Proceedings of the 18th Annual Conference of INEBRIA

doi:10.1186/s13722-023-00371-4

2023-04-13 00:00:00

Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Addiction Science & https://doi.org/10.1186/s13722-023-00371-4 Clinical Practice Open Access MEE TING ABSTR AC TS Proceedings of the 18th Annual Conference of INEBRIA Edinburgh, Scotland. 21-23 September 2022 Published: 13 April 2023 Oral presentations MIBI staff working at HSOs randomized to the experimental strategy had the opportunity to receive $10 USD per MIBI implemented, as well as $10 USD per MIBI implemented at or above the 80th percentile level O1 of fidelity. Guided by the Theory of Implementation Effectiveness, the Using pay‑for‑performance as a strategy to improve primary implementation outcome measure was implementation effec - the consistency and quality of implementing a motivational tiveness (i.e., the consistency and quality of MIBI implementation), a interviewing‑based brief intervention for people with HIV staff-level measure representing the standardized sum of the total and substance use disorders 1 2 2 3 number of MIBIs implemented and the total quality/fidelity scores. Bryan Garner *, Stephen J. Tueller , Michael Bradsha w , Kathryn J. Speck , 4 5 6 6 Results: The P4P strategy had a medium-sized effect (d = 0.47) that Denna Vandersloot , Mathew R. Roosa , James Ford II , Mark Zehner , 2 2 2 7 significantly (p = 0.001) improved staff-level implementation effective - Jackie Mungo , Sarah McDaniel , Richa Ruwala , Derek Satr e 1 2 ness during the project‚Äôs implementation phase. The Ohio State University, Columbus, OH 43218‑2646, USA; RTI Interna‑ 3 Conclusions: Consistent with prior research, the current research sup- tional, Research Triangle Park, NC 27709, USA; The University of Nebraska, 4 ports P4P as a highly-promising strategy to improve the implementa- Lincoln, NE 68336, USA; Vandersloot Consulting, Portland, OR 97220, 5 6 tion of brief motivational interventions. USA; Roosa Consulting, Syracuse, NY 13120, USA; University of Wis‑ consin‑Madison, Madison, WI 53706, USA; University of California‑San Francisco, San Francisco, CA 94143, USA O2 Correspondence: Bryan Garner (bryan.garner@osumc.edu) Text‑messaging brief interventions for hazardous drinking Addiction Science & Clinical Practice 2023, 18(Suppl 1): O1 and tobacco use intervention development lessons from India with digital alcohol interventions 1* Background: As part of a dual-randomized type 2 implementation-Abhijit Nadkarni effectiveness hybrid trial, which included 39 HIV service organizations Department of Population Health, London School of Hygiene & Tropical (HSOs) across the U.S., 78 HSO staff, and 824 client participants with Medicine, London, WC1E 7HT, UK HIV and a substance use disorder (SUD), a motivational interviewing- Correspondence: Abhijit Nadkarni (abhijit.nadkarni@lshtm.ac.uk) based brief intervention (MIBI) was found to be effective. Importantly, Addiction Science & Clinical Practice 2023, 18(Suppl 1): O2 the MIBI was only effective when implemented within the context of HSOs receiving the Implementation and Sustainment Facilitation Background: Despite the large and increasing burden of hazardous (ISF) strategy (i.e., monthly 30–60 min team-focused facilitation meet- drinking and tobacco use in India, access to appropriate interventions ings via Zoom) as an adjunct to the multifaceted control strategy (i.e., remains limited because of human resource shortages. The aim of staff-focused training, feedback, and consultation regarding the MIBI), AMBIT and ToQuit was to develop contextually appropriate text-mes- referred to as TFC. This presentation highlights results from the subse- saging brief interventions (BIs) for hazardous drinking and tobacco quent Substance Abuse Treatment to HIV Care II (SAT2HIV-II Project) ‚Äì use respectively using a systematic and evidence based intervention a cluster-randomized type 3 implementation-effectiveness hybrid trial development process. testing the effectiveness of pay-for-performance (P4P; TFC + ISF + P4P) Methods: The intervention development process included (a) exami- to improve MIBI implementation beyond the TFC + ISF strategy. nation and synthesis of global evidence on effectiveness of text mes- Materials and methods: As part of the SAT2HIV-II Project saging interventions for the target conditions; (b) in-depth qualitative (NCT04687917) approved by the Advarra IRB, 25 HSOs as well as par- interviews with a range of stakeholders such as hazardous drinkers, ticipating staff and clients, were cluster randomized to either the con- tobacco users, and health professionals; (c) Delphi surveys to refine trol strategy (TFC + ISF) or the experimental strategy (TFC + ISF + P4P). intervention content; (d) intervention development workshops; (e) © The Author(s) 2023. 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The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 2 of 27 intervention cohorts with measurement of process data and pre- O4 post- outcome evaluation to evaluate acceptability and feasibility of Methodological insights from a remote Randomised Controlled the interventions; and (f ) pilot RCTs with nested qualitative studies to Trial examining the effectiveness of an alcohol reduction app examine feasibility of trial procedures. in helping increasing and higher risk drinkers reduce their alcohol Results: Both the interventions resulted from the triangulation of out- consumption 1* puts from the participatory methods described above. The stepped Melissa Oldham intervention development process resulted in iterative changes made UCL Tobacco and Alcohol Research Group, Department of Behavioural to the interventions to make them contextually relevant, thus enhanc- Science and Health, University College London, London, WC1E 7HB, UK ing the feasibility and acceptability. Both interventions were accept- Correspondence: Melissa Oldham (m.oldham@ucl.ac.uk) able to the target groups and feasible to be delivered through text Addiction Science & Clinical Practice 2023, 18(Suppl 1): O4 messaging. Pilot RCT results indicated a trend in favour of the BIs when compared to the control arm. Background: Randomised Controlled Trials (RCTs) with no in-person Conclusion: Rigorous and systematic intervention development pro- contact between researchers and participants present unique chal- cesses are important to develop contextually relevant interventions. If lenges. We present methodological insights from a large, remote RCT demonstrated to be cost-effective in definitive trials, ToQuit and AMBIT examining the effectiveness of an alcohol reduction app. We highlight have the potential to reduce the treatment gaps for hazardous drink- how different sources of remote recruitment compare in terms of cost- ing and tobacco use through increasing access to care. effectiveness, retention rates, data quality and demographic diversity. We also outline the costs associated with different follow-up methods and outline broader challenges and recommendations around data O3 quality. Bot or not? Pitfalls and good practices in data management Materials and methods: A blinded descriptive analysis of 5607 haz- in digital alcohol research 1 1 ardous and harmful drinkers (Alcohol Use Disorders Identification Test Gemma Loebenberg , Larisa Dinu 1 (AUDIT) score ≥ 8), taking part in a two-arm, parallel group, remote UCL Tobacco and Alcohol Research Group, Department of Behavioural RCT with a 1:1 allocation comparing the intervention (Drink Less) with Science and Health, University College London, London, WC1E 7HB, UK usual digital care (NHS alcohol advice webpage). Participants were Correspondence: Gemma Loebenberg (gemma.loebenberg@ucl.ac.uk) recruited using varying methods between July 2020 and March 2022. Addiction Science & Clinical Practice 2023, 18(Suppl 1): O3 We evaluate the success and cost-effectiveness of different forms of remote recruitment (e.g. NHS website, social media and radio advertis- Background: Digital alcohol research is popular due to lower costs, ing) and different follow-up methods (emails, phone calls and postal and the relative convenience of recruiting large numbers of par- surveys). ticipants compared with in-person research. However, digital par- Results: The most cost-effective recruitment strategies were the free ticipation with little verification is open to automated “bots” and ones; the NHS advert (n = 1959) and advertising through local health manual fraud. This paper aims to highlight issues with fraudulent providers (n = 15), but these had varying levels of success. Social entries affecting digital alcohol research with financial incentives, and media (£3.46 per person recruited) was more cost-effective than the importance of rigorous data management to identify and rectify emailing users of the Smoke Free app (£6.81 pp) and radio advertis- problems. ing (£11.72 pp) but produced a less representative sample and higher Materials and methods: A randomised controlled trial (n = 5562) levels of participant fraud. At 6-month-follow-up, the majority of evaluating the effectiveness of an alcohol reduction app, Drink Less, participants responded after four emails (67%), with a further 10% recruited participants online from July 2020-March 2022. Follow- responding after phone calls and 7% responding to postal surveys. up occurred at three timepoints with financial incentives available. Broader methodological recommendations for future remote trials Numerous “bots”—automated responses generated in clusters—were are discussed including the importance of data checks and provid- identified during the first month’s recruitment. Manual fraud—partici- ing technical support for participants in accessing and using digital pants providing false information or duplicate entries—was detected interventions. thereafter. Both were initially identified by address authentication, Conclusions: We offer recommendations for cost effective strate - then telephone verification. gies for remote recruitment and follow-up retention rates as well as Results: 863 participants (75.6%) were identified as bots during data broader recommendations to ensure data quality. screening between 13th July-12th September 2020. A Captcha was added to the survey on 11th August 2020; no new bots were identi- fied as signing up after this. Ongoing checks throughout the study O5 detected additional suspicious responses caused by people engaging The effect of question order on outcomes in the core outcome set in manual fraud, particularly during November 2020, with 110 (34%) for brief alcohol interventions among online help‑seekers 1* entries identified as fraudulent, and October-December 2021 with Marcus Bendtsen 112 (22.4%). Further screening questions, removing the prominence Department of Health, Medicine and Caring sciences, Linköping Univer‑ of financial incentives from social media advertising, and an addi- sity, Linköping, SE‑581 83, Sweden tional requirement to provide a mobile phone number for verification Correspondence: Marcus Bendtsen (marcus.bendtsen@liu.se) reduced those detected engaging in manual fraud to a negligible level Addiction Science & Clinical Practice 2023, 18(Suppl 1): O5 with only 1 (0.16%) identified in February 2022. Conclusions: Data management protocols are necessary to detect Background: A core outcome set (COS) has been developed through and minimise automated bots and manual fraud in digital alcohol tri- international consensus to reduce selective reporting and research als. When creating online surveys, researchers should use fraud detec- waste, and guide outcome choice in brief alcohol intervention tion software offered (e.g., Captchas), consider how to advertise the research. This study aimed to estimate order effects among questions study, identify and deter duplicate entries, and avoid prominence of in the COS. financial incentives. A ddiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 3 of 27 Methods: Adults, aged over 18 years who searched online for alcohol- Results: Mean (SD) age was 22.34 (3.07), 54.1% were female; 66.0% related help were invited to complete a survey containing the COS were Bachelor students, 30.1% Master, 2.4% PhD, and 1.4% other. Base- items. The order of four item clusters was randomised following a fac- line mean number of drinks per week was 8.60(8.17). Baseline number torial design. Primary outcomes were order effects among the COS of HDD, past 30 days was 3.53 (4.02). Follow-up rate was 96.4% and items and patterns of abandonment of the questionnaire. 95.9% at 3 and 6 months, respectively. Compared to the no-interven- Results: We randomised 7334 participants, of which 5256 had tion condition, those who received access to the intervention reported responded to at least one question and were available for primary and significantly fewer SDW (intervention by 3-month follow-up interac - sensitivity analyses. Current non-drinkers were excluded. Median com- tion, IRR [95%CI] 0.88 [0.82;0.96]; intervention by 6-month follow-up pletion time for the COS was 4 min 16 s. We found evidence of order interaction, 0.88 [0.81;0.95]) and significantly fewer HDD (intervention effects among COS clusters, including higher self-reported average by 3-month follow-up interaction, IRR 0.90 [0.81;0.99]; intervention by consumption and odds of harmful and hazardous drinking among 6-month follow-up interaction, 0.88 [0.80;0.98]). those who first answered questions on recent consumption and Conclusion: Providing access to a smartphone-based secondary pre- impact of alcohol use. Lower self-reported recent consumption was vention intervention was efficacious to reduce unhealthy alcohol use found among those first asked about average consumption. Quality of among university students. The intervention has the potential for life was reported as lower among those who first responded to ques- widespread implementation. tions on impact of alcohol use, which in turn was lower among those who first answered question on average consumption and quality of O7 life. Attrition was lowest when average consumption was asked first, Implementation and workflow strategies for integrating digital and highest when quality of life or impact of alcohol use asked first. therapeutics for alcohol use disorders into primary care: Conclusions: Researchers designing studies should note that question a qualitative study order effects may exist. At a minimum, all study participants should be 1* 1 2 Jessica M. M ogk , Theresa E. Matson , Ryan M. Caldeiro , Angela M. Garza asked the same questions in the same order. There is no perfect ques- 2 1 1 1 Mcwethy, Tara Beatty , Brandie C. Sevey , Joseph E. Glass tion order; rather, researchers should be guided by the nature of the 1 Kaiser Permanente Washington Health Research Institute, Seattle, WA studied population, recruitment, additional questions, concerns about 2 98101, USA; Kaiser Permanente Washington Mental Health & Wellness under-reporting, screening for inclusion, and retention concerns. Services, PO Box 9010, Renton, WA 98057‑9010, USA Correspondence: Jessica M. Mogk (Jessica.M.Mogk@kp.org) O6 Addiction Science & Clinical Practice 2023, 18(Suppl 1): O7 Smartphone‑based secondary prevention intervention for university students with unhealthy alcohol use: a randomized Background: Alcohol use disorders (AUD) are prevalent and often go controlled trial untreated. Patients are commonly screened for AUD in primary care, 1 1 1 1 Nicolas Bertholet , Elodie Schmutz , Joseph Studer , Angéline Adam , but existing treatment programs are failing to meet demand. Digital 1 2,3,4 5 Gerhard Gmel , John A. Cunningham , Jennifer McNeely , Jean‑Bernard therapeutics are a cost-effective treatment option that may help fill Daeppen treatment gaps. The goal of this study was to identify implementation Department of Psychiatry, Addiction Medicine, Lausanne University Hos‑ needs and workflow design considerations for integrating digital ther - pital and Lausanne University, Lausanne, Switzerland; National Addiction apeutics for AUD into primary care. Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings Materials and methods: We conducted qualitative interviews with College London, London, SE5 8BB, UK; Centre for Addiction and Mental clinicians, care delivery leaders, and quality improvement staff (n = 16) Health, Institute of Mental Health and Policy Research, Toronto, Canada; in an integrated healthcare delivery system in the United States. All Departments of Psychiatry and Psychology, University of Toronto, participants had experience implementing digital therapeutics for Toronto, Canada; Department of Population Health, New York University depression and substance use disorders in primary care. Interviews Grossman School of Medicine, New York, USA were designed to gain insights into adaptations needed to optimize Correspondence: Nicolas Bertholet (nicolas.bertholet@chuv.ch) existing clinical processes, workflows, and implementation strategies Addiction Science & Clinical Practice 2023, 18(Suppl 1): O6 for use with alcohol-focused digital therapeutics. Interviews were recorded and transcribed and then analyzed using a rapid analysis Background: Unhealthy alcohol use is a leading cause of morbidity process and affinity diagramming. and mortality among university students. Smartphone-based inter- Results: Participants were enthusiastic about digital therapeutics ventions have the potential to reach large parts of the student popu- for AUD and anticipated high patient demand for such a resource. lation. We developed a proactive smartphone-based intervention for While many participants expressed confidence that previous imple - unhealthy alcohol use with the involvement of students and tested its mentation strategies would be effective for the implementation of efficacy in a randomized controlled trial. digital therapeutics for AUD, they suggested adaptations to accom- Methods: 1770 students with unhealthy alcohol use identified by modate high patient volume and to support patients with varying screening from four Swiss higher education institutions were rand- AUD severity. Several participants advocated for simplified workflows omized to receive access to a smartphone-based intervention (i.e. (e.g., instead of having to go through a provider, patients could con- smartphone application) (n = 884) or to a no-intervention control con- nect to the app directly). Participants hypothesized that patients who dition (n = 886). Follow-ups were at 3 and 6 months. Primary outcome are self-motivated to reduce drinking would be best suited for digital was number of standard drinks per week (SDW) at 6 months. Second- therapeutics; they also recommended that apps include goals besides ary outcome was number of heavy drinking days (HDD; past 30 days) abstinence. at 6 months. The intervention effect on SDW and HDD were tested Conclusions: The implementation of digital therapeutics for AUD using negative binomial generalized linear mixed models with par- would benefit from careful consideration of the target population. ticipants and recruitment sites as random effects and intervention and Optimal integration requires tailoring workflows to meet anticipated time as fixed effects (with an intervention by time interaction term). patient volume and designing workflow and implementation strate - Models were adjusted for age and gender. gies to meet the unique needs of patients with varying AUD severity. Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 4 of 27 O8 27710, USA; Center of Innovation to Accelerate Discovery and Practice Digital therapeutics for opioids and other substance use disorders Transformation, Durham VA Health Care System, Durham NC 27705, USA (DIGITS Trial) in primary care: results of a quality improvement Correspondence: Theresa E. Matson (tessa.e.matson@kp.org) pilot and study protocol for a hybrid type‑III implementation trial Addiction Science & Clinical Practice 2023, 18(Suppl 1): O9 1 1 2 Joseph E. Glass , Tara Beatty , Angela M. Garza Mcwethy , Edwin S. 3 2 1 1 Wong , Ryan M. C aldeiro , Abisola Idu , Jennifer F. Bobb , Jessica M. Background: Clinicians and community health workers may wish to 4 4 1 1 Mogk , Kelsey L Stefanik‑Guizlo , Dustin K ey , Caitlin N. Dorsey , Lorella use digital interventions to reach more patients with unhealthy sub- 1 1 Palazzo , Katharine A. Bradley stance use, optimize costs of care, and improve outcomes. However, Kaiser Permanente Washington Health Research Institute, Seattle, WA digital interventions have unique implementation considerations (e.g., 98101‑1466, USA; Kaiser Permanente Washington Mental Health & Well‑ technology infrastructure, digital literacy, monitoring and follow-up) ness Services, PO Box 9010, Renton, WA 98057‑9010, USA; Department and may not fit traditional care pathways. Effectiveness and imple - of Health Services, University of Washington, Box 357660, Seattle, WA mentation trials are needed to understand how well digital inter- 98195, USA; Center for Accelerating Care Transformation, Kaiser Perma‑ ventions work and how to best deploy them in the real-world. This nente Washington Health Research Institute, Seattle, WA 98101, USA presentation presents a framework to help researchers design their tri- Correspondence: Joseph E. Glass ( joseph.e.glass@kp.org) als in such a way that maximizes scientific understanding. Addiction Science & Clinical Practice 2023, 18(Suppl 1): O8 Methods: This framework draws from the literature on trial design, expert perspectives on the use of digital interventions, and lessons ® ® Background/Objectives: reSET and reSET-O are the first FDA- learned from implementation science research programs. It outlines authorized prescription digital therapeutics (PDTs) for substance use three major steps for designing trials of digital interventions: (1) fram- disorders and opioid use disorder, respectively. More information ing the research question; (2) delineating components of the inter- is needed on how to optimally engage primary care clinicians and vention, implementation strategy, and delivery approach; and (3) patients in using these treatments, which include the community specifying the experiment and other elements of trial design. reinforcement approach and contingency management. Objectives: Results: In Step 1 of this framework, researchers frame the research (1) Describe results of a pilot of reSET/reSET-O implementation in question in terms of the goals or activities to be tested (i.e., features primary care. (2) Describe the protocol for the DIGITS Trial, a cluster- of the digital intervention itself, specific implementation strategies, randomized, hybrid type-III implementation trial testing clinic- and or level of clinical support). In Step 2, researchers define and deline - patient-level strategies for implementing reSET/reSET-O in primary ate each study component as actor, activity, action target, or outcome care. to maximize inference and reproducibility across studies. Steps 1 Methods: From February to May 2021, researchers partnered with and 2 inform Step 3, in which researchers specify features of the trial Kaiser Permanente Washington clinical leaders on a quality improve- design (i.e., experimental/comparator selection, outcome selection, ment pilot of reSET/reSET-O involving two clinicians in two primary and design classification). To illustrate the utility of this framework, we care clinics. Goals were to iteratively refine clinical workflows and a compare and contrast implementation and effectiveness studies of standard implementation strategy. In December 2021, the DIGITS digital interventions for substance use. Trial launched, where primary care sites (currently n = 19) use stand- Conclusions: The proposed framework provides a foundation for ard implementation strategies such as clinician training and perfor- designing trials of digital interventions for substance use in healthcare mance monitoring. Clinics are randomized in a 2 × 2 factorial design and community settings. This framework can help researchers decide to receive up to two added implementation strategies: (1) external on appropriate methodology and help decision-makers understand practice facilitation, a clinic-level implementation strategy, and/or (2) how to apply findings. health coaching, a patient-level implementation strategy. Primary out- comes include reach (proportion of patients prescribed reSET/reSET- O10 O) and fidelity (patient engagement with reSET/reSET-O). Secondary A two‑arm parallel‑group individually randomised prison pilot outcomes include substance use and health care costs. study of a male remand alcohol brief intervention for self efficacy Results: In the 12-week quality improvement pilot, clinicians pre- enhancement: the APPRAISE study 1* 1 2 2 scribed reSET or reSET-O to 13 patients and 8 patients activated their Gillian Waller , Jennifer Ferguson , Aisha Holloway , Jamie B Smith , prescription. Improvements were made to workflows, training materi- Dorothy Newbury‑Birch als, EHR tools, and data management procedures to be leveraged in School of Social Sciences, Humanities and Law, Teesside University, Mid‑ the trial. dlesbrough, TS1 3BX, UK; School of Health in Social Science, University Conclusions: Oer ff ing digital therapeutics for substance use disorders, of Edinburgh, Edinburgh, EH8 9AG, UK; SSSHL Department of Humani‑ including opioids, in primary care appears feasible. The DIGITS Trial will ties and Social Sciences, Teesside University, TS1 3BX, USA provide data on the potential benefits and cost-effectiveness of imple - Correspondence: Gillian Waller (gillian.waller@outlook.com) mentation strategies. Addiction Science & Clinical Practice 2023, 18(Suppl 1): O10 O9 Background: The prevalence of at-risk drinking is higher amongst A proposed framework for designing trials, evaluating individuals within the criminal justice system, with 51–83% of incar- the effectiveness and implementation of digital interventions cerated people being classified as risky drinkers [1] and for individuals for substance use on remand in prison, the prevalence of risky drinking is consistently 1* 2 3 Theresa E. M atson , Eric D.A. Hermes , Aaron R. L yon , Andrew higher (62–68%) [2]. 