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Title: Brief interventions are effective in reducing alcohol consumption in opiate
dependent methadone maintained patients: results from an implementation study.
Running title: Brief interventions reduce alcohol consumption in methadone patients
Authors: Catherine D Darker, Brion P Sweeney, Haytham O El Hassan, Bobby P
Smyth, Jo-Hanna H Ivers, & Joe M Barry
Dr. Catherine D Darker is a Lecturer in Primary Care
Dr. Brion P Sweeney is a Consultant Adult Psychiatrist in Addiction Services
Dr. Haytham O El Hassan is a Research Registrar in Addiction Services
Dr. Bobby P Smyth is a Consultant Child & Adolescent Psychiatrist
Ms. Jo-Hanna H Ivers is a Research Assistant
Professor Joe M Barry is the Chair of Population Health Medicine
This research was carried out within the Department of Public Health & Primary
Care, Trinity College Dublin, Ireland and in three Drug Treatment Centres within the
Addiction Services of the Heath Service Executive, Dublin North Central Drug
Service, Ireland.
Corresponding author:
Dr. Catherine Darker
Department of Public Health & Primary Care
Trinity College Centre for Health Sciences
Adelaide & Meath Hospital Dublin, Incorporating the National Children’s Hospital
Tallaght
Dublin 24,
Ireland
Phone: +353 (0)1 8968510
Fax: +353 (0)1 4031212
Email: Catherine.Darker@tcd.ie
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Abstract
Introduction and Aims An implementation study to test the feasibility and
effectiveness of brief interventions to reduce hazardous and harmful alcohol
consumption in opiate dependent methadone maintained patients.
Design and Methods Before and after intervention comparison of Alcohol Use
Disorders Identification Test (AUDIT-C) scores from baseline to three-month followup. 710 (82%) of the 863 eligible methadone maintained patients within three urban
addiction treatment clinics were screened. A World Health Organization protocol for
a clinician delivered single brief intervention (BI) to reduce alcohol consumption was
delivered. The full AUDIT questionnaire was used at baseline (T1) to measure
alcohol consumption and related harms; and in part as a screening tool to exclude
those who may be alcohol dependent. AUDIT-C was used at three-month follow-up
(T2) to assess any changes in alcohol consumption.
Results 160 (23% of overall sample screened) ‘AUDIT positive’ cases were
identified at baseline screening with a mean total full AUDIT score of 13.5 (sd 6.7).
There was a statistically significant reduction in AUDIT-C scores from T1 (x =6.74,
sd=2.35) to T2 (x =5.74, sd=2.66) for the BI group [z=-3.98, p<0.01].
There was a statistically significant decrease in the proportion of males who were
AUDIT positive from T1 to T2 [χ2=8.25, p<0.003].
Discussion and Conclusions It is feasible for a range of clinicians to screen for
problem alcohol use and deliver BI within community methadone clinics. Opiate
dependent patients significantly reduced their alcohol consumption as a result of
receiving a brief intervention.
Key words: brief intervention, alcohol, methadone, patient
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Introduction
At present there are more than 8,500 patients receiving methadone maintenance
throughout the Irish Republic for opiate dependence syndrome (1). A recent Irish
study suggested that the prevalence of problem alcohol use among patients attending
primary care for methadone treatment was 35% (2). Most are injecting drug users and
this group demonstrates a high prevalence of hepatitis C infection, with an estimated
70-80% carrying the active virus at any one time (3). Both hepatitis C and alcoholism
are risk factors for developing liver cirrhosis and, in combination, speed the process
towards cirrhosis and decompensated liver failure (4). Chronic liver disease is the
second most common cause of death after overdose among opioid dependent people
(5).
