This pilot study
evaluates the app among adult internet help-seekers.
Methods: Adult internet-help seekers, recruited via advertisement, were included if
they scored ≥ 6 (women) or ≥ 8 (men) on the Alcohol Use Disorders Identification Test
(AUDIT). Those with depression scores of ≥ 31 on the Montgomery Åsberg Depression
Rating Scale (MADRS-S) or problematic drug use scores of ≥ 8 on the Drug Use Disorders
Identification Test (DUDIT) were contacted for a telephone interview and included
following clinical assessment; if not reached, they were excluded. Participants were
randomized at a 1:1 ratio to either the TeleCoach™ web-based app or to a web-based
app with information texts from primary care-based self-help material for changing
problematic alcohol use. At six-week follow-up, the primary outcome was the number
of standard drinks per past week (Timeline-Follow back).
Results: Of 147 persons assessed for eligibility, 89 were assigned to either the intervention
group (n = 42) or control group (n = 47). Average AUDIT levels at baseline were ≥ 18.
The baseline number of standard drinks per week was 32.73 (SD 21.16) for the intervention
group, and 26 (4.08) for the control group. At 6-week follow-up, the number of standard
drinks per week was 12.73 (10.52) and 13.48 (11.13) for the intervention and control
groups, respectively. No significant between-groups effects occurred, but within-group
changes over time were significant (F = 43.98; p < 0.000), with an effect size of
37 for the intervention group and 2 for the control group.
Conclusions: The results suggest that web-based apps can be of help to internet help-seekers
who are motivated to reduce problematic alcohol use. Proceeding with a planned larger
randomized-controlled study is warranted.
A4 Web-based therapy versus face-to-face therapy for alcohol dependence
Magnus Johansson1, Kristina Sinadinovic2, Ulric Hermansson2, Anne H Berman2, Sven
1Department of Public Health, Karolinska Institutet, Stockholm, Sweden; 2Centre for
Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, &
Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
Correspondence: Magnus Johansson - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A4
Background: Computer- and internet-based interventions for alcohol problems have been
available for over 20 years. Most previous studies have focused on prevention, using
screening and brief intervention (eSBI). More extended treatment interventions (iCBT)
have been found to reduce alcohol consumption significantly more than control interventions
in a small number of studies. There is a need for more studies in a clinical setting,
treating people with alcohol use disorder (AUD) and comparisons between internet-based
and face-to-face treatment. One reason for using internet-based interventions is lower
costs, although only a few economic evaluations have been carried out.
Methods: A randomized controlled non-inferiority trial was conducted at a clinic treating
AUD. Participants signed up via the clinic website, were assessed by a physician including
alcohol biomarkers and were randomized to treatment via internet or face-to-face.
The same treatment material and the same psychologists were used in both groups. Follow-up
was conducted at 6 months. The non-inferiority limit was set to 5 drinks (60 g of
alcohol) a week. Health economic analysis was based on calculation of quality adjusted
life years (QALYs) from the EQ-5D.
Results: Randomized patients (n = 303) had a mean age of 49 years (SD = 12) and 38%
were women. Mean consumption for the previous week was 24 (SD = 14) drinks. Mean AUDIT
score was 21 (SD = 5). 66% met criteria for severe AUD. The treatment cost was lower
in internet compered to face-to-face treatment. Preliminary analyses show that the
weekly alcohol consumption for patients treated face-to-face decreased by 2 more drinks
than for those treated via internet (95% CI − 4.5 to 0.5) at 6-month follow-up, indicating
non-inferiority for the iCBT treatment compared with face-to-face CBT treatment.
Conclusions: Internet-based CBT treatment can be used in specialized care and can
be as effective as face-to-face treatment in reducing alcohol use among people with
AUD and might be more cost-effective.
Trial registration: NCT02888002.
A5 Prevalence of alcohol misuse problem (AMP) recognition within UK military personnel
who meet criteria for alcohol misuse
Panagiotis Spanakis1, Rachael Gribble2, Sharon Stevelink2, Roberto Rona2, Nicola Fear2,
1University of Liverpool, Liverpool, UK; 2King’s College London, London, UK
Correspondence: Panagiotis Spanakis - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A5
Background: Although high rates of alcohol misuse problems (AMP) have been found in
the UK military, many military personnel do not reduce their heavy drinking and help
seeking is uncommon. Recognition of AMP is a fundamental step in the psychological
process of taking action to change behaviour. This study examined data from the most
recent wave of a UK military health and well-being cohort study to calculate prevalence
of self-identification of existing AMP.
Methods: A representative sample of serving and ex-military personnel (n = 8,093)
completed a battery of questionnaires, including the Alcohol Use Disorders Identification
Test (AUDIT), the General Health Questionnaire (GHQ-12; a measure of common mental
health disorders—CMD), and the Post-Traumatic Stress Disorder (PTSD) Checklist (PCL-C).
Participants also self-reported whether they have experienced any alcohol problems
in the last three years (self-identification of AMP). Data were cross-tabulated to
calculate weighted percentages with 95% confidence intervals (CI).
Results: 609 participants met criteria for AMP (AUDIT score ≥ 16). Preliminary analyses
suggest that 49% (CI = 44%–54%) self-identified their problems. Problems were also
self-identified by 8% (7%–9%) of hazardous drinkers (8 ≥ AUDIT < 16), 32% (27%–38%)
of harmful drinkers (16 ≥ AUDIT < 20), and 74% (67%–80%) of those with probable dependence
(AUDIT ≥ 20). 60% (53%–35%) of those with AMP and CMD comorbidity recognized their
AMP, as opposed to 41% (35%–47%) of those with no CMD comorbidity. Also, 68% (57%–78%)
of those with AMP and PTSD comorbidity recognized their AMP, as opposed to 45% (40%–50%)
of those with no PTSD comorbidity.
Conclusion: Around half of UK military personnel do not recognize their AMP. Recognition
is higher in more severe cases and in those with comorbid mental health issues. Future
studies should focus on policies and interventions that could increase self-awareness
of AMP among military personnel.
A6 Coping with alcohol use disorders: a consumer’s perspective
Anja Bischof, Miriam Brandes, Tjorven Stamer, Hans-Jürgen Rumpf, Gallus Bischof
Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
Correspondence: Anja Bischof - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A6
Background: The percentage of individuals with alcohol use disorders (AUD) seeking
treatment is low. Previous studies have examined barriers to treatment including comorbidity,
structural barriers, shame, and stigmatization, mainly based on standardized questionnaires.
Nevertheless, the assessment of barriers often does not include in-depth reasons for
not seeking treatment.
Methods: The study Alcohol-related treatment: a consumer’s perspective (ART-COPE)
aims at assessing the development of drinking problems, problem awareness, and coping
mechanisms from the perspective of participants using narrative interviews based on
Reflective Grounded Theory. Special emphasis lies on the perception of treatment offers
in individuals with AUD without treatment experience. Participants with and without
treatment experience were recruited pro-actively in general practices and general
hospitals. All interviews are recorded, transcribed verbatim, and analyzed using MAXQDA.
The study aims to interview 25 individuals. To date, ten interviews have been realized.
Results: All individuals reported that drinking was common in familial and social
contexts throughout adolescence and adult life. Family was perceived both as a stressor
and an accelerator of drinking problems as well as a facilitator for problem awareness
and treatment seeking. Alcohol consumption often served as a means for emotion regulation
and in some cases as self-medication for depression. Further common topics were loneliness,
shame, and stigmatization. Barriers to treatment included fear of losing autonomy
and the excessive bureaucratic effort to apply for a therapy. Due to less stable patterns
of alcohol dependence, a subgroup reported a sense of control as an additional barrier.
Conclusions: To increase the reach for patients with AUD, social structures and families
should be strengthened to facilitate access to treatment. Reducing bureaucratic procedures
and fostering shared decision making could further increase readiness for treatment.
It is expected that all interviews will be analyzed by the date of the conference.
A7 Brief Intervention for alcohol in pregnant women with criteria for Alcohol Use
Disorders: an exploratory study
Aldana Lichtenberger, Paula V. Gimenez, Raquel Peltzer, Mariana Cremonte
Research Group on Psychoactive substances and injuries, Institute of Basic Psychology,
Applied and Development of Psychological Technology (IPSIBAT), National Scientific
and Technical Research Council (CONICET), National University at Mar del Plata (UNMdP),
Buenos Aires, Argentina
Correspondence: Paula V. Gimenez - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A7
Background: The sub-population of patients with alcohol use disorders (AUD) is usually
excluded from studies on Screening and Brief Intervention (SBI), although SBI might
be effective in increasing motivation for behavior change. For that reason, the evidence
is scarce among the general population and non-existent for pregnant women. The aim
of this exploratory and secondary analysis of data (from an efficacy-randomized study)
is to present the results of the acceptability of SBI among a group of pregnant women
with criteria for AUD.
Methods: 23 pregnant women with criteria for AUDs were identified in a probabilistic
sampling of pregnant women who attended the Public Health Centers of Mar del Plata,
Argentina, during 2016 (n = 893). Every participant received BI and referral to treatment.
Screening was performed with the AUDIT (scores 16 were considered positive) and acceptability
was assessed with four ad hoc questions. Consumption and related problems were evaluated
three months later.
Results: Of all the women who were contacted again after three months (n = 10), only
one increased her AUDIT score, due to the number of standard units consumed per occasion,
although episodes of binge drinking decreased. Of the nine participants who decreased
their AUDIT scores, seven reported abstinence. All the participants stated that the
questions were easy to answer; most of them stated that they learned something new
and that they had shared the contents of the interview with others.
Conclusions: Despite limitations, these results suggest that SBI may be well accepted
among pregnant women with criteria for AUD.
A8 Understanding Recovery from Alcohol Use Disorders with Systematic Alcohol SBIRT
Constance Weisner1, Vanessa A. Palzes1, Derek Satre2, Stacy A. Sterling1
1Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; 2Department
of Psychiatry, University of California, San Francisco, CA, USA
Correspondence: Constance Weisner - Constance.Weisner@kp.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A8
Background: Alcohol use disorders (AUDs) are a health concern and understanding recovery
is imperative. Using data from a population-based SBIRT in primary care, we examined
correlates of recovery defined as reporting either abstinence or low-risk drinking
at a follow-up screening.
Methods: We identified 4,078 adults with both an AUD diagnosis and positive screening
for unhealthy drinking (any day drinking 5+/4+ and/or 15/8 drinks/week for men/women,
respectively) between 10/1/2015 and 9/30/2016, and extracted their electronic health
records through 10/2018, allowing a 3-year follow-up. We conducted survival analysis
using the Kaplan–Meier method and fit Cox proportional hazards models to examine associations
between recovery and patient characteristics, comorbidities, and health service utilization.
Results: About 57% of the cohort recovered during our follow-up, with 607 days the
median. Controlling for covariates, factors significantly associated with greater
odds of having shorter recovery times were female; older age; Black or Latino/Hispanic
race/ethnicity; having more medical comorbidities and no drug use disorders; lower
drinking severity; and being in addiction treatment within the prior year. Having
psychiatric comorbidities in the first year was associated with higher likelihood,
while being in psychiatric treatment during that period was associated with lower
relative likelihood of recovery at any given time during the follow-up. There was
not an association between having a brief intervention for the index positive screening
Conclusion: In a health system that has implemented systematic SBIRT, we had the unique
opportunity to examine correlates of AUD recovery utilizing longitudinal alcohol screening
data among individuals with AUD and unhealthy drinking. Our study adds to the growing
literature on recovery from a perspective that includes both abstinence and low-risk
drinking and suggests that primary care-based SBIRT may help understand the recovery
process, including vulnerable subgroups such as those with mental illness, and guard
against growing health disparities among ethnic minorities.
A9 Addiction and post-traumatic stress: evolution of post-traumatic stress symptoms
among the Maitre de sa vie program’s participants
Myriam Laventure, Geneviève Paquette, Jennifer Beauregard
Université de Sherbrooke, Sherbrooke, Canada
Correspondence: Myriam Laventure - Myriam.Laventure@USherbrooke.ca
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A9
Background: One person out of four being under treatment for an addiction would present
a post-traumatic stress state diagnosis. Individuals experiencing both these situations
concomitantly usually draws less benefits from addiction treatments. The addiction
relapse rates range from 40% to 60% among the people under treatment for addiction
and suffering from post-traumatic stress. The Program Maitre de sa vie—a brief intervention
of 6 weekly group workshops—was set up in a Quebec’s addiction rehabilitation center
in order to simultaneously target the issues related to addiction as well as to a
post-traumatic stress state.
Method: The sampling is composed of 75 adults (37 women) having an addiction to alcohol
(86.8%) and to drugs (88.1%), and presenting post-traumatic stress symptoms (self-disturbance,
post-traumatic stress, exteriorization, somatization). In order to assess the participant’s
evolution to the program, data collection including four measurement times was performed:
before the program, between the third and fourth meeting, at the end of the program
and 3 months after the program. Measurement of post-traumatic stress symptoms was
based on regression models including symptoms values when entering the program, gender,
age, exposition to the program, therapeutic alliance quality and adaptation strategies
Results and conclusion: Participation to the Program is associated with a significant
decrease of post-traumatic stress symptoms in between each measurement time. A significantly
fewer number of participants also reach the clinical thresholds of post-traumatic
stress at the end of the program. Among the variables under study, a decrease in post-traumatic
symptoms is foreseen while being a male, being younger, having a greatest exposition
to the Program, a better quality of therapeutic alliance and using a positive adaptation
strategy. The results support the relevance of introducing interventions based on
adaptation strategies among the persons presenting both addiction and post-traumatic
A10 Predicting Imminent Homelessness Among Emergency Department Patients with Unhealthy
Alcohol or Drug Use
Kelly M. Doran1, Eileen Johns2, Marybeth Shinn3, Maryanne Schretzman2, Donna Shelley1,
Ryan P. McCormack1, Lillian Gelberg4, John Rotrosen1, Tod Mijanovich5
1NYU School of Medicine, New York City, USA; 2NYC CIDI, New York City, USA; 3Vanderbilt,
Nashville, USA; 4UCLA, Los Angeles, USA; 5NYU Steinhardt School, New York City, USA
Correspondence: Kelly Doran - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A10
Background: Homelessness and substance use often coexist, with each issue exacerbating
the other. Both are prevalent among emergency department (ED) patients. Concurrent
screening and intervention to prevent homelessness might enhance the effectiveness
of ED-based SBIRT.
Materials and Methods: We conducted interviews with a random sample of New York City
(NYC) public hospital ED patients who screened positive for past year unhealthy alcohol
or drug use [using single-item screening questions (Smith et al. 2009, 2010)]. Adult
patients were eligible if they spoke English or Spanish, were medically stable, and
not in prison/police custody. Using patient identifiers, data were linked to the NYC
shelter administrative database, which captures 90% of NYC shelters. The primary outcome
was shelter entry within 6 months of the baseline ED visit, among patients who were
not already homeless at baseline.
