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Can brief alcohol interventions in general hospital inpatients improve mental and general health over 2 years? Results from a randomized controlled trial

Published online by Cambridge University Press:  04 September 2018

Jennis Freyer-Adam ,
Sophie Baumann ,
Katja Haberecht ,
Gallus Bischof ,
Christian Meyer ,
Hans-Jürgen Rumpf ,
Ulrich John  and
Beate Gaertner
Jennis Freyer-Adam*
Affiliation:
Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany German Center for Cardiovascular Research, Site Greifswald, Germany
Sophie Baumann
Affiliation:
German Center for Cardiovascular Research, Site Greifswald, Germany Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
Katja Haberecht
Affiliation:
German Center for Cardiovascular Research, Site Greifswald, Germany Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany
Gallus Bischof
Affiliation:
Department of Psychiatry and Psychotherapy, Medical University of Luebeck, Luebeck, Germany
Christian Meyer
Affiliation:
German Center for Cardiovascular Research, Site Greifswald, Germany Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany
Hans-Jürgen Rumpf
Affiliation:
Department of Psychiatry and Psychotherapy, Medical University of Luebeck, Luebeck, Germany
Ulrich John
Affiliation:
German Center for Cardiovascular Research, Site Greifswald, Germany Institute of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany
Beate Gaertner
Affiliation:
Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany
*
Author for correspondence: Jennis Freyer-Adam, E-mail: freyer@uni-greifswald.de
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Abstract

Background

Little is known about the impact of brief alcohol interventions on mental and general health. The aim was to investigate whether brief interventions for general hospital inpatients with at-risk drinking can improve mental and general health over 2 years; and whether effects are dependent on how they are delivered: in-person or through computer-generated feedback letters (CO).

Methods

Three-arm randomized controlled trial with 6-, 12-, 18-, and 24-month follow-ups. Data were collected on 13 general hospital wards from four medical departments (internal medicine, surgical medicine, trauma surgery, and ear-nose-throat) of one university hospital in northeastern rural Germany. A consecutive sample of 961 18- to 64-year-old general hospital inpatients with at-risk alcohol use was recruited through systematic screening. Inpatients with particularly severe alcohol problems were excluded. Participants were allocated to: in-person counseling (PE), CO, and assessment only (AO). PE and CO included three contacts: on the ward, 1, and 3 months later. Mental and general health were assessed using the five-item mental health inventory (0–100) and a one-item general health measure (0, poor – 4, excellent).

Results

Latent growth models including all participants revealed: after 24 months and in contrast to AO, mental and general health were improved in PE (change in mean difference, ΔMmental = 5.13, p = 0.002, Cohen's d = 0.51; ΔMgeneral = 0.20, p = 0.005, d = 0.71) and CO (ΔMmental = 6.98, p < 0.001, d = 0.69; ΔMgeneral = 0.24, p = 0.001, d = 0.86). PE and CO did not differ significantly.

Conclusions

Beyond drinking reduction, PE and CO can improve general hospital inpatients’ self-reported mental and general health over 2 years.

Keywords

Brief alcohol interventioncomputer-generated feedbackefficacymotivational interviewingpublic mental healthrandomized controlled trial
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 10 , July 2019 , pp. 1722 - 1730
Copyright
Copyright © Cambridge University Press 2018 