In response to this high degree of alcohol related morbidity and mortality,
efforts have been made to instigate early identification and intervention. The World
Health Organization (WHO) has developed a screening tool for early detection of
hazardous and harmful drinkers, the Alcohol Use Disorders Identification Test
(AUDIT) (6). Scores between 6-15 for women and between 8-15 for men indicate
hazardous drinking; scores between 16-19 for both men and women indicated harmful
drinking (7,8). The WHO has also developed brief interventions (BI) to be used
simultaneously with the AUDIT screening tool (9). Brief interventions as short as five
to ten minutes have been introduced as viable treatment options (10). Several reviews
of the effectiveness of brief interventions have been conducted with varying results. A
review, which included 32 controlled studies involving over 6000 patients including
those seeking treatment for alcohol and those opportunistically screened, found that
brief interventions were as effective as more intensive psychosocial treatments (11).
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Twelve randomised controlled trials were reviewed and it was concluded that drinkers
receiving a BI were twice as likely to reduce their drinking as those who received no
intervention (12). A review of eight randomised controlled studies found that brief
interventions could reduce excessive drinking within a general practice population,
but questioned the feasibility of clinicians screening the general practice settings (13).
A review of 11 trials of BI concluded that, while further research on specific issues is
required, the public health impact of brief interventions is potentially enormous (14).
In contrast to these results, a recent study found that the evidence was inconclusive
for the effectiveness of opportunistic brief interventions for problem drinkers within a
general hospital setting (15). A recent Cochrane review also indicated there is little
evidence that brief interventions for problem alcohol consumption are effective in
women within a primary care setting (16).
To our knowledge the effectiveness of brief interventions in reducing alcohol
use, as outlined by the WHO, has not been tested in an opiate dependent methadone
maintained cohort. Implementation studies are recommended to assess the feasibility
and effectiveness of programmes and interventions, which have been previously
shown to be efficacious (17). This current study is an implementation study to
determine whether it is feasible for treatment teams to screen patients and to deliver
BI where appropriate within their normal clinical load. The primary aim of the current
study is to assess the effectiveness of brief interventions in methadone maintained
opiate dependent patients to reduce alcohol consumption in those who are harmfully
and hazardously misusing alcohol. The secondary aim was to test whether it was
feasible for a range of clinicians to incorporate alcohol screening and the delivery of
brief interventions into their typical clinical workload. It was hypothesised that
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patients who participate in a BI will show a reduction in their alcohol consumption
post intervention, at three-month follow-up, as assessed by AUDIT-C scores. It was
also hypothesised that clinicians would be able to screen and deliver a BI in
conjunction with their normal clinical load.
Methods
Participants
Participants were all opiate dependent and accessing methadone maintenance
treatment within one of the three largest clinics in Dublin, Ireland. These sites were
selected because they have the largest numbers of patients attending their services and
also because they have the greatest numbers of clinicians working within them. In
choosing these sites we felt that we would maximise the numbers of patients available
to us and we would also get the opportunity to train a large number of clinicians in an
internationally recognised skill such as screening for problem alcohol use and
delivering a WHO BI. Participation was on a voluntary basis and no inducements to
participate were offered. All patients attending the clinics were eligible to participate
(N=863). Patients who were registered, but in prison or not attending the clinic at the
time of screening, or patients experiencing an acute psychotic episode as determined
by their treatment team, and patients who scored ≥ 20 on the full AUDIT at T1, were
all excluded from the study.
This study received ethical approval from the Drug Treatment Centre Board
Ethics Committee, Pearse Street, Dublin 2. All participants signed a consent form for
their data to be released to the research team and were made aware that the results of
the study would be made available for publication. A member of the clinical team
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conducted both the screening and delivery of the intervention. Structures were put in
place during the research phase to ensure that any patient who became upset as a
result of either the screening or intervention would be offered further assistance by the
in-house treatment team. No patient had to avail of this contingency during the study.
