Lisa Berger

Immediate Neurocognitive Effects of Concussion

OBJECTIVE To prospectively measure the immediate neurocognitive effects and early course of recovery from concussion and to examine the effects of loss of consciousness (LOC) and posttraumatic amnesia (PTA) on the severity of neurocognitive impairment immediately after concussion. METHODS A sports-related concussion research model was used to allow prospective immediate evaluation of concussion. A total of 2385 high school and college football players were studied. Ninety-one players (3.8%) sustained concussions during the study. A brief neurocognitive and neurological screening measure, the Standardized Assessment of Concussion, was used to assess cognitive functioning before the football season, immediately after injury, and 15 minutes, 48 hours, and 90 days after injury. RESULTS Standardized Assessment of Concussion scores immediately after concussion were significantly lower than the preseason baseline score and the noninjured population baseline mean, even for injured subjects without LOC or PTA. Subjects with LOC were most severely impaired immediately after injury, whereas those without LOC or PTA were least impaired. Significant impairment was also detected 15 minutes after injury, but all three groups returned to baseline levels of cognitive functioning within 48 hours. CONCLUSION These findings are the first to demonstrate not only that a gradient of increasing concussion severity is represented by PTA and LOC but also that measurable neurocognitive abnormalities are evident immediately after injury without PTA or LOC.

Sociodemographic correlates of energy drink consumption with and without alcohol: results of a community survey.

OBJECTIVE We examined the sociodemographic correlates of energy drink use and the differences between those who use them with and without alcohol in a representative community sample. METHODS A random-digit-dial landline telephone survey of adults in the Milwaukee, Wisconsin area responded to questions about energy drink and alcohol plus energy drink use. RESULTS Almost one-third of respondents consumed at least one energy drink in their lifetime, while slightly over 25% used energy drinks in the past year and 6% were past-year alcohol plus energy drink users. There were important racial/ethnic differences in consumption patterns. Compared to non-users, past-year energy drink users were more likely to be non-Black minorities; and past-year alcohol plus energy drink users when compared to energy drink users only were more likely to be White and younger. Alcohol plus energy drink users also were more likely to be hazardous drinkers. CONCLUSIONS Our results which are among the first from a community sample suggest a bifurcated pattern of energy drink use highlighting important population consumption differences between users of energy drinks only and those who use alcohol and energy drinks together.

Alcohol mixed with energy drinks: are there associated negative consequences beyond hazardous drinking in college students?

OBJECTIVE The consumption of alcohol mixed with energy drinks (AmED) is prevalent among college students as is hazardous drinking, a drinking pattern that places one at risk for alcohol-related harm. The present study, therefore, examined associations between AmED use, hazardous drinking, and alcohol-related consequences in college students. METHODS Based on a probability sample conducted in 2010, participants were 606 undergraduate students aged 18-25. AmED consumption included lifetime and past year use. Hazardous drinking and alcohol-related consequences were measured during the past year. Point prevalence was used to estimate rates of AmED use, and chi-square, ANOVA, and logistic regression were used to examine associations between AmED use, hazardous drinking, and alcohol-related consequences. RESULTS Lifetime and past year AmED use prevalence rates were 75.2% and 64.7%, respectively. Hazardous drinkers who engaged in AmED use were significantly more likely than past year hazardous drinkers who did not engage in AmED use to have had unprotected sex (OR=2.35, CI 1.27-4.32). CONCLUSIONS AmED use appears to be highly prevalent among college students, and AmED use may confer additional risk for unprotected sex beyond hazardous drinking. Unprotected sex has implications for public health, and students who drink hazardously and consume AmED may be at greater risk.

Ethyl glucuronide in hair and fingernails as a long-term alcohol biomarker

Aims This study aimed to evaluate the performance of ethyl glucuronide (EtG) in hair and fingernails as a long-term alcohol biomarker. Design Cross-sectional survey with probability sampling. Setting Midwestern United States. Participants Participants were 606 undergraduate college students between the ages of 18 and 25 years at the time of selection for potential study participation. Measurements EtG concentrations in hair and fingernails were measured by liquid chromatography-tandem mass spectrometry at three thresholds [30 picograms (pg) per milligram (mg); 20 pg/mg; and 8 pg/mg]. Any weekly alcohol use, increasing-risk drinking and high-risk drinking on average during the past 12 weeks was assessed by participant interview using the time-line follow-back method. Findings In both hair and fingernails at all three EtG thresholds, sensitivity was greatest for the high-risk drinking group [hair: 0.43, confidence interval (CI) = 0.17, 0.69 at 30 pg/mg, 0.71, CI = 0.47, 0.95 at 20 pg/mg; 0.93, CI = 0.79, 1.00 at 8 pg/mg; fingernails: 1.00, CI = 1.00–1.00 at 30, 20 and 8 pg/mg] and specificity was greatest for any alcohol use (hair: 1.00, CI = 1.00, 1.00 at 30 and 20 pg/mg; 0.97, CI = 0.92–0.99 at 8 pg/mg; fingernails: 1.00, CI = 1.00–1.00 at 30, 20 and 8 pg/mg). Areas under the receiver operating characteristic curves were significantly higher for EtG concentration in fingernails than hair for any weekly alcohol use (P = 0.02, DeLong test, two-tailed) and increasing-risk drinking (P = 0.02, DeLong test, two-tailed). Conclusions Ethyl glucuronide, especially in fingernails, may have potential as a quantitative indicator of alcohol use.

