OBJECTIVES: Comparatively little is known about the most effective educational strategies to train medical students to successfully intervene in their patients' alcohol problems. The relative effectiveness of two educational programs to teach medical students brief intervention skills for managing alcohol problems was examined. METHODS: Teaching took place over 3 hr and was either the traditional didactic teaching program on the principles and practice of brief and early intervention or an interactive program involving a shortened lecture, clinical practice, and small group feedback on clinical performance. Students were assessed on a 10-min videotaped encounter with a simulated patient before and after teaching according to how they addressed alcohol-related issues and on their general interactional skills. RESULTS: Performance on alcohol-related issues and interactional skills were significantly improved after teaching, although still poor in terms of clinical performance. A between-groups comparison on pre/ postteaching difference scores indicated interactive training was no more effective than traditional didactic lectures in developing the knowledge and skills needed for a brief alcohol intervention. CONCLUSION: The need for more detailed teaching sessions on sensitive areas such as alcohol use in indicated.

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Hazardous alcohol use: its delineation as a subthreshold disorder, and approaches to its diagnosis and management.

The last 20 years have seen a significant paradigm shift in how we view alcohol misuse. The dichotomous model of "alcoholism" and "normal drinking" has now been replaced by the concept of a spectrum of disorders. In this new framework, "hazardous alcohol use" is defined as a repeated pattern of drinking that confers the risk of harmful consequences. It is a typical example of a subthreshold disorder. Where actual physical or psychological harm or social problems have occurred, the terms "harmful alcohol use" and "alcohol abuse," respectively, are applied. These conditions would typically be considered to be above the clinical threshold. The most severe disorder, alcohol dependence, is a psychobiological syndrome with often severe physical, psychological, and social sequelae. This article describes how the concept of hazardous alcohol use originated, and reviews the intervention techniques that have been developed to induce and assist hazardous drinkers to reduce their consumption to nonhazardous levels. The findings from a series of World Health Organization (WHO) collaborative studies on brief interventions for hazardous alcohol use are described. This work has resulted in the development of the Alcohol Use Disorders Identification Test (AUDIT) screening instrument, which can detect over 90% of hazardous drinkers in a range of settings, and the demonstration that 5 minutes' structured advice can reduce hazardous consumption by 30%. The later phases of this program of work have examined strategies to promote the dissemination of brief interventions for hazardous alcohol use throughout primary health care, and the nationwide, systematic, and sustained utilization of these interventions.

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Patterns of drinking in Thai men.

Alcohol problems have increased considerably in Thailand in recent years, in common with many other countries in South East Asia. Little is known about the patterns or contexts of alcohol consumption in these countries, and so efforts to develop preventative strategies have been hampered. To identify current patterns related to alcohol consumption, we recruited 91 alcohol-dependent subjects, 77 hazardous or harmful drinkers, and 144 abstainers or light drinkers. A structured interview incorporating the World Health Organization 'tri-level' method to determine the amount and frequency of drinking, and the Alcohol Use Disorders and Associated Disabilities to diagnose alcohol dependence and harmful drinking was used. Median alcohol intake was 75 and 49 g/drinking day in the alcohol-dependent and harmful or hazardous groups respectively. The former group drank on average 25 days/month, whereas the harmful or hazardous drinkers drank 10 days/month. Drinking alone was more common in the alcohol-dependent group (67%), whereas harmful or hazardous drinkers typically drank with friends (58%), and infrequent drinkers drank only at social functions (61%). Only 28% of alcohol-dependent subjects perceived themselves as dependent on alcohol. The alcohol-dependent subjects and hazardous or harmful drinkers were more likely to currently smoke cigarettes and have a history of marijuana use than were non-drinkers, infrequent or light drinkers. Antisocial personality disorder was more commonly associated with alcohol dependence. In conclusion, alcohol dependence was characterized by continual drinking, whereas hazardous or harmful consumption was associated with an intermittent pattern. Other forms of substance use and personality disorder were associated with alcohol dependence. Clearer understanding of these factors would be of great benefit in planning an intervention programme for excessive drinking in Thailand.

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Geography and geopolitics in California medicine.

Explore the source record for details and available documents.

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