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Objective: Screening for alcohol misuse in primary care settings is strongly recommended but grossly underused. Using interactive voice response (IVR), we developed an automated screening tool (IVR Screen) for identifying alcohol misuse in outpatient primary care offices and evaluated its use rate and acceptability for both patients and providers. Method: Patients (N = 101) presenting to a primary care clinic for scheduled, nonemergent health care visits called the IVR Screen by using a dedicated telephone in the waiting room and answered five questions about their health. Results were printed immediately for patient and provider to review during the visit. Medical assistants interviewed patients about the IVR Screen in the examination room. Results: Ninety-six percent of patients who were invited to participate in the study consented to do so. Of those, 26% met criteria for alcohol misuse. Feedback from patients and providers was positive and included constructive suggestions for revisions to the IVR Screen for future use. Conclusions: IVR-based screening for at-risk drinking was feasible and did not interfere with the provider-patient interaction. The proportion of heavy drinkers identified by the IVR Screen was comparable to that of published reports of screening with written questionnaires. Implications for behavioral health screening, treatment, and clinical research are considerable because IVR-based screening assessments can be customized and targeted to different populations. Results suggest that continued development of IVR as a tool for health and alcohol screening in primary care settings is warranted., SCREENING FOR UNRECOGNIZED health problems is an important aspect of primary care practice. In particular, screening for alcohol misuse is recommended by the U.S. Preventive Services Task Force (2004), the [...]

Objective: Self-monitoring is recommended following brief alcohol intervention (BI). We have previously demonstrated that self-monitoring with an automated telephone system (interactive voice response; IVR) is associated with a steady reduction in alcohol consumption in the absence of BI. In this study we explore the feasibility and efficacy of IVR as a possible therapeutic enhancement for BI. Method: We updated all providers (N = 112) in 15 primary care clinics about BI and encouraged them to do a BI with their patients whenever appropriate and to invite those patients to participate in the research project. Interested patients (N = 338) were randomized to one of four study conditions including no IVR and three groups who self-monitored for 6 months using an IVR: no feedback, feedback, and feedback plus a monetary calling incentive. Results: The IVR proved to be a feasible method for self-monitoring. Of those invited to use the IVR, 90% initiated use and made 95% of the calls while they remained engaged with the system; more than half continued calling for the entire 6 months. Reported impact of the IVR and associated feedback on drinking awareness was high. Therapeutic results were mixed. Overall, the IVR groups reported higher consumption on the Timeline Followback (TLFB) at the 3- and 6-month follow-ups than did the no IVR group. However, because of a potential measurement confound, the TLFB may not have operated in an unbiased fashion across the four study conditions. A comparison of the feedback and no feedback IVR groups, which is independent of this confound, shows a significant therapeutic advantage of IVR with feedback. Conclusions: IVR is a feasible technology for behavioral self-monitoring in primary care clinics. IVR with regular feedback may be an effective therapeutic enhancement to BI., THE EFFICACY OF BRIEF INTERVENTION (BI) for heavy and problem drinking in the primary care office is now well established (Bertholet et al., 2005; Bien et al., 1993; Kahan et [...]

Objective: Randomized trials examining the effects of brief alcohol interventions by primary care providers have consistently excluded individuals with alcohol dependence. The purpose of this study was to examine whether a diagnosis of alcohol dependence, according to the criteria in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, predicted differential effectiveness of a brief intervention (BI). Method: Retrospective analyses were performed on participants (N = 326) enrolled in a randomized trial designed to examine the impact of interactive voice response following BI. All participants had received a BI from their primary care provider before enrolling in the study. Daily consumption data were collected using the Timeline Followback for the period before the BI (mean = 71days) and for 6 months following the BI. We compared nondependent and dependent participants on a number of consumption-based outcomes. Results: Dependent participants had significantly higher pre-BI consumption. At the index assessment (median = 15 days after BI), both dependent and nondependent participants reported significant reductions in total drinks per week and drinking days per week after BI. Dependent participants significantly reduced their drinks per drinking day. After BI, dependent participants no longer differed significantly from nondependent participants on these measures. Similar decreases from before BI were observed in both groups through 6 months, although dependent participants drank on fewer days and significantly more on days on which they drank than did nondependent participants. Regression analyses showed that baseline consumption was the only significant predictor of post-BI consumption. Conclusions: We found no evidence that dependent participants realized less benefit on measures of alcohol consumption following a BI than nondependent participants., BRIEF INTERVENTIONS (BIs) performed in primary care settings repeatedly have been found to be efficacious in assisting patients in reducing their alcohol consumption. A number of randomized, controlled trials (Chick [...]