Design
This was an implementation study to determine whether it was feasible for treatment
teams to screen patients and to deliver BI where appropriate within their normal
clinical setting and with high workloads. It employed a before and after comparison of
scores on the AUDIT-C from baseline (T1) to three months follow-up (T2). Power
analysis based on a reduction of AUDIT score by two standard deviations indicated a
need to recruit and retain 155 participants to receive a BI, giving 80% power to detect
a medium effect size of Cohen's d=0.5 with an alpha error level of p < 0.05.
Main outcome
The primary outcome was change in AUDIT-C score from baseline to follow-up. A
recent review of studies investigating the psychometric properties and use of Audit-C
to measure change has shown it to be as valid and reliable as the full AUDIT (8).
AUDIT-C has been used to screen for problem alcohol use in methadone maintained
patients (18).
Procedure
A total of forty-eight clinical staff, including pharmacists (n=9), general practitioners
(n=8), nurses (n=11), counsellors (n=11), psychiatrists (n=6) and outreach staff (n=3),
across three clinical sites were trained in BI protocols by an expert trainer using
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World Health Organisation guidelines of evidence-based approaches (9). Each staff
member attended a single three-hour training session. Additional training was made
available one week after the initial training session. This additional training entailed a
repeat of the main points relating to the screening procedure and delivery of the BI.
The additional training session was designed to last 30 minutes and only two
clinicians availed of this. A researcher (JI) was available in a supportive role
throughout the data collection periods. Each clinician was assigned a list of patients to
screen. The clinicians conducted the screening and delivered the BI alongside their
typical clinical tasks. No protected time was given specifically to complete the
screening and the BI. Data collection took place between January 2009 and November
2009.
The full AUDIT questionnaire has ten items with a possible range of scores
between 0-40. Different screening AUDIT scores have been recommended for men
and women (8,7). Scores between 0-5 for women and scores 0-7 for men indicated an
AUDIT negative result and therefore no intervention was required. Scores between 615 for women and between 8-15 for men indicated hazardous drinking; scores
between 16-19 for both men and women indicated harmful drinking. Both hazardous
and harmful drinkers received a BI, delivered by the screening clinician, immediately
after screening. The full AUDIT was also used in part as a screening tool to exclude
those patients with an AUDIT score ≥ 20, suggestive of possible alcohol dependence,
and these patients were referred for further follow-up and counselling with the
counselling team as per WHO BI protocol (9). The patients identified as having
possible alcohol dependence were not followed up in this study. Both hazardous and
harmful alcohol users received the BI. The screening and the BI took between 8-10
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minutes per patient to deliver. Hazardous and harmful users were re-screened for
problem alcohol use at three months follow-up using the AUDIT-C. The AUDIT-C
has three items, with scores ranging from 0 to 12 with an optimal screening threshold
of ≥4 for women and ≥5 for men (20-22). All patients hazardously or harmfully using
alcohol and receiving a BI were re-screened three months later. A different member of
the clinical team screened the patients at follow-up (than at baseline screening) to
reduce response bias.
Brief interventions
Elements of BI, as outlined by the WHO (7), include the presentation of screening
results, the identification of risks and a discussion of associated consequences, the
provision of medical advice, the solicitation of a patient’s commitment to change their
drinking behaviour, the identification of a goal related to either reduction of alcohol
intake or total abstinence from drinking and also the provision of advice and
encouragement. This is achieved using a motivational interviewing style that is nonjudgemental and collaborative in nature (23).
Treatment as usual
Currently patients on methadone maintenance in the research sites have a treating
doctor as well as access to nursing and other specialist disciplines including liaison
psychiatry, drug liaison midwifery, counselling and rehabilitation services. Generally
patients see their doctors on a regular basis for management of their treatment
depending on their degree of stability. Doctors normally intervene when they find
through urinalysis that patients are misusing substances such as benzodiazepines,
alcohol, cocaine or opiates on top of their methadone programme. The doctor will
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intervene if such substance misuse is ongoing, however generally doctors have not
been trained in BI techniques or in regular alcohol AUDIT screening. Interventions
usually include increased attendance requirements and ongoing urinalysis. Doctors
attempt to enlist patient compliance with the treatment plan and abstinence from
substances other than prescribed methadone. Patients can access counselling through
self-referral or referral by their doctor. Access to counselling is limited by availability
of counsellors and many patients are reluctant to engage with in-depth psychological
interventions. Substance misuse is monitored and addressed on an ongoing basis but
there is no standard comprehensive package of psychological interventions.