4 5 6 Quanbeck , Stephen M. S chueller , Sarah (“Sadie”) M. Wilson , Joseph E. Materials and methods: APPRAISE is a two-arm, parallel group, indi- Glass vidually randomised, pilot study of an alcohol brief intervention (ABI), Kaiser Permanente Washington Health Research Institute, Seattle WA which was developed for use with men on remand, across two prison 98101‑1466, USA; School of Medicine, Yale University, New Haven CT sites in North-East England and Scotland [3]. Semi-structured inter- 06510, USA; Department of Psychiatry and Behavioral Sciences, School views were used to explore the acceptability and feasibility of the ABI of Medicine, University of Washington, Seattle WA, USA; Department with (i) male remand prisoners who had received the in-prison ABI, of Family Medicine and Community Health, University of Wisconsin‑Mad‑ (ii) interventionists who had delivered the ABI, and (iii) stakeholders ison, Madison WI 53075, USA; School of Social Ecology, University involved with the running or the management of the pilot. of California, Irvine, Irvine CA 92697, USA; Department of Psychiatry & Results: Findings confirmed that in-prison ABI sessions were more Behavioral Sciences, Duke University School of Medicine, Durham NC acceptable and feasible than post-release sessions, due to being A ddiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 5 of 27 unable to reestablish contact and issues with relapse upon release. Background: Understanding the factors that may lead to alcohol mis- Findings from the prisoner interviews suggested that males welcomed use and problematic drinking is essential to understanding how best receiving support with making changes to their alcohol consumption to design interventions to ameliorate this. Evidence suggests that in and preferred continuous support. It was important for males to feel the UK, alcohol consumption has increased dramatically within cer- comfortable and trusting of an interventionist before sharing their tain regions and populations, with those households purchasing the personal experiences and habits. Findings from the interventionists most alcohol increasing these excess purchases 17 times more than were that the prison setting and culture affected the acceptability those purchasing the least (1) during the COVID-19 pandemic. These and the feasibility of the ABI, due to the lack of available space and increases, alongside the deepening of existing inequalities and crea- staff capacity. The ABI training and content appeared to be acceptable, tion of new pressures during COVID-19 suggests a need reassess these although the length and content could be condensed. The ABI deliv- factors in light of the pandemic. ery benefited from staff buying into the intervention and being moti- Materials and methods: To date 1242 responses to online ques- vated and engaged. The stakeholder data identified the importance of tionnaires have been gathered as well as the completion of 106 engagement with prisoners and the lack of currently available support semi-structured interviews. Data from these are presented, having for males on remand. undergone thematic analysis and their implication for future interven- Conclusion: The APPRAISE ABI appeared to be feasible and acceptable tions are discussed. to implement, although future work should focus on determining the Results: The self-reported impact of the pandemic, particularly lock- feasibility and acceptability of the ABI on a wider scale. downs on the general wellbeing of participants was significant, although not always negative. However for those that indicated that they did suffer a reduction in wellbeing (and increase in alcohol con- O11 sumption) sometimes multiple vulnerabilities were also implicated. An exploration of delivering screening and brief interventions Conclusions: Vulnerability can take many forms—cultural, economic, for women leaving prison, a holistic approach 1* 2 3 and social being just some of these. Interventions targeting prob- Jennifer Ferguson , Dorothy Newbury‑Birch , Aisha Hollo way lematic alcohol consumption in communities must be aware of these School of Social Sciences, Humanities and Law, Teesside University, Mid‑ vulnerabilities and the role they play in order to ensure their impact, dlesbrough, TS1 3BX, UK; SSSHL Department of Humanities and Social particularly in unprecedented times. Sciences, Teesside University, TS1 3BX, UK; School of Health in Social Science, University of Edinburgh, Edinburgh, EH8 9AG, UK Correspondence: Jennifer Ferguson ( jennifer.ferguson@tees.ac.uk) O13 Addiction Science & Clinical Practice 2023, 18(Suppl 1): O11 Safe and Wellbeing Visits: a brief intervention tool to drive forward population health improvements using the fire service Background: Whilst it is well evidenced that the prevalence of alcohol in County Durham 1* 2 2 3 misuse is high in the criminal justice system, and it can be shown it Natalie Connor , Mark Henderson , Rob Cherrie , Gill O’Neill , Dorothy is for women on their own also, it is important to investigate the dif- Newbury‑Birch ferences between men and women, in order to tailor interventions to School of Social Sciences, Humanities and Law, Teesside University, Mid‑ this specific population. More females are found to be risky drinkers dlesbrough, TS1 3BX, UK; County Durham and Darlington Fire & Rescue 3 4 when they arrive in prison (24%) compared to males (18%) and there Service; Durham County Council SSSHL Department of Humanities are established gendered pains of imprisonment. Early PhD work by JF and Social Sciences, Teesside University, Middlesbrough, TS1 3BX, UK explored this unmet need, this work further explores this with a par- Correspondence: Natalie Connor (n.connor@tees.ac.uk) ticular focus on prison staff delivering the intervention. Addiction Science & Clinical Practice 2023, 18(Suppl 1): O13 Materials and methods: Two systematic reviews and 18 in depth qualitative interviews were carried out with women in an open prison Background: Reductions in dwelling fires are largely due to preven- and relevant staff and stakeholders. Thematic analysis of the tran- tion work carried out by the Fire and Rescue Service (FRS). Safe and scripts was undertaken and triangulated with the reviews and recom- Wellbeing Visits (SWV) were introduced in 2016 by County Durham mendations for a future pilot study were made. and Darlington Fire and Rescue Service focusing on preventative Results: The findings of the qualitative work aligned with the already health as well as fire. Prevention work carried out by the FRS is enabled evidenced pains of imprisonment. The research highlighted the impor- by its reputation as a trusted organisation. Vulnerable residents at risk tance of using the 10 question AUDIT to establish rapport as well as from fire as well as a range of health conditions are an ideal audience its main purpose of screening. However, whilst participants discussed for the FRS to target brief interventions. One of the health conditions pragmatic issues but one of the main findings was the element of staff screened for in the SWV is risky alcohol consumption, with it being a rapport within the setting. It was surprisingly a uniformed officer who risk factor for dwelling fires. was most favoured for delivery of the intervention. Materials and methods: A mixed methods approach was used to Conclusions: SBI with women in an open prison setting is both feasi- analyse SWV referral data, alongside focus groups (N = 7) and inter- ble and acceptable but the importance is around who delivers the SBI, views (N = 16) with service beneficiaries, delivery staff and partners. with existing staff being favourable to the women. Results: 11,485 individuals were screened for risky alcohol consump- tion over a two year period. 0.4% were eligible for referral. There were high levels of engagement to services for dementia, loneliness and O12 Examining the role of vulnerabilities on alcohol consumption isolation, and a Warm Home scheme. Lower levels of engagement in th were experienced for alcohol, smoking and slips, trips and falls. Quali- e age of COVID19 and their implication for interventions 1* 2 3 tative analysis allowed key strategic and operational themes to be Andrew Divers , Judith Eberhardt , Dorothy Newbury‑Birch developed. School of Social Sciences, Humanities and Law, Teesside University, Mid‑ Conclusion: Although SWVs provide an opportunity for early inter- dlesbrough, TS1 3BX, UK; SSHL Psychology Centre for Applied Psycho‑ vention with those with risky alcohol consumption, less than 1% are logical Science, Teesside University, Middlesbrough, TS1 3BX, UK; SSSHL identified. In addition, services are then experiencing low levels of Department of Humanities and Social Sciences, Teesside University, Mid‑ engagement. Further work is required to explore this, as other refer- dlesbrough, , TS1 3BX, UK rals from SWVs are experiencing higher levels of identification and Correspondence: Andrew Divers (a.divers@tees.ac.uk) engagement. Addiction Science & Clinical Practice 2023, 18(Suppl 1): O12 Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 6 of 27 O14 Conclusions: One of the primary areas impacting mental (and in some Screening for and assessing alcohol use and consequences cases physical) health during this time has been the demands and in adolescents changes to employment, especially for young people. The effect that 1* 2 3 Paul Toner , Jim McCambridge , Jan R. Böhnke this has and will continue to have will be explored, and implications 1 2 3 Queen’s University Belfast, Belfast, UK; University of York, York, UK; Uni‑ for future brief interventions will be discussed. versity of Dundee, Dundee, UK Correspondence: Paul Toner (p.toner@qub.ac.uk) O16 Decoupling SBIRT from in person visits: understanding Addiction Science & Clinical Practice 2023, 18(Suppl 1): O14 factors influential to engaging college students in electronic health screens & motivational interventions Aims: This programme of work was stimulated by a gap in knowl- W. Turner*, J. Kamon, S. G. Mitchell, L. B Monico edge identified in research, policy and practice literature and aimed to Center for Behavioral Health Integration O5602 United States, Friends develop an item bank to screen for and assess the continuum of alco- Research Institute, Baltimore, MD 21201, USA hol risk and harm in adolescents. Correspondence: W. Turner (wincturner@gmail.com) Methods: The project adopted a sequential mixed methods design Addiction Science & Clinical Practice 2023, 18(Suppl 1): O16 integrating thematic and advanced psychometric analyses. Semi- structured interviews with 44 adolescents in a range of UK settings Background: High rates of substance use, mental health risk, and low including: schools, supported accommodation, criminal justice set- treatment engagement for college-aged young adults (18–24 years tings, community groups; were conducted to develop and refine item old) is a major healthcare problem in the US. While prior screening, content for screening and assessing alcohol use and consequences brief intervention, and referral to treatment (SBIRT) approaches with identified in a meta-analysis conducted by the authors. The resultant this population have been commonly embedded in campus coun- 65 items produced were completed by 381 adolescents, and the 33 seling/health centers and targeted screening with those seeking ser- items brought forward from this exploratory stage were then tested vices, COVID-19’s disruption and displacement of college students with 827 adolescents. required alternative methods for reaching college students. Results: Exploratory analysis indicated that an item based on Materials and methods: Data presented draw from a CSAT-funded heavy episodic drinking is most predictive of full AUDIT score > 8 for college SBIRT project conducted across 4 college campuses in Ver- screening. mont, US September 2020 through March 2022. Due to varied states of The new assessment items have an alpha of 0.92 (adjusted for 10 campus closure during this period, SBIRT was decoupled from in-per- items), outperforming the best existing instruments. son clinic visits and a universal screening approach was undertaken Confirmatory categorical structural equation modelling supported the using virtual platforms for screening as well as hybrid approaches for exploratory results with the best performing screening item: (In the treatment delivery. last 3 months) on how many days did you have six or more drinks on Results: Campus based wellness staff used a range of targeted out - the same occasion? reach activities to find and screen naturally occurring sub-commu- The assessment items demonstrated excellent model fit: CFI = 0.99, nities of students including campus wide email requests, QR codes TLI = 0.99, RMSEA = 0.059 (90% CI: 0.056-0.062) with an alpha value of on billboards, class & dormitory visits and events. Results indicated 0.87 (adjusted for 10 items). not just the feasibility and acceptability of using these outreach Conclusions: The significance of this new item bank for screening and approaches but a high overall prevalence of MH and SU together assessing alcohol-related consequences in adolescents, recommenda- (61%) with use of alcohol, cannabis, or other drugs (18%), mental tions for further validation and applicability to different practice set - health risk for depression (25%), and anxiety (36%). In addition, of tings will be discussed. those students screened 12% had thoughts of self-harm. Conclusions: College students hearing about the wellness program O15 through a class, residence hall, sports team or campus activity will ini- Measuring the impact of employment stresses on mental health tiate and complete the electronic health/wellness screening. Students and alcohol consumption in young people identified with risks during screening for depression, anxiety, and/or 1* 2 1 1 Andrew Divers , Fiona Helyer , Clifford Johnson, Hazel Wright , Dorothy substance use were willing to engage in brief motivational conversa- Newbury‑Birch tions with the wellness staff after receiving one or several of the fol- 1 2 Teesside University, Middlesbrough, UK; Middlesbrough Council, Mid‑ lowing: email response with health resources, calendar link and/or dlesbrough, UK incentives for engagement. Correspondence: Andrew Divers (a.divers@tees.ac.uk) Addiction Science & Clinical Practice 2023, 18(Suppl 1): O15 O17 Adolescent behavioral responses to COVID‑19 Background: The COVID-19 pandemic has affected many aspects of and the development of the Pandemic Response Index 1* 1 1 our lives, and the impact of this is far from over. This paper will exam- Shannon Gwin Mitchell , Laura B. Monico , Jan Gryczynski , Kaitlyn 1 1 2 ine both the temporary and lasting changes to factors affecting alco - Garrison, Tyler Ross , Kevin O’Grady 1 2 hol consumption—the amounts consumed as well as the patterns, Friends Research Institute, Baltimore, MD 21201, USA; QuantAid habits, and attitudes around this—in the light of changing pressures Correspondence: Shannon Gwin Mitchell (smitchell@friendsresearch. as we move through various stages of the pandemic. org) Materials and methods: Data for this study has been gathered Addiction Science & Clinical Practice 2023, 18(Suppl 1): O17 through a combination of purposive, semi-structured interviews and online questionnaires. In total, 106 participants have been interviewed Background: This analysis seeks to understand the impact of the and 1242 responses to online questionnaires have been gathered. COVID-19 pandemic-related lockdowns on substance use behaviors Both interview and qualitative survey data subjected to thematic anal- among a sample of adolescent primary care patients. ysis are presented here. Materials and methods: Data for this analysis were compiled from Results: The study is still ongoing, but initial findings suggest that a a large RCT testing the effectiveness of a screening, brief interven- significant contributor to deleterious mental health and wellbeing in tion, and referral to treatment (SBIRT) package among adolescents young people is their employment experience—from the stress of (aged 12–17, inclusive) in primary care. Recruitment largely ceased in being unable to find secure employment (and associated financial March 2020 but 249 individuals completed a 12-month follow-up sur- concerns) to unique demands and concerns over safety brought about vey that also included a COVID-19 specific questionnaire. These items by the workplace during the pandemic. A ddiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 7 of 27 4 4 4 4 were analyzed as five distinct indices, referred to as the Pandemic Ashley Case , Margaret Kline , Rebecca Price , Eve Jelstrom , Travis 5 6 7 Response index (PRI): Positive Actions, Negative Actions, Anti-Social Lovejoy , Lillian G elberg , Jane M. Liebschutz Behavior, Family Conflict, and Family Stress. Participants also com- Department of Population Health, New York University Grossman School pleted the S2BI, ASSIST, and BSTAD for substance use. Four separate of Medicine, New York, NY 10016, USA; Department of Psychiatry, New logistic regression analyses were conducted on each of the following York University Grossman School of Medicine, New York, NY 10016, USA; outcomes: tobacco, alcohol, marijuana, and any substance use. National Institutes of Health, National Institute on Drug Abuse, Bethesda, 4 5 Results: The sample was primarily white (70%), non-Hispanic (63%), MD 20852, USA ; The Emmes Company, Rockville, MD, USA; Department with an average age of 14.2 years. With regard to the PRI, the odds of of Psychiatry, Oregon Health & Science University, Portland, OR 97239, tobacco use decreased 50% with each 1 SD increase in Positive Action USA; Department of Family Medicine, David Geffen School of Medicine score, and increased 82% with each 1 SD increase in Family Stress at UCLA, Los Angeles, CA 90095, USA; Division of General Internal Medi‑ score. The odds of alcohol use increased 60% with each 1 SD increase cine, Center for Research On Health Care, University of Pittsburgh School in Negative Actions score, and increased 67% with each 1 SD increase of Medicine, Pittsburgh, PA 15213, USA in Antisocial Behavior score. The odds of any substance use increased Correspondence: Jennifer McNeely ( jennifer.mcneely@nyulangone.org) 45% with each 1 SD increase in Family Stress score. There were no sig- Addiction Science & Clinical Practice 2023, 18(Suppl 1): O19 nificant PRI predictors of marijuana use. Conclusions: Adolescents are a unique and vulnerable population to Background: The Subthreshold Opioid Use Disorder Prevention consider during the COVID-19 pandemic, given the loss of structural (STOP) Trial is a 5-site randomized controlled trial of a primary care support provided by daily activities and connections with other youth intervention for risky opioid use. The study tests the effectiveness of and adults outside the home. Greater behavioral and mental health a collaborative care intervention consisting of brief advice delivered support should be targeted toward adolescents experiencing negative by the primary care provider (PCP), telephone health coaching (2–6 responses in order to decrease the likelihood of substance use. sessions), and an in-clinic nurse care manager (12 months). Recruit- ment began in early 2021, and pandemic-related changes at the study sites (telehealth visits, restrictions on research staff in clinic) required O18 adaptation of the original plans for in-person recruitment, enrollment, Phone based brief intervention for alcohol use reduction assessments, and PCP interventions. during a COVID‑19 pandemic: a telenursing care proposal Methods: This cluster-randomized trial enrolls PCPs and their adult in primary health care in Brazil patients (18 +) who have opioid misuse but not moderate-severe opi- Divane de Vargas , Caroline Figueira Pereira, Erika Gisseth León Ramírez, oid use disorder. Key adaptations to study procedures were: (1) remote Jose’Adelmo da Silva Filho, Sheila Oliveira Ramos patient recruitment, using a combination of messages sent through School of Nursing, University of São Paulo, São Paulo, Brazil the electronic health record (EHR), mailed letters, email, and text mes- Correspondence: Divane de Vargas (vargas@usp.br) sages inviting patients to take an on-line prescreening assessment; Addiction Science & Clinical Practice 2023, 18(Suppl 1): O18 (2) delivery of PCP brief advice during telehealth visits or phone calls within 10 business days of enrollment; and (3) fully remote computer- Background: Studies from Brazil showed that more than 50% of the ized study procedures for screening and assessments. population had an increase in alcohol consumption during the first Results: The study is ongoing, and results are reported for the first year of the COVID-19 pandemic, which may result in complications 12 months. A total of 101,233 invitations to prescreen were sent to arising from harmful use of this substance and increased need for patients identified in the EHR, and 20,148 completed the prescreener, specialized medical care. This can be most challenging for emerging representing a 20% response rate. Of those completing prescreening, developing countries such as Brazil, where political and socioeco- 2.3% prescreened eligible, of which 36% were eligible for the study, nomic conditions, as well as a scarcity of mental health care services, and 83% enrolled. PCPs frequently delivered brief advice with phone had been experienced even before the COVID-19 pandemic. There- calls that were not part of a medical visit. Completion rates for on-line fore, preventive strategies to prevent mental health disorders, as well monthly assessments ranged from 94–99%. as alcohol misuse in the population, when face-to-face contact is Conclusions: Recruitment for this primary care study has been chal- restricted, should be implemented. lenged by relying on remote methods, primarily due to low response Objective: This analyzed the impact of a one-session remote brief to invitations to prescreen. For enrolled patients, participation in intervention, carried out by nurses through a telephone approach to remote assessments has been high, demonstrating good acceptability reduce alcohol use in Primary Health Care patients in Brazil. of this approach. Methods: Quasi-experimental study conducted with 1270 partici- pants who answered the Alcohol Use Disorders Identification Test (AUDIT C). This study considered delivering the phone-based brief O20 intervention to those whose AUDIT scores indicated risky or harmful Alcohol use and binge drinking during COVID‑19 pandemic: alcohol use. All participants who received the phone-based interven- a multicentre cross‑sectional study in Brazil 1* 1 tion were followed 90 and 180 days after the intervention. Erika Gisseth León Ramírez , Divane de Vargas , Jaqueline Ribeiro Results: A positive effect of the phone-based brief intervention Magalhães in alcohol use reduction was observed in all follow-ups (¬µ = 1.57 Psychiatric Nursing Department, School of Nursing University of São p < 0.001). Paulo, São Paulo, Brazil Conclusions: The results suggest that the phone-based brief interven- Correspondence: Erika Gisseth León Ramírez (egleonr@usp.br) tion delivered by primary health care nurses is a potential alternative Addiction Science & Clinical Practice 2023, 18(Suppl 1): O20 for preventive care in mental health and alcohol misuse, in situations where the face-to-face screening and brief intervention among pri- Background: Binge drinking is a type of harmful use defined as mary health care patients were restricted. the use of about 60 g of alcohol in about 2 h. The increase in binge drinking intensified with the restriction measures arising of COVID- 19 Pandemic. There is evidence that social isolation has potentiated O19 stress conditions, with consequences for the mental health of the Adapting a primary care collaborative care intervention trial population, such as increased the alcohol use. In Brazil, although in response to the COVID‑19 pandemic: remote recruitment there are few publications about the binge drinking associated with and assessments in the Subthreshold Opioid Use Disorder the isolation period, there is evidence of an increase about 17% in the Prevention (STOP) trial 1* 2 1 alcohol use by Brazilians during the pandemic. Therefore, this study Jennifer McNeely , Rebecca Stone , Noa Appleton , Amanda M. 1 3 4 4 aims to investigate the alcohol use, binge drinking and correlated Bunting , Geetha Subramaniam , Jennifer McCormack, Tobie Kim , Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 8 of 27 factors in patients from primary health care services in the city of São O22 Paulo-Brazil. Eec ff ts of adolescent SBIRT education using simulated learning Methods: This is a multicentre cross-sectional study carried out technology in health professional training 1* 1 2 between December 2020 and March 2022, conducted with 1285 Jackie Sheridan‑Johnson, Weiwei Liu , Hildie Cohen , Tracy L. patients of primary health care services in several regions of the city McPherson of São Paulo. The Alcohol use form was applied, with questions about Public Health, NORC at the University of Chicago, Chicago, IL 60603, USA; alcohol use before and during the pandemic. The alcohol use classifi- Health Sciences, NORC at the University of Chicago, Chicago, IL 60603, cation was performed using the short version of the Alcohol Use Disor- USA ders Identification Test (AUDIT-C). Correspondence: Jackie Sheridan‑Johnson (sheridan‑jackie@norc.org) Results: A large majority (83.1%) of the respondents reported con- Addiction Science & Clinical Practice 2023, 18(Suppl 1): O22 suming alcohol in the previous three months, of these 30% (44.9% male and 55.1% female) reported engaging in binge drinking at least Background: Social workers, nurses, and other health professionals once in the previous three months. Using logistic regression analy- can help