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BackgroundAlcohol consumption in the UK Armed Forces is higher than in the general population, and this pattern continues after leaving the service. Smartphone apps may be useful to increase ex-serving personnel’s awareness of their alcohol consumption, support self-monitoring, and prompt a change in behavior. ObjectiveThe study aimed to explore the acceptability of Information about Drinking in Ex-serving personnel (InDEx), a tailored smartphone app, combined with personalized short message service (SMS) text messaging designed to target ex-serving personnel who meet the criteria for hazardous alcohol use. MethodsThe InDEx intervention included 4 key modules: (1) assessment and normative feedback, (2) self-monitoring and feedback, (3) goal setting and review, and (4) personalized SMS text messaging. A semistructured telephone interview study was conducted with ex-serving personnel after using the app for a 28-day period. Interviews were used to explore the acceptability of app modules and its functionality and the perceived changes in participant’s drinking. Interview transcripts were analyzed using inductive thematic analysis. ResultsOverall, 94% (29/31) participants who used InDEx agreed to take part in a telephone interview. Overall, 4 themes were identified: Credibility, Meeting their needs, Simplicity, and Helpful for ex-serving personnel. The importance of credibility, functionality, and meeting the individual needs of ex-serving personnel was emphasized. Acceptability and engagement with specific modules of the app and text messages were influenced by the following: (1) if they felt it provided credible information, (2) whether the content was appropriately personalized to them, (3) the ease of use, and (4) beliefs about their own drinking behaviors. Participants recommended that the app would be most suitable for personnel about to leave the Armed Forces. ConclusionsInDEx was an acceptable smartphone app for ex-serving personnel for monitoring alcohol consumption and in providing meaningful feedback to the individual. Pages that met the participant’s interests and provided real time personalized, credible feedback on their drinking and text messages tailored to participant’s interactions with the app were particularly favored.

BackgroundUnderstanding how users engage with electronic screening and brief intervention (eSBI) is a critical research objective to improve effectiveness of app-based interventions to reduce harmful alcohol consumption. Although quantitative measures of engagement provide a strong indicator of how the user engages with an app at the group level, they do not elucidate finer-grained details of how apps function from an individual, experiential perspective and why, or how, users engage with an intervention in a particular manner. ObjectiveThe aim of this study was to (1) understand why and how participants engaged with the BRANCH app, (2) explore facilitators and barriers to engagement with app features, (3) explore how the BRANCH app impacted drinking behavior, (4) use these data to identify typologies of users of the BRANCH app in terms of engagement behaviors, and (5) identify future eSBI app design implications. MethodsIn total, 20 one-to-one semistructured telephone interviews were conducted with participants recruited from a randomized controlled trial, which evaluated the effectiveness of engagement-promoting strategies in the BRANCH app targeting harmful drinking in young adults (aged 18-30 years). The topic guide explored users’ current engagement levels with existing health promotion apps, their views toward the effectiveness of such apps, and what they liked and disliked about BRANCH, specifically focusing on how they engaged with the app. Framework analysis was used to develop typologies of user engagement. ResultsThe study identified 3 typologies of engagers. Trackers were defined by their motivations to use health-tracking apps to monitor and understand quantified self-data. They did not have intentions necessarily to cut down and predominantly used only the drinking diary. Cut-downers were motivated to use the app because they wanted to reduce their alcohol consumption Unlike Trackers, they did not use a range of different health apps daily, but saw the BRANCH app as an opportunity to test out a different method of trying to cut down their alcohol use. This typology used more features than Trackers, such as the goal setting function. Noncommitters were characterized as a group of users who were initially enthusiastic about using the app; however, this enthusiasm quickly waned and they gained no benefit from it. ConclusionsThis was the first study to identify typologies of user engagement with eSBI apps. Although in need of replication, it provides a first step in understanding independent categories of eSBI users, who may benefit from apps tailored to a user’s typology or motivation. It also provides new evidence to suggest that apps may be used more effectively as a tool to raise awareness of drinking, instead of reducing alcohol use, and be a step in the care pathway, identifying at-risk individuals and signposting them to more intensive treatment. Trial RegistrationInternational Standard Randomised Controlled Trial Number ISRCTN70980706; http://www.isrctn.com /ISRCTN70980706 (Archived by WebCite at http://www.webcitation.org/73vfDXYEZ)

