Factors associated with adolescent utilization of alcohol treatment services

OBJECTIVE: This study examined factors associated with adolescents' use of alcohol treatment services. METHOD: Data on adolescents (aged 12-17) from the 1994 National Household Survey on Drug Abuse (NHSDA, N = 4,698), a large representative sample of the U.S. population, were used in this study. Information obtained from the survey included adolescent alcohol use, drinking patterns, alcohol abuse/dependent problems, and service use for alcohol-related problems. In addition, socio- demographics, health insurance, mental and behavioral problems, and other drug use were also included in the analysis. RESULTS: The findings indicate that many adolescents with alcohol problems did not receive treatment. White adolescents were more likely to receive alcohol treatment services than nonwhites. Among alcohol-related problems, alcohol causing problems at home, school, or other settings predicted entry into alcohol treatment. Drug use and poor health status were also associated with receiving alcohol treatment services. CONCLUSIONS: This study calls for an improved service delivery system to meet service needs of adolescents with alcohol-related problems, especially among minorities, and those with alcohol-related problems but without yet experiencing significant negative social consequences.     

Use of Clergy Services among Individuals Seeking Treatment for Alcohol Use Problems

This study examined the prevalence and characteristics of adults with an alcohol use‐related problem who receive clergy services. Data come from the National Epidemiologic Survey on Alcohol and Related Conditions. Among persons who sought any services for alcohol‐related problems (n = 1,910), 14.7% reported using clergy services. In a multivariable logistic regression model, factors associated with increased likelihood of service use included being Black, aged 35–54 years, a lifetime history of alcohol dependence, major depressive disorder, and personality disorder. Clergy may benefit from training to identify alcohol use problems and serve an important role in making treatment referrals. (Am J Addict 2010;00:1–7)     

Insight into Alcohol-Related Problems and Its Associations with Severity of Alcohol Consumption,Mental Health Status,Race, and Level of Acculturation in Southern Taiwanese Indigenous People with Alcoholism

Objective: While not well known in the West, Taiwan has a substantial indigenous population, and this population has rapidly developed alcohol problems. This study examined the level of insight into alcohol-related problems and its associations with the severity of alcohol consumption, mental health status, race, and the level of acculturation among indigenous populations with alcohol problems in southern Taiwan. Methods: A total of 332 indigenes, whose total Alcohol Use Disorders Identification Test (AUDIT) score was equal to 8 or higher, were interviewed. The associations between the level of insight into alcohol-related problems and the severity of alcohol drinking on the AUDIT, mental health status on the Chinese Health Questionnaire-12 (≥ 4 vs. < 4), race (Bunun vs. non-Bunun), and the level of acculturation on the Taiwan Aboriginal Acculturation Scale were examined using logistic regression models. Results: The results of this study found that 72.6% of the participants had poor insight into alcohol-related problems and no participant had good insight. Participants who had more severe alcohol drinking or poor mental health were more likely to have a higher level of insight into alcohol-related problems. Participants who were non-Bunun were also more likely to have a higher level of insight into alcohol-related problems, but the level of acculturation was not associated with the level of insight into alcohol-related problems. Conclusions: These findings suggest that most alcoholic indigenes in southern Taiwan have poor insight into their own alcohol-related problems. Cultural specific interventions targeting and improving the indigenes' insight into alcohol-related problems are needed.     

Homeless women’s service use,barriers, and motivation for participating in substance use treatment

Background: Homeless women are at high risk for substance use disorder (SUD), and are a growing proportion of the homeless population. However, homeless women experience barriers to engaging in substance use services. Objectives: Among homeless women with SUD, to explore service use, motivation to change, service barriers, and willingness to have substance use and mental health problems addressed in primary health care. Methods: Women with SUD were sampled from 11 Health Care for the Homeless (HCH) primary care clinics in 9 states, yielding 241 with either an alcohol or drug use disorder who then completed questions about SUD services. Results: Over 60% of women with dual alcohol and drug use disorders used some type of SUD service in the past year, while 52% with a drug only disorder, and 44% with an alcohol only disorder used services. The most mentioned barrier to service use was depression, but cost, wait time, where to find treatment, and facilities located too far away, were also frequently noted. A large proportion across all groups indicated high motivation for treatment and willingness to discuss their SUD in a primary care setting. Conclusion: There are continued barriers to SUD service use for homeless women despite high motivation for treatment, and willingness to be asked about SUD and mental health problems in primary care. HCH primary care sites should more systematically ask about SUD and mental health issues and address women’s expressed need for support groups and alternative therapies to more holistically address their SUD needs.     