prevent and reduce substance use among youth by using the ses, results showed that having depression, occupational levels, and screening, brief intervention, and referral to treatment (SBIRT) model increase of alcohol during the pandemic, were all significantly and in care settings. NORC at the University of Chicago, along with leading independently associated with binge drinking. professional education experts, developed and tested an adolescent Conclusions: Our findings indicate that, situational, social and psy - SBIRT curriculum for use in nursing, social work, and interprofessional chological factors are important determinants of excessive alcohol education. Since 2015, the curriculum has been implemented with consumption, and it could be used as a potential target for interven- more than 15,000 students in over 600 U.S. programs. This study evalu- tions to reduce alcohol use and prevent complications arising from ated the impact of the education on students’ attitudes towards work- this consumption. ing with people who drink alcohol; perceived readiness, confidence, competence; knowledge, and skills. Materials and methods: Students completed a pre-training survey, O21 received adolescent SBIRT education including an online simula- Early identification and brief intervention for alcohol use tion, and a post-training survey. A pretest–posttest design was used disorders: the training programme on EIBI of the Local Health to investigate the effects of the education on student attitudes, con- Unit of Salerno, Italy 1* 2 1 1 fidence, competence, readiness, knowledge, and skills. The sample Claudia Gandin , Aniello Baselice , Silvia Ghirini , Alice Matone , Antonio 2 1 included 33 schools with 1646 students. Paired t-tests were conducted De Luna , Emanuele Scafato to evaluate overall differences between pre- and post- measures. National Observatory on Alcohol, National Centre on Addictions Subgroup (e.g., undergraduate/graduate, prior training) differences and Doping, Istituto Superiore di Sanità, Rome, 00161, Italy; Department in outcomes were evaluated using independent sample t-tests and of Addictions, Local Health Unit Salerno, Campania Region, Italy OLS regressions. Separate OLS regression models were conducted for Correspondence: Claudia Gandin (claudia.gandin@iss.it) undergraduate and graduate students. Addiction Science & Clinical Practice 2023, 18(Suppl 1): O21 Results: All outcome measures were significantly higher after SBIRT education. Undergraduate students showed significantly higher Background: "Rete IPIB-ASL Salerno" is a 4 year programme on EIBI improvement than graduate students in confidence, competence, (Identificazione Precoce e Intervento Breve ‚Äì IPIB in Italian) for Alco - and readiness. Controlling for other demographic covariates, gradu- hol Use Disorders (AUDs) in Primary Health Care (PHC) promoted by ate students without prior SBIRT training showed significantly higher the Addiction Department of the Salerno Local Health Unit (LHU), improvement in competence, confidence, readiness, and knowledge Campania Region and implemented in partnership with the Istituto compared to those with prior training. No such differences were Superiore di Sanità. shown for undergraduate students. – To develop and implement a local training programme on IPIB for Conclusions: Findings suggest that adolescent SBIRT education AUDs for PHC professionals; including simulation-based training can positively build students – To create a network of professionals of the Salerno LHU qualified on knowledge and skills and boost their confidence in implementing IPIB for AUDs and other lifestyles behaviours. adolescent SBIRT. Results also suggest the importance of tailoring Materials and methods: Steps of activities: training to suit the needs of different subgroups with different past 1. Analysis of the resources on alcohol prevention-interventions for training and experiences. activation of training (mapping the Salerno LHU services); 2. Implementation of the training on IPIB for AUDs and other lifestyles behaviours of health professionals starting from the PHEPA project O23 standard (Primary Health Care Project on Alcohol) plus additional Validity of the Single‑Item Screen‑Cannabis (SIS‑C) for cannabis units (such as Unit 2 ‚ Äú Attitudes to alcohol‚ Äù) from the new World use disorder screening in routine care Health Organization alcohol brief intervention training manual for pri- Theresa E. Matson*, Gwen T. Lapham, Jennifer F. Bobb, Malia Oliver, Kevin mary care (2017). A. Hallgren, Emily C. Williams, Katharine A. Bradley 3. Creation of a local network of professionals skilled on IPIB model. Kaiser Permanente Washington Health Research Institute, Seattle WA Results: Overall, training reached about 500 professionals of the 98101, USA Salerno LHU (who have completed the training). The attitudes on alco- Correspondence: Theresa E. Matson (tessa.e.matson@kp.org) hol of professionals before/after the training and the merged needs Addiction Science & Clinical Practice 2023, 18(Suppl 1): O23 will be summarized (the lack of sufficient training, of e-interventions during the COVID-19 emergency, of role legitimacy and of time as Background: Cannabis use is prevalent and increasing. Frequent can- main obstacles for the IPIB implementation; the availability of a mul- nabis use intensifies risk of cannabis use disorder (CUD). CUD is under - tidisciplinary team, the network and its coordination, the guidelines- recognized in medical settings, but a validated single-item cannabis protocols-tools as facilitators). screen could increase recognition and care. The study aimed to vali- Conclusions: For self-replicating / self-maintaining the training activ- date the Single-Item Screen-Cannabis (SIS-C), administered and docu- ity over time and for creating a consolidated network of trainers quali- mented in routine primary care, compared to a confidential reference fied on IPIB for AUDs and other lifestyles behaviours it is essential: standard of CUD. – To ensure training skills and knowledge on IPIB for AUDs for all pro- Methods: This validation study was conducted in an integrated health fessionals working in PHC settings; system in Washington, where adult cannabis use is legal. Participants – To support the coordination of the network at local level involving were adult patients screened for cannabis use in primary care who different settings for different target populations. also responded to a confidential survey (N = 1688; 34% response A ddiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 9 of 27 efficacy still needs to be studied (we expect to have the first results on rate). The SIS-C asks about frequency of past-year cannabis use with efficacy by august). responses (none, less than monthly, monthly, weekly, daily/almost daily) documented in patients medical records. The SIS-C was com- pared to patient response on the Diagnostic and Statistical Manual, O25 5th edition (DSM-5) Composite International Diagnostic Interview Understanding what strategies Dry January participants use (CIDI) for past-year CUD (i.e., reference standard), completed on the to temporarily abstain from alcohol 1* 1 2 2 survey. Analyses estimated screening performance (e.g., sensitivity, Anna L Butters , Matt Field , Inge Kersbergen , John Holmes specificity, area under receiver operating characteristic curves [AUC]) Department of Psychology, University of Sheffield, Sheffield, South of the SIS-C. Analyses were weighted, accounting for survey design Yorkshire, S1 2LT, UK; School of Health and Related Research, University and nonresponse, to obtain estimates representative of the health sys- of Sheffield, Sheffield, S1 4DA, UK tem primary care population. Correspondence: Anna L Butters (abutters1@sheffield.ac.uk) Results: 6.6% of patients met •2 criteria for past-year CUD, including Addiction Science & Clinical Practice 2023, 18(Suppl 1): O25. 1.9% who met •4 criteria for moderate-severe CUD. The SIS-C dem- onstrated strong validity for identifying any CUD (AUC 0.89 [95% CI: Background: Remaining fully abstinent during temporary abstinence 0.78–0.96]) and moderate-severe CUD (AUC 0.95 [0.94–0.96]). A thresh- challenges such as Dry January is associated with greater ongoing old of less than monthly cannabis use had the best balance of sensitiv- reductions in alcohol consumption. Participants in these challenges ity (0.88) and specificity (0.83) for detecting any CUD; a threshold of use various strategies to avoid drinking alcohol, including goal setting, monthly use had the best balance of sensitivity (0.96) and specificity self-monitoring, public commitment, and restructuring their social (0.89) for detecting moderate-severe CUD. environments. It is unclear how use of these strategies affects absti- Conclusion: The SIS-C had excellent performance when used in rou- nence during Dry January. This exploratory research aimed to identify tine care as a screen to identify patients at risk of CUD for brief inter- which strategies Dry January participants use to maintain abstinence vention or further assessment. and evaluate to what extent strategy use is associated with abstinence (or alcohol consumption) during the month. Materials and methods: We first identified 14 strategies to avoid O24 drinking in collaboration with past Dry January participants. Then, Usability of a brief intervention combined with a gamified 105 people who had registered for Dry January completed baseline webapp to improve retention to the addiction treatment and post-January questionnaires. We measured alcohol consumption in patients with alcohol‑related liver disease 1* 1 1 (AUDIT-C), motivation to change, drink-refusal self-efficacy (DRSE) Elsa Caballeria Lamora , Clara Oliveras , Maria Teresa Pons‑Cabrera , Neus 1 1 1 1 2 and how frequently participants used the 14 strategies to avoid drink- Freixa , Pol Bruguera , Laura Nuño , Anna Lligoña , Alexandra Estruch , 2,3 1 1 ing. Data were analysed using linear, logistic and poisson regression Oscar García‑Pañella , Soraya Sabate , Ana Isabel López‑Lazcano , Cristal 1 1 1 1 models. Martínez , Antoni Gual , Mercè Balcells‑Oliveró , Hugo López‑Pelayo Results: There was considerable variation in the number and fre- GRAC, Addictions Unit, Department of Psychiatry, Clinical Institute quency of strategies used during Dry January. Two strategies, Public of Neuroscience, Hospital Clínic, RETICS, University of Barcelona, Institut commitment and Restructuring the social environment were indepen- d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, 2 3 dently associated with greater reduction in AUDIT-C over the course of Spain; Cookie Box S.L, Barcelona, Spain; Escuela de Nuevas Tecnologías January. No strategy was significantly associated with total abstinence. Interactivas, Barcelona, Spain The number of strategies participants used was not significantly asso - Correspondence: Elsa Caballeria Lamora (caballeria@recerca.clinic.cat) ciated with total abstinence or change in AUDIT-C. Addiction Science & Clinical Practice 2023, 18(Suppl 1): O24 Conclusions: Making a public commitment to temporary abstinence or restructuring one social environment may help to limit any con- Background: Retention to the addiction treatment in patients with sumption that occurs when someone is attempting to abstain during alcohol-related liver disease (ARLD) is scarce despite the crucial role Dry January. Recommending the use of these strategies during Dry of abstinence. With the aim of improving treatment retention in these January may improve drinking outcomes among participants. Consid- patients, and using a co-creational methodology, we designed an erable variation in the use of strategies between participants indicates intervention consisting in a gamified Webapp (6 weeks of duration) that further research is needed to understand how and why people and a brief 2-sessions face-to-face motivational intervention. We pre- use certain strategies. sent the results regarding the usability and satisfaction of the patients with the intervention. Materials and methods: Two co-creation sessions were organ- O26 ized, with the participation of 40 people (professionals, patients and Investigating for whom brief substance use interventions are patients relatives) to collect information to design the intervention most effective: an individual participant data meta‑analysis 1* 2 3,4 format and contents. Once the first version of the intervention (brief Maria L. Schweer Collins , Nicholas J. Parr , Rich Saitz , Emily E. 1,5 face-to-face intervention + Webapp) was designed, a usability study Tanner‑Smith 1 2 was conducted. For that, 10 patients with ARLD and 10 professionals University of Oregon, Prevention Science Institute, Eugene, OR, USA; U.S. were recruited. They received a weekly call to answer an open inter- Department of Veterans Affairs Evidence Synthesis Program Coordinating view regarding the completed module of the webapp, and completed Center, VA Portland Health Care System, Portland, OR, USA; Department two questionnaires regarding usability (System Usability Scale, SUS; of Community Health Sciences, Boston University School of Public Health, Post-Study System Usability Questionnaire, PSSUQ). Boston, MA, USA; Clinical Addiction Research and Education Unit, Sec‑ Results: Receiving personalized feedback, the adaptation of the inter- tion of General Internal Medicine, Boston University School of Medicine; vention storytelling to the progress of the patient, providing additional Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA; content and sources, adding interactive elements to the intervention University of Oregon, Counseling Psychology and Human Services and using a broad variety of exercises are the most valued aspects of Department, University of Oregon, Eugene, OR, USA the intervention. The brief intervention was considered a good first Correspondence: Maria L. Schweer Collins (mschweer@uoregon.edu) step before being referred to the Addictions Unit, with the information Addiction Science & Clinical Practice 2023, 18(Suppl 1): O26 provided being of quality and useful. Regarding the Webapp, partici- pants reported that it was easy to use, with a pleasant interface, with Background: Brief interventions (BIs) are one evidence-based and clear information and the expected capabilities and contents. widely implemented prevention strategy to address substance use. A Conclusions: Including the targeted patients of the intervention and large body of literature has examined the efficacy of BIs for addressing professionals to the design process was feasible. Complementing the alcohol and other drug use and shows that BI effects can vary widely brief intervention with a gamified Webapp is promising, although the Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 10 of 27 across studies, including minimal or inconsistent efficacy among ado - O28 lescent and aging adults, persons experiencing unstable housing, Who benefits from brief motivational intervention women, and those with minoritized racial and ethnic identities. Due among alcohol‑intoxicated young adults admitted to these critical gaps, the objective of this individual participant data to the emergency department: a moderation profiles analysis 1* 2 3 1 (IPD) meta-analysis was to explore the types of patients for whom BIs Jacques Gaume , Molly M agill , Jim McCambridge , Nicolas Bertholet , 4 1 delivered in general healthcare settings are more or less effective on a Olivier Hugli , Jean‑Bernard Daeppen Bertholet range of outcomes. Department of Psychiatry‑Addiction Medicine, Lausanne University Methods: In this IPD meta-analysis, we synthesized evidence from Hospital, 1011 Lausanne, Switzerland; Center for Alcohol and Addiction 29 randomized trials, drawn from a larger aggregate data meta- Studies, Brown University School of Public Health, Providence, RI 02,912, analysis. The meta-analysis was pre-registered with PROSPERO USA; Department of Health Sciences, University of York, York, YO10 5DD, (#CRD42018086832). Analyses were carried out using a two-stage IPD UK; Emergency Department, Lausanne University Hospital, Lausanne, meta-analysis approach. 1011, Switzerland Results: Trials were conducted in the United States and Canada Correspondence: Jacques Gaume ( jacques.gaume@chuv.ch) (k = 17; 55%) and internationally (k = 13, 45%). For alcohol consump- Addiction Science & Clinical Practice 2023, 18(Suppl 1): O28 tion at 3-months post-treatment, BIs led to significant reductions in binge alcohol consumption (0.09, 95% CI [0.03, 0.14]) and frequency Background: Little is known about which patients benefit from brief of alcohol consumption (0.10, 95% CI [0.03, 0.17]) among females. BIs Motivational Interviewing (bMI) for heavy drinking among young also led to a significant reduction in frequency of alcohol consumption adults in the Emergency Department (ED). (0.16, 95% CI [0.09, 0.22]) among patients with educational attainment Materials and methods: We conducted moderation analyses of data below high school level. At 6-months post-treatment, patients with from a randomized controlled trial (RCT). Young adults (18–35 years) non-White identities showed BI effects on significant reductions in admitted in the ED with alcohol intoxication (N = 344) were rand- cannabis consumption quantity relative to control (0.07, 95% CI [0.05, omized to receive either bMI or brief advice (BA). Outcome was the 0.10]). Complete results will be presented. number of heavy drinking days at short- (1-month) and long-term Conclusions: When delivered in general healthcare settings, females (12-month) follow-up. We used latent profile analyses to derive par - and individuals with below high school educations show modest, ben- ticipants profiles based on baseline characteristics (gender, age, eficial reductions in alcohol consumption. There is limited evidence of AUD severity, attribution of ED admission to alcohol use, confidence/ benefits of BI on drug use outcomes, although non-White individuals importance to change, cognitive discrepancy, positive/negative alco- show BI-driven reductions in cannabis use following intervention. hol expectancies, anxiety, depression, and trait reactance). We then computed negative binomial regressions with an interaction between intervention and dummy-coded profiles. O27 Results: Fit statistics indicated a 4-profile solution. At short-term fol- Barriers to seeking treatment for alcohol use disorders: the role low-up, there were significant interactions when comparing Profiles 1 of severity of alcohol use and gender and 2, and Profiles 1 and 3. At long-term follow-up, there was a sig- Sara Wallhed Finn*, Anna Mejldal nificant interaction when comparing Profiles 1 and 2. Profile 2 was University of Southern Denmark, Odense, Denmark & Karolinska Insti‑ characterized by high severity, negative expectancies, importance, tutet, Stockholm, Sweden and discrepancy, low confidence, and low anxiety; those participants Correspondence: Sara Wallhed Finn (sara.wallhed‑finn@ki.se) benefitted more from bMI at 1-month and 12-month as compared to Addiction Science & Clinical Practice 2023, 18(Suppl 1): O27 Profile 1. Profile 3 was characterized as older participants, having the highest severity, negative expectancies, importance, discrepancy, Background: A minority of all individuals with alcohol use disorders reactance, anxiety and depression, but the lowest confidence; those (AUD) seek treatment. Since the suffering from AUD has severe conse - benefitted more from bMI at 1-month as compared to Profile 1. Profile quences for both the individual and for society, knowledge about bar- 1 was characterized as younger participants, having the lowest sever- riers for treatment seeking is of importance. Most studies of barriers ity, expectancies, importance, discrepancy, reactance, anxiety and this far have been conducted in the USA or the UK. There is a need for depression, and the highest confidence; those benefitted more from studies from other contexts. BA. Aim: To investigate barriers to treatment seeking for AUD. Conclusions: Findings showed important moderation effects within The specific aims are to investigate: a RCT having shown the effectiveness of bMI on heavy drinking. This 1. Barriers to AUD treatment at different levels of alcohol use. suggest that patients characteristics profiles should be considered 2. Gender differences regarding barriers to AUD treatment. when implementing bMI. Methods: Study design: Cross-sectional. Participants: 1594 represent- ative Danish adults from the general population aged 30 ‚Äì 65 years. An online questionnaire was administrated by a market research com- O29 pany. The questionnaire covered demographic data, barriers to treat- Eec ff tiveness of alcohol brief intervention on drinking and blood ment and level of alcohol use. Analyses were performed by means of pressure outcomes in adult patients with hypertension: results chi-2 test and logistic regression. from a systematic alcohol screening and brief intervention Results: The most common barriers were related to stigma. Those with initiative in a U.S. health system 1* 1 1 1 higher severity of alcohol use are more like to endorse a wish to han-Stacy Sterling , Felicia W. Chi , Sujaya Parthasarathy , Vanessa A. P alzes , 1 1 2 1 dle alcohol problems themselves and to report treatment related bar- Andrea H. Kline‑Simon, Constance Weisner , Derek D. Satre, Yun Lu , riers. Women with high severity of alcohol use, endorsed higher fear of Verena E. Metz the consequences than men. Division of Research, Kaiser Permanente Northern California, Oakland, Conclusion: Individuals with low alcohol use report a willingness to CA, United States, 94612; Department of Psychiatry and Behavioral Sci‑ seek professional treatment if a problem occur; however, it seems ences, University of California, 675 18th Street, San Francisco, CA 94107, that this decrease if severe alcohol use is present, in particular among USA women. Especially among individuals with high severity of alcohol use Correspondence: Stacy Sterling (stacy.a.sterling@kp.org) there is a need to address gender specific barriers. Addiction Science & Clinical Practice 2023, 18(Suppl 1): O29 A ddiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 11 of 27 Background: Many patients with hypertension drink above recom- in both years were included. ICD-10 diagnosis codes from the Problem mended limits, which may affect disease management and blood List prior to screening implementation identified MHCs and SRMCs. pressure (BP) outcomes. Alcohol brief intervention (ABI) in adult pri- Screening rates and screen-positive rates were compared for patients mary care has been found efficacious in reducing hazardous drinking. with and without MHCs and SRMCs using multivariate logistic regres- However, effectiveness research in the context of real-world imple - sion models adjusted for key demographic characteristics. mentation is rare, and little is known about effects of ABI on health Results: Of the 39,148 patients meeting inclusion criteria, 29% had outcomes. This study aims to evaluate the effectiveness of ABI in adult MHCs and 58% had SRMCs. Screening for alcohol/drugs was com- primary care on 2- and 5-year drinking and BP outcomes among adults pleted by 47% of patients with MHCs and 57% of patients with SRMCs. with hypertension, by using advanced causal inference techniques to Patients with MHCs had lower screening rates for alcohol (AOR = 0.43, emulate a target trial. 