Publications (154) View all
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Article: Post-treatment stage of change predicts 12-month outcome of treatment for alcohol problems.
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ABSTRACT: Aims: To evaluate relationships between clients' self-reported 'stage of change' and outcomes after treatment for alcohol problems. Methods: Using data from the 'United Kingdom Alcohol Treatment Trial', clients who had received at least one session of treatment and who had complete data (n = 392) entered the analysis. Two continuous measures of drinking behaviour (% days abstinent (PDA) and drinks per drinking day (DDD)) and categorical outcomes at the 12-month follow-up were compared between clients in Pre-action and Action stages of change at either pre- or post-treatment assessment. Multiple and logistic regression analyses examined the relationships between stage of change and treatment outcomes, evaluating the strength of these relationships by controlling for likely confounders. Results: Pre-treatment stage of change did not predict outcome but post-treatment stage of change predicted PDA and DDD at the 12-month follow-up. In unadjusted and adjusted analyses, clients in Action at post-treatment were two to three times more likely to show a favourable categorical outcome, variously defined, than those in Pre-action. There were no differences between clients who had received Motivational Enhancement Therapy and those who had received Social Behaviour and Network Therapy in proportions maintaining or moving towards Action from before to after treatment. Conclusions: These findings confirm previous reports that motivational variables predict outcome of treatment but add that such a relationship is seen for post-treatment stage of change. For therapists, it would seem important to monitor the client's stage of change-which in good clinical practice often occurs in informal ways-and have strategies to deal with low motivation to change whenever it occurs throughout treatment. The findings are also consistent with a 'common factors' perspective on effective treatment for alcohol problems.Alcohol and Alcoholism 02/2013; · 2.95 Impact Factor -
Article: Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial.
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ABSTRACT: To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in primary care. The hypothesis was that more intensive intervention would result in a greater reduction in hazardous or harmful drinking. Pragmatic cluster randomised controlled trial. Primary care practices in the north east and south east of England and in London. 3562 patients aged 18 or more routinely presenting in primary care, of whom 2991 (84.0%) were eligible to enter the trial: 900 (30.1%) screened positive for hazardous or harmful drinking and 756 (84.0%) received a brief intervention. The sample was predominantly male (62%) and white (92%), and 34% were current smokers. Practices were randomised to three interventions, each of which built on the previous one: a patient information leaflet control group, five minutes of structured brief advice, and 20 minutes of brief lifestyle counselling. Delivery of the patient leaflet and brief advice occurred directly after screening and brief lifestyle counselling in a subsequent consultation. The primary outcome was patients' self reported hazardous or harmful drinking status as measured by the alcohol use disorders identification test (AUDIT) at six months. A negative AUDIT result (score <8) indicated non-hazardous or non-harmful drinking. Secondary outcomes were a negative AUDIT result at 12 months, experience of alcohol related problems (alcohol problems questionnaire), health utility (EQ-5D), service utilisation, and patients' motivation to change drinking behaviour (readiness to change) as measured by a modified readiness ruler. Patient follow-up rates were 83% at six months (n=644) and 79% at 12 months (n=617). At both time points an intention to treat analysis found no significant differences in AUDIT negative status between the three interventions. Compared with the patient information leaflet group, the odds ratio of having a negative AUDIT result for brief advice was 0.85 (95% confidence interval 0.52 to 1.39) and for brief lifestyle counselling was 0.78 (0.48 to 1.25). A per protocol analysis confirmed these findings. All patients received simple feedback on their screening outcome. Beyond this input, however, evidence that brief advice or brief lifestyle counselling provided important additional benefit in reducing hazardous or harmful drinking compared with the patient information leaflet was lacking. Current Controlled Trials ISRCTN06145674.BMJ (Clinical research ed.). 01/2013; 346:e8501. -
Article: Introduction: Overview of Behavioural Economic Perspectives on Substance Use and Addiction.