Results: Interviews were conducted with 1,262 unique ED patients with unhealthy alcohol
or drug use who were not currently homeless. 8.5% had a shelter entry within the next
6 months. Self-judged risk of using a shelter in the next 6 months rated as “somewhat”
or “very likely” had 53.3% sensitivity and 26.5% PPV for future shelter entry. A brief
homelessness risk screening tool—developed via predictive modeling plus stakeholder
feedback—comprising 3 yes/no questions (shelter use in past year, applied for shelter
in past 3 months, lifetime incarceration history), with an affirmative answer to any
question considered a positive screen, had 85.0% sensitivity and 19.1% PPV.
Conclusions: A brief screening tool identified ED patients with unhealthy substance
use who were at risk for near-term homeless shelter entry with accuracy similar to
screeners developed for other populations, and exceeding the sensitivity of self-assessed
risk. If replicated, this screening tool or similar tools could be used to identify
which patients with unhealthy substance use may need targeted homelessness prevention
A11 Exploring a Complex Relationship: A Qualitative Study of Substance Use and Homelessness
Amanda Jurewicz1, Deborah Padgett2, Ziwei Ran2, Donna G. Castelblanco1, Ryan P. McCormack1,
Lillian Gelberg3, Donna Shelley1, Kelly Doran1
1NYU School of Medicine, New York City, NY, USA; 2NYU Silver School of Social Work,
New York City, NY, USA; 3University of California, Los Angeles, CA, USA
Correspondence: Kelly Doran - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A11
Background: Emergency department (ED) patients commonly face problems with both substance
use and homelessness. Research has suggested a bi-directional relationship between
substance use and homelessness, but most prior research has been quantitative and
cross-sectional. Better understanding this relationship could inform the design of
more responsive ED-based substance use interventions, including those that also address
Materials and Methods: We conducted in-depth, one-on-one interviews with ED patients
who had become homeless within the past 6 months. Using a semi-structured interview
guide, we asked patients about their pathways into homelessness and the relationship
between their substance use and homelessness. Interviews, on average lasting 42 min,
were digitally recorded and professionally transcribed. Transcripts were coded line-by-line
by 2–3 investigators, who discussed and refined codes in an iterative fashion. The
codes then formed the basis for thematic analysis and consensus discussions. ATLAS.ti
was used to assist with data organization.
Results: Of the 31 patients interviewed, 54.8% reported unhealthy alcohol use and
41.9% drug use in the past year; for others, substance use was only in the past. Five
themes emerged: (1) substance use often contributes to homelessness as an upstream
factor, through varied intermediary factors (e.g., job loss, family discord); (2)
homelessness affects substance use variably, both increasing (e.g., due to depression)
and decreasing substance use (e.g., due to lack of time); (3) substance use and homelessness
sometimes share precipitants, often related to interpersonal factors; (4) substance
use creates practical and environmental barriers relevant to homelessness (e.g., avoiding
shelters that might trigger relapse); (5) homelessness can both promote and hinder
entry into substance use treatment (e.g., may motivate “change”).
Conclusions: Substance use and homelessness are intertwined in complex ways. ED-based
substance use interventions should consider the high prevalence of homelessness and
the variable ways in which homelessness affects substance use and vice versa.
A12 Target populations for early interventions in gambling disorder
Anika Trachte, Dominique Brandt, Anja Bischof, Gallus Bischof, Bettina Besser, Svenja
Orlowski, Hannah Hoffmann, Tjorven Stamer, Hans-Jürgen Rumpf
Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
Correspondence: Anika Trachte - Anika.Trachte@uksh.de
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A12
Background: Gambling disorder is a rare but serious disease, and most affected individuals
do not seek treatment. Especially adolescents and young adults show a high prevalence
of subclinical gambling involvement, indicating that early interventions measures
might be promising. Aim of this study is to define suitable subgroups in a vocational
Methods: An unselected and non-treatment-seeking sample (n = 6,781) has systematically
been screened proactively in vocational schools in Schleswig–Holstein, Germany. Students
with at-risk or pathological gambling behavior (n = 1,809) according to the Stinchfield
questionnaire were asked to participate in three in-depth telephone interviews, one
at baseline, followed by two interviews after approximately 10 and 20 months. A subsample
of 405 potential participants were contacted for the baseline interview. Stability
of gambling involvement and associated socio-demographic variables were analyzed.
Results: The telephone assessments resulted in 309 valid baseline interviews (response
rate 78.7%), 268 in the first and 227 in the second follow-up. Of the baseline sample,
43.4% (n = 134) showed at least subclinical gambling involvement (2 or more DSM-5
criteria). Participants with at risk/pathological gambling were significantly more
often male (96.3%), had a migration background (72.4%), were single (66.4%), and had
a lower school education (88.0%) compared to participants without gambling problems.
Regarding the trajectory of gambling involvement, 44.3% reported deterioration of
their gambling behavior over time or maintained at least subclinical symptoms from
baseline to second follow-up.
Conclusions: Students in vocational schools show elevated levels of problematic gambling
patterns and can be successfully approached in this setting. Data show that symptoms
of pathological gambling are stable in this population and therefore should be addressed
using prevention measures. Response rates are comparable to other studies in the field
of substance-related Brief Interventions (BI). Implementing BI targeting pathological
gambling in vocational schools therefore seems to be a promising strategy.
A13 Screening and brief interventions for problematic Internet use in adolescents
and young adults
Dominique Brandt, Anja Bischof, Anika Trachte, Bettina Besser, Svenja Orlowski, Hannah
Hoffmann, Tjorven Stamer, Gallus Bischof, Hans-Jürgen Rumpf
Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
Correspondence: Dominique Brandt - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A13
Background: Problematic and pathological Internet use is an important current topic
in research and treatment of addictions. Especially adolescents and young adults constitute
a vulnerable group of users. Therefore, the effectiveness of brief interventions (BI)
to reduce problematic Internet use should be evaluated.
Method: Vocational students were screened proactively with the Compulsive Internet
Use Scale (CIUS) as well as with other impairment measures. Those with a CIUS score
higher than 21 were asked for permission to be approached for a telephone interview.
In case that at least two DSM-5 criteria for Internet use disorders were fulfilled
during the in-depth interview, participants were randomized into an intervention and
a control group. The intervention group received up to three counseling sessions based
on Motivational Interviewing. After five and ten months follow-up assessments were
Results: A total of 8,606 students were screened of which more than one-third (n = 3,142)
showed problematic Internet usage. This subgroup significantly showed higher impairment
in daily tasks and duties. In addition, approximately 80% were concerned to use certain
applications too much. Among the 1,481 screening-positive subjects eligible for study
participation, 934 interviews could be realized (Response rate 67%). Problematic or
pathological Internet use was discovered in 55% (n = 507) of the interviews. In this
ongoing study, vocational students’ accessibility via mobile phone proved to be challenging.
To realize one BI session several contacts were necessary.
Conclusion: Vocational schools are an appropriate setting for offering brief interventions
for pathological internet use due to elevated prevalence rates. However, motivation
of students to participate in counseling sessions was limited. Brief interventions
should be adapted for this target group for example by using smartphone applications.
Trial registration: NCT03646448.
A14 The Sustained Patient-centered Alcohol-Related Care (SPARC) Trial’s Use of Enhanced
Practice Coaching to Implement and Sustain Alcohol-related Care in Primary Care
Amy K. Lee1, Carol E. Achtmeyer2, Emily C. Williams3, Evette J. Ludman1, Julie E.
Richards1, Katharine A. Bradley1, Paula Lozano1, Rebecca L. Parrish4, Ryan M. Caldeiro4
1Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington,
Seattle, WA, USA; 2Center of Excellence in Substance Abuse Treatment and Education,
VA Puget Sound Health Care System, Seattle, WA, USA; 3Health Services Research and
Development Center of Innovations for Veteran-Centered and Value-Driven Care, VA Puget
Sound, Seattle, WA, USA; Department of Health Services, University of Washington,
Seattle, WA, USA; 4Kaiser Permanente Washington, Seattle, WA, USA
Correspondence: Amy Lee - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A14
Background: Practice coaches are effective for supporting quality improvement (QI)
in primary care (PC). Typically, PC teams possess the clinical expertise, and coaches
help teams implement process improvements. But what if PC teams do not have the clinical
knowledge needed to improve care? This report presents a model of enhanced practice
coaching used in the SPARC trial and findings based on performance metrics.
Methods: SPARC was a stepped-wedge pragmatic trial to implement evidence-based care
for unhealthy alcohol use in 22 PC clinics. At the request of operations partners,
SPARC was rolled out alongside a Behavioral Health Integration initiative. Prior to
SPARC, 19% of PC patients completed alcohol screening; there was no standardized assessment
for alcohol use disorder (AUD). The intervention had three components: front-line
PC support by practice coaches, electronic health record (EHR) tools, and performance
feedback. Practice coaches had weekly QI meetings with each clinic’s implementation
team for ~ 6 months (“active implementation”). Coaches addressed clinical knowledge
gaps, modeled destigmatizing language, and collaborated on EHR tools and performance
metrics development. Following active implementation, operations partners continued
quarterly QI meetings with PC teams (without coaches). We report findings from performance
metrics for all 22 clinics at the end of SPARC (7/2018), and sustainment eight months
later (3/2019): % completing alcohol screening among PC patients; and % completing
standardized assessment of DSM-5 AUD symptoms among patients with high-risk alcohol
Results: There were 37,093 PC patient visits across the 22 clinics in 7/2018, and
44,954 in 3/2019. Alcohol screening rates were 88% in 7/2018 and 89% in 3/2019. AUD
assessment rates of high-risk patients were 64% in 7/2018, and 70% in 3/2019.
Conclusion: Enhanced practice coaching can lead to sustained improvements. Based on
sustainment and staff/leader satisfaction, this implementation model has become a
“gold standard” for this health system.
A15 Secondary Evaluation of the Sustained Patient-centered Alcohol-related Care (SPARC)
Trial: Patient Reported Advice Across Primary Care Sites at Three Phases of Implementation
Emily C. Williams1,2, Madeline C. Frost1,2, Amy K. Lee3, Jennifer Bobb3, Julie E.
Richards3, Evette J. Ludman3, Carol E. Achtmeyer1, Malia M. Oliver3, Ryan M. Caldeiro3,
Rebecca L. Parrish3, Joseph E. Glass3, Paula Lozano3, Katharine A. Bradley3
1Health Services Research & Development Center for Veteran-Centered and Value-Driven
Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; 2Department
of Health Services, University of Washington, Seattle, WA, USA; 3Kaiser Permanente
Washington Health Research Institute, Seattle, WA, USA
Correspondence: Emily C. Williams - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A15
Background: To implement brief intervention for unhealthy alcohol use, SPARC tested
state-of-the-art implementation strategies—practice coaching, electronic health record
(EHR) decision support, and performance monitoring and feedback—in 22 clinics of Kaiser
Permanente Washington (KPW) from 01/15 to 07/18 using a stepped wedge design. Primary
results showed that the intervention significantly increased EHR-documented brief
intervention, but rates were very low (5%). This presentation uses data from a state-wide
patient experience survey conducted in the middle of the SPARC trial to report on
and compare rates of patient-reported receipt of brief intervention at sites surveyed
before, during or after active implementation.
Methods: From 08/17 to 11/17, the Washington Health Alliance survey included questions
assessing heavy episodic drinking (HED) and a question assessing receipt of alcohol-related
advice (a key component of brief intervention). Sites were categorized into 3 groups,
based on their randomly-assigned start date for the SPARC trial: those surveyed before,
during or after implementation. For each group of sites, we calculated the percent
of surveyed patients who reported alcohol-related advice (“% patient-reported brief
intervention”) among those reporting any HED, and compared % patient-reported brief
intervention at sites surveyed before, during and after implementation, using Chi-square
and test for trend.
Results: Five sites were surveyed before SPARC implementation, 3 during and 13 after;
% patient-reported brief intervention ranged 13.3% to 55.6% across sites. Rates of
patient-reported brief intervention in groups of sites surveyed before, during and
after implementation, respectively, were 40.9%, 47.9% and 39.2% (p-values for comparisons
all > 0.05).
Conclusions: Although rates of patient-reported alcohol-related advice were higher
than those based on EHR documentation, no differences in rates of patient-reported
brief intervention were observed before during and after SPARC implementation. As
in the main trial, results support further quality improvement efforts to ensure patients
with unhealthy alcohol use receive brief intervention.
A16 Preliminary evaluation of a mobile-based Brief Intervention for hazardous drinkers
Danielle Fernandes1, Abhijit Nadkarni2, Richard Velleman3, Urvita Bhatia1
1Addictions Research Group, Sangath-Goa, Porvorim, India; 2Department of Population
Health, The London School of Hygiene and Tropical Medicine, London, United Kingdom;
3Department of Psychology, University of Bath, Bath, UK
Correspondence: Danielle Fernandes - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A16
Background: Hazardous drinking (HD) is a major public health problem in India. However,
healthcare access is limited by the shortage of healthcare professionals. Extensive
global evidence demonstrates the effectiveness of technology-delivered BIs in reducing
alcohol consumption. Our study aims to increase healthcare access for HD, by designing
a contextually-appropriate mobile-based BI, and evaluating its acceptability, feasibility,
and preliminary impact.
Methods: Through a systematic review and in-depth interviews with experts and intended
recipients, initial content areas for the intervention were derived. These were presented
in a Delphi survey to 30 international experts, who rated each area on a five-point
Likert scale. At the end of this two-stage iterative process, content areas that reached
group consensus were synthesized to inform the intervention development. The draft
intervention was then delivered in a case series to participants who screened positive
for HD on the Alcohol Use Disorder Identification Test (AUDIT). At one-month follow-up,
in-depth interviews were conducted to understand the acceptability and feasibility
of the intervention. The preliminary impact was examined through changes in drinking
parameters measured using the Timeline-Follow-Back (TLFB).
Results: 26 content areas were derived from the systematic review and interviews,
and 22 of those met Delphi consensus. The intervention is currently being delivered
in the case series, and findings on acceptability, feasibility and impact will be
ready for presentation at the conference. Preliminary follow-up interviews (n = 11)
have indicated a preference for push messages and an app-based delivery. Higher number
of messages was cited as an engagement deterrent, with three messages per week considered
Conclusion: The content and delivery of the intervention will be iteratively refined
during the case series, and the final package will be pilot tested through a randomised
control trial. If demonstrated to be effective, the intervention will change the landscape
of interventions for HD in resource-constrained settings.
A17 Employment and living arrangement moderate the effectiveness of BI among university
Paula V. Gimenez, Karina Conde, Raquel Peltzer, Mariana Cremonte
Research Group on Psychoactive substances and injuries, Institute of Basic Psychology,
Applied and Development of Psychological Technology (IPSIBAT), National Scientific
and Technical Research Council (CONICET), National University at Mar del Plata (UNMdP),
Buenos Aires, Argentina
Correspondence: Paula V. Gimenez - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A17
Background: Although BI has shown to be effective among university students in high
income countries, little research has been done in Latin-America. Furthermore, evidence
examining moderators of intervention efficacy is scarce. Certain characteristics that
make alcohol more easily available to students, such as living outside of parental
control or having economic autonomy to spend money on alcohol, could moderate BI effectiveness.
