A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile

Poblete, Fernando; Barticevic, Nicolás; Zuzulich, María Soledad; Portilla, Rodrigo; Castillo‐Carniglia, Álvaro; Sapag, Jaime C.; Villarroel, Luís; Sena, Brena F.; Galarce, Magdalena

doi:10.1111/add.13808

Cited by 25 publications

(17 citation statements)

References 26 publications

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“…We used local data and the results of project MATCH as references for sample size calculation. Project MATC H [13] recruited participants with AUD in the outpatient setting and observed a standard deviation (SD) of 6.29 drinks, which is similar to reports in Chilean PC [28]. On admission, participants in the MATCH study consumed 11.5 DDD, which should be similar in our population.…”

Section: Sample Size {14}supporting

confidence: 71%

Brief motivational therapy versus enhanced usual care for alcohol use disorders in primary care in Chile: study protocol for an exploratory randomized trial

Barticevic

Poblete

Zuzulich

et al. 2020

Trials

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Background: Harmful alcohol use is a leading cause of global disability and death. However, increased detection and brief intervention capacity of more severe alcohol use disorders has not been accompanied by increased availability of treatment services. Incorporating treatment for such disorders into primary care is of paramount importance for improving access and health outcomes. This study aims to estimate the effectiveness of a Brief Motivational Treatment (BMT) applied in primary care for treatment of these disorders. Methods: A parallel-group, single-blinded, severity-stratified, randomized clinical trial will test the superiority of BMT over enhanced usual care. Eligible participants will be those seeking treatment and who fulfill DSM-V criteria for alcohol use disorder and criteria for harmful alcohol use. With an estimated a loss to follow-up of 20%, a total of 182 participants will be recruited and equally randomized to each treatment group. The intervention group will receive an adaptation of the motivational enhancement therapy, as manualized in Project MATCH. This treatment consists of four 45-min sessions provided by a general psychologist with at least 3 years of primary care experience. The primary outcome is the change from baseline in the drinks per drinking day during the last 90 days, which will be captured using the Timeline Follow Back method. Secondary outcomes will describe the changes in alcohol use pattern, motivational status, and severity of the disorder. All participants will be analyzed according to the group they were allocated, regardless of the treatment actually received. Mean differences (MD) will be computed for continuous outcomes and relative risks (RR) and RR reductions (RRR) for dichotomous results. Linear models will deliver the subgroup analyses. Missingness is assumed to be associated with the baseline alcohol use pattern and severity, so a multiple imputation method will be used to handle missing data. Discussion: This trial aims to test the superiority of BMT over enhanced usual care with a reasonable superiority margin, over which the BMT could be further considered for incorporation into PC in Chile. Its pragmatic approach ultimately aims to inform policymakers about the benefit of including a brief psychosocial treatment into PC. Trial registration: ClinicalTrials.gov NCT04345302. Registered on

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Section: Sample Size {14}supporting

confidence: 71%

Brief motivational therapy versus enhanced usual care for alcohol use disorders in primary care in Chile: study protocol for an exploratory randomized trial

Barticevic

Poblete

Zuzulich

et al. 2020

Trials

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“…Although implemented in a range of settings, collaborative care models seem best delivered in PHC settings 93 . Evidence demonstrates the effectiveness of PHC-based lifestyle interventions in Latin American contexts 94 , 95 , including brief advice programmes to reduce heavy drinking, as well as the potential to detect and refer high-risk patients.…”

Section: Protocolmentioning

confidence: 99%

Scaling-up primary health care-based prevention and management of heavy drinking at the municipal level in middle-income countries in Latin America: Background and protocol for a three-country quasi-experimental study

et al. 2017

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Background: While primary health care (PHC)-based prevention and management of heavy drinking is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes to increase PHC-based screening and brief advice activity to reduce heavy drinking. However, gains have been only modest and short term at best. WHO studies have concluded that a more effective uptake could be achieved by embedding PHC activity within broader community and municipal support. Protocol: A quasi-experimental study will compare PHC-based prevention and management of heavy drinking in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. In the implementation cities, primary health care units (PHCUs) will receive training embedded within ongoing supportive municipal action over an 18-month implementation period. In the comparator cities, practice as usual will continue at both municipal and PHCU levels. The primary outcome will be the proportion of consulting adult patients intervened with (screened and advice given to screen positives). The study is powered to detect a doubling of the outcome measure from an estimated 2.5/1,000 patients at baseline. Formal evaluation points will be at baseline, mid-point and end-point of the 18-month implementation period. We will present the ratio (plus 95% confidence interval) of the proportion of patients receiving intervention in the implementation cities with the proportions in the comparator cities. Full process evaluation will be undertaken, coupled with an analysis of potential contextual, financial and political-economy influencing factors. Discussion: This multi-country study will test the extent to which embedding PHC-based prevention and management of alcohol use disorder with supportive municipal action leads to improved scale-up of more patients with heavy drinking receiving appropriate advice and treatment. Study status: The four-year study will start on 1 st December 2017.

