T. Cameron Wild

A randomized controlled trial of an internet-based intervention for alcohol abusers

Objective Misuse of alcohol imposes a major public health cost, yet few problem drinkers are willing to access in-person services for alcohol abuse. The development of brief, easily accessible ways to help problem drinkers who are unwilling or unable to seek traditional treatment services could therefore have significant public health benefit. The objective of this project is to conduct a randomized controlled evaluation of the internet-based Check Your Drinking (CYD) screener (http://www.CheckYourDrinking.net). Method Participants (n = 185) recruited through a general telephone population survey were assigned randomly to receive access to the CYD, or to a no-intervention control group. Results Follow-up rates were excellent (92%). Problem drinkers provided access to the CYD displayed a six to seven drinks reduction in their weekly alcohol consumption (a 30% reduction in typical weekly drinking) at both the 3- and 6-month follow-ups compared to a one drink per week reduction among control group respondents. Conclusions The CYD is one of a growing number of internet-based interventions with research evidence supporting its efficacy to reduce alcohol consumption. The internet could increase the range of help-seeking options available because it takes treatment to the problem drinker rather than making the problem drinker come to treatment.

The role of absorption in experiential involvement.

The authors examined correlates of trait absorption to understand when and how pronounced engagement with attentional objects occurs. In Study 1 (N = 321), absorption and openness to experience were positively correlated (r =.64), and these involvement constructs were differentiated from Eysencks Big 3 (Extraversion, Neuroticism, and Psychoticism; H. J. Eysenck & M. W. Eysenck, 1985). In Study 2 (N = 68), absorption was positively correlated with participation in the arts, with effects of art on mood, and with ratings of the importance of art to daily life (ps <.05). Absorption was negatively correlated with speed and positively correlated with productivity ofvisual figure-ground differentiation and was positively correlated with cross-modal elaborative processing (ps <.05). Trait absorption reflects (a) a motivational readiness to engage in experiential, noninstrumental functioning and (b) distinctive cognitive capacities to efficiently identify and richly elaborate objects of attention.

Prevalence of co-occurring substance use and other mental disorders in the Canadian population.

Objective: Population health surveys around the world have studied the epidemiology of comorbid substance use disorders (SUDs) and other mental disorders as part of larger efforts to assess needs and direct integrated planning and delivery of services. This study presents the first national assessment in Canada of the prevalence of co-occurring SUDs and other mental disorders, with attention to differences by substance problem severity, sex, age, and region. Methods: This work is a secondary analysis of data from the 2002 Canadian Community Health Survey: Mental Health and Well-Being. The sample was obtained using a multistage stratified cluster design (n = 36 984, response rate = 77%). Results: The 12-month population prevalence of co-occurring disorders was 1.7%. The 12-month prevalence of other mental disorders was higher among those with illicit drug, relative to alcohol, problems and among those with dependence, compared with those with less severe problems. Sex and age differences mirrored population differences in pure disorders. Salient regional differences included the higher rate of co-occurring disorders in British Columbia and the lower rates in Quebec. Conclusions: Cross-study comparisons are hampered by methodological differences; however, these Canadian rates are at the lower end of the range reported internationally. This might have resulted from the exclusion of several disorders known to be highly comorbid with SUDs. Nonetheless, prevalence is high in certain subgroups, and efforts under way to improve Canadas substance abuse and mental health services should continue to ensure that adequate attention is directed to the needs of people with co-occurring disorders.

Measuring Treatment Process Beliefs Among Staff of Specialized Addiction Treatment Services

In a survey conducted in Ontario, front-line staff of specialized addiction treatment services were asked to indicate the extent to which they believed 53 different treatment processes to be necessary for the effective treatment of people with alcohol and drug problems. Cognitive-behavioural processes were generally rated as almost essential for treatment to be effective. Other processes received mixed ratings, while confrontation and pharmacological treatment were, on average, rated as detrimental. Factor analysis identified three interpretable dimensions of beliefs (a) cognitive-behavioural, (b) disease, and (c) medication. A fourth dimension involved both psychodynamic and conditioning processes and did not clearly correspond with any known therapeutic approach. Scores on scales developed using items from these four dimensions were variously influenced by respondents age, education, place of work, and certification status. Two groups identified using cluster analysis differed primarily with respect to scores on the disease scale. Logistic regression analysis showed that age, certification status, and place of work were associated with membership in these groups. Implications for treatment system development and research are discussed.