The objective of this study is to evaluate the moderator role of the living arrangements
and the employment situation on BI effectiveness.
Materials and methods: Participants were 473 students from Mar del Plata National
University (60% women, 40% men; between 17 and 46 years old (M = 20.34, SD = 3.9)).
Prospective participants were screened and those with high-risk alcohol consumption
in the last 12 months were randomly assigned to a control group or BI. After 3 months,
they were re-assessed. The measures were: effectiveness (i.e. decrease in AUDIT scores
(yes/no)), employment situation (work: yes/no) and living arrangements (living with
family: yes/no). Fisher´s exact test was used to analyze the moderator effects of
living arrangements and employment situation on effectiveness. Logistic regression
analyses were performed in order to control the possible effect of age.
Results: 76% of students lived with their families, while 24% lived alone or with
friends; 42% of the students were employed. Living with family moderated (increased)
BI effectiveness (9,310, p = 0.01). Similarly, not having employment (i.e. being supported
by family) also moderated (increased) BI effectiveness (7,611, p = 0.02). These moderator
effects were not accounted for by age.
Conclusions: Living arrangement and employment moderated effectiveness of BI, suggesting
that restricted access to alcohol may improve the effectiveness of interventions among
A18 Who are the users of the Brazilian self-help intervention program “Bebermenos”
(drink less) who accepted to participate in a RCT to evaluate its effectiveness?
Maria Lucia O. S. Formigoni1, André L. M. Andrade2, Fabricio Landi-Moraes3, Gabrielle
1Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, SP,
Brazil; 2Faculdade de Psicologia, PUC-Campinas, Campinas, SP, Brazil; 3 Departamento
de Informática em Saúde, Universidade Federal de São Paulo. Sao Paulo, SP, Brazil;
4Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
Correspondence: Maria Lucia O. S. Formigoni - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A18
Background: The World Health Organization supported researchers from four countries
(Belarus, Brazil, India, and Mexico) in the development of an e-health self-help six-week
intervention to reduce alcohol use and related problems. Objective: To describe the
profile of users of this web-based intervention.
Materials and methods: From September 2016 to January 2019, 579 users who filled out
the AUDIT and were considered risk users, or possibly dependent, participated in a
Randomized Clinical Trial to evaluate the effectiveness of the intervention. Out of
579, 281 were randomly allocated to the experimental group (virtual Brief Intervention)
and 298 to the control group (waiting list). Six months after admission, follow-up
Results: Of the total sample, most participants (61.1%) were men and 50% were between
33 and 44 years old (median = 36 years). Regarding the classification based on AUDIT
scores, 17.8% were risk users (zone II), 16.4% presented harmful/hazardous drinking
(zone III) and most (65.8%) were classified as possible dependence users (zone IV).
The mean AUDIT total score was 22 (SD = 6.8) and participants reported having consumed
about 37 (median) standard drinks in the week prior to entering the program. Regarding
the Readiness to Change questionnaire scores, most participants were classified in
the contemplation phase.
Discussion: Although designed for at-risk users, most of the users who registered
on the site already had severe alcohol-related problems. These data suggest there
is a hidden population that should be under treatment for alcohol dependence, but
refuse to do it, do not look for it or even do not find available treatment. Internet
interventions could help these people by raising awareness of their alcohol-related
problems and encourage them to enter the action phase and look for treatment.
Trial registration: ISRCTN14037475.
A19 Increasing access to treatment services for alcohol and substance service users
in low income countries: lessons learnt from a trial brief intervention program in
Sylvia T. Nabirye, David Kalema
Hope and Beyond, Kampala, Uganda
Correspondence: Sylvia T. Nabirye - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A19
Background: Low income countries are faced with a growing challenge of negative alcohol
and substance use, yet interventions are scarce and rarely documented. Uganda is estimated
to have 3,900,000 people with alcohol use disorders, yet the country’s main source
of treatment for addictive disorders is the National Mental Referral Hospital situated
in the capital city. The aim of this paper is to highlight brief intervention as an
alternative treatment for Alcohol and Substance Use Disorders (SUD), the likely challenges
and potential solutions for this strategy in a low resource setting.
Methods: As a way of evolving culturally appropriate services, Hope and Beyond conducted
a 5 days’ residential camp to treat and sensitize communities about SUD. The pilot
treatment camp was held at Kisigula Health Centre (HC) II in Wakiso District; a metropolitan
area that houses many city dwellers and nationals from Uganda and surrounding countries.
Residents in the program catchment area were also mobilized to contribute towards
logistical needs of camp participants. Camp activities included screening and assessments,
detoxification and medications; psychotherapies; HIV counseling and testing, sensitization
workshops, prayers/spiritual support and referrals. Challenges faced ranged from logistical
to human resource constraints, yet many clients were in severe physical and mental
condition and low on motivation.
Results: Although the project was planned for 20 participants, 53 clients turned up
and were treated for SUD, 12 health workers from nearby medical centers were trained
in addiction management and sensitization was conducted in 11 Churches and 2 Mosques
reaching out to over 10,000 people.
Conclusion: Camp treatment as a way of brief intervention for alcohol and substance
use disorders is a promising practice for alternative SUD treatment that should be
adapted in low income countries but scientific studies are necessary to establish
A20 Clinical needs of participants in brief intervention treatment for alcohol and
other substance use in Kampala, Uganda
Hope and Beyond, Kampala, Uganda
Correspondence: David Kalema - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A20
Background: Brief intervention is promoted as a cost-effective measure to reduce alcohol
consumption and prevent alcohol-related harm. However, there is scant evidence on
its implementation in developing countries. This paper offers insight into the clinical
treatment needs of alcohol and other substance users in low income countries by reporting
the prevalence of alcohol and drug use disorders and the co-occurring illnesses amongst
residential treatment participants in Kampala, Uganda.
Methods: 53 participants (50 males and 3 females) reporting for a 5 day residential
treatment camp were interviewed regarding their perception of their physical and mental
wellbeing, and screened for drug use disorder(s) using the Alcohol and Substance use
Screening Involvement Tool. The treatment camp was held in the Wakiso District near
the capital city of Uganda, Kampala.
Results: Alcohol was the most commonly consumed drug, used by 66% of participants,
followed by nicotine and cannabis at 23% and 8% respectively. 43% were diagnosed with
a single substance use disorder and the remainder had multiple use disorders, of which,
36% reported addiction to two drugs and 18.3% used three or more drugs. 86% reported
co-occurring physical medical conditions such as fever, sexually transmitted diseases
(STI) and/or a cough; 40% reported psychiatric symptoms such as psychosis, insomnia
and bipolar; and 57% reported psychological symptoms such as depression and anxiety.
Conclusion: Participants of brief intervention treatment for alcohol and substance
use in low income settings have varying needs resulting from multiple drug use disorders
and other co-occurring medical, psychiatric and psychological illnesses. Brief interventions
for alcohol and substance use disorders delivered in free treatment camps should include
a range of additional services to meet the participants’ varying multiple and complex
needs. Further research is necessary to establish culturally sensitive effective treatment
approaches and modalities of brief interventions in developing countries.
A21 Impact of health disparities and brief counseling interventions on drinking outcomes
in hospitalized Trauma patients
Elizabeth B. White1, Emily Wall2, Elizabeth Shilling3, Laura Veach3, Mary C. O’Brien3,
1Wake Forest Baptist Medical Center, Winston Salem, NC, USA; 2Wake Forest Graduate
School of Arts & Sciences, Winston Salem, NC, USA; 3Wake Forest School of Medicine,
Winston Salem, NC, USA
Correspondence: Emily Wall - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A21
Background: Alcohol use has been shown to increase an individual’s likelihood to experience
a traumatic injury, particularly those who misuse, use at risky levels, or have a
use disorder. Based on this information, screening and brief counseling interventions
(BCIs) can be particularly impactful in hospital trauma center settings to address
these patterns. Recently, efforts have grown to understand health disparities in order
to provide the best treatment possible. This study aimed to understand how health
disparity related factors, namely age, geographic location, insurance type, and sex,
as well as two distinct BCIs uniquely predict changes in drinking patterns.
Methods: This study was a retrospective analysis on a pre-existing dataset collected
from hospitalized trauma patients to evaluate two different BCIs for patients with
alcohol-related injuries. The initial study found that both quantitative BCIs and
personalized BCIs were effective in reducing self-reported drinking patterns at a
six-month follow up with the AUDIT screening tool. This retrospective analysis sought
to add depth to these findings by understanding the impact that the aforementioned
factors have on predicting these same drinking patterns. After statistically controlling
for other variables, each unique health disparity factor and intervention type was
tested through hierarchical regressions to determine its contribution.
Results: Results demonstrated that regardless of health disparity factors or BCI type,
on average, patients displayed reduction in drinking patterns at the six-month follow
up. These results also indicated that though all patients experienced improvements,
females were more likely to show greater changes than men in either intervention.
Conclusion: Overall, this study supports and further highlights the evidence that
the use of BCIs containing more innovative and empathy-based approaches are appropriate
for impacting positive patient change behaviors. In addition, these study results
show that this more flexible approach is appropriate in sub-populations that are more
likely to experience health disparity.
A22 Addiction and Suicide Interventions Specialized for Trauma (ASIST) patients
Elizabeth H. Shilling, Laura J. Veach, Olivia H. Smith, Elizabeth B. White
Department of Surgery, Wake Forest Baptist Health, Winston Salem, NC, USA
Correspondence: Olivia H. Smith - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A22
Background: In 2010, over 650,000 hospital visits were related to attempted suicide.
Risk factors for suicide include substance use disorders, mental health disorders,
and other demographic and sociocultural factors (Hawton et al. 2013). Addressing both
substance use and suicidal ideation is critical in integrated care settings, as those
who have been previously hospitalized following suicide attempts are at significantly
greater risk of subsequent attempts and hospitalizations (O’Connor et al. 2015). The
aim of this preliminary study is to demonstrate the results of providing Screening
and Brief Interventions (SBI) for patients who have suicidal ideation (SI) or were
hospitalized due to a suicide attempt.
Materials and Methods: This preliminary study looked at the feasibility of SBI for
substance use and suicide in a Level-1 trauma center. A sample of patients were identified
based on hospitalization due to suicide attempt or SI comorbidity with substance use,
and were placed in either a control group or intervention group to receive a specialized
SBI. Hospital readmission rates were measured to identify the impact of these interventions.
Results: Of the intervention group, none of the patients were readmitted to the hospital
within thirty days due to repeated suicide attempts or SI. In contrast, within the
control group, 37.5% were readmitted within thirty days of their initial hospitalization,
of which 25% were hospitalizations related to additional suicide attempts or SI.
Conclusions: Preliminary findings support a positive trend: patients that received
specialized SBIs addressing both substance use and SI show a reduction in hospital
readmissions. Given these findings, further research is warranted regarding the effectiveness
of specialized SBIs in patients who have attempted suicide or active SI.
A23 Counselor-provided SBIRT for hospitalized adults with substance misuse or disordered
use: evaluating hospital utilization outcomes
Marcia H. McCall
Wake Forest School of Medicine, Winston Salem, NC, USA
Correspondence: Marcia H. McCall - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A23
Background: This study’s purpose was to determine whether SBIRT interventions by professional
counselors working on inpatient integrated care settings are effective treatments
for alcohol and illicit drug misuse and disordered use. Effectiveness was determined
by evaluating the association between interventions and subsequent hospitalizations
and emergency department visits. Inpatient settings were selected for study given
inconclusive results from prior research for this category of SBIRT recipient. This
study controlled for type (alcohol, illicit drugs, or both) and severity of substance
use, with inpatient clinical service as a clustering variable.
Materials and methods: Using a difference-in-differences approach and generalized
linear mixed modeling, 1,577 hospitalized patients receiving SBIRT interventions were
compared to 618 patients identified for but not receiving interventions, for a single
U.S. hospital over a four-year period. Utilization data were collected one year prior
to and following the identifying hospitalization, along with substance use type and
severity and clinical service. Propensity scores were developed from demographic,
disease, and insurance indicators and used as covariates.
Results: On average, patients receiving counselor-provided SBIRT interventions experienced
22% fewer subsequent hospitalizations and emergency department visits than patients
not receiving interventions, controlling for substance use type and severity. Outcomes
varied significantly across inpatient clinical services. The study sample was 74%
male and 73% White, with a mean age of 44.7 years.
Conclusions: The study tested a novel substance use treatment model, counselor-provided
SBIRT, for a population with a wide spectrum of substance use types and levels of
severity. The results offer support for this process as an effective treatment model
for reducing utilization of hospitalizations and emergency department visits. Given
these findings, health system administrators, physicians, and community leaders may
support integrating professional counselors into hospital units and other medical
settings, raising the likelihood that people who need help with their substance use
actually receive it.
A24 Scaling up a healthcare workforce to deliver Screening, Brief Intervention and
Referral to Treatment (SBIRT): a pilot project
Yovan Gonzalez, Sharon L. Kozachik, Deborah S. Finnell
Johns Hopkins School of Nursing, Baltimore, MD, USA
Correspondence: Yovan Gonzalez - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A24
Background: As the largest profession in the healthcare workforce, nurses have important
roles in moving evidence related to Screening, Brief Intervention, and Referral to
Treatment (SBIRT) to action to address the global burden associated with alcohol and
other drug (AOD) use. The purpose of this quality improvement project was to evaluate
an online self-paced educational program, Screening, Brief Intervention, and Referral
to Treatment (SBIRT) for Healthcare Providers among nurses in an ambulatory care facility
with the goal of increasing their knowledge in the screening and management of patients
with AOD use.
Methods: A one-sample, pretest–posttest design was used in this project. The Wilcoxon
Signed Rank Test was used to analyze results from the SBIRT-related knowledge test
from before to after the intervention. Descriptive statistics were used to analyze
data related to previous SBIRT education and confidence to deliver SBIRT in practice.
Thematic analysis was used to categorize barriers to and facilitators for SBIRT implementation.
Results: There was a significant increase in SBIRT-related knowledge (p < .001) from
before to after the intervention. A high proportion of the nurses had no SBIRT knowledge
(45%) prior to the intervention. Nurses reported high confidence levels to screen
for alcohol and drugs after the intervention. Barriers to and facilitators for SBIRT
implementation related to five themes: (1) time, (2) education, (3) resources, (4)
receptivity and (5) interprofessional collaboration.