Gender and racial/ethnic differences in patterns of adolescent alcohol use and associations with adolescent and adult illicit drug use

Objectives: The study objective was to use latent class analyses (LCAs) to identify gender- and racial/ethnic-specific groups of adolescent alcohol users and associations between alcohol use group and adolescent and adulthood illicit drug use in a nationally-representative US sample. Methods: We used Wave I (1994–1995, adolescence) of the National Longitudinal Study of Adolescent Health to conduct LCAs by gender and race/ethnicity and measure associations between class membership and Wave I and Wave III (2001–2002, young adulthood) drug use. Participants included white (n?=?9548), African American (n?=?4005) and Hispanic (n?=?3184) participants. LCAs were based on quantity and frequency of adolescent alcohol use; physiological and social consequences of use; and peer use. Results: Males and females were characterized by different alcohol use typologies and consequences. Males in the highest severity class (i.e. drank both heavily and frequently) experienced disproportionate risk of alcohol-related consequences compared with abstainers and other alcohol-using groups. Females who drank heavily when drinking even if only occasionally, experienced high risk of alcohol-related consequences. Substantial proportions of males reported diverse alcohol-related problems, whereas females most commonly reported alcohol-related problems with dating and sexual experiences. Though levels of alcohol use and report of problems associated with use were higher among white versus minority populations, other racial/ethnic differences in patterns of alcohol use were minimal. Classification in any drinking class was a strong risk factor for adolescent and adulthood illicit drug use, with heavy drinkers at greatest risk of drug use. Conclusions: Gender-specific adolescent alcohol and substance use prevention programs are warranted.     

Old dog,new tricks: treating co-occurring anxiety and alcohol use disorders

Background: Over 100 million Americans live with chronic pain, and adults with chronic pain may be more likely to experience alcohol-related problems or Alcohol Use Disorder. An evolving conceptual model posits that bidirectional effects between pain and alcohol exacerbate both pain and drinking. Pain has been shown to motivate alcohol urge and consumption, and drinking for pain-coping predicts escalations in alcohol use over time. Pain-related anxiety is a transdiagnostic vulnerability factor that has been implicated in both pain and substance-related (i.e., tobacco, opioids, cannabis) outcomes, but has not yet been studied in relation to alcohol use.

Objective: We sought to conduct the first test of cross-sectional associations between pain-related anxiety, gender, and alcohol use.

Methods: Adults with chronic pain (N = 234; M_age = 29.54, 67% Female) self-reported pain-related anxiety, gender, and alcohol use (i.e., consumption frequency/quantity, alcohol-related consequences, and dependence symptoms measured with the Alcohol Use Disorders Identification Test; AUDIT). Hierarchical regression and conditional effects models were used to test associations between pain-related anxiety, gender, and alcohol use.

Results: Pain-related anxiety was positively associated with alcohol-related consequences and alcohol dependence symptoms measured by the AUDIT among males, but not females. Pain-related anxiety was not associated with the frequency/quantity of alcohol consumption in our sample.

Conclusions: These findings are consistent with prior research, which has demonstrated associations between pain-related anxiety and deleterious substance use outcomes. Results provide initial evidence that pain-related anxiety may be a relevant factor to consider in the context of alcohol research and treatment among male drinkers.     

