A randomized controlled trial of a brief intervention after alcohol-related facial injury

Aim To evaluate the effectiveness of a brief motivational intervention on alcohol consumption and misuse in young males with alcohol‐related face injury. Design Randomized controlled trial. Setting Oral and maxillofacial surgery out‐patient clinic in an urban teaching hospital. Participants One hundred and fifty‐one participants were randomized to motivational intervention and control conditions. Interventions Control was treatment as usual. The intervention was treatment as usual plus a one‐session brief motivational intervention administered by a nurse. Measurements Three sets of measurements were taken at baseline, 3‐month and 1‐year follow‐up. Collateral measurements were also taken at 1‐year follow‐up. Primary outcome measures were total alcohol consumption, typical weeks consumption and days abstinent in preceding 3 months. Other outcome measures included the Alcohol Use Disorders Identification Test, a short form of the Alcohol Problems Questionnaire, and a measure of satisfaction with social relationships. Results There was a significant decrease in 84‐day total alcohol consumption across the year (P < 0.006) and further, a significant effect for the motivational intervention was demonstrated (P < 0.029). This pattern was repeated for days abstinent and alcohol consumption in a typical week as well as alcohol‐related problems. There was a significantly greater reduction in the percentage of hazardous drinkers in the motivational intervention group (from 60% to 27%, P < 0.009) compared to the control group (from 54% to 51%, NS). Conclusion A proportion of young men change their alcohol consumption following alcohol‐related injury. A nurse‐led psychological intervention adds significantly to the proportion and magnitude of response.     

A randomized trial of a brief alcohol intervention for needle exchangers (BRAINE)

Aims To test motivational interviewing (MI) as a brief intervention for reducing alcohol use among needle exchange clients. Design Randomized clinical trial. Setting Needle exchange program—Providence, Rhode Island, USA. Participants Between 2/98 and 10/99, we recruited 187 AUDIT‐positive (>8) active injection drug users. Intervention Those assigned to a brief motivational intervention (MI) condition received two 1‐hour therapist sessions following assessment visits, 1 month apart, focusing on alcohol use and HIV risk‐taking. Measurements Control and MI subjects received identical research assessments at baseline, 1 and 6 months following study enrollment. At 6 months, study outcomes included days of alcohol use measured using the time‐line follow‐back method. Findings Study retention was 96.8% at 6 months. Participants reported an average of 12.0 drinking days at baseline and 8.3 at 6 months. Significant reductions in drinking days were observed in both treatment conditions. We found significant treatment × baseline drinking day interaction effects. Tests for simple main effects were significant for subjects with above median (>9) baseline drinking day frequency, but not for those with below median baseline drinking frequency. Comparisons on dichotomous outcomes provided supporting evidence of treatment efficacy; those in MI were over two times more likely than controls to report reductions of 7 days or more (P < 0.05). Conclusions This study provides the first direct evidence that brief MI can decrease alcohol use among active injection drug users with drinking problems. Heavier drinkers seem best suited for this intervention, but the optimal intensity of treatments and which components of brief intervention are most effective deserve further study.     

Web-based self-help for problem drinkers: a pragmatic randomized trial

AIMS: Self-help interventions for adult problem drinkers in the general population have proved effective. The question is whether this also holds for self-help interventions delivered over the internet. DESIGN: We conducted a pragmatic randomized trial with two parallel groups, using block randomization stratified for gender and with follow-up at 6 months. SETTING: The intervention and trial were conducted online in the Netherlands in 2003-2004. PARTICIPANTS: We selected 261 adult problem drinkers from the general population with a weekly alcohol consumption above 210 g of ethanol for men or 140 g for women, or consuming at least 60 g (men) or 40 g (women) at least 1 day a week over the past 3 months. Participants were randomized to either the experimental drinking less (DL) condition or to the control condition (PBA). INTERVENTION: DL is a web-based, multi-component, interactive self-help intervention for problem drinkers without therapist guidance. The recommended treatment period is 6 weeks. The intervention is based on cognitive-behavioural and self-control principles. The control group received access to an online psychoeducational brochure on alcohol use (PBA). OUTCOME MEASURES: We assessed the following outcome measures at 6-month follow-up: (i) the percentage of participants who had reduced their drinking levels to within the normative limits of the Dutch guideline for low-risk drinking; and (ii) the reduction in mean weekly alcohol consumption. FINDINGS: At follow-up, 17.2% of the intervention group participants had reduced their drinking successfully to within the guideline norms; in the control group this was 5.4% [odds ratio (OR) = 3.66; 95% confidence interval (CI) 1.3-10.8; P = 0.006; number needed to treat (NNT) = 8.5]. The intervention subjects decreased their mean weekly alcohol consumption significantly more than control subjects, with a difference of 12.0 standardized units (95% CI 5.9-18.1; P < 0.001; standardized mean difference 0.40). CONCLUSIONS: To our knowledge this is one of the first randomized controlled trials on a web-based self-help intervention without therapist guidance for self-referred problem drinkers among the adult general population. The intervention showed itself to be effective in reducing problem drinking in the community.     

