Publications by authors named "Jean-Bernard Daeppen"

173 Publications

Alcohol consumption and neurocognitive deficits in people with well-treated HIV in Switzerland.

PLoS One 2021 2;16(3):e0246579. Epub 2021 Mar 2.

Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.

Background: Hazardous alcohol consumption and HIV infection increase the risk of neurocognitive impairment (NCI). We examined the association between alcohol consumption and specific neurocognitive domain function in people with HIV (PWH) taking modern antiretroviral therapy.

Methods: The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is a prospective, longitudinal, multicentre and multilingual (French, German and Italian) study of patients aged ≥45 years old enrolled in the Swiss HIV Cohort Study (SHCS). Baseline data from 981 study participants were examined. Five neurocognitive domains were evaluated: motor skills, speed of information processing, attention/working memory, executive function and verbal episodic memory. NCI was examined as binary (presence/absence) and continuous (mean z-score) outcomes against Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) scores using logistic and linear regression models, respectively.

Results: Most participants (96.2%) had undetectable viral loads and 64% were aged >50 years old. Hazardous alcohol consumption was observed in 49.4% of participants and binge drinking in 4.2%. While alcohol consumption frequency and quantity were not associated with NCI, the practice of binge drinking was significantly associated with impaired motor skills and overall neurocognitive function in both binary (odds ratio, OR ≥2.0, P <0.05) and continuous (mean z-score difference -0.2 to -0.4, P ≤0.01) outcomes. A significant U-shaped distribution of AUDIT-C score was also observed for motor skills and overall neurocognitive function.

Conclusions: In this cohort of PWH with well-controlled HIV infection, NCI was associated with the practice of binge drinking rather than alcohol consumption frequency or quantity. Longitudinal analysis of alcohol consumption and NCI in this population is currently underway.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246579PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924787PMC
March 2021

Developing a brief motivational intervention for young adults admitted with alcohol intoxication in the emergency department - Results from an iterative qualitative design.

PLoS One 2021 8;16(2):e0246652. Epub 2021 Feb 8.

Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland.

Background: Unhealthy alcohol use among young adults is a major public health concern. Brief motivational interventions for young adults in the Emergency Department (ED) have shown promising but inconsistent results.

Methods: Based on the literature on brief intervention and motivational interviewing efficacy and active ingredients, we developed a new motivational intervention model for young adults admitted in the ED with alcohol intoxication. Using an iterative qualitative design, we first pre-tested this model by conducting 4 experimental sessions and 8 related semi-structured interviews to evaluate clinicians' and patients' perceptions of the intervention's acceptability and feasibility. We then conducted a consultation meeting with 9 international experts using a nominal group technique. The intervention model was adjusted and finally re-tested by conducting 6 new experimental sessions and 12 related semi-structured interviews. At each round, data collected were analyzed and discussed, and the intervention model updated accordingly.

Results: Based on the literature, we found 6 axes for developing a new model: High level of relational factors (e.g. empathy, alliance, avoidance of confrontation); Personalized feedback; Enhance discrepancy; Evoke change talk while softening sustain talk, strengthen ability and commitment to change; Completion of a change plan; Devote more time: longer sessions and follow-up options (face-to-face, telephone, or electronic boosters; referral to treatment). A qualitative analysis of the semi-structured interviews gave important insights regarding acceptability and feasibility of the model. Adjustments were made around which information to provide and how, as well as on how to deepen discussion about change with patients having low levels of self-exploration. The experts' consultation addressed numerous points, such as information and advice giving, and booster interventions.

Discussion: This iterative, multi-component design resulted in the development of an intervention model embedded in recent research findings and theory advances, as well as feasible in a complex environment. The next step is a randomized controlled trial testing the efficacy of this model.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246652PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869998PMC
February 2021

The Impact of Binge Drinking on Mortality and Liver Disease in the Swiss HIV Cohort Study.

J Clin Med 2021 Jan 14;10(2). Epub 2021 Jan 14.

Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.

