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Physicians’ attitudes toward unhealthy alcohol use and self-efficacy for screening and counseling as predictors of their counseling and primary care patients’ drinking outcomes

May 30, 2013 Comments off

Physicians’ attitudes toward unhealthy alcohol use and self-efficacy for screening and counseling as predictors of their counseling and primary care patients’ drinking outcomes

Source: Substance Abuse Treatment, Prevention, and Policy

Objective

Patients’ unhealthy alcohol use is often undetected in primary care. Our objective was to examine whether physicians’ attitudes and their perceived self-efficacy for screening and counseling patients is associated with physicians’ counseling of patients with unhealthy alcohol use, and patients’ subsequent drinking.

Methods

This study is a prospective cohort study (nested within a randomized trial) involving 41 primary care physicians and 301 of their patients, all of whom had unhealthy alcohol use. Independent variables were physicians’ attitudes toward unhealthy substance use and self-efficacy for screening and counseling. Outcomes were patients’ reports of physicians’ counseling about unhealthy alcohol use immediately after a physician visit, and patients’ drinking six months later.

Results

Neither physicians’ attitudes nor self-efficacy had any impact on physicians’ counseling, but greater perceived self-efficacy in screening, assessing and intervening with patients was associated with more drinking by patients six months later.

Conclusions

Future research needs to further explore the relationship between physicians’ attitudes towards unhealthy alcohol use, their self-efficacy for screening and counseling and patients’ drinking outcomes, given our unexpected findings.

Categories: alcohol abuse, health care providers, Substance Abuse Treatment Prevention and Policy

Substance Abuse — Recovery post treatment: plans, barriers and motivators

January 30, 2013 Comments off

Recovery post treatment: plans, barriers and motivators

Source: Substance Abuse Treatment, Prevention, and Policy

Background

The increasing focus on achieving a sustained recovery from substance use brings with it a need to better understand the factors (recovery capital) that contribute to recovery following treatment. This work examined the factors those in recovery perceive to be barriers to (lack of capital) or facilitators of (presence of capital) sustained recovery post treatment.

Methods

An opportunity sample of 45 participants was recruited from 11 drug treatment services in northern England. Semi-structured qualitative interviews lasting between 30 and 90 minutes were conducted one to three months after participants completed treatment. Interviews examined key themes identified through previous literature but focused on allowing participants to explore their unique recovery journey. Interviews were transcribed and analysed thematically using a combination of deductive and inductive approaches.

Results

Participants generally reported high levels of confidence in maintaining their recovery with most planning to remain abstinent. There were indications of high levels of recovery capital. Aftercare engagement was high, often through self referral, with non substance use related activity felt to be particularly positive. Supported housing was critical and concerns were raised about the ability to afford to live independently with financial stability and welfare availability a key concern in general. Employment, often in the substance use treatment field, was a desire. However, it was a long term goal, with substantial risks associated with pursuing this too early. Positive social support was almost exclusively from within the recovery community although the re-building of relationships with family (children in particular) was a key motivator post treatment.

Conclusions

Addressing internal factors and underlying issues i.e. ‘human capital’, provided confidence for continued recovery whilst motivators focused on external factors such as family and maintaining aspects of a ‘normal’ life i.e. ‘social and physical capital’. Competing recovery goals and activities can leave people feeling under pressure and at risk of taking on or being pushed to do too much too soon. The breadth of re-integration and future plans at this stage is limited primarily to the recovery community and treatment sector. Services and commissioners should ensure that this does not become a limiting factor in individuals’ long term recovery journeys.

Categories: business and economics, children and families, mental health and substance abuse, social and cultural issues, Substance Abuse Treatment Prevention and Policy

Underage alcohol policies across 50 California cities: An assessment of best practices

June 28, 2012 Comments off

Underage alcohol policies across 50 California cities: An assessment of best practices

Source: Substance Abuse Treatment, Prevention, and Policy

Background

We pursue two primary goals in this article: (1) to test a methodology and develop a dataset on U.S. local-level alcohol policy ordinances, and (2) to evaluate the presence, comprehensiveness, and stringency of eight local alcohol policies in 50 diverse California cities in relationship to recommended best practices in both public health literature and governmental recommendations to reduce underage drinking.

Methods

Following best practice recommendations from a wide array of authoritative sources, we selected eight local alcohol policy topics (e.g., conditional use permits, responsible beverage service training, social host ordinances, window/billboard advertising ordinances), and determined the presence or absence as well as the stringency (restrictiveness) and comprehensiveness (number of provisions) of each ordinance in each of the 50 cities in 2009. Following the alcohol policy literature, we created scores for each city on each type of ordinance and its associated components. We used these data to evaluate the extent to which recommendations for best practices to reduce underage alcohol use are being followed.

Results

(1) Compiling datasets of local-level alcohol policy laws and their comprehensiveness and stringency is achievable, even absent comprehensive, on-line, or other legal research tools. (2) We find that, with some exceptions, most of the 50 cities do not have high scores for presence, comprehensiveness, or stringency across the eight key policies. Critical policies such as responsible beverage service and deemed approved ordinances are uncommon, and, when present, they are generally neither comprehensive nor stringent. Even within policies that have higher adoption rates, central elements are missing across many or most cities’ ordinances.

Conclusion

This study demonstrates the viability of original legal data collection in the U.S. pertaining to local ordinances and of creating quantitative scores for each policy type to reflect comprehensiveness and stringency. Analysis of the resulting dataset reveals that, although the 50 cities have taken important steps to improve public health with regard to underage alcohol use and abuse, there is a great deal more that needs to be done to bring these cities into compliance with best practice recommendations.

[Category
Substance Abuse Treatment, alcohol, adolescents]

Categories: alcohol abuse, government and politics, legal and law enforcement, social and cultural issues, Substance Abuse Treatment Prevention and Policy
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