95% CI:0.41–0.45) and drugs (AOR = 0.43, 95% CI:0.41–0.45) in com- Materials and methods: This population-based observational study parison to patients without MHCs. Similarly, patients with SRMCs had was conducted at Kaiser Permanente Northern California, an inte- lower screening rates for alcohol (AOR = 0.41, 95% CI = 0.38–0.43) grated healthcare system that implemented system-wide alcohol and drugs (AOR = 0.41, 95% CI = 0.39–0.43). Patients with MHCs were SBIRT in adult primary care in mid-2013. Using longitudinal electronic more likely to screen positive for alcohol (AOR = 1.48, 95% CI = 1.37– health record (EHR) data on 72,979 hypertensive patients aged 18–85 1.60) and drugs (AOR = 1.55, 95% CI = 1.32–1.83), while patients with who screened positive for unhealthy alcohol use between 2014 and SRMCs were more likely to screen positive for alcohol (AOR = 1.39, 95% 2017, dynamic marginal structural models with inverse probability CI = 1.29–1.50) but not drugs (AOR = 1.08, 95% CI = 0.93–1.27). weighting for informative censoring were fit to estimate adjusted Conclusions: With a universal screening approach, patients with effects of ABI. MHCs and SRMCs were less likely to be screened, and more likely to Results: Compared with never receiving ABI, receiving ABI whenever screen positive for alcohol use, in comparison to patients without screened positive was associated with a greater decrease in heavy these conditions. While there may be unique barriers to screening drinking days at 2 years (mean difference [95% confidence inter - patients with mental health and substance-related medical condi- vals] = -– 0.21 [– 0.39, – 0.04]); the effect became smaller at 5 years. tions, clinics should consider prioritizing them for screening given the Receiving ABI whenever screened positive was also associated with substantial burden of unhealthy substance use. better BP outcomes at 2 years, resulting in 6–8% higher odds of hav- ing clinically meaningful reduction in BP (i.e., ‚â•3 mmHg reduction O31 from baseline). However, we found no significant ABI effects on BP at Natural course of behavioural health risk factors in general 5 years. hospital patients with at‑risk alcohol use over two years 1* 1,2 3 1,2 Conclusions: Our analysis using causal inference techniques suggests Jennis Freyer Adam, Anika Tiede , Sophie Baumann , Filipa Krolo , 4 2,5 that ABI holds promise for reducing drinking and helping to improve Beate Gaertner , Ulrich John health outcomes among adults with hypertension who screen positive Institute for Medical Psychology, University Medicine Greifswald, for unhealthy drinking. However, more research is needed to under- Greifswald, Germany; German Centre for Cardiovascular Research, Site stand effect heterogeneity across diverse sub-populations and to Greifswald, Greifswald, Germany; Department of Methods in Community study ABI’s long-term public health impact. Medicine, Institute of Community Medicine, University Medicine Greif‑ swald, Germany; Robert Koch Institute Berlin, Department of Epidemiol‑ O30 ogy and Health Monitoring, Berlin, Germany; Department of Preven‑ Substance use screening rates and screening results among adult tion Research and Social Medicine, Institute of Community Medicine, primary care patients with mental health conditions University Medicine Greifswald, Germany and substance use‑related medical conditions Correspondence: Jennis Freyer Adam ( jennis.freyer‑adam@med. 1* 2 2 3 Jennifer McNeely, Aimee Wahle , Margaret Kline, Sarah Wakeman , uni‑greifswald.de) 4 5 6 Timothy Wilens , Dr. Joseph Kannry , Richard N. R osenthal , Angeline Addiction Science & Clinical Practice 2023, 18(Suppl 1): O31 7 1 8 9 2 Adam , Noa Appleton , Sarah Farkas , Carmen Rosa , Seth Pitts , Keith 1 8 10 Goldfeld , John Rotrosen , Leah Hamilton Background: About 90% of persons who drink alcohol at-risk also Department of Population Health, New York University Grossman School report tobacco smoking, physical inactivity and/ or overweight. Co- of Medicine, New York, NY 10016, USA; The Emmes Company, Rockville, occurrence of such behavioral health risk factors (BHRFs) more than MD 20850, USA; Department of Medicine, Harvard Medical School, Mas‑ doubles the risk for chronic disease and mortality. Little is known sachusetts General Hospital, Boston, MA 02114, USA; Department of Psy‑ about the development of BHRFs over time, particularly among gen- chiatry, Massachusetts General Hospital, Boston, MA 02114, USA; Division eral hospital patients with at-risk alcohol use hospitalized for somatic of General Internal Medicine, Icahn School of Medicine at Mount Sinai, disease or injury. Hospitalization is considered to be a learnable New York, NY 10029, USA; Renaissance School of Medicine, Stony Brook moment for patients. The aim was to investigate whether general hos- University, Stony Brook, NY 11794, USA; Department of Psychiatry, pital patients identified with at-risk alcohol use change their BHRFs University Hospital Lausanne, Lausanne, Switzerland; Department of Psy‑ during the first two years after hospitalization. chiatry, New York University Grossman School of Medicine, New York, Materials and methods: Data from a randomized controlled trial NY 10016, USA; National Institutes of Health, National Institute on Drug which was approved by the local ethic commission were used (Clini- Abuse, Bethesda, MD 20852, USA; Kaiser Permanente Washington calTrials.gov: NCT01291693). Eighteen to 64-year-old general hospital Health Research Institute, Seattle, WA 98101, USA patients with at-risk alcohol use were identified through systematic Correspondence: Jennifer McNeely ( jennifer.mcneely@nyulangone.org) screening (91% participation). Patients with particularly severe alcohol Addiction Science & Clinical Practice 2023, 18(Suppl 1): O30 problems were excluded. Of those eligible, 81% provided informed written consent. For this investigation, data of the treatment as usual Background: Patients with mental health conditions (MHCs) and control group were analyzed (n = 220). Alcohol use measured by the substance-related medical conditions (SRMCs) are at elevated risk for AUDIT-C, tobacco smoking, vegetable and fruit intake, physical activ- poor health outcomes related to alcohol and drug use. We analyzed ity and body-mass-index were assessed at baseline, after 6, 12, 18, and substance use screening for patients with these conditions in 6 U.S. 24 months. Latent growth models were calculated. primary care clinics that participated in a screening implementa- Results: Twenty-four months after hospital discharge, participants tion study. Clinics initiated universal screening for adult patients in reported less physical activity (p = 0.04), a higher body-mass-index 2017–2018. (p = 0.01), no change in vegetable and fruit intake (p = 0.11), fewer cig- Methods: Data were extracted from electronic health records for one arettes per week (p < 0.001), and less alcohol use (p < 0.001) compared year pre- and post-screening implementation, and adults having visits to baseline. Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 12 of 27 Discussion: Although alcohol use and tobacco smoking were pharmacotherapy prior to the study. Primary outcomes were change reduced, energy-balance related BHRFs developed unfavorably or did in weekly alcohol consumption and heavy drinking days at 3- and not improve over 2 years after hospitalization. 12 months follow-up compared with baseline, as measured with time- Conclusions: These findings underline the need of the implementa- line follow back. Secondary outcomes were severity of dependence, tion of multi-behavioral interventions for at-risk alcohol users in rou- consequences of drinking, psychological health and biomarkers. tine care. Results: Intention-to-treat analysis (n = 132 + 132) failed to dem- onstrate improved outcomes when iCBT was added to TAU. The per protocol analysis (n = 102 + 132) however finds that, when the O32 combination actually occurs, iCBT + TAU led to reduced alcohol Disparities in receipt of alcohol brief intervention: consumption. the intersectionality of sex, age and race/ethnicity 1 1 Conclusions: The participants had considerable problems with alco- Sujaya Parthasarathy *, Andrea H. Kline‑Simon hol and health and a majority reduced their alcohol use considerably Division of Research, Kaiser Permanente Northern California, Oakland, as well as symptoms of dependence, anxiety and depression at follow- CA 94612, USA ups. Access to a treatment method that does not take time or require Correspondence: Sujaya Parthasarathy (sujaya.parthasarathy@kp.org) expertise might increase the likelihood that questions about alcohol Addiction Science & Clinical Practice 2023, 18(Suppl 1): O32 are asked and contribute to the development of a treatment system where primary care is the base of treatment. Background: Brief intervention (BI) to address unhealthy alcohol use early shows promise but disparities exists across sex, age and race/ ethnicity. The Alcohol as a Vital Sign program (AVS) was introduced O34 into the adult primary care workflow to screen patients for unhealthy Brief interventions in decreasing alcohol use in users of a Family alcohol use and provide BI as needed. This study examines BI rates by Health Unit 1* sex, age, and race/ethnicity, and their intersectionality, incorporating Tereza Maria Mendes Diniz de Andrade Barroso , Fernanda Matos 2 3 important patient characteristics. Fernandes Castelo Branco , Ferreira Ana Cristina Ferreira Materials and methods: This population-based observational study Mental Health Departement, Nursing School Coimbra/Health Sciences included adult patients (N = 287,551) screening positive for unhealthy Research Unit: Nursing (UICISA: E), Coimbra, Portugal; University of Fed‑ alcohol use between 2014 and 2017 during routine alcohol screening eral do Amapá, Oiapoque, AP, Brail; Family Health Unit Rainha Santa in internal medicine, family practice, and urgent care clinics in an inte- Isabel, Coimbra, Portugal grated health delivery system. Measures included unhealthy alcohol Correspondence: Tereza Maria Mendes Diniz de Andrade Barroso use and receipt of BI, and patient and provider demographics which (tesouraria@esenfc.pt) were obtained from electronic health records. Addiction Science & Clinical Practice 2023, 18(Suppl 1): O34 Results: Multilevel logistic regression was used to examine the like- lihood of receiving BI accounting for clustering of patients within Introduction: In the Portuguese health system, Primary Health Care providers. Women had lower odds of receiving BI than men in all (PHC) is the first level of access of individuals, families, and commu- age groups. Women also had lower odds of receiving BI than men nities to the health system. PHC professionals occupy a privileged in all racial/ethnic groups; the sex differences in odds of receiving BI position and play a key role in the identification and screening of were greater for the Latino/Hispanic group (OR [95% CI] for women individuals with hazardous and harmful alcohol consumption, and/ vs. men = 0.69 [0.66, 0.72]) and smaller for the Asian/Pacific Islander or likely alcohol dependence for adequate evaluation, diagnosis, and group (OR [95% CI] for women vs. men = 0.76 [0.72, 0.81]). treatment interventions. Despite this, BIs are not widely used in clinical Conclusions: Development of primary care-based alcohol BI practice. approaches that address sex disparities are critical in order to ensure Objective: To evaluate the effect of brief interventions in decreas- equitable access to this important preventive service. ing alcohol use in users of a Family Health Unit in the urban region of Portugal. Methodology: Pre-experimental study, before and after evaluation O33 (four months) of 205 users (single group). The SBIRT protocol was The efficacy of iCBT added to treatment as usual for alcohol implemented and was used the Alcohol Use Disorders Identification dependent patients in primary care: a randomized controlled trial 1* 1,3 1,4 Test (AUDIT ). Karin Hyland , Anders Hammarberg , Erik Hedman‑Lagerlöf , Magnus 2,3 1,3 2,3 Results: In the first assessment, 189 (92.2%) were in zone I; 15 (7.3%) Johansson , Philip Lindner , Sven Andreasson in zone II and 1 (0.5%) in zone IV, this was excluded and referred to Department of Clinical Neuroscience, Karolinska Institutet, 17177 the family doctor, with diagnosis and referral for specialized unitIn. In Stockholm, Sweden; Department of Public Health Sciences, Karolinska the follow-up, four months after the interventions with the 15 users Institutet, 17177 Stockholm, Sweden; Centre for Dependency Disorders, who scored zone 2, there was a sample loss of 5, showing that 6 (60%) Stockholm Health Care Services, Stockholm County Council, Stockholm, scored zone I, 3 (30%) zone II and 1 (10%) zone III. The results of the Sweden; Gustavsberg Primary Health Care Center, Stockholm, Sweden Wilcoxon test (before and after the BIs) show that, the risk level after Correspondence: Karin Hyland (karin.hyland@regionstockholm.se) the intervention is lower than before the intervention (Z = -1,402; Addiction Science & Clinical Practice 2023, 18(Suppl 1): O33 p = 0,161). Conclusion: The results show a positive effect in reducing the alcohol Background: Most alcohol dependent persons have a moderate level consumption level of risk associated with the intervention performed. of dependence. Treatment seeking in this group is low, mainly due to Future studies should be conducted with a bigger sample, with a con- stigma and because treatment in specialized care is seen as unappeal- trol group and increasing the time between the implementation and ing. This group is more positive to seeking treatment in primary care. the evaluation. Brief interventions are effective resources in the early General practitioners (GP) hesitate to engage in this area due to time detection of alcohol use, which are necessary for dissemination in pri- constraints and uncertainty regarding their competence. To lessen the mary health care. morbidity associated with alcohol dependence and encourage GPs to raise questions about alcohol, they need to have access to treatment they find applicable and feasible to use. O35 Materials and methods: A two group, parallel, randomized controlled Managing alcohol problems through GP practices: referrals superiority trial with a 1:1 allocation. 264 individuals fulfilling ICD-10 to and engagement with a specialist alcohol service 1* 2 2 2 criteria for alcohol dependence were randomized to an Internet-based Andrea Mohan , Clare Sharp , Danielle Mitchell , Niamh Fitzgerald 1 2 Cognitive Behavioral Treatment program (iCBT ) added to treatment as School of Health Sciences, University of Dundee, Dundee, UK; Institute usual (TAU) or TAU only. GPs at 14 primary care centers were offered of Social Marketing and Health, University of Stirling a 1-h training in giving feedback on assessments and biomarkers and Correspondence: Andrea Mohan (amohan001@dundee.ac.uk) A ddiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 13 of 27 Addiction Science & Clinical Practice 2023, 18(Suppl 1): O35. Interviews assessed experiences in PC, alcohol/substance use treat- ment history, and ideas for improvement. Transcripts were analyzed Background: General Practitioners (GPs) see a large proportion of using a rapid qualitative approach, which summarized interviews to the general population and are ideally placed to identify people with extract key points and relevant themes. alcohol problems. Many GPs will ask patients about their alcohol use if Results: PC interviews revealed the following top barriers: variability there is a suspected alcohol problem, and provide brief interventions in clinicians’ knowledge and confidence in defining unhealthy alcohol or refer patients to specialist alcohol treatment services. For various use and providing evidence-based care; logistical issues triaging/refer- reasons, there remains groups of people who do not engage with spe- ring patients to behavioral health; competing clinical priorities (e.g., cialist alcohol services; it is important to understand how to improve diabetes); and varying PC leadership support. Facilitators included this engagement. We conducted a qualitative study that focused on belief in alcohol-related intervention in PC; identification of clinical a specialist alcohol service, the Primary Care Alcohol Nurse Outreach champions; and support for implementation ideas presented (e.g., Service (PCANOS), that was closely linked to GP practices in Glasgow, audit and feedback). Veteran interviews [45.5% female; Mage = 60.2; Scotland, and supported patients who had low engagement with 41.0% Black; average AUDIT-C = 4.23 (range: 0–11)] revealed the fol- other alcohol services. lowing themes: overall positive experiences in PC, varying experience Materials and methods: From September 2020 to June 2021, we with and desire for alcohol-related care, desire for shared decision- conducted 25 semi-structured interviews with staff and patients from making, and willingness to meet with other PC providers besides phy- six GP practices in Glasgow, to explore their views and experiences of sicians to improve alcohol care. managing or receiving support for alcohol problems in primary care. Conclusions: Multidisciplinary providers and Veterans perspectives on Interviews were transcribed and data were analysed thematically. We delivering/receiving PC-based alcohol-related care supported devel- present findings relating to the process of referring patients to PCA - opment of a tailored multilevel implementation intervention that NOS and engaging patients with the service. capitalizes on facilitators and minimizes barriers. PC providers should Results: Most referrals to PCANOS were made by GPs after speaking to continue building compassionate relationships with Veterans and the patients about their alcohol use. Speedy referrals were facilitated offer repeated non-judgmental evidence-based advice and treatment by the close working relationship practices had with PCANOS. Addic- options, from a shared decision-making approach, regarding alcohol tion Nurses (ANs) employed by PCANOS phoned patients as soon as use. referrals were received and visited patients in their homes to provide specialist care. The ANs used a non-judgemental, person-centred O37 approach and built therapeutic relationships to engage patients with SBIRT in non‑medical settings for clients with substance use the service. problems evaluation of its effectiveness 1* 2 2 Conclusions: Speedy patients referrals and a person-centred Fatima Abiola P opoola , Olibamoyo Olushola , Ola Bolanle Adeyemi 1 2 approach to care were essential to patients engaging with PCANOS. It National Drug Law Enforcement Agency, Abuja, Nigeria; Department may be beneficial for more GP practices to work collaboratively with of Behavioural Medicine, Lagos State University College of Medicine Ikeja, specialist alcohol services to appropriately support patients in need to Lagos, Nigeria more intensive treatment. Correspondence: Fatima Abiola Popoola (abiolaodus9@gmail.com) Addiction Science & Clinical Practice 2023, 18(Suppl 1): O37 O36 Primary care provider and U.S. Veteran perspectives on barriers Background: Screening, brief intervention, and referral to treatment and facilitators to alcohol‑related care and ideas for improvement (SBIRT) is an evidence-based practice that has been shown to reduce in the Veterans Health Administration alcohol and drug use in healthcare and other settings, but there is a 1* 1 2 Rachel L. Bachrach , Matthew Chinman , Nicole M. Beyer , Angela paucity of research on the effectiveness of SBIRT in a non-medical set - 1 2 3 4,5 Phares , Keri L. Rodriguez , Kevin L. Kraemer , Emily C. Williams ting. These populations have high rates of substance use but have lim- Center for Health Equity Research and Promotion; Mental Illness ited access to interventions. Research, Education, and Clinical Center; VA Pittsburgh Healthcare Materials and methods: A simple random sampling technique was System, Pittsburgh, PA 15240, USA; Center for Health Equity Research used for this research, 75 participants were selected from a pool of and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, 150 users, referred mainly from criminal justice, place of work, and USA; Division of General Internal Medicine, Department of Medicine, schools. Using the ASSIST, the intervention assessed the risk level for University of Pittsburgh, Pittsburgh, PA 15261, USA; Department illicit drug use by participants and provided those who were at low or of Health Systems and Population Health, University of Washington medium risk with a brief intervention and referred those at high risk School of Public Health, Seattle, WA 98195, USA; Health Services to intensive treatment. RCQ was used to assess the level of motivation Research & Development (HSR&D) Center of Innovation for Veteran‑Cen‑ of participants. The intervention was given at baseline and 3 months tered and Value‑Driven Care, VA Puget Sound Health Care System, Seattle, following baseline intervention. Assessments were carried out at base- WA 98108, USA line and 6 months. Using interviews and records data from baseline Correspondence: Rachel L. Bachrach (rachel.bachrach2@va.gov) and 6-month, analyses compared the differences. All analyses were set Addiction Science & Clinical Practice 2023, 18(Suppl 1): O36. at 95% CI, p < 0.05, and were carried out by SPSS 22.0. Results: We found that the risk of harmful use of cannabis, prescrip- Background: Veterans Health Administration (VA) clinical guidelines tion opioids, and sedatives reduced significantly between baseline stipulate that patients receive evidence-based alcohol-related care in and 6-months so also were their mean ASSIST scores. Furthermore, PC (e.g., brief counseling interventions, pharmacotherapy), but many participants have a statistically significant better level of motiva- do not. We conducted qualitative interviews with clinical and Veteran tion to stop the use of cannabis, prescription opioids, and sedatives stakeholders in one VA PC clinic to understand barriers and facilitators between baseline and 6-months. Although participants have reduced and tailor an implementation support intervention to help improve risks of harmful use of solvent, the differences between baseline and care. 6-months were not significant. Materials and methods: We interviewed 10 PC stakeholders (e.g., Conclusions: This study has illustrated that the use of screening and physicians, pharmacists) about: (1) experiences with and thoughts the administration of brief interventions for reducing the harmful risk about providing alcohol-related care; and (2) feedback regarding the and improving the level of motivation to stop substance use in a non- planned implementation support intervention. We then interviewed medical setting can be feasible and effective. a purposive sample of Veterans with a history of unhealthy alcohol use (N = 22; ages‚â•18) seeking care at a northeastern VA PC clinic. Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 14 of 27 O38 volunteers. Having brief conversations about alcohol was shown to be Assessment by the JT method of brief intervention applied the predominant activity of AHCs. Focus groups highlighted the felt to Brazilian workers with a score of 8 or more in the audit needs of community representatives were orientated towards improv- 1* 2 Sandra Regina Chalela Ayub , Raul Aragão M artins ing the local alcohol treatment system to provide better responses to 1 2 Fatec Catanduva‑SP, Brasil; Departamento Educação, UNESP, Marília, alcohol dependence. Brasil Conclusion: CICA was successful in training lay people in health- Correspondence: Sandra Regina Chalela Ayub (sandrachalela@gmail. deprived areas, providing them with a qualification and confidence com) to provide brief advice. The felt needs of AHCs and community repre- Addiction Science & Clinical Practice 2023, 18(Suppl 1): O38 sentatives highlighted the importance of having integrated local treat- ment systems for alcohol misuse in place when building capacity in Background: Alcohol Dependence Syndrome (ADS) is a disease early intervention. worldwide considered a public health problem. Aec ff ts the worker’s performance and the work environment due to the consequences of O40 abusive use of alcohol, causing a drop in productivity and quality at Piloting a strategy to screen and detect risky drinking of alcohol work, as well as absences during the period of their journey; changes in the community pharmacies of Catalonia 1* 1 2 in personal habits, poor relationships with colleagues; accidents at Joan Colom F erran , Jorge PalacioV ‑ ieira , Berta Torres‑Novellas , Toni 2 1 1 3 work, among other vulnerabilities. This research aimed to evaluate, Veciana , Lidia Segura‑García , Estela Díaz , Gemma Galofré Pomés using the JT Method, the effect of a Brief Intervention (BI), aimed at Program on Substance Abuse, Public Health Agency of Catalonia, Health returning to abstinence or at least to moderation, applied to workers Department of the Government of Catalonia, Roc Boronat 81‑95, 08005, who scored 8 or more in the AUDIT. Barcelona, Spain; Catalan Council of Pharmacists’ Associations. Girona Methods: The research was carried out in four stages: initial survey 64‑66, 08009, Barcelona, Spain; Tarragona Pharmacists Association, Enric (LI), interview, application of the BI and follow-up after six months. In d’Ossó, 1, 43005, Tarragona, Spain LI, 229 workers participated, of which 78 (34.1%) reached the cut-off Correspondence: Joan Colom Ferran ( joan.colom@gencat.cat) score (8 or more points). In the second stage, the results were con- Addiction Science & Clinical Practice 2023, 18(Suppl 1): O40 firmed with the Alcohol Dependence Scale—ADS and these work - ers were invited to participate in the IB, which was accepted by 46 of Background: Community pharmacists (CP) may play an important them. In the third stage, the IB was performed. In the follow-up ses- role in the identification and management of alcohol consumption at sion, the fourth stage of the research, the AUDIT was applied, after the population level. The objective of this study is to show the results 6 months of the IB, in 23 participants who were located. Data analysis of piloting a novel strategy addressed to the identification and brief by the JT Method can result in four possibilities: positive maintenance, intervention of alcohol problems among the community pharmacies positive change, no change and negative change. The first case, posi- users. tive maintenance, would be for participants who had a cutoff score Materials and methods: A total of 36 CP of Tarragona (Catalonia) below 8 points and would remain there, but who were not evaluated were invited to screen risky drinkers using the AUDIT-C (cut-off points in this study. of 5 or more for men and 4 or more for women) specifically among Results: Results show that 14 (60.9%) participants had positive those who attended their pharmacies to acquire medications that change and nine had no change. These results were satisfactory for interact with alcohol, including Benzodiazepines, Acenocumarol, Levo- the applied BI and can contribute to the implementation of programs thyroxine, Carbimazole, pregnancy test or emergency contraceptive aimed at workers’ health using the IB, which is easy to apply, fast, low pills. In addition, three options of brief intervention were used, face-to- cost and effective. face oral advise, leaflet council and referral to primary healthcare units. Results: During 45 days of piloting, a total of 17 CP (47%) screened 173 O39 eligible users, 68% of them were women, the mean age was 53.4 years Communities in Charge of Alcohol: Building capacity in alcohol (50.2 among women and 60.1 among men) and 45% of users screened screening and brief interventions through asset based acquired Benzodiazepines. Among those who accepted being community development screened (n = 149), 20% were non-drinkers, and among drinkers 43% Elizabeth J Burns*, Cathy Ure, Penny Cook were considered risky drinkers. A total of 62% of drinkers received a School of Health & Society, University of Salford, Salford, M6 6PU, UK face-to-face oral intervention, 88% received leaflets and less than 1% Correspondence: Elizabeth J Burns (e.j.burns@salford.ac.uk) were referred to primary health care units. The average time reported Addiction Science & Clinical Practice 2023, 18(Suppl 1): O39 for screening and brief intervention was less than 5 min in the 52% of cases, between 5 and 10 min in 36% of the cases and more than Background: Communities in Charge of Alcohol (CICA) takes an asset- 10 