Conclusion: It was feasible to deliver this online SBIRT education to nurses at a
busy ambulatory care facility and impactful in terms of increasing SBIRT-related knowledge
and confidence. To promote system-wide readiness for widescale dissemination, providing
this online program to other ambulatory care clinics and other healthcare professionals
A25 It’s not just what you do, it’s how you do it: variation in substance use screening
outcomes with commonly used screening approaches in primary care clinics
Jennifer McNeely1, Joseph L. Kannry2, Richard N. Rosenthal3, Sarah E. Wakeman4, Timothy
E. Wilens4, Sarah Farkas5, Angeline Adam5, Carmen L. Rosa6, Aimee Wahle7, Seth Pitts7,
1Dept. of Population Health, NYU School of Medicine, New York, NY USA; 2Icahn School
of Medicine at Mt. Sinai, New York, NY, USA; 3Stony Brook University Medical Center,
Stony Brook, NY, USA; 4Massachusetts General Hospital, Boston, MA, USA; 5NYU School
of Medicine, New York, NY USA; 6National Institute on Drug Abuse, Center for the Clinical
Trials Network, Bethesda, MD USA; 7The Emmes Company, Rockville, MD, USA
Correspondence: Jennifer McNeely - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A25
Background: Primary care clinics often struggle to choose the approach to alcohol
and drug screening that is best suited to their resources, workflows, and patient
populations. We are conducting a multi-site study to inform the implementation and
feasibility of electronic health record (EHR)-integrated screening.
Methods: In two urban academic health systems, researchers worked with stakeholders
from 6 clinics to define and implement their optimal screening approach. All clinics
used single-item screening questions for alcohol/drugs followed by AUDIT-C/DAST-10.
Clinics chose between: (1) screening at routine vs. annual visits; and (2) staff-administered
vs. computer self-administered screening. Results were recorded in the EHR, and data
was extracted quarterly to describe implementation outcomes including screening rate
and detected prevalence of unhealthy (moderate-high risk) use among those screened.
Findings are from the first 3–12 months post-implementation at each clinic.
Results: Across sites, of 84,311 patients with primary care visits, 58,492 (69%) were
screened. In the 4 clinics with mature (9–12 months) implementation, screening rates
ranged from 42 to 95%. Rates were lower (10–22%) in the 2 clinics that recently launched.
Screening at routine encounters, in comparison to annual visits, achieved higher screening
rates for alcohol (90–95% vs. 42–62%) and drugs (90–94% vs 38–60%). Staff-administered
screening, in comparison to patient self-administered screening, had lower rates of
detection of unhealthy alcohol use (2% vs. 15–37%). Detection of unhealthy drug use
was low, ranging from 0.3 to 1.5%.
Conclusions: EHR-integrated screening was feasible to implement in at least 4 of the
6 clinics; 1-year results (available Fall 2019) will determine feasibility at all
sites. Self-administered screening at routine primary care visits achieved the highest
rates of screening and detection of unhealthy alcohol use. Although limited by differences
among clinics and their patient populations, this study provides insight into outcomes
that may be expected with commonly used screening strategies in primary care.
ClinicalTrials.gov identifier: NCT02963948.
A26 Dissemination of a web-based program to reduce drug use in Mexico, are we ready
Marcela Tiburcio1, Nora Martínez-Vélez1, Morise Fernández1, Ma. Asunción Lara2
1Department of Social Sciences in Health, Instituto Nacional de Psiquiatría Ramón
de la Fuente Muñiz, Mexico City, Mexico; 2Department of Innovation and Global Health,
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
Correspondence: Marcela Tiburcio - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A26
Background: Web-based programs for substance use have been designed, evaluated and
implemented over the past two decades in high-income countries. The development of
such tools in Latin America is more recent. One of the few available web-based programs
is the Programa de Ayuda para Abuso de Drogas y Depresión (PAADD). Its feasibility
was demonstrated through a randomized trial. The next step is to design a strategy
to promote its implementation.
Methods: This study aimed at identifying the factors involved in the implementation
of technological innovation in Mexico. The level of readiness to adopt technologies
for health-care provision was measured with an adapted version of the Telehealth Capacity
Assessment Tool (TCAT), which considers 6 domains: organizational, technology, regulatory,
financial, clinical, and workforce factors. Free training was offered at 12 substance
use prevention and treatment institutions. The managers were asked to complete the
TCAT before the training.
Results: We received eight completed questionnaires: four from treatment centers affiliated
to Psychology Schools in two Universities; one from an immune-infectious clinic, and
three from Primary Care Centers for Addictions (PCCA). Additionally, professionals
who were trained provided information about: internet use; academic background; experience
in substance use treatment and attitudes towards the use of technology. The highest
TCAT scores (3–4.5) were observed at the clinic, showing a high degree of readiness
to implement web-based programs, the lowest scores (0–2.5) belong to the PCCA, where
the implementation is challenging.
Conclusions: The information provided by the professionals indicates a negative attitude
towards technology and less success in enrolling clients in web-based program at institutions
with a low TCAT score, while professionals at institutions with moderate scores were
more successful at enrolling and had positive attitudes. The data is relevant to create
a dissemination strategy to approach the misconceptions about web-based interventions
and facilitate its acceptance as a valid therapeutic alternative.
A27 Proactive computer-based interventions simultaneously targeting hazardous alcohol
consumption and depressiveness: preliminary findings from a randomized controlled
proof of concept trial
Christian Meyer1,2, Kristian Krause1, Diana Guertler1,2, Anne Moehring1,2, Jennis
Freyer-Adam2,3, Sophie Baumann2,3,4, Sabina Ulbricht1,2, Anil Batra5, Sandra Eck5,
Gallus Bischof6, Hans-Jürgen Rumpf6, Ulrich John1,2
1Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald,
Germany; 2DZHK (German Center for Cardiovascular Research), Partner Site Greifswald;
Greifswald, Germany; 3Institute for Medical Psychology, University Medicine Greifswald,
Greifswald, Germany; 4Institute and Policlinic for Occupational and Social Medicine,
Technische Universität Dresden, Dresden, Germany; 5Department of Psychiatry and Psychotherapy,
University Hospital of Tübingen, Tübingen, Germany; 6Department of Psychiatry and
Psychotherapy, University of Lübeck, Lübeck, Germany
Correspondence: Christian Meyer - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A27
Background: We developed a fully automatized computer-based intervention to address
alcohol consumption and depression simultaneously. In the present paper, we report
an initial proof of concept trial.
Methods: Participants were recruited via a multicenter screening program approaching
adult patients from ambulatory practices and hospitals. Inclusion criteria were hazardous
alcohol consumption and an episode of subclinical or clinical symptoms of depression
in the past year. Patients with current severe depression or indication of alcohol
dependence were excluded. In total, 132 participants were randomized to an assessment
only control or an intervention group receiving six individually tailored motivational
feedback letters and weekly text messages over a period of 6 months. Intervention
content was constructed based on the principals of the Transtheoretical Model of behavior
change. Outcome was assessed by computer-assisted telephone interviews scheduled 6,
12 and 24 months after baseline.
Results: Preliminary analyses were based on data from 6- (n = 104) and 12-month (not
completed, current state of April 2019: n = 107) follow-ups. Generalized estimating
equation analysis adjusting for recruitment setting, age, and sex revealed a significant
decrease in depression scores (p < .01) and no significant time effect for alcohol
measures. After 12 months, changes in alcohol and depression measures were numerically
larger in the intervention compared to the control group, with small to medium effect-sizes
(Cohen’s d: heavy drinking days = 0.36, mean daily consumption = 0.25, depression
score = 0.29), but statistical significance was only reached for frequency of heavy
drinking days (t-test, one-sided p = .03)
Conclusions: The intervention and research logistic proved to be technically feasible.
Based on our preliminary analysis, effects seem comparable to single focused motivational
interventions among unselected samples. Thus, a future adequately powered effectiveness
trial is warranted. Given the low baseline motivation to adopt healthy behaviors final
conclusion on effectiveness should be postponed to the availability of long-term outcome
Trial registration: German Clinical Trials Register DRKS00011635.
A28 How severity affects short-term effects of a computer-based brief intervention
addressing the full spectrum of alcohol use: results from a randomized controlled
Sophie Baumann1, Andreas Staudt2, Jennis Freyer-Adam3, Gallus Bischof4, Christian
Meyer1, Ulrich John1
1Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine,
Technische Universität Dresden, Dresden, Germany; 2Institute of Social Medicine and
Prevention, University Medicine Greifswald, Greifswald, Germany; 3Institute for Medical
Psychology, University Medicine Greifswald, Greifswald, Germany; 4Department of Psychiatry
and Psychotherapy, University Lübeck, Lübeck, Germany
Correspondence: Sophie Baumann - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A28
Background: The public health impact of brief alcohol interventions (BAIs) might be
increased by approaching an entire population rather than selected high-risk individuals
only. In this study, all persons who drink alcohol were offered BAI, including those
identified as having low-risk alcohol use or with greater severity. The aim was to
investigate the BAI efficacy during the active intervention phase as a function of
alcohol use severity.
Methods: In our ongoing randomized controlled trial (http://www.drks.de/DRKS00014274),
we systematically screened all persons aged 18–64 years appearing in the waiting area
of a local registration office over a period of two months. Those who reported alcohol
use in the past 12 months (n = 1,648) were randomized to BAI or assessment only. BAI
consisted of computer-generated individualized feedback letters delivered at baseline,
month 3, and month 6. Latent growth modeling was used to test BAI effects through
the 6 months of intervention as a function of the Alcohol Use Disorders Identification
Test-Consumption (AUDIT-C) score. By the cut-off date for this analysis, 6-month assessments
have been completed and two of three interventions have been delivered.
Results: The trial participation rate was 67%. Three- and 6-month retention rates
were 85% and 81%, respectively. Participants with lower AUDIT-C scores were more likely
to participate in the trial (OR = 1.07, p = 0.010) and in multiple BAIs (OR = 1.11,
p = 0.003) than those scoring high on the AUDIT-C. At month 6, BAI produced significant
changes in the number of drinks per week among participants with low AUDIT-C scores
(IRR = 0.83, p = 0.035). Effects decreased with increasing AUDIT-C scores (IRR = 1.04,
p = 0.048).
Conclusions: We provided a computer-based BAI that may be particularly appropriate
for the large but understudied group of persons with low severity. Twelve-month data
need to be included in analyses before we can draw more definite conclusions about
its efficacy in the population as a whole.
Trial registration: German Clinical Trials Register DRKS00014274.
A29 Screening for alcohol use disorder in the general population: an empirical investigation
of evidence-based assessments
Stéphanie Baggio1, Bastien Trächsel2, Valentin Rousson2, Frank Sporkert3, Jean-Bernard
Daeppen4, Gerhard Gmel4, Katia Iglesias5
1Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland; 2Division
of Biostatistics, Center for Primary Care and Public Health, University of Lausanne,
Lausanne, Switzerland; 3Centre of Legal Medicine, Forensic Toxicology and Chemistry
Unit, Lausanne and Geneva Universities, Lausanne, Switzerland; 4Addiction Medicine,
Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland; 5School
of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland,
Correspondence: Stéphanie Baggio - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A29
Background: Population-based screening of alcohol use disorder (AUD) are crucially
needed for public health planning. Evidence-based measurements are needed, but empirical
studies comparing different self-reported measures to a gold standard are scarce.
This study aimed at identifying a valid screening tool.
Methods: This Swiss controlled study collected data among young men from the ongoing
Cohort Study on Substance Use and Risk Factors, using a stratified random sample selection
(n = 233). AUD was diagnosed using the Diagnostic Interview for Genetic Studies (gold
standard). Self-reported measures included criteria of AUD, alcohol-related consequences,
and previous twelve-month alcohol use. We tested psychometric performances of the
self-reported measures deriving sensitivity and specificity from receiver operating
characteristics curves and using all possible subsets of questions.
Results: Taken separately, none of the self-reported measures displayed good psychometric
properties, maximizing sensitivity and specificity. This was true for the self-reported
AUD (cut-off of two or more symptoms: sensitivity = 92.3%, specificity = 45.8%; cut-off
of four or more symptoms: sensitivity = 60.3%, specificity = 87.1%) and alcohol use
(cut-off of 10 drinks per week: sensitivity = 85.9%, specificity = 55.5%; cut-off
of 21 drinks per week: sensitivity = 38.5%, specificity = 93.6%). The best model combined
8 self-reported AUD criteria and 4 alcohol-related consequences. With a cut-off of
3, this screening tool displayed good sensitivity (83.3%) and specificity (78.7%).
Conclusions: These findings provided important insights among young men in current
debate in the alcohol field: heavy alcohol use was not a suitable single criterion
to assess AUD and consequences were important to identify a valid assessment. Even
if alcohol use is not part of the final screening tool, it should not be neglected,
as it is responsible of a large burden of disease and detrimental health consequences.
A30 Assessing heavy alcohol use and risky single occasion drinking using an alcohol
biomarker among young Swiss men
Katia Iglesias1, Frank Sporkert2, Jean-Bernard Daeppen3, Gerhard Gmel3,4,5,6, Stéphanie
1School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western
Switzerland, Fribourg, Switzerland; 2Centre of Legal Medicine, Forensic Toxicology
and Chemistry Unit, Lausanne and Geneva Universities, Lausanne, Vaud, Switzerland;
3Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne,
Vaud, Switzerland; 4Addiction Switzerland, Lausanne, Vaud, Switzerland; 5Centre for
Addiction and Mental Health, Toronto, ON, Canada; 6University of the West of England,
Bristol, UK; 7Division of Prison Health, Geneva University Hospitals and University
of Geneva, Thônex, Geneva, Switzerland; 8Department of Forensic Psychiatry, Institute
of Forensic Medicine, University of Bern, Bern, Switzerland
Correspondence: Katia Iglesias - Katia.Iglesias@hefr.ch
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A30
Background: Empirical studies on the quality of self-reported alcohol use as measures
of excessive drinking compared to objective measures, such as ethyl glucuronide (EtG),
are needed. In addition, associations of EtG with risky single occasion drinking (RSOD,
i.e., ≥ 6 drinks on a single occasion) have been scarcely investigated. This study
tested whether self-reported measures of alcohol use and RSOD allow detecting excessive
chronic drinking as assessed by EtG.
Methods: Data were collected among young Swiss men, recruited in the ongoing Cohort
Study on Substance Use and Risk Factors using a stratified random selection. Assessments
included self-reported measures of alcohol use (previous twelve-month and previous-week)
and RSOD. Capillary blood was collected to determine EtG (n = 227). Data were analyzed
using receiver operating characteristics curves, using EtG (cut-off of 30 pg/mg) as
the gold standard of excessive drinking. Sensitivity and specificity were computed.
We also performed a multivariate logistic regression to test whether alcohol use and
RSOD were uniquely associated with EtG.
Results: Overall, 23.4% of the participants presented a chronic excessive drinking
according to the EtG cut-off of 30 pg/mg. For previous twelve-month alcohol use, a
cut-off > 15 drinks per week yielded acceptable psychometric performance (sensitivity = 75.5%,
specificity = 78.7%). No cut-off maximized sensitivity and specificity for previous-week
alcohol use. Weekly RSOD detected EtG with acceptable psychometric properties (sensitivity = 75.5%,
specificity = 70.1%). Sensitivity and specificity were respectively maximized for
monthly RSOD (sensitivity = 94.3%) and daily RSOD (specificity = 98.9%). In the multivariate
logistic regression, both previous twelve-month alcohol use with a cut-off of 15 and
weekly RSOD were significantly associated with EtG (respectively p < .001 and p = .022).
