Cheryl A. Eaton

Concurrent versus delayed smoking cessation treatment for persons in early alcohol recovery. A pilot study.

This pilot study investigated the efficacy of initiating a smoking cessation intervention early in inpatient treatment for alcohol dependence versus shortly after an inpatient stay. Thirty-six male smokers recruited from an inpatient substance abuse treatment program were randomly assigned to begin smoking cessation either two weeks (concurrent treatment) or six weeks (delayed treatment) after admission to the substance abuse program. Smoking cessation treatment involved three sessions of individual smoking cessation treatment plus eight weeks of transdermal nicotine replacement. Significantly fewer participants began the delayed treatment than the concurrent treatment. Few participants were smoking-abstinent at follow-up, and the timing of treatment onset did not have an impact on smoking outcome. Clinical trials with larger samples may be needed to better evaluate the efficacy of concurrent versus delayed treatment and to test the efficacy of more aggressive interventions with smokers in early alcohol recovery.

The Important People Drug and Alcohol Interview: Psychometric Properties, Predictive Validity, and Implications for Treatment

Research with the Important People instrument has shown that social support for abstinence is related to alcohol treatment outcomes, but less work has been done on the role of network support in drug treatment outcomes. A drug and alcohol version of the Important People instrument (IPDA) was developed and administered to 141 patients in residential treatment for cocaine dependence. Three components were found, all with acceptable internal consistency: (a) substance involvement of the network, (b) general/treatment support, and (c) support for abstinence. These components and three fundamental network characteristics (size of daily network, size of network, and importance of the most important people) were investigated as correlates of pretreatment and posttreatment alcohol and drug use. The general/treatment support component and network size were inversely related to pretreatment days using drugs, whereas network substance involvement positively correlated with pretreatment drinking frequency. Size of the daily network predicted less drinking, less drug use, and less problem severity during the 6 months after treatment, whereas general/treatment support and support for abstinence did not predict outcome. Network substance involvement decreased for patients who stayed abstinent but not for those who later relapsed. Results suggest that increasing the number of people the patient sees daily while replacing substance-involved with abstinent-supportive people may improve treatment outcomes. Treatment programs may use the IPDA to identify clients most likely to benefit from changes in their social networks.

The relationship between Anxiety levels and outcome of cocaine abuse treatment

Although a number of studies have examined the comorbidity of anxiety disorders and substance use disorders, much less is known about the impact of anxiety symptoms on substance use and on substance abuse treatment outcome. In the current study, we examined how self-reported anxiety levels, as measured by the Spielberger State-Trait Anxiety Inventory, were related to cocaine use variables and patterns following substance abuse treatment. There were 108 patients in substance abuse treatment who met DSM-III-R diagnostic criteria for cocaine abuse or dependence who completed an assessment battery at pretreatment, posttreatment, and 3-month follow-up. State anxiety scores significantly declined from pre- to posttreatment and remained stable into the 3-month follow-up period regardless of relapse status. Trait anxiety was correlated positively with negative consequences due to cocaine use and negatively correlated with days in treatment. State and trait anxiety both were correlated positively with the Alcohol Composite Index of the Addiction Severity Index (ASI). These findings suggest that elevated anxiety scores at pretreatment subside with time, do not require clinical management of associated anxiety symptoms, and may be a temporary by-product of experiencing negative consequences due to recent cocaine use.

The Significance of Marijuana Use Among Alcohol-using Adolescent Emergency Department Patients

OBJECTIVES The objective was to determine if adolescents presenting to a pediatric emergency department (PED) for an alcohol-related event requiring medical care differ in terms of substance use, behavioral and mental health problems, peer relationships, and parental monitoring based on their history of marijuana use. METHODS This was a cross-sectional comparison of adolescents 13-17 years old, with evidence of recent alcohol use, presenting to a PED with a self-reported history of marijuana use. Assessment tools included the Adolescent Drinking Inventory, Adolescent Drinking Questionnaire, Young Adult Drinking and Driving Questionnaire, Center for Epidemiologic Studies Depression Scale, Behavioral Assessment System for Children, and Peer Substance Use and Tolerance of Substance Use Scale. RESULTS Compared to adolescents using alcohol only (AO), adolescents who use alcohol and marijuana (A+M) have higher rates of smoking (F = 23.62) and binge drinking (F = 11.56), consume more drinks per sitting (F = 9.03), have more externalizing behavior problems (F = 12.53), and report both greater peer tolerance of substance use (F = 12.99) and lower parental monitoring (F = 7.12). CONCLUSIONS Adolescents who use A+M report greater substance use and more risk factors for substance abuse than AO-using adolescents. Screening for a history of marijuana use may be important when treating adolescents presenting with an alcohol-related event. A+M co-use may identify a high-risk population, which may have important implications for ED clinicians in the care of these patients, providing parental guidance, and planning follow-up care.

Utility of the AUDIT for screening adolescents for problematic alcohol use in the emergency department.

