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Aims: To test the effectiveness of an intervention, Al-Anon Intensive Referral (AIR), to facilitate participation in Al-Anon Family Groups (Al-Anon). Design, Setting and Participants: Multi-site, randomized controlled trial of AIR versus usual care (UC), with follow-up assessments at 3, 6 and 12 months. The 12-month follow-up rate was 74%. Residential alcohol use disorder (AUD) treatment programs in three US locations. Concerned others (COs) of patients in treatment for AUD. COs were mainly women (77%) who were patients' spouses (33%) or parents (25%). Intervention and Comparator: AIR (n = 128) consisted of four sessions over 3 months with an Al-Anon coach. UC (n = 151) was the treatment program's offer of educational sessions for COs. Measurements: Primary outcome: COs' self-reports of any Al-Anon attendance (yes or no) at 3 months. Secondary outcomes: number of Al-Anon meetings and the CO-patient relationship (stressors, resources). Potential predictors of outcomes examined in generalized linear mixed models were their baseline value, time, CO-patient relationship type (marital or non-marital), treatment program and condition. Findings: There was no effect of condition for the primary outcome (28% in AIR, 21% in UC; Bayes factor = 1.86). Relationship stressors at follow-ups were more severe for COs in a marital relationship with the patient than for COs in a non-marital relationship [ß = 2.19, 95% confidence interval (CI) = 1.07, 3.32]. For CO-patient relationship resources at follow-ups, the main effect for condition was significant (ß = 1.33, 95% CI = 0.04, 2.61). COs assigned to the AIR condition had more resources than COs who were in the UC condition. Conclusions: Relative to usual care, Al-Anon Intensive Referral was not associated with increases in participation of concerned others in Al-Anon, but was associated with more resources in the concerned other-patient relationship. [ABSTRACT FROM AUTHOR]

Background and aims: Reducing alcohol consumption by liver disease patients can reduce morbidity and mortality. This study compared a computer‐delivered brief alcohol intervention (cBAI) with standard care in a sample of US military veterans with liver disease. Design Multi‐site, randomized controlled trial of a cBAI plus standard care (n = 67) versus standard care only (n = 71). Participants were assessed at baseline and 3‐ and 6‐month follow‐up. Setting: US Veterans Health Administration liver clinics. Participants: Participants were mostly male and diagnosed with hepatitis C. Interventions and comparators: A cBAI tailored to veterans with liver disease and consisting of assessment and personalized feedback. Standard care was brief education and advice about alcohol and liver disease. Measurement Primary outcomes were self‐reported number of drinking days and unhealthy drinking days (defined as more than two drinks for men and more than one for women) in the past 30 days at 6‐month follow‐up. Secondary outcomes were these two variables at 3‐month follow‐up, and drinks consumed per drinking day, depression and overall health at 3‐ and 6‐month follow‐ups. Missing data were imputed using multiple imputation. Findings Compared with standard care, cBAI participants reported significantly fewer drinking days at 6‐month follow‐up and fewer unhealthy drinking days at both 3‐ and 6‐month follow‐ups. Least square means (LS‐means) for number of drinking days were 3.78 for the cBAI condition and 6.89 for the standard care condition at 6 months [LS‐mean ratio = 3.78/6.89 = 0.55, 95% confidence interval (CI) = 0.34, 0.89]. LS‐means for number of unhealthy drinking days were 1.04 for the cBAI condition and 2.57 for the standard care condition at 3‐month follow‐up (LS‐mean ratio = 1.04/2.57 = 0.41, 95% CI = 0.19, 0.85). At 6‐months follow‐up, LS‐means were 1.18 for the cBAI condition and 2.75 for the standard care condition (LS‐mean ratio = 1.18/2.75 = 0.43, 95% CI = 0.20, 0.91). Conclusions: A computer‐delivered brief alcohol intervention reduced drinking days and unhealthy drinking days at 6‐month follow up in military veterans with liver disease compared with brief education and advice to reduce consumption. [ABSTRACT FROM AUTHOR]

