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5. Cognitive functioning of long-term heavy cannabis users seeking treatment. (Original Contribution)

Author

Solowij, Nadia, Stephens, Robert S., Roffman, Roger A., Babor, Thomas, Kadden, Ronald, Miller, Michael, Christiansen, Kenneth, McRee, Bonnie, and Vendetti, Janice

Subjects
Marijuana -- Adverse and side effects, Cognition disorders -- Causes of
Abstract

Long-term marijuana use can adversely impact memory, attention, learning, retention, and retrieval, according to a study of 102 marijuana users and 33 non-users. The marijuana users were tested an average of 17 hours after they had last used marijuana., Context Cognitive impairments are associated with long-term cannabis use, but the parameters of use that contribute to impairments and the nature and endurance of cognitive dysfunction remain uncertain. Objective To examine the effects of duration of cannabis use on specific areas of cognitive functioning among users seeking treatment for cannabis dependence. Design, Setting, and Participants Multisite retrospective cross-sectional neuropsychological study conducted in the United States (Seattle, Wash; Farmington, Conn; and Miami, Fla) between 1997 and 2000 among 102 near-daily cannabis users (51 long-term users: mean, 23.9 years of use; 51 shorter-term users: mean, 10.2 years of use) compared with 33 nonuser controls. Main Outcome Measures Measures from 9 standard neuropsychological tests that assessed attention, memory, and executive functioning, and were administered prior to entry to a treatment program and following a median 17-hour abstinence. Results Long-term cannabis users performed significantly less well than shorter-term users and controls on tests of memory and attention. On the Rey Auditory Verbal Learning Test, long-term users recalled significantly fewer words than either shorter-term users (P=.001) or controls (P=.005); there was no difference between shorter-term users and controls. Long-term users showed impaired learning (P=.007), retention (P=.003), and retrieval (P=.002) compared with controls. Both user groups performed poorly on a time estimation task (P Conclusions These results confirm that long-term heavy cannabis users show impairments in memory and attention that endure beyond the period of intoxication and worsen with increasing years of regular cannabis use.

