Jacques Gaume - Academia.edu (original) (raw)
Papers by Jacques Gaume
Addiction (Abingdon, England), Jan 14, 2015
To test the efficacy of an internet-based brief intervention (IBI) in decreasing alcohol use amon... more To test the efficacy of an internet-based brief intervention (IBI) in decreasing alcohol use among young Swiss men aged 21 year on average. 2 parallel-group randomized controlled trial with a 1:1 allocation ratio containing follow-up assessments at 1 and 6 months post-randomization SETTING: Internet-based study in a general population sample. 21 years old men from Switzerland with unhealthy alcohol use (>14 drinks/week or > =6 drinks/occasion at least monthly or Alcohol Use Disorders Identification Test (AUDIT) scores > =8) INTERVENTION: IBI consisting of 1) normative feedback 2) feedback on consequences of alcohol use 3) calorific value of reported consumption 4) computed blood alcohol concentration for reported consumption, 5) indication of risk 6) information on alcohol and health and 7) recommendations indicating low-risk drinking limits. Control condition: no intervention (assessment only). At 1 and 6 months: quantity/frequency questions on alcohol use (primary outcome...
Drug and alcohol dependence, 2015
The alcohol purchase task (APT), which presents a scenario and asks participants how many drinks ... more The alcohol purchase task (APT), which presents a scenario and asks participants how many drinks they would purchase and consume at different prices, has been used among students and small clinical samples to obtain measures of alcohol demand but not in large, general population samples. We administered the APT to a large sample of young men from the general population (Cohort Study on Substance Use Risk Factors). Participants who reported drinking in the past year (n=4790), reported on past 12 months alcohol use, on DSM-5 alcohol use disorder (AUD) criteria and on alcohol related consequences were included. Among the APT's demand parameters, intensity was 8.7 (SD=6.5) indicating that, when drinks are free, participants report a planned consumption of almost 9 drinks. The maximum alcohol expenditure (Omax) was over 35CHF (1CHF=1.1USD) and the demand became elastic (Pmax) at 8.4CHF (SD=5.6). The mean price at which the consumption was suppressed was 15.6CHF (SD=5.4). Exponential ...
Journal of studies on alcohol and drugs, 2013
The aim of this study was to examine the differences between those who gave informed consent to a... more The aim of this study was to examine the differences between those who gave informed consent to a study on substance use and those who did not, and to analyze whether differences changed with varying nonconsent rates. Cross-sectional questionnaire data on demographics, alcohol, smoking, and cannabis use were obtained for 6,099 French- and 5,720 German-speaking 20-year-old Swiss men. Enrollment took place over 11 months for the Cohort Study on Substance Use Risk Factors (C-SURF). Consenters and nonconsenters were asked to complete a short questionnaire. Data for nearly the entire population were available because 94% responded. Weekly differences in consent rates were analyzed. Regressions examined the associations of substance use with consent giving and consent rates and the interaction between the two. Nonconsenters had higher substance use patterns, although they were more often alcohol abstainers; differences were small and not always significant and did not decrease as consent ...
Revue médicale suisse, Jan 5, 2007
Alcohol-related injuries are responsible for a large share of the global mortality and morbidity ... more Alcohol-related injuries are responsible for a large share of the global mortality and morbidity burden. Scant information existed, however, for Switzerland. Based on 3653 injured patients and 3519 patients attending the emergency department of the Lausanne University Hospital for other reasons, alcohol attributable fractions with regard to the alcohol consumption in the 6 hours before the injury were estimated. Among men 17% of all injures were alcohol attributable, and 12% among women. Relative risks increased in dose-response relationship with alcohol intake. Leisure time related injuries were most likely to be alcohol attributable. Most of the alcohol-related injuries occurred at already small ethanol quantities ingested.
Revue médicale suisse, Jan 4, 2007
Teenagers and young adults often combine alcohol, tobacco, cannabis or other drugs use and relate... more Teenagers and young adults often combine alcohol, tobacco, cannabis or other drugs use and related hazardous behaviours. This article presents a brief motivational intervention (BMI) targeting multiple substance use and related behaviours. The values and projects that can enter into conflict with the substance use are discussed in order to introduce a change perspective. Talking and thinking freely about change in a non-judgmental, empathic and collaborative manner can lead to an effective behaviour change. This time-limited BMI is appropriate and promising in a primary care.
Addictive Behaviors, 2015
Despite their widespread use across clinical and research settings, no study has yet investigated... more Despite their widespread use across clinical and research settings, no study has yet investigated the fit of several standard alcohol measures for Hispanic youth, including those used to assess motivation to change, self-efficacy, peer norms, and problem drinking. This study thus served to address this gap by evaluating measurement invariance with substance-using youth. We enrolled a large sample of regular substance-using youth who were involved with the justice system (N=368; 72.9% male; 76.9% Hispanic; M age=16.17years). Similar to the broader Hispanic population of the southwest United States (U.S.), Hispanic youth in the sample were on average 3.5th generation (with at least 1 foreign-born grand-parent). Following standard administration and scoring procedures, all youth completed measures of motivation to change (e.g., readiness rulers, intentions to change), self-efficacy (e.g., drink refusal in social situations), peer norms (e.g., peer norms for substance use), and problem drinking (e.g., substance use quantity/frequency; Alcohol Use Disorders Identification Test; Rutgers Alcohol Problems Index; Timeline FollowBack). Measurement equivalence was evaluated via multiple group confirmatory factor analysis. Our results indicated that each measure evaluated herein worked equally well for Hispanic and Caucasian youth. We found measurement invariance at every level tested. This study supports the validity and future use of these important and widely-used alcohol use measures for high-risk substance-using Hispanic youth. Further, given the representativeness of this sample within the southwestern U.S., these results show promise for generalizability to U.S.-born Hispanic youth within this geographic region.