Alcohol use and alcohol-related consequences: associations with emotion regulation difficulties

Background: Understanding factors associated with alcohol-related consequences is an important area of research. Emotional functioning has been associated with alcohol-related consequences but there is less research examining a comprehensive underlying model of emotional regulation. The Difficulties in Emotion Regulation Scale (DERS) is a recent measure developed to assess six facets of emotion regulation difficulties that contribute to overall emotional functioning. Objectives: The current study examines associations between these six facets of emotion regulation difficulties and problematic alcohol use. Methods: Participants (n?=?1758 college students) were recruited as part of a larger study and were asked to complete online questionnaires assessing demographics, alcohol use and problems, and emotion regulation difficulties. Results: Negative binomial hurdle models for alcohol use and alcohol-related consequences were estimated. Impulse control difficulties were positively related to the number of drinks consumed during the week among active drinkers. Non-acceptance of emotional responses, impulse control difficulties, lack of emotional clarity, and difficulties engaging in goal-directed behavior were all positively associated with number of consequences endorsed. Difficulty engaging in goal-directed behavior was also positively associated with the likelihood of experiencing any alcohol-related consequences. Conclusions: The findings support previous research indicating that emotion-regulation difficulties are broadly associated with alcohol-related consequences. Results suggest exposure and/or mindfulness based prevention/interventions with emotion focused psychoeducation may offer one path to reducing alcohol-related consequences among college students.     

Costs and consequences of drug use: a comparison of health care utilization and social-psychological consequences for clinical and nonclinical adolescents and their families

A retrospective (case control) design was used to compare adolescents in treatment for alcohol and drug problems and their families with adolescents and families not in treatment to determine: (1) the extent to which adolescents' drug-using behavior was associated with greater physical and mental health services utilized by the adolescent and his/her family members over a period of 3 years; and (2) costs incurred for a health maintenance organization and social-psychological consequences for the individuals and their families. On the average, those families with an adolescent with alcohol and/or drug problems use more health services, resulting in greater costs to the prepaid health plan than the costs for families with adolescents not in treatment or not using drugs. For both the adolescents and other family members, significant differences between groups were found for utilization of mental health services, but not for services for physical health. Consequences of drug use--relational, health related, and social/legal--were greatest for adolescents in treatment. Adolescents whose drug use was similar to those in treatment, but who were not in treatment, also experienced drug-related consequences; this group can be considered at high risk for alcohol and drug problems that, in the future, may require treatment.     

The effect of mental health screening and referral on symptoms of depression among HIV positive outpatients in Vietnam: Findings from a three-month follow up study

ABSTRACT

This study investigated whether screening for symptoms of mental disorders and referral to mental health services was associated with decreased depression symptoms among people living with HIV/AIDS (PLHIV) in Vietnam. Four hundred PLHIV (63.5% male, mean age 34.8 (SD?=?6.8) years) at two outpatient clinics in Ho Chi Minh City were interviewed by psychiatrists and also completed the Center for Epidemiologic Studies–Depression scale (CES-D). One hundred and seventy-four (43.5%) were identified with symptoms of a range of mental illnesses, including depression, anxiety, alcohol use disorder, substance use disorder and HIV associated dementia and were referred to mental health services. Of the 174 PLHIV referred, 162 (93%) returned and completed the CES-D three months later and 125 of these 162 (77%) had attended a mental health service and undertaken treatment. A significant improvement was found in the mean CES-D scores of the 125 attenders from baseline (M?=?19.0, SD?=?7.5) to month three (M?=?11.7, SD?=?7.9, p?<?0.001). PLHIV who had attended a mental health service and undertaken treatment demonstrated a greater reduction of mean scores on the CES-D compared to PLHIV who had either received a referral but not attended a mental health service to undertake treatment, or not been referred initially.     

