Substance Use & Addiction Journal

Documented treatment rates for Hepatitis C virus (HCV) infection are low. Within this cohort of HCV-infected patients (N = 373), participants who were not actively injecting drugs or not co-infected with HIV were most likely to initiate HCV treatment. Persons of white race and HIV-infected participants with a CD4 count above 200 were also more likely to have initiated HCV treatment. We defined five factors as potentially modifiable, and found almost all (90%) of the cohort had at least one such factor. Participants with more than one of these factors were least likely to initiate treatment. The proportion of patients receiving treatment increased as their number of modifiable risk factors decreased (p < 0.01, for trend). Focused strategies to overcome these potentially modifiable factors may be indicated to increase HCV treatment in affected populations.

Motivational Interviewing (MI) is a clinical technique that has received considerable attention in the addictions arena over the past decade. In the present pilot study, the impact of providing up to five MI sessions during the first two weeks of intensive outpatient treatment (IOP), relative to the treatment as usual was addressed. The participants were 106 IOP patients, and a post-test design was utilized. Results showed that adding MI sessions during the first two weeks of IOP did not increase the number of days in treatment nor was there an increase in treatment completion. It is possible that the MI sessions by themselves were not sufficient to offset factors that were contributing to less than optimal treatment involvement.

Project CREATE was an initiative to strengthen undergraduate medical education in addictions. As part of a needs assessment, forty-six medical students at Ontario's five medical schools completed a bi-weekly, interactive web-based survey about addiction-related learning events. In all, 704 unique events were recorded, for an average of 16.7 entries per student. The most commonly discussed topic was alcohol withdrawal and the complications of alcohol use. The most common learning venues were lectures and clinical encounters in the emergency department or hospital. The proportion of advice-related topics (e.g., advice to drinkers and smokers) to advice plus non-advice related topics (e.g., medical complications) was greater for outpatient and community settings than for acute care and didactic settings (ratio 1.29, chi sq 15.85, p < 0.01). Students reacted strongly to the psychosocial impact of addictions on patients, yet they viewed addiction as a personal choice, not an illness. Conclusion: Medical students are not being trained to diagnose addiction or provide advice and counseling. Medical schools need to provide students with positive clinical experiences supervised by physicians experienced in addictions.

This study investigated the relationship between age of first drink (AFD) and a broad range of negative alcohol-related outcomes among college students exhibiting unhealthy alcohol use. We conducted an anonymous on-line survey to collect self-report data from first-year college students at a large northeastern university. Among 1,792 respondents who reported ever drinking, 14% reported an AFD before age 14. These early onset drinkers were more likely than later onset drinkers to report frequent drinking, heavy drinking, and other unhealthy alcohol use behaviors. Among the subset of drinkers with unhealthy alcohol use (36%), early drinkers were more likely than later onset drinkers to report experiencing five out of 13 alcohol-related consequences, including driving while intoxicated, missing work or school due to drinking, getting into trouble at work or school due to drinking, receiving lower grades than they should have due to drinking, and developing a tolerance to alcohol.

The goal of the present study was to identify the multidimensional factor structure of external barriers to substance abuse treatment and test its invariance across gender, ethnic, and age groups in a sample of 518 substance abusers assessed at a centralized intake unit. Exploratory (EFA) and confirmatory factor analyses (CFA) demonstrated a well-defined multidimensional factor structure of highly differentiated external barrier factors: time conflict, treatment accessibility, treatment entry difficulty, and financial problems. Furthermore, multi-group CFA tests were used to test equivalencies of the measurement and structural models. The statistical fit results supported the invariance of the ethnic groups. Although there were some gender and age differences in measurement and structural relations among the external barrier facets, the model fit indices results provided support for the invariance of both measurement and structural models. The findings suggest that it would be reasonable to consider the pattern of factor loadings and structure relations as invariant across gender, ethnic, and age groups.