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References

Alvarez-Bueno, C, Rodriguez-Martin, B, Garcia-Ortiz, L, Gomez-Marcos, MA and Martinez-Vizcaino, V (2015) Effectiveness of brief interventions in primary health care settings to decrease alcohol consumption by adult non-dependent drinkers: a systematic review of systematic reviews. Preventive Medicine 76(Suppl), S33–S38.Google Scholar
Anker, JJ, Kushner, MG, Thuras, P, Menk, J and Unruh, AS (2016) Drinking to cope with negative emotions moderates alcohol use disorder treatment response in patients with co-occurring anxiety disorder. Drug and Alcohol Dependence 159, 93–100.Google Scholar
Babor, TF, Del Boca, F and Bray, JW (2017) Screening, brief intervention and referral to treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice. Addiction 112(Suppl 2), 110–117.Google Scholar
Barnes, AJ, Xu, H, Tseng, CH, Ang, A, Tallen, L, Moore, AA, Marshall, DC, Mirkin, M, Ransohoff, K, Duru, OK and Ettner, SL (2016) The effect of a patient-provider educational intervention to reduce at-risk drinking on changes in health and health-related quality of life among older adults: the project SHARE study. Journal of Substance Abuse Treatment 60, 14–20.Google Scholar
Baumann, S, Gaertner, B, Haberecht, K, Meyer, C, Rumpf, HJ, John, U and Freyer-Adam, J (2017) Does impaired mental health interfere with the outcome of brief alcohol intervention at general hospitals? Journal of Consulting and Clinical Psychology 85, 562–573.Google Scholar
Bertholet, N, Daeppen, JB, Wietlisbach, V, Fleming, M and Burnand, B (2005) Reduction of alcohol consumption by brief alcohol intervention in primary care: systematic review and meta-analysis. Archives of Internal Medicine 165, 986–995.Google Scholar
Berwick, DM, Murphy, JM, Goldman, PA, Ware, JE Jr., Barsky, AJ and Weinstein, MC (1991) Performance of a five-item mental health screening test. Medical Care 29, 169–176.Google Scholar
Boden, JM and Fergusson, DM (2011) Alcohol and depression. Addiction 106, 906–914.Google Scholar
Bott, K, Meyer, C, Rumpf, HJ, Hapke, U and John, U (2005) Psychiatric disorders among at-risk consumers of alcohol in the general population. Journal of Studies on Alcohol 66, 246–253.Google Scholar
Bray, JW, Cowell, AJ and Hinde, JM (2011) A systematic review and meta-analysis of health care utilization outcomes in alcohol screening and brief intervention trials. Medical Care 49, 287–294.Google Scholar
Bridle, C, Riemsma, RP, Pattenden, J, Sowden, AJ, Mather, L, Watt, IS and Walker, A (2005) Systematic review of the effectiveness of health behavior interventions based on the transtheoretical model. Psychology & Health 20, 283–301.Google Scholar
Bush, K, Kivlahan, DR, Mcdonell, MB, Fihn, SD and Bradley, KA (1998) The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Archives of Internal Medicine 158, 1789–1795.Google Scholar
Coder, B, Freyer-Adam, J, Bischof, G, Pockrandt, C, Hartmann, B, Rumpf, HJ, John, U and Hapke, U (2008) Alcohol problem drinking among general hospital inpatients in northeastern Germany. General Hospital Psychiatry 30, 147–154.Google Scholar
Cooper, ML, Kuntsche, E, Levitt, A, Barber, LL and Wolf, S (2015) Motivational models of substance use: a review of theory and research on motives for using alcohol, marijuana, and tobacco. In Sher, KJ (ed.), The Oxford Handbook of Substance Use and Substance Use Disorders, vol. 1, pp. 1–53. Available at http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199381678.001.0001/oxfordhb-9780199381678-e-017.Google Scholar
DiClemente, CC, Prochaska, JO, Fairhurst, SK, Velicer, WF, Velasquez, MM and Rossi, JS (1991) The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology 59, 295–304.Google Scholar
Donovan, D, Mattson, ME, Cisler, RA, Longabaugh, R and Zweben, A (2005) Quality of life as an outcome measure in alcoholism treatment research. Journal of Studies on Alcohol Suppl (s15), 119–139.Google Scholar
Donovan, DM, Kivlahan, DR, Doyle, SR, Longabaugh, R and Greenfield, SF (2006) Concurrent validity of the alcohol use disorders identification test (AUDIT) and AUDIT zones in defining levels of severity among out-patients with alcohol dependence in the COMBINE study. Addiction 101, 1696–1704.Google Scholar
Freyer-Adam, J, Bischof, G, Goeze, C, Gaertner, B, Baumann, S, Schnuerer, I, Gross, B, Meyer, C and John, U (2011) PECO intervention software. [Online]. Available at https://www2.medizin.uni-greifswald.de/prevention2/forschung/ehealth/peco/setupPeco.exe (Accessed 18 October 2018).Google Scholar