Brief motivational intervention (BMI) has shown promising results among young adults, but its und... more Brief motivational intervention (BMI) has shown promising results among young adults, but its underlying mechanisms are seldom investigated. Analyzing the dynamic processes of therapist and client behaviors throughout the session might help to better understand mechanisms operative during BMI. We used data from a BMI randomized controlled trial for heavy drinking among non-treatment seeking Swiss young men. The parent study found significantly lowered drinking in the BMI group (N=179) compared to a control group receiving no intervention (N=182) 3 months later. In the present study, we conducted psycholinguistic coding of 174 BMI using the Motivational Interviewing (MI) Skill Code (MISC 2.1; Miller et al. 2008) and then divided the sessions in thirds to examine within-session processes across time. Alcohol outcome was dichotomized into a "changers" group (baseline to 3-month difference greater than the mean of the control group) and a "non-changers" group. We then tested for interactions between time (thirds) and outcome group in GEE models accounting for within-person correlations across repeated (time) measures. Interactions were not significant for therapist frequency of MI-consistent behaviors, percent of open questions, and ratio of reflections to questions, but were significant for the frequency of MI-inconsistent behaviors (MIIN) and the percent of therapist reflections that were complex. Regarding client change talk, interactions were significant only for commitment to change. Findings indicated that there were dynamic processes at play during our BMI which were related to better alcohol outcomes. Specifically, the presence of MIIN in the beginning of a BMI appeared to be related to poor outcomes while an increase in complex reflections was related to good outcomes. As in prior MI process research, commitment to change strength was related to outcomes, but here the difference came from non-changers increasing their commitment not to change rather than from changers increasing their commitment to change.
Frontiers in Psychiatry, 2014
A growing body of evidence has shown the efficacy of brief intervention (BI) for hazardous and ha... more A growing body of evidence has shown the efficacy of brief intervention (BI) for hazardous and harmful alcohol use in primary health care settings. Evidence for efficacy in other settings and effectiveness when implemented at larger scale are disappointing. Indeed, BI comprises varying content; exploring BI content and mechanisms of action may be a promising way to enhance efficacy and effectiveness. Medline and PsychInfo, as well as references of retrieved publications were searched for original research or review on active ingredients (components or mechanisms) of face-to-face BIs [and its subtypes, including brief advice and brief motivational interviewing (BMI)] for alcohol. Overall, BI active ingredients have been scarcely investigated, almost only within BMI, and mostly among patients in the emergency room, young adults, and US college students. This body of research has shown that personalized feedback may be an effective component; specific MI techniques showed mixed findings; decisional balance findings tended to suggest a potential detrimental effect; while change plan exercises, advice to reduce or stop drinking, presenting alternative change options, and moderation strategies are promising but need further study. Client change talk is a potential mediator of BMI effects; change in norm perceptions and enhanced discrepancy between current behavior and broader life goals and values have received preliminary support; readiness to change was only partially supported as a mediator; while enhanced awareness of drinking, perceived risks/benefits of alcohol use, alcohol treatment seeking, and self-efficacy were seldom studied and have as yet found no significant support as such. Research is obviously limited and has provided no clear and consistent evidence on the mechanisms of alcohol BI. How BI achieves the effects seen in randomized trials remains mostly unknown and should be investigated to inform the development of more effective interventions.
Journal of Consulting and Clinical Psychology, 2014
The technical hypothesis of motivational interviewing (MI) posits that therapist-implemented MI s... more The technical hypothesis of motivational interviewing (MI) posits that therapist-implemented MI skills are related to client speech regarding behavior change and that client speech predicts client outcome. The current meta-analysis is the first aggregate test of this proposed causal model. A systematic literature review, using stringent inclusion criteria, identified 16 reports describing 12 primary studies. We used review methods to calculate the inverse-variance-weighted pooled correlation coefficient for the therapist-to-client and the client-to-outcome paths across multiple targeted behaviors (i.e., alcohol or illicit drug use, other addictive behaviors). Therapist MI-consistent skills were correlated with more client language in favor of behavior change (i.e., change talk; r = .26, p < .0001), but not less client language against behavior change (i.e., sustain talk; r = .10, p = .09). MI-inconsistent skills were associated with less change talk (r = -.17, p = .001) as well as more sustain talk (r = .07, p = .009). Among these studies, client change talk was not associated with follow-up outcome (r = .06, p = .41), but sustain talk was associated with worse outcome (r = -.24, p = .001). In addition, studies examining composite client language (e.g., an average of negative and positive statements) showed an overall positive relationship with client behavior change (r = .12, p = .006; k = 6). This meta-analysis provides an initial test and partial support for a key causal model of MI efficacy. Recommendations for MI practitioners, clinical supervisors, and process researchers are provided.