BackgroundSelf-reported alcohol misuse remains high in armed forces personnel even after they have left service. More than 50% of ex-serving personnel meet the criteria for hazardous alcohol use; however, many fail to acknowledge that they have a problem. Previous research indicates that interventions delivered via smartphone apps are suitable in promoting self-monitoring of alcohol use, have a broad reach, and may be more cost-effective than other types of brief interventions. There is currently no such intervention specifically designed for the armed forces. ObjectiveThis study sought to describe the development of a tailored smartphone app and personalized text messaging (short message service, SMS) framework and to test the usability and feasibility (measured and reported as user engagement) of this app in a hard-to-engage ex-serving population. MethodsApp development used Agile methodology (an incremental, iterative approach used in software development) and was informed by behavior change theory, participant feedback, and focus groups. Participants were recruited between May 2017 and June 2017 from an existing United Kingdom longitudinal military health and well-being cohort study, prescreened for eligibility, and directed to download either Android or iOS versions of the ”Information about Drinking for Ex-serving personnel” (InDEx) app. Through the app, participants were asked to record alcohol consumption, complete a range of self-report measures, and set goals using implementation intentions (if-then plans). Alongside the app, participants received daily automated personalized text messages (SMS) corresponding to specific behavior change techniques with content informed by the health action process approach with the intended purpose of promoting the use of the drinks diary, suggesting alternative behaviors, and providing feedback on goals setting. ResultsInvitations to take part in the study were sent to ex-serving personnel, 22.6% (31/137) of whom accepted and downloaded the app. Participants opened the InDEx app a median of 15.0 (interquartile range [IQR] 8.5-19.0) times during the 4 week period (28 days), received an average of 36.1 (SD 3.2) text messages (SMS), consumed alcohol on a median of 13.0 (IQR 11.0-15.0) days, and consumed a median of 5.6 (IQR 3.3-11.8) units per drinking day in the first week, which decreased to 4.7 (IQR 2.0-6.9) units by the last week and remained active for 4.0 (IQR 3.0-4.0) weeks. ConclusionsPersonnel engaged and used the app regularly as demonstrated by the number of initializations, interactions, and time spent using InDEx. Future research is needed to evaluate the engagement with and efficacy of InDEx for the reduction of alcohol consumption and binge drinking in an armed forces population.

BackgroundElectronic screening and brief intervention (eSBI) apps demonstrate potential to reduce harmful drinking. However, low user engagement rates with eSBI reduce overall effectiveness of interventions. As “Digital Natives,” young adults have high expectations of app quality. Ensuring that the design, content, and functionality of an eSBI app are acceptable to young adults is an integral stage to the development process. ObjectiveThe objective of this study was to identify usability barriers and enablers for an app, BRANCH, targeting harmful drinking in young adults. MethodsThe BRANCH app contains a drinking diary, alcohol reduction goal setting functions, normative drinking feedback, and information on risks and advice for cutting down. The app includes a social feature personalized to motivate cutting down and to promote engagement with a point-based system for usage. Three focus groups were conducted with 20 users who had tested the app for 1 week. A detailed thematic analysis was undertaken. ResultsThe first theme, “Functionality” referred to how users wanted an easy-to-use interface, with minimum required user-input. Poor functionality was considered a major usability barrier. The second theme, “Design” described how an aesthetic with minimum text, clearly distinguishable tabs and buttons and appealing infographics was integral to the level of usability. The final theme, “Content” described how participants wanted all aspects of the app to be automatically personalized to them, as well as providing them with opportunities to personalize the app themselves, with increased options for social connectivity. ConclusionsThere are high demands for apps such as BRANCH that target skilled technology users including young adults. Key areas to optimize eSBI app development that emerged from testing BRANCH with representative users include high-quality functionality, appealing aesthetics, and improved personalization.

