Kristen L. Barry

Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices.

OBJECTIVE Project TrEAT (Trial for Early Alcohol Treatment) was designed to test the efficacy of brief physician advice in reducing alcohol use and health care utilization in problem drinkers. DESIGN Randomized controlled clinical trial with 12-month follow-up. SETTING A total of 17 community-based primary care practices (64 physicians) located in 10 Wisconsin counties. PARTICIPANTS Of the 17695 patients screened for problem drinking, 482 men and 292 women met inclusion criteria and were randomized into a control (n=382) or an experimental (n=392) group. A total of 723 subjects (93%) participated in the 12-month follow-up procedures. INTERVENTION The intervention consisted of two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information. MAIN OUTCOME MEASURES Alcohol use measures, emergency department visits, and hospital days. RESULTS There were no significant differences between groups at baseline on alcohol use, age, socioeconomic status, smoking status, rates of depression or anxiety, frequency of conduct disorders, lifetime drug use, or health care utilization. At the time of the 12-month follow-up, there were significant reductions in 7-day alcohol use (mean number of drinks in previous 7 days decreased from 19.1 at baseline to 11.5 at 12 months for the experimental group vs 18.9 at baseline to 15.5 at 12 months for controls; t=4.33; P<.001), episodes of binge drinking (mean number of binge drinking episodes during previous 30 days decreased from 5.7 at baseline to 3.1 at 12 months for the experimental group vs 5.3 at baseline to 4.2 at 12 months for controls; t=2.81; P<.001), and frequency of excessive drinking (percentage drinking excessively in previous 7 days decreased from 47.5% at baseline to 17.8% at 12 months for the experimental group vs 48.1% at baseline to 32.5% at 12 months for controls; t=4.53; P<.001). The chi2 test of independence revealed a significant relationship between group status and length of hospitalization over the study period for men (P<.01). CONCLUSIONS This study provides the first direct evidence that physician intervention with problem drinkers decreases alcohol use and health resource utilization in the US health care system.

Depressive symptoms among pregnant women screened in obstetrics settings.

OBJECTIVES This study aimed to describe the prevalence of depressive symptomatology during pregnancy when seen in obstetric settings, the extent of treatment in this population, and specific risk factors associated with mood symptoms in pregnancy. METHODS A total of 3472 pregnant women age 18 and older were screened while waiting for their prenatal care visits in 10 obstetrics clinics using a brief (10 minute) screening questionnaire. This screen measured demographics, tobacco and alcohol (TWEAK problem alcohol use screening measure), and depression measures, including the Center for Epidemiological Studies-Depression scale (CES-D), use of antidepressant medications, past history of depression, and current treatment (i.e., medications, psychotherapy, or counseling) for depression. RESULTS Of women screened, 20% (n = 689) scored above the cutoff score on the CES-D, and only 13.8% of those women reported receiving any formal treatment for depression. Past history of depression, poorer overall health, greater alcohol use consequences, smoking, being unmarried, unemployment, and lower educational attainment were significantly associated with symptoms of depression during pregnancy. CONCLUSIONS These data show that a substantial number of pregnant women screened in obstetrics settings have significant symptoms of depression, and most of them are not being monitored in treatment during this vulnerable time. This information may be used to justify and streamline systematic screening for depression in clinical encounters with pregnant women as a first step in determining which women may require further treatment for their mood symptoms. As elevations in depressive symptomatology have been associated with adverse maternal and infant outcomes, further study of the impact of psychiatric treatment in gravid women is essential.

The alcohol use disorders identification test (AUDIT) in a college sample

This study was conducted to estimate the psychometric properties of the questionnaire section of the Alcohol Use Disorders Identification Test (AUDIT) in a college sample using DSM-III criteria for alcohol abuse as the criterion standard. This alcohol screening test was developed for the 10 country AMETHYST project. In this young adult sample the instrument exhibited a sensitivity of .84 and specificity of .71 when utilizing the recommended cut-off score of 11. The 10-item questionnaire section of the AUDIT appears to have important advantages over other alcohol screening instruments such as the CAGE and the MAST.

Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings.

BACKGROUND Few studies have estimated the economic costs and benefits of brief physician advice in managed care settings. OBJECTIVE To conduct a benefit-cost analysis of brief physician advice regarding problem drinking. DESIGN Patient and health care costs associated with brief advice were compared with economic benefits associated with changes in health care utilization, legal events, and motor vehicle accidents using 6- and 12-month follow-up data from Project TrEAT (Trial for Early Alcohol Treatment), a randomized controlled clinical trial. SUBJECTS 482 men and 292 women who reported drinking above a threshold limit were randomized into control (n = 382) or intervention (n = 392) groups. MEASURES Outcomes included alcohol use, emergency department visits, hospital days, legal events, and motor vehicle accidents. RESULTS No significant differences between control and intervention subjects were present for baseline alcohol use, age, socioeconomic status, smoking, depression or anxiety, conduct disorders, drug use, crimes, motor vehicle accidents, or health care utilization. The total economic benefit of the brief intervention was

Detection of problem drinkers: the Alcohol Use Disorders Identification Test (AUDIT).

423,519 (95% CI:

Older patients with at-risk and problem drinking patterns: new developments in brief interventions.

35,947,

Primary Care Based Intervention to Reduce At-Risk Drinking in Older Adults: A Randomized Controlled Trial

884,848), composed of

The Relationship Between Alcohol Problems and Health Functioning of Older Adults in Primary Care Settings

195,448 (95% CI:

Medical education about substance abuse: changes in curriculum and faculty between 1976 and 1992.

36,734,

Treatment guidelines for depression in pregnancy

389,160) in savings in emergency department and hospital use and