Swiss Medical Weekly, 2011
To determine whether first alcohol intoxication before the age of 15 is associated with risky dri... more To determine whether first alcohol intoxication before the age of 15 is associated with risky drinking patterns [Weekly Risky Drinking (WRD) and Binge Drinking (BD)], tobacco use, cannabis use at age 20 and other illicit substance use at somepoint within their lifetime. A survey was conducted among 20-year-old French-speaking Swiss men attending the mandatory army recruitment process, using a self-administered questionnaire on alcohol and other substance use, as well as demographics (age, employment status, education level and living location). Of the 12'133 men attending the recruitment centre between January 2007 and September 2008, 9'686 were included in the study. Among them, 89% reported been intoxicated from alcohol at least once in the past, 11% reported WRD, 59% reported BD, 50% reported current tobacco use, 30% reported current cannabis use, and 19% reported other illicit substance use at somepoint within their lifetime. Subjects who reported first alcohol intoxication before age 15 were more likely to present current WRD (OR [95%CI]: 3.75[3.27-4.29]), BD (3.14[2.86-3.44]), current tobacco (3.17 [2.89-3.47]) or current cannabis use (3.26[2.97-3.58]), and other illicit drug use at somepoint within their lifetime (4.02[3.61-4.48]), than those who had a first intoxication at age 15 or older, or who had never been intoxicated. This study was consistent with the literature, and showed an association between age at first intoxication and future risky alcohol use patterns and other substance use at age 20. Although the results showing an association between age at first intoxication and later risky drinking do not necessarily imply causation, knowing the age of first intoxication may be useful to health care professionals in targeting adolescents and young adults who are at a high risk for developing alcohol and other substance use problems. As such, age at first intoxication may be used to identify vulnerable individuals in a clinical prevention setting.
Substance Abuse, 2007
To explore the relationship between patient&a... more To explore the relationship between patient's intention to change regarding future alcohol consumption following brief alcohol intervention (BAI) and changes in alcohol consumption 12-months later and the communication characteristics between patient and counselor during BAI. Data from 367 patients (experimental arm) of a pragmatic randomized controlled trial were used to assess the effectiveness of BAI among hazardous drinkers attending an Emergency Department (Lausanne University Hospital, Lausanne, Switzerland). Alcohol outcome measures at baseline and 12 months follow-up included usual number of drinks per week, monthly frequency of heavy episodic drinking (5 or more standard drinks for men; 4 or more for women), and the Alcohol Use Disorders Identification Test (AUDIT) score. In addition, the communication characteristics between patient and counselor were analyzed via tape recordings using the Motivational Interviewing Skill Code (MISC) from 97 participants. Patient readiness and importance to change on a 10-point Likert scale (readiness/importance to change ruler) was asked during BAI, and patient intention to change alcohol consumption (yes/no) was asked at the last step. Differences in alcohol outcome at follow-up between the 367 patients who did or did not have an intention to change consumption at baseline were compared, as were differences between these two groups in communication characteristics for the 97 who completed tape recordings. Patients with an intention to decrease alcohol consumption reduced alcohol use and related problems more often, and reported higher levels of importance and readiness to change than did their counterparts. Analyses of MISC-coded data showed a significantly higher use of MI-consistent skills among those with a moderation intention, but no group differences on the 8 other counselor communication skills measures were found. Analyses of patient speech during the intervention indicated that those with an intention to change their alcohol consumption significantly more often self-explored personal ambivalence towards alcohol, expressed more intensely their ability, commitment, desire, need and reason to change their alcohol use than did those in the no decrease group. The intention expressed by hazardous drinkers when concluding BAI is associated with both patient change talk during BAI and drinking outcome 12 months later, but is mainly independent of counselor communication skills. This intention may be an important clinical indicator of which hazardous drinkers are most likely to improve after BAI.
Journal of Substance Abuse Treatment, 2013
Client change talk (CT) during motivational interviewing and brief motivational interventions (BM... more Client change talk (CT) during motivational interviewing and brief motivational interventions (BMIs) have been described as predictors of behavior change, but these links have not been clearly evaluated in research on young people. Within 127 BMIs with 20-year-old men with at-risk alcohol consumption, each CT utterance was categorized and given a strength rating using the Motivational Interviewing Skill Code 2.1. Several ways of categorizing and measuring CT were tested using stepwise regression procedures. Overall CT measures were not significantly related to changes in drinking at 6-month follow-up. Regarding CT sub-dimensions, the frequency of ability/desire/need to change and of ability/desire/need not to change, as well as the average strength of ability/desire/need, predicted significant change in the expected direction. CT length was not significantly linked to outcome. The frequency and strength with which some CT sub-dimensions are expressed during BMI seemed to be important predictors of change in drinking among young men and might thus be especially important for clinicians to notice.
Journal of Substance Abuse Treatment, 2013
Brief interventions (BI) commonly employ screening and target a single substance. Multi-substance... more Brief interventions (BI) commonly employ screening and target a single substance. Multi-substance interventions are a more adequate reflection of risk behaviors in adolescents and young adults. Systematic screening complicates BI in many settings. The effectiveness of a voluntary multi-substance intervention among 19-year-old men and the incremental impact of booster sessions were analyzed. Participants were enrolled during mandatory army conscription in Switzerland. Compared with 461 controls, 392 BI subjects showed reduced substance use on 10 of 12 measures (4 tobacco, 4 cannabis, and 2 alcohol measures). Between-group effects were small and non-significant (except for cannabis use prevalence). Three-month booster sessions were not effective and even contraindicated. The usefulness of targeting multi-substances during BIs without prior screening depends on the value of small effects. The addition of booster sessions was not effective and therefore is not recommended.
Journal of Substance Abuse Treatment, 2010
The process of eliciting client language toward change (change talk [CT]) is implicated as a caus... more The process of eliciting client language toward change (change talk [CT]) is implicated as a causal mechanism in motivational interviewing (MI) and brief motivational interventions (BMI). We investigated the articulation of counselor behaviors and CT during BMI with young men. We coded 149 sessions using the Motivational Interviewing Skill Code and summarized these codes into three counselor categories (MI-consistent [MICO], MI-inconsistent [MIIN], other) and three client categories (CT, counter CT [CCT], follow/neutral [F/N]). We then computed immediate transition frequencies and odds ratios using sequential analysis software. CT was significantly more likely following MICO behaviors, whereas MIIN behaviors only led to CCT and F/N. This strongly supports the use of MI skills to elicit CT during BMI with young men, whose speech also predicted counselor behaviors (particularly CT to MICO and CCT to MIIN). Additional analyses showed that among MICO behaviors, reflective listening may be a particularly powerful technique to elicit CT.