Conclusion: Self-reported measures of RSOD and of previous twelve-month alcohol use
were acceptable measures of excessive drinking for population-based screening. Self-reported
RSOD appeared as an interesting screening measure to identify accurately excessive
drinking among young people.
A31 Development of the COS for health economic research on alcohol brief interventions
Jeremy Bray1, Carolina Barbosa2
1University of North Carolina at Greensboro, Greensboro, NC, USA; 2RTI International,
Chicago, IL, USA
Correspondence: Jeremy Bray - JWBRAY@uncg.edu
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A31
Background: Systematic reviews suggest that cost-effectiveness evidence for ABI in
emergency care and hospital settings is scarce and that the cost-effectiveness evidence
for primary care is not based on a consistent set of economic outcomes. These reviews,
as well as future economic evaluations of ABI, are hampered by the lack of a consensus
on what economic outcomes should be measured in ABI evaluations. In this presentation,
we present a preliminary methodology to establish a core outcome set (COS) for economic
evaluations of ABI. This COS is intended to be supplemental to the COS developed for
ABI trials by the INEBRIA Research Measurement Standardization Special Interest Group
Methods: We present a rapid review of the ABI economic evaluation literature as a
first step towards developing an ABI economic COS. Our review began by first mining
the existing Outcome Reporting in Brief Intervention Trials: Alcohol (ORBITAL) systematic
review database to assess outcomes use in previous economic evaluations of ABI trials.
We then supplemented the ORBITAL review with a rapid review specifically designed
to identify any gaps in our literature database.
Results: We find that ABI economic evaluations seldom use consistent measures, but
an increasing number of studies report quality adjusted life years (QALYs) in addition
to measures of social costs. Studies suggest that the RMS-SIG should consider measures
of: health state utility as derived from health-related quality of life; health care
use; injuries and accidents, including motor vehicle accidents; crime and criminal
justice involvement; employment, workplace productivity, and absenteeism; and, for
adolescent studies, educational outcomes such as school attendance and matriculation.
Conclusion: To support the development of a rigorous evidence base for the economic
benefits of ABI, the RMS-SIG should develop a core set of economic outcome measures
that build on the ORBITAL COS.
A32 Development of a COS for implementation studies on alcohol brief interventions
Amy J. O’Donnell1, Anne H. Berman2, Zarnie Khadjesari3
1Newcastle University, Newcastle upon Tyne, UK; 2Karolinska Institutet, Center for
Psychiatry Research, Stockholm, Sweden; 3University of East Anglia, Norwich, UK
Correspondence: Amy J. O’Donnell - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A32
Background: With robust evidence for effectiveness, recent alcohol screening and brief
intervention (ASBI) studies have focused on the challenge of encouraging their implementation
in routine healthcare. However, as in other intervention fields, outcomes to assess
ASBI implementation are currently defined in different ways, and assessed by different
measures. Under the INEBRIA Research Measurement Standardization Special Interest
Group (RMS-SIG), progress has been made to establish a core outcome set to assess
ASBI effectiveness and efficacy. However there remains a need to identify which implementation
outcome measures are most appropriate for this field. This presentation will identify
which outcomes and associated measurement instruments are currently employed in implementation-focused
research overall, and consider their potential applicability to ASBI.
Methods: We scrutinised existing systematic reviews (Proctor 2011; Lewis 2015; Khadjesari
unpublished) to identify outcomes and associated measurement instruments employed
in implementation-focused research. We also searched databases of outcomes assessed
in the existing ASBI trial literature (Shorter et al. in press) to determine whether
any appropriate implementation outcomes/measures were included.
Results: Proctor’s taxonomy identifies a core set of implementation outcomes (acceptability;
adoption; appropriateness; cost; feasibility; fidelity; penetration; sustainability).
However whilst previous research has employed various implementation outcome measures
with relevance to mental, behavioural and/or physical health (n = 154 studies), most
assess intervention acceptability (n = 77) and/or adoption (n = 27), and are of relatively
low psychometric quality. There is a particular need to develop instruments to assess
feasibility, appropriateness and sustainability. Current ASBI trials do not collect
implementation outcome data or employ relevant measurement instruments when assessing
Conclusions: Recognised outcome taxonomies exist to support efforts to improve the
quality and consistency of ASBI implementation research. However, there is an identified
lack of robust instruments to support their measurement. Future research is needed
to evaluate the status of ASBI implementation research, and to develop/validate instruments
relevant to the field.
A33 Predictive models for the emergence of alcohol or other drug use problems during
ages 12–18: opportunities for targeting screening and brief interventions
Stacy Sterling1, Stacey Alexeeff1, Beth Waitzfelder2, Brian K. Ahmedani3, Joseph Boscarino4,
Timothy Frankland2, Amy Loree2, Yong Hu2, Felicia Chi1
1Kaiser Permanente Northern California Division of Research, Oakland, CA, USA; 2Kaiser
Permanente Center for Health Research, Honolulu, HI, USA; 3Center for Health Policy
& Health Services Research, Behavioral Health Services, Henry Ford Health System,
Detroit, MI, USA; 4Geisiger, Canville, PA, USA
Correspondence: Stacy Sterling - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A33
Background: Substance use (SU) problems significantly impact many adolescents. Early
identification and intervention can be beneficial, yet clinical tools for facilitating
identification are lacking. We developed and validated predictive models of adolescent
SU problem emergence, using clinical and demographic data from four health systems.
Methods: This observational, electronic health records (EHR)-based retrospective cohort
study identified a birth cohort of 41,176 adolescents, born between 1997 and 2000
in Kaiser Permanente Hawaii, KPHI; Kaiser Permanente Northern California, KPNC; Geisinger
Health System, GHS and Henry Ford Health System, HFHS, with continuous membership
since birth, allowing a 12-month gap. We examined data on demographics, socioeconomic
status, diagnoses, risk behaviors, prescriptions and services utilization from 0 to
12, and data on diagnoses received by adolescents 12–18. The outcome was development
of an SU use disorder between ages 12–18, defined as either: (1) a non-tobacco SU
diagnosis, or (2) an SU treatment program contact. We used Cox regression models to
develop a baseline model with child and maternal predictors occurring before age 12
as time-invariant predictors, and a series of time-varying models with final baseline
model predictors plus diagnoses that teens received 12–18 as time-varying predictors.
Results: Age, gender, race/ethnicity and Medicaid-insured status, ADHD, conduct disorders,
headache, oppositional defiant disorder and trauma/stress-related disorders before
age 12 were associated with SU problems by 18, along with maternal SU disorders, major
depression, and other depressive disorders. In the time-varying models, several early
predictors were no longer significant if not also present between 12 and 18. Trauma/stress
diagnoses, self-harm, injury/poisoning, and headache remained significant predictors
even in the absence of later diagnoses.
Conclusion: Many early mental health problems alone are not predictive of adolescent
SU disorders, but ongoing, persistent comorbidities seem to predict the development
of adolescent AOD problems. Predictive models of this kind may inform targeted screening
and intervention efforts.
A34 Brief intervention for cannabis, alcohol, and sex-risk behaviors for adolescents
in school-based health centers: comparison with assessment-only historical control
Jan Gryczynski1, Shannon G. Mitchell1, Robert P. Schwartz1, Kristi Dusek1, Kevin E
O’Grady2, Courtney D. Nordeck1
1Friends Research Institute, Baltimore, MD, USA; 2University of Maryland, College
Park, MD, USA
Correspondence: Jan Gryczynski - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A34
Background: School-based health centers (SBHCs) have emerged as important clinical
settings in the US for expanding access to healthcare for underserved adolescents.
SBHCs could hold promise as sites in which to deliver brief intervention (BI) for
Methods: Participants were adolescents aged 14–18 who screened positive for risky
cannabis and/or alcohol use on the CRAFFT screener at two urban school-based health
centers (SBHCs). A sample of adolescents were enrolled in a randomized trial of computer-
vs. nurse practitioner-delivered BI (N = 300). Additionally, in the year prior to
launching the trial, we enrolled an assessment-only cohort of adolescents using the
same recruitment protocol and inclusion/exclusion criteria (N = 50). Participants
completed assessments at baseline, 3-, and 6-month follow-up. The current study compared
outcomes for the BI conditions with the historical assessment-only cohort. Frequency
of cannabis, alcohol, unprotected sex, and sex while intoxicated at follow-up were
examined using negative binomial regression, controlling for participant sex, age,
clinic site, and baseline value of the outcome.
Results: There were no significant differences between computer- and nurse practitioner-delivered
BI conditions on reported past-30-day frequency of cannabis, alcohol, unprotected
sex, or sex while intoxicated. At 3-month follow-up, the pooled BI conditions had
lower past-30-day frequency of alcohol use (IRR = .43; 95% CI = .29, .64; p < .001)
and cannabis use (IRR = .74; 95% CI = .57, .97; p = .03) than the assessment-only
cohort. At 6-month follow-up, the pooled BI conditions had lower frequency of alcohol
use (IRR = .58; 95% CI = .34, .98; p = .04) and sex while intoxicated (IRR = .42,
95% CI = .21, .83; p = .01) than the assessment-only cohort.
Conclusions: Although we found no differences between two approaches to delivering
BI at SBHCs on the outcomes considered, on average, participants who received a BI
reported greater behavioral risk reductions than participants in a recent historical
cohort that received no intervention.
Trial registration: NCT02387489.
A35 A randomized trial of adolescent SBIRT in rural U.S. health centers: establishing
90 day substance use change in standard care participants
Shannon G. Mitchell, Laura B. Monico, Jan Gryczynski, Robert P. Schwartz
Friends Research Institute, Baltimore, MD, USA
Correspondence: Shannon G. Mitchell - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A35
Background: The proposed presentation will include an overview of an on-going stepped-wedge
randomized trial of adolescent SBIRT being conducted at 4 rural health centers in
the United States. The study examines the effectiveness of delivering the full range
of provider interventions using the FaCES (Facilitating Change for Excellence in SBIRT)
approach. FaCES includes a prescribed set of responses (anticipatory guidance, abbreviated
BI, full BI) based on S2BI screening results. Adolescent patients, age 12–17 years,
will receive either the FaCES intervention or standard care, depending on when their
provider is randomized to begin delivering the intervention.
Methods: As of March 31, 2019 a total of 621 patients had been recruited into the
study across 4 rural U.S. health centers. Of those, 381 standard care control condition
participants had also completed their 3-month follow-up interview, which included
a re-administration of the S2BI assessing past 90 day substance use. Paired-samples
t-tests were conducted to compare baseline with follow-up self-reported past 90 day
use of tobacco, marijuana, and alcohol.
Results: Among the 381 standard care participants in the follow-up sample, 52% were
female, 67% were white, and 34% were Hispanic. Significantly higher rates of alcohol
use in the past 90 days were reported at follow-up (M = .366, SD = .66) than at baseline
(M = .276, SD = .54); t(379) = − 3.4845, p = .0006. No significant differences were
noted in past 90 day use rates of either tobacco or marijuana.
Conclusions: In order to interpret the effectiveness of adolescent SBIRT interventions
it is important to include a standard care arm to track changes in substance use,
which can fluctuate rapidly during adolescence. Early data indicate that reported
alcohol use may increase for patients receiving standard care over the 3-month follow-up
A36 Polysubstance use patterns and HIV disease severity among those with substance
use disorder: Latent Class Analysis
Nicolas Bertholet1, Michael Winter2, Timothy Heeren3, Alexander Walley4, Richard Saitz5,6
1Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University
of Lausanne, Lausanne, Switzerland; 2Biostatistics and Epidemiology Data Analytics
Center, Boston University School of Public Health, Boston, Massachusetts, USA; 3Department
of Biostatistics, Boston University School of Public Health, Boston, Massachusetts,
USA; 4Clinical Addiction Research and Education Unit, Section of General Internal
Medicine, School of Medicine and Boston Medical Center, Boston University, Boston,
Massachusetts, USA; 5Clinical Addiction Research and Education Unit, Section of General
Internal Medicine, School of Medicine and Boston Medical Center, Boston University,
Boston, Massachusetts, USA; 6Department of Community Health Sciences, Boston University
School of Public Health, Boston, Massachusetts, USA
Correspondence: Nicolas Bertholet - Nicolas.Bertholet@chuv.ch
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A36
Background: Polysubstance use is common among people living with HIV infection (PLWH)
and substance use disorder (SUD) but its effects are under-studied. We aimed to (1)
identify polysubstance use patterns over time with latent class analysis, and (2)
assess their associations with HIV disease severity.
Methods: We studied a prospective cohort of 233 PLWH who also had SUD. Latent class
analysis identified polysubstance use patterns based on the Alcohol Use Disorders
Identification Test (consumption) and past 30-day use of cannabis, cocaine, opioids,
and tranquilizers. We categorized changes in substance use patterns over 12 months
and tested associations between those changes and CD4 cell count and HIV viral suppression
at 12 months in linear and logistic regressions, adjusting for demographics.
Results: At baseline, three patterns (classes) were identified: 18% did not use any
substance (NONE), 63% used mostly cannabis and alcohol (CA), and 19% used mostly opioids,
cocaine, tranquilizers, cannabis and alcohol (MULTI). At 12 months, 61% were in the
same class. Forty percent decreased the number of substances used (MULTI to CA, either
to NONE) or remained as NONE; 43% were in CA both times; and 17% increased (NONE to
CA or either to MULTI, including remaining MULTI). Adjusted mean CD4 count was lower
among participants increasing substance use (mean [95% CI] 446 [318–574]) and among
those in CA both times (464 [373–556]) compared to those who decreased or abstained
throughout (605 [510–700], p = 0.005). No significant difference was observed for
HIV viral suppression.
Conclusions: We identified distinct substance use patterns among PLWH and SUD: cannabis/alcohol,
and opioids with alcohol and other drugs. Patterns changed over time, and changes
towards fewer substances or no use were associated with better HIV disease severity
(based on CD4 count). Findings may inform clinical advice for PLWH and SUD.
Supported by: U01AA020784/U24AA020778/U24AA020779/UL1TR001430.
A37 Improved pain control and interpersonal relationships among older adults receiving
buprenorphine therapy: results of a pilot study
J. Paul Seale1, Amanda Abraham2, Samantha Harris2, J. Aaron Johnson3, Keerthika Ravikumar1,
Omar Ahmad1, Mansi Amin1, Jorge del Rio1, Parth K. Patel1, Huma Rahman1, Kirk Von
Sternberg4, Mary M. Velasquez4
1Department of Family Medicine, Navicent Health, Macon, Georgia, USA; 2School of International
and Public Affairs, University of Georgia, Athens, Georgia, USA; 3Institute of Public
and Preventive Health, Augusta University, Augusta, Georgia, USA; 4Steve Hicks School
of Social Work, University of Texas, Austin, Texas, USA
Correspondence: J. Paul Seale - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A37
Background: While the U.S. opioid use disorder (OUD) epidemic affects large numbers
of young adults, a significant minority of patients are older adults. The highest
overdose rate is among those age 45–54. OUD in this population is poorly described.