BackgroundElectronic screening and brief intervention (eSBI) is effective in reducing weekly alcohol consumption when delivered by a computer. Mobile phone apps demonstrate promise in delivering eSBI; however, few have been designed with an evidence-based and user-informed approach. ObjectiveThis study aims to explore from a user perspective, preferences for content, appearance, and operational features to inform the design of a mobile phone app for reducing quantity and frequency of drinking in young adults engaged in harmful drinking (18-30 year olds). MethodsPhase 1 included a review of user reviews of available mobile phone apps that support a reduction in alcohol consumption. Apps were identified on iTunes and Google Play and were categorized into alcohol reduction support, entertainment, blood alcohol content measurement (BAC), or other. eSBI apps with ≥18 user reviews were subject to a content analysis, which coded praise, criticism, and recommendations for app content, functionality, and esthetics. Phase 2 included four focus groups with young adults drinking at harmful levels and residing in South London to explore their views on existing eSBI apps and preferences for future content, functionality, and appearance. Detailed thematic analysis of the data was undertaken. ResultsIn Phase 1, of the 1584 apps extracted, 201 were categorized as alcohol reduction, 154 as BAC calculators, 509 as entertainment, and 720 as other. We classified 32 apps as eSBI apps. Four apps had ≥18 user reviews: Change for Life Drinks Tracker, Drinksmeter, Drinkaware, and Alcohol Units Calculator. The highest proportion of content praises were for information and feedback provided in the apps (12/27, 44%), followed by praise for the monitoring features (5/27, 19%). Many (8/12, 67%) criticisms were for the drinking diary; all of these were related to difficulty entering drinks. Over half (18/32, 56%) of functionality criticisms were descriptions of software bugs, and over half of those (10/18, 56%) were for app crashing or freezing. Drinksmeter and Alcohol Units Calculator were the most highly praised apps overall (23/57 and 22/57; 39% of praise overall). In Phase 2, two main themes were identified. The meaningfulness theme reflected how young adults thought apps needed to be tailored to the interests and values of their age group, particularly emphasizing content and feedback around broader health and well-being factors such as exercise, diet, and image. The community theme suggested that young adults want to be able to engage with other app users, both in groups of friends and with online users for motivation and support. ConclusionsTargeted and relevant information and feedback, in addition to easy-to-use monitoring tools, were found to be important features of a mobile phone app to support a reduction in drinking. Future app development should consider tailoring all app aspects to the needs of young adults, considering broader well-being monitoring tools and online community functions.

BackgroundElectronic screening and brief intervention (eSBI) has been shown to reduce alcohol consumption, but its effectiveness over time has not been subject to meta-analysis. ObjectiveThe current study aims to conduct a systematic review and meta-analysis of the available literature to determine the effectiveness of eSBI over time in nontreatment-seeking hazardous/harmful drinkers. MethodsA systematic review and meta-analysis of relevant studies identified through searching the electronic databases PsychINFO, Medline, and EMBASE in May 2013. Two members of the study team independently screened studies for inclusion criteria and extracted data. Studies reporting data that could be transformed into grams of ethanol per week were included in the meta-analysis. The mean difference in grams of ethanol per week between eSBI and control groups was weighted using the random-effects method based on the inverse-variance approach to control for differences in sample size between studies. ResultsThere was a statistically significant mean difference in grams of ethanol consumed per week between those receiving an eSBI versus controls at up to 3 months (mean difference –32.74, 95% CI –56.80 to –8.68, z=2.67, P=.01), 3 to less than 6 months (mean difference –17.33, 95% CI –31.82 to –2.84, z=2.34, P=.02), and from 6 months to less than 12 months follow-up (mean difference –14.91, 95% CI –25.56 to –4.26, z=2.74, P=.01). No statistically significant difference was found at a follow-up period of 12 months or greater (mean difference –7.46, 95% CI –25.34 to 10.43, z=0.82, P=.41). ConclusionsA significant reduction in weekly alcohol consumption between intervention and control conditions was demonstrated between 3 months and less than 12 months follow-up indicating eSBI is an effective intervention.