Barriers and Facilitators of Transferring Research to Practice: An Exploratory Case Study of Motivational Interviewing

Based on Simpsons program change model, this study explored personal and organizational barriers and facilitators of transferring a research-based innovation, motivational interviewing (MI), into the practices of county-employed case managers and counselors. A mixed-method perspective was employed whereby practitioner and consumer data were gathered via focus groups, and additional practitioner data were collected by means of a 2-wave panel survey. Practitioner focus group data revealed several perceived organizational barriers related to the resource of time, whereas the consumer focus group data uncovered the potential need for practitioners to adopt a research-based technology such as MI. Correlational analyses of practitioner survey data found that the organizational resource of adequate computer equipment and the staff attributes of professional growth, efficacy, and job satisfaction facilitated intention to adopt and implement MI. Implications for human services administrators and MI trainers are discussed.

Community-based treatment for opioid dependent offenders: A pilot study

BACKGROUND Primary care opioid substitution treatment (OST) has not been compared to program-based OST for community-supervised offenders. OBJECTIVE The purpose of this project was to compare primary care to specialist supervised OST for opioid dependent offenders in terms of substance use and HIV risk outcomes. METHODS This project randomly assigned 15 jail diversion participants to either: (i) primary care buprenorphine OST, (ii) specialist facility buprenorphine OST, or (iii) specialist facility methadone OST. Participation lasted 13.5 months (12-month active treatment plus a post-participation visit). RESULTS All subjects endorsed 0 days of opioid use in the previous 14 at follow-up. Specialty care reduced HIV risk (Risk Assessment Battery composite score) over 6 months (-.24 ± .17) compared to primary care (.02 ± .14; p = .032). CONCLUSION Findings support primary care OST feasibility for a community-supervised offender sample. Specialist care may facilitate improvements in secondary outcomes, such as HIV risk behaviors. SCIENTIFIC SIGNIFICANCE Further research is needed to clarify (i) the role of primary care in addicted offender management, and (ii) the matching of offenders, based upon history and co-morbidity, to care coordination conditions.

Screening, Brief Intervention, and Referral to Treatment (SBIRT): An Interview with Scott Caldwell, MA, and Darla Spence Coffey, PhD2

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an integrated, public health approach to the identification, early intervention, and as needed, facilitation of treatment services for substance misuse (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). SBIRT is delivered in settings such as primary care that are different from specialty alcohol or drug treatment. Years of research, plus a recent U.S. demonstration program, support the positive health effects of SBIRT (Babor et al., 2007; Madras et al., 2009). As a result, national SBIRT dissemination and implementation efforts are underway, for example, through federal grants supported by the SAMHSA. Data from such efforts indicate that social workers, counselors, and nurses comprise the majority of providers delivering SBIRT services (SAMHSA, 2013). Within the new national policy context of the Affordable Care Act, which might enhance the integration of physical and behavioral health care (Croft & Parish, 2012), more social work practitioners and administrators might be incorporating SBIRT into their practices and workflows, respectively.

Computer-Assisted Substance Abuse Treatment: An Interview With Richard Cloud, PhD

Due to the rapid evolution of technology, many industries including substance abuse treatment have incorporated the use of technology into their services and products. Much of the original development and research of computer-assisted treatment in the addictions field began with smoking, later extending to gambling, and then to alcohol and other drug use (Carroll et al., 2011; Newman, Szkodny, Llera, & Przeworski, 2011). Computer assistance can include Web-based interventions, messaging using hand-held devices or cellular phones (e.g., texting), e-mail interventions, and educational computer and computer-assisted counseling programs (Buti et al., 2013; Carroll et al., 2011; Newman et al., 2011). The use of technology for substance abuse treatment has the potential to address barriers for those who need treatment but who might not be able or willing to use specialized treatment services due to geographical access, public stigma, child care, high cost, or feelings that traditional services are more intensive than what is needed (e.g., Moore, Fazzino, Garnet, Cutter, & Barry, 2011). This interview describes computer-assisted substance abuse treatment from the perspective of Dr. Richard Cloud, an Associate Professor at the

Does Job Satisfaction Mediate the Relationships Between Work Environment Stressors and Employee Problem Drinking

SUMMARY This study tested a mediation model of work environment stressors, job satisfaction, and employee drinking status. Specifically, decreased job satisfaction was examined as a mediator by which work environment stressors may be linked to employee alcohol problems. Individual social vulnerabilities also were examined as predictors of employee problem drinking. Study data were derived from self-report mailed surveys, and study participants were union-represented administrative support and blue-collar maintenance employees of a large public urban university. Although path analysis results did not support the role of job satisfaction in linking work environment stressors to employee problem drinking, several study variables of interest were found to be associated significantly and directly with employee problem drinking status. Implications for workplace alcohol prevention are discussed.

Referral to treatment for hospitalized medical patients with an alcohol use disorder: A proof-of-concept brief intervention study

ABSTRACT Substance misuse intervention in healthcare settings is becoming a US national priority, especially in the dissemination and implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT). Yet, the referral to treatment component of SBIRT is understudied. This proof-of-concept investigation tested an enhanced coordinated hospital-community two session brief intervention designed to facilitate the referral to treatment of hospitalized medical patients with an alcohol use disorder. Participants (N = 9) attended the second session of the brief intervention held in the community in most cases (56%), while one out of three (33%) received some level of post-brief intervention alcohol and/or other drug treatment. Alcohol use and alcohol-related problems also statistically improved. Based, in part, on the results plus the widespread dissemination of SBIRT, next step investigations of brief interventions to help bridge hospitalized medical patients in need to community substance abuse treatment are warranted.