Gerard M. Schippers

Effectiveness of opportunistic brief interventions for problem drinking in a general hospital setting: systematic review

Abstract Objective To determine the effectiveness of opportunistic brief interventions for problem drinking in a general hospital setting. Design Systematic review. Data sources Medline, PsychInfo, Cochrane Library, reference lists from identified studies and review articles, and contact with experts. Main outcome measure Change in alcohol consumption. Results Eight studies were retrieved. Most had methodological weaknesses. Only one study, with a relatively intensive intervention and a short follow up period, showed a significantly large reduction in alcohol consumption in the intervention group. Conclusions Evidence for the effectiveness of opportunistic brief interventions in a general hospital setting for problem drinkers is still inconclusive.

On the relationship between emotional and external eating behavior

Although there is a strong relationship between emotional and external eating, separate subscales for these behaviors have been constructed in the Dutch Eating Behavior Questionnaire. This study tries to establish whether this distinction is justified. We studied relationships among self-reported ( 1) degree of emotional and external eating behavior and (2) problems with (a) emotional distress and relationships, (b) stimulus-boundness (inappropriate amounts of either too much or too little exercise, work, leisure activities, and spending money), and (c) problems with substance use (alcohol, illicit drugs, nicotine, or caffeine) in a sample of female students. No relationships were found between either type of eating behavior and problems with substance use. Furthermore, the significant relationship between emotional and external eating behavior and stimulus-boundness disappeared in the subsample who had problems with overeating. The fact that in all samples emotional eating was significantly related to problems with emotional distress and relationships (anxiety, depression, phobias, suicidal acts or ideations, intimate relations, and sexual contacts) but external eating was not, suggests that the two types of eating behaviors refer to independent constructs. Thus, the use of separate scales to measure these theoretically different aspects of overeating seems warranted.

Missing data approaches in eHealth research: simulation study and a tutorial for nonmathematically inclined researchers.

Background Missing data is a common nuisance in eHealth research: it is hard to prevent and may invalidate research findings. Objective In this paper several statistical approaches to data “missingness” are discussed and tested in a simulation study. Basic approaches (complete case analysis, mean imputation, and last observation carried forward) and advanced methods (expectation maximization, regression imputation, and multiple imputation) are included in this analysis, and strengths and weaknesses are discussed. Methods The dataset used for the simulation was obtained from a prospective cohort study following participants in an online self-help program for problem drinkers. It contained 124 nonnormally distributed endpoints, that is, daily alcohol consumption counts of the study respondents. Missingness at random (MAR) was induced in a selected variable for 50% of the cases. Validity, reliability, and coverage of the estimates obtained using the different imputation methods were calculated by performing a bootstrapping simulation study. Results In the performed simulation study, the use of multiple imputation techniques led to accurate results. Differences were found between the 4 tested multiple imputation programs: NORM, MICE, Amelia II, and SPSS MI. Among the tested approaches, Amelia II outperformed the others, led to the smallest deviation from the reference value (Cohen’s d = 0.06), and had the largest coverage percentage of the reference confidence interval (96%). Conclusions The use of multiple imputation improves the validity of the results when analyzing datasets with missing observations. Some of the often-used approaches (LOCF, complete cases analysis) did not perform well, and, hence, we recommend not using these. Accumulating support for the analysis of multiple imputed datasets is seen in more recent versions of some of the widely used statistical software programs making the use of multiple imputation more readily available to less mathematically inclined researchers.

Reforming Dutch substance abuse treatment services

The Dutch substance abuse treatment system is in the middle of a major reorganization. The goal is to improve outcomes by redesigning all major primary treatment processes and by implementing a system of regular monitoring and feedback of clinical outcome data. The new program includes implementing standardized psychosocial behavior-oriented treatment modalities and a stepped-care patient placement algorithm in a core-shell organizational model. This article outlines the new program and presents its objectives, developmental stages, and current status.

