Search

OBJECTIVE: To examine the effectiveness of motivational interviewing (MI) training among medical students. METHODS: All students (n=131) (year 5) at Lausanne Medical School, Switzerland were randomized into an experimental or a control group. After a training in basic communication skills (control condition), an 8-h MI training was completed by 84.8% students in the exprimental group. One week later, students in both groups were invited to meet with two standardized patients. MI skills were coded by blinded research assistants using the Motivational Interviewing Treatment Integrity 3.0. RESULTS: Superior MI performance was shown for trained versus control students, as demonstrated by higher scores for 'Empathy' [p<0.001] and 'MI Spirit' [p<0.001]. Scores were similar between groups for 'Direction', indicating that students in both groups invited the patient to talk about behavior change. Behavior counts assessment demonstrated better performance in MI in trained versus untrained students regarding occurences of MI-adherent behavior [p<0.001], MI non-adherent behavior [p<0.001], Closed questions [p<0.001], Open questions [p=0.001], simple reflections [p=0.03], and Complex reflections [p<0.001]. Occurrences were similar between groups regarding 'Giving information'. CONCLUSION: An 8-h training workshop was associated with improved MI performance. PRACTICE IMPLICATIONS: These findings lend support for the implementation of MI training in medical schools. [ABSTRACT FROM AUTHOR]

The objectives of this study were to analyse (a) the distribution of risky single-occasion drinking (RSOD) among 19-year-old men in Switzerland and (b) to show the percentage of all alcohol consumption in the form of RSOD. Methods: The study was based on a census of Swiss francophone 19-year-old men consecutively reporting for processing. The study was conducted at Army Recruitment Center. The participants were 4116 recruits consecutively enrolling for mandatory army recruitment procedures between 23 January and 29 August in 2007. The measures were alcohol consumption measured in drinks of ~10 g of pure alcohol, number of drinking occasions with six or more drinks (RSOD) in the past 12 months and a retrospective 1 week drinking diary. Results: 264 recruits were never seen by the research staff, 3536 of the remaining 3852 conscripts completed a questionnaire which showed that 7.2% abstained from alcohol and 75.5% of those drinking had an RSOD day at least monthly. The typical frequency of drinking was 1-3 days per week on weekends. The average quantity on weekends was about seven drinks, 69.3% of the total weekly consumption was in the form of RSOD days, and of all the alcohol consumed, 96.2% was by drinkers who had RSOD days at least once a month. Conclusion: Among young men, RSOD constitutes the norm. Prevention consequently must address the total population and not only high-risk drinkers. [ABSTRACT FROM AUTHOR]

Aims: To identify communication characteristics of patients and counsellors during brief alcohol intervention (BAT) which predict changes in alcohol consumption 12 months later. Methods: Tape-recordings of 97 BAT sessions with hazardous drinkers were analysed using the Motivational Interviewing Skill Code (MISC). Outcome measures were (i) baseline to a 12-month difference in the weekly drinking quantity, and (ii) baseline to a 12-month difference in heavy drinking episodes per month. Bivariate analyses were conducted for all MISC measures, and significant variables were included in multiple linear regression models. Results: Patient communication characteristics (ability to change) during BAT significantly predicted the weekly drinking quantity in the multiple linear regression model. There were significant differences for some of the counsellor skills in bivariate analyses but not in the multiple regression model adjusting for patients' talk characteristics. Changes in heavy drinking showed no significant association with patient or counsellor skills in the multiple linear regression model. Conclusion: Findings indicate that the more the patient expresses ability to change during the intervention, the more weekly alcohol use decreases. The role of the counsellor during the interaction, and influence on the outcomes was not clearly established. Implications for BAT and related research are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: An association between alcohol consumption and injury is clearly established from volume of drinking, heavy episodic drinking (HED), and consumption before injury. Little is known, however, about how their interaction raises risk of injury and what combination of factors carries the highest risk. This study explores which of 11 specified groups of drinkers (a) are at high risk and (b) contribute most to alcohol-attributable injuries. METHODS: In all, 8,736 patients, of whom 5,077 were injured, admitted to the surgical ward of the emergency department of Lausanne University Hospital between January 1, 2003, and June 30, 2004, were screened for alcohol use. Eleven groups were constructed on the basis of usual patterns of intake and preattendance drinking. Odds ratios (ORs) comparing injured and noninjured were derived, and alcohol-attributable fractions of injuries were calculated from ORs and prevalence of exposure groups. RESULTS: Risk of injury increased with volume of drinking, HED, and preattendance drinking. For both sexes, the highest risk was associated with low intake, HED, and 4 (women), 5 (men), or more drinks before injury. At the same level of preattendance drinking, high-volume drinkers were at lower risk than low-volume drinkers. In women, the group of low-risk non-HED drinkers taking fewer than 4 drinks suffered 47.5% of the alcohol-attributable injuries in contrast to only 20.4% for men. Low-volume male drinkers with HED had more alcohol-attributable injuries than that of low-volume female drinkers with HED (46.9% vs 23.2%). CONCLUSIONS: Although all groups of drinkers are at increased risk of alcohol-related injury, those who usually drink little but on occasion heavily are at particular risk. The lower risk of chronic heavy drinkers may be due to higher tolerance of alcohol. Prevention should thus target heavy-drinking occasions. Low-volume drinking women without HED and with only little preattendance drinking experienced a high proportion of injuries; such women would be well advised to drink very little or to take other special precautions in risky circumstances. [ABSTRACT FROM AUTHOR]

Background: There is sufficient and consistent evidence that alcohol use is a causal risk factor for injury. For cannabis use, however, there is conflicting evidence; a detrimental dose-response effect of cannabis use on psychomotor and other relevant skills has been found in experimental laboratory studies, while a protective effect of cannabis use has also been found in epidemiological studies.Methods: Implementation of a case-crossover design study, with a representative sample of injured patients (N = 486; 332 men; 154 women) from the Emergency Department (ED) of the Lausanne University Hospital, which received treatment for different categories of injuries of varying aetiology.Results: Alcohol use in the six hours prior to injury was associated with a relative risk of 3.00 (C.I.: 1.78, 5.04) compared with no alcohol use, a dose-response relationship also was found. Cannabis use was inversely related to risk of injury (RR: 0.33; C.I.: 0.12, 0.92), also in a dose-response like manner. However, the sample size for people who had used cannabis was small. Simultaneous use of alcohol and cannabis did not show significantly elevated risk.Conclusion: The most surprising result of our study was the inverse relationship between cannabis use and injury. Possible explanations and underlying mechanisms, such as use in safer environments or more compensatory behavior among cannabis users, were discussed. [ABSTRACT FROM AUTHOR]