min in 12% of the cases. based community development approach to build capacity in alcohol Conclusions: Screening and brief intervention on alcohol are both screening and brief interventions in the North West of England. Lay feasible at the community pharmacies. Ensuring that time does not people volunteered to become an ’Alcohol Health Champion’ (AHC) exceed 5 min, targeting risky drinkers and those who acquire medica- by attending a Royal Society of Public Health (RSPH) training course to tions that interact with alcohol could easy and ensure the implemen- equip them with the knowledge and skills to use AUDIT-C and provide tation of SBI other regions of Catalonia. opportunistic informal brief advice. An additional half day course was provided on how to navigate the alcohol licensing process in England. O41 Methods: The process evaluation explored the coordination, recruit- Opportunities for screening, brief interventions, and treatment ment, training delivery, and volunteer activity of AHCs. Data collec- of alcohol use disorders in low‑income countries: Lessons tion included training registers, pre- and post-training questionnaires, from the SAFER program in Uganda reflective diaries, interviews with key stakeholders and interviews with David Kalema* Alcohol Health Champions at 3 months and 12 months. Focus groups Uganda Alcohol Policy Alliance, Uganda were carried out with community members after the first year. Data Correspondence: David Kalema (kalemdav@gmail.com) were analysed using descriptive statistics, framework analysis and the- Addiction Science & Clinical Practice 2023, 18(Suppl 1): O41 matic analysis. Results: In total, seven areas coordinated the delivery of the CICA pro- gramme for 12 months, training 123 people as AHCs including 95 lay A ddiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 15 of 27 Background: SAFER represents 5 effective and cost-effective alcohol O43 control interventions including (1) Strengthening restrictions on alco- Nursing students: experience with the training hol availability, (2) Advancement of drink-driving countermeasures, and implementation of a brief alcohol motivational interviewing 3) Facilitating Screening, Brief Interventions and Treatment (SBIT), (4) program 1 1 1 Enforcement of bans or comprehensive restrictions on advertising, Maria Lavilla Gracia *, Navidad Canga Armayor , Maria Pueyo Garrigues sponsorship and promotion and (5) Raising prices on alcohol through Community, Maternity and Pediatric Nursing Department, University excise taxes and pricing policies. Uganda is the first country to part - of Navarra, Pamplona, Spain ner with the World Health Organization (WHO) led SAFER Initiative and Correspondence:Maria Lavilla Gracia (mlavilla@unav.es) this collaboration has the potential to provide leadership and lessons Addiction Science & Clinical Practice 2023, 18(Suppl 1): O43 to other governments and advocates seeking to reduce the health, social and economic impacts of harmful use of alcohol. SBIT was iden- Background: Peer-led brief motivational interventions in the uni- tified among the priority SAFER interventions with high need and high versity setting are promising for reducing alcohol consumption and feasibility in Uganda. related negative consequences among undergraduates. Knowing peer Materials and methods: This presentation focuses on the SAFER counsellors‚Äô competence and their experience in conducting this desk-based review and joint WHO and Ministry of Health joint pro- kind of intervention is important to improve their training; unfortu- gramming mission in regards to SBIT in Uganda. The report analyses nately, evidence on this topic is scarce. potential facilitators and barriers to Uganda’s response to the harmful Aim: To evaluate nursing students’ competence and their experience use of alcohol and shall provide an update on the implementation of in leading a brief alcohol-focused motivational interviewing with their the suggested 24-month (effective January 2022) multi-sectoral road- peers. map to scale up SBIT services in Uganda. Materials and methods: A mixed-method study was undertaken with Results: Barriers/Opportunities; Although established government 21 peer counsellors. Competency in motivational interviewing and and private facilities and peer support groups offer services for AUD alcohol-related content was evaluated through the Peer Proficiency treatment, they are few and segmented, with a general lack of special- Assessment instrument and a checklist coding two videotaped inter- ized professionals. Besides, the coverage of AUDs in the Uganda Clini- ventions by each participant. Experiences were explored through cal Guidelines is insufficient. three focus groups (they were asked about their strengths, weak- Conclusions: Recommendations for enhancing SBIT include training nesses, benefits, and challenges of being students who do the inter - regional focal persons in hospitals and schools; facilitating peer sup- views), and content analysis was undertaken. port groups at regional and community levels; establishing an accredi- Results: In general, nursing students achieved proficiency in motiva- tation system for AUD services and an inventory of private treatment tional interviewing by asking more open-ended questions and com- centers; integrating AUD indicators/statistics in the National Health plex reflections. All of them covered most of the alcohol-related topics Information Management System; and promoting SBIT for Uganda that should come up during the interview. Regarding their experi- Police Force members. ences, they found being a peer as a strength because of the confidence and openness that students have by sharing common experiences. On the other hand, the most common challenges where the lack of self- O42 confidence and experience, conflict of role between being a peer and Training of trainers on screening and brief intervention being professional and they struggle with the preconceptions about and referral to treatment (SBIRT) for tobacco use 1 1 peer status. Most peer counsellors agree that they achieved the goal of Marianne Hochet *, Nicolas Bonnet making the student reflect on their alcohol consumption. RESPADD (French Network for addiction prevention), Paris, France Conclusions: Nursing students who receive training in alcohol- Correspondence: Marianne Hochet (marianne.hochet@respadd.org) focused motivational interviewing improve their skills. In addition, Addiction Science & Clinical Practice 2023, 18(Suppl 1): O42. they feel satisfied when conducting this intervention with their peers to raise awareness about alcohol consumption. However, before con- Background: The prevalence of smoking is still very high in France ducting an interview with an alcohol student user, they need to do despite all the public health actions led during past years. 25% of more practice during the training. people aged between 18 and 75 years old are daily smokers in France. One action in France is to encourage and support hospitals and health services in becoming tobacco-free. In order for this strategy to be O44 efficient, health care professionals must be trained to screen smok - A dose–response analysis of adolescent SBIRT education ers and support them quitting. Thus, the French addiction prevention for health professionals: navigating a post‑COVID landscape 1* 2 2 network, RESPADD, which is the national coordinator of this important Weiwei Liu , Jackie Sheridan‑Johnson , Hildie Cohen , Tracy L. strategy, is implementing training of trainers to quickly disseminate McPherson knowledge and know-how. Public Health, NORC at the University of Chicago, Bethesda, MD 20814, Materials and methods: With the help of each regional health agen- USA; Public Health, NORC at the University of Chicago, Chicago, IL 60603, cies, we have set up at least one training of trainers on SBIRT for USA tobacco use in all French regions during the past three years. For each Correspondence: Weiwei Liu (liu‑weiwei@norc.org) session, around 20 persons were trained during two days on tobacco Addiction Science & Clinical Practice 2023, 18(Suppl 1): O44 basic knowledge, SBIRT and how to train colleagues on this topic and thus spread information. Participants were mainly healthcare profes- Background: The screening, brief intervention, and referral to treat- sionals, with the ability to prescribe nicotine replacement therapy like ment (SBIRT) model is effective in preventing and reducing substance nurses and doctors or not allowed to prescribe but to discuss tobacco use among youth. NORC at the University of Chicago, along with consumption with patients. Several tobacco-free hospital project coor- leading professional education experts, developed and tested an dinators were also trained. adolescent SBIRT curriculum for use in nursing, social work, and inter- Results: In three years, more than 200 new trainers were trained on professional education. In prior publications, we demonstrated that the previous mentioned topics and are now able to spread knowledge this training is effective in preparing health professionals to imple - and know-how in their own health structure but also elsewhere. Each ment adolescent SBIRT. Less understood is how the effectiveness of region has now its own trainers on SBIRT for tobacco use. such training may vary as a function of setting and dosage. This study Conclusions: People are willing to learn more on tobacco issues and evaluated the impact of implementation setting (online, in-person, to spread knowledge as trainers which is part of the evidence-based hybrid) and dosage (hours of SBIRT) on students’ attitudes; perceived program of tobacco-free hospitals. readiness, confidence, competence; knowledge, and skills. Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 16 of 27 Materials and methods: Students completed a pre-training survey, O46 adolescent SBIRT education, and post-training survey. The sample Development of a mobile application for screening, brief included 33 schools with 1,646 students. In addition to analysis of the intervention and referral of adolescents and young adults overall sample, we stratified analyses by graduate and undergradu- with substance use disorders 1 1 ate students. We also stratified by pre- and post-COVID to account for Maria Lucia Oliveira de Souza‑Formigoni , Richard A. Reichert , Denise 1 3 3 the ubiquitous shift to online learning and changes in online training De Micheli , Matheus Sabino de Souza , Adriana Gomes Alves , Paulo 2 2 4 delivery. OLS regression models were conducted to evaluate pre-post Bandiera Paiva , Antonio Carlos da Silva Junior , Anne H Berman changes by implementation setting and dosage, adjusting for stu- Departamento de Psicobiologia, Escola Paulista de Medicina, Univer‑ dent’s level and prior training. sidade Federal de São Paulo, São Paulo, Brazil Cep 04023062; Departa‑ Results: For undergraduate students, longer SBIRT training was posi- mento de Informática em Saúde, Escola Paulista de Medicina, Universi‑ tively associated with improvement in confidence and readiness; this dade Federal de São Paulo, São Paulo, Brazil Cep 04023062; Universidade effect was not significant for graduate students. Pre-COVID, online do Vale do Itajaí, Itajaí, Santa Catarina, Brazil; Department of Psychology, learning was associated with less improvement on competence, con- Uppsala University, Uppsala, Sweden fidence, and readiness compared to in-person training. This reversed Correspondence: Maria Lucia Oliveira de Souza‑Formigoni (mlosfor ‑ post-COVID, with online learning associated with greater improve- migoni@unifesp.br) ment than in-person learning. Addiction Science & Clinical Practice 2023, 18(Suppl 1): O46 Conclusions: Findings suggest that longer training may lead to greater improvement in outcome measures for certain subgroups. Background: Alcohol and other drug use disorders among youth are a The drastic and rapid shift to online learning introduced by COVID-19 public health concern worldwide. The dissemination of Screening and did not negatively impact effectiveness of SBIRT education and may Brief Interventions (SBI) directed to adolescents and young adults is have improved online learning tools that can be utilized for adolescent important to mitigate the potential social and health harms related to SBIRT training in the future. drugs misuse. Materials and methods: The objectives of this project were: a) to per- form the cross-cultural adaptation and validation of the DUDIT-E (Drug O45 Use Disorders Identification Test Extended) screening scale to be used Association between previous emotional state and drinking risk in Brazil; b) to develop a digital application to be used by health pro- levels in young adults 1 1 fessionals or social workers including SBI and referral of adolescents Maria Lucia Oliveira de Souza Formigoni , Giovanna T P etucco , Professor and young adults with drug use disorders. This interdisciplinary and Claudia B M ello multicenter project has been carried out in Brazil at the Deparments Departamento de Psicobiologia, Escola Paulista de Medicina, Universi‑ of Psychobiology and Informatics in Health of Universidade Federal dade Federal de São Paulo, São Paulo, Cep 04023062, Brazil de São Paulo (UNIFESP) in partnership with researchers from the Uni- Correspondence: Maria Lucia Oliveira de Souza Formigoni (mlosfor‑ versidade do Vale do Itaja (UNIVALI) and Uppsale University (Sweden), migoni@unifesp.br) integrating knowledge from the areas of health and computer science. Addiction Science & Clinical Practice 2023, 18(Suppl 1): O45 Results: The (DUDIT-E) was translated into Portuguese, back-trans- lated and approved by the authors of the original version, then Background: When carrying out brief interventions for alcohol misus- adapted for online use. The app for mobile devices (TrIE-AD) includes: ers, it is important to understand the situations that trigger excessive a) the online version of the DUDIT-E to assess the patterns of use of consumption. Alcohol use in social gatherings may involve consump- psychoactive substances, the positive and negative perceptions on tion to deal with positive or negative emotions or to facilitate the drug use and the level of motivation and readiness to change behav- creation of social bonds. In this study, we investigated the association ior; (b) guided BI based on FRAMES (Feedback, Responsibility, Advice, between antecedent emotional situations and the classification of Menu of options, Empathy, and Self-efficacy) principles and on the young people according to their drinking risk levels. answers to DUDIT-E; (c) links to referral to specialized services, and (d) Materials and methods: We evaluated 122 volunteers, aged between links to complementary materials for training of professionals. 18 and 25 years old, regarding their alcohol consumption and asso- Conclusions: In the next phase of the study the adherence of profes- ciated problems (Alcohol Use Disorders Identification Test-AUDIT sionals to the app will be evaluated and its use is expected to improve scores), drinking risk situations (Inventory of Drinking Situations/IDS- SBI dissemination for the reduction of problems associated with drug 42), family history of psychoactive substances related problems and use by young people. sociodemographic characteristics. We tested the association between IDS-42 situations and AUDIT scores using regression analysis and com- pared IDS-42 items scores between low-risk and at-risk/suggestive of O47 dependence groups by Students t test. Brief parent interventions: Parents needs and recommendations Results: Out of the 122 volunteers, 91 were female and 31 male; 79 for the prevention of alcohol intoxications among teenagers participants were classified by AUDIT in Zone 1 (low risk) and 43 in Silke Diestelkamp , Rainer Thomasius the at-risk/ suggestive of dependence (zones II-IV). Linear regression German Center for Addiction Research in Childhood and Adolescence, analyses indicated higher AUDIT scores were associated with: drink- University Medical Center Hamburg‑Eppendorf, Martinistr. 52, D‑20246 ing when they presented unpleasant emotions (p < 0.001); test of per- Hamburg, Germany sonal control (p = 0.01) or when they have pleasant times with others Correspondence: Silke Diestelkamp (s.diestelkamp@uke.de) (p = 0.006). The IDS-42 item (I drank heavily) When I wanted to feel Addiction Science & Clinical Practice 2023, 18(Suppl 1): O47 closer to someone I liked stands out, with significantly higher scores in the high-risk/suggested of dependence group (p = 0.001). Background: In Germany, around 20.000 children and adolescents are Conclusions: Detecting high-risk drinking situations is essential to beeing treated for acute alcohol intoxication every year. Every single plan adequate Brief Interventions. Difficulties in the ability to relate to alcohol intoxaction is associated with an elevated risk of experiencing other people is one of the reasons that lead young people to misuse a number of negative consequences, such as inju-ry, violence or sex- alcohol. In the next phase of the study, we will test the associations ual assault. Parent interventions may contribute to preventing a-cute between social cognition skills and drinking related problems. alcohol intoxications in children and adolscents. The current study A ddiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 17 of 27 aimed at identifying circumstances which lead to alcohol intoxications identification (with potential to reinforce recent abstinence), but among teenagers as well as parents needs and recommendations for historical measures may not reflect recent behavior even among preventive parent interventions. adolescents. Materials and methods: N = 201 children and adolescents who had received a brief intervention following acute alcohol intoxication par- O49 ticipated in the quantitative study on circumstances which lead to the Using health utility to set drinking targets for alcohol brief alcohol intoxication. Additionally, in-depth interviews with N = 9 car- interventions 1* 2 3 egivers and N = 8 children and adolescents were conducted. The semi- Jeremy W. Bray , Arnie Aldridge , Carolina Barbosa , Abraham 1 1 4 structured telephone interviews assessed rules regarding alcohol use Gebreselassie , Collin Labutte, Eve Wittenberg 1 2 before and after the in-toxication, consequences of non-compliance Department of Economics, UNC Greensboro, Greensboro, NC, USA; RTI 3 4 with rules and needs and recommen-dations for preventive parent International, RTP, NC, USA; RTI International, Chicago, IL, USA; Center interventions. for Health Decision Science, Harvard T.H. Chan School of Public Health, Results: Five of nine parents reported to have had specified alcohol- Boston, MA, USA related rules with their child before the intoxication. Six of nine par- Correspondence: Jeremy W. Bray ( jwbray@uncg.edu) ents introduced new rules after the into-xication with a focus on Addiction Science & Clinical Practice 2023, 18(Suppl 1): O49 enhanced monitoring, more communication about their children’s alcohol use and specific rules, e.g. related to participation in drinking Background: Low-risk drinking guidelines are often used to set drink- ga-mes. Five parents introduced new consequences for non-compli- ing targets for alcohol brief interventions, but their morbidity and ance with alcohol-related rules after the intoxication. Consequences mortality focus ignore the quality of life of the drinker. To better inform for non-compliance can be grouped into either intensified communi- low-risk drinking guidelines, we estimate the relationship between cation or sanctions. Parents articulated needs to reflect on advantages specific drinking behaviors and health utility, a measure of health- and disadvantages of rules containing prohibitions and to exchange related quality that is the basis for quality adjusted life years (QALYs). experiences with other parents. Six of nine parents recommend to talk Materials and methods: We use data from the US nationally rep- to children about alcohol use before they start consuming. resentative National Epidemiologic Survey on Alcohol and Related Conclusions: Parent interventions should take place before chil- Conditions-III (NESARC-III) dataset. We modeled individuals’ health dren start consuming alcohol and should include opportunities to utility as a quadratic function of typical quantity consumed, typical reflect on alcohol-related rules and consequences of non-compliance frequency of consuming that amount, maximum quantity consumed as well as give parents the opportunity to exchange opinions and in a single occasion, and frequency of consuming that amount while experiences. limiting our analyses to the target population for most alcohol brief interventions‚Äîcurrent drinkers with no history of AUD. O48 Results: For typical frequency and quantity, utility increased with Comparison of substance use screening instruments and time frequency but decreased with quantity, suggesting that utility was frames among adolescents in rural health clinics maximized by a typical consumption pattern of 1 drink per occasion, 1* 1 2 1 Jan Gryczynski , Laura Monico , Kevin O’Grady, Mishka Terplan , 5 days per week. For maximum quantity and frequency, however, util- Shannon Gwin Mitchell ity decreased with frequency and increased quantity, suggesting util- 1 2 Friends Research Institute, Baltimore, MD, USA; University of Maryland, ity was maximized when the largest amount consumed on a single College Park, MD, USA occasion was about 3 drinks no more than 1 day per year. Taking both Correspondence: Jan Gryczynski ( jgryczynski@friendsresearch.org) patterns into account, our estimates suggest that overall utility is max- Addiction Science & Clinical Practice 2023, 18(Suppl 1): O48 imized by consuming 1 drink per occasion on about 4 days per week. Conclusions: When the health utility of drinkers is considered, the Background: Initiation of substance use often occurs during ado- optimal level of drinking is less than that recommend by many low-risk lescence. Many young people access primary care, which offers an drinking guidelines, suggesting that alcohol brief interventions should opportunity for screening and brief intervention. Several self-report target lower consumption levels than they currently do. Furthermore, screening tools have been validated with adolescents that query because health utility is the basis for calculating QALYs, such interven- behavior in different time frames. tion targets may result in more QALYs gained and thereby increase the Methods: This is a secondary analysis of baseline data from a multi- cost-effectiveness of brief interventions. site, stepped wedge trial of the FaCES organizational change package to promote adoption of SBIRT services in adolescent primary care. The O50 analysis sample includes N = 1119 adolescent patients ages 12–17 Incorporating universal opioid use disorder screening recruited from five rural primary care clinics in New Mexico and Ten- into primary care: experiences from a national cohort of U.S. nessee, USA. Participants completed several self-report screening clinics 1,2* 1 1 3 questionnaires (S2BI, BSTAD, ASSIST ) at enrollment. We compared self- Emily C. Williams , Elizabeth J. Austin , Elsa S. Briggs , Lori F erro , Paul 4 4 5 3,6 2,3 reported substance use at different time frames used by these meas- Barry , Ashley Heald , Geoff M. Curran , Andrew Saxon , John F ortney , 3,6 ures (lifetime, past year, past 3-months, past 30-days) and examined Anna D. R atzliff their concordance using Cohen’s kappa. Differences in kappas were Department of Health Systems and Population Health, School of Public tested using Gwet’s procedure for comparing correlated kappas. Health University of Washington, Seattle, WA, USA; Center of Innovation Results: Tobacco, alcohol, and cannabis were the most commonly for Veteran‑Centered and Value‑Driven Care, Health Services Research & reported substances, with lifetime use (ASSIST ) reported by 24%, 28%, Development, VA Puget Sound, Seattle, WA, USA; Department of Psy‑ and 19%, respectively. Rates of past year use (S2BI) of tobacco, alcohol, chiatry and Behavioral Sciences, School of Medicine, University of Wash‑ and cannabis were 18%, 19%, and 15%, respectively, while past 30-day ington, Seattle, WA, USA; Advancing Integrated Mental Health Solutions use (BSTAD) was reported by 12%, 8%, and 8%, respectively. Compar- (AIMS) Center, University of Washington, Seattle, WA, USA; Departments ing lifetime (ASSIST) to past year (S2BI), 3-month (ASSIST), and 30-day of Pharmacy Practice and Psychiatry, University of Arkansas for Medical (BSTAD) disclosure, kappa concordance values were 0.80, 0.68, and Sciences, Little Rock AR; Central Arkansas Veterans Health Care System, 0.57 [tobacco]; 0.75, 0.56, 0.33 [alcohol]; and 0.86, 0.74, 0.54 [cannabis], Little Rock, AR, USA; Center of Excellence in Substance Addiction Treat‑ respectively. As expected, there was a significant decline in degree of ment and Education, VA Puget Sound, Seattle, WA, USA agreement (i.e., magnitude of kappas) with widening windows of time Correspondence: Emily C. Williams (emwilli@uw.edu) (ps < 0.05). Addiction Science & Clinical Practice 2023, 18(Suppl 1): O49 Conclusions: Time frame is an important consideration in substance use screening. Querying substance use over more extended time Background: In response to rising incidence of and associated mor- horizons (lifetime, past year) yields higher rates of disclosure and tality with opioid use disorder (OUD) and evidence that identification Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 18 of 27 followed directly by treatment can support OUD reduction, the U.S. health system (n = 12) to PROUD Intervention or Usual Care. All quan- Preventive Services Taskforce recommends routine screening for OUD, titative data were obtained from secondary electronic health records in primary care settings. Yet little is known about the barriers primary and insurance claims with waivers of consent and HIPAA authorization. care teams