Freyer-Adam, J, Baumann, S, Schnuerer, I, Haberecht, K, Bischof, G, John, U and Gaertner, B (2014) Does stage tailoring matter in brief alcohol interventions for job-seekers? A randomized controlled trial. Addiction 109, 1845–1856.Google Scholar
Freyer-Adam, J, Baumann, S, Haberecht, K, Tobschall, S, Schnuerer, I, Bruss, K, Bandelin, E, John, U and Gaertner, B (2016) In-person and computer-based alcohol interventions at general hospitals: reach and retention. European Journal of Public Health 26, 844–849.Google Scholar
Freyer-Adam, J, Baumann, S, Haberecht, K, Tobschall, S, Bischof, G, John, U and Gaertner, B (2018) In-person alcohol counseling versus computer-generated feedback: results from a randomized controlled trial. Health Psychology 37, 70–80.Google Scholar
GBD 2015 Risk Factors Collaborators (2016) Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388, 1659–1724.Google Scholar
German Centre for Addiction Issues (eds) (2008 a) Handling Alcohol Use: Information, Tests and Support in 5 Stages. Hamm, Germany: German Centre for Addiction Issues.Google Scholar
German Centre for Addiction Issues (eds) (2008 b) Yearbook Addiction 2008. Geesthacht: Neuland.Google Scholar
Glasgow, RE and Estabrooks, PE (2018) Pragmatic applications of RE-AIM for health care initiatives in community and clinical settings. Preventing Chronic Disease 15, E02.Google Scholar
Glasgow, RE, Vogt, TM and Boles, SM (1999) Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American Journal of Public Health 89, 1322–1327.Google Scholar
Heather, N (2012) Can screening and brief intervention lead to population-level reductions in alcohol-related harm? Addiction Science and Clinical Practice 7, 15.Google Scholar
Hunt, GE, Siegfried, N, Morley, K, Sitharthan, T and Cleary, M (2013) Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Systematic Reviews 10, CD001088.Google Scholar
Idler, EL and Benyamini, Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health and Social Behavior 38, 21–37.Google Scholar
Jane-Llopis, E and Matytsina, I (2006) Mental health and alcohol, drugs and tobacco: a review of the comorbidity between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug and Alcohol Review 25, 515–536.Google Scholar
Jonas, DE, Garbutt, JC, Amick, HR, Brown, JM, Brownley, KA, Council, CL, Viera, AJ, Wilkins, TM, Schwartz, CJ, Richmond, EM, Yeatts, J, Evans, TS, Wood, SD and Harris, RP (2012) Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine 157, 645–654.Google Scholar
Kaner, EF, Dickinson, HO, Beyer, F, Pienaar, E, Schlesinger, C, Campbell, F, Saunders, JB, Burnand, B and Heather, N (2009) The effectiveness of brief alcohol interventions in primary care settings: a systematic review. Drug and Alcohol Review 28, 301–323.Google Scholar
Kaner, EF, Beyer, FR, Muirhead, C, Campbell, F, Pienaar, ED, Bertholet, N, Daeppen, JB, Saunders, JB and Burnand, B (2018) Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Systematic Reviews 2, CD004148.Google Scholar
Killip, S, Mahfoud, Z and Pearce, K (2004) What is an intracluster correlation coefficient? Crucial concepts for primary care researchers. Annals of Family Medicine 2, 204–208.Google Scholar
Kraemer, KL, Maisto, SA, Conigliaro, J, Mcneil, M, Gordon, AJ and Kelley, ME (2002) Decreased alcohol consumption in outpatient drinkers is associated with improved quality of life and fewer alcohol-related consequences. Journal of General and Internal Medicine 17, 382–386.Google Scholar
Lippke, S, Ziegelmann, JP, Schwarzer, R and Velicer, WF (2009) Validity of stage assessment in the adoption and maintenance of physical activity and fruit and vegetable consumption. Health Psychology 28, 183–193.Google Scholar
Little, RJ and Rubin, DB (2002) Statistical Analysis with Missing Data. New York: Jon Wiley & Sons.Google Scholar
McCambridge, J and Jenkins, RJ (2008) Do brief interventions which target alcohol consumption also reduce cigarette smoking? Systematic review and meta-analysis. Drug and Alcohol Dependence 96, 263–270.Google Scholar
McCambridge, J and Saitz, R (2017) Rethinking brief interventions for alcohol in general practice. British Medical Journal 356, j116.Google Scholar
McHorney, CA, Ware, JE Jr. and Raczek, AE (1993) The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care 31, 247–263.Google Scholar