Measures
The AUDIT and the AUDIT-C were utilised within this study. The full AUDIT
questionnaire had a Cronbach’s alpha of 0.75 and the AUDIT-C questionnaire had a
Cronbach’s alpha of 0.71. The four most recent urine toxicology result samples prior
to TI screening date for each patient for opiates, benzodiazepines and cocaine were
also gathered, as there is evidence from other studies that concurrent polydrug use can
predict alcohol consumption (24,25).
Analysis
The analyses were conducted within SPSS (version 18) and R (version 2.12.2, R
CORE TEAM, 2009). A Wilcoxon rank test was used to evaluate change in AUDITC scores between T1 and T2. AUDIT-C scores were collapsed into AUDIT negative
and positive for both males and females. A McNemar test was used to determine if
there was a change in the proportion of patients who were AUDIT-C negative at
baseline compared with follow-up. A mid-point value, regarding the number of drinks
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consumed on a typical day when drinking, was created and a Wilcoxon rank test was
used to evaluate whether there was a change in number of drinks from baseline to
follow-up. Multiple linear regression analyses were used to develop models to predict
AUDIT-C scores at baseline and follow-up, urine toxicology results (summed total
number of urine samples testing positive for opiates, cocaine and benzodiazepines,
from last four samples provided by patient immediately before baseline AUDIT
screening), time in treatment, sex, age, clinical site and the clinical discipline of the
screener.
Results
A total of 153/863 (18%) patients were excluded because of imprisonment (27), nonattendance (98) or psychosis (28). A total of 710 patients were screened (82% of the
overall eligible population) with 160 (23%) AUDIT positive cases being identified.
This meant that an average of one quarter of those screened required a brief
intervention to be delivered immediately after screening by the same clinician. The
baseline demographics, urine toxicology screening results and time in treatment for
the sample are presented in Table 1. This sample was indicative of the overall clinical
population within the three clinics at the time of screening and also reflects patients in
treatment within Ireland (26) and Europe (27).
(insert Table 1 about here)
There was a high follow-up at T2 screening (145/160; 91%) with only 15
patients being lost to follow-up. Of these 15 patients only two refused follow-up. A
CONSORT diagram (28) is used to show the flow of participants through the study
(Figure 1). The full AUDIT scores at baseline for the sample are presented in Table 2.
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(insert Table 2 about here)
The entire sample (N=160) had drunk alcohol in the last year, with 26 patients
(16%) drinking alcohol four or more times a week. Thirty-two per cent (51/160) of
the sample reported binge drinking (i.e., drinking six or more standard drinks on one
occasion) at least weekly or daily.
There was a statistically significant reduction in AUDIT-C scores from T1 (x
=6.74, sd=2.35) to T2 (x =5.74, sd=2.66) [z=-3.98, p<0.01]. There was a statistically
significant reduction in the typical number of drinks consumed on a typical day when
drinking from baseline (x =6.91, sd=2.46) to T2 (x =5.21, sd=2.50) [z=-5.63,
p<0.01] to T2 follow-up.
There was a statistically significant decrease in the proportion of males who
were AUDIT-C positive from T1 (N=104) to T2 (N=87) [χ2=8.25, p<0.003]. There
was no significant decrease for females from T1 (N=46) to T2 (35) [χ2=0.348,
p=0.42].