face when trying to implement OUD screening into prac- The primary outcome was a clinic-level measure of patient-years of tice. In a randomized trial to integrate OUD treatment alongside col- OUD treatment with buprenorphine or NTX. The secondary outcome laborative care for behavioral health, we supported 10 U.S. primary was a patient-level measure of days of acute care utilization. The Trial care clinics in implementing OUD screening and documented early tested one-sided hypotheses: whether the intervention 1) increased implementation experiences using formative evaluation. OUD treatment and 2) decreased acute care utilization (Œ ± = 0.05). Materials and methods: Trained qualitative researchers took detailed Results: Intervention and Usual Care clinics included 130,623 and observation notes at implementation meetings with individual clinics 159,459 patients respectively. Intervention clinics provided 8.2 (95% and regular debriefings with practice facilitators (n = 149 meetings). CI: 5.39, ‚àû) more patient-years of OUD treatment (p = 0.002), per Fieldnotes were analyzed weekly using a Rapid Assessment Process 10,000 PC patients post randomization, compared with Usual Care. guided by the Consolidated Framework for Implementation Research. These benefits were largely driven by 2 health systems. The Interven- After clinics launched OUD screening, we conducted a structured tion increased treatment in men more than women (p for interac- fidelity assessment with each site to systematically assess clinic expe - tion = 0.047). Days of acute care utilization did not differ between Trial riences. Data from fieldnotes and structured assessments were com- arms (RR 1.16; 95% CI: 0.47, 2.92; p = 0.70). bined into a matrix to compare across clinics and identify common Conclusion: The PROUD Intervention implementing the Massachu- patterns and cross-cutting themes. Resultant themes from early imple- setts Model of nurse care management increased PC OUD treatment. mentation were iteratively reviewed with the study team. Additional improvements or interventions will be needed to increase Results: While all clinics had the goal of implementing population- OUD treatment consistently across systems and among women, as based OUD screening, clinics experienced barriers across multiple well as decrease days of acute care utilization. domains, including: (1) challenges identifying which patients to screen, (2) complexity of the screening recommended tool, (3) staff O52 discomfort, (4) workflow barriers that decreased follow-up to positive Successful implementation of substance use screening screening/referral to treatment, (5) staffing shortages and turnover, in rural federally qualified health centres identified high rates (6) discouragement from low screening yield, and (7) stigma. Promis- of unhealthy alcohol, cannabis, and tobacco use 1* 2 3 3 ing implementation strategies included: a more universal screening Jennifer McNeely , Bethany McLeman, Trip Gardner , Noah Nesin , Sarah 4 5 5 5 5 approach, health information technology (HIT), audit and feedback, Farkas, Aimee Wahle , Seth Pitts , Margaret Kline , Jacquie King , Carmen 6 2 4 7 and repeated staff trainings. Rosa , Lisa Marsch , John R otrosen , Leah Hamilton Conclusions: Implementing OUD screening in diverse primary care Department of Population Health, New York University Grossman clinics was challenging. Implementation strategies that standardize School of Medicine, New York, NY 10016, USA; Center for Technology workflows via HIT, decrease stigma, and increase staff knowledge and and Behavioral Health, Geisel School of Medicine at Dartmouth College, confidence regarding OUD care may increase feasibility. Lebanon, NH 03766, USA; Penobscot Community Health Center, Bangor, ME 04401, USA; Department of Psychiatry, New York University Gross‑ O51 man School of Medicine, New York, NY 10016, USA; The Emmes Com‑ PROUD trial main results: a pragmatic implementation trial pany, Rockville, MD 20850, USA; National Institutes of Health, National testing the Massachusetts model of nurse collaborative care Institute on Drug Abuse, Bethesda, MD 20852, USA; Kaiser Permanente for opioid use disorder Washington Health Research Institute, Seattle, WA 98101, USA 1 1 2 Kathy Bradley , Jennifer F. Bobb , Abigail G. Matthews , Denise M. Correspondence: Jennifer McNeely ( jennifer.mcneely@nyulangone.org) 1 1 2 2 Boudreau , Paige D. Wartko , Jennifer McCormack , David S. Liu , Cynthia Addiction Science & Clinical Practice 2023, 18(Suppl 1): O52. 3 1 4 4 I. Campbell , Amy K. Lee , Jeffrey H. Samet , Colleen T. Labelle , Megan 1 1 1 5 1 Addis, Onchee Yu , Abisola Idu , Hongxiang (David) Qiu , Noorie Hyun , Background: Screening for substance use in rural primary care clin- 1 6 7 7 Joseph E. Glass , Ryan C aldeiro , Julia Arnsten , Chinazo Cunningham , ics faces unique challenges due to limited resources, high patient vol- 8 8 9 9 Jordan M. Braciszewski , Amy L oree , Angela Stotts , Mohammad Zare , umes, and multiple demands on providers. To explore the potential for 10 10 11 12 José Szapocznik, Viviana Horigian , Mark Murphy , Andrew J. Saxon electronic health record (EHR)-integrated screening, we conducted an Kaiser Permanente Washington Health Research Institute, Seattle, WA implementation feasibility study with a rural federally-qualified health 98101, USA; National Institute on Drug Abuse, Bethesda, MD, USA; center (FQHC) in Maine. This was an ancillary study to a NIDA Clinical RI Center for Community Health and Evaluation, Kaiser Permanente Trials Network study of screening in urban clinics (CTN-0062). Southern California, Oakland, CA, USA; Boston Medical Center, Boston, Methods: Researchers worked with stakeholders from 3 FQHC clin- 5 6 MA, USA; University of Washington, Seattle, WA, USA; Kaiser Permanente ics to define and implement their optimal screening approach. Clinics Washington, Everett, WA, USA; Montefiore Medical Center, New York, NY, used the TAPS Tool, completed on tablets in the waiting room; results 8 9 USA; Henry Ford Health System, Detroit, MI, USA; Harris Health System, were immediately recorded in the EHR. Adults presenting for annual Houston, TX, USA; Miller School of Medicine, University of Miami, Miami, preventive care visits were eligible for screening. Data were collected 11 12 FL, USA; MultiCare, Tacoma, WA, USA; Veterans Affairs Puget Sound between 11/1/2018–5/5/2020, and analyzed for 12 months following Health Care System, Seattle, WA, USA implementation at each clinic to assess screening rates and prevalence Correspondence: Kathy Bradley (katharine.a.bradley@kp.org) of reported unhealthy substance use. Addiction Science & Clinical Practice 2023, 18(Suppl 1): O51 Results: Screening was completed by 3,749 patients, representing 93.4% of those eligible and 18.4% of all adult patients presenting for Background: Evidence-based treatment for opioid use disorder (OUD) primary care visits. In 92.9% of cases, screening was self-administered. includes two medications that can be prescribed in primary care Current unhealthy substance use (TAPS score 1 + for at least one sub- (PC): buprenorphine and injectable naltrexone (NTX). Despite recom- stance) was identified in 1,219 patients (32.5% of those screened): mendations to treat OUD in PC, few PC practices do so. The PRimary 508 (13.6%) had unhealthy use of tobacco, 1064 (28.4%) alcohol, 383 care Opioid Use Disorders Treatment (PROUD) Trial was a pragmatic (10.2%) cannabis, 11 (0.3%) illicit drugs, and 18 (0.5%) non-medical use implementation trial (NCT03407638) that evaluated whether imple- of prescription drugs. mentation of the Massachusetts Model of nurse care management Conclusion: Self-administered EHR-integrated screening was feasible increased medication treatment for OUD in PC (primary objective) and to implement and detected substantial alcohol, cannabis, and tobacco decreased acute care utilization among patients with OUD pre-rand- use in rural FQHC clinics. Rates of drug use (including cannabis) iden- omization (powered secondary objective). tified through screening were higher (10% vs. 0.3–1.0%) than in the Materials and methods: PROUD was conducted in 6 U.S. health sys- parent study, possibly because the TAPS allows patients to report tems (3/1/2018‚Äì2/29/2020). We randomized two PC clinics in each A ddiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 19 of 27 cannabis separately from other drugs in a cannabis-legal state. Future Materials and methods: We randomly approached patients at an work may broaden the reach of screening by offering it at routine vis- urban public hospital ED to assess for eligibility. Eligible patients were its rather than restricting to annual preventive care, within these and adults, medically stable, not incarcerated, spoke English, screened other rural clinics. positive for unhealthy alcohol or any drug use using single-item screening questions, and were not homeless but screened positive for risk of future homelessness using a previously-developed three-item O53 homelessness risk screening tool (HRST). The study intervention con- Profile of Substance dependence with adult ADHD: a study sisted of: (1) brief counseling and referral to substance use treatment from a tertiary care setting in India 1* 1 2 1 via a pre-existing ED program; (2) enhanced referral to Homebase, an Sneha Goyal , Paulomi M. Sudhir , Vivek Benegal , Keshav Kumar , evidence-based homelessness prevention program; (3) up to 3 trou- Urvakhsh M. Mehta 1 2 bleshooting phone calls to ensure participants accessed Homebase. Department of Clinical Psychology, NIMHANS, Bangalore; Department Participants completed questionnaires at baseline and 6 months. The of Psychiatry; Head Centre for Addiction Medicine (CAM), NIMHANS, study was IRB approved. Bangalore, India Results: Of 2,183 patients screened, 51 were eligible; most screened Correspondence: Sneha Goyal (sneha.goyal591@gmail.com) negative on the HRST and thus were ineligible. Forty of 51 (78%) eligi- Addiction Science & Clinical Practice 2023, 18(Suppl 1): O53 ble patients participated; 1 later withdrew. Of the 32 (82%) participants reached at 6 months, most said it was very or extremely helpful talking Background: One of the neurodevelopmental risk factors for sub- to someone about their housing situation (n = 23, 72%) and receiving stance dependence is adult ADHD. Individuals with alcohol use and resources about substance use (n = 21, 66%) in the ED. Thirteen (41%) ADHD are noted to have higher alcohol consumption, faster progres- said their housing situation had improved in the past 6 months and 16 sion towards dependence, shorted abstinence periods, and early (50%) said it had not changed. Twenty (62.5%) had made contact with relapses. Comorbid alcohol use and ADHD may also be associated a Hombase office, 50% of whom said Homebase services were helpful. with greater number of Axis-I comorbidities. Individuals with Nico- Thirty-one (97%) were satisfied with the study experience. tine use and cannabis with comorbid ADHD are noted to have earlier Conclusions: Our ED pilot intervention to address homelessness risk age of onset, cognitive biases about substance-use, and greater use and substance use was feasible and well-received. Addressing home- of substances for coping. Individuals with nicotine dependence and lessness risk in tandem with substance use interventions in the ED adult ADHD are also noted to have difficulty quitting and worse with- warrants future study. drawal symptoms. Indian literature has pointed towards high overlap between substance-dependence and ADHD. The present study aims to examine profile of adults with Substance-related and Addictive dis- O55 orders with comorbid ADHD. Understanding the acceptability and experiences Methods: In the present study, 43 individuals with Substance-related of screening and brief interventions for problematic alcohol and Addictive disorders and comorbid adult ADHD were recruited consumption in people with co‑occurring depression: insights from a tertiary-care hospital setting in South India. Mean age of partic- from a qualitative study from the North East of England, UK. ipants was 27 years, with 41 males and 2 females, belonging to middle Katherine L Jackson , Amy Jane O’Donnell socio-economic status. Data was analyzed for a pattern of substance Population Health Sciences Institute, Newcastle University, Newcastle use, severity of ADHD, nature of impulsivity, executive functions, upon Tyne, NE2 4AX, UK socio-emotional factors, and functioning. Most common substances Correspondence: Katherine L Jackson (kat.jackson@newcastle.ac.uk) were noted to be alcohol, nicotine, and cannabis and one individual Addiction Science & Clinical Practice 2023, 18(Suppl 1): O55. had Gambling disorder. Majority of the sample had one additional comorbid axis I diagnosis. Background: In the UK, it is estimated that people with depression Results: The results indicated higher rate of dependence of nicotine are twice as likely to engage in problematic alcohol consumption. and cannabis, and higher rate of abstinence with alcohol. The results Yet, evidence suggests that screening people with depression for also suggested moderately severe ADHD, high impulsivity, and poor heavy alcohol use is not routine in primary care or mental health ser- cognitive-emotional-social functioning. The study has two major vices. Consequently, in this presentation we will draw on the experi- implications, 1) there is a need to screen for neurodevelopmental vul- ences of people with co-occurring heavy alcohol use and depression nerability factors like ADHD in population of adults with tobacco, alco- to understand factors that may challenge or create opportunities for hol, and cannabis use, or polysubstance use; and 2) early treatment of the delivery of alcohol screening and brief interventions and suggest ADHD is likely to reduce the risk for developing substance use. implications for policy and practice. Material and methods: Semi-structured qualitative interviews were undertaken with 40 people (22 men and 18 women) with current or O54 recent experience of co-occurring heavy alcohol use and depression Targeted SBIRT and homelessness prevention intervention who live in the North East and Cumbria, UK. Qualitative analysis drew for emergency department patients with drug use or unhealthy on interpretive description methodology. alcohol use: a pilot feasibility study 1* 1 2 2 Results: Three main themes were identified: (1) Lack of recognition; Kelly Doran , Daniela Fazio , Sara Zuiderveen , Dana Guyet , Andrea participants described that alcohol was sometimes not addressed or Reid dismissed by practitioners, or that their reasons for drinking were not Departments of Emergency Medicine and Population Health, NYU acknowledged in alcohol interventions (2) Nowhere to go; participants School of Medicine, New York, NY 10016, USA; Homelessness Prevention indicated that practitioners could sometimes lack knowledge or con- Administration, NYC Human Resources Administration, New York, NY fidence in addressing alcohol use. The emphasis on themselves to 10007, USA manage their alcohol use and the processes of self-referral could be Correspondence: Kelly Doran (kelly.doran@nyulangone.org) challenging (3) Inequities in good care; participants valued non-judge- Addiction Science & Clinical Practice 2023, 18(Suppl 1): O54. mental care from professionals who were knowledgeable about sup- port for reducing alcohol use, but there were inconsistencies across Background: Housing insecurity is commonly endorsed by emer- the region. gency department (ED) patients, and is particularly prevalent among Conclusions: People were receptive to the idea of discussing alcohol ED patients with drug or unhealthy alcohol use. We describe a pilot with practitioners. Yet, when they disclosed their alcohol use, they study of an intervention to simultaneously address substance use and homelessness risk among ED patients. Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 20 of 27 wanted access to appropriate advice and support as they struggle Correspondence: Kelly M. Doran (kelly.doran@nyulangone.org) to manage their drinking without support. Screening and brief inter- Addiction Science & Clinical Practice 2023, 18(Suppl 1): O57 ventions by themselves will not address the needs of this population; however, they could be valuable alongside other more intense inter- Background: Despite growing interest in screening and interventions ventions which acknowledge the social context of alcohol use and for substance use among emergency department (ED) patients, there depression. has been little examination into concurrent screening for patients & significant intersecting social needs such as housing insecurity. In this study we examine performance of two single-item screening ques- O56 tions assessing self-perceived risk of future homelessness among ED A multidisciplinary approach to expanding substance use patients with drug or unhealthy alcohol use. disorder treatment in an under‑resourced majority Latinx Materials and methods: We conducted a prospective cohort study community 1* 2 1 of a randomly selected sample of adult patients at an urban public Sandra J. Gonzalez , Monica Hernandez Sanchez , Samuel MacMaster , hospital ED. Patients completed a questionnaire that included two Roger Zoorob single-item screening questions on self-perceived risk for future hous- Department of Family and Community Medicine, Baylor College ing instability and homelessness. Questionnaires were linked to city of Medicine, Houston, Texas, 77098, USA; Behavioral Health Solutions administrative data, allowing us to assess patients & subsequent shel- of South Texas, Pharr, Texas, 78577, USA ter entry. We examined sensitivity, specificity, positive predictive value Correspondence: Sandra J. Gonzalez (sandra.gonzalez@bcm.edu) (PPV), and area under the receiver operating characteristic (AUROC) Addiction Science & Clinical Practice 2023, 18(Suppl 1): O56 curve of each screening question in predicting shelter entry 2-, 6-, and 12-months post-ED visit. Background: Substance use is associated with a higher risk of HIV Results: The final study analytic sample included 701 participants infection. The Rio Grande Valley (RGV) of Texas, USA, has experienced who screened positive for drug use or unhealthy alcohol use (using the impact of HIV/AIDS almost exclusively among young members of single-tem screeners) and were not homeless at baseline. Prevalence the Latinx community. In the RGV, it appears that the HIV epidemic is of shelter entry within 2-, 6-, and 12-months of the ED visit was 4.6%, fueled by three factors: substance use, poverty, and a lack of access to 6.7%, and 10.1%, respectively. For both single-item homelessness risk services. Additionally, national cross-sectional surveys have found that screening questions, participants who answered affirmatively had racial and ethnic respondents are more likely to perceive bias and lack significantly higher likelihood of future shelter entry at each time of cultural competence when seeking health care. point. Sensitivity of the questions at various time points ranged from Materials and methods: The demonstration project was conducted 0.27‚Äì0.65, specificity from 0.71‚Äì0.95, PPV from 0.10‚Äì0.40, and by a multi-site, multi-level substance use disorder (SUD) treatment AUROC from 0.61‚Äì0.75. facility in south Texas in collaboration with a university partner and Conclusions: Two single-item screening questions assessing self- key stakeholders representing the HIV and recovery services com- perceived risk of future housing instability and homelessness among munity. The evaluation strategy involves a single group design, with ED patients with drug or unhealthy alcohol use had adequate to good repeated measures of program outcome indicators at program intake performance in predicting future shelter entry. Similar questions could (baseline), program discharge, and 6-month post intake follow-up to be added to ED-based substance use interventions, with positive examine changes over the course of program participation. screens prompting interventions such as referral to community-based Results: A total of 307 participants were enrolled in intensive commu- homelessness prevention services. nity-based outpatient SUD treatment and recovery support services over the five-year life of the project. All individuals participated in the evaluation study by completing a baseline interview and, to date, 291 Poster presentations have completed 6-month follow up interviews. Preliminary findings show a significant improvement in abstinence rates, a decrease in the P1 frequency of HIV and HCV risk behaviors, increases in self-sufficiency Evaluating barriers and facilitators to implementing adolescent and psychosocial functioning, and a decrease in mental health and screening, brief intervention, and referral to treatment education trauma symptoms when comparing the baseline and 6-month follow in social work and nursing curriculum using the CFIR model 1* 1 up interviews. Adrienne H. Call , Hildie Cohen Conclusions: The preliminary findings of this evaluation study sug- NORC, University of Chicago, Chicago, IL 60603, USA gest that a multidisciplinary, community-based approach to treatment Correspondence: Adrienne H. Call (call‑adrienne@norc.org) may increase engagement and result in positive treatment outcomes Addiction Science & Clinical Practice 2023, 18(Suppl 1): P1 among participants. The study also sheds an important light on the unique needs of Latinx people with substance use disorders and sub- Background: Screening, Brief Intervention, Referral to Treatment populations, including sexual minority individuals. (SBIRT ) is an evidenced-based model to deliver prevention, early inter- vention, and treatment services for people with substance use dis- O57 orders and those at risk of developing them. NORC, in collaboration Can single‑item screening questions predict future homelessness with leading professional associations, subject matter experts, and among emergency department patients with drug or unhealthy technology partner Kognito, developed and evaluated an Adolescent alcohol use? SBIRT Curriculum to train the current and future workforce on screen- 1* 2 3,4 Kelly M. Doran , Mindy Hoang , Ann Elizabeth Montgomery , Eileen ing and intervening for substance use and co-occurring mental health 5 6 7 8 Johns , Marybeth Shinn , Tod Mijanovich , Dennis Culhane , Thomas risks. NORC and IRETA conducted a retrospective analysis using the Byrne Consolidated Framework for Implementing Research (CFIR) model to Departments of Emergency Medicine and Population Health, NYU identify barriers and facilitators to implementing the Adolescent SBIRT School of Medicine, New York, NY, USA; University of Cincinnati College curriculum. of Medicine, Cincinnati, OH, USA; School of Public Health, University Materials and methods: NORC collected data from progress reports, of Alabama at Birmingham, Birmingham, AL, USA; Birmingham Veterans learning collaborative calls, and implementation calls with participat- Affairs Health Care System, Birmingham, AL, USA; NYC Center for Inno‑ ing nursing and social work schools. Nearly 180 individual statements vation through Data Intelligence, New York, NY, USA; Department were extracted from the data for analysis. Two raters independently of Human and Organizational Development, Peabody College, Vanderbilt reviewed each of the statements and categorized them according to University, Nashville, TN, USA; Department of Applied Statistics, Social the CFIR model. Each statement was grouped within one of the five Sciences, and Humanities, NYU Steinhardt School, New York, NY, USA; CFIR domains and assigned a specific construct based on relevancy. School of Social Policy and Practice, University of Pennsylvania, Philadel‑ Coding was later assessed for agreement. phia, PA, USA; School of Social Work, Boston University, Boston, MA, USA A ddiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 21 of 27 Results: Barriers and facilitators related to the Inner Setting arose to respond to alcohol-impaired employees. These then grew into more most often with 85 (47%) of statements meeting the domains criteria. formalized occupational alcoholism programs, and eventually gave Though less common, 39 (22%) statements were associated with Pro- way to modern EAP’s. Here, we examine the effect on absentee hours cess, followed by Characteristics of Individuals, and Intervention Char- of EAP’s as a series of brief interventions for employees with addiction- acteristics, each with 25 (14%) statements. Only 5 statements (3%) met related presenting issues. the CFIR definition for Outer Setting, suggesting that such external Materials and methods: We use data from EAP provider Empathia’s factors impacted implementation the least. Workplace Outcomes Suite dataset. We tested for statistically signifi- Conclusions: Inner Setting, Process, and Characteristics of Individuals cant differences in outcomes between various subgroups using one CFIR domains had the largest impact on curriculum implementation. and two-sample t-testing. The more access to materials and training, the more likely people were Results: Those with addiction-related presenting issues saw a reduc- to feel comfortable and implement. Continual engagement and feed- tion of 7.38 absentee hours, compared to a reduction of 4.03 absentee back opportunities between stakeholders and implementation teams hours for non-addiction-related presenting issues. Those with an alco- is critical, as is ongoing access to the training curriculum and imple- hol-related presenting issue saw a reduction of 9.08 absentee hours. mentation support materials. Additionally, those with addiction-related presenting issues were more likely than others to indicate that their personal issues did not interfere with work, that they were happy with their lives and work, P2 and that they were eager to start the workday. Brief intervention for patients using psychoactive substances 1* 2 1 Conclusions: While Employee Assistance Programs