Alcohol and social anxiety in women and men: Pharmacological and expectancy effects

A replication study was conducted to determine pharmacological and expectancy effects of alcohol on self-reported anxiety in a social interaction situation. Thirty-two male and thirty-two female social drinkers were randomly assigned to four conditions in a 2 x 2 factorial balanced placebo design, controlling for drink content and expectations. Results show that in women alcohol expectancy reduced self-reported anxiety, whereas in men there was no significant effect of expectancy. Alcohol consumption reduced anxiety in both men and women. Controlling for beliefs increased some of the effects we found. We conclude that although cognitive factors do mediate the effects of alcohol on self-reported anxiety, this influence seems to be different for men and women and the role of pharmacological factors might be more crucial.

The Obsessive Compulsive Drinking Scale: Translation into Dutch and Possible Modifications

The 14-item Obsessive Compulsive Drinking Scale (OCDS) is a quick and reliable self-rating instrument developed to measure cognitive aspects of craving for alcohol. The aim of this study was to transl

The Addiction Severity Index: Reliability and Validity in a Dutch Alcoholic Population

The Addiction Severity Index (ASI) was evaluated for its psychometric qualities in a Dutch alcoholic population admitted to an addiction treatment center in The Netherlands. Its factorial structure in this population was found to be consistent with the established six factor structure of the ASI. Reliability analysis revealed that the homogeneity of the subscales was acceptable with the exception of the Alcohol Scale. The six subscales were not highly intercorrelated. The results of this study indicate that the ASI is a useful instrument for the assessment of several problems associated with alcoholism. However, the Alcohol Scale appears to be limited as a diagnostic and research instrument in the field of inpatient treatment of alcohol dependence in The Netherlands.

Motivation for treatment in substance-dependent patients. Psychometric evaluation of the TCU motivation for treatment scales.

The objective of this paper is to analyze the psychometric properties of the TCU Motivation for Treatment (MfT) scale in alcohol- and drug-dependent patients in an inpatient treatment facility in the Netherlands, to see whether it is useful in European populations as well. In the study, 279 consecutive patients were enrolled: 132 drug and 147 alcohol dependents. Exploratory and confirmatory factor analysis revealed 4 subscales: recognition of general problems (4 items), recognition of specific problems (5), desire for help (5) and treatment readiness (8). The results of the analyses showed that the MfT scale is a valid instrument for measuring treatment motivation, both in drug- and in alcohol-dependent patients. We demonstrated evidence for consistency of the scale through cultural barriers, in different populations and in different treatment settings.

Motives for and Against Injecting Drug Use Among Young Adults in Amsterdam: Qualitative Findings and Considerations for Disease Prevention

To elucidate injection initiation and risky injection practices among young drug users (YDUs) in Amsterdam, this study identifies self-reported motives for injecting and not injecting to inform interventions to be targeted at issues personally relevant for this population. A qualitative study was performed using in-depth interviews to obtain retrospective drug use histories. Recruitment took place both directly (by street outreach, outreach at methadone outposts) and indirectly (by respondent-driven sampling). The study started in the year 2001 and included 50 YDUs, aged 18–30, of which 18 had a history of injecting. Reasons for not starting injection were fears of needles, overstepping a limit, damage to appearance, fears of missing veins and causing abscesses, and illnesses. Reasons for starting injection were stronger effect or rush, curiosity, economy, knowing injectors, and perceived lack of danger to health. Motives for injecting and not injecting can differ widely individually. Some strong motives are hardly addressed by prevention programs and should inform new prevention initiatives. Users’ own motives for not injecting should be promoted, whereas their motives for initiation should be counter-balanced with factual information.

No effect of negative mood on the alcohol cue reactivity of in-patient alcoholics

Forty in-patient alcoholics were exposed to an alcohol cue (holding and smelling an alcoholic drink) while in a negative mood, and while in a neutral mood. For the negative mood condition either a distressing or depressing Mood Induction Procedure (MIP) was used. In the control condition, a neutral MIP was used. In the negative mood condition, the subjects were found to be more distressed, more irritated, less calm, and less satisfied than in the neutral mood condition. In all conditions, following exposure to the alcohol cue, the desire to drink, systolic blood pressure, and heart rate variability increased, while self-efficacy beliefs to resist the urge to drink, and heart rate decreased. In sum, alcohol cue reactivity was observed, but not in response to a negative as opposed to a neutral mood or a distressed versus a depressed mood.