August 17, 2017

Some Prevention Efforts Can Actually Backfire

Some prevention campaigns aimed at stopping young drinkers from risky drinking habits can actually backfire if not worded properly.

Campaigns designed to stop young people "bolting" drinks can be ineffective and can even make them more likely to do it, new research suggests. Scientists from the University of Exeter and the University of Queensland examined reactions to a poster warning of the consequences of bolting (downing an alcoholic drink in one) and found it had no effect on people's future intentions.

Correcting Misperceptions

And when a statement was added saying other people disapproved of bolting, study participants reported stronger intentions to bolt in the future.

However, changing this to a message saying most people "do not bolt drinks on a night out" was effective.

"Many young people overestimate the extent to which their peers both approve of and engage in risky drinking behaviors," said study author Dr Joanne Smith, of the University of Exeter.

"One way to tackle risky drinking is to try to correct these misperceptions through health campaigns, such as posters.

Some Messages More Effective

"In our research, we wanted to explore what kinds of messages are more effective in changing people's intentions to bolt.

"Our results highlight the potentially harmful effects of exposure to what's called an 'injunctive norm' - a message about the approval or disapproval of others.

"Meanwhile, a 'descriptive norm' - telling people what others do rather than what they think - had a positive impact."

The study is published in the journal Addiction Research and Theory.

Poorly Designed Campaigns Can Backfire

Professor Charles Abraham, of the University of Exeter Medical School, said: "This demonstrates how careful we need to be in selecting the right message in campaigns, and evaluating them before wider dissemination, as poorly designed campaigns, however well-intentioned, can backfire."

The research consisted of three studies, in which volunteers (221 in total) saw the poster or did not, and then either received or did not receive messages about what their peers thought or how they behaved.

In one study, some participants received an accurate message saying 70% of their peers "disapprove of bolting", and in another some received an accurate message saying 65% of their peers "do not bolt drinks on a night out."

Drinking Responsibly

They all then completed identical questionnaires to measure their perceptions of group norms related to bolting, and their own intentions to do it in the future.

The researchers point out that beliefs about how other people behave are often the "best predictor" in terms of general drinking behavior and binge drinking, but note that using these beliefs to change behavior needs to be done carefully to ensure campaigns have the desired effect.

The paper is entitled: "Normative feedback in alcohol-related health promotion: When and how does normative feedback reduce intentions to drink irresponsibly?"

Posted by Webmaster at 09:50 AM

August 14, 2017

Primary Care Should Include Drug Screening

The misuse of both prescription and illicit drugs is so prevalent in Tijuana and East Los Angeles that community clinics in those areas should routinely, though discreetly, screen for it, according to new UCLA research. The study, published in the peer-reviewed journal Substance Use and Misuse, found that 19.4 percent of people answering a computerized self-administered survey in East Los Angeles community clinics admitted to moderate-to-high drug use.

In Tijuana it was 5.7 percent. Rates of drug use among the participants in the study were much higher than what has been found in household surveys in the two countries.

The researchers also found that Los Angeles patients born in Mexico were twice as likely, and Los Angeles patients born in the United States were six times more likely, of being moderate-to-high drug users compared with Tijuana patients born in Mexico.

High Rate of Drug Use Was Surprising

The findings of high rates of drug use ran counter to assumptions, said Dr. Lillian Gelberg, the study's lead investigator and a professor of family medicine at the David Geffen School of Medicine at UCLA.

"Prevailing expectations were that alcohol would be the major problem and drug use would be lower,'' said Gelberg, who is also a professor of health policy and management at the UCLA Fielding School of Public Health. "But what we found was that the rate of problem drug use -- that is, moderate-to-high use -- was very similar to problem alcohol use."

Moderate-to-high alcohol use was 15.2 percent in East Los Angeles compared to 6.5 percent in Tijuana. Moderate-to high tobacco use was 20.4 percent in East Los Angeles and 16.2 percent in Tijuana.