Recognition of barriers and bridges to treatment in older adults could increase treatment
Materials and methods: Structured interviews were conducted with 25 individuals age
45 and older receiving outpatient buprenorphine therapy in a small southern U.S. city.
Results: Mean age was 56 years. Mean age at first opioid use was 30.5. Most widely
used opioids included hydrocodone (n = 23), oxycodone (23), methadone (4) and heroin
(4). All met DSM 5 criteria for OUD (mean number of criteria 8.68). Six (24%) reported
previous overdose. Most reported prior medication assisted treatment (MAT) with methadone
(n = 12, 48%) or buprenorphine (n = 19, 76%). Referrals by family/friends were more
common than physician/medical referrals [13 (52%) vs. 5 (20%)]. Patients’ concerns
before starting MAT included how to control pain (58%), cost (50%), medication side
effects (50%), and feeling MAT was “just another addiction” (42%). Reported benefits
on MAT were regaining control of their lives (100%), absence of withdrawal (92%),
improved relationships with friends/family (92%), better health (88%), decreased risk
of overdose (88%), and less pain (80%). Most patients with chronic pain (20/21, 95%)
reported pain control was equal or better than with other opioids.
Conclusions: Older adults with OUD are at significant risk of overdose. Concerns include
pain control, cost, and potential side effects. In this pilot study, buprenorphine
effectively managed pain for almost all patients. Clinicians providing SBIRT services
should provide information regarding buprenorphine’s effectiveness in controlling
chronic pain and common side effects. Policy makers should be urged to support access
to MAT at low cost in order to increase the number of older adults accessing MAT.
A38 Other drug use is common in hospital patients willing to start alcohol use disorder
medication treatment: screening data from a comparative effectiveness trial
Esperanza Romero-Rodriguez1, Susie Kim1, Clara Chen1, Debbie Cheng1, Henri Lee2, Tibor
Palfai3, Jeffrey Samet2, Richard Saitz1
1Boston University School of Public Health, Boston, MA, USA; 2Boston University School
of Medicine, Boston, MA, USA; 3Boston University College of Arts and Sciences, Boston,
Correspondence: Richard Saitz - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A38
Background: Drug use is common in people with alcohol use disorder (AUD) and opioid
use can preclude use of naltrexone to treat it. The aim of this study was to describe
substance use, and specifically opioid use, in adults with AUD, who were eligible
to start naltrexone during hospitalization.
Methods: Adult inpatients with AUD (DSM5) and at least one past-month heavy drinking
day (HDD) who had no naltrexone contraindications were enrolled in the Alcohol Disorder
hOsPital Treatment (ADOPT) randomized trial comparing oral and extended-release naltrexone
at discharge. AUD was assessed by the following: AUD and Associated Disabilities Interview
Schedule-5 (AUDADIS-5); past 30-day alcohol use by the Timeline Followback; and past
3-month other drug use by the Alcohol, Smoking and Substance Involvement Screening
Results: Of 821 patients screened who met AUD criteria, 11% were excluded due to opioid
use. Among the first 176 participants enrolled, 82% were men, 48% black, 42% white;
13% were Hispanic; mean age was 50 ± 10 years. Participants reported mean 11 ± 11
standard (14 g) drinks/day, 20 ± 10 HDDs/month, mean percent HDD 68 ± 32. Almost half
(48%) reported cannabis use and 27% reported cocaine use; 41% and 31%, respectively,
had a moderate or high risk ASSIST specific substance involvement score.
Conclusion: Illicit drug use is common among medically hospitalized patients with
alcohol use disorder. However, opioid use specifically only excludes a small minority
of potential patients from receiving naltrexone for their AUD. Nevertheless, as drug
use and disorder may affect prognosis and treatment selection, it should be considered
in treatment planning.
A39 Behavioral economics indices predict alcohol use and consequences in young men
at 4-year follow-up – a target for brief intervention?
Jacques Gaume1, James G. Murphy2, Gerhard Gmel1, Joseph Studer1, Jean-Bernard Daeppen1,
1Lausanne University Hospital, Lausanne, Switzerland; 2University of Memphis, Memphis,
Correspondence: Jacques Gaume - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A39
Background: According to the behavioral economics framework, substance use is more
likely when constraints on use are minimal and when there are important constraints
on access to substance-free reinforcers. For example, alcohol is a potent reinforcer,
but its consumption is sensitive to constraints on access (including drink price)
and the presence of alternative reinforcers. The alcohol purchase task (APT) presents
a scenario and asks participants how many drinks they would purchase and consume at
different prices. It has been used among students and small clinical samples and has
not been tested using long-term prospective design.
Methods: We administered the APT to a large sample of 4790 Swiss young men from the
general population. Among those, 4326 (90.3%) were successfully followed-up 4 years
later [mean age 21.4 and 25.4 (sd = 1.3)]. Parameters derived from the APT at baseline
were used to predict weekly drinking, monthly binge drinking, maximum drinks in one
occasion, alcohol-related consequences, and DSM-5 alcohol use disorder criteria.
Results: Intensity (planned consumption when drinks are free) and Omax (maximum alcohol
expenditure) were significantly correlated with all outcomes (r range: 0.25–0.37 for
Intensity, 0.17–0.28 for Omax, all p < 0.001). Breakpoint (price at which consumption
was suppressed) and Elasticity were significantly, but weakly correlated with outcomes
(r range: 0.09–0.12 for Breakpoint, − 0.07 to 0.11 for Elasticity, all p < 0.001).
Pmax (price at which demand became elastic) was not a significant predictor. Regression
analyses controlling for baseline value of outcome showed consistent findings.
Conclusions: Behavioral economics measures are useful in characterizing alcohol demand
in young men from the general population and have long-term predictive value. Integrating
behavioral economics components in BI models has been proposed but seldom tested.
Potential for this approach will be discussed.
A40 Analyzing profiles of co-occurring risk among low-income SBIRT patients engaged
in federally-qualified health centers in the United States
Michael A. Lawson1, Shanna A McIntosh2, Lauren Holmes2, David L. Albright2, Jacqueline
1College of Education, University of Alabama, Tuscaloosa, AL, USA; 2School of Social
Work, University of Alabama, Tuscaloosa, AL, USA
Correspondence: Michael A. Lawson - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A40
Background: The aim of this study is to analyze how substance use and mental health
risks present themselves among different sub-populations of patients who “screen in”
for SBIRT services. A secondary purpose is to explore how analyses of patient risk
can be used by SBIRT program staff to enhance clinical intervention and training.
The setting for the study is an SBIRT program serving low-income, Federally Qualified
Health Centers (FQHC) in the Southeastern United States.
Methods: Latent Class Analysis (LCA) was used to model different profiles of substance
use and mental health risk/difficulty among 600 patients with qualifying DAST-10 or
Audit scores. These models were estimated using the DAST-10, the Audit, and the PHQ-9
for depression. In addition, patient age, race/ethnic status, and sex (as a binary)
were analyzed for their association with each risk profile.
Results: Median age = 42 (range 20 to 72), 42% women 38% white, 62% African American.
LCA yielded three characteristically different risk profiles among patients with qualifying
AUDIT/DAST-10 scores. These profiles included a “Drugs Only” class (70%) comprised
of patients who screened-in for brief intervention. A second risk profile, the “Dual
Vulnerability” (25%) class, included patients who engaged in regular binge drinking
and had DAST-10 scores that qualified them for brief intervention. The third risk
profile, the “Severe Vulnerability” class (5%), was indicated by severe alcohol abuse,
related behavioral difficulty, depression, and qualifying DAST-10 scores. Last, our
regression analyses indicated that these profiles could be partially differentiated
by patient age, sex, and ethnicity.
Conclusions: These sub-population profiles, together with their respective correlates,
can be used by program staff to improve clinical practice and training. Specifically,
an analysis of interview data suggested that these profiles were useful in helping
program leaders develop modified scripts for motivational interviewing and client
engagement among qualifying patients.
A41 Screening and brief interventions to reduced unhealthy alcohol use and improved
subjective mental health: results of Prague RCT study
Ladislav Czemy, Bohumil Seifert, Zuzana Dvorakova
Centre of Epidemiological and Clinical Research in Addictions, National Institute
of Mental Health, Klecany, Czech Republic
Correspondence: Ladislav Czemy - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A41
Goal: To evaluate the effects of brief intervention to reduce unhealthy alcohol use
in primary care setting.
Background: The Czech Republic belongs to countries with high per capita alcohol consumption.
Screening and brief intervention in primary health care may reduce harmful alcohol
Materials and methods: 161 patients (61% were males) of 699 were identified as hazardous
or harmful drinkers in ten offices of general practitioners using the ASSIST v.3 or
AUDIT‐C screening tests. Patients were assigned into intervention group 1 (intervention
provided by the doctor) and intervention group 2 (only feedback from screening and
self‐help materials were provided).The baseline mean alcohol consumption calculated
BSQF method was compared with consumption after 3 months.
Results: The results showed that in the intervention group 1 there was a statistically
significant decrease in the total mean alcohol consumption from 262.6 grams of alcohol
per week to 175.2 g (t = 3.64; df = 89; p < .001; Cohen‘s d = 0.36). With the exception
of consumption of spirits, a statistically significant decrease in consumption was
found in beer (from 162.5 to 101.5 grams per week) and wine (from 92.5 to 52.5 grams
per week). Total alcohol consumption also decreased in the intervention group 2 from
194.6 to 155.0 grams per week, but the difference in means did not reach statistical
significance (t = 1.45; df = 32; p = 0.158). Subjectively perceived mental health
improved in group 1 as well.
Conclusions: The results suggest that brief interventions implemented in primary care
are effective and can be recommended for implementation into primary health care.
A42 An application of deviance regulation theory to increase safe drinking strategies
in first year students
Robert Dvorak, Angelina Leary
Department of Psychology, University of Central Florida, Orlando, FL, USA
Correspondence: Robert Dvorak - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A42
Background: Many students come to university relatively inexperienced with alcohol,
which may increase alcohol-related consequences. Several interventions exist to combat
this problem. However, recent research suggests these interventions may not be as
successful as initially thought. The current study investigates the use of a relatively
new web-based intervention, grounded in Deviance Regulation Theory (DRT), aimed at
increasing alcohol Protective Behavioral Strategies (PBS).
Methods: College freshmen participants (n = 157) were randomly assigned to one of
three conditions: a positive message about individuals who use PBS, a negative message
about individuals who do not use PBS, or an attention control condition. Participants
then completed weekly assessments examining alcohol-related behaviors for six weeks.
Participants also reported norms of PBS use each week.
Results: Findings replicated previous research, showing actual PBS use increases across
time among those with initially high PBS norms who also received a negative message
about non-PBS use (b = 0.120, p = .022). Further, there was an increase in PBS norms
across time (b = 0.023, p = .019). The growth in the effectiveness of the negative
message was related to increases in PBS norms across time (r = .129, p < .001). There
were no immediate effect of the positive message. However, within-subjects analyses
showed that within a given week, the positive message was associated with increased
weekly PBS among those with low weekly PBS norms, a finding consistent with DRT prediction.
Conclusion: These results suggest that DRT works by (a) increasing PBS use across
time among those who receive a negative message by also increasing PBS norms and (b)
increasing PBS use at the event level as a function of current PBS normative beliefs.
The results indicate an in-the-moment DRT intervention may be beneficial for first-time-in-college
A43 Pharmacy undergraduates’ alcohol use and perceptions to supporting those with
Aliya Khan, Ranjita Dhital
Pharmacy Department, University of Reading, Reading, UK
Correspondence: Ranjita Dhital - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A43
Background: Young people (18–24 years) are more likely to ‘binge drink’ and increase
their health risks than other age groups. There is growing evidence that health staffs’
attitudes affect alcohol service delivery. This research aims to identify alcohol
use amongst UK final-year pharmacy undergraduates and explore if alcohol consumption
and other characteristics are related to perceptions to supporting those with alcohol
Methods: Mixed-methods approach was used to: screen students’ drinking using the Alcohol
Use Disorders Identification Test (AUDIT); measure attitudes to support patients using
a modified version of the Short Alcohol and Alcohol Problems Perception Questionnaire
(SAAPPQ); and explore students’ perceptions toward supporting drinkers through a focus
Results: 54 students (44 female, age-range 21–25 years) from 106 participated (51%
response). Mean AUDIT was 3.46 [S.D. ± 4.58]; 19% (N = 10) were higher risk (AUDIT ≥ 8),
mean AUDIT = 11.4 [S.D. ± 3.01]; and 82% (N = 44) were low risk drinkers (AUDIT ≤ 7),
mean AUDIT = 1.66 [S.D. ± 2.36]. Median total attitudes (most positive = 7 and least
positive = 1) was 3.8 (range 4.2 to 3.5), close to neutral. Non-parametric tests identified
higher-risk drinkers had significantly higher work-satisfaction (P = 0.013) and total
positive attitudes toward this patient group (P = 0.013) compared to low-risk drinkers.
Also, smokers (N = 8) had significantly higher work-satisfaction (P = 0.034) and total
positive attitudes (P = 0.034) compared to non-smokers (N = 46). Focus group (involving
8 students) identified themes relating to work environment, social influences, alcohol
education and stigma as possible factors relating to alcohol use and support.
Conclusions: Most students were low-risk drinkers with neutral attitudes to supporting
patients. Students wanted further alcohol education and counselling skills during
their pharmacy degree to support this patient group for future clinical practice.
Smokers and higher-risk drinkers had more positive attitudes. These findings require
further examination, especially if experience of alcohol use and smoking may enhance
knowledge and relatability to drinkers.
A44 Comorbid depression in alcohol users: refining target groups for brief alcohol
interventions in medical care settings
Diana Guertler1,2, Anne Moehring1,2, Kristian Krause1, Jennis Freyer-Adam2,3, Sabina
Ulbricht1,2, Gallus Bischof4, Hans-Jürgen Rumpf4, Anil Batra5, Sandra Eck5, Sophie
Baumann1,2,6, Ulrich John1,2; Christian Meyer1,2
1Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald,
Germany; 2DZHK (German Center for Cardiovascular Research), Partner Site Greifswald,
Greifswald, Germany; 3Institute for Medical Psychology, University Medicine Greifswald,
Greifswald, Germany; 4Department of Psychiatry and Psychotherapy, University of Lübeck,
Lübeck, Germany; 5Department of Psychiatry and Psychotherapy, University Hospital
of Tübingen, Tübingen, Germany; 6Institute and Policlinic for Occupational and Social
Medicine, Technische Universität Dresden, Germany
Correspondence: Diana Guertler - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A44
Background: Medical care provides a suitable setting to reach large numbers of alcohol
users. As comorbid depression adds to the maintenance of risky alcohol use, the effectiveness
of brief interventions (BI) might be enhanced by adjusting them to depression severity.
The aim of this paper was to estimate comorbid depressive symptom severity and presence
of major depression along the full continuum of alcohol use.