Published
2002

10. Proceedings of the 14th annual conference of INEBRIA

Author

Holloway, Aisha S., primary, Ferguson, Jennifer, additional, Landale, Sarah, additional, Cariola, Laura, additional, Newbury-Birch, Dorothy, additional, Flynn, Amy, additional, Knight, John R., additional, Sherritt, Lon, additional, Harris, Sion K., additional, O’Donnell, Amy J., additional, Kaner, Eileen, additional, Hanratty, Barbara, additional, Loree, Amy M., additional, Yonkers, Kimberly A., additional, Ondersma, Steven J., additional, Gilstead-Hayden, Kate, additional, Martino, Steve, additional, Adam, Angeline, additional, Schwartz, Robert P., additional, Wu, Li-Tzy, additional, Subramaniam, Geetha, additional, Sharma, Gaurav, additional, McNeely, Jennifer, additional, Berman, Anne H., additional, Kolaas, Karoline, additional, Petersén, Elisabeth, additional, Bendtsen, Preben, additional, Hedman, Erik, additional, Linderoth, Catharina, additional, Müssener, Ulrika, additional, Sinadinovic, Kristina, additional, Spak, Fredrik, additional, Gremyr, Ida, additional, Thurang, Anna, additional, Mitchell, Ann M., additional, Finnell, Deborah, additional, Savage, Christine L., additional, Mahmoud, Khadejah F., additional, Riordan, Benjamin C., additional, Conner, Tamlin S., additional, Flett, Jayde A. M., additional, Scarf, Damian, additional, McRee, Bonnie, additional, Vendetti, Janice, additional, Gallucci, Karen Steinberg, additional, Robaina, Kate, additional, Clark, Brendan J., additional, Jones, Jacqueline, additional, Reed, Kathryne D., additional, Hodapp, Rachel M., additional, Douglas, Ivor, additional, Burnham, Ellen L., additional, Aagaard, Laura, additional, Cook, Paul F., additional, Harris, Brett R., additional, Yu, Jiang, additional, Wolff, Margaret, additional, Rogers, Meighan, additional, Barbosa, Carolina, additional, Wedehase, Brendan J., additional, Dunlap, Laura J., additional, Mitchell, Shannon G., additional, Dusek, Kristi A., additional, Gryczynski, Jan, additional, Kirk, Arethusa S., additional, Oros, Marla T., additional, Hosler, Colleen, additional, O’Grady, Kevin E., additional, Brown, Barry S., additional, Angus, Colin, additional, Sherborne, Sidney, additional, Gillespie, Duncan, additional, Meier, Petra, additional, Brennan, Alan, additional, de Vargas, Divane, additional, Soares, Janaina, additional, Castelblanco, Donna, additional, Doran, Kelly M., additional, Wittman, Ian, additional, Shelley, Donna, additional, Rotrosen, John, additional, Gelberg, Lillian, additional, Edelman, E. Jennifer, additional, Maisto, Stephen A., additional, Hansen, Nathan B., additional, Cutter, Christopher J., additional, Deng, Yanhong, additional, Dziura, James, additional, Fiellin, Lynn E., additional, O’Connor, Patrick G., additional, Bedimo, Roger, additional, Gibert, Cynthia, additional, Marconi, Vincent C., additional, Rimland, David, additional, Rodriguez-Barradas, Maria C., additional, Simberkoff, Michael S., additional, Justice, Amy C., additional, Bryant, Kendall J., additional, Fiellin, David A., additional, Giles, Emma L., additional, Coulton, Simon, additional, Deluca, Paolo, additional, Drummond, Colin, additional, Howel, Denise, additional, McColl, Elaine, additional, McGovern, Ruth, additional, Scott, Stephanie, additional, Stamp, Elaine, additional, Sumnall, Harry, additional, Vale, Luke, additional, Alabani, Viviana, additional, Atkinson, Amanda, additional, Boniface, Sadie, additional, Frankham, Jo, additional, Gilvarry, Eilish, additional, Hendrie, Nadine, additional, Howe, Nicola, additional, McGeechan, Grant J., additional, Ramsey, Amy, additional, Stanley, Grant, additional, Clephane, Justine, additional, Gardiner, David, additional, Holmes, John, additional, Martin, Neil, additional, Shevills, Colin, additional, Soutar, Melanie, additional, Chi, Felicia W., additional, Weisner, Constance, additional, Ross, Thekla B., additional, Mertens, Jennifer, additional, Sterling, Stacy A., additional, Shorter, Gillian W., additional, Heather, Nick, additional, Bray, Jeremy, additional, Cohen, Hildie A., additional, McPherson, Tracy L., additional, Adam, Cyrille, additional, López-Pelayo, Hugo, additional, Gual, Antoni, additional, Segura-Garcia, Lidia, additional, Colom, Joan, additional, Ornelas, India J., additional, Doyle, Suzanne, additional, Donovan, Dennis, additional, Duran, Bonnie, additional, Torres, Vanessa, additional, Gaume, Jacques, additional, Grazioli, Véronique, additional, Fortini, Cristiana, additional, Paroz, Sophie, additional, Bertholet, Nicolas, additional, Daeppen, Jean-Bernard, additional, Satterfield, Jason M., additional, Gregorich, Steven, additional, Alvarado, Nicholas J., additional, Muñoz, Ricardo, additional, Kulieva, Gozel, additional, Vijayaraghavan, Maya, additional, Adam, Angéline, additional, Cunningham, John A., additional, Díaz, Estela, additional, Palacio-Vieira, Jorge, additional, Godinho, Alexandra, additional, Kushir, Vladyslav, additional, O’Brien, Kimberly