Background: New methods of ultra-rapid opiate detoxification (URD) under intravenous sedation have been criticized because of limited data on safety and long-term follow-up. Premedication with buprenorphine has been advocated to improve safety by decreasing vomiting. Prior research has not explored URD in socially impaired patients.Method: Sixteen patients were detoxified with URD and prospectively evaluated over at least 30 months. Data of this procedure were compared with those of our previous study without buprenorphine preparation (Drug Alcohol Depend. 52(3) (1998) 243). The 16 patients were followed up by a general practitioner (GP) before and after URD. The GPs also supervised the 7-day course of buprenorphine treatment prescribed for the 16 patients prior to URD.Results: During the procedure, only one episode of vomiting occurred instead of 13 out of 20 in our previous study. Post-procedure, only two patients experienced moderate withdrawal symptoms, such as persistent nausea, abdominal cramps and vomiting lasting from 24 to 48 h, in comparison with most patients in the previous study without buprenorphine. After a period of at least 30 months (36.0+/-6.38), the 16 patients were still alive and were regularly monitored by their GP. Only two of the 16 never relapsed after URD and reported total opiate abstinence. Fourteen patients relapsed; 12 of these were prescribed a licensed methadone substitution program and two were still using heroin.Conclusion: In this small sample, the data indicated that URD with buprenorphine preparation was safe and that it markedly decreased post-procedure morbidity. No patient died over a minimum 30-month follow-up period. Furthermore, the procedure was employed with socially impaired patients. In the long term, a few patients were still free of opiates, while the majority opted for a methadone maintenance program, showing that URD can serve as one possible step in a long-term treatment program. [ABSTRACT FROM AUTHOR]

Background: Many digital interventions for unhealthy alcohol use are based on personalized normative feedback (PNF) and personalized feedback on risks for health (PFR). The hypothesis is that PNF and PFR affect drinkers' perceptions of drinking norms and risks, resulting in changes in drinking behaviors. This study is a follow-up mediation analysis of the primary and secondary outcomes of a randomized controlled trial testing the effect of a smartphone-based intervention to reduce alcohol use., Objective: This study aimed to investigate whether perceptions of drinking norms and risks mediated the effects of a smartphone-based intervention to reduce alcohol use., Methods: A total of 1770 students from 4 higher education institutions in Switzerland (mean age 22.35, SD 3.07 years) who screened positive for unhealthy alcohol use were randomized to receive access to a smartphone app or to the no-intervention control condition. The smartphone app provided PNF and PFR. Outcomes were drinking volume (DV) in standard drinks per week and the number of heavy drinking days (HDDs) assessed at baseline and 6 months. Mediators were perceived drinking norms and perceived risks for health measured at baseline and 3 months. Parallel mediation analyses and moderated mediation analyses were conducted to test whether (1) the intervention effect was indirectly related to lower DV and HDDs at 6 months (adjusting for baseline values) through perceived drinking norms and perceived risks for health at 3 months (adjusting for baseline values) and (2) the indirect effects through perceived drinking norms differed between participants who overestimated or who did not overestimate other people's drinking at baseline., Results: The intervention's total effects were significant (DV: b=-0.85, 95% bootstrap CI -1.49 to -0.25; HDD: b=-0.44, 95% bootstrap CI -0.72 to -0.16), indicating less drinking at 6 months in the intervention group than in the control group. The direct effects (ie, controlling for mediators) were significant though smaller (DV: b=-0.73, 95% bootstrap CI -1.33 to -0.16; HDD: b=-0.39, 95% bootstrap CI -0.66 to -0.12). For DV, the indirect effect was significant through perceived drinking norms (b=-0.12, 95% bootstrap CI -0.25 to -0.03). The indirect effects through perceived risk (for DV and HDD) and perceived drinking norms (for HDD) were not significant. Results of moderated mediation analyses showed that the indirect effects through perceived drinking norms were significant among participants overestimating other people's drinking (DV: b=-0.17, 95% bootstrap CI -0.32 to -0.05; HDD: b=-0.08, 95% bootstrap CI -0.15 to -0.01) but not significant among those not overestimating., Conclusions: Perceived drinking norms, but not perceived risks, partially mediated the intervention's effect on alcohol use, confirming one of its hypothesized mechanisms of action. These findings lend support to using normative feedback interventions to discourage unhealthy alcohol use., Trial Registration: ISRCTN Registry 10007691; https://doi.org/10.1186/ISRCTN10007691., (©Joseph Studer, John A Cunningham, Elodie Schmutz, Jacques Gaume, Angéline Adam, Jean-Bernard Daeppen, Nicolas Bertholet. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 06.02.2025.)

Background: Caring for patients with substance use disorders (SUD) is held in low regard and many clinicians resist treating them. To address this situation, numerous research projects assessed training program gaps and professional attitudes. In contrast, this study explored the actual clinical difficulties that a variety of hospital-based professionals encounter when treating patients with SUD. Methods: Qualitative multiple method design including: (1) individual semi-structured interviews with SUD experts and educators; (2) video-elicited, cross self-confrontation interviews with clinicians working in a specialist addiction unit; (3) paired semi-structured interviews with clinicians working in non-specialist units. Participants were recruited within one university hospital. Data collected at stages (1) and (3) relied on an interview guide and were analyzed using conventional content analyses. Data collected at stage (2) consisted of discussions of video recorded clinical interviews and were analyzed based on a participatory approach. Results: Twenty-three clinicians from seven hospital units participated. Forty-four difficulties were reported that we classified into six categories: knowledge-based; moral; technical; relational; identity-related; institutional. We identified seven cross-category themes as key features of SUD clinical complexity: exacerbation of patient characteristics; multiplication of medical issues; hybridity and specificity of medical discipline; experiences of stalemate, adversity, and role reversal. Conclusions: Our study, providing a comprehensive analysis of the difficulties of caring for patients with SUD, reveals a highly challenging clinical practice for a diversity of healthcare providers. They represent a complementary approach to addressing resistance as an important feature of a complex clinical system, and valuable material to discussing professional preparedness.

