Interpersonal violence exposure and alcohol treatment utilization among medical inpatients with alcohol dependence.

The goal of this study was to examine the association between interpersonal violence exposure and utilization of alcohol treatment after medical hospitalizations among adults with alcohol dependence. We analyzed data collected from a prospective cohort of 238 adults with alcohol dependence who were inpatients in a large urban hospital. Participants who reported interpersonal violence victimization had 1.

Depressive symptoms and subsequent alcohol use and problems: a prospective study of medical inpatients with unhealthy alcohol use.

Objective: We sought to determine whether depressive symptoms assessed during hospitalization predicted alcohol use and alcohol-related problems during the subsequent year among medically ill patients.

Method: The study sample was a cohort of hospitalized medical patients with unhealthy alcohol use who participated in a randomized controlled trial of an alcohol brief intervention. Depressive symptoms at baseline, assessed with the Center for Epidemiologic Studies-Depression Scale (CES-D), were used to predict alcohol use and problems at 3 and 12 months.

Alcohol consumption and HIV disease progression.

Objective: To assess the relation between alcohol consumption and laboratory markers of HIV disease progression.

Methods: We prospectively assessed CD4 cell counts, HIV RNA levels, and alcohol consumption for up to 7 years in 595 HIV-infected persons with alcohol problems recruited between 1997 and 2003. We investigated the relation of these markers of HIV disease progression to alcohol consumption using longitudinal regression models controlling for known prognostic factors, including adherence and depressive symptoms, and stratified by antiretroviral therapy (ART) use.

Persistent pain is associated with substance use after detoxification: a prospective cohort analysis.

Aims: To test the hypothesis that persistent pain is associated with an increased odds of substance use after detoxification.

Design: Analysis of data from a prospective cohort enrolled in a randomized controlled trial (RCT) to improve linkage with primary medical care.

Setting: An urban residential detoxification program.

Awareness of hepatitis C diagnosis is associated with less alcohol use among persons co-infected with HIV.

Background And Objective: It is unknown whether testing HIV-infected individuals for hepatitis C virus (HCV) and informing them of their HCV status impacts subsequent alcohol use. We hypothesized that HIV-infected individuals with current or past alcohol problems who reported being told they had HCV were more likely to 1) abstain from alcohol and 2) not drink unhealthy amounts compared to individuals who had not been told.

Design, Participants, And Measurements: Data from a prospective, observational cohort study (HIV-Longitudinal Interrelationships of Viruses and Ethanol) were used to assess the association between awareness of having HCV at baseline and subsequent abstinence and not drinking unhealthy amounts as reported at 6-month follow-up intervals.

PTSD in urban primary care: high prevalence and low physician recognition.

Background: Posttraumatic stress disorder (PTSD) is associated with medical and psychological morbidity. The prevalence of PTSD in urban primary care has not been well described.

Objective: To measure the prevalence of PTSD in primary care patients overall and among those with selected conditions (chronic pain, depression, anxiety, heavy drinking, substance dependence (SD), irritable bowel syndrome (IBS), and immigrant status).

Impact of hepatitis C on HIV progression in adults with alcohol problems.

Background: Coinfection of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is a substantial medical and public health concern due to its increasing prevalence and complex patient management. Alcohol use may worsen HCV-related liver disease and interfere with adherence to antiretroviral therapy (ART) and medical care. We therefore studied the association between HCV infection and markers of HIV disease progression in adults with alcohol problems.

Associations between alcohol, heroin, and cocaine use and high risk sexual behaviors among detoxification patients.

The purpose of this study was to assess associations between substance use (alcohol to intoxication, heroin, and cocaine) and sexual activity, high risk sexual behaviors, and STD among detoxification inpatients (n = 470). Participants were surveyed on past 30 day substance use, past 6 month sexual behaviors, and STD in the past 6 months and/or over 24 months of follow-up. Logistic regression models adjusted for demographics found that cocaine use was significantly associated with being sexually active (OR(adj) = 2.

Primary care quality and addiction severity: a prospective cohort study.

Background: Alcohol and drug use disorders are chronic diseases that require ongoing management of physical, psychiatric, and social consequences. While specific addiction-focused interventions in primary care are efficacious, the influence of overall primary care quality (PCQ) on addiction outcomes has not been studied. The aim of this study was to prospectively examine if higher PCQ is associated with lower addiction severity among patients with substance use disorders.

A cautionary note regarding count models of alcohol consumption in randomized controlled trials.

Background: Alcohol consumption is commonly used as a primary outcome in randomized alcohol treatment studies. The distribution of alcohol consumption is highly skewed, particularly in subjects with alcohol dependence.

Methods: In this paper, we will consider the use of count models for outcomes in a randomized clinical trial setting.

Do brief measures of readiness to change predict alcohol consumption and consequences in primary care patients with unhealthy alcohol use?

Background: Assessing readiness to change is recommended as part of brief interventions for patients with unhealthy alcohol use. However, the utility and predictive validity of readiness measures have not been well established.

Methods: In a prospective cohort study, we assessed primary care patients with unhealthy alcohol use (past-month drinking of risky amounts, or any amount and an affirmative response to CAGE alcohol screening questionnaire) and reassessed them 6 months later.

Brief intervention for medical inpatients with unhealthy alcohol use: a randomized, controlled trial.

Background: The efficacy of brief intervention in reducing alcohol consumption is well established for selected outpatients but not for medical inpatients.

Objective: To determine whether brief intervention improves alcohol outcomes in medical inpatients who were identified by screening as having unhealthy alcohol use.

Design: Randomized, controlled trial.

