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1.  The Short Inventory of Problems—Modified for Drug Use (SIP-DU): Validity in a Primary Care Sample 
Primary care physicians can help drug-dependent patients mitigate adverse drug use consequences; instruments validated in primary care to measure these consequences would aid in this effort. This study evaluated the validity of the Short Inventory of Problems—Alcohol and Drugs modified for Drug Use (SIP-DU) among subjects recruited from a primary care clinic (n = 106). SIP-DU internal consistency was evaluated using Cronbach’s alphas, convergent validity by correlating the total SIP-DU score with the DAST-10, and construct validity by analyzing the factor structure. The SIP-DU demonstrated high internal consistency (Cronbach’s alpha for overall scale .95, subscales .72–.90) comparable with other SIP versions and correlated well with the DAST-10 (r = .70). Confirmatory factor analysis suggested an unacceptable fit of previously proposed factors; exploratory factor analyses suggested a single factor of drug use consequences. The SIP-DU offers primary care clinicians a valid and practical assessment tool for drug use consequences.
doi:10.1111/j.1521-0391.2012.00223.x
PMCID: PMC3889861  PMID: 22494228
2.  The Incidence and Severity of Hangover the Morning after Moderate Alcohol Intoxication 
Addiction (Abingdon, England)  2008;103(5):10.1111/j.1360-0443.2008.02181.x.
Background
Differential propensity for hangover may play a role in determining individuals’ drinking practices so predictors of incidence and severity are needed.
Methods
Data were combined from three randomized crossover trials investigating the residual effects of heavy drinking on next-day performance. All 172 participants received either an alcoholic beverage (M=.115 g% breath alcohol concentration [BrAC]) or placebo matched on type and amount one night and a week later received the other beverage. Alcoholic beverages were vodka, bourbon or high alcohol beer. After each drinking session, following a 9-hour period for sleep and breakfast, participants completed questionnaire a hangover measure.
Results
No hangover was reported by 24% of participants, mild hangover by 44% and moderate hangover by 32%. Neither alcoholic beverage type nor participant characteristics (sex, age, drinking practices, tobacco use, or family history of alcohol problems) were associated with incidence of hangover.
Conclusion
The majority of people experienced mild to moderate hangover the morning after this level of intoxication. Further studies are required to investigate other hypothesized causes of variation in the propensity for hangover.
doi:10.1111/j.1360-0443.2008.02181.x
PMCID: PMC3864560  PMID: 18412754
hangover; heavy drinking; family history of alcohol problems
3.  Disparities in safe sex counseling & behavior among individuals with substance dependence: a cross-sectional study 
Reproductive Health  2012;9:35.
Background
Despite the vast literature examining disparities in medical care, little is known about racial/ethnic and mental health disparities in sexual health care. The objective of this study was to assess disparities in safe sex counseling and resultant behavior among a patient population at risk of negative sexual health outcomes.
Methods
We conducted a cross-sectional analysis among a sample of substance dependent men and women in a metropolitan area in the United States. Multiple logistic regression models were used to explore the relationship between race/ethnicity (non-Hispanic black; Hispanic; non-Hispanic white) and three indicators of mental illness (moderately severe to severe depression; any manic episodes; ≥3 psychotic symptoms) with two self-reported outcomes: receipt of safe sex counseling from a primary care physician and having practiced safer sex because of counseling.
Results
Among 275 substance-dependent adults, approximately 71% (195/275) reported ever being counseled by their regular doctor about safe sex. Among these 195 subjects, 76% (149/195) reported practicing safer sex because of this advice. Blacks (adjusted odds ratio (AOR): 2.71; 95% confidence interval (CI): 1.36,5.42) and those reporting manic episodes (AOR: 2.41; 95% CI: 1.26,4.60) had higher odds of safe sex counseling. Neither race/ethnicity nor any indicator of mental illness was significantly associated with practicing safer sex because of counseling.
Conclusions
Those with past manic episodes reported more safe sex counseling, which is appropriate given that hypersexuality is a known symptom of mania. Black patients reported more safe sex counseling than white patients, despite controlling for sexual risk. One potential explanation is that counseling was conducted based on assumptions about sexual risk behaviors and patient race. There were no significant disparities in self-reported safer sex practices because of counseling, suggesting that increased counseling did not differentially affect safe sex behavior for black patients and those with manic episodes. Exploring the basis of how patient characteristics can influence counseling and resultant behavior merits further exploration to help reduce disparities in safe sex counseling and outcomes.
Trial registration
NCT00278447
doi:10.1186/1742-4755-9-35
PMCID: PMC3565911  PMID: 23276300
Counseling; Disparities; Sexual behavior; Stereotyping
5.  Chronic disease and recent addiction treatment utilization among alcohol and drug dependent adults 
Background
Chronic medical diseases require regular and longitudinal care and self-management for effective treatment. When chronic diseases include substance use disorders, care and treatment of both the medical and addiction disorders may affect access to care and the ability to focus on both conditions. The objective of this paper is to evaluate the association between the presence of chronic medical disease and recent addiction treatment utilization among adults with substance dependence.