Factors such as age, opiate use, cocaine use, benzodiazepine use, the clinical
discipline of the screener and clinical site did not predict alcohol consumption at
baseline. Both the sex of the patient and the length of time in treatment did predict
AUDIT-C scores at baseline. The eight factor predictor model (see Table 3) was able
to account for 25% of the variance in AUDIT-C scores at baseline [F(17, 106) = 3.41,
p<0.001].
(insert Table 3 about here)
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Factors such as sex, age, time in treatment, opiate use, cocaine use,
benzodiazepine use, the clinical discipline of the screener and clinical site did not
predict alcohol consumption at follow-up. AUDIT-C scores at baseline did predict
AUDIT-C scores at follow-up ( = 0.43, p<0.001). The nine predictor model (see
Table 4) was able to account for 11% of the variance in AUDIT-C score at follow-up
[F(18, 110) = 1.81, p <0.05].
(insert Table 4 about here)
Discussion
Twenty-three percent of the sample screened was AUDIT positive at baseline,
indicating that they were harmfully and hazardously misusing alcohol. This was
similar to a recent prevalence study conducted within Ireland amongst current or
former heroin users attending primary care for methadone treatment (2). This study
provides the first evidence that a single clinician delivered brief intervention, as
outlined by the World Health Organization, can result in a reduction of alcohol
consumption in a methadone maintained cohort. This has important clinical relevance
when considered in relation to the high HCV infection among Irish drug users (3) that
is compounded by a high prevalence of problem drinking. Also of clinical relevance is
that a significant number of males reduced their drinking to within safer limits as a
result of the brief intervention. However, there was no similar finding for women.
This supports a recent Cochrane review that found that there is little evidence that
brief interventions are effective in women (16). However this may be a result of under
powering, as there were forty-six women within the BI group at baseline. Also the
gender differences observed may be an artefact of the differences in the range of
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scores for men and women and the more limited scope for change that women have
compared to men on the AUDIT scoring system. Of these forty-six women, thirty-five
were AUDIT-C positive at follow-up. This finding is suggestive that some women do
respond to a BI; however, this was not statistically significant and should be viewed
in light of a lack of a control comparison condition.
This study had a number of strengths. Implementation studies are
recommended to assess the feasibility and effectiveness in real‐life of programmes
which have been tested in randomised controlled trials. This was an implementation
study to determine whether it was feasible for treatment teams to screen patients for
alcohol problems and to deliver BI where appropriate within their normal clinical
setting and with high workloads. Evidence-based health education programmes, such
as BI, are often poorly diffused among practitioners and health-care providers, and
have modest reach in the populations within which they are tested (29). We took a
variety of clinicians from different clinical disciplines and exposed them to a short
single training session by an expert trainer. Results from the regression analysis
showed that the professional background of clinician performing the screening and
delivering the intervention whether it be psychiatry, nursing, pharmacy or counselling
did not affect the results of the intervention. This is a positive finding for addiction
treatment centres utilising a multidisciplinary approach, as it means that the full
resources of the clinical teams can be used to intervene with patients who are
experiencing problem alcohol use. The clinical teams screened a high proportion of
the total available populations within their respective clinics. Follow-up screening of
participants was also high (145/160). These achievements were possible because the
training focused on delivering both the screening and the BI within a single short
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session as suggested by WHO guidelines. A recent study with drug users within
Ireland called for addiction treatment services to consider tertiary prevention
strategies that aim to ameliorate risk factors for HCV, such as alcohol misuse, to
reduce liver disease progression (23). It is the intention of the treatment clinics
included within this study to incorporate the use of the AUDIT and delivery of BI as
routine clinical practice. These findings are likely to be of interest to similar addiction
treatment services.