H. M., additional, Aguinaldo, Laika D., additional, Sellers, Christina M., additional, Spirito, Anthony, additional, Chang, Grace, additional, Blake-Lamb, Tiffany, additional, LaFave, Lea R. Ayers, additional, Thies, Kathleen M., additional, Pepin, Amy L., additional, Sprangers, Kara E., additional, Bradley, Martha, additional, Jorgensen, Shasta, additional, Catano, Nico A., additional, Murray, Adelaide R., additional, Schachter, Deborah, additional, Andersen, Ronald M., additional, Rey, Guillermina Natera, additional, Vahidi, Mani, additional, Rico, Melvin W., additional, Baumeister, Sebastian E., additional, Johansson, Magnus, additional, Sinadinovic, Christina, additional, Hermansson, Ulric, additional, Andreasson, Sven, additional, O’Grady, Megan A., additional, Kapoor, Sandeep, additional, Akkari, Cherine, additional, Bernal, Camila, additional, Pappacena, Kristen, additional, Morley, Jeanne, additional, Auerbach, Mark, additional, Neighbors, Charles J., additional, Kwon, Nancy, additional, Conigliaro, Joseph, additional, Morgenstern, Jon, additional, Magill, Molly, additional, Apodaca, Timothy R., additional, Borsari, Brian, additional, Hoadley, Ariel, additional, Scott Tonigan, J., additional, Moyers, Theresa, additional, Fitzgerald, Niamh M., additional, Schölin, Lisa, additional, Barticevic, Nicolas, additional, Zuzulich, Soledad, additional, Poblete, Fernando, additional, Norambuena, Pablo, additional, Sacco, Paul, additional, Ting, Laura, additional, Beaulieu, Michele, additional, Wallace, Paul George, additional, Andrews, Matthew, additional, Daley, Kate, additional, Shenker, Don, additional, Gallagher, Louise, additional, Watson, Rod, additional, Weaver, Tim, additional, Bruguera, Pol, additional, Oliveras, Clara, additional, Gavotti, Carolina, additional, Barrio, Pablo, additional, Braddick, Fleur, additional, Miquel, Laia, additional, Suárez, Montse, additional, Bruguera, Carla, additional, Brown, Richard L., additional, Capell, Julie Whelan, additional, Paul Moberg, D., additional, Maslowsky, Julie, additional, Saunders, Laura A., additional, McCormack, Ryan P., additional, Scheidell, Joy, additional, Gonzalez, Mirelis, additional, Bauroth, Sabrina, additional, Liu, Weiwei, additional, Lindsay, Dawn L., additional, Lincoln, Piper, additional, Hagle, Holly, additional, Wallhed Finn, Sara, additional, Hammarberg, Anders, additional, Andréasson, Sven, additional, King, Sarah E., additional, Vargo, Rachael, additional, Kameg, Brayden N., additional, Acquavita, Shauna P., additional, Van Loon, Ruth Anne, additional, Smith, Rachel, additional, Brehm, Bonnie J., additional, Diers, Tiffiny, additional, Kim, Karissa, additional, Barker, Andrea, additional, Jones, Ashley L., additional, Skinner, Asheley C., additional, Hinman, Agatha, additional, Svikis, Dace S., additional, Thacker, Casey L., additional, Resnicow, Ken, additional, Beatty, Jessica R., additional, Janisse, James, additional, Puder, Karoline, additional, Bakshi, Ann-Sofie, additional, Milward, Joanna M., additional, Kimergard, Andreas, additional, Garnett, Claire V., additional, Crane, David, additional, Brown, Jamie, additional, West, Robert, additional, Michie, Susan, additional, Rosendahl, Ingvar, additional, Andersson, Claes, additional, Gajecki, Mikael, additional, Blankers, Matthijs, additional, Donoghue, Kim, additional, Lynch, Ellen, additional, Maconochie, Ian, additional, Phillips, Ceri, additional, Pockett, Rhys, additional, Phillips, Tom, additional, Patton, R., additional, Russell, Ian, additional, Strang, John, additional, Stewart, Maureen T., additional, Quinn, Amity E., additional, Brolin, Mary, additional, Evans, Brooke, additional, Horgan, Constance M., additional, Liu, Junqing, additional, McCree, Fern, additional, Kanovsky, Doug, additional, Oberlander, Tyler, additional, Zhang, Huan, additional, Hamlin, Ben, additional, Saunders, Robert, additional, Barton, Mary B., additional, Scholle, Sarah H., additional, Santora, Patricia, additional, Bhatt, Chirag, additional, Ahmed, Kazi, additional, Hodgkin, Dominic, additional, Gao, Wenwu, additional, Merrick, Elizabeth L., additional, Drebing, Charles E., additional, Larson, Mary Jo, additional, Sharma, Monica, additional, Petry, Nancy M., additional, Saitz, Richard, additional, Weisner, Constance M., additional, Young-Wolff, Kelly C., additional, Lu, Wendy Y., additional, Blosnich, John R., additional, Lehavot, Keren, additional, Glass, Joseph E., additional, Williams, Emily C., additional, Bensley, Kara M., additional, Chan, Gary, additional, Dombrowski, Julie, additional, Fortney, John, additional, Rubinsky, Anna D., additional, Lapham, Gwen T., additional, Forray, Ariadna, additional, Olmstead, Todd A., additional, Gilstad-Hayden, Kathryn, additional, Kershaw, Trace, additional, Dillon, Pamela, additional, Weaver, Michael F., additional, Grekin, Emily R., additional, Ellis, Jennifer D., additional, and McGoron, Lucy, additional