Introduction: The influence of age on brief motivational interventions (BMI) effects remains unknown. In the present study, we explored whether change in alcohol consumption after BMI differs across age groups and whether these differences are reflected in motivational interviewing (MI) counsellor skills., Method: Secondary analysis of a randomized controlled trial among emergency room (ER) patients screened for unhealthy alcohol consumption. Participants (N = 97, 80 % men, 18-21 y: 19.6 %, 22-29 y: 22.7 %, 30-49 y: 34.0 % and ≥50 y: 23.7 %) received a single BMI in the ER, which was coded using the MI Skills Code 2.0. Alcohol outcomes were measured at 12-month. First, we tested whether BMI effect varied by age group using negative binomial regression for weekly drinking consumption, and logistic regression for change to low-risk drinking. Second, MI counsellor skills (global ratings of empathy, MI spirit and acceptance, and percentages of open questions, complex reflections (CR) and MI-consistent behaviors) were examined through one-way ANOVA or Welch test., Results: The 22-29 y group i) reported lower consumption at follow-up compared to the 30-49 y group (IRR=1.60, p  = .04) and the ≥ 50 y group (IRR=1.67, p  = .03), and ii) was more likely to change to low-risk drinking than the 18-21 y group (OR=11.25, p  = .04). When comparing MI counsellor skills across age groups, higher empathy ratings (F(3,93)= 2.70, p  = .05) and a higher percentage of CR (F(3,93)= 4.10, p  = .009) were recorded for the 22-29 y group., Conclusion: This exploratory study shows that BMI was associated with significantly better 12-month alcohol outcomes among patients aged 22-29 years, which corresponded with higher counsellor empathy ratings and percentage of CR., Competing Interests: none., (© 2024 The Authors.)

People suffering from substance use disorders frequently suffer from concomitant affections such as other addictions, psychiatric, somatic or social problems. Clarifying objectives and priorities with the patient and coordination of care are the priority in the follow up suggested in this article. We present a clinical example in which the modality of care is adapted depending on the evolution of the patient's needs. The follow up by a general practitioner can be pursued in parallel to specialized care. The modality of this collaboration will have to adapt to the patients' and healthcare workers' needs. This follow-up aims to provide good quality health care all the while supporting the healthcare providers who can, sometimes, feel helplessness., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Objective: Investigate the effect of change talk (CT) within successive brief motivational interventions (BMIs) as a mechanism of change for alcohol use., Method: We conducted a secondary analysis of data from a randomized controlled trial in which 344 young adults (18-35 years old) admitted to a Swiss emergency department with alcohol intoxication received either BMI ( N = 171) or brief advice ( N = 173). Participants with a baseline audio-recorded BMI were included ( N = 140; median age 23 [ Q 1- Q 3: 20-27], 72.9% men). Up to three booster sessions by phone were offered at 1 week, 1 month, and 3 months. Percent CT and CT Average Strength were used as predictor variables. The outcome was the number of heavy drinking days (HDD) over the 30 days prior to research assessments at 1-, 3-, 6-, and 12-month follow-up. A latent growth curve modeling framework was first used to estimate predictor and outcome variable growth parameters (i.e., intercept and slope) over time, and then to regress HDD growth parameters on CT growth parameters., Results: CT increased specifically from baseline to the 1-week booster session and thereafter remained stable. Higher baseline CT was associated with lower HDD at 1 month (Percent CT: b = -0.04, 95% confidence interval [-0.06, -0.01]; Average Strength: b = -0.99 [-1.67, -0.31]). An increase in CT from baseline to the 1-week booster session was related to a decrease in HDD from 1 month to 12 months (Percent CT: b = -0.08 [-0.14, -0.03]; Average Strength: b = -2.29 [-3.52, -1.07])., Conclusions: Both baseline CT and CT trajectory over the first week are meaningful predictors of HDD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: To explore how professionals deal with informing their patients and how they experience the process per se, in order to deepen understanding of the issues involved and to identify areas of focus for improvement., Methods: Semi-structured qualitative interviews were conducted with 13 hospital professionals at Lausanne University Hospital, Switzerland., Results: Information includes feedback, practical information, patient condition, treatment/process of care, and educational material. Information-delivery is a process that involves informing the patient then checking patient reception of the information. The main expected outcome is patient action. Providers can feel trapped, guilty, inadequate, powerless, disenchanted when the process fails to achieve its expected purpose., Conclusions: Informing and checking strategies are not implemented optimally, and providers could benefit from guidance in order to decrease discomfort and become more proficient at delivering information., Innovation: Addressing the information-delivery process per se provides us with a novel insight into the complexity of the process and contributes to identifying essential ingredients of future innovative training programs for providers at large., Competing Interests: None., (© 2023 The Authors.)

Introduction: Chronic heavy alcohol use is known to cause neurological complications such as peripheral neuropathy. Concerning the pathophysiology, few sural nerve and skin biopsy studies showed that small fibers might be selectively vulnerable to degeneration in alcohol-related peripheral neuropathy. Pain has rarely been properly evaluated in this pathology. The present study aims at assessing pain intensity, potential neuropathic characteristics as well as the functionality of both small and large nerve sensitive fibers., Methods: In this observational study, 27 consecutive adult patients, hospitalized for alcohol withdrawal and 13 healthy controls were recruited. All the participants underwent a quantitative sensory testing (QST) according to the standardized protocol of the German Research Network Neuropathic Pain, a neurological examination and filled standardized questionnaires assessing alcohol consumption and dependence as well as pain characteristics and psychological comorbidities., Results: Nearly half of the patients (13/27) reported pain. Yet, pain intensity was weak, leading to a low interference with daily life, and its characteristics did not support a neuropathic component. A functional impairment of small nerve fibers was frequently described, with thermal hypoesthesia observed in 52% of patients. Patients with a higher alcohol consumption over the last 2 years showed a greater impairment of small fiber function., Discussion: Patients report pain but it is however unlikely to be caused by peripheral neuropathy given the non-length-dependent distribution and the absence of neuropathic pain features. Chronic pain in AUD deserves to be better evaluated and managed as it represents an opportunity to improve long-term clinical outcomes, potentially participating to relapse prevention., (© 2023 The Authors. Journal of the Peripheral Nervous System published by Wiley Periodicals LLC on behalf of Peripheral Nerve Society.)