Do drinking games matter? An examination by game type and gender in a mandated student sample

Abstract

Background: College students who violate alcohol policies engage in riskier alcohol use and demonstrate more problems related to their use than non-violating peers. Drinking games (DG) have been linked to increased alcohol use and negative consequences. Objectives: The present study sought to assess potential differences in DG participation among mandated males and females by examining rates of endorsement, types of DG played, and how types of games are related to alcohol use and related consequences. Methods: Participant data were obtained from 154 undergraduate students mandated to receive an alcohol intervention, Results: DG players were found to have higher typical and peak blood alcohol concentrations, consume more drinks per week on average, consume more standard drinks per highest drinking occasion, and to experience a considerably greater number of alcohol-related consequences than non-players. Males endorsed greater participation in DG and cited “team” and “motor” games more often than females. “Gambling” games were endorsed equally by both sexes, but resulted in increased consequences for females only. Conclusion: Engaging in DG results in higher levels of alcohol consumption. The likelihood of consequences experienced may vary by type of DG in which individuals choose to participate, as well as by gender. Results from this study provide information that can be utilized in targeted alcohol programming efforts, not only for a high-risk population such as mandated students, but tailored to the specific needs of males and females.     

Integrating intervention for substance use disorder in a healthcare setting: practice and outcomes in New York City STD clinics

ABSTRACT

Objective: This article reports the integration and outcomes of implementing intervention services for substance use disorder (SUD) in three New York City public sexually transmitted disease (STD) clinics. Methods: The screening, brief intervention, and referral to treatment (SBIRT) service model was implemented in the STD clinics in 2008. A relational database was developed, which included screening results, service dispositions, face-to-face interviews with 6-month follow-ups, and treatment information. Results: From February 2008 to the end of September 2012, 146 657 STD clinic patients 18 years or older were screened for current or past substance use disorders; 15 687 received a brief intervention; 954 received referrals to formal substance abuse treatment; 2082 were referred to substance abuse support services such as Alcoholics Anonymous (AA), and 690 were referred to mental health, social or HIV awareness services. Intervention services delivered through SBIRT resulted in improvements in multiple outcomes at 6 month follow-up. Patients who received interventions had reduced SUD risks, fewer mental health problems, and fewer unprotected sexual contacts. Conclusion: Delivery of SUD services in a public health setting represents a significant policy and practice change and benefits many individuals whose SUDs might otherwise be overlooked. Intervention services for substance use disorder were integrated and highly utilized in the STD setting. Further research needs to focus on the long-term impact of SUD interventions in the STD setting, their cost effectiveness, and the extent they are financially sustainable under the new healthcare law.     

HIV-related thought avoidance,sexual risk,and alcohol use among men who have sex with men

HIV-related “cognitive escape” refers to a tendency to avoid thoughts associated with HIV, which may be particularly common among men who have sex with men (MSM) who are often inundated with HIV information, potentially to the point of fatigue. HIV-related cognitive escape is associated with increased sexual risk behaviors, such as condomless sex, and heavier alcohol use patterns. Other studies show that some MSM may use alcohol specifically to facilitate sex. These sexual motives for drinking (SMDs) could be one mechanism whereby cognitive escape leads to health risk behaviors. In this study, we tested models exploring whether cognitive escape was associated with markers of sex risk (condom use, number of sex partners) and alcohol use/problems, and examined whether SMDs mediated these associations. Heavy drinking, HIV-negative men (N?=?196) aged?≥?21 years who self-reported past year condomless anal sex with men completed assessments as part of a larger study. Results suggest that cognitive escape was associated with higher number of anal sex partners (incidence rate ratio [IRR]?=?1.50, SE?=?0.04, p?B?=??0.30, SE?=?0.14, p?=?.028), and increased alcohol-related problems (IRR?=?1.28, SE?=?0.07, p?=?.001) but not with drinking quantity. Sexual motives for drinking appeared to partially mediate the observed relationship between cognitive escape and alcohol-related problems, but other relationships did not show evidence of mediation. Findings suggest that those who tend to avoid HIV-related thoughts may be at increased risk for HIV and alcohol-related problems. Drinking to facilitate sex may partially account for the higher risk for alcohol-related problems conferred by cognitive escape. Alcohol interventions for MSM may be more effective if they address alcohol’s role in coping with HIV threat and in facilitating sex under these circumstances.     