Journal of Substance Abuse Treatment, 2009
The aim of this study was to estimate the influence of counselor skills during brief motivational... more The aim of this study was to estimate the influence of counselor skills during brief motivational interventions (BMIs) on patient alcohol use 12 months later. Ninety-five BMIs delivered by five counselors of similar background and training were recorded and coded using the Motivational Interviewing Skills Code (MISC). Baseline alcohol measures and sociodemographics of patients did not differ across counselors, whereas MISC scores and outcome at 12 months did. Multilevel models showed that counselors with better motivational interviewing (MI) skills achieved better outcomes overall and maintained efficacy across all levels of an important predictor (patient ability to change), whereas counselors with poorer MI skills were effective mostly at high levels of ability to change. Findings indicated that avoidance of MI-inconsistent skills was more important than frequency of using MI-consistent skills and that training and selection of counselors should be based more on the overall MI-consistent gestalt than on particular MI techniques.
International Journal of Environmental Research and Public Health, 2010
3,537 men enrolling in 2007 for mandatory army recruitment procedures were assessed for the co-oc... more 3,537 men enrolling in 2007 for mandatory army recruitment procedures were assessed for the co-occurrence of risky licit substance use among risky cannabis users. Risky cannabis use was defined as at least twice weekly; risky alcohol use as 6+ drinks more than once/monthly, or more than 20 drinks per week; and risky tobacco use as daily smoking. Ninety-five percent of all risky cannabis users reported other risky use. They began using cannabis earlier than did non-risky users, but age of onset was unrelated to other risky
Drug and Alcohol Review, 2010
Issue. This article explores mechanisms of the efficacy of brief intervention (BI). Approach. We ... more Issue. This article explores mechanisms of the efficacy of brief intervention (BI). Approach. We conducted a BI trial at the emergency department of the Lausanne University Hospital, of whom 987 at-risk drinkers were randomised into BI and control groups. The overall results demonstrated a general decrease in alcohol use with no differences across groups. The intention to change was explored among 367 patients who completed BI. Analyses of 97 consecutive tape-recorded sessions explored patient and counsellor talks during BI, and their relationship to alcohol use outcome. Key Findings. Evaluation of the articulation between counsellor behaviours and patient language revealed a robust relationship between counsellor motivational interviewing (MI) skills and patient change talk during the intervention. Further exploration suggested that communication characteristics of patients during BI predicted changes in alcohol consumption 12 months later. Moreover, despite systematic training, important differences in counsellor performance were highlighted. Counsellors who had superior MI skills achieved better outcomes overall, and maintained efficacy across all levels of patient ability to change, whereas counsellors with inferior MI skills were effective mostly with patients who had higher levels of ability to change. Finally, the descriptions of change talk trajectories within BI and their association with drinking 12 months later showed that final states differed from initial states, suggesting an impact resulting from the progression of change talk during the course of the intervention. Implication. These findings suggest that BI should focus on the general MI attitude of counsellors who are capable of eliciting beneficial change talk from patients. [Daeppen J-B, Bertholet N, Gaume J. What process research tells us about brief intervention efficacy. Drug Alcohol Rev 2010;29;612-616]
Drug and Alcohol Dependence, 2013
Background. Non-response is a major concern among substance use epidemiologists. When differences... more Background. Non-response is a major concern among substance use epidemiologists. When differences exist between respondents and non-respondents, survey estimates may be biased. Therefore, researchers have developed time-consuming strategies to convert non-respondents to respondents. The present study examines whether late respondents (converted former nonparticipants) differ from early respondents, non-consenters or silent refusers (consent givers but non-participants) in a cohort study, and whether non-response bias can be reduced by converting former non-respondents.
Drug and Alcohol Dependence, 2011
Background: Brief motivational intervention (BMI) is one of the few effective strategies targetin... more Background: Brief motivational intervention (BMI) is one of the few effective strategies targeting alcohol consumption, but has not been tested in young men in the community. We evaluated the efficacy of BMI in reducing alcohol use and related problems among binge drinkers and in maintaining low-risk drinking among non-bingers. Methods: A random sample of a census of men included during army conscription (which is mandatory for 20-year-old males in Switzerland) was randomized to receive a single face-to-face BMI session (N = 199) or no intervention (N = 219). A six-month follow-up rate was obtained for 88.7% of the subjects. Results: Among binge drinkers, there was 20% less drinking in the BMI group versus the control group (incidence rate ratio = 0.80, confidence interval 0.66-0.98, p = 0.03); the BMI group showed a weekly reduction of 1.5 drinks compared to an increase of 0.8 drinks weekly in the control group. Among subjects who experienced one or more alcohol-related consequences over the last 12 months, there was 19% less drinking in the BMI group compared to the control group (incidence rate ratio = 0.81, confidence interval 0.67-0.97, p = 0.04). Among non-bingers, BMI did not contribute to the maintenance of low-risk drinking. Conclusion: BMI reduced the alcohol use of binge drinkers, particularly among those who experienced certain alcohol-related adverse consequences. No preventive effect of BMI was observed among nonbingers. BMI is a plausible secondary preventive option for young binge drinkers.