Education of key personnel in student pubs leads to a decrease in alcohol consumption among the patrons: a randomized controlled trial

Aims To decrease alcohol consumption among patrons in student pubs by server‐training programmes. Design Randomized controlled trial. Setting University campus. Participants A total of 1322 students visiting local student pubs during ordinary pub evenings. Intervention Educational programmes were given to bartenders (n = 40) in a randomized design in six of 12 pubs on a university campus. Bartenders in control pubs were not given the programme. Measurements Breath alcohol concentration (BAC), expressed in percentage, among the patrons and the reported social atmosphere in the pub (‘high’, ‘cosy’ and ‘rowdy’) measured on a visual analogue scale in the pub before and after the intervention programme was given. Findings BACs of patrons in the intervention pubs were reduced by more than those of the patrons in the control pubs at a 1‐month follow‐up. The mean difference in BAC between intervention and control groups was ?0.011% (95% confidence interval, 0.022–0.000). The intervention group also decreased more in reported level of ‘rowdy’ social atmosphere than did the control group. The mean difference was ?6 points (95% confidence interval ?11 to ?1). No differences were found in reported ‘cosy’ and ‘high’ atmosphere. Conclusion Alcohol levels among the patrons were decreased and the ‘rowdy’ social atmosphere reduced in the intervention group. Server‐training programmes for personnel in student pubs could be a component in the prevention of alcohol problems in university student populations.     

Happy ending: a randomized controlled trial of a digital multi-media smoking cessation intervention

AIMS: To assess the long-term efficacy of a fully automated digital multi-media smoking cessation intervention. DESIGN: Two-arm randomized control trial (RCT). Setting World Wide Web (WWW) study based in Norway. PARTICIPANTS: Subjects (n = 396) were recruited via internet advertisements and assigned randomly to conditions. Inclusion criteria were willingness to quit smoking and being aged 18 years or older. INTERVENTION: The treatment group received the internet- and cell-phone-based Happy Ending intervention. The intervention programme lasted 54 weeks and consisted of more than 400 contacts by e-mail, web-pages, interactive voice response (IVR) and short message service (SMS) technology. The control group received a self-help booklet. Additionally, both groups were offered free nicotine replacement therapy (NRT). MEASUREMENTS: Abstinence was defined as 'not even a puff of smoke, for the last 7 days', and assessed by means of internet surveys or telephone interviews. The main outcome was repeated point abstinence at 1, 3, 6 and 12 months following cessation. FINDINGS: Participants in the treatment group reported clinically and statistically significantly higher repeated point abstinence rates than control participants [22.3% versus 13.1%; odds ratio (OR) = 1.91, 95% confidence interval (CI): 1.12-3.26, P = 0.02; intent-to-treat). Improved adherence to NRT and a higher level of post-cessation self-efficacy were observed in the treatment group compared with the control group. CONCLUSIONS: As the first RCT documenting the long-term treatment effects of such an intervention, this study adds to the promise of digital media in supporting behaviour change.     