Purpose: Many US military veterans experience anxiety, depression, and trauma‐related disorders. A major goal of the Veterans Health Administration (VHA) has been to increase access to evidence‐based psychotherapies (EBPs) such as cognitive‐behavioral therapy to address veterans' substantial health burden. However, despite widespread implementation of EBPs throughout the VHA, smaller clinics that often serve rural veterans face barriers to delivering these interventions. The Veterans Affairs Coordinated Anxiety Learning and Management (VA CALM) program aims to empower providers in rural areas with varying levels of training and experience in delivering EBPs to provide high‐quality cognitive‐behavioral therapy for anxiety, depression, and trauma‐related disorders. The goal of this study was to better understand, through qualitative interviews, VHA community‐based outpatient clinic providers' perspectives on implementing VA CALM. Methods: Qualitative interviews with providers (N = 22) were conducted to understand implementation of VA CALM. Template analysis was used to organize and summarize responses. Findings: Providers noted several facilitators for implementing VA CALM in rural community clinics, including its perceived effectiveness, broad applicability, and structure. Barriers to implementation included scheduling problems and patient‐related barriers. Conclusions: Incorporating providers' perspectives on factors that affect implementing cognitive‐behavioral therapy in this setting may inform future efforts to disseminate‐implement EBPs in smaller, more remote VHA clinics. [ABSTRACT FROM AUTHOR]

Purpose: To explore the feasibility and utility of using a workshop, and supervision‐consultation plus external facilitation to disseminate and implement cognitive‐behavioral therapy in Veterans Affairs (VA) community‐based outpatient clinics (CBOCs). Methods: This study occurred in the context of a randomized controlled trial aimed at comparing 2 methods for implementing Coordinated Anxiety Learning Management (CALM) in VA CBOCs. A 3‐phase (workshop, supervision‐consultation, external facilitation) model was used to support 32 VA CBOC mental health providers in learning and adopting CALM in their clinical practice. Qualitative data describe training activities and the feasibility and utility of each training phase in addressing challenges to adopting CALM. Findings: All 3 phases of the model were feasible to use with our sample of CBOC mental health providers. Providers reported challenges learning CALM during the workshop and concerns about not having enough training post‐workshop to use CALM in practice. Providers primarily utilized supervision‐consultation to tailor CALM to their practice, including learning how to prioritize a target disorder, "switch" the focus of treatment to a different disorder when comorbidities were present, and modify CALM sessions to fit shorter treatment visits. Providers primarily utilized external facilitation to further tailor CALM to their practice through implementation (eg, concrete help) and support‐oriented help. Key lessons for implementing CALM in CBOCs are presented and discussed. Conclusions: Findings provide initial evidence for the feasibility and utility of using each component of a facilitation‐enhanced training model to promote CBOC VA providers' implementation of a computer and manual version of CALM in their practice. [ABSTRACT FROM AUTHOR]

Background: Poor functioning among Concerned Others (COs; family and friends of an individual with an alcohol or other substance use disorder) is a significant public health problem. The purpose of this study was to inform interventions for COs by examining potential correlates of 3 aspects of functioning: quality of life, mental health, and knowledge of how to handle problems related to their drinker. Methods: This study collected data from 277 COs when their friend or family member (their "drinker") was entering treatment for an alcohol use disorder. Potential correlates were the drinker's substance use severity, the CO–drinker relationship and communication, and COs' coping and perceived stigma related to involvement with their drinker. Results: In a summary analysis, only stressors in the CO–drinker relationship (the drinker's criticism, disagreement, anger, and demands) were consistently associated with poorer functioning as indicated by COs' poorer quality of life and mental health. In contrast, only COs' use of approach coping was associated with COs' knowing how to handle problems related to the drinker. Conclusions: Because reducing both relationship stressors and the link between stressors and poor functioning can be achieved through CO and drinker education and intervention, these findings inform how to effectively support COs' goals for better functioning. [ABSTRACT FROM AUTHOR]