provide a benefit Angela Maria Mendes Abreu , Riany Brites , Sonia Sueli S. E.Santo , 1 1 to most employees who utilize them, they can provide an increased Larissa Mattos , Marcia Cesar benefit to those employees that struggle with addiction. When used Federal University of Rio de Janeiro Health Science Center Anna Nery as a series of brief interventions and/or as part of a larger treatment Nursing School Public Health Department of Nursing, Rio de Janeiro, RJ, plan, they have the potential to decrease absenteeism among employ- Brazil; Federal University of Rio de Janeiro, Occupational Health Service. ees with addiction issues, therefore generating a return on investment Rio de Janeiro, RJ, Brazil to the employer as they are able to direct fewer resources toward cov- Correspondence:Angela Maria Mendes Abreu (angelamendesabreu@ ering late, absent, or impaired employees. gmail.com) Addiction Science & Clinical Practice 2023, 18(Suppl 1): P2. P4 Background: About 275 million people used drugs worldwide in the Nalmefene prescribing in UK primary care: an overview of general last year, while more than 36 million suffered from disorders associ- patterns, insights from professionals, and implications for alcohol ated with the use of psychoactive substances, according to the World interventions in primary care 1* 1 2 Drug Report 2021. Objective To analyze the effect of Brief Intervention Clare Sharp , Niamh Fitzgerald , Linda Bauld on reduction in the consumption of psychoactive substances. Institute of Social Marketing and Health, University of Stirling, Stirling, Methods: Longitudinal descriptive pilot study, carried out in a UK; Usher Institute, University of Edinburgh, Edinburgh, UK medium-complexity Unit with Primary Care programs, in users of Correspondence: Clare Sharp (clare.sharp1@stir.ac.uk) psychoactive substances, in a University Hospital, Rio de Janeiro/ Bra- Addiction Science & Clinical Practice 2023, 18(Suppl 1): P4 zil, applying the ASSIST. The study population was 147 patients seen between March 2019 to March 2022, the pilot study sample consisted Introduction: Nalmefene, first approved for use in the UK NHS in of 22 randomly selected patients. The cutoff point for inclusion in the 2013, is the first pharmacotherapy to be licensed for the reduction of sample was patients from 3 consecutive consultations, leaving 18 alcohol consumption in patients with alcohol dependence. Marketed patients in the final sample, who were undergoing Brief Intervention mainly towards prescribing in primary care, the evidence supporting consultations. Descriptive statistics were used with simple frequencies, its efficacy and use in this setting remans contested. means, raw values and percentages through univariate analysis, per- Aims: This study aims to describe levels of and patterns in nalmefene formed in SPSS Version 21. prescribing in UK primary care, and to provide insights into factors Preliminary results: Higher frequency for males 83.3%, single 46.0%, which may have influenced uptake of the drug. age group over 40 years 66.7%, with an average of 45.3 years, ele- Methods: A mixed-methods study including a quantitative analysis mentary schooling 44.4%, income between 1 and 4 minimum wages of GP prescribing data (using monthly nalmefene prescribing for GP 50.0%. Substances used in the last three months were cocaine 66.6% practices in England obtained from OpenPrescribing.net and patient- and alcohol 33.3%. Time taken in the Service until the beginning of the level data from the Clinical Practice Research Datalink (CPRD) for IB consultation was from 0 to 8 weeks. The highest frequency for drug patients who have received nalmefene) and semi-structured inter- cessation was around 1 to 12 weeks (38.8%). They reduced consump- views (n = 19) with alcohol treatment and policy professionals. tion (88.8%). Results: Nalmefene prescribing in UK primary care was low, apart Conclusions: You can see the effect of consultation using the Brief from a temporary increase after nalmefene was recommended by the Intervention technique on substance use reduction and cessation. The National Institute for Health and Care Excellence (NICE) in 2014, and implementation of a protocol based on Brief Intervention became a prescribing was poorly aligned with the drug’s licensing conditions. guide for all care in the Service. Study in progress, the main results will Whilst marketing activities were thought to have garnered some sup- be presented at the Inebria Congress. port for nalmefene, there remained substantial barriers to its use in UK primary care, including poor compatibility with current models of alcohol treatment, and a lack of skills, resources and confidence in pri- P3 mary care to treat alcohol dependence. Exploring the impact of employee assistance programs Discussion: The nalmefene experience, in line with some other stud- on the reduction of absentee hours for addiction‑related ies, highlights the challenges of implementing alcohol interventions presenting issue 1* 1 2 3 in primary care, and raises questions about the primary care role in Ashley Peters , Jeremy Bray , David Goehner , Richard L ennox addressing alcohol problems. Department of Economics, UNC Greensboro, Greensboro, NC, USA; 2 3 Empathia, Waukesha, Wisconsin, USA; Chestnut Global Partners, Bloom‑ ington, IL, USA P5 Correspondence: Ashley Peters (arpeter2@uncg.edu) A randomized iterative approach to optimizing an online Addiction Science & Clinical Practice 2023, 18(Suppl 1): P3 substance use intervention for collegiate athletes 1* 2 David Wyrick , Cheryl Haworth Wyrick 1 2 Background: Employee Assistance Programs (EAP’s) originally grew UNC Greensboro, Greensboro, NC, USA; Prevention Strategies, LLC, Uni‑ out of occupational counseling programs in the 1940’s which aimed versity of North Carolina, Greensboro, NC, USA Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 22 of 27 Correspondence: David Wyrick (dlwyrick@uncg.edu) Results: Three interactive case-based learning modules were devel- Addiction Science & Clinical Practice 2023, 18(Suppl 1): P5 oped and integrated into courses for NP students: Overview of Pain and Opioid Use, Addressing Stigma in Healthcare, Caring for Patients Background: Interventions targeting alcohol use among college with Chronic Pain Over Time. A final module was developed to direct students show some efficacy in RCTs. Notably, most interventions do students to the 24-h waiver training requirements. not address the unique motivations for substance use among colle- Conclusions: The case-based modules provided students with the giate student-athletes and the few interventions that do only address opportunity to visualize patients with opioid use disorder at a time alcohol. Furthermore, the average intervention effect sizes are typi- when the pandemic precluded clinical practice opportunities. The cally small to moderate. Our primary objective was to maximize the enhanced curriculum is the first step toward expanding the NP work - impact of myPlaybook, an online substance use intervention for col- force prepared to manage patients with opioid use disorder. This sus- lege student-athletes, on the two most abused substances: alcohol tainable curriculum holds promise for increasing the number of NPs and marijuana. who can prescribe buprenorphine. Methods: We evaluated intervention lessons through three sequential optimization trials, using the Multiphase Optimization Strategy frame- P7 work. Each trial used a fully powered longitudinal, randomized facto- Changes in alcohol use during the COVID‑19 pandemic: survey rial design. We recruited and randomized N = 54 (Trial 1), N = 47 ( Trial among women in primary health care 1* 1 1 2), and N = 42 (Trial 3) schools and invited all first-year and transfer Divane de Vargas , Erika Gisseth León Ramírez , Caroline Figueira Pereira , 1 1 student-athletes to participate. Student-athletes completed a baseline Rosa Maria Jacinto Volpato , Ana Vitoria Correa Lima , Jose Adelmo Da survey, their randomly assigned intervention lessons, and immediate Silva Filho posttest and 30-day follow-up surveys. Across trials, N = 3,244 (48.8% Psychiatric Nursing Department, School of Nursing University of São female), N = 2,837 (51.9% female), and N = 2,193 (51.4% female) com- Paulo, São Paulo, Brazil pleted the baseline survey and at least one posttest survey. We revised Correspondence: Divane de Vargas (vargas@usp.br) lessons that did not meet the optimization criterion (d ≥ 0.3) for the Addiction Science & Clinical Practice 2023, 18(Suppl 1): P7 proximal outcomes. Results: Trial 1: The alcohol lesson significantly improved descriptive Background: In the last decades, the women’s role in the society had and approval norms, and positive expectancies and the marijuana les- been changed, women began to take on multiple tasks, and face the son significantly improved negative expectancies, but all d < 0.15. We challenges of a world built for men. During the pandemic period, this then revised lessons to target proximal outcomes, rather than specific situation became worse, generating overload and stress feelings. Con- substances. Trial 2: the norms and expectancies lessons had some sig- sequently studies warning about the change in alcohol use profile in nificant effects, but some d < 0.3, so all lessons were revised. Trial 3: The women during the pandemic. In this way, this study aims to investi- norms lesson improved all proximal outcomes (all d > 0.35). The expec- gate the changes in women’s pattern of alcohol use during the first tancies lesson improved alcohol positive expectancies (d = 0.3) and twelve months of the COVID-19 pandemic and the correlated factors, marijuana negative expectancies (d = 0.16). The other lessons had no in primary care health services in Brazil. significant effects. Methods: Cross-sectional study with a convenience sample and tele- Conclusions: After three optimization trials, myPlaybook lessons had phone-based interviews to identify alcohol use patterns among 3252 substantially stronger effects on proximal outcomes, increasing the women from primary health care (PHC) patients during the COVID- likelihood that the intervention “package” will have a meaningful clini- 19 pandemic. The Alcohol Use Disorders Identification Test (AUDIT-C) cal impact on college student-athletes’ substance use. were used to assess the alcohol use patterns. To assess the change of alcohol use patterns, the pandemic periods were classified according P6 to the intensity of the restriction measures during the twelve months Curricular innovation related to management of patients of pandemic in three categories (Maximum restriction, lessening of with opioid use disorder restrictions and transition to eliminate restrictions). 1* 1 Deborah S. Finnell , Tammy M. Slater Results: The mean score of AUDIT C was 2.08 (SD 2.75), indicating a School of Nursing, Johns Hopkins University, Baltimore, MD 21205, trend of alcohol use among low risk and moderate risk. When ana- USA lyzed the change of alcohol use by periods, the higher AUDIT C mean Correspondence: Deborah S. Finnell (dfinnell@jhu.edu) observed was 3.35 (SD3.04) indicating moderate risk during the transi- Addiction Science & Clinical Practice 2023, 18(Suppl 1): P6 tion to eliminate restrictions. On the other hand the lower mean (0.78 SD 1.71) was observed in the Maximum restriction period. Among the Background: Buprenorphine prescribing for treatment of persons factors significantly related (p < 0.05) with these changes were marital with opioid use disorder is heavily regulated in the U.S. Since 2016, status, income, education level and age. nurse practitioners (NPs) have the legal right to provide buprenor- Conclusions: The results of this study could be important in identi- phine treatment, albeit with completion of federally-approved educa- fying ways of responding to the consequences of the pandemic on tion, possession of a federal waiver to prescribe buprenorphine, and women’s mental health and providing support for the development of within the context of their state’s scope of practice. The demand for strategies for the assessment and prevention. opioid-related treatment outpaces the number of qualified providers. Adding specialized content to nursing curricula will prepare NP gradu- P8 ates to manage patients with opioid use disorder, including treatment I thought cancer was a tobacco issue: perspectives of Veterans with buprenorphine. with and without HIV on cancer risks associated with alcohol Materials and methods: With funding from the Substance Abuse and and tobacco use 1,2* 1,2 1 Mental Health Administration, the project team (NP faculty) at a large Elsa S. Briggs , Madeline C. Frost , Rachel M. Thomas , Olivia V. 1 1,3 1 mid-Atlantic School of Nursing conducted a gap analysis of the current Fletcher , Kristina A. Crothers , Clementine K. Chalal , Jennifer B. 4 5 1,2 NP curriculum. While content related to screening, brief intervention McClure , Sheryl L. Catz , Emily C. Williams and referral to treatment for alcohol and other drug use was included Health Services Research and Development, Center of Innovation in the curriculum, opioid-specific content was lacking. The project for Veteran‑Centered and Value‑Driven Care, Veterans Affairs Puget team developed interactive learning modules to enhance opioid- Sound Health Care System, Seattle, Washington, 98108, USA; Depart‑ related knowledge and skills for managing patients with opioid use ment of Health Systems & Population Health, University of Washington disorder. To ensure that the content was delivered within the context School of Public Health, Seattle, Washington, 98195, USA; Division and framework of existing curricula, the modules were placed in rel- of Pulmonary, Critical Care, and Sleep Medicine, University of Washington evant courses. School of Medicine, Seattle, Washington, 98195, USA; Kaiser Permanente A ddiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 23 of 27 Washington Health Research Institute, Seattle, Washington, 98101, USA; Methods: Trained research staff virtually interviewed adolescents Betty Irene Moore School of Nursing, University of California, Davis, and adults recruited from clinical and community settings using Sacramento, California, 95817, USA a semi-structured guide about thoughts and concerns regarding Correspondence: Elsa S. Briggs (elsa8@uw.edu) genetic testing and personalized prevention, perceived risks, and ben- Addiction Science & Clinical Practice 2023, 18(Suppl 1): P8 efits. Qualitative interviews were transcribed, coded, and thematically analyzed. Background: Feedback linking substance use to health is a key com- Results: Participants (N = 9) ranged in age from 16 to 63 (Ave.26.7), ponent of brief intervention. Both U.S. Veterans and people living with of which, 67% identified as female and 22% had previously received HIV (PWH) experience higher rates of unhealthy alcohol and tobacco genetic testing. Overall, attitudes were strongly favorable toward the use than non-Veterans and people without HIV (PWoH) and are often model. Perceived benefits included informing decisions to modify more susceptible to adverse health outcomes associated with these behavior early in life to avoid future risk, opportunity to share impor- substances, including many cancers. Understanding awareness of tant health information with family members for their protection, cancer risk related to alcohol and tobacco use and their co-occurrence confirmation of and insight into health problems. Potential harms could inform brief interventions for both substances. included the potential for experiencing anxiety, increasing risk behav- Materials and methods: We conducted semi-structured interviews iors on the false assumption of protection should a genetic test be exploring awareness of and beliefs about how alcohol and tobacco negative, stigma. Most participants favored integration of a person- use, alone and together impact cancer risk in a diverse sample of Vet- alized prevention model into routine pediatric care with parental erans Health Administration (VA) patients with and without HIV. Par- involvement for adolescents. ticipants were identified from national electronic health record data in Conclusions: High interest in and acceptability of a personalized pre- VA, using a stratified purposive sampling frame to ensure a range of vention model were found along with appreciation for how under- alcohol and tobacco use and diverse lived experiences and identities. standing genetic risk for alcohol and other substance use disorders Interviews were conducted via telephone, recorded, and transcribed might motivate health decision making and risk modifying behaviors. and analyzed using a Rapid Assessment Process. Further research is needed to elucidate operational, ethical, and com- Results: Among 41 participants (46% PWH, 54% PWoH; 73% male, munications strategies to advance this model. 39% black), 63% reported current smoking and most screened posi- tive for unhealthy alcohol use (mean AUDIT-C score = 5.9). For patients P10 with and without HIV, preliminary analyses showed awareness of Implementation and impact of adolescent SBIRT training tobacco-related cancer risk was high, while awareness of alcohol- for substance use and co‑occurring mental health risks 1* 1 1 related cancer risk was very limited, with no notable differences Hildie Cohen , Tracy L. McPherson , Giana Calabrese between groups. Despite limited awareness, some participants felt it Public Health, NORC at the University of Chicago, Chicago, IL 60603, USA was plausible that cancer risk would increase for individuals with co- Correspondence: Hildie Cohen (cohen‑hildie@norc.org) occurring alcohol and tobacco use. Addiction Science & Clinical Practice 2023, 18(Suppl 1): P10 Conclusions: Among PLWH and PWoH, there was minimal awareness of how alcohol or co-occurring alcohol and tobacco use impact long- Background: Screening, Brief Intervention, Referral to Treatment term cancer risk. Findings suggest that, among PWH and PWoH, there (SBIRT ) is an evidenced-based model to deliver prevention, early inter- is a need for increased and improved messaging around cancer risk vention, and treatment services for people with substance use disor- related to alcohol and co-occurring alcohol and tobacco use. These ders and those at risk of developing them. NORC, in collaboration with findings could inform future iterations of brief interventions for both leading professional associations, subject matter experts, and technol- substances across populations. ogy partner Kognito, developed and evaluated an Adolescent SBIRT Curriculum to train the current and future workforce on screening and P9 intervening for substance use and co-occurring mental health risks Acceptability of a brief personalized prevention model such as suicide risk. Since 2015, over 600 academic institutions and for reducing alcohol and other substance use risk among youth: organizations have implemented the curriculum and 25,000 individu- findings from a qualitative interview study als have been trained via virtual and classroom instruction. This pres- 1,2,3* 1 3,4 Elissa R. Weitzman , Laura M Blakemore , Joe Kossowsky , Sharon entation will discuss the Adolescent SBIRT Curriculum resources and 3,5 Levy its large-scale implementation including the results of an evaluation of Division of Adolescent/Young Adult Medicine, Boston Children’s Hospi‑ the virtual SBIRT-Suicide Prevention Training. tal, Boston, MA 02115; Computational Health Informatics Program, Bos‑ Materials and methods: The Adolescent SBIRT Initiative at NORC ton Children’s Hospital, Boston, MA 02115, USA; Department of Pediat‑ engaged a national learning collaborative and steering committee to rics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; develop, implement, and evaluate the curriculum. In addition, a vir- Department of Anesthesiology, Critical Care and Pain Medicine, Boston tual SBIRT-Suicide Prevention Training with dedicated website with Children’s Hospital, Boston, MA 02115, USA; Adolescent Substance Use resources were created. and Addiction Program, Division of Developmental Medicine, Boston Over 3,550 individuals attended the virtual SBIRT-Suicide Prevention Children’s Hospital, Boston, MA 02115, USA Training. A posttest and 2-month follow up survey was administered Correspondence: Elissa R. Weitzman (elissa.weitzman@childrens. to assess learner outcomes and practice uptake with a sample of 331 harvard.edu) attendees completing both the posttest and 2-month posttest. Addiction Science & Clinical Practice 2023, 18(Suppl 1): P9 Results: Findings indicated 64% of trainees reported sharing informa- tion with colleagues, 20% trained other health professionals on utiliz- Background: Humans are compelled by notions of biological vulner- ing adolescent screening tools for suicide risk; and 17% implemented ability to disease, driving direct-to-consumer genetic testing. One in screening and/or brief interventions to assess suicide risk. Attendees 25 US adults obtained personalized genetic test reports in 2017, and showed a statistically significant increase in confidence in screen- substance use disorder is an area of peak interest including among ing for alcohol and drug use and suicide risk using a validated tool at adolescents who stand to benefit greatly from early preventive inter - 2-months post webinar. ventions. Still, little is known about the acceptability of a personalized Conclusions: Findings suggest that large-scale implementation of the brief intervention involving return of personal genetic risk information Adolescent SBIRT Curriculum focusing on substance use and suicide to adolescents to motivate alcohol or other substance use risk limiting prevention is feasible and can positively build workforce capacity to behavior. deliver key components of SBIRT in a short period of time. Objective: To explore acceptability of a model for returning individual genetic testing information to adolescents to motive risk reducing behaviors. Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 24 of 27 P11 clinical assessment, various types of SUD treatments, and ongoing Interventions targeting women at risk of drinking alcohol care are required. While didactic standards include teaching elements during pregnancy within the FAR SEAS pilot project of screening, brief intervention, and referral to treatment (SBIRT ) prac- 1* 2 2 Katarzyna Okulicz‑Kozaryn , Carla Bruguera Soler , Lidia Segura Garcia , tices, few models involve integration of SBIRT practices throughout the 2 3 4 4 Joan Colom Farran , Fleur Braddick , Emanuele Scafato , Claudia Gandin , fellowship program. Previous criticisms of large scale U.S. SBIRT imple- 4 5 Alice Matone , Marta Zin‑Sędek mentation found that very few physicians continued SBIRT practices. Children and Adolescent Health Department, Institute of Mother Methods: As a Clinical Surgery Professor at Wake Forest University and Child, Warsaw, 01‑211, Poland; ASPCAT, GENCAT Roc Boronat 81‑95, School of Medicine, core faculty member of our ACGME-accredited 08005 Barcelona, Spain; Clínic Addictions Research Group (GRAC), Hos‑ program, and integral in the planning in 2017 of this new 2-year fel- pital Clínic, Barcelona, 08036, Spain; 4National Observatory on Alcohol, lowship program, innovative integration of addiction medicine didac- National Centre on Addictions and Doping, Istituto Superiore di Sanità, tics with pioneering SBIRT practices has been at the forefront. As the Rome, 00161, Italy; Research, Monitoring and International Coopera‑ Founding Director of the Addiction Research & Clinical Health M.S. tion Department, National Centre for Prevention of Addictions (KCPU), program, integrating the fellows on a continual basis with graduate Warsaw, Poland learners practicing SBIRT at the hospital bedside underscored impor- Correspondence: Katarzyna Okulicz‑Kozaryn (katarzyna.okulicz@imid. tant immersive education. med.pl) Results: Data related to immersive SBIRT instructional methods since Addiction Science & Clinical Practice 2023, 18(Suppl 1): P11 2018 will be shared. Findings of post-fellowship SBIRT practices in medical settings and the practice of addiction medicine as their pri- Background: FAR SEAS is a tendered service contract for the Euro- mary specialty utilizing SBIRT practices will be reviewed. This presen- pean Commission under the EU Health Programme, aimed at reducing tation outlines immersive pedagogy using SBIRT in ongoing medical alcohol exposed pregnancies (AEP) to improve public health. One FAR practice and its implications for future research. SEAS task is to pilot the implementation of good practice interven- Conclusion: Ongoing examination of key contributors to SBIRT imple- tions in the Mazovian region (Poland). mentation suggests immersive medical education is an area for further Methods: Staff (n = 30) from local-level services in 4 towns (social, research. Substantial effort in this research may involve a continued therapeutic and psychological), screened women of child-bearing emphasis on addiction medicine integrated with SBIRT practices. age (pregnant and not pregnant) for alcohol risky use (using AUDIT- C) and psychosocial risks. Interventions ranged from simple feedback, P13 via brief intervention (BI), motivational interviewing (MI) sessions, to Implementation of systematic screening, brief intervention, referral to other specialist and individualized care package, and were and management of alcohol use disorders: an adaptation tailored to the needs of the women according to their level and type of the SPARC trial intervention for small primary care clinics 1* 2 2 2 of risk and their reproductive status. 