Drug Screening Should Be Routine

While drug use was higher in Los Angeles than it was in Tijuana, the rates in both cities are high enough that screening for drug, alcohol and tobacco use should be integrated into routine primary care in community clinics on both sides of the border, said Melvin Rico, clinical research coordinator in the UCLA Department of Family Medicine who served as the field research coordinator for the study.

"Being able to reach a vulnerable population while waiting for a doctor is, I think, very important," Rico said.

The paper is part of a larger study of an intervention that found a few minutes of counseling in a primary care setting could steer people away from risky drug use and full-fledged addiction.

Self-Reported Substance Abuse

For this study, which ran from March 2013 through October 2013, the researchers recruited 2,507 adults in Los Angeles and 2,890 in Tijuana who were eligible for the World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test. The researchers designed a simple tool that allowed participants to anonymously self-report substance abuse on a computer tablet with a touch screen. Given the stigma associated with drug use, the researchers wanted to remain sensitive to people's fears of privacy in a way that still encouraged them to be truthful about their substance use.

Questions about substance use were combined with others about healthy eating, exercise, and chronic illnesses so that the patients would not feel stigmatized about a particular behavior, Gelberg said.

Quiz Adapted for Cultural Differences

"We aren't using interviews and the patients are filling it in on their own," she said. "We developed this program so that it would work even for patients of low-literacy levels, asking one question at a time and allowing for an audio option with headsets according to patient's preference. For instance, it would ask 'did you use cocaine in the last three months and a 'yes' or 'no' would light up on the computer screen.'"

The tool could also easily switch between English and Spanish and the questions and approach were adapted to Latinos in Mexico, whose culture and characteristics had differences compared to those in Los Angeles.

Results Subject to Under-Reporting

Participants took the survey while they were in the clinic waiting room, and it took very little time -- a mean of 1.3 minutes in Tijuana and 4.2 minutes in Los Angeles.

This tool can be of use in a primary care clinic because people generally don't volunteer their drug use to their doctors, who for their part don't know how to broach the subject, Gelberg said.

The study has some limitations. Substance use was based on patient self-reporting, which could make the findings subject to under-reporting. Also, the findings may or may not be the same in health care settings other than community health centers or in other cities in the United States and Mexico.

Posted by Webmaster at 03:01 AM

August 13, 2017

Is Kratom an Opioid Alternative?

A delayed U.S. Drug Enforcement Administration ban on kratom would stifle scientific understanding of the herb's active chemical components and documented pharmacologic properties if implemented, according to a special report published today in The Journal of the American Osteopathic Association.

The report cited the pharmacologically active compounds in kratom, including mitragynine, 7-hydroxymitragynine, paynantheine, speciogynine and 20 other substances, as one basis for further study. It also emphasized the extensive amount of anecdotal evidence and current scientific research that indicates kratom may be safer and less addictive than current treatments for pain and opioid withdrawal.

Kratom Does Not Depress Respiration

"There's no question kratom compounds have complex and potential useful pharmacologic activities and they produce chemically different actions from opioids," said author Walter Prozialeck, chairman of the Department of Pharmacology at Midwestern University Chicago College of Osteopathic Medicine. "Kratom doesn't produce an intense euphoria and, even at very high doses, it doesn't depress respiration, which could make it safer for users."

Kratom (Mitragyna speciosa) is indigenous to Southeast Asia, where the plant was used for centuries to relieve fatigue, pain, cough and diarrhea and aid in opioid withdrawal. Currently sold in the United States as an herbal supplement, kratom drew DEA scrutiny after poison control centers noted 660 reports of adverse reactions to kratom products between January 2010 and December 2015.

Source of Adverse Reactions Unclear

"Many important medications, including the breast cancer treatment tamoxifen, were developed from plant research," said Prozialeck.

"While the DEA and physicians have valid safety concerns, it is not at all clear that kratom is the culprit behind the adverse effects," said Anita Gupta, DO, PharmD and special advisor to the FDA.