Risk and protective factors for heavy binge alcohol use among American Indian adolescents utilizing emergency health services

Background: American Indian (AI) adolescents are disproportionately burdened by alcohol abuse and heavy binge use, often leading to problematic drinking in adulthood. However, many AI communities also have large proportions of adults who abstain from alcohol. Objective: To understand these concurrent and divergent patterns, we explored the relationship between risk and protective factors for heavy binge alcohol use among a reservation-based sample of AI adolescents. Methods: Factors at individual, peer, family, and cultural/community levels were examined using a cross-sectional case–control study design. Cases were adolescents with recent heavy binge alcohol use that resulted in necessary medical care. Controls had no lifetime history of heavy binge alcohol use. 68 cases and 55 controls were recruited from emergency health services visits. Participants were 50% male; average age 15.4 years old, range 10 to 19. Independent variables were explored using logistic regression; those statistically significant were combined into a larger multivariate model. Results: Exploratory analyses showed adolescents who were aggressive, impulsive, had deviant peers, poor family functioning or more people living at home were at greater risk for heavy binge alcohol use. Protective factors included attending school, family closeness, residential stability, social problem-solving skills, having traditional AI values and practices, and strong ethnic identity. Confirmatory analysis concluded that school attendance and residential stability reduce the probability of heavy binge alcohol use, even among those already at low risk. Conclusions: Findings deepen the understanding of AI adolescent heavy binge alcohol use and inform adolescent intervention development fostering trajectories to low-risk drinking and abstinence.     

Changes in Substance Use Associated with Emergency Room and Primary Care Services Utilization in the United States General Population: 1995–2000

Objective: The purpose of this study was to compare changes in the prevalence of heavy problem drinking and drug use among those obtaining emergency room (ER), primary care, and other health care services between 1995 and 2000 in the U.S. general population. Method: Data analyzed are from the Alcohol Research Group's 1995 (n = 4925) and 2000 (n = 7612) National Alcohol Surveys. Data for the 1995 survey was based on face‐to‐face interviews in respondents' homes in the 48 contiguous states, while the 2000 interview was a random‐digit dialing computer‐assisted telephone interview of the household population in all 50 states. Results: Those reporting any health services utilization were less likely to report heavy drinking, two or more alcohol problems, and symptoms of alcohol dependence during the previous year in 2000 compared with 1995, but heavy or problem drinking was not predictive of health services utilization at either time. Controlling for demographic characteristics and health insurance coverage, illicit drug users were almost twice as likely [odds ratio (OR) = 1.85] compared with nonusers, to report ER utilization, and one and a half times more likely (OR = 1.55) to report primary care utilization during the past year in the 2000 survey, but drug use was not significantly predictive of health services utilization in 1995. Conclusions: These data suggest that while those alcohol‐involved individuals were no more likely than others to use ER and primary care services in either 1995 or 2000, those drug‐involved individuals were more likely to do so in 2000, perhaps related to the fact that these individuals may be incurring more health problems associated with their drug use that require medical attention. While identification and intervention with problem drinkers in clinical settings has received a great deal of attention, drug users may be overrepresented in health service settings, and such settings also may provide a window of opportunity for screening and intervention for a reduction in drug‐related problems.     

Drinking games,tailgating, and pregaming: Precollege predictors of risky college drinking

Background: The transition from high school to college is a critical period for developing college drinking habits. Hazardous alcohol consumption increases during this period, as well as participation in drinking games, pregaming, and tailgating. All of these risky drinking practices are associated with higher levels of intoxication as well as an increased risk of alcohol-related problems. Objective: The current study aimed to evaluate pre-college predictors (personality, social norms, and beliefs reflecting the internalization of the college drinking culture [ICDC]) of estimated peak BAC (pBAC) reached during drinking games, pregaming, and tailgating, as well as pBAC and alcohol-related problems during the first 30 days of college. Methods: Participants (n?=?936) were incoming freshmen at a large university who completed a baseline assessment prior to college matriculation and a follow-up assessment after they had been on campus for 30 days. Results: Using path analysis, ICDC was significantly associated with pBAC reached during the three risky drinking practices. ICDC had an indirect effect on both pBAC and alcohol-related problems via pBAC from drinking games, pregaming, and tailgating. Hopelessness and sensation seeking were significantly related to alcohol use outcomes. Conclusion: Precollege perceptions of the college drinking culture are a stronger predictor of subsequent alcohol use than social norms. Interventions that target these beliefs may reduce peak intoxication and associated harms experienced during the first 30 days of college.     