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“…Hombres consumían más alcohol y cannabis; mientras que las mujeres tenían un mayor consumo de sedantes/hipnóticos. (3) En Chile (10) , los resultados de línea de base de un ensayo clínico aleatorizado reportaron valores superiores de riesgo moderado a los del presente estudio; aproximadamente 52% de los participantes tenían un consumo de riesgo moderado para el alcohol, 49% para cannabis y 19% para cocaína. Algunos participantes tenían un riesgo moderado para más de una sustancia: 13% para el alcohol y el cannabis, 7% para el alcohol y la cocaína y 7% para el cannabis y cocaína.…”

Section: Discussionunclassified

“…Algunos participantes tenían un riesgo moderado para más de una sustancia: 13% para el alcohol y el cannabis, 7% para el alcohol y la cocaína y 7% para el cannabis y cocaína. (10) Los porcentajes de consumo de riesgo alto para tabaco en ambos grupos (0,9% el valor más bajo en el grupo de docentes y administrativos) y de riesgo moderado, muestran la necesidad de un programa integral, considerando el tamaño de la población estudiada. Como se muestra en la Tabla 3, la estimación con base a los limites inferiores de los IC95% de las cuatro sustancias con más alta frecuencia, evidencian el número elevado de personas que necesitan intervención tanto en estudiantes como en docentes y trabajadores.…”

Section: Discussionunclassified

Consumo de riesgo de drogas utilizando la herramienta ASSIST modificado en estudiantes, docentes y personal administrativo de una universidad pública.

Piedra¹,

Olalla²,

Jácome³

et al. 2019

RMV

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Drug use is a major cause of global morbidity and its impact generates significant health, economic and social expenditures. The highest rates of drug use are seen in the population between the ages of 18 and 25, where a significant proportion are university students. The objective of this study was to calculate the prevalence of substance risk consumption among students, professors and workers at a public university in Ecuador. In addition, the calculation of the internal consistency (reliability) of the modified ASSIST questionnaire was performed. Patients and Methods: A cross-analytical study was conducted, the Alcohol, Tobacco and Substances Consumption Detection (ASSIST) test was applied in two population groups (students and workers – teachers). The internal consistency of each subscale of the questionnaire was evaluated with Cronbach’s alpha. Percentages with 95% CI were used to estimate the prevalence of risk consumption. Results: 4958 students and 425 teachers, workers and employees responded to the ASSIST questionnaire. The calculation of the internal consistency (reliability) of the instrument, proved Cronbach satisfactory (>0.7) for consumption of tobacco, alcohol and marijuana. The prevalence of high-risk alcohol use (5.3% for students and 4.9% for workers and teachers), tobacco and cannabis were high in the groups studied. In addition, the percentage of the population with moderate risk consumption was also significant. Conclusions: Under the high rates of high and moderate risk use for drug use, it is necessary to implement a comprehensive program of promotion, prevention, treatment and rehabilitation aimed at university students. The modified ASSIST test showed satisfactory internal consistency in the assessment of substance risk consumption.

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A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile

Abstract: It is not clear whether a brief intervention associated with the Alcohol Smoking and Substance Involvement Screening Test is more effective than an informational pamphlet in reducing alcohol and illicit substance consumption in non-treatment-seeking, primary care users with moderate risk.

Cited by 25 publications

References 26 publications

Brief motivational therapy versus enhanced usual care for alcohol use disorders in primary care in Chile: study protocol for an exploratory randomized trial

Brief motivational therapy versus enhanced usual care for alcohol use disorders in primary care in Chile: study protocol for an exploratory randomized trial

Scaling-up primary health care-based prevention and management of heavy drinking at the municipal level in middle-income countries in Latin America: Background and protocol for a three-country quasi-experimental study

Consumo de riesgo de drogas utilizando la herramienta ASSIST modificado en estudiantes, docentes y personal administrativo de una universidad pública.

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