Background: Effective interventions for the management of alcohol‐related liver disease (ARLD) remain a gap in clinical practice, and patients' engagement with alcohol services is suboptimal. Based upon the principles of operant conditioning, contingency management (CM) is a psychosocial intervention th at involves gradual, increasing incentives upon completion of treatment‐related goals such as treatment attendance. Methods: A pilot feasibility trial was conducted with 30 adult patients recruited from an inpatient clinical setting. Consecutive sampling was used to recruit patients presenting comorbid alcohol use disorder (AUD) and ARLD. Participants were randomized to integrated liver care (ILC), receiving hepatology and AUD care, or ILC with a voucher‐based CM intervention (intervention arm). A longitudinal qualitative approach was adopted to explore anticipated (Stage 1) and experienced acceptability (Stage 2). The Theoretical Framework of Acceptability (TFA) guided semi‐structured in‐depth interviews and deductive analysis. Results: Thirty participants were enrolled in the pilot trial, and interviews were conducted with 24 participants at Stage 1 and seven at Stage 2. Over half of the cohort (54.2%, n = 13) presented decompensated liver disease, and an average of 179 units of alcohol were consumed per week. Overall positive views toward voucher‐based CM were noted, and explanatory data emerged across five TFA domains (intervention coherence, ethicality, self‐efficacy, perceived effectiveness, and affective attitude). The core aspects of the voucher‐based CM intervention matched participants' preferences and needs. Participants regarded CM as having a symbolic value and strengthening the therapeutic alliance with healthcare providers. Conclusion: The data support the scope of voucher‐based CM intervention to promote engagement with treatment services, and its potential to address the gaps in the care continuum in ARLD. The findings are of practical significance for developing person‐centered, tailored interventions for this clinical population. The outcomes of this investigation can inform decision‐making among stakeholders and healthcare providers and improve health outcomes for this clinical population. [ABSTRACT FROM AUTHOR]

Background: Effective interventions to improve patient outcomes in comorbid alcohol use disorder (AUD) and alcohol‐related liver disease (ARLD) remain a clinical unmet need. While the choice of abstinence is the cornerstone for the prevention of disease progression and mortality, evidence suggests a suboptimal engagement with treatment supporting recovery. This qualitative investigation aims to understand barriers and facilitators to treatment as experienced by this clinical population by applying a multidimensional adherence model proposed by the World Health Organization. Methods: Twenty‐four participants with comorbid AUD and ARLD were recruited from an inpatient clinical setting. Data for this study were collected through semistructured, in‐depth interviews. Deductive analysis was organized by the Framework method, and theory‐driven themes were identified according to the multidimensional adherence model. This included factors across the social and economic, patient, condition, treatment, and healthcare system levels. Results: The findings in this study indicate systematic challenges in maintaining continuity between primary, secondary, and community care. Aspects related to social and economic context, treatment, and healthcare systems were found to hinder engagement. Identified facilitators to engagement included the participatory role of family, shared lived experience of addiction/recovery, and therapeutic alliance with healthcare providers. Conclusion: The understanding of these barriers and facilitators from a service user's perspective can bridge the treatment gap for this clinical population. This can provide an opportunity for the implementation of effective interventions and inform the development of policies promoting accessible care. Government and public health bodies have fundamental roles in shifting treatment paradigms in comorbid AUD and ARLD. [ABSTRACT FROM AUTHOR]

Background Substance use and offending are related in the context of other disinhibitory behaviours. Adolescents involved in the criminal justice system constitute a particularly vulnerable group, with a propensity to engage in risky behaviour that has long-term impact on their future health and well-being. Previous research of the RISKIT programme provided evidence of a potential effect in reducing substance use and risky behaviour in adolescents. Objectives To evaluate the clinical effectiveness and cost-effectiveness of a multicomponent psychosocial intervention compared with treatment as usual in reducing substance use for substance-using adolescents involved in the criminal justice system. Design A mixed-methods, prospective, pragmatic, two-arm, randomised controlled trial with follow-up at 6 and 12 months post randomisation. Setting The study was conducted across youth offending teams, pupil referral units and substance misuse teams across four areas of England (i.e. South East, London, North West, North East). Participants Adolescents aged between 13 and 17 years (inclusive), recruited between September 2017 and June 2020. Interventions Participants were randomised to treatment as usual or to treatment as usual in addition to the RISKIT-Criminal Justice System (RISKIT-CJS) programme. The RISKIT-CJS programme was a multicomponent intervention and consisted of two individual motivational interviews with a trained youth worker (lasting 45 minutes each) and two group sessions delivered over half a day on consecutive weeks. Main outcome measures At 12 months, we assessed per cent days abstinent from substance use over the previous 28 days. Secondary outcome measures included well-being, motivational state, situational confidence, quality of life, resource use and fidelity of interventions delivered. Results A total of 693 adolescents were assessed for eligibility, of whom 505 (73%) consented. Of these, 246 (49%) were allocated to the RISKIT-CJS intervention and 259 (51%) were allocated to treatment as usual only. At month 12, the overall follow-up rate was 57%: 55% in the RISKIT-CJS arm and 59% in the treatment-as-usual arm. At month 12, we observed an increase in per cent days abstinent from substances in both arms of the study, from 61% to 85%, but there was no evidence that the RISKIT-CJS intervention was superior to treatment as usual. A similar pattern was observed for secondary outcomes. The RISKIT-CJS intervention was not found to be any more cost-effective than treatment as usual. The qualitative research indicated that young people were positive about learning new skills and acquiring new knowledge. Although stakeholders considered the intervention worthwhile, they expressed concern that it came too late for the target population. Limitations Our original aim to collect data on offences was thwarted by the onset of the COVID-19 pandemic, and this affected both the statistical and economic analyses. Although 214 (87%) of the 246 participants allocated to the RISKIT-CJS intervention attended at least one individual face-to-face session, 98 (40%) attended a group session and only 47 (19%) attended all elements of the intervention. Conclusions The RISKIT-CJS intervention was no more clinically effective or cost-effective than treatment as usual in reducing substance use among adolescents involved in the criminal justice system. Future research The RISKIT-CJS intervention was considered more acceptable, and adherence was higher, in pupil referral units and substance misuse teams than in youth offending teams. Stakeholders in youth offending teams thought that the intervention was too late in the trajectory for their population. Trial registration This trial is registered as ISRCTN77037777. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 3. See the NIHR Journals Library website for further project information. Plain language summary We explored how useful a psychological intervention was in reducing substance use among young people who had some involvement in the criminal justice system. We recruited young people aged between 13 and 17 years in four areas of England (i.e. South East, London, North West and North East). Young people were recruited from youth offending teams, pupil referral units and substance misuse teams. Those young people who were willing to participate were offered usual treatment and half, chosen at random, were offered an opportunity to take part in the RISKIT-Criminal Justice System (RISKIT-CJS) programme. The RISKIT-CJS programme had four distinct parts. The first was a 1-hour session that used an approach called motivational interviewing to explore the young person’s substance use and discuss different strategies to change their behaviour. This was followed by two group sessions delivered over 2 consecutive weeks. These group sessions addressed risks associated with substance use, what triggers use and the health and social consequences. In addition, young people were taught new skills to help them manage in situations in which they might normally use substances. At the end of the group sessions, the young people had another motivational interview. Twelve months after participants started, we found that the frequency of substance use had decreased in both groups; however, the RISKIT-CJS intervention was no better than treatment as usual. When we spoke with young people who had taken part and staff involved with this population, we got a mixed picture. In some settings, particularly pupil referral units, the RISKIT-CJS intervention was well received by young people and staff, and staff felt that it was a useful additional resource to the work that they were currently undertaking. On the other hand, in the youth offending teams, the staff thought that the programme was too different from their normal work to be implemented easily and they considered the population they work with too established in their substance use and criminal activity to benefit from the programme. Scientific summary Background Adolescence is a critical developmental stage when young people make behavioural and lifestyle choices that have the