Objective: To estimate the effects of providing access to an alcohol intervention based on a smartphone., Design: Randomised controlled trial.., Setting: Four higher education institutions in Switzerland., Participants: 1770 students (≥18 years) who screened positive for unhealthy alcohol use (ie, a score on the alcohol use disorders identification test-consumption (AUDIT-C) of ≥4 for men and ≥3 for women) were randomly assigned by 1:1 allocation ratio in blocks of 10., Intervention: Providing access to a brief, smartphone based alcohol intervention., Outcome Measures: The primary outcome studied was number of standard drinks per week at six months and the secondary outcome was number of heavy drinking days (past 30 days). Additional outcomes were maximum number of drinks consumed on one occasion, alcohol related consequences, and academic performance. Follow-up assessments occurred at months three, six, and 12. Data were analysed by intention to treat and by using generalised linear mixed models with random intercepts for the recruitment site and participants nested within the recruitment site, and with intervention ( v control), time (three months v six months; 12 months v six months), and baseline outcome values as fixed effects., Results: Between 26 April 26 2021 and 30 May 2022, 1770 participants (intervention group (n=884); control group (n=886)) were included. Mean age was 22.4 years (standard deviation 3.07); 958 (54.1%) were women; and 1169 (66.0%) were undergraduate students, 533 (30.1%) were studying for a master's degree, 43 (2.4%) were studying for a doctorate, and 25 (1.4%) were students of other higher education programme. The baseline mean number of standard drinks per week was 8.59 (standard deviation 8.18); the baseline number of heavy drinking days was 3.53 (4.02). Of 1770 participants, follow-up rates were 1706 (96.4%) at three months, 1697 (95.9%) at six months, and 1660 (93.8%) at 12 months. Of 884 students randomly assigned to the intervention group, 738 (83.5%) downloaded the smartphone application. The intervention had a significant overall effect on the number of standard drinks per week (incidence rate ratio 0.90 (95% confidence interval 0.85 to 0.96)), heavy drinking days (0.89 (0.83 to 0.96)), and the maximum number of drinks consumed on one occasion (0.96 (0.93 to 1.00), P=0.029), indicating significantly lower drinking outcomes in the intervention group than in the control group during the follow-up period. The intervention did not affect alcohol related consequences or academic performance., Conclusions: Providing access to the smartphone application throughout the 12 month follow-up was effective at limiting the average drinking volume of university students who had self-reported unhealthy alcohol use at baseline., Trial Registration: ISRCTN 10007691., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare: support from the Swiss National Science Foundation for the submitted work. NB reports a grant from: Commission de Promotion de la Santé et de Lutte Contre Les Addictions (CPSLA; Public regional funding from State of Vaud, Switzerland), as co-investigator; honoraria from the Swiss Medical Association, for the development of screening and brief intervention guidelines for primary care providers. AA reports a grant from CPSLA. GG reports a grant from the Swiss National Science Foundation (separate from the trial grant); he is a member of the technical advisory group on alcohol epidemiology, World Health Organization and of FEDESTAT (Federal commission on statistics, Swiss Federal Statistical Office, Berne, Switzerland). JAC reports grants from Canadian Institutes of Health Research (No. CFP 425862) as principal investigator and for a randomised controlled trial on targeting mailed nicotine patch distribution interventions to rural regions of Canada (Canadian Cancer Society, No. 706201, as principal investigator), and as a principal investigator for offering nicotine patches to all households in a municipality with high smoking rates (Canadian Institutes of Health Research, No. 153324). He was also involved in the trial: Does providing a brief Internet intervention for hazardous alcohol use to people seeking online help for depression reduce both alcohol use and depression symptoms among participants with these dual disorders? JM reports grants from NIH/NIDA, CDC, and a subcontract from the Northstar Node of the NIH/NIDA Clinical Trials Network. She also reports consulting fees from the National Committee for Quality Assurance, Expert for Alcohol Screening Learning Collaborative, Boston University, Fellowship Immersion Training, Faculty NYC Dept of Health and Mental Hygiene, buprenorphine mentorship program. She participates in data safety monitoring boards: as chair for extended-release v oral naltrexone for alcohol dependence treatment in primary care; as a member for integrated care for chronic pain and opioid use disorder: the IMPOWR Montefiore/Einstein (IMPOWR-ME) research center; and as a member for the randomised controlled trial of the effects of psilocybin-facilitated experience on the psychology and effectiveness of professional leaders in religion. She is a member of the Committee for the Care of Substance Users with HIV Infection, NYS Department of Health AIDS Institute, HIV Clinical Guidelines Program., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Research has not identified which patients optimally benefit from brief Motivational Interviewing (bMI) for heavy drinking when delivered to young adults in the Emergency Department (ED)., Methods: We conducted secondary analyses of data from a randomized controlled trial in which 344 young adults (18-35 years) presenting to the ED with alcohol intoxication received either bMI or Brief Advice (BA, control group). We used Latent Class Analysis to derive participants' profiles from baseline characteristics (i.e., sex, age, severity of alcohol use disorder, attribution of ED admission to alcohol use, importance, and confidence to change, cognitive discrepancy, anxiety, depression, and trait reactance). We then conducted a moderation analysis to assess the number of heavy drinking days at short-term (1-month) and long-term (12-month) follow-up using negative binomial regressions with interactions between the intervention and derived classes., Results: Fit statistics indicated that a 4-class solution best fit the data. Class 3 (high severity, importance and discrepancy, and low confidence and anxiety) benefitted more from bMI than BA at short- and long-term follow-up than Class 1 (younger; lowest severity, importance, discrepancy, reactance, anxiety and depression, and highest confidence). Class 2 (older; highest severity, importance, discrepancy, reactance, anxiety and depression, and lowest confidence) also benefitted more from bMI than BA than did Class 1 at short-term follow-up. In these significant contrasts, Class 1 benefitted more from BA than bMI. There were no significant interactions involving Class 4 (more likely to be women; low severity; high levels of anxiety, depression, and reactance)., Conclusions: This study identified the patient profiles that benefitted more from bMI than BA among nontreatment-seeking young adults who present intoxicated to the ED. The findings have implications for intervention design and argue for the importance of research aimed at developing intervention content tailored to patient profiles., (© 2023 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.)

Aims: Frequent users of the emergency department (FUED; five ED visits or more per year) often have negative experiences in health care settings, potentially aggravating their health problems. Scarce research has explored FUED experiences in health care in Europe, none in Switzerland. Thus, this study aimed to conduct an in-depth exploration of FUED experiences in health care settings in Switzerland., Methods: Semi-structured interviews were conducted among 20 FUED (75% female; mean age = 40.6, SD = 12.8). Qualitative data were subject to inductive content analysis., Results: Five main themes emerged from the analysis. The main findings documented that FUED experiences in health care were mostly negative, leading to negative emotions, dissatisfaction and a loss of confidence in the system, although some positive experiences were reported as well. The relationship with health care workers was perceived as playing a key role in FUED experiences., Conclusion: The findings indicate that FUED often have negative experiences in the health care system in Switzerland. The relationship with the health care staff is reported as a decisive ingredient of the experience in health care. Future research is needed to develop awareness-raising interventions for health care staff to improve FUED experiences in health care.

