Examining the Attitudes of Non-Psychiatric Practicing Healthcare Workers Towards Patients With Alcohol Problems in General Hospital Setting

Background and objectives: Problematic alcohol-use affect the physical and mental well-being of hospitalised individuals and may receive screening and brief-intervention during treatment. Non-psychiatric doctors and nurses might respond inadequately due to negative attitudes and beliefs. This study aimed to examine these attitudes of non-psychiatric workers in the medical and surgical wards. Methods: A total of 457 doctors and 1643 nurses were recruited from the medical, surgical and orthopaedic disciplines over a period of 4 months. Three questionnaires were administered: demographics, Alcohol & Alcohol-Problems Perceptions Questionnaire (AAPPQ) and Staff Perception of Alcohol Treatment Resources. Results: About 128 doctors and 785 nurses responded. Around 75.5% doctors and 51.9% nurses endorsed role-legitimacy in the AAPPQ. Both the doctor (86.7%) and nurse (77.6%) groups agreed on the importance to initiate intervention for patients with problematic alcohol-use in daily work. Both groups were sceptical and negative towards these patients endorsing low-level role-adequacy (41.2%), role-support (36.9%), motivation (36.5%), task-specific self-esteem (25.1) as well as work satisfaction (20.5%). Conclusion/discussion: Doctors and nurses demonstrated low levels of therapeutic commitments towards patients with problematic alcohol-use thereby necessitating the introduction of in-house programmes to educate, empower and emphasise the importance of therapeutic contact with patients for alcohol intervention. Scientific significance: The prompt identification and treatment of patients with alcohol problems are contingent on the workers’ attitudes towards them. This study’s results should spark a nation-wide interest to improve the training and recognition of such patients and providing adequate educational resources.

Using Consolidated Framework for Implementation Research to investigate facilitators and barriers of implementing alcohol screening and brief intervention among primary care health professionals: a systematic review

Background Alcohol screening and brief intervention (SBI) is recommended to be implemented in primary care settings to intervene against hazardous/harmful drinking. However, studies showed that the uptake rate was low in many regions/countries. This systematic review presented current findings on the facilitators and barriers of SBI implemented by health professionals in primary care settings using the Consolidated Framework for Implementation Research (CFIR). Methods We included qualitative, quantitative, and mixed-method studies identified through four electronic databases (PubMed, MEDLINE, PsycInfo, and Web of Science) from inception to June 2020. Included articles had to address barriers and facilitators of SBI implementation and provide sufficient details that the CFIR domains could be identified and data were abstracted using a standardized extraction form. Results A total of 74 studies published from 1985 to 2019 were finally analysed and summarized. The most common facilitators were knowledge and positive beliefs about SBI (characteristics of the individuals) and available resources (inner setting). In contrast, the most common barriers were cost related to implementing SBI (intervention characteristics), negative beliefs about SBI (characteristics of the individuals), and lack of self-efficacy in implementing SBI (characteristics of the individuals). It could be observed that factors related to the inner setting and characteristics of individuals were extensively studied whilst the process received the least attention. Conclusions Most of the facilitators and barriers are modifiable. Additionally, most literature focused on various kinds of available assets to implement SBI. To promote the spread of SBI implementation, more high-quality studies on the implementation process are needed. This systematic review could serve as a reference framework for health authorities to devise strategies for improving the implementation of SBI in primary care settings. Trial registration This systematic review was registered in PROSPERO (CRD42021258833).

Portuguese Validated Versions of the Alcohol Use Disorders Identification Test: A Systematic Review Protocol

Introduction: Alcohol consumption ranks among the top ten risk factors contributing to the global disease burden. Several international organizations recommend the use of the Alcohol Use Disorders Identification Test to screen for at-risk drinkers. However, a fully validated Portuguese version of this test is lacking. The aim of this study is to systematically review validated versions of the Alcohol Use Disorders Identification Test in the Portuguese language, the documented problems and solutions in its application and proposed cut-offs to identify at-risk drinkers.Material and Methods: A systematic search will be performed in Ovid MEDLINE, CINAHL, PsycINFO, ÍndexRMP, LILACS, African Journals Online and SciELO databases, along with grey literature searches to identify validation studies of the AUDIT in Portuguese. Two authors will independently extract data and assess the studies’ methodological quality, using QUADAS-2 and CASP checklists.Discussion: This review will compare different validation studies of the Alcohol Use Disorders Identification Test in Portuguese-speaking countries, reporting, where possible, the psychometric properties, performance characteristics, suggested cut-offs and any documented limitations and suggestions. The results of this review could be used to propose an update of the alcohol screening and brief intervention guidelines in Portugal. The results could also prove useful to support the implementation of alcohol screening delivery by healthcare providers in Portugal and other official Portuguese-speaking countries.Conclusion: This review will provide important information on the validity of the Alcohol Use Disorders Identification Test as a screening tool for at-risk drinking in Portugal and other official Portuguese speaking countries.

