Susa Reinhardt

Effectiveness of brief alcohol interventions for general practice patients with problematic drinking behavior and comorbid anxiety or depressive disorders.

BACKGROUND Brief interventions (BIs) are effective methods to reduce problematic drinking. It is not known, if the effectiveness of BI differs between patients with or without comorbid depression or anxiety disorders. METHODS In a randomized controlled BI study with two intervention groups and one control condition, data were collected from 408 general practice (GP) patients with alcohol use disorders, at-risk drinking or binge drinking. 88 participants were diagnosed with comorbid anxiety and/or depressive disorders. The effectiveness of BI was assessed at a 12-month follow-up in relation to the presence and absence of comorbidity. Reduction of drinking in six ordered categories (g/alcohol) between baseline and follow-up served as the outcome variable. RESULTS BI were significantly related to reduction of drinking in the non-comorbid (-2.64 g/alcohol vs. -8.61 g/alcohol; p=.03) but not in the comorbid subsample (-22.06 g/alcohol vs. -22.09 g/alcohol; p=.76). Compared to non-comorbid participants, a significantly higher reduction of drinking was found for comorbid individuals (-6.55 g/alcohol vs. -22.08 g/alcohol; p=.01). An ordinal regression analysis revealed comorbidity to be a positive predictor for reduction of drinking (estimator=.594; CI=.175-1.013; p<.01). When entering the variables amount of drinking at baseline, intervention and classification of problematic drinking, these became significant predictors, whereas comorbidity showed only a tendency. CONCLUSION BI did not significantly effect a reduction of drinking in comorbid patients. As BI are known to be less effective for dependent drinkers, a larger proportion of dependents among the comorbid might have limited the effectiveness of BI. Future studies with larger sample sizes of comorbid problem drinkers are necessary to confirm the results.

Differences in help seeking rates after brief intervention for alcohol use disorders in general practice patients with and without comorbid anxiety or depressive disorders.

Aims: To examine, if the utilization of help for problematic drinking after brief intervention (BI) differs between general practice (GP) patients with and without comorbid depression or anxiety disorders. Methods: Longitudinal data of 374 GP patients, who met the diagnostic criteria of alcohol dependence or abuse according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‐IV) and criteria of at‐risk drinking or binge drinking, were drawn from a randomized controlled BI study. Participants were randomly allocated to either a control or one of two intervention groups, receiving a series of alcohol related BI. Of the sample, 88 participants were diagnosed with comorbid anxiety and/or depressive disorders. At 12‐months follow‐up, differences in utilization of formal help for drinking problems were assessed between comorbid and non‐comorbid individuals. Results: BI were significantly related to an increase in utilization of formal help in non‐comorbid patients (χ2 = 4.54; df = 1; p < 0.05) but not in comorbid individuals (χ2 = 0.40; df = 1; p = 0.60). In a logistic regression analysis, comorbidity [odds ratio (OR) = 1.81; 95% confidence interval (CI) = 1.14–2.88; p = 0.01) and previous help seeking (OR = 15.98; CI = 6.10–41.85; p < 0.001) were found to be positive predictors for utilization of formal help. Conclusion: BIs do not seem to significantly support help‐seeking in the comorbid. As comorbid anxiety and depression constitute a positive predictor for help‐seeking, individuals with problematic drinking and comorbid anxiety or depressive disorders might benefit from more specialized support exceeding the low level of BI. Copyright

Severity of unhealthy alcohol consumption in medical inpatients and the general population: is the general hospital a suitable place for brief interventions?