441 women of child-bearing age, Leah K. Hamilton , Mariah BlackW ‑ atson , Anya Day , Christine Stanik , 2 1 including 42 pregnant women (9,5%), were recruited to the pilot study Rachelle May‑Maki , Katharine Bradley (in low, moderate, and high-risk groups: 70%, 23%, 7%, respectively). Kaiser Permanente Washington Health Research Institute, Seattle, WA, Results: At least one intervention was offered to 95% of screened 98101; Altarum Institute, Ann Arbor, MI 48105, USA women. The number of interventions increased with the risk level ‚Äì Correspondence: Leah K. Hamilton (leah.k.hamilton@kp.org) at least two types of interventions were received by 7% of women at Addiction Science & Clinical Practice 2023, 18(Suppl 1): P13 low risk, 75% moderate risk and 84% high risk of AEP. Three or more types of interventions were received by 1%; 15% and 36% of partici- Background: The Sustained Patient-centered Alcohol-Related Care pants at the respective the risk levels. The professionals‚Äô first-choice (SPARC) implementation trial used three implementation strategies; intervention was typically feedback and/or BI, while, for those receiv- practice facilitation, EHR clinical decision support, and performance ing multiple interventions, MI and referrals to specialists were more feedback to improve alcohol-related primary care (PC) along with common. other behavioral health integration. However, it is unknown whether Conclusions: Considering that most project staff only became this approach to implementing alcohol-related care could be adapted acquainted with the screening, BI and MI procedures during the FAR to small, independent PC practices. Michigan SPARC tested an adapta- SEAS training, the implementation rates seem satisfactory. However, tion of the SPARC implementation intervention in small PC practices the success of the project will be determined only by the final evalua- in Michigan and Indiana (March 2020-Dec. 2022). Results to date are tion data (due end of June this year), which will allow us to assess the presented. impact of the interventions on women’s knowledge and behavioral Materials and methods: 28 practices were recruited. Clinics were outcomes. assigned a practice facilitator who provided Continuing Medical Education training and guided alcohol-related implementation for P12 6 months using SPARC strategies; practices were also provided a Transformation: integrating SBIRT practice within US accredited patient decision aid to support shared decision making about AUD. addiction medicine MD fellowship program Data were collected by manual chart review (n = 7) or electronic EHR 1* 2 Laura J. Veach , Jie Cao data (n = 2). Analyses were at the practice level. Department of Surgery‑Trauma, Wake Forest University School of Medi‑ Results: 14 practices completed CME and engaged with practice facili- cine, Winston Salem, NC 27157, USA; MBBS, MS, MD, Wake Forest Univer‑ tators; 13 practices integrated paper screening using the AUDIT-C into sity School of Medicine, Winston Salem, NC 27157, USA their workflow. No practice was able to build prompts for screening Correspondence: Laura J. Veach (lveach@wakehealth.edu) into their EHR, and only nine practices (so far) obtained baseline EHR Addiction Science & Clinical Practice 2023, 18(Suppl 1): P12 data for performance feedback. At baseline (n = 9), mean prevalence of alcohol screening was 26% (0–100%) of patients, with mean prac- Background: Efforts to set quality U.S. addiction medicine training tice prevalence of positive screens 0–54.5%. Mean baseline prevalence standards were first implemented by the American College of Aca- of documented AUD diagnosis was 0.07% (range: 0.09–0.3%). Five demic Addiction Medicine with 86 programs now listed. In 2018, the practices that collected 6-month follow-up data (so far) had a mean prestigious American College of Graduate Medical Education (ACGME) screening prevalence of 25% (6–45%) of patients, with a mean practice began historic accreditation of addiction medicine programs. The prevalence of positive screens 16% (0–42%), and AUD diagnoses 0.7% ACGME fellowship involves a multispeciality training focused on those (0%-2%). impacted by substance use disorders (SUD), unhealthy substance use, Conclusion: Michigan SPARC was heavily impacted by both COVID and other addiction-related disorders. Important areas of prevention, and non-COVID-related barriers, resulting in uneven implementation A ddiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 25 of 27 and the need for iterative adaptations to the SPARC approach. To date, We also contacted international organisations to know more about the implementation has not increased prevalence of screening overall existing data and resources. We then gathered evidence-based ques- and minimally increased AUD diagnosis. tionnaires which can be used by healthcare professionals. All the col- lected data were discussed with a multi-professional working group, gathering governmental bodies, associations, healthcare professionals P14 from both sexual health and addiction fields. The group met several Gaps between teaching and implementing BI in public services times to think about the guidebook, its content, the format and the in Brazil 1* 2 3 best way to conduct an early detection and brief intervention for sex- Liz Paola D omingues , Danilo Polverini Locatelli , André Bedendo , Ana ual health in addiction settings. Regina Noto Results: We have set up and regrouped a working group several times Department of Psychobiology, Federal University of São Paulo, São Paulo, and the main results are: first a real need identified for the guidebook Brazil; Research Incentive Fund Association (AFIP), São Paulo, Brazil; but also to talk and think about this theme. And finally, the publica- Department of Health Sciences, University of York, York, UK tion of the guidebook distributed electronically and in printed form in Correspondence: Liz Paola Domingues (liz.paola@unifesp.br) 2000 copies. Addiction Science & Clinical Practice 2023, 18(Suppl 1): P14 Conclusions: The guidebook has been well accepted by health pro- fessionals and is often ordered. It answers to a real need and must be Background: Despite promising results of Brief Intervention (BI) in completed by trainings. reducing alcohol and other drugs use, its implementation in profes- sional routine is very challenging. Studies on training program out- comes show that professionals struggle to implement the content in P16 their routine practice. Worldwide distribution of studies on brief intervention for alcohol Objective: This study has aimed to assess the implementation chal- and its relationship with countries’ alcohol dependence rates 1* 2 lenges of BI in the work routine following a multi-professional training Micaella Leandro Silva , Wellington Francisco Rodrigues , Maria Lucia on alcohol and drugs in São Paulo—Brazil. Oliveira Souza Formigoni Methodology: Between 2016 and 2017, a Regional Reference Center Wellington Francisco Rodrigues, Psychobiology, University of São Paulo, (CRR) located at Universidade Federal de São Paulo (Brazil) offered São Paulo, Brazil; Health Sciences, Federal University of Triangulo Mineiro, 40 h trainings to professionals working in public institutions of health, Uberaba, Brazil; Departamento de Psicobiologia, Escola Paulista de education, social assistance, justice, and the safety system; addressing Medicina, Universidade Federal de São Paulo, São Paulo, Brazil topics from basic knowledge of drug addiction to the development Correspondence: Micaella Leandro Silva (micaella.leandro@unifesp.br) of specific skills, such as screening and BI. A year later, 28 of the 310 Addiction Science & Clinical Practice 2023, 18(Suppl 1): P16 professionals who concluded the training were assessed at follow up interviews. They were randomly selected and interviewed using semi- Background: Studies on Brief intervention developed in different structured script. Data were collected until reaching theoretical satura- countries indicated its effectiveness in reducing harmful alcohol tion. Two collective interviews were also conducted with 09 experts/ consumption. professors who offered the referred trainings. Objectives: To describe the association between the frequency and Results: The data indicated that after a year, trained professionals from types of studies on brief intervention to reduce alcohol use with the different working areas recognized the importance of the new prac - prevalence of alcohol dependence in the countries where the studies tices, but implementation was challenging. The professionals reported were developed. the lack of leaders’ support as a major barrier for implementation of Methods: We carried out a systematic review using the mesh terms screening and BI, followed by lack of time due to work overload. The “crisis intervention” and “alcohol drinking”, as well as their respective experts reinforced the need to teach the use of protocols consistent entry terms for the selection of studies (Boolean operators "or" and with the professionals’ real routine. They also indicated that more tra- "and") over a period of 10 years (2012 to 2021), following the recom- ditional assessment strategies may not access real changes related to mendations of Prisma (2020). Medline/ Pubmed, Cochrane and Pros- training. pero (grey literature) databases were consulted, without language Conclusion: This study shows that the implementation of BI and other restriction. We extracted the variables "authors", "year of study", "type practices is difficult to achieve unless stakeholders and leaders are also of study" and "country" to evaluate their association with the num- appreciative and supportive of the implementation process. It is also ber and kind of studies. The frequencies of adults (15 + years) suffer - important that the protocols reflect the professional’s routine. ing from disorders attributable to alcohol consumption (ICD-10: F10.1 and F10.2) for different countries and continents (year 2018 data— last update) were obtained in the Global Health Observatory (World P15 Health Organization). Early detection and brief intervention for sexual health Results: In the period evaluated, most of the studies were conducted in addiction settings 1* 1 in the US (48.7%), followed by the UK and Australia (9.2% each). The Marianne Hochet , Nicolas Bonnet American continent was responsible for 56.6% of the studies, fol- RESPADD (French Network for addiction prevention), Paris, 75014, France lowed by the European continent with 26.3%. All other countries Correspondence: Marianne Hochet (marianne.hochet@respadd.org) were responsible for 17.1% of the studies. Considering the regional Addiction Science & Clinical Practice 2023, 18(Suppl 1): P15 prevalence of alcohol dependence, the Americas had the highest prevalence (4.1%), followed by Europe (3.7%). The number of studies Background: There are limits both from primary care health profes- was positively correlated with alcohol dependence rates (Spearman’s sionals and from patients to discuss sexual health issues. The first one rho = 0.82). might feel uncomfortable with this topic and in need of more informa- Conclusion: We found a correlation between the number of studies tion and resources. Patients could be embarrassed or shameful to talk on brief intervention for reducing alcohol and the alcohol dependence about it. In the meantime, people are more likely to meet a primary rates of the countries where they were performed. care health professional like their general practitioner and they mainly consider that their doctor should ask them about their sexual health. Moreover, sexual health troubles are often linked with an addictive P17 behaviour like drug consumption. Thus, the French addiction preven- Comfort and beliefs around SBIRT and sexual risk screening tion network, RESPADD, worked on a practical guidebook to support among U.S. trauma surgery providers 1 2 3 3 primary care health professionals while talking of sexual health in Michael S. Argenyi, William McGill , Laura J. Veach , Preston R. Miller III addiction settings. Department of Anesthesiology, Wake Forest University School of Medi‑ Materials and methods: In order to write this practical tool, several cine Winston‑Salem, NC 27157, USA; Monalco Research, Port Wash‑ methods were used like a national and international literature review. Addiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 26 of 27 ington, WI, USA; Department of General Surgery, Wake Forest School screens) in SU (score ranges from 0 [no risk] to 3 [high risk] or 4 ([for of Medicine, Winston‑Salem, NC 27157, USA alcohol only]), PHQ-9 (range 0 to 27), and GAD-2 (range 0 to 6) among Correspondence: Michael S. Argenyi (drargenyi@gmail.com) PWH who screened positive for SU, depression (PHQ-9 ‚â•10) or anxiety Addiction Science & Clinical Practice 2023, 18(Suppl 1): P17 (GAD-2 ‚â•3). Changes were evaluated with generalized linear models, with adjustment for demographics, HIV risk, CD4, HIV RNA, SU, depres- Background: Since 2006, U.S. Surgical Specialty Trauma Centers are sion/anxiety, and BHS visits. mandated to implement SBIRT services for alcohol-related injuries Results: Of 2,865 PWH screened, 403 screened positive and had a and complications. However, since this key care initiative impacts: sur- 6-month follow-up screen (61% •50 years; 51% White; 77% men who geons, advanced practice providers, fellows, and residents, particularly have sex with men). 32% screened positive for tobacco, 36% for alco- surrounding incorporation of sexual behavior such as sexualised drug hol, 27% for cannabis, 27% for depression and 31% for anxiety. We use. This presentation will review quantitative and qualitative find- noted decreases (P < 0.05) for tobacco, alcohol, cannabis, PHQ-9, and ings of an institutional IRB-approved study exploring SBIRT and sexual GAD-2 over time. Decreases were similar (P > 0.05) by gender, age health beliefs and comfort among trauma physicians and trainees and race/ethnicity for most outcomes, except for greater decreases in before and after an educational didactic on SBIRT and brief advice. alcohol for ages 50–59 vs. 18–49 years (difference -0.49; p = 0.004) and Materials and methods: Participants received a pre-training survey, greater decreases in GAD-2 for black compared with white PWH (dif- 1-h didactic, and post-training didactic. Participants self-assessed ference -0.89; p = 0.049). comfort levels with SBIRT implementation, substance use-related Conclusions: Routine SU and mental health screening and treatment sexual behaviors, and addiction care pre- and post-training. Responses in HIV primary care has potential to improve outcomes broadly by age, were analyzed using paired descriptive statistics. A subset participated gender and race/ethnicity. in qualitative interviews. Transcripts were coded and analyzed for emerging themes. P19 Results: Participants pre- and post-training survey results will be Project lifeline pilot: implementing SBIRT in rural community presented. The qualitative interview analyses will focus on emerging pharmacies to address opioid overdoses and substance use themes regarding implementing SBIRT and brief advice, given a case disorder 1* 1 2 3 study of a trauma patient with problematic sexualized drug use. Both Renee M. Cloutier , Abigail Talbert, Joseph Weidman , Janice L. Pringle qualitative and quantitative analyses will demonstrate whether the Program Evaluation and Research Unit (PERU), University of Pittsburgh didactic was effective in changing comfort levels and beliefs about School of Pharmacy, Pittsburgh, PA 15206, USA; Janssen Pharmaceu‑ SBIRT, brief advice, and sexualized drug use. ticals, A Johnson and Johnson Company, West Chester, PA 19380, USA; Conclusions: Improved training is impactful and provider comfort in Program Evaluation and Research Unit (PERU), University of Pittsburgh implementing brief advice and support SBIRT policy for the trauma School of Pharmacy, Pittsburgh, PA 15206, USA patient, particularly in the setting of sexualized drug use, are key areas Correspondence: Renee M. Cloutier (renee.cloutier@pitt.edu) to address. A future multisite trial is recommended, alongside patient Addiction Science & Clinical Practice 2023, 18(Suppl 1): P19 chart data analysis, to objectively determine the observed rates of provider advice or referral. Examination of survey items post didactic Background: There is emerging recognition of the benefits of imple - can yield beneficial indicators for future study in other U.S. trauma care menting screening, brief intervention, referral to treatment (SBIRT) in institutions. pharmacy settings as they have more accessible locations and hours than other healthcare structures. Pharmacists already monitor pre- P18 scriptions for contraindications, provide patient and provider educa- Lack of demographic differences in effectiveness tion, and are the final scheduled face-to-face interaction with patients of self‑administered screening and follow‑up treatment at their highest risk moments (i.e., filling prescriptions). Project Lifeline for mental health and substance use in HIV primary care is a public health initiative to provide training and technical support to 1* 1 1 Michael. J. Silverberg , Tory Levine‑Hall, Varada Sarovar , Alexandra N. community pharmacies implementing SBIRT for substance use disor- 1 1 2 3 Lea , Amy S. Leibowitz , Michael A. Horberg , C. Bradley Hare , Mitchell N. der (SUD) and providing harm reduction services. 4 5 1,6 Lu , Jason A. Flamm , Derek D. Satre Materials and methods: Between 2018–2020, eight community Division of Research, Kaiser Permanente Northern California, Oakland, pharmacies were recruited from rural counties in Pennsylvania, USA. CA, USA; Mid‑Atlantic Permanente Research Institute, Kaiser Permanente Patients receiving/dropping off a Schedule II prescription were invited Mid‑Atlantic States, Rockville, MD, USA; San Francisco Medical Center, to engage in SBIRT and offered naloxone. Descriptive statistics on Kaiser Permanente Northern California, San Francisco, CA, USA; Oakland patient screening summarized the patients served. Key informant Medical Center, Kaiser Permanente Northern California, Oakland, CA, USA; interviews with pharmacy staff were analyzed to categorize barriers Sacramento Medical Center, Kaiser Permanente Northern California, and facilitators to SBIRT implementation. Oakland, CA, USA; Department of Psychiatry and Behavioral Sciences, Results: 3,514 screens were completed for 3,122 unique adult patients University of California, San Francisco, CA, USA (54.1% male, 45.9% female; < 0.01% nonbinary; 96.4% White; 3.6% Correspondence: Michael. J. Silverberg (michael.j.silverberg@kp.org) non-White); 2.2% were indicated for a BI, and 1% were indicated for Addiction Science & Clinical Practice 2023, 18(Suppl 1): P18. SUD RT. Of indicated patients, 44.2% accepted BI and 13.8% RT. 372 patients received naloxone. Facilitators identified via key informant Background: Substance use (SU), depression and anxiety are com- interviews highlighted the importance of person-centered staff educa- mon among persons with HIV (PWH) yet often go unrecognized and tion, role-playing, anti-stigma training, and integrating activities into untreated. We evaluated the effectiveness of computerized SU and patient-care workflows. Barriers included lack of SBIRT service reim- mental health screening and behavioral treatment among PWH. bursement as well as addiction stigmas held by staff members and Materials and methods: The Promoting Access to Care Engagement patients. (PACE) trial enrolled 2,865 PWH from 2018–2020 in 3 HIV primary Conclusions: Results demonstrate the feasibility of implementing care clinics in Kaiser Permanente Northern California. PWH received SBIRT in community pharmacies, including the potential to improve bi-annual questionnaires consisting of the Tobacco, Alcohol, Prescrip- identifying patients at risk for overdose, provide real time brief inter- tion medication, and other Substance use (TAPS) instrument, Patient ventions/harm reduction tools, and refer to local services. Findings Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-2 currently serve as the foundation for an ongoing project aimed at (GAD-2). Results were integrated into electronic health records and demonstrating the impact of SBIRT implementation on down-stream were visible to physicians and behavioral health specialists (BHS) health care costs in additional counties which will also be discussed. for clinical follow-up. We measured changes (between consecutive A ddiction Science & Clinical Practice 2023, 18(Suppl 1):20 Page 27 of 27 P20 non-treatment seeking, adults with AUD. Participants were recruited Evaluating training in alcohol screening and brief intervention via advertisements. Assessments included Timeline Follow-back, AUD from the participants perspective severity (DSM-5), Alcohol Use Disorders Identification Test (AUDIT) 1* 1 1 2 Tadeja Hočevar , Karmen Henigsman , Pika Založnik , Marko Kolšek and biological markers. Primary outcome was weekly consumption at 1 2 National Institute of Public Health, Slovenia; Department of family 13-weeks. medicine, Medical faculty, University of Ljubljana, Slovenia Results: 140 participants were randomized (mean age 54 years, Correspondence: Tadeja Hočevar ( Tadeja.Hocevar@nijz.si) SD = 12). More women (70%) than men were included. Participants Addiction Science & Clinical Practice 2023, 18(Suppl 1): P20 drank on average 20 (SD = 11) standard drinks/week. Mean DSM-5 diagnostic criteria for AUD and AUDIT were 5 (SD = 2) and 17 (SD = 9) Background: Until 2022 Alcohol screening and brief intervention (SBI) respectively. At follow-up, the within-group changes in consump- in Slovenia has been practiced systematically by general practitioners. tion were statistically significant in all three groups: aerobic exercise There was a need to renew the training programme and to broaden mean = -5.0 (95% CI = -10.3, – 3.5), yoga mean = -6.9 (95% CI = -– 10.3, the SBI practice to other profiles. Within the national project, we – 3.5) and TAU mean = -6.6 (95% CI = -– 8.8, – 4.4). No significant group formed a more in depth training modules, trained the selected profiles differences were found on the primary or secondary outcomes. Per- and piloted the SBI practice in 18 areas across the country. protocol analyses favored yoga (mean = -– 8.7, 95% CI = -– 13.2, – 4.1) One of the objectives of our research was to learn about participants’ and usual care (mean = -– 7.1, 95% CI = -– 0.6, – 3.7) compared to aero- opinions regarding contents of the SBI training. bic exercise (mean = -– 1.7, 95% CI = -– 4.4, 1. 0), [F = 4.9, p = 0.011]. Materials and methods: Phase one, before piloting the approach: Conclusions: A 12-week exercise program has effects on alcohol con- A cross sectional survey was conducted before and after a 32-h long sumption comparable to usual care. A per protocol analysis suggests training. A total of 263 participants, primary health care providers and that yoga tends to reduce consumption more than aerobic exercise. social workers participated. Participants filled in surveys regarding the content of the training, in 5 sections: self-assessment of knowledge on alcohol related issues, of use of motivational interviewing elements, Publisher’s Note and of their effectiveness in using SBI, opinions regarding the legiti- Springer Nature remains neutral with regard to jurisdictional claims in pub‑ macy of discussing alcohol drinking, and evaluation of responses to lished maps and institutional affiliations. two scenarios. They also addressed their further needs for an effective use of SBI. Phase two, during piloting the SBI practice: We conducted training in form of monthly group sessions with participants/piloting experts and offered them individual support by phone/email. On three occasions we asked them about the usefulness of them both. We used the same method as in phase one. Results: Phase one: In almost all sections the data showed statistically significant improvement after the training. Participants emphasized the need for more practice in order to achieve greater effectiveness. Phase two: Participants found training motivational and useful. There was a non-response bias. Conclusions: According to the results of our research, the training was successful, engaging in some form of training for doing SBI should be a continuous part of practicing the measure. P21 Getting fit for change: exercise as treatment for alcohol use disorder Victoria Gunillasdotter*, Sven Andréasson, Maria Jirwe, Örjan Ekblom, Mats Hallgren Karolinska Institutet, Department of Global Public Health, Substance use and Social Environment, Stockholm, Sweden; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Services, Stockholm, Sweden; Depart‑ ment of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Health Sciences, the Swedish Red Cross University College, Huddinge, Sweden; Swedish School of Sport and Health Science, Stockholm, Sweden Correspondence: Victoria Gunillasdotter (victoria.gunillasdotter@ki.se) Addiction Science & Clinical Practice 2023, 18(Suppl 1): P21 Re Read ady y to to submit y submit your our re researc search h ? Choose BMC and benefit fr ? Choose BMC and benefit from om: : Background: Alcohol use disorders (AUD) are highly undertreated. fast, convenient online submission Major barriers to treatment are stigma and the desire to self-manage thorough peer review by experienced researchers in your ﬁeld the problem. In addition to health risks of heavy drinking, hazardous rapid publication on acceptance drinkers are reported to be less physical active than non-hazardous support for research data, including large and complex data types drinkers. Exercise is a non-stigmatizing treatment option with syn- • ergistic effects on physical fitness, somatic health, and mood. Prior • gold Open Access which fosters wider collaboration and increased citations research has demonstrated the potential role of exercise as treatment maximum visibility for your research: over 100M website views per year for AUD, but robust studies in non-treatment seeking individuals are lacking. At BMC, research is always in progress. Materials and methods: A three-group community-based rand- omized controlled trial compared the effects of aerobic exercise, Learn more biomedcentral.com/submissions yoga and usual care (phone counselling) in physically inactive,

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