A methodological limitation of this study was that we relied on self-reported
measures of alcohol use and consumption, which may be subject to influences such as
social desirability, particularly at follow-up, and memory bias. Previous studies
however have concluded that problem alcohol users participating in treatment
research give reasonably accurate accounts of their drinking (30). We attempted to
limit the effects of social desirability bias by having different clinicians screen at
follow-up. As a result of the tension between the desire to gather as much data as
possible versus keeping this a feasible piece that clinicians can incorporate into their
usual clinical duties, it was decided to use the AUDIT-C at follow-up to assess
change. This meant that we were not able to examine any changes to the harms
associated with problem alcohol use, which is captured within the full AUDIT
questionnaire. We measured the standard co-variables that can assist in explaining
effects within interventions in methadone maintained populations, such as age, sex,
other substances (opiate, benzodiazepines, & cocaine), length of time in treatment,
clinical discipline of screener and clinical site. However, despite this, the regression
model examining which factors could predict alcohol consumption at follow-up only
accounted for a modest amount of variance. It was not apparent during the data
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collection period (January 2009 to November 2009) of the prevalence of a new
emerging phenomenon within Ireland of ‘legal highs’ or psychoactive substances
being sold in ‘Head shops’ throughout the country (31). Problem drug users appear to
be an especially vulnerable subgroup of new psychoactive substance users and it is
possible that drug substitution was occurring during the data collection period and this
may explain the reduction in alcohol consumption observed in the current study. This
study utilised a before and after design and did not randomly assign patients to
groups, and the study results should be interpreted with this in mind.
Although research designs are often conceptualised within a hierarchy, with
those that maximise internal validity seen as most preferable (32), this view has been
challenged in the realm of treatment research (33). Critics of the pre-eminence of
RCTs note the frequency with which between-group equivalence is not achieved,
often for reasons related to the study design itself (e.g. clients may withdraw
following random assignment to a non-preferred treatment). Even when internal
validity is not compromised, controls on sample characteristics and treatment delivery
may limit external validity, i.e. the ability to generalise study findings to real-world
patient populations and treatment programs (34). Thus, the choice of research design
needs to be evaluated within the broader context of study goals and data collection
circumstances (35). All research designs have strengths and weaknesses; no single
study can be definitive, and both clinical practice and theory are advanced by a
convergence of results across differing, complementary, methods. Indeed, reviewers
comparing RCT results with those from well-designed observational and quasiexperimental studies often report that treatment effects are similar in size and
direction for alcoholism treatments (35). The choice of study design should be guided
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by both the research question of interest and the state of the existing knowledge base.
This current study was a study of how clinicians could implement alcohol screening
and BI into their usual clinical routines and we acknowledge the absence of a control
group. We wanted to answer a specific research question – does this intervention
work in a real life addiction treatment clinic? Also, since there is over a decade of
empirical literature supporting the effectiveness of BIs to modify alcohol
consumption, we felt that randomisation was not necessary. This research may inform
the basis of a more rigorous controlled intervention study design with a similar cohort
in a similar treatment setting. This study incorporated a three-month follow-up; future
research is needed to determine whether the effects of the BI are sustained within a
longer time frame. It may also be of interest to determine the optimum length of time
needed for clinicians to deliver an additional BI to patients so as to maximise the
effects of the intervention.
The WHO recently reported on an international randomised controlled trial
evaluating the effectiveness of a brief intervention for illicit drug use (36). This trial
demonstrated that brief interventions were effective compared with no intervention in
assisting members of the general population to reduce their substance use and
associated risk. The protocol of this trial included delivering the BI to not only
participants deemed at moderate risk but also those at high risk (similar to the
dependent category within the AUDIT framework). It would be of interest and of
clinical relevance to investigate in future studies whether such an intervention would
be effective within a clinical population, such as a methadone maintained cohort, to
determine whether a similar intervention would be effective in moderating their
substance use and associated harms.
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Conclusion
This study suggests that a variety of clinicians can help methadone maintained
patients to reduce their alcohol use in the short term. Brief interventions can be
incorporated into the practices of nurses, general practitioners, counsellors, social
workers and outreach workers in drug treatment facilities.
Acknowledgements
The authors would like to acknowledge the statistical expertise and input of Dr. Alan
Kelly, Senior Lecturer in Biostatistics, Department of Public Health & Primary Care,
Trinity College Dublin.