Background: Despite considerable efforts devoted to the development of prevention interventions aiming at reducing unhealthy alcohol use in tertiary students, their delivery remains often challenging. Interventions including information technology are promising given their potential to reach large parts of the population., Objective: This study aims to develop a secondary prevention smartphone app with an iterative qualitative design involving the target population., Methods: The app development process included testing a first prototype and a second prototype, developed based on the results of 2 consecutive qualitative assessments. Participants (aged ≥18 years, screened positive for unhealthy alcohol use) were students from 4 tertiary education institutions in the French-speaking part of Switzerland. Participants tested prototype 1 or prototype 2 or both and provided feedback in 1-to-1 semistructured interviews after 2-3 weeks of testing., Results: The mean age of the participants was 23.3 years. A total of 9 students (4/9 female) tested prototype 1 and participated in qualitative interviews. A total of 11 students (6/11 female) tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. Content analysis identified 6 main themes: "General Acceptance of the App," "Importance of the Targeted and Relevant App Content," "Importance of Credibility," "Importance of the App Usability," "Importance of a Simple and Attractive Design," "Importance of Notifications to Ensure App Use over Time." Besides a general acceptance of the app, these themes reflected participants' recommendations toward increased usability; to improve the design; to include useful and rewarding contents; to make the app look serious and credible; and to add notifications to ensure its use over time. A total of 11 students tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. The 6 same themes emerged from the analysis. Participants from phase 1 generally found the design and content of the app improved., Conclusions: Students recommend prevention smartphone apps to be easy to use, useful, rewarding, serious, and credible. These findings may be important to consider when developing prevention smartphone apps to increase the likelihood of app use over time., Trial Registration: ISRCTN registry 10007691; https://www.isrctn.com/ISRCTN10007691., International Registered Report Identifier (irrid): RR2-10.1186/s13063-020-4145-2., (©Nicolas Bertholet, Elodie Schmutz, John A Cunningham, Jennifer McNeely, Gerhard Gmel, Jean-Bernard Daeppen, Véronique S Grazioli. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 07.03.2023.)

Intravenous drug use (IVDU) is a major public health issue, associated with high mortality rates. The risk of overdose, cardiovascular and infectious complications are well known, but IVDU can also lead to different types of kidney disease. Patients can develop acute or chronic kidney injury due to direct nephrotoxicity of the drugs, or present with different types of glomerulonephritis, interstitial nephritis, and bacterial or viral infection-related nephropathy. Diagnosis can be difficult but is essential to prevent irreversible kidney damage. The number of persons with IVDU that develop end-stage kidney disease is increasing and poses challenges for dialysis and transplantation centers. This article summarizes the renal manifestations that clinicians may encounter in persons with IVDU, especially of heroin and cocaine., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Addictions appear everywhere, mutate, transform with new products and behaviors, playing on our painstaking efforts to try to control them. Drawn into this current, the impression that dominates invites more to understand and to coax rather than to fight. Addictions are our condition, let's deal with it, rather than fight against them. It is therefore a question of knowing the products, that everyone can identify their level of risk, and of giving as many tools as possible, at any age, whatever the behavior or the product. This article shows us that there is a lot to do, from school benches to liver transplantation. There is also a lot to discover, in the recognition of the therapeutic virtues, of cannabinoids for example or even in their prescription, of pharmaceutical heroin for example, sometimes by far the best option., Competing Interests: La Pre Broers est membre du comité de la Société suisse pour le cannabis en médecine mais déclare qu’il n’y a pas de conflit d’intérêts en relation avec cet article. Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: Effective management of frequent users of emergency departments (FUED) remains challenging. Case management (CM) has shown to improve patient quality of life while reducing ED visits and associated costs. However, little data is available on FUED's perception of CM outside of North America to further improve CM implementation., Objectives: Explore the FUED's perspectives about CM in Switzerland., Design, Setting & Participants: Semi-structured qualitative interviews eliciting FUED's experiences of CM were conducted among 20 participants (75% female; mean age = 40.6, SD = 12.8) across 6 hospital ED., Outcomes Measures & Analysis: Inductive content analysis., Main Results: Most participants were satisfied with the CM program. In particular, FUEDs identified the working relationship with the case manager (cm) as key for positive outcomes, and also valued the holistic evaluation of their needs and resources. Overall, patients reported increased motivation and health literacy, as well as facilitated interactions within the healthcare system. Conversely, a small number of participants reported negative views on CM ( ie , stigmatization, lack of concrete outcomes). Barriers identified were cm's lack of time, COVID-19's negative impact on CM organization, as well as lack of clarity on the objectives of CM. FUED perceived CM as useful, in particular establishing a working relationship with the cm. Our results suggest that CM can be further improved by (1) professionals remaining non-judgmental toward FUED, (2) making sure the aims and objectives of the CM are understood by the participants, and (3) allowing more time for the cm to carry out their work.

Background and Aims: The alcohol purchase task (APT), which presents a scenario and asks participants how many drinks they would purchase and consume at different prices, generates indices of alcohol reward value that have shown robust associations with alcohol-related outcomes in numerous studies. The aim was to test its prospective validity at 4-year follow-up., Design: Prospective cohort study., Setting: General population sample of young Swiss men., Participants: A total of 4594 Swiss young men (median age = 21, 25th - 75th quartiles = 20.5 - 21.5) completed baseline questionnaires; among those, 4214 (91.7%) were successfully followed-up 4 years later., Measurements: Alcohol reward value parameters (i.e. intensity, the planned consumption when drinks are free; breakpoint, the price at which consumption would be suppressed; O max , the maximum alcohol expenditure; P max , the price associated with O max ; and elasticity, the relative change in alcohol consumption as a function of the relative change in price) were derived from the APT at baseline and used to predict self-reported weekly drinking amount, monthly binge drinking, alcohol-related consequences and DSM-5 alcohol use disorder criteria., Findings: Regression analyses, adjusting for the baseline alcohol measure, age, linguistic region and socio-economic indicators showed that intensity, breakpoint, O max and elasticity significantly predicted all tested outcomes in the expected direction (e.g. standardized incidence rate ratio [95% confidence interval] = 1.11 [1.07-1.15], 1.07 [1.03-1.10], 1.08 [1.04-1.11], and 0.92 [0.89-0.95], respectively, for weekly drinking amount, all P < 0.001). P max did not significantly predict any outcomes. Non-adjusted correlations, baseline adjusted regression and ancillary analyses using (1) latent alcohol variables, (2) multiple imputation for missing data and (3) replications in training and testing subsamples to evaluate predictive accuracy provided consistent findings., Conclusions: The alcohol purchase task demand curve measures of alcohol reward value are useful in characterizing alcohol-related risk in young men and have long-term predictive utility., (© 2022 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Importance: Heavy drinking among young adults is a major public health concern. Brief motivational interventions in the emergency department have shown promising but inconsistent results., Objective: To test whether young adults receiving a newly developed brief motivational intervention reduce their number of heavy drinking days and alcohol-related problems over 1 year compared with participants receiving brief advice., Design, Setting, and Participants: This randomized clinical trial was conducted at an emergency department of a tertiary care university hospital in Lausanne, Switzerland. Recruitment ran from December 2016 to August 2019. Follow-up was conducted after 1, 3, 6, and 12 months. All adults aged 18 to 35 years presenting for any cause and presenting with alcohol intoxication were eligible (N = 2108); 1764 were excluded or refused participation. Follow-up rate was 79% at 12 months and 89% of participants provided follow-up data at least once and were included in the primary analyses. Statistical analysis was performed from September 2020 to January 2021., Interventions: The novel intervention was based on motivational interviewing and comprised in-person discussion in the emergency department and up to 3 booster telephone calls. The control group received brief advice., Main Outcomes and Measures: Primary outcomes were the number of heavy drinking days (at least 60 g of ethanol) over the previous month and the total score on the Short Inventory of Problems (0-45, higher scores indicating more problems) over the previous 3 months. Hypotheses tested were formulated before data collection., Results: There were 344 young adults included (median [IQR] age: 23 [20-28] years; 84 women [24.4%]). Among the 306 participants providing at least 1 follow-up point, a statistically significant time × group interaction was observed (β = -0.03; 95% CI, -0.05 to 0.00; P = .02), and simple slopes indicated an increase of heavy drinking days over time in the control (β = 0.04; 95% CI, 0.02 to 0.05; P < .001) but not in the intervention group (β = 0.01; 95% CI, -0.01 to 0.03; P = .24). There was no effect on the Short Inventory of Problems score (β = -0.01; 95% CI, -0.03 to 0.02; P = .71)., Conclusions and Relevance: This randomized clinical trial found that a brief motivational intervention implemented in the emergency department provided beneficial effects on heavy drinking, which accounts for a substantial portion of mortality and disease burden among young adults., Trial Registration: ISRCTN registry: 13832949.