Published
2017
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13. Identifying Patients at Risk for Alcohol-Exposed Pregnancies: The Importance of Addressing Multiple Risk Factors

Author

McRee, Bonnie G., Hanson, Bridget L., Vendetti, Janice, King, Diane K., Pawlukiewicz, Iwona, Berry, Erin, Johnson, Jessica, Marshall, Deanna, Rosato, Lauren, Steinberg Gallucci, Karen, and Whitmore, Corrie

Abstract

Background: The increasing prevalence of fetal alcohol spectrum disorders is a critical public health issue. Two behaviors, consuming alcohol and using less effective pregnancy prevention, may result in alcohol-exposed pregnancies (AEPs) in individuals who can become pregnant. In the context of alcohol screening and brief intervention (SBI) services, cutoff scores on widely used alcohol risk assessments (eg, Alcohol Use Disorders Identification Test, U.S. version [USAUDIT]) may fail to identify individuals whose relatively low alcohol consumption may still put them at risk for an AEP due to their pregnancy prevention method.Methods: To identify this gap in alcohol SBI service delivery, we examined data from 2 reproductive healthcare systems implementing alcohol SBI, to explore the prevalence of individuals who met both of the following risk conditions: reported any alcohol use on the USAUDIT and a pregnancy prevention method less than 88% effective. Electronic health records for individuals aged 18 to 49 presenting for preventive care in 2021 were analyzed.Results: Of 11 567 screened, 7638 reported some alcohol use, but screened at a lower-risk level and were not flagged to receive an alcohol-focused brief intervention (BI). Of these, 1477 were using a method of pregnancy prevention that was less than 88% effective. In addition, 118 of the 1676 who screened positive on the USAUDIT were using less effective contraception and did not receive a BI. In summary, the number of individuals at risk of an AEP who did not receive an alcohol BI was 1595 (13.8%) of the total patients screened for at-risk alcohol use.Conclusions: There is a need for system modifications to assess multiple behaviors simultaneously and alert providers when a combination of behaviors increases a specific health risk, such as an AEP. Tailored alcohol BIs that include the risks/benefits of various pregnancy prevention methods to reduce AEPs provide opportunities to enhance the reach of standard alcohol SBI services.

Published
2024
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14. Cross-Site Evaluation of Alcohol Screening and Brief Intervention Implementation Programs in Healthcare Systems Serving Individuals of Reproductive Age

Author

Vendetti, Janice, Bangham, Candice, Riba, Melissa, Whitmore, Corrie, Steinberg Gallucci, Karen, Hanson, Bridget L., and Greece, Jacey A.

Abstract

Background: With US Centers for Disease Control and Prevention funding, from 2018 to 2022, 4 large healthcare systems (n = 53 health centers across 7 states) serving people of reproductive age trained staff and provided implementation support for alcohol screening and brief intervention (SBI). This cross-site evaluation explores each healthcare system’s implementation approach to implement SBI, reduce excessive alcohol use, and prevent prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorders.Methods: The SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix framed the multilevel strategies to implement alcohol SBI programs from 2018 to 2022. Qualitative and quantitative data sources examined outcomes, guided by one logic model, through systems-level process data and provider-level performance metrics. Data analyses utilized frequencies and means for quantitative data and themes for qualitative data according to an established framework.Results: Successful approaches within systems included using electronic health records, flexible implementation and workflow protocols, customized training and technical assistance programs, quality assurance feedback loops, and stakeholder buy-in. Centralized management structures were efficient in standardizing implementation across health centers. Decentralized management structures used tailored approaches, enhancing provider/staff SBI acceptance. Across systems, 1259 staff (eg, clinicians, medical assistants) were trained to provide alcohol SBI services and reported pre-post training increases in self-efficacy in performing brief intervention; skills in PAE counseling; and confidence in screening. Fifty-three (48 providing data) health centers implemented alcohol SBI, screening 106 826 patients over the study period with most of the 10 087 patients who screened positive for excessive alcohol use receiving a BI.Conclusions: Maximizing the use of technology, employing flexibility in program delivery, and institutionalizing processes and protocols improved workflow, efficiency, and program reach. Ongoing partnership and stakeholder communication identify areas for ongoing improvement, engagement, and best practices for sustainability around substance use screening, which are essential with increases in substance use since the pandemic.