Investigating a Substance Abuse Screening in a Trauma Setting

Introduction Drug and alcohol consumption are often associated with trauma-related injuries. Various studies have been conducted which have shown the benefits of screening and brief intervention (SBI) tools for alcohol consumption. Despite their success, there are few SBI tools utilized for substance use and minimal reports of computerized versions. We hypothesized that a computerized SBI tool for drug use would be effective at identifying patients at risk of substance abuse in a trauma setting. Methods This was a prospective evaluation of a computerized alcohol and drug screening and brief intervention survey derived from the National Institute on Drug Abuse. The survey was given to all eligible trauma patients at UCI’s Level 1 trauma facility between February 2019 and March 2020. Based on self-reported answers, a substance involvement (SI) score was generated which classified a patient’s drug abuse risk as none (0), low (1-3), moderate (4-26), or high (27+). Statistical tests were then used to examine associations between demographic variables and risk categorization. Results A total of 1801 patients completed the entire survey. Of those, 346 (19.3%) patients reported use of illicit drugs: 10 for non-medical prescription use (.6%), 308 (17.1%) for non-prescription drug use, and 28 (1.6%) for both. Secondary analysis revealed a greater number of males were eligible for further SI assessment (25.1% vs 11.0%, P < .001). Of those, a greater proportion of men were classified as moderate/high risk (81.6% vs 61.5%, P < .001). Further breakdown revealed a greater proportion of patients ≤25 years old reported use of drugs compared to >85 years old (37.0% vs .5%, P < .001). In contrast to the self-reported data, there was an overall positive rate of toxicology of 48.51%. Conclusion The analysis shows that the electronic survey identifies patients at risk of drug abuse, allowing for real-time intervention. Furthermore, it is granular enough to specify at-risk groups. However, a lower self-reported rate, as expected, was elucidated. Further studies to evaluate for improved screening and targeted intervention are warranted.

Reimagining brief interventions for alcohol: towards a paradigm fit for the twenty first century?

Background There is no longer support for the idea that brief intervention programmes alone can contribute meaningfully to the improvement of population health relating to alcohol. As a result, calls for major innovations and paradigm shifts grow, notably among research leaders. This paper briefly examines the history of the development of the evidence-base from the landmark World Health Organisation projects on Screening and Brief Intervention (SBI) in the 1980s onwards. Particular attention is given to weaknesses in the theorisation of social influence and interventions design, and declining effect sizes over time. Although the old SBI paradigm may be exhausted where it has been applied, it has not been replaced by a new paradigm. Alcohol marketing encourages heavy drinking and today may have more powerful effects on thinking about alcohol, and about alcohol problems, than previously. The nature of the societal challenge being faced in an alcogenic environment in which alcohol is widely promoted and weakly regulated underpins consideration of the possibilities for contemporary evidence-informed public health responses. Evidence-informed perspectives in discourses on alcohol problems need to be strengthened in redeveloping rationales for brief interventions. This process needs to move away from sole reliance on a model based on a two-person discussion of alcohol, which is divorced from wider concerns the person may have. Reimagining the nature of brief interventions involves incorporating digital content, emphasising meso-level social processes based on material that people want to share, and seeking synergies with macro-level population and media issues, including alcohol policy measures. Conclusions Current versions of brief interventions may be simply too weak to contend with the pressures of an alcogenic environment. A new generation of brief interventions could have a key role to play in developing multi-level responses to the problems caused by alcohol.

Perspectives of Women Living With HIV on Addressing Violence and Use of Alcohol During HIV Services: Qualitative Findings From Fishing Communities in Uganda

The syndemic relationship between harmful alcohol use, intimate partner violence (IPV), and HIV is well established across international settings. Less is known about how these health issues are perceived by women living with HIV (WLWH), who are disproportionately affected by these intertwined epidemics. A qualitative study was undertaken with 20 WLWH in Rakai, Uganda, to assess their perceptions of how these issues have affected their lives and their communities and to assess the acceptability of integrating a screening and brief intervention for alcohol use and IPV into HIV posttest counseling. Recommendations for intervention programming arising from the results are discussed.