Circulation, 2008
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Addiction (Abingdon, England), Jan 14, 2015
To test the efficacy of an internet-based brief intervention (IBI) in decreasing alcohol use amon... more To test the efficacy of an internet-based brief intervention (IBI) in decreasing alcohol use among young Swiss men aged 21 year on average. 2 parallel-group randomized controlled trial with a 1:1 allocation ratio containing follow-up assessments at 1 and 6 months post-randomization SETTING: Internet-based study in a general population sample. 21 years old men from Switzerland with unhealthy alcohol use (>14 drinks/week or > =6 drinks/occasion at least monthly or Alcohol Use Disorders Identification Test (AUDIT) scores > =8) INTERVENTION: IBI consisting of 1) normative feedback 2) feedback on consequences of alcohol use 3) calorific value of reported consumption 4) computed blood alcohol concentration for reported consumption, 5) indication of risk 6) information on alcohol and health and 7) recommendations indicating low-risk drinking limits. Control condition: no intervention (assessment only). At 1 and 6 months: quantity/frequency questions on alcohol use (primary outcome...
Drug and alcohol dependence, 2015
The alcohol purchase task (APT), which presents a scenario and asks participants how many drinks ... more The alcohol purchase task (APT), which presents a scenario and asks participants how many drinks they would purchase and consume at different prices, has been used among students and small clinical samples to obtain measures of alcohol demand but not in large, general population samples. We administered the APT to a large sample of young men from the general population (Cohort Study on Substance Use Risk Factors). Participants who reported drinking in the past year (n=4790), reported on past 12 months alcohol use, on DSM-5 alcohol use disorder (AUD) criteria and on alcohol related consequences were included. Among the APT's demand parameters, intensity was 8.7 (SD=6.5) indicating that, when drinks are free, participants report a planned consumption of almost 9 drinks. The maximum alcohol expenditure (Omax) was over 35CHF (1CHF=1.1USD) and the demand became elastic (Pmax) at 8.4CHF (SD=5.6). The mean price at which the consumption was suppressed was 15.6CHF (SD=5.4). Exponential ...
Journal of studies on alcohol and drugs, 2013
The aim of this study was to examine the differences between those who gave informed consent to a... more The aim of this study was to examine the differences between those who gave informed consent to a study on substance use and those who did not, and to analyze whether differences changed with varying nonconsent rates. Cross-sectional questionnaire data on demographics, alcohol, smoking, and cannabis use were obtained for 6,099 French- and 5,720 German-speaking 20-year-old Swiss men. Enrollment took place over 11 months for the Cohort Study on Substance Use Risk Factors (C-SURF). Consenters and nonconsenters were asked to complete a short questionnaire. Data for nearly the entire population were available because 94% responded. Weekly differences in consent rates were analyzed. Regressions examined the associations of substance use with consent giving and consent rates and the interaction between the two. Nonconsenters had higher substance use patterns, although they were more often alcohol abstainers; differences were small and not always significant and did not decrease as consent ...
Revue médicale suisse, Jan 5, 2007
Alcohol-related injuries are responsible for a large share of the global mortality and morbidity ... more Alcohol-related injuries are responsible for a large share of the global mortality and morbidity burden. Scant information existed, however, for Switzerland. Based on 3653 injured patients and 3519 patients attending the emergency department of the Lausanne University Hospital for other reasons, alcohol attributable fractions with regard to the alcohol consumption in the 6 hours before the injury were estimated. Among men 17% of all injures were alcohol attributable, and 12% among women. Relative risks increased in dose-response relationship with alcohol intake. Leisure time related injuries were most likely to be alcohol attributable. Most of the alcohol-related injuries occurred at already small ethanol quantities ingested.
Revue médicale suisse, Jan 4, 2007
Teenagers and young adults often combine alcohol, tobacco, cannabis or other drugs use and relate... more Teenagers and young adults often combine alcohol, tobacco, cannabis or other drugs use and related hazardous behaviours. This article presents a brief motivational intervention (BMI) targeting multiple substance use and related behaviours. The values and projects that can enter into conflict with the substance use are discussed in order to introduce a change perspective. Talking and thinking freely about change in a non-judgmental, empathic and collaborative manner can lead to an effective behaviour change. This time-limited BMI is appropriate and promising in a primary care.
Addictive Behaviors, 2015
Despite their widespread use across clinical and research settings, no study has yet investigated... more Despite their widespread use across clinical and research settings, no study has yet investigated the fit of several standard alcohol measures for Hispanic youth, including those used to assess motivation to change, self-efficacy, peer norms, and problem drinking. This study thus served to address this gap by evaluating measurement invariance with substance-using youth. We enrolled a large sample of regular substance-using youth who were involved with the justice system (N=368; 72.9% male; 76.9% Hispanic; M age=16.17years). Similar to the broader Hispanic population of the southwest United States (U.S.), Hispanic youth in the sample were on average 3.5th generation (with at least 1 foreign-born grand-parent). Following standard administration and scoring procedures, all youth completed measures of motivation to change (e.g., readiness rulers, intentions to change), self-efficacy (e.g., drink refusal in social situations), peer norms (e.g., peer norms for substance use), and problem drinking (e.g., substance use quantity/frequency; Alcohol Use Disorders Identification Test; Rutgers Alcohol Problems Index; Timeline FollowBack). Measurement equivalence was evaluated via multiple group confirmatory factor analysis. Our results indicated that each measure evaluated herein worked equally well for Hispanic and Caucasian youth. We found measurement invariance at every level tested. This study supports the validity and future use of these important and widely-used alcohol use measures for high-risk substance-using Hispanic youth. Further, given the representativeness of this sample within the southwestern U.S., these results show promise for generalizability to U.S.-born Hispanic youth within this geographic region.