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ABSTRACT: The key challenge for any theory of addiction is to explain why an individual would continue a behaviour pattern of excessive consumption when that pattern produces a variety of sometimes extremely negative consequences of which he or she is aware. To explain this puzzling phenomenon, the disease-based views that have dominated the field historically argue that consumption has somehow gotten outside the individual's volitional control. On the other hand, economic and behavioural economic views of addiction are fundamentally based on some model of choice, and appealing to non-volitional forces is not an option for a theory of addiction based on choice. Thus, the challenge of developing a theory of addiction is particularly acute in the choice literature because of the basic assumption that individuals choose their behavioural allocation patterns based on some function of the consequences of those patterns. This book is about the theory, data, and applied implications of these choice-based models of substance use and addiction. The distinction between substance use and addiction obviously is important, because many individuals use substances but are not also addicted to them. The behavioural economic perspective has made contributions to the analysis of both of these phenomena and, while the major focus of the book is on theories of addiction, it is necessary also to consider the behavioural economic account of substance use in order to place the theories in their proper context and provide full coverage of the contribution of behavioural economics to this field of study. The papers in this book are based on conference papers given by experts in the field, most of whom have long histories of dealing with this material. The purpose of this introductory chapter is to provide a summary of the key conceptual and empirical developments that led to the current status of the area as represented in this volume. The four primary theories discussed in this book are hyperbolic temporal discounting as applied to addiction, the melioration theory of addiction, the relative theory of addiction, and the theory of rational addiction. This introduction provides some background to the development of each of these four theories. (PsycINFO Database Record (c) 2012 APA, all rights reserved)10/2012; -
Article: Commentary on Seppänen and colleagues (2012): Institutionalization of brief alcohol intervention in primary health care-the Finnish case.
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ABSTRACT: Despite good evidence for the effectiveness of brief intervention (BI) for hazardous and harmful drinking delivered in primary health care, the uptake of such interventions among physicians and other healthcare staff still leaves much to be desired. Seppänen and colleagues (2012) report an evaluation of efforts funded by the Finnish government to "institutionalize" BI among primary care physicians in Finland. The evaluation was based on 2 surveys of Finnish primary healthcare physicians, one conducted in 2002 before the government-funded implementation project had begun and the other in 2007 after it had ended. Major findings were that the proportion of physicians offering BI had increased between the 2 surveys from 59.2 to 78.5% and that, of those who said they offered BI in 2007, 52.4% reported increased activity compared with 5 years earlier. However, in the 2007 survey, regular BI activity was reported by 17.2% of the sample but 61.3% reported only occasional activity. Also, a separate survey of the Finnish general population indicated that the extent to which people are asked by health professionals about their alcohol consumption, and the extent to which heavy drinkers receive advice about it, still appears to be low. Thus, the claim that the institutionalization of BI in the Finnish primary care system has been successful is tentative. The clinical benefits of increased BI activity are unquestionable but it can be argued that, for a public health benefit to occur, a greater proportion of hazardous and harmful drinkers need to receive BI than is suggested in the data reported by Seppänen and colleagues.Alcoholism Clinical and Experimental Research 07/2012; 36(8):1311-3. · 3.34 Impact Factor -
Article: Screening for alcohol use in criminal justice settings: an exploratory study.
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ABSTRACT: To examine the feasibility and acceptability of alcohol screening and delivery of brief interventions within criminal justice settings. A quantitative survey of those aged 18 or over in English criminal justice settings (three custody suites within police stations, three prisons and three probation offices). The Fast Alcohol Screening Test (FAST) and a modified version of the Single Alcohol Screening Question (M-SASQ) were compared with the Alcohol Use Disorders Identification Test (AUDIT) as the 'gold standard'. Participants completed a health status questionnaire (EQ5D), questions on service utilization and the Readiness to Change Questionnaire. Questions relating to the acceptability and feasibility of delivering brief interventions and about perception of coercion were included. Five hundred and ninety-two individuals were approached and 251 were eligible. Of these, 205 (82%) consented to take part in the study. The mean AUDIT score was 19.9 (SD 13.5) and 73% scored 8 or more on AUDIT. A higher percentage of those approached in the probation setting consented to take part (81%: prison 36%, police setting 10%). Those scoring AUDIT positive were more likely to be involved in violent offences (36.5 vs 9.4%; P < 0.001) and less likely to be involved in offences involving property (27.7 vs 45.3%; P = 0.03). Three quarters of the sample (74%) reported that they would not feel coerced to engage in an intervention about their alcohol use. FAST and M-SASQ had acceptable screening properties when compared with AUDIT with area under the curves of 0.97 and 0.92, respectively. The results confirm that there is a major problem with alcohol use in the criminal justice system and this impacts on health and criminal behaviour. Of the three criminal justice settings, probation was found to be the most suitable for screening. Participants were positive about receiving interventions for their alcohol use in probation settings.Alcohol and Alcoholism 05/2012; 47(4):423-7. · 2.95 Impact Factor