potential to affect their health and well-being into adulthood. Six per cent of youths aged 14 years and 11% of youths aged 15 years report having used cannabis in the last month, with 2% of 14-year-olds and 4% of 15-year-olds reporting use of a class A substance at least once. Data from the Juvenile Cohort Study [Wilson E. Youth Justice Interventions – Findings from the Juvenile Cohort Study (JCS). London: Ministry of Justice Analytical Series; 2013] show that 32% of young offenders indicate substance use is, at least in part, a reason for them associating in criminal activity. Substance use is defined as the use of alcohol, traditional illicit substances and legal highs, as well as inappropriate use of prescribed medication. Although the relationship between substance use and criminal activity is complex, it is clearly a major issue in the youth offending population. To date, systematic reviews of interventions for substance-using offenders in criminal justice system (CJS) environments have not identified a clear evidence-based intervention strategy. Systematic reviews have revealed the paucity of good-quality research in the area and a lack of UK-based studies, with no scientifically rigorous studies focusing on young offenders. Importantly, previous research has identified what has been proven not to work, and this includes focusing on negative aspects of risk and risk abstinence. Promising intervention approaches identified include motivational interviewing and cognitive and socioemotional life skills training. In addition, there is emerging recognition of the importance of providing interventions in a structured manner and, with the young people’s preference for peer group interventions, the importance of managing the potentially negative effects of labelling and peer influence. The RISKIT-Criminal Justice System (RISKIT-CJS) programme is a structured psychosocial intervention developed from evidence reviews and co-production with young people. Pilot research work among risk-taking adolescents in school settings found that the intervention was acceptable and associated with significant reductions in substance use. Objectives To conduct a prospective, pragmatic, randomised controlled trial (RCT) to evaluate the clinical effectiveness of the RISKIT-CJS intervention in reducing the frequency of substance use, compared with treatment as usual (TAU), among substance-using adolescents involved in the CJS. To evaluate the cost-effectiveness of the RISKIT-CJS intervention compared with TAU. To explore participants’ and criminal justice staff’s experience of the intervention and the acceptability of the methods employed. To assess the fidelity with which the intervention was conducted and to explore the role of fidelity, therapeutic alliance and baseline psychological factors on the outcomes observed. Methods The study evaluated the clinical effectiveness of the RISKIT-CJS programme using a prospective, pragmatic RCT. The study was conducted across three settings [i.e. youth offending teams (YOTs), pupil referral units (PRUs) and substance misuse teams] across four geographical areas of England (i.e. South East, London, North West and North East). Embedded within the trial was a comprehensive qualitative component that explored young people’s and stakeholders’ perspectives on the acceptability and usefulness of the RISKIT-CJS programme. Young people aged between 13 and 17 years (inclusive) who were eligible and consented were randomised with equal probability to TAU or to TAU augmented with the RISKIT-CJS programme. The RISKIT-CJS programme was a multicomponent psychosocial intervention, which involved two individual sessions, using motivational interviewing approaches, and two group sessions, employing cognitive–behavioural approaches. An initial individual session was followed by two half-day group sessions, delivered over consecutive weeks, followed by a final individual session. The primary end point for the study was at 12 months post randomisation and the primary outcome measure was the frequency of substance use, assessed as per cent days abstinent (PDA) from substances in the past 28 days, derived from the Timeline Followback 28. Results Overall, 693 young people were assessed for eligibility into the trial, of whom 505 were eligible and consented. Among the 188 young people who did not participate, the main reason was declining consent (n = 55, 29%). Of the 505 participants, 246 (49%) were randomised to the RISKIT-CJS programme and 259 (51%) were randomised to TAU. At the primary end point, 275 (57%) participants were followed up, 130 (55%) in the RISKIT-CJS arm and 145 (59%) in the TAU arm. The most common substance used was cannabis (used by 76% of young people). Of those participants randomised to the RISKIT-CJS programme, 214 (87%) attended the first face-to-face session, but only 98 (40%) attended the first group session. Overall, 104 (42%) participants attended at least one individual session and one group session and 47 (19%) participants attended all sessions. Over the 12 months of the study, the PDA from substance use increased in both groups, with a median increase from 