Objective: We conducted a formal analysis of the potential effects on alcohol consumption of daily reports to an Interactive Voice Response (IVR) system over a 2-year period. Method: Thirty-three white men who had been recruited from bars were invited to call a toll-free number daily to answer a 2-minute questionnaire regarding alcohol consumption the previous day, reasons for drinking or not drinking, mood and stress levels, and a few other relevant items. A recorded voice asked the questions and callers responded using the telephone keypad. During the 2-year study, all subjects were personally interviewed each quarter, including regular Timeline Follow Back (TLFB) assessments. We compared mean consumption levels reported for the first year with those reported the second year. Results: Although there were consistent seasonal variations and holiday peaks, reported consumption declined over the 2 years of study. A comparison of average consumption across all subjects revealed significant declines in drinks per day, drinking days per week, and drinks per drinking day. Analysis of individuals showed at least some reduction in 82% of the subjects and statistically significant reductions in 45%. There was an estimated 19% reduction in consumption from Year 1 to Year 2 based on the IVR reports and a 21% reduction as ascertained by the TLFB. No significant changes were observed in nonalcohol-related measures. Conclusions: After exploring possible reasons for our results, we conclude that the most likely explanation of the decline in alcohol consumption is a reactivity effect due to reporting consumption regularly. The results suggest that IVR may have potential utility as an intervention for excessive alcohol consumption., INTERACTIVE VOICE RESPONSE (IVR) is an automated telephone system in which a caller listens to a series of scripted questions and responds using the telephone keypad. IVR is widely used [...]

Objective: To compare near-concurrent and retrospective reports of alcohol consumption and to determine whether a simple adjustment function could be applied to the retrospective reports to correct any distortions in reporting. Method: Reports of daily alcohol consumption collected via an Interactive Voice Response (IVR) system were aggregated over 30, 90 and 366 days and compared with the corresponding retrospective reports gathered with the Timeline Follow Back (TLFB). Comparisons of the IVR and TLFB reports for five consumption variables were made for each time period for 33 men. Results: Significant differences between reporting methods were found for four of the five variables tested. On average, the TLFB yielded an underestimate of alcohol consumption compared to the IVR. This underestimate associated with TLFB reports was not dependent on the length of the recall period. Regression analyses indicated that the relationship between the two modalities of reporting was dependent on the quantity of drinks reported, thus precluding the application of a simple, linear metric to the TLFB data to model near real-time daily data obtained through the IVR more accurately. Conclusions: The retrospective TLFB consistently and significantly underestimated alcohol consumption compared to the aggregated daily reports. This underestimate, however, was stable across the three reporting periods. With one exception, no simple linear function could be applied to the retrospective TLFB consumption reports to more accurately reflect the IVR data gathered daily. Evidence presented here also suggests that underreporting on the TLFB is not simply a matter of consciously attempting to conceal consumption., THE TIMELINE FOLLOW BACK (TLFB) method of collecting alcohol consumption data is the de facto standard in retrospective reporting (Sobell and Sobell, 1996). Developed initially in the 1970s, the TLFB [...]

Alcohol-dependent drinkers show fairly regular weekly cycles of drinking behavior compared to non-alcohol dependent drinkers. Researchers statistically examined logs of alcohol consumption kept by dependent and non-dependent drinkers. Non-dependent drinkers show fluctuations over longer periods of time. The findings suggest that for the dependent drinker, alcohol consumption may be an important part of regular activity. A regular pattern of drinking may be a symptom of alcohol-dependent behavior.

The alcohol intake patterns of 51 males were measured using an Interactive Voice Response (IVR) system. Study participants reported alcohol consumption on 46.3% of the reporting days, with a mean of 4.59 drinks were consumed on reported consumption days. Beer was the most-consumed beverage, and more alcohol intake was reported on weekends. The IVR technique is adequate for long-term data collection and has advantages over traditional methods, which tend to produce underreporting by heavy drinkers.