Risk factors for methamphetamine use in youth: a systematic review

BackgroundMethamphetamine (MA) is a potent stimulant that is readily available. Its effects are similar to cocaine, but the drug has a profile associated with increased acute and chronic toxicities. The objective of this systematic review was to identify and synthesize literature on risk factors that are associated with MA use among youth.More than 40 electronic databases, websites, and key journals/meeting abstracts were searched. We included studies that compared children and adolescents (≤ 18 years) who used MA to those who did not. One reviewer extracted the data and a second checked for completeness and accuracy. For discrete risk factors, odds ratios (OR) were calculated and when appropriate, a pooled OR with 95% confidence intervals (95% CI) was calculated. For continuous risk factors, mean difference and 95% CI were calculated and when appropriate, a weighted mean difference (WMD) and 95% CI was calculated. Results were presented separately by comparison group: low-risk (no previous drug abuse) and high-risk children (reported previous drug abuse or were recruited from a juvenile detention center).ResultsTwelve studies were included. Among low-risk youth, factors associated with MA use were: history of heroin/opiate use (OR = 29.3; 95% CI: 9.8–87.8), family history of drug use (OR = 4.7; 95% CI: 2.8–7.9), risky sexual behavior (OR = 2.79; 95% CI: 2.25, 3.46) and some psychiatric disorders. History of alcohol use and smoking were also significantly associated with MA use. Among high-risk youth, factors associated with MA use were: family history of crime (OR = 2.0; 95% CI: 1.2–3.3), family history of drug use (OR = 4.7; 95% CI: 2.8–7.9), family history of alcohol abuse (OR = 3.2; 95% CI: 1.8–5.6), and psychiatric treatment (OR = 6.8; 95% CI: 3.6–12.9). Female sex was also significantly associated with MA use.ConclusionAmong low-risk youth, a history of engaging in a variety of risky behaviors was significantly associated with MA use. A history of a psychiatric disorder was a risk factor for MA for both low- and high-risk youth. Family environment was also associated with MA use. Many of the included studies were cross-sectional making it difficult to assess causation. Future research should utilize prospective study designs so that temporal relationships between risk factors and MA use can be established.

Medical, demographic, and psychosocial correlates of exercise in colorectal cancer survivors: an application of self-determination theory

ObjectivesThe purpose of the present study was to evaluate medical, demographic, and psychosocial correlates of exercise in colorectal cancer survivors (CRC-S) using self-determination theory (SDT).MethodsParticipants were 414 CRC-S who completed a mailed survey that assessed self-reported exercise, medical and demographic variables, and SDT constructs consisting of behavioral regulation for exercise, psychological needs satisfaction in exercise (PNSE), and perceived autonomy support (PAS).ResultsCRC-S with less education were significantly less likely to meet exercise guidelines (21 vs 31%; p < 0.001). Path analysis indicated that SDT and education explained 16% of the variance in exercise behavior with identified regulation (β = 0.17, p = 0.031), introjected regulation (β = 0.14, p = 0.006), and education (β = 0.16, p < 0.001) each making a significant independent contribution.ConclusionsFew medical and demographic factors are correlates of regular exercise in CRC-S, but SDT provided a good understanding of exercise behavior in this population. Exercise behavior change interventions incorporating principles of SDT may have utility for promoting exercise and improving outcomes in this important population of cancer survivors.

Chronic Disease–Related Lifestyle Risk Factors in a Sample of Canadian Adolescents

This study examined the prevalence, clustering, age trends, and gender differences of chronic-disease related risk factors among a large sample of adolescents (N = 4932) in Alberta, Canada. Approximately 43% of boys and 53% of girls displayed two or more risk factors. Age trends and gender differences were also observed.