The emergency department is a setting conducive to screening adolescents for problematic alcohol use, who can then be targeted for further evaluation and intervention. This study examined the utility of the Alcohol Use Disorders Identification Test (AUDIT) as a screening measure for identifying young adolescents in an urban emergency department (ED). Adolescents (13-17 years old) who presented to the ED were screened as part of a larger study. A total of 859 adolescents, who denied alcohol use prior to their ED visit were administered the AUDIT. Of the 500 younger adolescents (13-15 years old), approximately 4% (n=22) were classified as AUDIT-positive using a cut-score of four or greater. Of the 359 older adolescents (16-17 years old), almost 19% (n=67) were classified as AUDIT-positive. The ability of shorter versions of the AUDIT to identify AUDIT-positive adolescents (as classified by the 10-item AUDIT using a cut-score of four or greater) was also explored. Since the adolescents in the current study were not alcohol-positive at the time of the ED visit, they would likely have been missed by biochemical alcohol screening alone. Screening procedures that employ the AUDIT may be most efficient when adapted for the specific adolescent age group (younger versus older), thus identifying the highest number of adolescents who should be targeted for intervention. Lowering the recommended adult cut-scores on the shorter versions of the AUDIT appears necessary to identify adolescents who may benefit from intervention or referral.

Potential biases in case detection of alcohol involvement among adolescents in an emergency department.

Objective To determine the factors associated with physician decisions to test for alcohol involvement in adolescents treated in an emergency department (ED) and to examine patient and event characteristics associated with being identified as alcohol positive, either by testing or by clinical examination. Methods Medical chart reviews were conducted for all adolescent patients (n = 9660; age range, 13–19 y) treated over a 1-year period in a Level I regional trauma center/ED. Results Among all 9660 patients in the ED, 298 (3.1%) were identified as alcohol positive by test or clinical examination. Of the 9660 patients, 464 (4.8%) were tested for alcohol, and 49% of these had alcohol-positive test results. Physicians were more likely to order alcohol tests when patients were male, older, injured, and treated during the overnight shift or on weekends. Testing was most common for suicide attempts, motor vehicle crashes, assaults, and intoxication. Patients being treated for an illness or for occupational or athletic injuries were rarely tested. A large proportion of alcohol-related treatment was for intoxicated, uninjured patients, whose profile was different (ie, younger, more often female, with higher blood alcohol concentrations, and admission distributed more evenly across ED shifts). Conclusions Case detection rates for alcohol involvement may be biased and inflated when based on physician decisions to test for alcohol use. Rates based on comprehensive chart reviews and clinical examination may be better estimates but are also subject to methodologic limitations. Universal screening would yield the most accurate estimates of alcohol prevalence and would provide more accurate guidance to physicians regarding when to test for alcohol use. Universal screening as a clinical standard would help to identify more adolescents who might benefit from additional alcohol use intervention.

Parental factors influence teen alcohol use after an emergency department visit.

Objectives: To determine if parental factors are significant predictors of short-term adolescent drinking after an alcohol-related emergency department (ED) visit. Methods: Adolescents, 13 to 17 years, who either had evidence or reported usage of alcohol in the 6 hours before an ED visit, were eligible for this study. Alcohol use was assessed at baseline and at 3-month follow-up. Data on parental variables and parenting practices were collected at baseline. Linear regression models were created to determine the relationship between parental factors and follow-up drinking. Results: Parental alcohol use, socioeconomic status, and monitoring practices were significant predictors of adolescent alcohol use at 3-month follow-up. Conclusions: Parental factors may significantly influence subsequent adolescent drinking after an ED visit. These factors should be assessed when treating alcohol-positive teens, and parents should be advised to closely monitor their teens.

Alcohol Use History Differentiates Adolescents Treated in the Emergency Department After an Alcohol-Related Incident

Objectives: The current study compared 3 groups of adolescents identified in an emergency department (ED) following an alcohol-related event: (1) alcohol-positive adolescents scoring at or above the clinical cutoff on a measure of problematic drinking, the Adolescent Drinking Inventory (ADI) (n = 45); (2) alcohol-positive adolescents scoring below the clinical cutoff on the ADI (n = 68), and (3) alcohol-negative adolescents (n = 64). We examined whether these 3 groups of adolescents differed on measures of substance use as well as psychosocial factors. Methods: Participants were recruited as part of a larger clinical trial. Alcohol-positive adolescents were recruited from a level I regional trauma center for treatment related to an alcohol-related incident. Alcohol-negative adolescents were recruited from the ED and the community. The data reported here were from the baseline adolescent and parent assessments. Before completing assessments, adolescents were required to pass a brief mental status examination. Results: Adolescents in the alcohol-positive, high-ADI group reported significantly more substance use, peer substance use, and peer tolerance of substance use than adolescents in the alcohol-positive, low-ADI group followed by adolescents in the alcohol-negative group. Adolescents in the alcohol-positive, high-ADI group reported significantly less parental supervision than adolescents in the other 2 groups. Conclusions: These findings underscore that alcohol-positive adolescents being treated in an ED are a heterogeneous group with respect to substance use as well as parent and peer risk factors. Physicians need to consider relevant background factors when making individualized discharge recommendations.