McQueen, J, Howe, TE, Allan, L, Mains, D and Hardy, V (2011) Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Systematic Reviews 8, CD005191.Google Scholar
Mdege, ND, Fayter, D, Watson, JM, Stirk, L, Sowden, A and Godfrey, C (2013) Interventions for reducing alcohol consumption among general hospital inpatient heavy alcohol users: a systematic review. Drug and Alcohol Dependence 131, 1–22.Google Scholar
Miller, WR and Rollnick, S (2002) Motivational Interviewing. Preparing People for Change. New York, NY: The Guilford Press.Google Scholar
Moyer, A, Finney, JW, Swearingen, CE and Vergun, P (2002) Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment- seeking populations. Addiction 97, 279–292.Google Scholar
Muthén, LK and Muthén, BO (2011) Mplus User's Guide, 6th edn. Los Angeles, CA: Muthén & Muthén.Google Scholar
National Institute on Alcohol Abuse and Alcoholism (2012) Available at http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking (Accessed 28 June 2017).Google Scholar
Noar, SM, Benac, CN and Harris, MS (2007) Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychological Bulletin 133, 673–693.Google Scholar
Olariu, E, Forero, CG, Castro-Rodriguez, JI, Rodrigo-Calvo, MT, Alvarez, P, Martin-Lopez, LM, Sanchez-Toto, A, Adroher, ND, Blasco-Cubedo, MJ, Vilagut, G, Fullana, MA and Alonso, J (2015) Detection of anxiety disorders in primary care: a meta-analysis of assisted and unassisted diagnoses. Depression and Anxiety 32, 471–484.Google Scholar
Poikolainen, K, Paljarvi, T and Makela, P (2007) Alcohol and the preventive paradox: serious harms and drinking patterns. Addiction 102, 571–578.Google Scholar
Prochaska, JO (2008) Multiple Health Behavior Research represents the future of preventive medicine. Preventive Medicine 46, 281–285.Google Scholar
Prochaska, JO and Diclemente, CC (1984) The Transtheoretical Approach: Crossing the Traditional Boundaries of Therapy. Malabar, FL: Krieger.Google Scholar
Prochaska, JO and Velicer, WF (1997) The transtheoretical model of health behavior change. American Journal of Health Promotion 12, 38–48.Google Scholar
Rehm, J, Baliunas, D, Borges, GL, Graham, K, Irving, H, Kehoe, T, Parry, CD, Patra, J, Popova, S, Poznyak, V, Roerecke, M, Room, R, Samokhvalov, AV and Taylor, B (2010) The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction 105, 817–843.Google Scholar
Reinert, DF and Allen, JP (2007) The alcohol use disorders identification test: an update of research findings. Alcoholism: Clinical and Experimental Research 31, 185–199.Google Scholar
Rose, G (1985) Sick individuals and sick populations. International Journal of Epidemiology 14, 32–38.Google Scholar
Rumpf, H-J, Meyer, C, Hapke, U and John, U (2001) Screening for mental health: validity of the MHI-5 using DSM-IV axis I psychiatric disorders as gold standard. Psychiatry Research 105, 243–253.Google Scholar
Saitz, R (2014) The best evidence for alcohol screening and brief intervention in primary care supports efficacy, at best, not effectiveness: you say tomāto, I say tomăto? That's not all it's about. Addiction Science & Clinical Practice 9, 14–16.Google Scholar
Saunders, JB, Aasland, OG, Babor, TF, De La Fuente, JR and Grant, M (1993) Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 88, 791–804.Google Scholar
Sutton, S (2001) Back to the drawing board? A review of applications of the transtheoretical model to substance use. Addiction 96, 175–186.Google Scholar
Thorsen, SV, Rugulies, R, Hjarsbech, PU and Bjorner, JB (2013) The predictive value of mental health for long-term sickness absence: the Major Depression Inventory (MDI) and the Mental Health Inventory (MHI-5) compared. BMC Medical Research Methodology 13, 115.Google Scholar
Velicer, WF, Prochaska, JO, Bellis, JM, Diclemente, CC, Rossi, JS, Fava, JL and Steiger, JH (1993) An expert system intervention for smoking cessation. Addictive Behaviors 18, 269–290.Google Scholar
Wang, J and Wang, X (2012) Structural Equation Modeling: Applications Using Mplus. West Sussex, UK: John Wiley & Sons.Google Scholar
Webb, TL, Joseph, J, Yardley, L and Michie, S (2010) Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. Journal of Medical Internet Research 12, e4.Google Scholar
World Health Organization (2014) Global status Report on Alcohol and Health 2014. Geneva, Switzerland: WHO Press.Google Scholar