Brief motivational intervention (BMI) has shown promising results among young adults, but its und... more Brief motivational intervention (BMI) has shown promising results among young adults, but its underlying mechanisms are seldom investigated. Analyzing the dynamic processes of therapist and client behaviors throughout the session might help to better understand mechanisms operative during BMI. We used data from a BMI randomized controlled trial for heavy drinking among non-treatment seeking Swiss young men. The parent study found significantly lowered drinking in the BMI group (N=179) compared to a control group receiving no intervention (N=182) 3 months later. In the present study, we conducted psycholinguistic coding of 174 BMI using the Motivational Interviewing (MI) Skill Code (MISC 2.1; Miller et al. 2008) and then divided the sessions in thirds to examine within-session processes across time. Alcohol outcome was dichotomized into a "changers" group (baseline to 3-month difference greater than the mean of the control group) and a "non-changers" group. We then tested for interactions between time (thirds) and outcome group in GEE models accounting for within-person correlations across repeated (time) measures. Interactions were not significant for therapist frequency of MI-consistent behaviors, percent of open questions, and ratio of reflections to questions, but were significant for the frequency of MI-inconsistent behaviors (MIIN) and the percent of therapist reflections that were complex. Regarding client change talk, interactions were significant only for commitment to change. Findings indicated that there were dynamic processes at play during our BMI which were related to better alcohol outcomes. Specifically, the presence of MIIN in the beginning of a BMI appeared to be related to poor outcomes while an increase in complex reflections was related to good outcomes. As in prior MI process research, commitment to change strength was related to outcomes, but here the difference came from non-changers increasing their commitment not to change rather than from changers increasing their commitment to change.
Frontiers in Psychiatry, 2014
A growing body of evidence has shown the efficacy of brief intervention (BI) for hazardous and ha... more A growing body of evidence has shown the efficacy of brief intervention (BI) for hazardous and harmful alcohol use in primary health care settings. Evidence for efficacy in other settings and effectiveness when implemented at larger scale are disappointing. Indeed, BI comprises varying content; exploring BI content and mechanisms of action may be a promising way to enhance efficacy and effectiveness. Medline and PsychInfo, as well as references of retrieved publications were searched for original research or review on active ingredients (components or mechanisms) of face-to-face BIs [and its subtypes, including brief advice and brief motivational interviewing (BMI)] for alcohol. Overall, BI active ingredients have been scarcely investigated, almost only within BMI, and mostly among patients in the emergency room, young adults, and US college students. This body of research has shown that personalized feedback may be an effective component; specific MI techniques showed mixed findings; decisional balance findings tended to suggest a potential detrimental effect; while change plan exercises, advice to reduce or stop drinking, presenting alternative change options, and moderation strategies are promising but need further study. Client change talk is a potential mediator of BMI effects; change in norm perceptions and enhanced discrepancy between current behavior and broader life goals and values have received preliminary support; readiness to change was only partially supported as a mediator; while enhanced awareness of drinking, perceived risks/benefits of alcohol use, alcohol treatment seeking, and self-efficacy were seldom studied and have as yet found no significant support as such. Research is obviously limited and has provided no clear and consistent evidence on the mechanisms of alcohol BI. How BI achieves the effects seen in randomized trials remains mostly unknown and should be investigated to inform the development of more effective interventions.
Journal of Consulting and Clinical Psychology, 2014
The technical hypothesis of motivational interviewing (MI) posits that therapist-implemented MI s... more The technical hypothesis of motivational interviewing (MI) posits that therapist-implemented MI skills are related to client speech regarding behavior change and that client speech predicts client outcome. The current meta-analysis is the first aggregate test of this proposed causal model. A systematic literature review, using stringent inclusion criteria, identified 16 reports describing 12 primary studies. We used review methods to calculate the inverse-variance-weighted pooled correlation coefficient for the therapist-to-client and the client-to-outcome paths across multiple targeted behaviors (i.e., alcohol or illicit drug use, other addictive behaviors). Therapist MI-consistent skills were correlated with more client language in favor of behavior change (i.e., change talk; r = .26, p < .0001), but not less client language against behavior change (i.e., sustain talk; r = .10, p = .09). MI-inconsistent skills were associated with less change talk (r = -.17, p = .001) as well as more sustain talk (r = .07, p = .009). Among these studies, client change talk was not associated with follow-up outcome (r = .06, p = .41), but sustain talk was associated with worse outcome (r = -.24, p = .001). In addition, studies examining composite client language (e.g., an average of negative and positive statements) showed an overall positive relationship with client behavior change (r = .12, p = .006; k = 6). This meta-analysis provides an initial test and partial support for a key causal model of MI efficacy. Recommendations for MI practitioners, clinical supervisors, and process researchers are provided.