Clinical correlates of desire for treatment for current alcohol dependence among patients with a primary psychiatric disorder

Background and Objectives: Rates of treatment-seeking for alcohol use disorders are notably low. To elucidate the clinical correlates of treatment-seeking for alcoholism, this study compared patients with current alcohol dependence and a primary psychiatric diagnosis who endorsed a desire for alcoholism treatment to patients who refused treatment or who were unsure.

Method: A total of 131 (54 females) psychiatric outpatients with current alcohol dependence completed an intake assessment at a large hospital-based psychiatric clinic and at the end of the intake were asked whether they would like to receive treatment for alcohol problems.

Results: Compared with alcohol-dependent patients who refused treatment for alcoholism or who were unsure (n = 46), patients who expressed a desire for treatment (n = 85) were older, were more likely to be female, reported higher levels of social impairments, and were more likely to endorse the following alcohol dependence symptoms: (i) multiple unsuccessful efforts or persistent desire to stop or cut down on their drinking; and (ii) drinking more than intended.

Conclusions: Approximately, 35% of patients who met current DSM-IV criteria for alcohol dependence reported no interest (or were unsure) in alcoholism treatment despite being engaged in treatment-seeking for another psychiatric disorder.

Scientific Significance: These findings extend previous epidemiological studies documenting treatment-seeking patterns for alcoholism by identifying clinical features associated with interest in treatment for this disorder among psychiatric outpatients.     

Outcomes of two quality improvement implementation interventions for depression services in adults with substance use problems

ABSTRACT

Background: Comorbid depression and substance use disorders (SUDs) are associated with poor health and social outcomes disproportionately affecting under-resourced communities.

Objectives: To test the hypothesis that a coalition approach to collaborative care (CC) for depression would improve outcomes of hazardous drinking and behavioral health hospitalizations, relative to technical assistance, for individuals with comorbid substance use problems. Substance use problems were defined by meeting criteria for DSM-IV substance abuse or dependence, hazardous drinking by AUDIT-C, or treatment in a SUD program within the prior 6 months.

Methods: Two depression CC implementation approaches were compared: Resources for Services (RS) provided expert technical support for CC toolkits to individual programs. Community engagement and planning (CEP) supported multi-sector coalitions in collaborating in planning, adapting, implementing and monitoring CC toolkits. One thousand eighteen individuals with depression (PHQ-8 ≥10) enrolled. Regression analyses estimated intervention effects in participants with comorbid substance use problems (n = 588, 281 females, 307 males). Substance use problems were defined by meeting criteria for DSM-IV substance abuse or dependence, hazardous drinking by AUDIT-C, or treatment in a SUD program within the prior 6 months.

Results: There were no significant baseline differences by intervention status among participants with depression and substance use problems. Intervention effects on primary outcomes including depression were not significant at 6 months. Compared to RS, CEP significantly reduced alcohol consumption (CEP = 1.6, RS = 2.1, p = .038), probability of behavioral health hospitalizations (OR = 0.50, p = .036), and use of specialty mental health visits (IRR = 0.52, p = .027), while increasing use of faith-based depression services (IRR = 3.4, p = .001).

Conclusions: Given feasibility and possible benefits, CEP should be considered a promising approach to implementing depression CC with potential benefits to adults with comorbid substance use problems.     

Substance use among emergency room patients: an exploratory analysis by ethnicity and acculturation

Objective: While substantial literature exists on the role of alcohol in injury occurrence, little is known about other substance use or abuse and injury, or drug use among the alcohol involved at the time of the emergency room (ER) visit.