Published
2024
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15. Program- and service-level costs of seven screening, brief intervention, and referral to treatment programs.

Author

Bray, Jeremy, Mallonee, Erin, Dowd, Bill, Aldridge, Arnie, Cowell, Alexander J., Vendetti, Janice, Bray, Jeremy, Mallonee, Erin, Dowd, Bill, Aldridge, Arnie, Cowell, Alexander J., and Vendetti, Janice

Abstract

This paper examines the costs of delivering screening, brief intervention, and referral to treatment (SBIRT) services within the first seven demonstration programs funded by the US Substance Abuse and Mental Health Services Administration. Service-level costs were estimated and compared across implementation model (contracted specialist, inhouse specialist, inhouse generalist) and service delivery setting (emergency department, hospital inpatient, outpatient). Program-level costs were estimated and compared across grantee recipient programs. Service-level data were collected through timed observations of SBIRT service delivery. Program-level data were collected during key informant interviews using structured cost interview guides. At the service level, support activities that occur before or after engaging the patient comprise a considerable portion of the cost of delivering SBIRT services, especially short duration services. At the program level, average costs decreased as more patients were screened. Comparing across program and service levels, the average annual operating costs calculated at the program level often exceeded the cost of actual service delivery. Provider time spent in support of service provision may comprise a large share of the costs in some cases because of potentially substantial fixed and quasifixed costs associated with program operation. The cost structure of screening, brief intervention, and referral to treatment is complex and discontinuous of patient flow, causing annual operating costs to exceed the costs of actual service provision for some settings and implementation models.

Published
2014

16. Program- and service-level costs of seven screening, brief intervention, and referral to treatment programs

Author

Bray,Jeremy W, Mallonee,Erin, Dowd,William, Aldridge,Arnie, Cowell,Alexander J, Vendetti,Janice, Bray,Jeremy W, Mallonee,Erin, Dowd,William, Aldridge,Arnie, Cowell,Alexander J, and Vendetti,Janice

Abstract

Jeremy W Bray,1 Erin Mallonee,2 William Dowd,2 Arnie Aldridge,2 Alexander J Cowell,2 Janice Vendetti31Department of Economics, Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, NC, USA; 2RTI International, Research Triangle Park, NC, USA; 3Department of Community Medicine and Health Care, School of Medicine, UCONN Health, Farmington, CT, USAAbstract: This paper examines the costs of delivering screening, brief intervention, and referral to treatment (SBIRT) services within the first seven demonstration programs funded by the US Substance Abuse and Mental Health Services Administration. Service-level costs were estimated and compared across implementation model (contracted specialist, inhouse specialist, inhouse generalist) and service delivery setting (emergency department, hospital inpatient, outpatient). Program-level costs were estimated and compared across grantee recipient programs. Service-level data were collected through timed observations of SBIRT service delivery. Program-level data were collected during key informant interviews using structured cost interview guides. At the service level, support activities that occur before or after engaging the patient comprise a considerable portion of the cost of delivering SBIRT services, especially short duration services. At the program level, average costs decreased as more patients were screened. Comparing across program and service levels, the average annual operating costs calculated at the program level often exceeded the cost of actual service delivery. Provider time spent in support of service provision may comprise a large share of the costs in some cases because of potentially substantial fixed and quasifixed costs associated with program operation. The cost structure of screening, brief intervention, and referral to treatment is complex and discontinuous of patient flow, causing annual operating costs to exceed the costs of actual service provision for some se

Published
2014

18. Brief treatments for cannabis dependence: findings from a randomized multisite trial

Author

Solowij, Nadia, Stephens, Robert S, Litt, Mark D, Kadden, Ronald M, Christiansen, Kenneth, Barbor, Thomas F, Miller, Michael, Donaldson, Jean, Roffman, Roger, Herrell, James, McRee, Bonnie, Carroll, Kathleen, Steinberg, Karen, Vendetti, Janice, Solowij, Nadia, Stephens, Robert S, Litt, Mark D, Kadden, Ronald M, Christiansen, Kenneth, Barbor, Thomas F, Miller, Michael, Donaldson, Jean, Roffman, Roger, Herrell, James, McRee, Bonnie, Carroll, Kathleen, Steinberg, Karen, and Vendetti, Janice