This study examined the role of parenthood and parental influences on substance use patterns for 710 stimulant users age 18–61 living in the rural Midwest and Mid‐south U.S. Longitudinal growth analyses showed that a maternal history of drug use was associated with increased baseline drug use severity, lesser declines in severity, and greater plateau of drug use severity over time. Parental conflict was associated with lesser declines in drug use severity, and drug use severity declined more steeply for participants who were themselves parents. Participants with two parents having a history of alcohol use had a greater baseline severity of alcohol use, with paternal history of drug use associated with lower baseline alcohol use severity. These findings demonstrate the importance of identifying parental influences in evaluating adult substance use, and point to the inclusion of parents in efforts to prevent and treat substance use disorders. [ABSTRACT FROM AUTHOR]

A host of interventions are now known to be helpful to alleviate subjective distress and improve well-being in dementia caregivers. However, few intervention studies have focused on measures of physical health, and none have examined cortisol as an outcome-despite the fact that cortisol is regarded as a crucial biological intermediary by which chronic stress leads to disease. In this study, we examined demographic and psychosocial factors as predictors of salivary cortisol at a baseline assessment, among a sample of 175 Latino/Hispanic and Caucasian women caring for a family member with dementia. We also examined the influence of a cognitive-behaviour-based psychoeducational intervention (Coping with Caregiving) on cortisol at a post-treatment assessment, compared with a minimal support condition. Results revealed that caregivers with high intensity caregiving situations, characterized by long hours of care and co-residence with the care recipient, tended to have less adaptive cortisol patterns. However, these 'at-risk' caregivers benefited most from the Coping with Caregiving intervention and had more normal cortisol patterns at post-treatment, compared with caregivers in the control condition. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Three experiments investigated the role of ‘change blindness’ in mistaken eyewitness identifications of innocent bystanders to a simulated crime. Two innocent people appeared briefly in a filmed scene in a supermarket. The ‘continuous innocent’ (CI) walked down the liquor aisle and passed behind a stack of boxes, whereupon the perpetrator emerged and stole a bottle of liquor, thereby resulting in an action sequence promoting the illusion of continuity between perpetrator and innocent. The ‘discontinuous innocent’ (DI) was shown immediately afterward in the produce aisle. Results revealed that: (1) more than half of participants failed to notice the change between the CI and the perpetrator, (2) among those who failed to notice the change, more misidentified the ‘CI’ than the ‘DI’, a pattern that did not hold for those who did notice the change. Participants were less likely to notice the change when they were distracted while watching the video. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Substance use disorders are prevalent among people with hepatitis C virus (HCV) and adversely affect HCV management. Addressing this comorbidity is paramount as more effective HCV treatment options emerge. Existing screening tools and treatment options for addressing the spectrum of substance use disorders have the potential to improve HCV treatment outcomes. [ABSTRACT FROM AUTHOR]

Commentary to: How should we set consumption thresholds for low risk drinking guidelines? Achieving objectivity and transparency using evidence, expert judgement and pragmatism [ABSTRACT FROM AUTHOR]

The authors present a discussion of "High-intensity cannabis use is associated with retention in opioid agonist treatment: a longitudinal analysis" by M.E. Socias et al. in the current issue. They mention the therapeutic use of marijuana in opioid addiction treatment, how marijuana use may increase retention in drug treatment, and the effectiveness of treatment.

The authors focuses on the study "Specialty substance use disorder services following brief alcohol intervention: A meta-analysis of randomized controlled trials," by J. Glass and published in a previous issue and the efficacy of Screening, Brief Intervention and Referral to Treatment (SBIRT) for linking patients with alcohol misuse to specialty addiction treatment. They consider the need for researching optimal methods of improving the linkage between addiction treatment and medical settings.

In this article the author discusses resources available to address the issues of greater efforts on treatment of hepatitis C virus (HCV) infection and reducing the long-term impact of alcohol consumption. This infection leads to mortality caused by liver disease. Programs focusing on the screening and identification of the HCV infection are required. Barriers in receiving treatment include not following appointments, alcohol use disorders and treatment side effects.