Method: A probability sample of 1429 patients attending the ER at Santa Clara Valley Medical Center (CA) was interviewed and was asked questions pertaining to licit and illicit drug use and alcohol use within 6 hr prior to the event, and drug use within the last year.

Results: While drug use within the 6 hr prior to the event was not found to be significantly different between injured and noninjured patients, injured patients were more likely to report drug use during the last year, and those with violence-related injuries were more likely to report drug use during both time periods compared to those with other injuries. Drug use was associated with ethnicity, with whites more likely than blacks or Hispanics to report use. Among Hispanics, acculturation was related to drug use, with those high on acculturation as likely or more likely than whites to report use. Among those reporting alcohol consumption within 6 hr prior to the event and those meeting criteria for alcohol dependence, differences across ethnic/acculturation subgroups for drug use in the same 6-hr period were not significant, and a higher prevalence of both 6-hr and 12-month substance use was found compared to those not reporting drinking during the 6 hr and those not alcohol dependent.

Conclusions: Data suggest that ethnic differences in substance use becomes less important among those alcohol involved, and future research should focus on the interaction of alcohol and other substances on injury occurrence. Data also suggest that substance use associated with increasing acculturation among U.S. Hispanics may have a strong impact on health services utilization, and research is needed by gender, ethnicity, and acculturation to determine the burden that substance use places on the ER.     

Screening,Brief Intervention,and Referral to Treatment (SBIRT) for Substance Use in a School‐Based Program: Services and Outcomes

Background: Despite the advantages of using high schools for conducting school‐based Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs for adolescent substance misuse, there have been very few studies of Brief Interventions (BIs) in these settings. Objectives: This multi‐site, repeated measures study examined outcomes of adolescents who received SBIRT services and compared the extent of change in substance use based on the intensity of intervention received. Methods: Participants consisted of 629 adolescents, ages 14–17, who received SBIRT services across 13 participating high schools in New Mexico. The level of service received and number of sessions were collected through administrative records, while the number of self‐reported days in the past month of drinking; drinking to intoxication; and drug use were gathered at baseline and 6‐month follow‐up. Results: BI was provided to 85.1% of adolescents, while 14.9% received brief treatment or referral to treatment (BT/RT). Participants receiving any intervention reported significant reductions in frequency of drinking to intoxication (p < .05) and drug use (p < .001), but not alcohol use, from baseline to 6‐month follow‐up. The magnitude of these reductions did not differ based on service variables. Controlling for baseline frequency of use, a BT/RT service level was associated with more days of drinking at 6‐month follow‐up (p < .05), but was no longer significant when controlling for number of service sessions received. Conclusions and Scientific Significance: These findings support school‐based SBIRT for adolescents, but more research is needed on this promising approach. (Am J Addict 2012;21:S5–S13)     

Psychiatric Comorbidity Related to Alcohol Use Among Adolescents

Introduction: Alcohol use is apparently related to high prevalences of psychiatric comorbidity, although scientific studies focusing the problem among adolescents are still lacking. Objective: To evaluate the performance of adolescents with different patterns of alcohol use on screening instruments for psychiatric disorders. Method: Forty-one adolescents seeking assistance for alcohol-related problems were compared to a nonclinical sample of 43 adolescents. These 84 users were divided in three sub-groups according to pattern of recent alcohol intake. All subjects responded to validated versions of screening scales for mental disorders. Comparison of groups was held through Analysis of variance (ANOVA). Results: Self Report Questionnaire (SRQ) aims to evaluate the presence of mental disorders. Heavy users presented significant higher scores than the other groups (p < .05) and half of them presented a psychiatry diagnosis. The same was observed for the CES-D. Using the cut-off, 76.9% of daily-users adolescents were considered depressive. In the Beck Anxiety Inventory the same was observed and 50.0% of those adolescents who drank daily could be considered at risk of presenting anxiety disorders. Conclusion: We detected higher prevalences of mental disorders among heavy alcohol users. This reinforces the importance of detailed diagnostic investigation of patients.