The debate surrounding the brain disease model and the associated questioning of the relevance of animal models is polarizing the field of addiction, and tends to widen the gap between preclinical research and addiction medicine. Here, we aimed at bridging this gap by establishing a dialog between a preclinical researcher and a clinician in addiction medicine. Our objective was to evaluate animal models and the neuroscientific conceptualization of addiction in light of alcohol or drug dependence and treatment in patients struggling with an addiction. We sought to determine how preclinical research influenced addiction medicine over past decades, and reciprocally, what can preclinical researchers learn from addiction medicine that could lead to more effective approaches. In this dialog, we talk about the co-evolution of addiction concepts and treatments from neuroscientific and medical perspectives. This dialog illustrates the reciprocal influences and mutual enrichment between the two disciplines and reveals that, although preclinical research might not produce new pharmacotherapies, it does shape the theoretical conceptualization of addiction and could thereby contribute to the implementation of therapeutic approaches., (© 2022. The Author(s).)

Objective: To investigate the risk factors for and the consequences (ie, substance use disorders (SUD), depression, personality traits) of traumatic brain injury (TBI) in young Swiss men., Design: This is a three-wave cohort study. Risk factors were measured at baseline (2010-2012) and at follow-up 1 (FU1; 2012-2014), while the consequences and TBI were measured at follow-up 2 (FU2; 2016-2018)., Setting: Switzerland., Participants: All participants at FU2 (Mage=25.43, SD=1.25) of the Cohort Study on Substance Use Risk Factors (N=4881 young Swiss men after listwise deletion)., Measures: The outcomes measured were TBI, SUD (ie, alcohol, nicotine, cannabis, other illicit drugs), depression and personality traits (ie, sensation seeking, anxiety-neuroticism, sociability, aggression-hostility) at FU2. The predictors were previous TBI (lifetime TBI but not in the past 12 months at FU2), SUD, personality traits and sociodemographics (highest level of achieved education, age, linguistic region) measured at FU1., Results: At FU2, 3919 (80.3%) participants reported to never have had TBI, 102 (2.1%) have had TBI in the last 12 months (TBI new cases), and 860 (17.6%) have had TBI during their lifetime but not in the 12 months preceding FU2 (previous TBI). Low educational attainment (OR=3.93, 95% CI 2.10 to 7.36), depression (OR=2.87, 95% CI 1.35 to 6.11), nicotine dependence (OR=1.72, 95% CI 1.09 to 2.71), high sociability (OR=1.18, 95% CI 1.07 to 1.30), high aggression-hostility (OR=1.15, 95% CI 1.06 to 1.26) and high sensation seeking (OR=1.33, 95% CI 1.04 to 1.68) at FU1 were significantly associated with TBI new cases at FU2. Previous TBI was significantly associated with nicotine dependence (OR=1.46, 95% CI 1.16 to 1.83), depression (OR=2.16, 95% CI 1.56 to 2.99) and aggression-hostility (B=0.14, 95% CI >0.00 to 0.28) at FU2., Conclusion: Low educational attainment and depression are the most significant risk factors associated with increased odds of future TBI, while depression, nicotine dependence and high aggression-hostility are the main consequences of previous TBI. TBI should be considered an underlying factor in the treatment of depression, SUD or unfavourable personality profiles., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Screening and brief interventions are among the evidence-based recommended practices to reduce the negative impact of substance use on the population. The digitization of these interventions makes it possible to disseminate them widely and to circumvent some of the barriers to the implementation of face-to-face interventions. Current evidence shows that electronic screening and brief interventions are effective in reducing alcohol and tobacco consumption. For other substances and for gambling, current evidence is more limited but promising and additional research is needed. These interventions can represent an alternative to face-to-face interventions., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Excessive alcohol consumption is the leading cause of liver diseases in Western countries, especially in France. Alcohol-related liver disease (ARLD) is an extremely broad context and there remains much to accomplish in terms of identifying patients, improving prognosis and treatment, and standardising practices. The French Association for the Study of the Liver wished to organise guidelines together with the French Alcohol Society in order to summarise the best evidence available about several key clinical points in ARLD. These guidelines have been elaborated based on the level of evidence available in the literature and each recommendation has been analysed, discussed and voted by the panel of experts. They describe how patients with ARLD should be managed nowadays and discuss the main unsettled issues in the field., (© 2022 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