Twelve-Month Follow-up Results from a Randomized Controlled Trial of a Brief Personalized Feedback Intervention for Problem Drinkers

Aims: To examine the impact of a web-based personalized feedback intervention, the Check Your Drinking (CYD; www.CheckYourDrinking.net) screener at 12-month follow-up. Methods: Respondents (N = 185) were recruited from a general population telephone survey of Ontario, Canadian adults (≥18 years) by asking risky drinkers if they were willing to help develop and evaluate Internet-based interventions for drinkers. Those randomly assigned to the intervention condition were provided with the web address and a unique password to a study-specific copy of the CYD. Respondents assigned to the control condition were sent a written description of the different components of the CYD and asked how useful they thought each of the components might be. Respondents were followed up at 3, 6 and 12 months. Results: By the 12-month follow-up, the impact of the intervention previously reported at 3 and 6 months of CYD on problem drinkers’ alcohol consumption was no longer apparent (P > 0.05). Conclusions: Recognizing that many people with alcohol concerns will never seek treatment, recent years have seen an increase in efforts to find ways to take treatment to problem drinkers. The CYD is one such intervention that has a demonstrated effect on reducing alcohol consumption in the short term (i.e. 6 months). Other more intensive Internet-based interventions or interventions via other modalities may enhance this positive outcome over the short and long term among problem drinkers who would be otherwise unlikely to access treatment for their alcohol concerns. www.ClinicalTrials.gov registration #NCT00367575.

‘Herbal’ but potentially hazardous: an analysis of the constituents and smoke emissions of tobacco-free waterpipe products and the air quality in the cafés where they are served

Background There are limited data on the composition and smoke emissions of ‘herbal’ shisha products and the air quality of establishments where they are smoked. Methods Three studies of ‘herbal’ shisha were conducted: (1) samples of ‘herbal’ shisha products were chemically analysed; (2) ‘herbal’ and tobacco shisha were burned in a waterpipe smoking machine and main and sidestream smoke analysed by standard methods and (3) the air quality of six waterpipe cafés was assessed by measurement of CO, particulate and nicotine vapour content. Results We found considerable variation in heavy metal content between the three products sampled, one being particularly high in lead, chromium, nickel and arsenic. A similar pattern emerged for polycyclic aromatic hydrocarbons. Smoke emission analyses indicated that toxic byproducts produced by the combustion of ‘herbal’ shisha were equivalent or greater than those produced by tobacco shisha. The results of our air quality assessment demonstrated that mean PM2.5 levels and CO content were significantly higher in waterpipe establishments compared to a casino where cigarette smoking was permitted. Nicotine vapour was detected in one of the waterpipe cafés. Conclusions ‘Herbal’ shisha products tested contained toxic trace metals and PAHs levels equivalent to, or in excess of, that found in cigarettes. Their mainstream and sidestream smoke emissions contained carcinogens equivalent to, or in excess of, those of tobacco products. The content of the air in the waterpipe cafés tested was potentially hazardous. These data, in aggregate, suggest that smoking ‘herbal’ shisha may well be dangerous to health.

Brief emergency department interventions for youth who use alcohol and other drugs: a systematic review

Objective Brief intervention (BI) is recommended for use with youth who use alcohol and other drugs. Emergency departments (EDs) can provide BIs at a time directly linked to harmful and hazardous use. The objective of this systematic review was to determine the effectiveness of ED-based BIs. Methods We searched 14 electronic databases, a clinical trial registry, conference proceedings, and study references. We included randomized controlled trials with youth 21 years or younger. Two reviewers independently selected studies and assessed methodological quality. One reviewer extracted and a second verified data. We summarized findings qualitatively. Results Two trials with low risk of bias, 2 trials with unclear risk of bias, and 5 trials with high risk of bias were included. Trials evaluated targeted BIs for alcohol-positive (n = 3) and alcohol/other drug–positive youth (n = 1) and universal BIs for youth reporting recent alcohol (n = 4) or cannabis use (n = 1). Few differences were found in favor of ED-based BIs, and variation in outcome measurement and poor study quality precluded firm conclusions for many comparisons. Universal and targeted BIs did not significantly reduce alcohol use more than other care. In one targeted BI trial with high risk of bias, motivational interviewing (MI) that involved parents reduced drinking quantity per occasion and high-volume alcohol use compared with MI that was delivered to youth only. Another trial with high risk of bias reported an increase in abstinence and reduction in physical altercations when youth received peer-delivered universal MI for cannabis use. In 2 trials with unclear risk of bias, MI reduced drinking and driving and alcohol-related injuries after the ED visit. Computer-based MI delivered universally in 1 trial with low risk of bias reduced alcohol-related consequences 6 months after the ED visit. Conclusions Clear benefits of using ED-based BI to reduce alcohol and other drug use and associated injuries or high-risk behaviours remain inconclusive because of variation in assessing outcomes and poor study quality.