ObjectivesEvidence for brief interventions in general hospital (GH) settings is scarce, probably due to higher rates of dependent drinkers. The present study aims to compare unhealthy drinking patterns in GH patients with the general population (GP).MethodsSample 1 consisted of 4,075 individuals randomly drawn from registration office files, representing the non-institutionalised GP of a northern mixed rural–urban German area. Sample 2 consisted of 2,949 consecutively admitted patients from a GH covering the same area.ResultsCompared to individuals from the GP, GH patients revealed higher prevalence rates of alcohol dependence (1.3 vs. 5.5%) and alcohol abuse (1.2 vs. 2.8%), but did not differ significantly concerning at-risk drinking (5.1 vs. 6.2%). Multinomial logistic regression analysis controlling for age, sex and smoking using unrisky alcohol consumption as reference category belonging to the GH group was predictive for alcohol use disorders but not for at-risk drinking.ConclusionData show that a substantial number of individuals with unhealthy drinking patterns without alcohol use disorders can easily be accessed in GH settings if appropriate screening measures are conducted.ZusammenfassungHintergrundDie Evidenz für die Wirksamkeit von Kurzinterventionen im Setting des Allgemeinkrankenhauses ist eingeschränkt, möglicherweise aufgrund des hohen Anteils Alkoholabhängiger. Die vorliegende Studie vergleicht riskante Trinkmuster bei Patienten eines Allgemeinkrankenhauses mit der Allgemeinbevölkerung.MethodenStichprobe 1 bestand aus 4075 anhand von Einwohnermeldeamtsdaten randomisiert ausgewählten Personen, welche die nicht-institutionalisierte Bevölkerung einer gemischten ländlich-städtischen Bevölkerung Norddeutschlands repräsentieren (GP). Stichprobe 2 bestand aus 2949 konsekutiv aufgenommenen Patienten eines Allgemeinkrankenhauses der selben Region (GH).ErgebnisseGegenüber Personen der GP, wiesen Personen der GH höhere Prävalenzen an Alkoholabhängigkeit (1,3% vs. 5,5%) und Alkoholmissbrauch (1,2% vs. 2,8%) auf, ohne dass sich die Stichproben in der Häufigkeit riskanten Alkoholkonsums unterschieden (5,1% vs. 6,1%). In einer multinomialen logistischen Regression war die Zugehörigkeit zur GH-Gruppe nach Kontrolle auf Alter, Geschlecht und Rauchstatus prädiktiv für das Vorliegen einer alkoholbezogenen Störung, jedoch nicht für riskanten Alkoholkonsum.SchlussfolgerungDie Daten zeigen dass eine substanzielle Gruppe von Personen mit riskantem Alkoholkonsum im Setting des Allgemeinkrankenhauses bei Verwendung geeigneter Screening-Instrumente erreicht werden kann.

Performance of the Pictorial Representation of Illness and Self Measure in Individuals with Alcohol Dependence, Alcohol Abuse or At-Risk Drinking

Background: The impact of chronic illnesses is not only influenced by one’s physical functioning but also by its subjective importance to the individual’s life. However, it is often difficult to asses such an impact in an appropriate way. PRISM (pictorial representation of illness and self measure) measures the perception of illness and first data on its validity have been published. The aim of the present study was to prove the applicability of PRISM regarding alcohol-dependent patients. Therefore, a comparison was made between alcohol-dependent patients, alcohol abusers and at-risk drinkers. Method: The sample consisted of 763 general practice patients, who scored above the cutoff in alcohol-related screening questionnaires. Of this sample, 330 were diagnosed as alcohol dependent, alcohol abusers (both according to DSM-IV) or at-risk drinkers. To prove the applicability, PRISM was put in context with the severity of alcohol dependence and the core constructs of the transtheoretical model of behavior change. Results: PRISM was related to the severity of the drinking problem: the severer the drinking problem, the shorter the distance between self and illness. High correlations with aspects of alcohol consumption – such as adverse consequences from drinking, temptation to drink, and self-efficacy to abstain – were found. Concerning stages of change according to the transtheoretical model of behavior change, data show a significant difference in the self-illness separation between patients in the stage of contemplation compared to those in the precontemplation or action stage. Conclusions: The PRISM task is applicable to patients with alcohol use disorders. Within this group and in contrast to other chronic diseases, PRISM reveals a significant relationship not only to the severity of drinking, but also to the readiness to change one’s drinking behavior.

The Impact of Having a Loved One With Alcohol Consumption-Related Problems on Subjective Health Status and Health-Risk Behaviors in a General Hospital Sample

Consecutively admitted inpatients of a general hospital in Northern Germany (N = 2903) completed a standardized screening questionnaire in 2005–2006 containing questions about alcohol consumption-related problems in loved ones, their own alcohol consumption, and other health-related aspects. Almost 26.2% reported having a loved one with alcohol consumption-related problems. The proportions of smokers and those who screened positively for at-risk consumption or alcohol abuse were significantly higher in those patients; they were significantly younger and reported worse overall states of health and emotional health. Since those patients showed a high risk of numerous health problems, psychological interventions were implemented. The studys limitation noted.