Published
2009

21. Cognitive functioning of long-term heavy cannabis users seeking treatment

Author

Solowij, Nadia, Stephens, Robert S, Roffman, Roger A, Babor, Thomas, Kadden, Ronald M, Miller, Michael, Christiansen, Kenneth, McRee, Bonnie, Vendetti, Janice, Solowij, Nadia, Stephens, Robert S, Roffman, Roger A, Babor, Thomas, Kadden, Ronald M, Miller, Michael, Christiansen, Kenneth, McRee, Bonnie, and Vendetti, Janice

Abstract

CONTEXT: Cognitive impairments are associated with long-term cannabis use, but the parameters of use that contribute to impairments and the nature and endurance of cognitive dysfunction remain uncertain. OBJECTIVE: To examine the effects of duration of cannabis use on specific areas of cognitive functioning among users seeking treatment for cannabis dependence. DESIGN, SETTING, AND PARTICIPANTS: Multisite retrospective cross-sectional neuropsychological study conducted in the United States (Seattle, Wash; Farmington, Conn; and Miami, Fla) between 1997 and 2000 among 102 near-daily cannabis users (51 long-term users: mean, 23.9 years of use; 51 shorter-term users: mean, 10.2 years of use) compared with 33 nonuser controls. MAIN OUTCOME MEASURES: Measures from 9 standard neuropsychological tests that assessed attention, memory, and executive functioning, and were administered prior to entry to a treatment program and following a median 17-hour abstinence. RESULTS: Long-term cannabis users performed significantly less well than shorter-term users and controls on tests of memory and attention. On the Rey Auditory Verbal Learning Test, long-term users recalled significantly fewer words than either shorter-term users (P =.001) or controls (P =.005); there was no difference between shorter-term users and controls. Long-term users showed impaired learning (P =.007), retention (P =.003), and retrieval (P =.002) compared with controls. Both user groups performed poorly on a time estimation task (P<.001 vs controls). Performance measures often correlated significantly with the duration of cannabis use, being worse with increasing years of use, but were unrelated to withdrawal symptoms and persisted after controlling for recent cannabis use and other drug use. CONCLUSIONS: These results confirm that long-term heavy cannabis users show impairments in memory and attention that endure beyond the period of intoxication and worsen with increasing years of regular cannabis use.

Published
2002

23. Cross-Site Evaluation of Alcohol Screening and Brief Intervention Implementation Programs in Healthcare Systems Serving Individuals of Reproductive Age.

Author

Vendetti J, Bangham C, Riba M, Whitmore C, Steinberg Gallucci K, Hanson BL, and Greece JA

Abstract

Background: With US Centers for Disease Control and Prevention funding, from 2018 to 2022, 4 large healthcare systems (n = 53 health centers across 7 states) serving people of reproductive age trained staff and provided implementation support for alcohol screening and brief intervention (SBI). This cross-site evaluation explores each healthcare system's implementation approach to implement SBI, reduce excessive alcohol use, and prevent prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorders., Methods: The SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix framed the multilevel strategies to implement alcohol SBI programs from 2018 to 2022. Qualitative and quantitative data sources examined outcomes, guided by one logic model, through systems-level process data and provider-level performance metrics. Data analyses utilized frequencies and means for quantitative data and themes for qualitative data according to an established framework., Results: Successful approaches within systems included using electronic health records, flexible implementation and workflow protocols, customized training and technical assistance programs, quality assurance feedback loops, and stakeholder buy-in. Centralized management structures were efficient in standardizing implementation across health centers. Decentralized management structures used tailored approaches, enhancing provider/staff SBI acceptance. Across systems, 1259 staff (eg, clinicians, medical assistants) were trained to provide alcohol SBI services and reported pre-post training increases in self-efficacy in performing brief intervention; skills in PAE counseling; and confidence in screening. Fifty-three (48 providing data) health centers implemented alcohol SBI, screening 106 826 patients over the study period with most of the 10 087 patients who screened positive for excessive alcohol use receiving a BI., Conclusions: Maximizing the use of technology, employing flexibility in program delivery, and institutionalizing processes and protocols improved workflow, efficiency, and program reach. Ongoing partnership and stakeholder communication identify areas for ongoing improvement, engagement, and best practices for sustainability around substance use screening, which are essential with increases in substance use since the pandemic., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Published
2024
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24. Identifying Patients at Risk for Alcohol-Exposed Pregnancies: The Importance of Addressing Multiple Risk Factors.