A randomized controlled trial of a multifactorial falls prevention intervention for older fallers presenting to emergency departments

OBJECTIVES: To investigate the effect of a referral‐based targeted multifactorial falls prevention intervention on the occurrence of recurrent falls and injuries in older people presenting to an emergency department (ED) after a fall and discharged directly home from the ED. DESIGN: Randomized controlled trial. Assessors of outcomes were unaware of group allocation. SETTING: Seven EDs in metropolitan Melbourne, Australia. PARTICIPANTS: Inclusion criteria were community dwelling, aged 60 and older, presenting to an ED after a fall, and discharged directly home. Exclusion criteria were unable to follow simple instructions or walk independently. INTERVENTION: Targeted referrals to existing community services and health promotion recommendations, based on the falls risk factors found in a baseline assessment. MEASUREMENTS: Primary outcome measures were falls and resultant injuries occurring over the 12‐month follow‐up period. Falls and injury data were collected using falls calendars supported by medical record reviews. RESULTS: Three hundred sixty‐one participants were randomized to the standard care group and 351 to the intervention group. No significant difference was found between the two groups over the 12‐month follow‐up period in number of fallers (relative risk (RR)=1.11, 95% confidence interval (CI)=0.95–1.31] or number of participants sustaining an injury from a fall (RR=1.06, 95% CI=0.86–1.29). CONCLUSION: This study does not support the use of a referral‐based targeted multifactorial intervention program to reduce subsequent falls or fall injuries in older people who present to an ED after a fall.     

Addressing the efficacy of dihydrocodeine versus methadone as an alternative maintenance treatment for opiate dependence: A randomized controlled trial

AIM: The aim of this study is to define the efficacy of dihydrocodeine as an alternative to methadone in the maintenance treatment of opiate dependence. DESIGN: A pragmatic open-label randomized controlled study of patients recommended for opiate maintenance treatment to test equivalence of the two treatment options with follow-up continuing for up to 42 months after recruitment. SETTING: Assessment at either Edinburgh's Community Drug Problem Service or at two general practitioner practices with specialist drug community psychiatric nurses, then with shared care follow-up. PARTICIPANTS: Two hundred and thirty-five subjects (168 male, 67 female) with opiate dependence syndrome were recruited. Subjects selected were suitable for opiate maintenance treatment. Routine treatment was offered throughout. INTERVENTION: Patients were randomized to receive either methadone mixture 1 mg/ml or dihydrocodeine, 30 mg or 60 mg tablets. MEASUREMENTS: The primary outcome measure was retention in treatment. Eight secondary outcomes included total illicit opiate use, reported crime, physical health, mental health, injecting drug use, overdoses, selling drugs and being in education or work. Measures were compared over 42 months follow-up. FINDINGS: There was no difference in groups for retention in treatment at follow-up and there was improvement in all secondary outcomes from baseline. No significant difference in outcomes was found between randomized groups over time. Compliance with randomized treatment differed by randomized group and was affected by experiences in custody during follow-up. Those randomized to dihydrocodeine were more likely to switch treatments. CONCLUSIONS: These results, combined with existing clinical experience, provide evidence that dihydrocodeine is a viable alternative to methadone as a maintenance treatment for opiate dependence. Indirect comparisons with other studies show dihydrocodeine (and methadone) to be superior to placebo.     

Five-year outcomes of a brief alcohol intervention for adult in-patients with psychiatric disorders

Aims To compare 5 year outcomes (general hospital and mental health morbidity and mortality) among general hospital psychiatric in‐patients randomized to receive either an alcohol reduction motivational interview (MI) or information pack (IP), and compare these to matched controls. Design We recruited 120 patients aged 18–64 years who scored ≥8 on the Alcohol Use Disorders Identification Test (AUDIT). We selected matched controls from in‐patients not recruited but who reached the same AUDIT threshold. At 5 years, follow‐up data were collected via a state‐wide hospital record system. Findings There were no significant differences between the MI and IP groups in terms of ‘survival’ to their first alcohol‐related, other general hospital or mental health admission over 5 years. Matched controls had significantly more mental health in‐patient episodes (F[1,226] 4.4, P < 0.05) and greater length of hospital stay (F[1,226] 4.8, P < 0.05) than the combined MI‐IP group. Furthermore, the MI‐IP group had longer ‘survival’ times to both first general hospital (mean 583 versus 392 days) and mental health in‐patient (mean 788 versus 580 days) events. Collapsed across groups, dependent and harmful consumers had shorter ‘survival’ times than hazardous consumers (AUDIT classifications). Conclusions Alcohol interventions have medium‐term health benefits for those with mental health and alcohol use problems. Importantly, there were no differences in outcome between the intervention groups. The low cost of providing an IP makes it attractive as an alcohol intervention. The AUDIT provided an effective means of identifying those who are at risk of subsequent alcohol‐related admissions and may benefit from intervention.