Methods: Medical care patients aged 18–64 years were proactively approached for an
anonymous health screening (participation rate = 87%, n = 12,828). Continuous alcohol
use measures were derived from an expanded Alcohol Use Disorder Identification Test
(AUDIT): alcohol consumption per day and occasion, excessive consumption days and
the AUDIT sum score. Depressive symptoms for the worst 2-week period in the last year
were assessed with the Patient Health Questionnaire (PHQ-8). Negative binomial and
logistic regression analyses were used to predict depressive symptom severity (PHQ-8
sum score) and presence of major depression (PHQ-8 sum score ≥ 10). Fractional polynomials
were applied to model potential non-linearity.
Results: Data revealed curvilinear relationships of depressive symptom severity and
presence of major depression with all alcohol use measures after controlling for socio-demographics
and health behaviors (P < 0.05). Lowest depressive symptom severity and odds of major
depression were found for alcohol consumptions of 1.1 g per day, 10.5 g per occasion,
one day of excessive consumption per month, and those with an AUDIT sum score of 2.
Higher values were found for abstinence and higher consumption levels. Women and younger
individuals showed higher depression outcomes along the full continuum of alcohol
use with steeper risk slopes compared to men and older individuals.
Conclusions: Increases of depressive symptom severity and odds of major depression
were already evident in alcohol users drinking below the established limits for low
risk drinking. Findings demonstrate the public health relevance of screening for depressive
symptoms within alcohol users. Especially women and young individuals may benefit
from dual focus BI.
A45 Hazardous alcohol consumption in depressed health care patients – associations
with health-related quality of life
Kristian Krause1, Diana Guertler1,2, Anne Moehring1,2, Gallus Bischof3, Hans-Jürgen
Rumpf3, Anil Batra4, Thomas Kohlmann5, Ulrich John1,2, Christian Meyer1,2
1Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald,
Germany; 2DZHK (German Center for Cardiovascular Research), Partner Site Greifswald,
Greifswald, Germany; 3Department of Psychiatry and Psychotherapy, University of Lübeck,
Lübeck, Germany; 4Department of Psychiatry and Psychotherapy, University Hospital
of Tübingen, Tübingen, Germany; 5Institute for Community Medicine, University Medicine
Greifswald, Greifswald, Germany
Correspondence: Kristian Krause - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A45
Background: Previous research revealed that individuals with alcohol use problems
and comorbid depression or anxiety report less health-related quality of life (HRQOL)
than those with alcohol use problems alone. Here we analyze how the presence of comorbid
hazardous alcohol consumption is associated with HRQOL in depressed health care patients
Method: Consecutive HCPs from ambulatory practices and general hospitals were systematically
screened. We recruited 589 participants (61.5% female, mean age 39.3 years) reporting
an episode with clinical or subclinical depressive symptoms in the past year. Among
those, 134 (22.8%) reported hazardous alcohol consumption. HRQOL was measured by the
Veterans Rand 12 Item Health Survey (VR-12). Multivariate regression analyses controlling
for sociodemographics and recruitment setting were conducted to analyze associations
between hazardous alcohol consumption and the physical (PCS) and mental component
score (MCS) of the VR-12.
Results: Hazardous alcohol consumption was significantly associated with the PCS (Beta = .118,
p = .001) but not with the MCS (Beta = .048, p = .255) of the VR-12 when controlling
for covariates. Regarding the PCS subscales, significant associations were found for
general health perception (Beta = .126, p = .001), physical functioning (Beta = .099,
p = .008), and bodily pain (Beta = .105, p = .008). Among the MCS subscales, significant
associations were found for energy/vitality (Beta = .134, p = .002) and social functioning
(Beta = 1.28, p = .002).
Discussion: Hazardous alcohol consumption was associated with better HRQOL in depressed
HCPs. This could imply that hazardous consumption was used to effectively cope with
depressive symptoms. However, the results should be interpreted with caution. Due
to the cross-sectional nature of our data, causal interpretations are precluded. Furthermore,
non-linear associations between depression and alcohol consumption may have existed.
Our analysis, however, was restricted to linear associations.
A46 Computerized screening and clinical decision support can increase primary care
provider delivery of brief intervention for unhealthy drug use: baseline results from
a pilot study of the Substance Use Screening and Intervention Tool (SUSIT)
Jennifer McNeely, Medha Mazumdar, Antonia Polyn, Steven Floyd, Akarsh Sharma, Donna
Shelley, Charles Cleland
Dept. of Population Health, NYU School of Medicine, New York, NY USA
Correspondence: Jennifer McNeely - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A46
Background: Primary care providers (PCPs) face multiple barriers to offering substance
use interventions, including lack of time, knowledge, and information about their
patients’ drug use. We developed a tablet-based Substance Use Screening and Intervention
Tool (SUSIT) to assist PCPs by delivering screening results and clinical decision
support for conducting brief intervention (BI) to address unhealthy drug use. The
SUSIT screener is a self-administered brief screen (SUBS) and modified WHO-ASSIST.
This pilot study examined whether the SUSIT increases delivery of BI during primary
Methods: Adult patients completed tablet-based screening in the waiting room, and
identified their drug of most concern (DOMC). Those with moderate-risk use of any
drug (without high-risk alcohol or drug use) were eligible. A pre-post design compared
participants enrolled during the control period to a new group of participants enrolled
during the intervention period, in which PCPs received the SUSIT. All participants
completed an after-visit survey documenting the elements of BI delivered by the PCP,
and a 90-day timeline follow-back.
Results: The 78 participants (42 control, 36 intervention) were majority male (76%),
with a mean age of 46 (SD = 13). Marijuana was the most prevalent DOMC (n = 52 (66.7%));
cocaine was the second most prevalent DOMC (n = 7 (9.0%)). Mean days of use of the
DOMC in the past 90 days was 38.8 (SD = 37.7). During the intervention period, PCPs
used the SUSIT with 31 of 36 (86%) participants. Participants in the intervention
condition were more likely to report receiving BI [(n = 33 (91.7%) vs. n = 17 (40.5%),
P < 0.001]. The intervention group also received more elements of BI [median = 9.5,
mean 7.8 (SD = 4.5) vs. median = 0, mean 2.7 (SD = 4.3); P < 0.001].
Conclusions: Providing drug use screening information and clinical decision support
to PCPs increased the delivery of BI during routine primary care visits. Future analyses
will examine changes in drug use behavior 3 months post-intervention.
Trial registration: ClinicalTrials.gov registration number: 16-01074.
A47 Consumption of psychoactive substances in tuberculosis patients: interface to
adherence to treatment and brief intervention
Sônia Suelí S. E. Santo1, Angela Maria M. Abreu1, Luciana F. Portela2, Larissa R.
1Department of Public Health, Anna Nery School of Nursing, Federal University of Rio
de Janeiro, Rio de Janeiro, RJ, Brazil; 2Evandro Chagas Infectology Institute, FIOCRUZ,
Rio de Janeiro, RJ, Brazil
Correspondence: Sônia Suelí S.E. Santo - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A47
Background: Association of the use of psychoactive substances and tuberculosis make
diagnosis and treatment a barrier to reach universal coverage of the disease worldwide.
Objectives: To identify the profile and the pattern of consumption of psychoactive
substances of patients undergoing tuberculosis treatment in the network of basic health
services; to analyse the adherence to the treatment of patients of tuberculosis who
consume these substances and perform brief intervention in this clientele from the
perspective of the adherence to the tuberculosis treatment.
Methods: Sectional study, carried out in primary care units in the modality of the
Family Health Strategy, in Rio de Janeiro, with a sample of 114 patients in the treatment
of tuberculosis using the ASSIST. The exposure variable was the consumption of psychoactive
substances and the outcome variable adherence to treatment. In the first phase the
brief intervention was carried out, in the stages of feedback, due guidance and empathically.
In the second phase after two months, a search was performed on the medical record
for confirmation or non‐compliance.
Results: Prevalence in the male population 71.1%, median age 39 years, incomplete
primary schooling 52.6%, brown skin color 42.1%, family income > 1 minimum wage, 74.5%
lived with relatives. Prevalence for tobacco 28.0%, alcoholic beverages 12.3%, marijuana
5.4% and cocaine/Crack 3.5%. Regarding adherence, after two months of Brief Intervention,
with a survey in the patients’ charts, a higher prevalence of adherence was observed
in the male population, over 40 years old, with medium/high school education, married
and living in union, whites received up to 1 minimum wage, live with relatives, adhered
to the treatment of tuberculosis.
Conclusions: These results demonstrate the importance of brief interventions applied
by health Professionals with these patients, decreasing the incidence of infected
and bacilliferous patients, prone to the spread of the disease.
A48 Prevalence of alcohol misuse problem (AMP) recognition within those meeting criteria
for alcohol misuse: A meta-analysis
Panagiotis Spanakis1, Jessica Smith1, Rachael Gribble2, Sharon Stevelink2, Roberto
Rona2, Nicola Fear2, Laura Goodwin1
1University of Liverpool, Liverpool, UK; 2King’s College London, London, UK
Correspondence: Panagiotis Spanakis - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A48
Background: Recognition of AMP is a fundamental stage in the psychological process
of taking action to change behaviour and, if necessary, seek treatment. Several studies
have identified that AMP recognition is a significant correlate of help-seeking, while
lack of recognition is a barrier to help. A systematic review and meta-analysis were
conducted to estimate the prevalence of AMP recognition within individuals meeting
validated AMP criteria.
Methods: We searched PsycInfo, Web of Science, Scopus and MedLine using the keywords:
problem*; recogni* OR perceive* OR perception OR self-identif*; alcohol. We identified
studies that reported weighted or unweighted frequencies of individuals who meet criteria
for AMP (e.g. AUDIT scores or DSM criteria) and who self-identified their problems,
self-recognised a need for receiving help, or have passed the pre-contemplation stage
for taking action on their problems. Studies were eligible if they were published
between 2000 and 2019 in English and included an adult sample. Studies were excluded
if the study used a sample of adolescents, university students, or illicit drug users.
A random-effects model meta-analysis was used to estimate the pooled prevalence of
AMP recognition with 95% CIs.
Results: 27 papers were included in the meta-analysis (N = 77,081, on average 73%
were male). Seventeen studies included participants with at least hazardous drinking
and ten studies included participants with alcohol use disorder (AUD). Thirteen studies
examined AMP recognition directly (self-identification), eight studies examined stage
of change, and six studies examined need for help. Preliminary results showed that
the pooled prevalence of AMP recognition was 42% (95 CI = 34%–51%).
Conclusion: Less than half of those with AMP recognise their problems. Given the importance
of AMP recognition in the process of change, future research should focus on policies
and interventions that could help the affected individuals increase their self-awareness
regarding their AMP.
A49 Designing an alcohol brief intervention targeted at the unemployed
Mike Jecks1, Laura Goodwin1, Mark Gabbay1, Caryl Beynon2, Matt Field3
1University of Liverpool, Liverpool, UK; 2Public Health England, Liverpool, UK; 3University
of Sheffield, Sheffield, UK
Correspondence: Mike Jecks - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A49
Background: Problematic drinking is associated with unemployment, and this association
may be bidirectional (Department for Work and Pensions 2015). Unemployment has been
associated with depression (Zuelke et al. 2018) as well as boredom (De Witte et al.
2012) which in turn may be linked to increased alcohol consumption (Mercer-Lynn et
al. 2011; Patrick and Schulenberg 2011) as well as increased likelihood of relapse
in alcohol and substance use (Corvinelli 2005). This paper aims to investigate the
potential links between alcohol use, unemployment, and drinking motives including
boredom, with a view to designing an Alcohol Brief Intervention for those out of work
based on this information.
Methods: The study recruited employed (n = 94) and unemployed (actively seeking employment)
(n = 94) individuals through social media. The groups were compared on their drinking
habits (Alcohol Use Disorder Identification Test), drinking motivations (Drinking
Motivations Questionnaire), and recent feelings of boredom and low mood. MANOVAs were
run to explore the between group differences, with adjusted regressions examining
the role of potential confounders.
Results: The average age was 33.05 (SD = 10.902) years, with more females (73.5%)
recruited. Unemployed participants scored significantly higher on the AUDIT [F(1,164) = 8.59,
p < 0.01], coping [F(1,164) = 9.80, p < 0.01], and boredom[F(1,164) = 14.83, p < 0.01]
drinking motivations compared to the employed group. These motivations were significantly
positively associated with higher AUDIT scores in the unemployed group when controlling
for demographic, depression, and boredom scores.
Conclusion: The study shows that problematic alcohol use is more common in the unemployed
and demonstrates the links between alcohol use and unemployment, with boredom and
coping as two key motives among the unemployed for increased drinking. Further qualitative
work will seek to engage those who are out of work to further understand the link
between boredom and alcohol use in the unemployed. This will then be used to develop
an Alcohol Brief Intervention which will be targeted at the unemployed.
A50 Adaptation, for Indigenous teenagers, of an alcohol and drugs screening test:
Jennifer Beauregard1, Myriam Laventure1, Chantal Plourde2, Joël Tremblay2
1Université de Sherbrooke, Sherbrooke, Canada; 2Université du Québec à Trois-Rivières,
Correspondence: Jennifer Beauregard - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A50
Background: In order to improve interventions efficiency among Indigenous teenagers,
adapting questionnaires to their cultural reality is paramount. In fact, without this
cultural adaptation, the results obtained with these questionnaires could minimize
or exaggerate the extent of youth’s difficulties. The present study adapted the Detection
of Alcohol and Drug Problems among Teenagers (Landry et al. 2004).
Method: Crees (anglophones) and Attikamekws (francophones) have collaborated to the
validation of this screening test. A first step constituted in a co-building process
allowing for the development of an initial version of the DEP-ADO adapted to Indigenous’
cultural reality. During a second step, 20 youth have filled the adapted version and
have taken part in focus groups aimed to give them the opportunity to comment their
understanding and usefulness of such a grid for Indigenous Youth. Finally, during
a third step, a second adapted version of the test was administered to Youth from
three communities (N = 421, average age 14.75) for a final validation.
Results and conclusion: The main challenge was to make sure that the wording and the
examples were easily understandable and make sense for Indigenous Youth. For examples:
changing the questionnaire response options, give examples to help understand the
issues at stake, review the phrasing of the questions. During the focus groups, youth
reported that many questions or concepts were difficult to understand and needed to
be reworded or clarified. Also, as some questions are more sensitive, participants
reported experiencing shame and hesitating to answer accurately. Regarding the reliability,
the DEP-ADO (adapted) scales indicated that alcohol scale (α tet = 0.91), drugs scale
(α tet = 0.86), risk factors scale (α tet = 0.88) and global score (α tet = 0.93)
had adequate reliability for Indigenous Youth. The one-factor latent structure was
confirmed for all scales.
A51 Implementation of a Parenthood and Addiction Program: programs based on probative
data vs practices based on probative data
Myriam Laventure, Marie-Josée Letarte, Jennifer Beauregard
1Université de Sherbrooke, Sherbrooke, Canada
Correspondence: Myriam Laventure - Myriam.Laventure@USherbrooke.ca
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A51
Background: Less than 10% of the organizations treating addiction include parenthood
support in their treatment plan. The Parent Management Training (PMT) programs have
proven their efficiency among the parents who have an addiction. These programs based
on probative data and relying on the best practices are, however, not easy to implement
in some practice environments. Two approaches are in opposition; the one of a program
type based on probative data and the one of a practice type based on probative data.