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21
Table 1: Baseline demographic characteristics (N=160).
N (%)
Average age
Mean (SD)
34.16 (6.43)
Gender
Male
114 (71)
Number of months in treatment
0-6 months
7-12 months
13-24 months
25-60 months
61+ months
21 (13)
38 (24)
24 (15)
35 (22)
42 (26)
Drug use
Opiates*
Zero
One
Two
Three
Four
42 (26)
28 (18)
27 (17)
23 (14)
40 (25)
Cocaine*
Zero
One
Two
Three
Four
80 (50)
20 (13)
19 (12)
23 (14)
18 (11)
Benzodiazepines*
Zero
One
Two
Three
Four
11 (7)
29 (18)
16 (10)
25 (16)
79 (49)
*= Number of urine samples testing positive from last four samples provided by
patient immediately before baseline Audit screening
22
Table 2: Baseline AUDIT scores for all patients screened.
____________________________________________________________________
Total screened
AUDIT Positive
AUDIT Negative
Dependent
(n=710)
(n=160)
(n=485)
(n=65)
10.1 (9.6)
13.5 (6.7)
4.7 (4.5)
28.7 (7.2)
____________________________________________________________________
means (standard deviations)
23
Table 3: Multiple linear regression of which factors predict alcohol consumption at
baseline.
Variable

Std. Error
p value
Intercept
1.12 2.53
0.65
Age
0.03
0.03
0.279
Male (Female)
1.97
0.42
0.001
Total opiate score
0.17
0.12
0.139
Total benzodiazepine score
-0.14 0.14
0.301
Total cocaine score
-0.01 0.17
0.947
Length of time in treatment
7-12 months (0-6 months)
13-24 months (0-6 months)
25-60 months (0-6 months)
61+ months (0-6 months)
2.17
1.67
1.48
1.13
0.67
0.73
0.69
0.68
0.001
0.024
0.034
0.101
Clinical discipline of screener
General Practitioner (Outreach)
Pharmacist (Outreach)
Counsellor (Outreach)
Psychiatrist (Outreach)
Nurses (Outreach)
2.15
1.22
2.00
2.09
2.11
2.13
2.23
2.15
2.26
2.14
0.314
0.585
0.354
0.356
0.348
-0.72 0.97
0.41 0.93
0.462
0.661
Clinical site
Site 2 (Site 1)
Site 3 (Site 1)
F value = 3.41, p<0.001
R-Square = 0.353
Adjusted R-Square = 0.249
() = baseline category
24
Table 4: Multiple linear regression of which factors predict alcohol consumption at
follow-up.
Variable

Std. Error
p value
Intercept
Age
0.02
0.04
0.542
Male (Female)
0.53
0.63
0.397
Total opiate score
0.12
0.16
0.438
Total benzodiazepine score
0.19
0.19
0.313
Total cocaine score
0.13
0.23
0.570
Total Audit C score at baseline
0.43
0.12
0.001
Length of time in treatment
7-12 months (0-6 months)
13-24 months (0-6 months)
25-60 months (0-6 months)
61+ months (0-6 months)
-0.40
-0.41
0.30
-0.05
0.95
-0.41
0.94
0.92
0.669
0.678
0.745
0.954
Clinical discipline of screener
General Practitioner (Outreach)
Pharmacist (Outreach)
Counsellor (Outreach)
Psychiatrist (Outreach)
Nurses (Outreach)
0.57
-0.27
0.51
-0.58
0.62
2.84
-0.09
2.87
3.01
2.99
0.841
0.927
0.858
0.845
0.876
Clinical site
Site 2 (Site 1)
Site 3 (Site 1)
F value = 1.815
R-Square = 0.246
Adjusted R-Square = 0.110
() = base category
-0.78 1.31
-1.45 1.24
0.550
0.246