60.7% to 85.7% in the RISKIT-CJS arm and a median increase from 61.8% to 83.9% in the TAU arm. A fractional regression indicated no difference between the groups in terms of PDA from substance use at month 12 (odds ratio 1.14, 95% confidence interval 0.74 to 1.76). A similar finding was confirmed when missing data were imputed and a per-protocol analysis undertaken. No differences were observed between the groups on secondary outcomes of well-being and quality of life. The health economic analysis found that the RISKIT-CJS programme had a probability of being cost-effective of 69% when a commissioner’s willingness-to-pay (WTP) threshold was zero. At an established WTP threshold of £20,000–30,000, the probability that the RISKIT-CJS programme was cost-effective reduced to 60–63%. The qualitative analysis explored the views of young people who took part in the RISKIT-CJS programme and of stakeholders working in the services in which the programme was delivered. It addressed three key areas: (1) strengths and weaknesses, (2) usefulness and acceptability, and (3) implementation. The data covered 59 interviews with young people, 14 focus groups with young people, 23 interviews with professionals and 18 sets of research field notes. Several young people and stakeholders identified strengths of the programme, including the varied content and delivery styles and the opportunity to discuss issues in a safe and non-judgemental environment. Weaknesses of the programme that were identified included the inappropriateness of the programme for some participants, particularly older participants with entrenched substance use and criminal histories. In terms of usefulness, stakeholders tended to agree that the programme was more useful for the younger end of the cohort. Acceptability from the perspective of young people varied by setting, with those in PRUs, where group interventions are relatively common, considering the intervention more acceptable than those in YOTs. Analysis of fidelity indicated high levels of fidelity in the delivery of motivational behavioural change interventions. The exploratory analysis of prognostic factors that may affect outcome identified three predictors. Higher score on the SOCRATES-7DS (Stages Of Change Readiness And Treatment Eagerness Scale – 7 Dimension) preparatory stage, that is, an indicator of lower motivational state, predicted lower PDA at month 12. Higher self-efficacy, that is, the confidence to resist substance use, particularly as it related to managing unpleasant emotions and physical discomfort, predicted higher PDA at month 12. When the fidelity measures and therapeutic analysis were included in the model for the RISKIT-CJS arm only, the findings remained similar; however, there was a strong therapist effect, with strong therapeutic alliance predicting higher PDA at month 12. Conclusions The results of the statistical and economic analysis showed no significant differences between the trial arms for any of the primary or secondary outcomes. This finding was consistent when underlying assumptions were varied and missing data imputed. The qualitative findings were more mixed, with those in PRUs finding the intervention the most useful and acceptable and those in YOTs finding the intervention least useful and acceptable. Trial registration The trial is registered as ISRCTN77037777. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 3. See the NIHR Journals Library website for further project information.

Ulnar collateral ligament (UCL) tears occur due to the prolonged exposure and overworking of joint stresses, resulting in decreased strength in the flexion and extension of the elbow. Current rehabilitation approaches for UCL tears involve subjective assessments (pain scales) and objective measures such as monitoring joint angles and range of motion. The main goal of this study is to find out if using wearable near-infrared spectroscopy technology can help measure digital biomarkers like muscle oxygen levels and heart rate. These measurements could then be applied to athletes who have been injured. Specifically, measuring muscle oxygen levels will help us understand how well the muscles are using oxygen. This can indicate improvements in how the muscles are healing and growing new blood vessels after reconstructive surgery. Previous research studies demonstrated that there remains an unmet clinical need to measure biomarkers to provide continuous, internal data on muscle physiology during the rehabilitation process. This study's findings can benefit team physicians, sports scientists, athletic trainers, and athletes in the identification of biomarkers to assist in clinical decisions for optimizing training regimens for athletes that perform overarm movements; the research suggests pathways for possible earlier detection, and thus earlier intervention for injury prevention. [ABSTRACT FROM AUTHOR]