Doctors learn different communication approaches for use during prevention consultations to promote healthy habits, so as to set up a partnership and to promote patient autonomy. Three of these approaches are shared decision making, when there is more than one reasonable choice, motivational interviewing, principally for behaviour change and therapeutic education, a pedagogical approach helping patients develop skills so that they may have a better management of their chronic illness. This article presents an overview of the commonalities and the differences between these approaches, often considered separately, nevertheless they are complementary and in practice, using elements of all three during a consultation could improve preventative care., Competing Interests: Marie-Anne Durand a développé l’outil d’aide à la décision Option Grid, qui est sous licence auprès de la compagnie EBSCO Health. Elle est consultante pour EBSCO Health. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Use of the methodology of cross self-confrontation (CSC) is limited in the field of healthcare and in the context of clinical practice. We applied this methodology within an addiction medicine unit of a university hospital, as part of an exploration of addiction-related clinical difficulties. Cross self-confrontation was used according to a 3-phase design based on video recorded clinical interviews with pairs of nurses and medical doctors. The article reports and discusses the application of CSC in a specific clinical context and illustrates the methodological process through one result. Findings suggest two major strengths of CSC in the context of clinical practice research and education: (1) the capacity to elicit tacit knowledge from daily clinical practice and (2) the ability to enhance self-reflection by questioning professionals both individually and collectively. Further use of CSC in nursing surroundings and clinical settings should be encouraged., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background and Aims: There are concerns about the potential impact of the coronavirus disease (COVID-19) pandemic on substance use (SU) and other reinforcing behaviours (ORB). This paper investigates changes in SU and ORB among young men during the COVID-19 crisis (i.e. March-June 2020)., Methods: Before and during the COVID-19 crisis, 2,344 young Swiss men completed questionnaires covering SU (i.e. alcohol, cigarettes, illegal cannabis), ORB (i.e. gaming, watching TV series, internet pornography) and sociodemographic and work-related characteristics (i.e. deterioration in the work situation, change in working hours, change in working hours from home, healthcare workers' and other professionals' contacts with potentially infected people, linguistic region, call up to military or civil protection unit, living situation, age)., Results: Latent-change score models showed significant decreases of 17% for drinking volume and frequency of heavy episodic drinking, and a significant increase of 75% for time spent gaming and watching TV series. Subgroups showed greater relative increases. French-speaking participants, those who experienced a deterioration in their work situation and healthcare workers in contact with potentially infected people reported increased cigarette use. Those without children increased gaming, whereas those who worked fewer hours, experienced a deterioration in their work situation or were French-speaking did more gaming and watched more TV series. Those who lived alone or were German-speaking watched more internet pornography., Conclusion: During the COVID-19 crisis, young Swiss men drank less alcohol and spent more time gaming and watching TV series. Changes in SU and ORB were not homogenous in the young Swiss men population.

Aims: The COVID-19 pandemic caused many disturbances to daily life worldwide and may also have significantly affected people's psychological well-being. The present study aimed to describe the psychological impact of the crisis on our sample of young Swiss men and to examine differences due to their linguistic region, experiencing COVID-19 symptoms and living arrangements., Methods: Based on an ongoing cohort study, we assessed a general-population sample of young Swiss men (n = 2345; average 29 years old) shortly before (from April 2019) and early on during the COVID-19 crisis (between 13 May and 8 June 2020). This was a unique opportunity to estimate the crisis' psychological impact in the form of depression, perceived stress and sleep quality (assessed before and during COVID-19), and any crisis-induced fears, isolation or psychological trauma. Associations of psychological impact with living arrangements, experiencing COVID-19 symptoms and linguistic region (German-speaking vs French-speaking) were investigated using linear regression models., Findings: By the time participants responded to our questionnaire, less than 1% had been tested positive for COVID-19, 2.6% had been tested negative and 14.7% had had some COVID-19 symptoms but had not been tested. About 8.2% of the sample reported at least some symptoms of psychological trauma (≥24 points on the Impact of Event Scale). On average, participants reported higher levels of fear for others (43.6% at least moderate) and economic fear (12.7% at least moderate) than fear for themselves (5.8% at least moderate). Those living alone and those who reported having COVID-19 symptoms themselves, or knowing someone with symptoms, reported higher overall psychological impact in the form of depression, perceived stress, sleep quality, psychological trauma, fear and isolation. Associations with linguistic region varied by outcome, with higher levels of depression and fear in French-speaking regions and higher levels of perceived stress and isolation in German-speaking regions., Interpretation: The crisis had a considerable impact on the psychological well-being of our sample of young Swiss men, and some groups were more affected than others: those living alone and those who had shown COVID-19 symptoms themselves or had known someone with symptoms may have felt a greater psychological impact from the crisis. Supporting those at a higher risk of psychological consequences in such crises, whether through structural measures or via individual support, should be an important aspect of crisis management and could help reduce the overall impact of the current pandemic on Switzerland's population.

Objective: The purpose of this study was to report the "Outcome Reporting in Brief Intervention Trials: Alcohol" (ORBITAL) recommended core outcome set (COS) to improve efficacy and effectiveness trials/evaluations for alcohol brief interventions (ABIs)., Method: A systematic review identified 2,641 outcomes in 401 ABI articles measured by 1,560 different approaches. These outcomes were classified into outcome categories, and 150 participants from 19 countries participated in a two-round e-Delphi outcome prioritization exercise. This process prioritized 15 of 93 outcome categories for discussion at a consensus meeting of key stakeholders to decide the COS. A psychometric evaluation determined how to measure the outcomes., Results: Ten outcomes were voted into the COS at the consensus meeting: (a) typical frequency, (b) typical quantity, (c) frequency of heavy episodic drinking, (d) combined consumption measure summarizing alcohol use, (e) hazardous or harmful drinking (average consumption), (f) standard drinks consumed in the past week (recent, current consumption), (g) alcohol-related consequences, (h) alcohol-related injury, (i) use of emergency health care services (impact of alcohol use), and (j) quality of life., Conclusions: The ORBITAL COS is an international consensus standard for future ABI trials and evaluations. It can improve the synthesis of new findings, reduce redundant/selective reporting (i.e., reporting only some, usually significant outcomes), improve between-study comparisons, and enhance the relevance of trial and evaluation findings to decision makers. The COS is the recommended minimum and does not exclude other, additional outcomes., Competing Interests: Gillian W. Shorter, Jeremy W. Bray, Nick Heather, Emma L. Giles, Carolina Barbosa, Amy J. O'Donnell, Aisha Holloway, Alex Cowell, Paul Toner, Heleen Riper, Jean-Bernard Daeppen, Maristela G. Monteiro, Jennifer McNeely, and Lela McKnight-Eily have no conflict of interests to declare. Anne H. Berman is the author of Swedish-language manuals in book form for the AUDIT and DUDIT as well as the Alcohol-E and DUDIT-E, questionnaires recommended for national use in health care and social services in Sweden. Maristela G. Monteiro has been involved in the development of the AUDIT questionnaire. Mike Clarke is a member of the COMET management group. Dorothy Newbury-Birch is co-president of INEBRIA. Richard Saitz is principal investigator of a study funded by the National Institutes of Health in an award to Boston University, which received medication from Alkermes for that trial.

