A pilot study comparing peer supported web-based CBT to self-managed web CBT for primary care veterans with PTSD and hazardous alcohol use.

BACKGROUND The transition to adulthood is a unique developmental period characterized by numerous personal and social role changes and increased opportunities for alcohol consumption. Using alcohol to cope with anxiety symptoms is commonly reported, and young people with anxiety are at a greater risk of hazardous alcohol use and progression to alcohol use disorder. Anxiety and alcohol use tend to fuel each other in an exacerbating feed-forward cycle, leading to difficult-to-treat chronic problems. The peak in onset of anxiety and alcohol disorders suggests this developmental window represents a promising opportunity for early intervention before these problems become entrenched. OBJECTIVE This study aims to evaluate the efficacy of the Inroads program, a therapist-supported, internet-delivered early intervention for young adults that targets alcohol use, anxiety symptoms, and the interconnections between these problems. METHODS A randomized controlled trial will be conducted nationally among young Australians (aged 17-24 years) who experience anxiety symptoms and drink alcohol at hazardous or harmful levels. Participants will be individually randomized on a 1:1 basis to receive the Inroads intervention or assessment plus alcohol guidelines. Participants randomized to the Inroads intervention will receive access to 5 Web-based cognitive behavioral therapy (CBT) modules and weekly therapist support via email and/or phone. The primary outcome assessment will be 8 weeks post baseline, with follow-up assessment 6 months post baseline to determine the sustainability of the intervention effects. Primary outcomes will be the total number of standard drinks consumed in the past month (assessed by the Timeline Follow-Back procedure), severity of alcohol-related harms (assessed by the Brief Young Adult Alcohol Consequences Questionnaire), and anxiety symptoms across multiple disorders (assessed by the Generalized Anxiety Disorder-7). Secondary outcomes will include alcohol outcome expectancies; functional impairment and quality of life; and symptoms of social anxiety, anxious arousal, and depression. Results will be analyzed by intention-to-treat using multilevel mixed effects analysis for repeated measures. RESULTS The study is funded from 2017 to 2020 by Australian Rotary Health. Recruitment is expected to be complete by late-2018, with the 6-month follow-ups to be completed by mid-2019. Results are expected to be published in 2020. CONCLUSIONS The study will be the first to evaluate the benefits of a youth-focused early intervention that simultaneously targets anxiety and hazardous alcohol use. By explicitly addressing the interconnections between anxiety and alcohol use and enhancing CBT coping skills, the Inroads program has the potential to interrupt the trajectory toward co-occurring anxiety and alcohol use disorders. The Web-based format of the program combined with minimal therapist support means that if effective, the program could be widely disseminated to reach young people who are not currently able or willing to access face-to-face treatment. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12617001609347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372748&isReview=true (Archived by WebCite at http://www.webcitation.org/77Au19jmf) INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12370

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‘Re-Train Your Brain’: Protocol for a randomized controlled pilot trial of a web-based Cognitive Bias Modification intervention for emerging adults with comorbid social anxiety and hazardous alcohol use (Preprint)

10.2196/preprints.28667 ◽

2021 ◽

Author(s):

Katrina Prior ◽

Elske Salemink ◽

Reinout W Wiers ◽

Bethany A Teachman ◽

Monique Piggott ◽

...

Keyword(s):

Social Anxiety ◽

Alcohol Use ◽

Emerging Adults ◽

Pilot Trial ◽

Treatment Seeking ◽

Hazardous Alcohol Use ◽

Web Based ◽

Randomized Controlled ◽

Hazardous Alcohol ◽

Bias Modification

BACKGROUND Alcohol use and anxiety disorders commonly co-occur, resulting in a more severe clinical presentation and poorer response to single-disorder treatments. Research has shown that Approach Bias Modification (ApBM) and Interpretation Bias Modification (IBM) cognitive re-training interventions can be efficacious adjunctive treatments that improve outcomes for alcohol use and social anxiety symptoms, respectively. However, the acceptability, feasibility and clinical utility of combining ApBM and IBM programs to optimise standard treatments among comorbid samples is unknown. It is also unclear as to whether integrating ApBM and IBM within each training session, or alternating them between each session, is more acceptable and efficacious. OBJECTIVE This paper describes the study protocol for a randomized controlled pilot trial investigating the feasibility, acceptability, and preliminary efficacy of the ‘Re-Train Your Brain’ intervention – an adjunct web-based ApBM+IBM program – among a clinical sample of emerging adults with hazardous alcohol use and social anxiety. METHODS The study involves a 3-arm randomized controlled pilot trial in which treatment-seeking emerging adults (18-30 years) with co-occurring hazardous alcohol use and social anxiety disorder symptoms will be individually randomized to receive: (1) the Re-Train Your Brain ‘integrated’ program, delivered with 10 bi-weekly sessions focusing on both social anxiety and alcohol each week (50:50 ratio), plus treatment as usual (TAU i.e., the model of care provided in accordance with standard practice at their service; n=30); (2) the Re-Train Your Brain ‘alternating’ program, delivered with 10 bi-weekly sessions focusing on social anxiety one week and alcohol the next week in an alternating pattern, plus TAU (n=30); or (3) TAU only (n=30). Primary outcomes include feasibility (uptake, follow-up rates, treatment adherence, attrition, adverse events) and acceptability (system usability, client satisfaction, user experience, training format preference). Secondary efficacy outcomes include changes in alcohol approach and interpretation biases, social anxiety symptoms, and alcohol use (e.g., average drinks per day, binge-drinking, alcohol use motives, severity of alcohol dependence, alcohol craving). The primary endpoint will be post-treatment (6 weeks post-baseline), with a secondary endpoint at 3 months post-baseline. Descriptive statistics will be conducted for primary outcomes, while intention-to-treat multi-level mixed effects analysis for repeated measures will be performed for secondary outcomes. RESULTS The study is funded from 2019―2023 by Australian Rotary Health. Recruitment is expected to be complete by mid―late 2022, with follow-ups completed by early 2023. CONCLUSIONS The study will be the first to evaluate whether an ApBM+IBM program is acceptable to treatment-seeking emerging adults and whether it is feasible to deliver it online, in settings where it will ultimately be used (e.g., at home). The findings will broaden our understanding of the types of programs that emerging adults will engage with, and whether there is preliminary evidence of it being an efficacious treatment option for this comorbidity. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001273976