Swiss Medical Weekly, 2011
To determine whether first alcohol intoxication before the age of 15 is associated with risky dri... more To determine whether first alcohol intoxication before the age of 15 is associated with risky drinking patterns [Weekly Risky Drinking (WRD) and Binge Drinking (BD)], tobacco use, cannabis use at age 20 and other illicit substance use at somepoint within their lifetime. A survey was conducted among 20-year-old French-speaking Swiss men attending the mandatory army recruitment process, using a self-administered questionnaire on alcohol and other substance use, as well as demographics (age, employment status, education level and living location). Of the 12'133 men attending the recruitment centre between January 2007 and September 2008, 9'686 were included in the study. Among them, 89% reported been intoxicated from alcohol at least once in the past, 11% reported WRD, 59% reported BD, 50% reported current tobacco use, 30% reported current cannabis use, and 19% reported other illicit substance use at somepoint within their lifetime. Subjects who reported first alcohol intoxication before age 15 were more likely to present current WRD (OR [95%CI]: 3.75[3.27-4.29]), BD (3.14[2.86-3.44]), current tobacco (3.17 [2.89-3.47]) or current cannabis use (3.26[2.97-3.58]), and other illicit drug use at somepoint within their lifetime (4.02[3.61-4.48]), than those who had a first intoxication at age 15 or older, or who had never been intoxicated. This study was consistent with the literature, and showed an association between age at first intoxication and future risky alcohol use patterns and other substance use at age 20. Although the results showing an association between age at first intoxication and later risky drinking do not necessarily imply causation, knowing the age of first intoxication may be useful to health care professionals in targeting adolescents and young adults who are at a high risk for developing alcohol and other substance use problems. As such, age at first intoxication may be used to identify vulnerable individuals in a clinical prevention setting.
Substance Abuse, 2007
To explore the relationship between patient&a... more To explore the relationship between patient's intention to change regarding future alcohol consumption following brief alcohol intervention (BAI) and changes in alcohol consumption 12-months later and the communication characteristics between patient and counselor during BAI. Data from 367 patients (experimental arm) of a pragmatic randomized controlled trial were used to assess the effectiveness of BAI among hazardous drinkers attending an Emergency Department (Lausanne University Hospital, Lausanne, Switzerland). Alcohol outcome measures at baseline and 12 months follow-up included usual number of drinks per week, monthly frequency of heavy episodic drinking (5 or more standard drinks for men; 4 or more for women), and the Alcohol Use Disorders Identification Test (AUDIT) score. In addition, the communication characteristics between patient and counselor were analyzed via tape recordings using the Motivational Interviewing Skill Code (MISC) from 97 participants. Patient readiness and importance to change on a 10-point Likert scale (readiness/importance to change ruler) was asked during BAI, and patient intention to change alcohol consumption (yes/no) was asked at the last step. Differences in alcohol outcome at follow-up between the 367 patients who did or did not have an intention to change consumption at baseline were compared, as were differences between these two groups in communication characteristics for the 97 who completed tape recordings. Patients with an intention to decrease alcohol consumption reduced alcohol use and related problems more often, and reported higher levels of importance and readiness to change than did their counterparts. Analyses of MISC-coded data showed a significantly higher use of MI-consistent skills among those with a moderation intention, but no group differences on the 8 other counselor communication skills measures were found. Analyses of patient speech during the intervention indicated that those with an intention to change their alcohol consumption significantly more often self-explored personal ambivalence towards alcohol, expressed more intensely their ability, commitment, desire, need and reason to change their alcohol use than did those in the no decrease group. The intention expressed by hazardous drinkers when concluding BAI is associated with both patient change talk during BAI and drinking outcome 12 months later, but is mainly independent of counselor communication skills. This intention may be an important clinical indicator of which hazardous drinkers are most likely to improve after BAI.
Journal of Substance Abuse Treatment, 2013
Client change talk (CT) during motivational interviewing and brief motivational interventions (BM... more Client change talk (CT) during motivational interviewing and brief motivational interventions (BMIs) have been described as predictors of behavior change, but these links have not been clearly evaluated in research on young people. Within 127 BMIs with 20-year-old men with at-risk alcohol consumption, each CT utterance was categorized and given a strength rating using the Motivational Interviewing Skill Code 2.1. Several ways of categorizing and measuring CT were tested using stepwise regression procedures. Overall CT measures were not significantly related to changes in drinking at 6-month follow-up. Regarding CT sub-dimensions, the frequency of ability/desire/need to change and of ability/desire/need not to change, as well as the average strength of ability/desire/need, predicted significant change in the expected direction. CT length was not significantly linked to outcome. The frequency and strength with which some CT sub-dimensions are expressed during BMI seemed to be important predictors of change in drinking among young men and might thus be especially important for clinicians to notice.
Journal of Substance Abuse Treatment, 2013
Brief interventions (BI) commonly employ screening and target a single substance. Multi-substance... more Brief interventions (BI) commonly employ screening and target a single substance. Multi-substance interventions are a more adequate reflection of risk behaviors in adolescents and young adults. Systematic screening complicates BI in many settings. The effectiveness of a voluntary multi-substance intervention among 19-year-old men and the incremental impact of booster sessions were analyzed. Participants were enrolled during mandatory army conscription in Switzerland. Compared with 461 controls, 392 BI subjects showed reduced substance use on 10 of 12 measures (4 tobacco, 4 cannabis, and 2 alcohol measures). Between-group effects were small and non-significant (except for cannabis use prevalence). Three-month booster sessions were not effective and even contraindicated. The usefulness of targeting multi-substances during BIs without prior screening depends on the value of small effects. The addition of booster sessions was not effective and therefore is not recommended.
Journal of Substance Abuse Treatment, 2010
The process of eliciting client language toward change (change talk [CT]) is implicated as a caus... more The process of eliciting client language toward change (change talk [CT]) is implicated as a causal mechanism in motivational interviewing (MI) and brief motivational interventions (BMI). We investigated the articulation of counselor behaviors and CT during BMI with young men. We coded 149 sessions using the Motivational Interviewing Skill Code and summarized these codes into three counselor categories (MI-consistent [MICO], MI-inconsistent [MIIN], other) and three client categories (CT, counter CT [CCT], follow/neutral [F/N]). We then computed immediate transition frequencies and odds ratios using sequential analysis software. CT was significantly more likely following MICO behaviors, whereas MIIN behaviors only led to CCT and F/N. This strongly supports the use of MI skills to elicit CT during BMI with young men, whose speech also predicted counselor behaviors (particularly CT to MICO and CCT to MIIN). Additional analyses showed that among MICO behaviors, reflective listening may be a particularly powerful technique to elicit CT.