Objective: Frequent users of emergency departments (FUED) account for a disproportionate number of emergency department (ED) visits and contribute to a wide range of challenges for ED staff. While several research has documented that case management (CM) tailored to FUED leads to a reduction in ED visits and a better quality of life (QoL) among FUED, whether there is added value for ED staff remains to be explored. This study aimed to compare, among staff in two academic EDs in Switzerland (one with and one without CM), the FUED-related knowledge, perceptions of the extent of the FUED issue, FUED-related work challenges and FUEDs' legitimacy to use ED., Method: Mixed methods were employed. First, ED physicians and nurses (N = 253) of the two EDs completed an online survey assessing their knowledge and perceptions of FUEDs. Results between healthcare providers working in an ED with CM to those working in an ED without CM were compared using independent two-sided T-tests. Next, a sample of participants (n = 16) took part in a qualitative assessment via one-to-one interviews (n = 6) or focus groups (n = 10)., Results: Both quantitative and qualitative results documented that the FUED-related knowledge, the extent FUED were perceived as an issue and perceived FUEDs' legitimacy to use ED were not different between groups. The level of perceived FUED-related challenges was also similar between groups. Quantitative results showed that nurses with CM experienced more challenges related to FUED. Qualitative exploration revealed that lack of psychiatric staff within the emergency team and lack of communication between ED staff and CM team were some of the explanations behind these counterintuitive findings., Conclusion: Despite promising results on FUEDs' QoL and frequency of ED visits, these preliminary findings suggest that CM may provide limited support to ED staff in its current form. Given the high burden of FUED-related challenges encountered by ED staff, improved communication and FUED-related knowledge transfer between ED staff and the CM team should be prioritized to increase the value of a FUED CM intervention for ED staff., (© 2021. The Author(s).)

Objective: Change talk has been proposed as a mechanism of change in motivational interviewing (MI) by mediating the link between MI technical skills and behavioral outcomes. We tested the influence of therapists' relational skills on this mediation model. Method: Secondary analysis of a randomized controlled trial of individual brief MI for heavy drinking among 20-year-old-Swiss young men, where the MI group (n = 179) significantly reduced drinking compared to an assessment-only control. We coded MI sessions and derived: therapists' MI technical skills, clients' change talk (CT) and sustain talk (ST), and global relational ratings (empathy and MI spirit). We tested moderated mediation models with technical skills as the independent variable, CT and ST as parallel mediators, predicting drinking at 3-month follow-up (controlling for baseline drinking), and relational skills as moderators of the path from technical skills to client mediators. Results: Conditional indirect effects were significant for overall MI technical skills, open questions, and simple reflections (i.e., more of these behaviors related to more ST, which was related to more drinking) when relational skills were low. In contrast, there was a significant conditional indirect effect for complex reflections when relational skills were high (i.e., more complex reflections related to less ST). Conclusions: This study provides partial support for the MI technical and relational process models. Interestingly, support was found regarding the negative side of client ambivalence (ST) in this highly precontemplative sample. Accordingly, MI therapists should work cautiously with ST when clients are at early stages of motivational readiness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Aims: The present study aimed to investigate whether the psychological impact of the COVID-19 crisis varied with regards to young Swiss men's pre-crisis level of education and socioeconomic status and to changes in their work situation due to it., Methods: A cohort of 2345 young Swiss men (from 21 out of 26 Swiss cantons; mean age = 29) completed survey-based assessments shortly before (April 2019 to February 2020) and early on during the COVID-19 crisis (May to June 2020). Outcomes measured were psychological outcomes before and during the COVID-19 crisis (depression, perceived stress and sleep quality), and the fear, isolation and psychological trauma induced by it. We investigated associations between these outcomes and their predictors: pre-crisis socioeconomic status (relative financial status, difficulty paying bills, level of education), changes in work situation during the crisis (job loss, partial unemployment, working from home, change in workload) and working in contact with potentially infected people, both inside and outside the healthcare sector. For outcomes measured before and during the crisis, the analyses were adjusted for their pre-crisis levels., Results: About 21% of participants changed their employment status (job loss, partial unemployment or lost money if self-employed) and more than 40% worked predominantly from home during the COVID-19 crisis. Participants with a lower relative socioeconomic status already before the crisis experienced a higher psychological impact due to the COVID-19 crisis, compared to participants with an average socioeconomic status (major depression (b = 0.12 [0.03, 0.22]), perceived stress (b = 0.15 [0.05, 0.25]), psychological trauma (b = 0.15 [0.04, 0.26]), fear (b = 0.20 [0.10, 0.30]) and isolation (b = 0.19 [0.08, 0.29])). A higher impact was also felt by participants who lost their job due to the COVID-19 crisis, the partially unemployed, those with an increased workload or those who worked mainly from home (e.g. depression b = 0.25 [0.16, 0.34] for those working 90%+ at home, compared to those not working at home)., Conclusions: Even in a country like Switzerland, with relatively high social security benefits and universal healthcare, the COVID-19 crisis had a considerable psychological impact, especially among those with a lower socioeconomic status and those who experienced deteriorations in their work situation due to the COVID-19 crisis. Supporting these populations during the crisis may help to prevent an amplification of inequalities in mental health and social status. Such support could help to lower the overall impact of the crisis on the mental well-being of Switzerland's population., Competing Interests: The authors have declared that no competing interests exist.

The outbreak of the COVID-19 pandemic and the measures taken for tackling it had the potential to lead to deep modifications in the supply of illegal drugs and to impact substance users' health and social situation. To investigate this, we used mixed methods, i.e., quantitative data collected with a brief questionnaire from substance users receiving opioid agonist treatment in a treatment centre in Switzerland ( N = 49), and qualitative data obtained using semi-structured phone interviews among a sub-group of participants ( N = 17). We repeated data collection twice over four weeks to investigate trends over time ( N = 51 and 14 at wave 2). Findings consistently showed the limited impact of the COVID-19 outbreak on the illegal substance market. Over the two waves, the supply, price and purity of three main illegal substances did not significantly vary. Substance use was estimated as usual by most, trending toward a decrease. The impact of the pandemic on participants' social situation and health was appraised as low to medium. Nevertheless, a minority of participants reported higher impact and multivariate analyses showed a more important impact for those who were female, younger, and not using multiple substances. This process was implemented quickly and provided an understanding of the short-term impact of the pandemic on drug markets and users.