Author

McRee BG, Hanson BL, Vendetti J, King DK, Pawlukiewicz I, Berry E, Johnson J, Marshall D, Rosato L, Steinberg Gallucci K, and Whitmore C

Abstract

Background: The increasing prevalence of fetal alcohol spectrum disorders is a critical public health issue. Two behaviors, consuming alcohol and using less effective pregnancy prevention, may result in alcohol-exposed pregnancies (AEPs) in individuals who can become pregnant. In the context of alcohol screening and brief intervention (SBI) services, cutoff scores on widely used alcohol risk assessments (eg, Alcohol Use Disorders Identification Test, U.S. version [USAUDIT]) may fail to identify individuals whose relatively low alcohol consumption may still put them at risk for an AEP due to their pregnancy prevention method., Methods: To identify this gap in alcohol SBI service delivery, we examined data from 2 reproductive healthcare systems implementing alcohol SBI, to explore the prevalence of individuals who met both of the following risk conditions: reported any alcohol use on the USAUDIT and a pregnancy prevention method less than 88% effective. Electronic health records for individuals aged 18 to 49 presenting for preventive care in 2021 were analyzed., Results: Of 11 567 screened, 7638 reported some alcohol use, but screened at a lower-risk level and were not flagged to receive an alcohol-focused brief intervention (BI). Of these, 1477 were using a method of pregnancy prevention that was less than 88% effective. In addition, 118 of the 1676 who screened positive on the USAUDIT were using less effective contraception and did not receive a BI. In summary, the number of individuals at risk of an AEP who did not receive an alcohol BI was 1595 (13.8%) of the total patients screened for at-risk alcohol use., Conclusions: There is a need for system modifications to assess multiple behaviors simultaneously and alert providers when a combination of behaviors increases a specific health risk, such as an AEP. Tailored alcohol BIs that include the risks/benefits of various pregnancy prevention methods to reduce AEPs provide opportunities to enhance the reach of standard alcohol SBI services., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Published
2024
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25. Correlates of pre-treatment drop-out among persons with marijuana dependence.

Author

Vendetti J, McRee B, Miller M, Christiansen K, and Herrell J

Subjects
Adolescent, Adult, Age Factors, Analysis of Variance, Educational Status, Employment, Female, Humans, Male, Marijuana Abuse therapy, Marriage, Marijuana Abuse psychology, Patient Dropouts psychology
Abstract

Aims: Our objective was to identify client characteristics and other factors associated with pre-treatment drop-out by people with marijuana dependence., Design and Participants: Data from the Marijuana Treatment Project's screening assessment were used to examine correlates of pre-treatment drop-out. Information from all eligible study participants (n = 813) (i.e. those who were interested in receiving treatment for their marijuana dependence and were determined to be eligible for the randomized treatment efficacy trial) was used to examine differences between the 450 participants who initiated treatment (by enrolling in the trial) and the 363 individuals who declined enrollment., Setting: The study was conducted at three community-based outpatient treatment facilities in Farmington, CT, Seattle, WA and Miami, FL., Measurements: The information gathered in the screening interview included demographic characteristics, residential stability variables, employment and education history and referral source. Substance use variables included the number of days and the number of times per day marijuana was used, self-perceived dependence on marijuana, alcohol or other drugs, other drug use history and current treatment (i.e. substance abuse, medical, psychiatric) situation., Findings: Stepwise logistic regression was conducted to confirm variables associated with treatment initiation in bivariate analyses. Pre-treatment drop-out was associated with being younger, unmarried, unemployed, less educated and Asian American or Native American. It was also associated with self-perceived dependence on marijuana and use of other drugs., Conclusions: By recognizing demographic and substance use factors that may serve as barriers for individuals accessing treatment for marijuana dependence, clinicians may target clients with these characteristics proactively to encourage treatment initiation and subsequent attendance.

Published
2002
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