A brief intervention for alcohol problems and smoking delivered by general practitioners [Elektronische Ressource] : a randomised controlled trial / vorgelegt von Verena Zimmer

Sujets

• Gesundheit

Informations

• Publié par: westfalische_wilhelms-universitat_munster
• Publié le: 01 janvier 2007
• Nombre de lectures: 46
• Langue: English
• Poids de l'ouvrage: 4 Mo

Extrait

Fachgebiet Psychologie






A Brief Intervention for Alcohol Problems and Smoking
Delivered by General Practitioners:
A Randomised Controlled Trial




Inaugural-Dissertation
zur Erlangung des Doktorgrades
der Philosophischen Fakultät
der Westfälischen Wilhelms-Universität zu Münster (Westf.)




vorgelegt von


Verena Zimmer
aus Laer
2007 Tag der mündlichen Prüfung: 4. Juni 2007

Dekan: Prof. Dr. Dr. h.c. Wichard Woyke

Referent: Priv.-Doz. Dr. Ralf Demmel

Korreferent: Prof. Dr. Fred Rist

Acknowledgements

Without PD Dr. Ralf Demmel I would never have begun this piece of work. He
encouraged me to start the doctorate in the first place and showed great flexibility with
respect to my family life. Furthermore, I benefited from his expert knowledge
thoughout the whole process of planning and writing. I felt continually supported and
encouraged.

I would also like to thank Prof. Fred Rist who was particularly helpful when it
came to the statistical analysis of the tremendous amount of data we had to consider. He
often managed to gain clarity whenever I had lost focus.

Special thanks are addressed to my collegues Ines Aulhorn, Jutta Hagen,
J e n n i fe r N i c o l a i , and B a r b a r a S c h e u r e n without whose help I could never
have finished this dissertation. I really appreciate all the preliminary work they took on.

Furthermore, I like to thank André Heppner who is my personal computer
specialist and who helped me out whenever new software had to be installed. A big, big
thank you is also addressed to Emma Zvesper, my ‘proof reading princess’, who
uncomplainingly and very quickly proof read everything I sent her.

I am also deeply indebted to m y p a r e n t s and s i s t e r s without whose help I could
not have done this work. They not only provided moral support but most importantly
looked after our children with so much patience, care, and love whenever I needed time
to work.

My special thanks are addressed to m y h u s b a n d who, despite his own workload, did
not hesitate to support this ‘project’ by helping with the housework, looking after the
children and, of course, by giving me all the emotional support I needed.

Last but not least, I would like to thank my children, Maura and Milan, who –
however difficult work became – reminded me that there are other important, wonderful
things in life that shouldn’t be overlooked. Contents I
Contents
Introduction ............................................................................................ 1

Background .............................................................................................. 3
Categorisation and Definitions of Alcohol Use Disorders ........... 3
Prevalence of Alcohol Use Disorders ................................................... 4
Screening and Brief Interventions for Alcohol Use Disorders ... 6
Screening .................................................................................................. 6
Laboratory indicators ............................................................................... 6
Self-report questionnaires ......................................................................... 7
Assessment of alcohol consumption ........................................................... 10
Brief Interventions ................................................................................... 11
How brief is brief? .................................................................................. 11
Opportunistic versus specialist brief interventions ......................................... 12
Formats and components of brief interventions ............................................. 12
Efficacy of brief interventions ................................................................... 15
Nicotine Dependence: A Correlate of Alcohol Use Disorders ... 25
Prevalence of Nicotine Dependence ........................................................ 25
Assessment of Nicotine Dependence ....................................................... 26
Brief Interventions for Nicotine Dependence ......................................... 27
Study Aims ................................................................................................. 30

Method ......................................................................................................... 32
Participants32
Total Sample ............................................................................................ 32
Attrition analyses: I. Adherence to study protocol ......................................... 38
Attrition analyses: II. Participants lost to follow-up ....................................... 42
Subsample ................................................................................................ 48
Procedures ................................................................................................... 49
Recruitment of Doctors ............................................................................ 49
Training .................................................................................................... 50
Intervention .............................................................................................. 51
Implementation and Randomisation ........................................................ 54
Follow-up ................................................................................................ 56
Contents II
Assessment .................................................................................................. 57
The Screening Questionnaire ................................................................... 57
Health care utilisation .............................................................................. 57
Demographic characteristics ..................................................................... 58
Alcohol Use Disorders Identification Test .................................................... 58
Quantity and frequency of alcohol use ........................................................ 58
Drinker’s Inventory of Consequences ......................................................... 58
Tobacco use ........................................................................................... 60
Readiness to change and current treatment ................................................... 60
Interview Materials ......................................................................... 60
Readiness to change and self-efficacy 60
Evaluation ............................................................................................. 60
Documentation ....................................................................................... 61
International Diagnostic Check Lists ........................................................... 61
The Follow-up Questionnaire .................................................................. 62
Health care utilisation .............................................................................. 62
Alcohol Use Disorders Identification Test .................................................... 62
Tobacco Use .......................................................................................... 62
Current relationsship, readiness to change, self-efficacy, and behaviour change .. 62
Rationale of Analysis .............................................................................. 63

Results ......................................................................................................... 65
Alcohol Use ............................................................................................... 65
Baseline Alcohol Use .............................................................................. 65
Alcohol Use at Follow-up ........................................................................ 67
Tobacco Use70
Smoking Status ........................................................................................ 70
Baseline Tobacco Use .............................................................................. 71
Tobacco Use at Follow-up ........................................................................ 72

Discussion ................................................................................................ 74
Potential Sources of the Brief Intervention’s Inefficacy ........... 76
Adherence to Study Protocol ................................................................... 76
The Screening .......................................................................................... 77
The Intervention ....................................................................................... 80
The Follow-up .......................................................................................... 83
Contents III
Surrounding Conditions .........................................................