A Non-Pharmaceutical Remedy?

Dr. Gupta, an osteopathic anesthesiologist, pain specialist and licensed pharmacist, has treated a number of patients who've used kratom. "Many of my patients are seeking non-pharmaceutical remedies to treat pain that lack the side effects, risk, and addiction potential of opioids," she said.

Kratom is currently banned in states including Alabama, Florida, Indiana, Arkansas, Wisconsin and Tennessee. The DEA is scheduled to decide whether to place kratom on its list of Schedule 1 drugs, a classification for compounds thought to have no known medical benefit. Marijuana, LSD and heroin are Schedule 1 drugs, which prevents the vast majority of U.S.-based researchers from studying those substances.

Posted by Webmaster at 08:15 PM

Moms' Sensitivity a Key to Prevention

Research from the University at Buffalo Research Institute on Addictions suggests the approach to preventing alcohol and drug use by some adolescents should begin in early childhood.

"The children of parents with alcohol problems are at much greater risk for underage drinking and developing a substance use disorder," says the study's author, Rina Das Eiden, PhD, senior research scientist at RIA. "It's important to understand when and under what circumstances such problems develop, so we can craft interventions to steer this high-risk population away from substance use and its attendant problems."

Pathway Begins Early for Children of Alcoholics

Eiden examined different pathways to adolescent substance use, starting in infancy, for children of parents with alcohol use disorder (AUD), and found that maternal warmth and sensitivity in early childhood played a significant role.

"When mothers can be warm and sensitive during interactions with their toddlers, even under the stresses associated with their partners' alcohol problems, there is a lower likelihood of adolescent substance use," Eiden says.

Drinking Parents Less Sensitive

Parents with AUD demonstrated lower rates of maternal sensitivity toward their toddlers, continuing into kindergarten age, Eiden found. As the children entered middle school (6th grade), their mothers were less likely to monitor peer groups and activities, leading to higher engagement with substance-using and delinquent peers and drinking in early adolescence (8th grade).

These children also displayed lower self-regulation, or the ability to behave according to rules without supervision, at preschool age, leading to problem behaviors from kindergarten age to early adolescence and higher alcohol and marijuana use in late adolescence.

Encouraging Mothers to Be Sensitive

The results have implications for both the timing and content of preventive interventions against substance use among adolescents of parents with AUD. Timing interventions in early childhood and before major developmental transitions, such as transition to school and moving from elementary to middle school, may be most beneficial.

For content, the most helpful interventions would be to encourage and support mothers in being warm and sensitive during interactions with their toddlers, and to keep a close eye their children's activities and peer groups during the transition from middle childhood to early adolescence.

"This attention also would promote children's self-regulation in the preschool years, which may lead to a decrease in problem behaviors from school age into adolescence," Eiden says.

The article appears in the October issue of Developmental Psychology.

Posted by Webmaster at 08:14 PM

Nurse-Delivered Alcohol Interventions More Accepted

The U.S. Joint Commission approved new hospital accreditation measures related to alcohol screening, brief intervention, and referral to treatment (SBIRT) for all hospitalized patients. Yet little is known about the effectiveness of brief interventions (BIs) or inpatient acceptability of SBIRT when performed by healthcare professionals other than physicians. A new study has found high hospital-patient acceptability of and comfort with nurse-delivered SBIRT.

Results were published in Alcoholism: Clinical & Experimental Research.

Identifying Unhealthy Alcohol Use

"SBIRT is widely endorsed for identifying and managing unhealthy alcohol use that ranges from hazardous or 'risky' drinking to the more serious alcohol abuse and dependence," explained Lauren M. Broyles, a research health scientist at the VA Pittsburgh Healthcare System, assistant professor of medicine at the University of Pittsburgh, and corresponding author for the study.