Journal of Substance Abuse Treatment, 2009
The aim of this study was to estimate the influence of counselor skills during brief motivational... more The aim of this study was to estimate the influence of counselor skills during brief motivational interventions (BMIs) on patient alcohol use 12 months later. Ninety-five BMIs delivered by five counselors of similar background and training were recorded and coded using the Motivational Interviewing Skills Code (MISC). Baseline alcohol measures and sociodemographics of patients did not differ across counselors, whereas MISC scores and outcome at 12 months did. Multilevel models showed that counselors with better motivational interviewing (MI) skills achieved better outcomes overall and maintained efficacy across all levels of an important predictor (patient ability to change), whereas counselors with poorer MI skills were effective mostly at high levels of ability to change. Findings indicated that avoidance of MI-inconsistent skills was more important than frequency of using MI-consistent skills and that training and selection of counselors should be based more on the overall MI-consistent gestalt than on particular MI techniques.
International Journal of Environmental Research and Public Health, 2010
3,537 men enrolling in 2007 for mandatory army recruitment procedures were assessed for the co-oc... more 3,537 men enrolling in 2007 for mandatory army recruitment procedures were assessed for the co-occurrence of risky licit substance use among risky cannabis users. Risky cannabis use was defined as at least twice weekly; risky alcohol use as 6+ drinks more than once/monthly, or more than 20 drinks per week; and risky tobacco use as daily smoking. Ninety-five percent of all risky cannabis users reported other risky use. They began using cannabis earlier than did non-risky users, but age of onset was unrelated to other risky
Drug and Alcohol Review, 2010
Issue. This article explores mechanisms of the efficacy of brief intervention (BI). Approach. We ... more Issue. This article explores mechanisms of the efficacy of brief intervention (BI). Approach. We conducted a BI trial at the emergency department of the Lausanne University Hospital, of whom 987 at-risk drinkers were randomised into BI and control groups. The overall results demonstrated a general decrease in alcohol use with no differences across groups. The intention to change was explored among 367 patients who completed BI. Analyses of 97 consecutive tape-recorded sessions explored patient and counsellor talks during BI, and their relationship to alcohol use outcome. Key Findings. Evaluation of the articulation between counsellor behaviours and patient language revealed a robust relationship between counsellor motivational interviewing (MI) skills and patient change talk during the intervention. Further exploration suggested that communication characteristics of patients during BI predicted changes in alcohol consumption 12 months later. Moreover, despite systematic training, important differences in counsellor performance were highlighted. Counsellors who had superior MI skills achieved better outcomes overall, and maintained efficacy across all levels of patient ability to change, whereas counsellors with inferior MI skills were effective mostly with patients who had higher levels of ability to change. Finally, the descriptions of change talk trajectories within BI and their association with drinking 12 months later showed that final states differed from initial states, suggesting an impact resulting from the progression of change talk during the course of the intervention. Implication. These findings suggest that BI should focus on the general MI attitude of counsellors who are capable of eliciting beneficial change talk from patients. [Daeppen J-B, Bertholet N, Gaume J. What process research tells us about brief intervention efficacy. Drug Alcohol Rev 2010;29;612-616]
Drug and Alcohol Dependence, 2013
Background. Non-response is a major concern among substance use epidemiologists. When differences... more Background. Non-response is a major concern among substance use epidemiologists. When differences exist between respondents and non-respondents, survey estimates may be biased. Therefore, researchers have developed time-consuming strategies to convert non-respondents to respondents. The present study examines whether late respondents (converted former nonparticipants) differ from early respondents, non-consenters or silent refusers (consent givers but non-participants) in a cohort study, and whether non-response bias can be reduced by converting former non-respondents.
Drug and Alcohol Dependence, 2011
Background: Brief motivational intervention (BMI) is one of the few effective strategies targetin... more Background: Brief motivational intervention (BMI) is one of the few effective strategies targeting alcohol consumption, but has not been tested in young men in the community. We evaluated the efficacy of BMI in reducing alcohol use and related problems among binge drinkers and in maintaining low-risk drinking among non-bingers. Methods: A random sample of a census of men included during army conscription (which is mandatory for 20-year-old males in Switzerland) was randomized to receive a single face-to-face BMI session (N = 199) or no intervention (N = 219). A six-month follow-up rate was obtained for 88.7% of the subjects. Results: Among binge drinkers, there was 20% less drinking in the BMI group versus the control group (incidence rate ratio = 0.80, confidence interval 0.66-0.98, p = 0.03); the BMI group showed a weekly reduction of 1.5 drinks compared to an increase of 0.8 drinks weekly in the control group. Among subjects who experienced one or more alcohol-related consequences over the last 12 months, there was 19% less drinking in the BMI group compared to the control group (incidence rate ratio = 0.81, confidence interval 0.67-0.97, p = 0.04). Among non-bingers, BMI did not contribute to the maintenance of low-risk drinking. Conclusion: BMI reduced the alcohol use of binge drinkers, particularly among those who experienced certain alcohol-related adverse consequences. No preventive effect of BMI was observed among nonbingers. BMI is a plausible secondary preventive option for young binge drinkers.
Circulation, 2008
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