Objectives. Prospectively gathered data were used to reexamine and to strengthen previously described observations about education and the risk of alcohol abuse and dependence. The hypothesis was that individuals who dropped out of high school and those who entered college but failed to get a college degree might be at increased risk for an alcohol disorder. Methods. Study subjects were selected between 1980 and 1984 by taking probability samples of roughly 3000 adult household residents at each of the five Epidemiologic Catchment Area Program survey sites. To assess the occurrence of psychiatric conditions, staff administered the Diagnostic Interview Schedule soon after sampling and again at follow-up, roughly 1 year later. Results. Individuals who had dropped out of high school were 6.34 times more likely to develop alcohol abuse or dependence than were individuals with a college degree. For those who had entered college but failed to achieve a degree, the estimated relative risk was 3.01. To extend these analyses, estimates for annual incidence were calculated, and an exploratory evaluation of interaction is presented. Conclusions. If these findings can be replicated, they should help identify subgroups at higher risk for the development of alcohol disorders. (Am J Public Health. 1993; 83:830-837), High school dropouts and people who attended college but did not earn a degree may be at risk for alcohol problems. Interviews were conducted with 11,871 adults without alcohol disorders from five different metropolitan areas. After one year, subjects were interviewed again, and 160 of them were diagnosed with an alcohol disorder. When education levels of all study participants were analyzed, it was found that high school dropouts were over six times more likely to have alcohol problems than people with a college degree. People who had some college and those who left school before the ninth grade were three times more likely to have alcohol problems than those with a degree.

Psychiatric morbidity of hospitalized foreign students in Yugoslavia was analyzed in a 25-year retrospective study and was compared to the psychiatric morbidity of a group of Yugoslav students hospitalized in the same psychiatric institutions, over the same time period. Results showed significantly higher rates of paranoid and depressive reactions amongst foreign students, and suggested correlation between their psychiatric morbidity and maladaptation to the new living conditions.

The first occurence of help seeking as measured by first discussion among alcoholics were studied. Results showed that alcoholics usually experience numerous problems first before seeking professional help for their drinking problem. This was made evident by ranking alcohol symptoms such as social impairment, pathological use and tolerance/withdrawal before first discussion about drinking problem with a health professional or attending Alcoholic Anonymous. Early identification of the drinking problem and well-timed intervention may have a positive effect on the course of alcoholism.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a source of common terminology for mental and addictive disorders. The concept of alcoholism in the DSM has evolved markedly […]

A group of individuals drawn from three different areas of St. Louis, Missouri were involved in a survey to examine the relationship between depression and cigarette smoking. The epidemiological catchment areas that were used included urban, suburban and rural areas, so that the subject profiles would be similar to those in the general national population. Results from 3,213 subjects were included in this report. The Diagnostic Interview Schedule was used to collect demographic information and cigarette use history, and contained sections designed to investigate whether the subject had ever suffered major depressive disorders. An association between the rate of cigarette smoking and the presence of symptoms indicative of a major depressive illness was found. Some data suggest that when certain individuals who have a history of major depressive disorder stop smoking, serious depression may follow. The increase in rate of smoking of depressed individuals may also help explain why groups of individuals with major depressive illnesses have a high mortality. While smoking was related to major depression, a similar relationship was not found between smoking and other forms of psychiatric illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Most studies that have been conducted regarding the risk for HIV (human immunodeficiency virus) infection have focused upon high-risk groups such as homosexual men and intravenous drug users. Little information has been collected on the risk for AIDS among the general population. It has been assumed by some that the general public will be offended by questions regarding their sexual behavior or their use of illegal substances. One large study was done that collected such data; it is the St. Louis National Institutes of Mental Health Epidemiologic Catchment Area survey. The survey included questions about sexual behavior and drug abuse, and these data were used to determine whether people who engage in high-risk sexual behavior are more likely to have a pattern of high-risk substance abuse. The subjects were 3,004 people living in the community and 494 who were institutionalized. The results showed a striking correlation between high-risk sexual behaviors and substance use patterns, when both factors were considered over the person's lifetime. High-risk sexual behaviors included marital infidelity (with three or more different persons); this was strongly related to the use of drugs, particularly hard drugs (cocaine, heroin, and other opiates). Hard drug use was 17 times more likely in women who reported infidelity than in women who reported faithfulness in marriage; unfaithful men were four times as likely as faithful husbands to use hard drugs. Drug use was also linked to sexual promiscuity and to homosexual relationships (for both men and women). More men than women reported prostitution (having been paid for sex), and the use of hard drugs was equally common among men and women who had been paid for sex. Prostitution is a primary means of spreading HIV infection, and this behavior needs to be studied further. (Consumer Summary produced by Reliance Medical Information, Inc.), INTRODUCTION The proportion of reported AIDS cases is currently low among heterosexuals without any reported risk factors. Further spread of HIV into this population will certainly depend on their sexual [...]

Although this article is a Counterpoint to the Point article titled, "The DSM: Should It Have a Future?" there are many areas of agreement. The Point article faults the DSM [...]