"A more recent focus has extended to identification of hazardous drinking consumption that exceeds guidelines established by the National Institute on Alcohol Abuse and Alcoholism as more than 14 standard drinks/week or more than four/occasion for men, and more than seven standard drinks/week or more than three/occasion for women and healthy individuals age 65 or older," she said. "Despite [supporting] evidence, recommendations and mandates concerning SBIRT implementation, uptake by healthcare providers in real-world clinical settings is still relatively limited."

"SBIRT is a brief conversation, about 10 to 15 minutes, about hazardous alcohol consumption," added Deborah S. Finnell, a research nurse scientist at the VA Western New York Healthcare System and associate professor of nursing at the University at Buffalo. "Healthcare team members could easily deliver SBIRT, assuming they are qualified. Since nurses provide 24-hour care in hospitals, nurses are most likely to have contact with patients compared with other healthcare team members, such as physicians and social workers."

High Rate of Acceptability

Broyles and her colleagues conducted a cross-sectional survey of 355 (342 males, 13 females) hospitalized medical-surgical patients at a large university-affiliated medical center that is part of the U.S. Department of Veterans Affairs.

Results indicated acceptability for nurse-delivered SBIRT was high. Patient acceptability for eight out of 10 individual nurse-delivered SBIRT tasks was greater than 84 percent. Roughly 20 percent of the patients reported some degree of personal discomfort with the discussions; in general these individuals had a lower belief in their ability to reduce their drinking risk, were older than 60 years of age, had a positive alcohol screening, and were of non-black race.

"We found, in general, that acceptability for nurse-delivered SBIRT tasks was associated with how people perceived their own alcohol-related risks," explained Broyles. "Patients had higher acceptability if they felt that they were able to determine and reduce their own alcohol-related health risks, and if they had expressed concern about their own alcohol use. Conversely, roughly 20 percent of the patients expressed annoyance or embarrassment with the questions while also showing high levels of acceptability. While this might seem contradictory, patients might feel embarrassed or uncomfortable with the topic or discussion even though they see the discussions as a legitimate, necessary, and acceptable part of the nurse's role."

Alcohol and Health Risks

"This study also highlights the importance of being patient-centered," said Finnell. "Patients are accepting of receiving information from nurses about changing their alcohol use and about self-help groups. Specifically, when patients can make the connection between their alcohol use and health risks, they may be more accepting of having the conversation with the nurse and continuing that conversation about decreasing the amount of alcohol they consume. Additionally, nurses providing patient-centered care will be sensitive to signs that the patient is uncomfortable during the conversation."

Broyles agreed. "For hazardous drinkers, nurses and other healthcare providers can normalize alcohol screening and BI by drawing analogies, for themselves and their patients, to screening and structured health behavior advice for other health conditions," she said. "Normalizing talk about unhealthy alcohol use and alcohol use disorders in general medical settings, by general medical providers, in general medical encounters in this way may help both providers and patients feel more comfortable."

Finnell said she was not surprised that patients were comfortable with nurse-delivered SBIRT. "I have been amazed at what patients share with me during my interactions with them," she said. "Americans consistently rank nurses 'very high' or 'high' on honesty and ethical standards. The concept of trust is an important element in the nurse-patient relationship."

Appropriate Training Needed

Both Broyles and Finnell emphasized the need for appropriate training, practice, support, and pragmatic strategies for incorporating alcohol SBIRT into existing clinical practices and routines. "Our findings suggest that once trained in SBIRT and motivational interviewing techniques, providers can proceed with greater confidence in alcohol-related risk assessment and risk-reduction conversations with patients," said Broyles.

"While this study focused on nurse-delivered SBIRT, the take-home points are highly relevant to other clinicians," added Finnell. "Clinicians who have been asked about barriers to delivering SBIRT report concern about jeopardizing their relationship with the patient. This study shows that patients are accepting of alcohol-related discussions, particularly brief counseling about alcohol, educational materials about changing alcohol use, and information about alcohol self-help groups. The findings from this study should alert nurses, physicians, and other health care providers to be prepared to meet the needs of these patients."

Posted by Webmaster at 06:45 PM