Introduction: Training in addiction medicine and addiction psychology is essential to ensure the quality of treatment for patients with substance use disorders. Some earlier research has shown varying training between countries, but no comprehensive study of addiction training across Europe has been performed. The present study by the European Federation for Addiction Societies (EUFAS) aimed to fill this gap. Methods: A Delphi process was used to develop a questionnaire on specialist training in addiction treatment in 24 European countries. The final questionnaire consisted of 14 questions on either addiction medicine or addiction psychology, covering the nature and content of the training and institutional approval, the number of academic professorial positions, and the estimated number of specialists in each country. Results: Information was not received from all countries, but six (Belgium, Denmark, Ireland, Italy, Poland, and Romania) reported no specialized addiction medicine training, while 17 countries did. Seven countries (Belgium, France, Ireland, Italy, Russia, Switzerland, and the Netherlands) reported no specialized addiction psychology training, while 14 countries did. Training content and evaluation methods varied. Approval was given either by governments, universities, or professional societies. Eighteen countries reported having professorships in addiction medicine and 12 in addiction psychology. The number of specialists in addiction medicine or psychology varied considerably across the countries. Discussion: The survey revealed a large heterogeneity in training in addiction medicine and addiction psychology across Europe. Several countries lacked formal training, and where formal training was present, there was a large variation in the length of the training. Harmonization of training, as is currently the case for other medical and psychology specializations, is warranted to ensure optimal treatment for this under-served patient group. [ABSTRACT FROM AUTHOR]

The development of transdermal alcohol sensors (TASs) presents a new method to monitor alcohol consumption with the ability to objectively measure data 24/7. We aimed to evaluate the accuracy of two TASs (BACtrack Skyn and Smart Start BARE) in a laboratory setting. Thirty-two adults received a dose of ethanol 0.56 g/kg body weight as a 20% solution while wearing the two TASs and provided Breath Alcohol Concentration (BrAC) measurements for 3.5 h postalcohol consumption. Pearson's correlations and repeated measures analysis of variance tests were conducted on the peak, time-to-peak, and area under the curve data. Bland–Altman plots were derived. A time series analysis and cross-correlations were conducted to adjust for time lag. Both TASs were able to detect alcohol and increase within 20 min. BrAC peaked significantly quicker than Skyn and BARE. BrAC and Skyn peaks were negatively significantly correlated (r  = −0.381, P  = .035, n  = 31), while Skyn and BARE peaks were positively significantly correlated (r  = 0.380, P  = .038, n  = 30). Repeated measures analysis of variance found a significant difference between BrAC, Skyn, and BARE (F (1.946, 852.301) = 459.873, P  < .001)). A time series analysis found when BrAC-Skyn and BrAC-BARE were adjusted for the delay to peak, and there was still a significant difference. Failure rates: 1.7% (Skyn) and 4.8% (BARE). Some evidence was obtained for TAS validity as both consistently detected alcohol. Failure rates and time lag show improvements in older device generations. However, neither TAS presented strong equivalence to the breathalyser even when the lag time was adjusted. With further testing and technology advancements, TAS could be a potential alcohol monitoring tool. Two of the newest TAS devices were worn in laboratory conditions for one afternoon to compare their accuracy of alcohol monitoring to a breathalyser. Findings suggest that the two TASs (BACtrack Skyn and SmartStart BARE) recorded significantly similar data postalcohol consumption, but not with the breathalyser. [ABSTRACT FROM AUTHOR]

Introduction: Process research in psychotherapy is important to understand how treatment works. The National Institute of Clinical Excellence guidelines suggest that in methadone maintenance treatment (MMT) for opioid dependence, drug key-working should be based on cognitive behavioural therapy (CBT) principles. This article reports the findings of process research component of a larger study investigating the effectiveness and cost-effectiveness of CBT in MMT in the UK (UKCBTMM project). Method: This was a multicentre randomized controlled trial comparing MMT plus CBT with MMT alone. The following concepts have been measured as part of the process research: (i) coping skills, (ii) self-efficacy and (iii) outcome expectancies. Results: CBT group has gained coping skills over time (as predicted) at 6 months, which were sustained at 12 months. Self-efficacy showed delayed greater increase in the CBT group at 12 months (as predicted). Positive outcome expectancies from reduction of drug use were reduced for the CBT group both at 6 and 12 months whereas negative expectancies had increased (against prediction). Conclusions: As this is the first trial in which the process changes in CBT in opioid dependence have been explored, the reported limited findings are of importance for further development in the field. (Contains 1 table.)