How can we maintain the equilibrium between the «ingredients» associated to a program’s
efficiency and the implementation in all the different practice environments?
Method: Developed in order to meet the specific needs of the families in which parents
are addicted to alcohol or drugs, the PMT Cap sur la famille was implemented in addiction
treatment centers in Quebec. However, in consideration of regional particularities,
the program could not be implemented in its entirety uniformly. A consultation was
carried out in order to identify the factors that could hamper the implementation
of this type of program in the practice environments. In total, 17 addiction treatment
centers (22 standardized interviews) have been consulted.
Results and conclusion: During consultation and despite the acknowledgement of the
need for a PMT program specific to the clientele in addiction, managers and addiction
workers agreed that the implementation feasibility of the PMT program presents important
challenges on human resources and facilities aspects. Up to now, 8 addiction treatment
centers are implementing the program, each with its adapted formula. Aspects such
as dosage, intensity, content and clientele reached needed to be adapted while respecting
the best practices recommendations. The steps taken, the various versions of the program
and the implementation quality will be discussed according to the practice based on
A52 Association of perceived parental disapproval with marijuana and alcohol use among
urban US high school students receiving brief intervention
Courtney D. Nordeck, Kristi Dusek, Shannon G. Mitchell, Robert Schwartz, Jan Gryczynski
Friends Research Institute, Baltimore, MD, USA
Correspondence: Courtney D. Nordeck - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A52
Background: Adolescent substance use poses serious physical and mental health risks
that can extend into adulthood. Parental disapproval of substance use is commonly
considered an important protective factor for prevention of risky adolescent behaviors.
Less is known about the role of parental disapproval among youth who have initiated
risky substance use and are candidates for brief intervention.
Methods: Adolescents ages 14–18 with risky alcohol and/or marijuana use were recruited
from two US urban school-based health centers into a randomized trial comparing a
computer versus nurse practitioner-delivered brief intervention. This secondary analysis
examines the relationship between perceived parental disapproval of substance use
and adolescents’ frequency of marijuana and alcohol use at baseline, 3-, and 6-month
follow-up. Measures of parental disapproval were aligned with questions from national
epidemiological survey data. Generalized estimating equations were used to examine
trajectories of alcohol and marijuana use frequency by level of perceived parental
disapproval, adjusting for identified covariates.
Results: Compared to national norms, youth in this sample reported low parental disapproval
of substance use. Nevertheless, perceived parental disapproval was associated with
fewer days of marijuana use (ps < 0.01; e.g., at baseline, mean [SD]: 14.39 [11.39]
versus 9.96 [9.73] days). The relationship between parental disapproval and frequency
of alcohol use was non-significant (p = 0.06). Level of perceived parental disapproval
did not yield different trajectories of use frequency over time for marijuana (p = 0.59)
or alcohol (p = 0.92), nor did the brief interventions perform differently based on
level of perceived parental disapproval (p = .90 and .29 for marijuana and alcohol,
Conclusions: Perceived parental disapproval of substance use may play a role in tempering
frequency of marijuana use, even among youth who already meet risk thresholds for
intervention. Degree of parental disapproval may be important to consider in the design
of brief interventions for adolescents to reduce substance use and promote healthy
A53 Barriers to the implementation of brief interventions in primary care centers
for addictions in Northwest Mexico
Ana L. Jimenez-Perez1, Eunice Vargas-Contreras1, Kalina I. Martinez-Martinez2, Marcela
1Universidad Autonoma de Baja California, Ensenada, Baja California, Mexico; 2Universidad
Autonoma de Aguascalientes, Aguascalientes, Mexico; 3Instituto Nacional de Psiquiatria
Ramon de la Fuente Muniz, Ciudad de Mexico, Mexico
Correspondence: Eunice Vargas-Contreras - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A53
Background: In Mexico, there are 324 Primary Care Centers for Addictions (CAPA) responsible
for providing services to individuals with problematic alcohol or drug use. National
practice guidelines recommends the delivery of Brief Interventions (BI) as a means
to address substance use‐related problems. However, in the Northwest of Mexico, as
in the rest of the country, BIs have not yet been routinely implemented.
Methods: The objective of this descriptive study was to determine which factors hinder
the implementation of BI from the perspective of 102 therapists working at 17 different
CAPA located in the Northwest of Mexico. A questionnaire with internal consistency
level of alpha .89 was used to collect data.
Results: The results suggest that the frequency with which participants read scientific
documents during their time as addiction therapists, as well as their knowledge about
BI, explain 68.55% of the variance of their use of BI. However there is also limited
information on the content of the treatment currently provided by therapists in this
region. Although substance use treatment has been provided by CAPAs for over 12 years,
there has not yet been any evaluation of existing provision by local authorities.
Conclusions: We conclude that it is necessary to develop relevant strategies to stimulate
the use of BI in CAPAs, including face‐to‐face training, and feedback to demonstrate
the benefits associated with implementation. It is also necessary to strengthen local
health policies to better support providers to deliver BI for substance use, in order
to reduce the high consumption of alcohol and other drugs in the region.
A54 Experiences of encountering outpatients with problematic substance use in the
Elisabeth Petersén, Anna Thurang, Anne H. Berman
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet,
& Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
Correspondence: Elisabeth Petersen - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A54
Background: High co-morbidity is known to exist between mental illness and problematic
substance use. In patients seeking psychiatric care, 20–30% have been found to have
problematic substance use, most often alcohol. Living with problematic alcohol consumption
can contribute to a sense of exclusion, a sense of not complying with society’s norms,
where seeking help for problematic alcohol consumption can be experienced as stigmatizing
and challenging for the patient. Offering effective digital interventions for reducing
alcohol consumption among patients in psychiatry might help reduce the feeling of
stigma or shame and lead to more patients seeking help.
Methods: Exploratory study with a qualitative design. Data from interviews with outpatient
psychiatry clinic directors and focus groups with clinical staff were evaluated using
content analysis inspired by phenomenological-hermeneutic methodology.
Results: The experience of encountering patients with problematic substance use and
elucidating visions of digital interventions resulted in three themes with corresponding
sub-themes: Bridging the organizational gap was illuminated by: having an established
collaboration and facing difficulties in the collaboration. Having beliefs about the
patient you encounter was illuminated by: working with stigmatized patients and stigmatizing
the patient. Striving to achieve a therapeutic alliance was illuminated by: having
a feeling of developing together and supporting the patient towards recovery.
Conclusions: Caring for patients with problematic substance use was perceived by psychiatric
health care professionals as difficult. They felt that a lack of resources and knowledge
were obstacles in their work. Cooperation between psychiatry and dependency care often
led to problems. Being able to work with digital screening and digital interventions
in the future was perceived by the participants as positive and as a potential opportunity
to overcome the gap between psychiatry and dependency care.
A55 Brief intervention to motivate behaviour change in women with risky and harmful
Divane de Vargas, Talita Dutra Ponce
Sao Paulo University, School of Nursing, Sao Paulo, Brazil
Correspondence: Divane de Vargas - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A55
Background: A significant number of women attending Primary Health Care (PHC) services
are drinking at risky or harmful levels, with increased prevalence of problematic
consumption patterns in this population in recent years. Therefore, the delivery of
coping strategies and prevention measures in PHC settings has been suggested, including
Brief Interventions (BI) for alcohol. BI focuses on increasing patients’ motivation
for behavior change and has demonstrated positive effects on women drinkers. Objective:
To assess the effectiveness of BI on increasing the motivation to change, drinking
behavior in women attending PHC services with at-risk/harmful use of alcohol.
Methods: Randomized clinical trial with 20 women who screened positive for at-risk/harmful
alcohol consumption using the Alcohol Use Disorder Identification Test (AUDIT) at
a PHC service. Participants were randomly divided into two groups; the Intervention
Group (IG) who participated in the BI (20 to 30-min individual session using motivational
techniques) and the Control Group (CG) who received Brief Advice (BA) (feedback on
the pattern of alcohol consumption). Outcomes were assessed at baseline and at follow‐
up after one and three months. For the intragroup and intergroup analysis, the generalized
linear model was used, and for all tests, ≤ 0.05 value was considered significant.
Results: Data suggest the effectiveness of BI in the stages of readiness to change
alcohol use (IG - pre-BI 4.89, post 1st BI 6.67, p = 0.12). The results observed on
the CG (pre-BA 3.27, post 1st BA 3.09, p = 0.77), did not show significant pre/post
increase in stages of readiness
Conclusions: BI delivered in a PHC setting has the potential to increase stages of
readiness to change drinking behavior.
Trial registration: RBR65262c.
A56 Systematic reviews of brief intervention in pregnancy: quality assessment with
Vanderléa P. Cabral1,2, Ângela M. M. Abreu3, José M. B. Lima4, Carlos A. F. Andrade5
1Fernandes Figueira National Institute/Fiocruz, Rio de Janeiro, RJ, Brazil; 2Anna
Nery Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil; 3Public Health
Department, Anna Nery Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil;
4Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil; 5Department of Epidemiology
and Quantitative Methods in Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
Correspondence: Vanderléa Poeys Cabral - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A56
Background: Drinking alcohol during pregnancy can cause harm to the woman and the
fetus. Studies have shown promising results from brief interventions combined with
the early detection of alcohol consumption in pregnancy in relation to the prevention
of such damages. National and international guidelines have concluded that there is
no safe dose of alcohol ingestion during pregnancy. The aim of this study is to assess
the quality of the systematic reviews of brief interventions to avoid alcohol consumption
among pregnant women.
Methods: We searched systematic reviews on brief interventions to avoid alcohol consumption
by pregnant women via Medline, Cochrane Library and Cumulative Index to Nursing and
Allied Health Literature (Cinahl). The quality of each systematic review was assessed
using the validated tool Assessing the Methodological Quality of Systematic Reviews
Results: Six of 42 abstracts of systematic reviews identified were selected for full
reading. Quality assessment was conducted in four studies. In two of these studies
(Whitworth and Dowswell 2010; Stade et al. 2014), two reviewers independently completed
the selection and data extraction. Both of them reached “high-quality” level (≥ 8/11
of the AMSTAR checklist). The first study authors’ (Whitworth and Dowswell) concluded
that there is little evidence on the effects of pre-pregnancy health promotion. The
second study authors’ (Stade et al.) concluded that the educational interventions
may result in increased abstinence from alcohol, however, results were not consistent.
Conclusions: Although brief interventions are recommended to prevent prenatal alcohol
use, there is currently insufficient evidence to recommend the widespread implementation
of routine pre-pregnancy health promotion. These findings show that it is important
to carry out systematic reviews and clinical trials of adequate quality.
A57 Web-based screening and brief intervention with weekly text-message-initiated
individualized prompts for reducing risky alcohol use among teenagers: focus groups
and pilot study results
Kristina Wille1, Silke Diestelkamp1, Rainer Thomasius1, ProHEAD Consortium2
1German Center for Addiction Research in Childhood and Adolescence, University Medical
Center Hamburg-Eppendorf, Hamburg, Germany; 2Heidelberg, Hamburg, Leipzig, Marburg,
Schwäbisch Gmünd, Germany
Correspondence: Kristina Wille - email@example.com
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A57
Background: Technology based, short alcohol related interventions have the potential
to reach a large number of recipients with a service that can be individualized. For
young people in particular, technology based interventions represent an opportunity
to address the target group in an age appropriate way and reach them in the context
of their lives in the sense of an “ecological momentary intervention”. These are the
results of two focus groups and pilot testing of viability, acceptance and functioning
of the individualized SMS initiated boosters that had already been developed and are
used in conjunction with web-based short interventions to reduce risky alcohol consumption
in young people.
Methods: As part of the ProHEAD consortium, the effectiveness of fully automated web-based
short interventions with weekly individualized SMS initiated boosters for schoolchildren
under the age of 12 was investigated in a multi-center randomized controlled study
(ProWISE-TIP study). Two focus groups (n = 5) of young people aged 13–17 were carried
out to test the SMS initiated, fully automated booster messages. A group discussion
based on guidelines was used to gather feedback on young people’s language, acceptance
and on the content of the booster messages. Pilot testing (N = 20) of the functioning
and viability of the SMS initiated individualized booster and the functioning of randomization
for the 4-arm randomized controlled effectiveness study was carried out over 3 weeks
with a final telephone survey.
Results: It was shown that the fully automated processes function technically and
almost all participants used the SMS initiated individualized boosters over the three
weeks. 50% of participants in the pilot study assessed the boosters as helpful with
their alcohol use. 16.7% even stated that they drank less at the weekend due to the
SMS messages. The tips for dealing with alcohol were found to be helpful and appropriate
by almost 60% of participants.
A58 Barriers and enablers for the implementation of the German Guideline on Screening,
Diagnosis and Treatment of Alcohol-Related Disorders in routine care
Christina Lindemann1, Maren Spiess2, Martin Härter2, Jens Reimer1, Uwe Verthein1,
Bernd Schulte1, Angela Buchholz2
1Centre for Interdisciplinary Addiction Research (ZIS), University Medical Centre
Hamburg-Eppendorf, Hamburg, Germany; 2Department of Medical Psychology, University
Medical Centre Hamburg-Eppendorf, Hamburg, Germany
Correspondence: Christina Lindemann - firstname.lastname@example.org
Addiction Science & Clinical Practice 2019, 14(Suppl 1):A58
Background: The German guideline on alcohol-related disorders aims to promote evidence-based
care for the prevention and treatment of alcohol use disorders (AUDs) in different
health care settings. As part of the Federal Ministry of Health’s funded project “Implementation
and Evaluation of the Guideline on Screening, Diagnosis and Treatment of Alcohol-Related
Disorders” (IMPELA), the objective of this research project was to identify barriers
and facilitators for the guideline implementation in routine care.
Method: We followed a mixed-methods approach to analyze barriers and facilitators
in different care settings in the city of Bremen. A questionnaire was distributed
to relevant care providers as well as to patients with AUD. Based on the results of
the survey, qualitative interviews were conducted to validate and deepen the quantitative
Results: Data sets of 163 practitioners (63.2% female; 33.7% male) and 94 patients
(42.3% female; 57.7% male) were analyzed. Main barriers expressed by the practitioners
were a lack of knowledge about the guideline, limited time and financial resources
for the provision of guideline-oriented AUD care, as well as long waiting periods
before AUD treatment (47.8%). The most frequent barriers mentioned by patients were
the fact that those affected did not seek help due to the fear of consequences or
missing acceptance of their alcohol-related problems. Furthermore, patients stressed
screening in areas other than health care (i.e. at the workplace) as well as direct
referral between acute AUD care and rehabilitation as important areas of improvement.
A potential facilitator to increase guideline-oriented care in the view of patients
included public awareness campaigns. Practitioners reported to prefer setting specific
summaries of the guidelines (e.g. fact-sheets, booklets).
Conclusions: The provider- and patient-related findings will be used to select and
develop setting- and context-specific implementation strategies for specific recommendations
of the German guideline on AUDs.