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ALCOHOL USE SCREENING AND INTEGRATED BEHAVIORAL HEALTH IN GERIATRIC PRIMARY CARE IN THE DEEP SOUTH

Innovation in Aging ◽

10.1093/geroni/igz038.3394 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S933-S933

Author(s):

Bailey Lanai ◽

Deanna Dragan ◽

Rebecca S Allen ◽

Anne Halli-Tierney ◽

Dana Carroll ◽

...

Keyword(s):

Primary Care ◽

Health Literacy ◽

Alcohol Use ◽

Behavioral Health ◽

Hazardous Alcohol Use ◽

Integrated Behavioral Health ◽

Medical Diagnoses ◽

Objective Health ◽

Hazardous Alcohol ◽

Clinically Significant

Abstract This longitudinal behavioral health surveillance and integrated care project aims to assess physical and mental health and substance use in a geriatric primary care setting. Approximately 230 patients (mean age = 76; 74% female; 16% African American) attending an interdisciplinary geriatrics clinic in Alabama have taken part in baseline behavioral health screenings since 2014. Behavioral health measures include cognitive status, self-reported mood, subjective and objective health literacy, and alcohol use. All measures are administered by clinical psychology graduate students. Patients had an average of 5.83 medical diagnoses. Only 26.2% of patients had scores indicating cognitive functioning within normal limits; 32.6% had scores indicative of mild neurocognitive disorder, and 41.2% had scores indicative of dementia. Over 80% of patients had adequate self-reported health literacy; however, measurements of objective health literacy indicated a significant number of individuals have difficulty following medical directions independently. Over 30% of patients reported clinically significant levels of depression or anxiety, and 16.5% of patients reported at least one indicator of hazardous alcohol use. Specifically, 50.7% of patients consume alcohol on at least a yearly basis with 38.2% endorsing at least one problematic drinking behavior and 11.6% scoring in the clinically significant range for alcohol misuse. Moreover, 22.7% report use of opioid pain medication. The results of this study demonstrate that routine hazardous alcohol use screening as one component of integrated behavioral health care within geriatric primary care increases detection of hazardous alcohol use among older adults.

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Acceptability of chronic liver disease screening in a UK primary care setting: a qualitative evaluation

BMJ Open ◽

10.1136/bmjopen-2020-041574 ◽

2020 ◽

Vol 10 (11) ◽

pp. e041574 ◽

Cited By ~ 1

Author(s):

Holly Knight ◽

David Harman ◽

Joanne R Morling ◽

Guruprasad Aithal ◽

Timothy Card ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Primary Care ◽

Alcohol Use ◽

Care Setting ◽

Primary Care Setting ◽

Hazardous Alcohol Use ◽

Patient Awareness ◽

Hazardous Alcohol

ObjectivesThe increasing incidence of chronic liver disease (CLD) in the UK may be attributed to a rise in preventable risk factors, including hazardous alcohol use and type 2 diabetes. Transient elastography (TE) can rapidly stratify risk of CLD in primary care populations and provide an opportunity to raise patient awareness of risk factors.This study explores patients’ experiences of TE screening in a primary care setting. In addition, patient awareness of CLD risk is explored.Study design and settingThis study used a qualitative process evaluation of a community screening pathway for CLD (Nottingham, UK). Participants completed semistructured interviews, which were audio-recorded, transcribed verbatim and analysed thematically.ParticipantsTwenty adults were purposively recruited 6 months to 2 years after TE screening. Inclusion criteria included (1) hazardous alcohol use, (2) type 2 diabetes and/or (3) persistently elevated liver enzymes without known cause.ResultsUndergoing TE in primary care was seen as acceptable to most participants. Hazardous alcohol use was identified as the primary cause of CLD; no participants were aware of metabolic risk factors. TE improved understanding of personal risk factors and prompted contemplation of lifestyle changes across all TE stratifications. However, participants’ perceptions of risk were altered by the healthcare providers’ communication of TE scores.ConclusionsHigh acceptability of TE, regardless of the risk factor, provides strong support for inclusion of TE stratification in primary care. Findings highlight the positive impact of receiving TE on risk awareness. Future clinical iterations should improve the structure and communication of TE results to patients.

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