cording to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria; and (3) either. Results: Of 393 eligible patients, 243 (62%) completed AUDIT-C and interviews. For detecting heavy drinking, AUDIT-C had a higher AUROC than the full AUDIT (0.891 vs 0.881; P = .03). Although the full AUDIT performed better than AUDIT-C for detecting active alcohol abuse or dependence (0.811 vs 0.786; P<.001), the 2 questionnaires performed similarly for detecting heavy drinking and/or active abuse or dependence (0.880 vs 0.881).

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/208954/ioi70602.pdf

The AUDIT Alcohol consumption questions (AUDIT-C) : An effective brief screening test for problem drinking

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(05)17870-2.pdf

Alcohol and public health

A meta-analysis was conducted on controlled clinical trials investigating adaptations of motivational interviewing (AMIs), a promising approach to treating problem behaviors. AMIs were equivalent to other active treatments and yielded moderate effects (from .25 to .57) compared with no treatment and/or placebo for problems involving alcohol, drugs, and diet and exercise. Results did not support the efficacy of AMIs for smoking or HIV-risk behaviors. AMIs showed clinical impact, with 51% improvement rates, a 56% reduction in client drinking, and moderate effect sizes on social impact measures (d=0.47). Potential moderators (comparative dose, AMI format, and problem area) were identified using both homogeneity analyses and exploratory multiple regression. Results are compared with other review results and suggestions for future research are offered.

/pdf/the-efficacy-of-motivational-interviewing-a-meta-analysis-of-2hycrwhc30.pdf

The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials.

Two studies, tested self-determination theory with 2nd-year medical students in an interviewing course Study I revealed that (a) individuals with a more autonomous orientation on the General Causality Orientations Scale had higher psychosocial beliefs at the beginning of the course and reported more autonomous reasons for participating in the course, and (b) students who perceived their instructors as more autonomy-supportive became more autonomous in their learning during the 6-month course Study 2, a 30-month longitudinal study, revealed that students who perceived their instructors as more autonomy-supportive became more autonomous in their learning, which in turn accounted for a significant increase in both perceived competence and psychosocial beliefs over the 20-week period of the course, more autonomy support when interviewing a simulated patient 6 months later, and stronger psychosocial beliefs 2 years later

/pdf/internalization-of-biopsychosocial-values-by-medical-6z720hhy3f.pdf

Internalization of biopsychosocial values by medical students: a test of self-determination theory.

The widely disseminated clinical method of motivational interviewing (MI) arose through a convergence of science and practice. Beyond a large base of clinical trials, advances have been made toward "looking under the hood" of MI to understand the underlying mechanisms by which it affects behavior change. Such specification of outcome-relevant aspects of practice is vital to theory development and can inform both treatment delivery and clinical training. An emergent theory of MI is proposed that emphasizes two specific active components: a relational component focused on empathy and the interpersonal spirit of MI, and a technical component involving the differential evocation and reinforcement of client change talk. A resulting causal chain model links therapist training, therapist and client responses during treatment sessions, and posttreatment outcomes.

http://www.miinstitute.com/wp/wp-content/uploads/Miller%20Rose%20Theory%20of%20MI.pdf

Toward a Theory of Motivational Interviewing

Relatively brief interventions have consistently been found to be effective in reducing alcohol consumption or achieving treatment referral of problem drinkers. To date, the literature includes at least a dozen randomized trials of brief referral or retention procedures, and 32 controlled studies of brief interventions targeting drinking behavior, enrolling over 6000 problem drinkers in both health care and treatment settings across 14 nations. These studies indicate that brief interventions are more effective than no counseling, and often as effective as more extensive treatment. The outcome literature is reviewed, and common motivational elements of effective brief interventions are described. There is encouraging evidence that the course of harmful alcohol use can be effectively altered by well-designed intervention strategies which are feasible within relatively brief-contact contexts such as primary health care settings and employee assistance programs. Implications for future research and practice are considered.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1360-0443.1993.tb00820.x

Brief interventions for alcohol problems: a review

Smoking and drinking share many detrimental effects, some of which operate synergistically. Over 90% of alcoholic inpatients are smokers, with similar findings regarding outpatients. In the general population, the relationship between smoking and drinking appears positive but modest. Nicotine appears to facilitate ethanol consumption and vice versa. While ample theoretical viewpoints exist to explain the covariance of alcohol and cigarette consumption, conclusive data supporting one or another of these views are lacking. The assumption that alcoholics should be discouraged from quitting smoking as well as drinking is without empirical basis. Research should ascertain whether problem drinkers with greater positive association between alcohol and smoking benefit differentially from quitting both.

Smoking and drinking: a review of the literature.

According to the stories of many cultures, the human beginning was a time of ease and wonder, free from hard labor, struggle, strife, and the alienation and fragmentation we know today. Sometimes this perfection is projected into the future—a New Jerusalem descending upon the earth, the city of God, or a heaven we enter after death. Sometimes it is viewed as the possible result of human effort, a tradition spanning from Plato’s Republic (ca. 360 B.C.E.; Hamilton and Cairns, 1969) and Thomas Moore’s Utopia (1516), to James Hilton’s Shangri-La, (1933) and B. F. Skinner’s Walden Two (1948), among many others. In a Buddhist context, paradise is always available, but it cannot be found in the future or in the past. It is only available in the present moment, in that brief moment of perception before we split the world into judgments of pleasure and pain, gain and loss, desire and aversion. With these comes the sense of I or ego, the feeling that “I like this and want more of that for myself,” or “I dislike that, and want to avoid that.” This sense of I is the flaming sword blocking our return to the garden. It is the sense that we are a separate, unchanging entity, cut off from everything and everyone else, a bit of flotsam and jetsam floating haphazardly in a meaningless universe. In Buddhism, paradise is found the moment we reverse this process. Paradise is found when we re-enter the present moment deeply and clearly, without being caught in either desire or aversion, without the narrow point of view of the separate and alienated self that wants and wants and wants, without our habitual mental patterns of judgment or blame. This kind of perception is called mindfulness. And with mindfulness, paradise is available here and now. Indeed, it can only be found here and now—not in the mythic past, not in the eschatological future, and not even as the result of human social engineering—important as such efforts may be for other reasons. This human tendency to seek pleasure and avoid pain is neither wrong nor evil. It even has a certain necessity about it, a certain utility. Life requires such a capacity. Only, when coupled with our large brains, it becomes a capacity that can easily run amok. It is impossible that this endless process

Thomas H. Bien

Papers

Brief interventions for alcohol problems: a review

Smoking and drinking: a review of the literature.

Paradise Lost: Mindfulness and Addictive Behavior

Brief intervention: a reply to a review of a review