Methods
Cross-sectional secondary data analysis of self-reported baseline data from alcohol and/or drug-dependent adults enrolled in a randomized clinical trial of a disease management program for substance dependence in primary care. The main independent variable was chronic medical disease status, categorized using the Katz Comorbidity Score as none, single condition of lower severity, or higher severity (multiple conditions or single higher severity condition), based on comorbidity scores determined from self-report. Asthma was also examined in secondary analyses. The primary outcome was any self-reported addiction treatment utilization (excluding detoxification) in the 3 months prior to study entry, including receipt of any addiction-focused counseling or addiction medication from any healthcare provider. Logistic regression models were adjusted for sociodemographics, type of substance dependence, recruitment site, current smoking, and recent anxiety severity.
Results
Of 563 subjects, 184 (33%) reported any chronic disease (20% low severity; 13% higher severity) and 111 (20%) reported asthma; 157 (28%) reported any addiction treatment utilization in the past 3 months. In multivariate regression analyses, no significant effect was detected for chronic disease on addiction treatment utilization (adjusted odds ratio [AOR] 0.88 lower severity vs. none, 95% confidence interval (CI): 0.60, 1.28; AOR 1.29 higher severity vs. none, 95% CI: 0.89, 1.88) nor for asthma.
Conclusions
In this cohort of alcohol and drug dependent persons, there was no significant effect of chronic medical disease on recent addiction treatment utilization. Chronic disease may not hinder or facilitate connection to addiction treatment.
doi:10.1186/1747-597X-6-28
PMCID: PMC3220629  PMID: 22008255
addiction; substance abuse; substance abuse; treatment; medical care; chronic disease
6.  A Single-Question Screening Test for Drug Use in Primary Care 
Archives of internal medicine  2010;170(13):1155-1160.
BACKGROUND
Drug use (illicit drug use and nonmedical use of prescription drugs) is common but under-recognized in primary care settings. We validated a single-question screening test for drug use and drug use disorders in primary care.
METHODS
Adult patients recruited from primary care waiting rooms were asked the single screening question, “How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?” A response of ≥1 was considered positive. They were also asked the 10-item Drug Abuse Screening Test (DAST). The reference standard was the presence or absence of current (past year) drug use or a drug use disorder (abuse or dependence) as determined by a standardized diagnostic interview. Drug use was also determined by oral fluid testing for common drugs of abuse.
RESULTS
Of 394 eligible primary care patients, 286 (73%) completed the interview. The single screening question was 100% sensitive (95% CI 90.6% to 100%) and 73.5% specific (95% CI 67.7% to 78.6%) for the detection of a drug use disorder. It was less sensitive for the detection of self-reported current drug use (92.9%, 95% CI 86.1% to 96.5%) and drug use detected by oral fluid testing or self-report (81.8%, 95% CI 72.5% to 88.5%). Test characteristics were similar to that of the DAST, and were affected very little by subject demographic characteristics.
CONCLUSIONS
The single screening question accurately identified drug use in this sample of primary care patients, supporting the utility of this brief screen in primary care.
doi:10.1001/archinternmed.2010.140
PMCID: PMC2911954  PMID: 20625025
8.  Primary Care Validation of a Single-Question Alcohol Screening Test 
ABSTRACT
BACKGROUND
Unhealthy alcohol use is prevalent but under-diagnosed in primary care settings.
OBJECTIVE
To validate, in primary care, a single-item screening test for unhealthy alcohol use recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
DESIGN
Cross-sectional study.
PARTICIPANTS
Adult English-speaking patients recruited from primary care waiting rooms.
MEASUREMENTS
Participants were asked the single screening question, “How many times in the past year have you had X or more drinks in a day?”, where X is 5 for men and 4 for women, and a response of >1 is considered positive. Unhealthy alcohol use was defined as the presence of an alcohol use disorder, as determined by a standardized diagnostic interview, or risky consumption, as determined using a validated 30-day calendar method.
MAIN RESULTS
Of 394 eligible primary care patients, 286 (73%) completed the interview. The single-question screen was 81.8% sensitive (95% confidence interval (CI) 72.5% to 88.5%) and 79.3% specific (95% CI 73.1% to 84.4%) for the detection of unhealthy alcohol use. It was slightly more sensitive (87.9%, 95% CI 72.7% to 95.2%) but was less specific (66.8%, 95% CI 60.8% to 72.3%) for the detection of a current alcohol use disorder. Test characteristics were similar to that of a commonly used three-item screen, and were affected very little by subject demographic characteristics.
CONCLUSIONS
The single screening question recommended by the NIAAA accurately identified unhealthy alcohol use in this sample of primary care patients. These findings support the use of this brief screen in primary care.
doi:10.1007/s11606-009-0928-6
PMCID: PMC2695521  PMID: 19247718
alcohol screening test; alcoholics; primary care validation; NIAAA

Results 1-8 (8)