Overdose after detoxification: a prospective study.

Objective: The aim of this study was to determine predictors of non-fatal overdose (OD) among a cohort of 470 adults after detoxification from heroin, cocaine or alcohol.

Methods: We examined factors associated with time to OD during 2 years after discharge from an urban detoxification unit in Boston, MA, USA using multivariable regression analyses. Separate analyses were performed for both the total sample and a subgroup with problem opioid use.

Risk of mortality during four years after substance detoxification in urban adults.

The objective of this analysis was to assess the mortality rate and risk factors in adults, with substance dependence, who are not receiving primary medical care (PC). Date and cause of death were identified using the National Death Index data and death certificates for 470 adults without PC over a period of almost 4 years after detailed clinical assessment after detoxification. Factors associated with risk of mortality were determined using stepwise Cox proportional hazards models.

The association between hepatitis C infection and prevalent cardiovascular disease among HIV-infected individuals.

Objective: To examine the association between hepatitis C and prevalent cardiovascular disease (CVD) among HIV-infected individuals.

Design: A cross-sectional analysis of data from the HIV-Longitudinal Interrelationships of Viruses and Ethanol (HIV-LIVE) cohort, a prospective cohort of HIV-infected individuals with current or past alcohol problems.

Methods: We analysed health questionnaire and laboratory data from 395 HIV-infected individuals (50.

Teaching internal medicine resident physicians about Alcoholics Anonymous: a pilot study of an educational intervention.

Greater physician confidence in treating alcoholism is associated with a higher frequency of referring alcoholic patients for treatment, but many physicians have limited experience with Alcoholics Anonymous. We implemented a brief, didactic and experiential educational intervention about AA and evaluated its effect on knowledge and attitudes, using a before-after repeated measures study design. Thirty-six first-year internal medicine resident physicians received an educational intervention, which consisted of a 45-minute lecture about AA, a visit to an AA meeting, and a 30-minute debriefing session the next day.

Screening and brief intervention online for college students: the ihealth study.

Aims: To test the feasibility of online alcohol screening and brief intervention (BI) by comparing (i) two approaches to inviting all students to be screened, and (ii) a minimal versus a more extensive BI.

Methods: Freshmen students at one university were randomized to receive one of two types of email invitations to an online anonymous: (i) general health assessment, or (ii) alcohol-specific assessment. All were linked to the same alcohol screening survey.

Substance abuse treatment and receipt of liver specialty care among persons coinfected with HIV/HCV who have alcohol problems.

We examined the association of substance abuse treatment with access to liver specialty care among 231 persons coinfected with HIV and hepatitis C virus (HCV) with a history of alcohol problems who were recruited and followed up in the HIV-Longitudinal Interrelationships of Viruses and Ethanol cohort study from 2001 to 2004. Variables regarding demographics, substance use, health service use, clinical variables, and substance abuse treatment were from a standardized research questionnaire administered biannually. We defined substance abuse treatment services as any of the following in the previous 6 months: 12 weeks in a halfway house or residential facility, 12 visits to a substance abuse counselor or mental health professional, day treatment for at least 30 days, or any participation in a methadone maintenance program.

Barriers to treatment of hepatitis C in HIV/HCV-coinfected adults with alcohol problems.

Background: Alcohol use and human immune deficiency virus (HIV) infection are both associated with accelerated progression of hepatitis C virus (HCV) disease and reduced response rates to interferon therapy. In this study, we assessed the prevalence of barriers to interferon treatment in a population of HIV/HCV-coinfected patients with current or past alcohol problems and the extent to which they received treatment to address the barriers.

Methods: This is a cross-sectional, descriptive analysis of baseline data from a prospective study assessing the impact of HCV and alcohol use on HIV disease progression.

Impact of health literacy on depressive symptoms and mental health-related: quality of life among adults with addiction.

Background: Health literacy has been linked to health status in a variety of chronic diseases. However, evidence for a relationship between health literacy and mental health outcomes is sparse.

Objective: We hypothesized that low literacy would be associated with higher addiction severity, higher levels of depressive symptoms, and worse mental health functioning compared with those with higher literacy in adults with alcohol and drug dependence.

Emergency department and hospital utilization among alcohol and drug-dependent detoxification patients without primary medical care.

Utilization of emergency department (ED) services and hospitalization among a cohort of substance abusers are described based on structured research interviews with 470 adults without primary care admitted to an urban residential detoxification program. Cross-sectional analysis of baseline data of subjects found nearly 19% of subjects went to an ED on 2 or more occasions in the 6 months prior to detoxification and 14% were admitted for an overnight hospitalization. Upon further analysis of past 6-month ED utilization, the following factors were independently associated with increased odds of ED use: White race; at least one month homeless in the past 5 years chronic health condition; injury in past 6 months; and subject perception that their substance abuse interfered with seeking care from a regular doctor.

Hepatitis C infection is associated with depressive symptoms in HIV-infected adults with alcohol problems.

Objectives: Depression is common in persons with HIV infection and with alcohol problems, and it has important prognostic implications. Neurocognitive dysfunction has been reported with chronic hepatitis C virus (HCV) infection. We hypothesized that HCV infection is associated with more depressive symptoms in HIV-infected persons with a history of alcohol problems.

Readiness to change in primary care patients who screened positive for alcohol misuse.

Purpose: Readiness to change drinking may influence the content or effectiveness of brief alcohol counseling. This study was designed to assess readiness to change and its relationship to alcohol misuse severity among primary care patients whose screening questionnaire was positive for alcohol misuse.

Methods: This study was a cross-sectional analysis of data collected from 2 consecutive mailed questionnaires.