Whereas excessive alcohol consumption increases liver disease incidence and mortality, evidence on the risk associated with specific drinking patterns is emerging. We assessed the impact of binge drinking on mortality and liver disease in the Swiss HIV Cohort Study. All participants with follow-up between 2013 and 2020 were categorized into one of four drinking pattern groups: "abstinence", "non-hazardous drinking", "hazardous but not binge drinking" (Alcohol Use Disorder Identification Test Consumption [AUDIT-C] score ≥ 3 in women and ≥4 in men), and "binge drinking" (≥6 drinks/occasion more than monthly). We estimated adjusted incidence rate ratios (aIRR) for all-cause mortality, liver-related mortality and liver-related events using multivariable quasi-Poisson regression. Among 11,849 individuals (median follow-up 6.8 years), 470 died (incidence rate 7.1/1000 person-years, 95% confidence interval [CI] 6.5-7.8), 37 experienced a liver-related death (0.6/1000, 0.4-0.8), and 239 liver-related events occurred (3.7/1000, 3.2-4.2). Compared to individuals with non-hazardous drinking, those reporting binge drinking were more likely to die (all-cause mortality: aIRR 1.9, 95% CI 1.3-2.7; liver-related mortality: 3.6, 0.9-13.9) and to experience a liver-related event (3.8, 2.4-5.8). We observed no difference in outcomes between participants reporting non-hazardous and hazardous without binge drinking. These findings highlight the importance of assessing drinking patterns in clinical routine.
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http://dx.doi.org/10.3390/jcm10020295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830571PMC
January 2021

[What's new in addiction medicine].

Rev Med Suisse 2021 Jan;17(720-1):10-12

Centre cantonal d'addictologie, Réseau fribourgeois de santé mentale, Route de Morat 8, 1700 Fribourg.

The development of research, clinical practice and prevention in addiction medicine is, compared to other disciplines, more influenced by socio-political factors. Research on psychedelics has thus long been hampered by prohibitive policy but has recently been revived thanks to the relaxation of these political positions. The extensive prescription of baclofen for alcohol addiction is mainly the consequence of popular support and has so far not been clearly supported by specific research. The aim of the new Gambling Act was to harmonize the regulatory provisions for lotteries and betting on the one hand and casino gambling on the other, while at the same time opening up the market for online gambling.
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January 2021

Health care providers' perception of the frequent emergency department user issue and of targeted case management interventions: a cross-sectional national survey in Switzerland.

BMC Emerg Med 2021 Jan 7;21(1). Epub 2021 Jan 7.

Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland.

Background: Frequent users of emergency departments (FUEDs) (≥5 ED visits/year) represent a vulnerable population with complex needs accounting for a significant number of emergency department (ED) consultations, thus contributing to EDs overcrowding. Research exploring ED staff perceptions of FUEDs is scarce.

Objectives: The current study aimed to evaluate in ED staff a) the extent to which FUEDs are perceived as an issue; b) their perceived levels of knowledge and understanding of FUEDs; c) levels of perceived usefulness of case management (CM) and interest in implementing this intervention in their ED service.

Methods: Head physicians of the EDs at all public hospitals in Switzerland (of various level of specialization) were sent a 19-item web-based survey, pilot tested prior to its dissemination. The head physicians were asked to forward the survey to ED staff members from different health professional backgrounds.

Results: The hospital response rate was 81% (85/106). The exploitable hospital response rate was 71% (75/106 hospitals) including 208 responding health professionals. Issues and difficulties around FUEDs were perceived as important by 64% of respondents. The perceived frequency of being confronted with FUEDs was higher among nurses in more specialized EDs. In total, 64% of respondents felt poorly informed about FUEDs, nurses feeling less informed than physicians. The understanding of FUEDs was lower in the French-Italian-speaking parts (FISP) of Switzerland than in the German-speaking part. Eighty-one percent of respondents had no precise knowledge of FUED-related interventions. The perceived usefulness of CM interventions after receiving explanations about it was high (92%). However, the overall level of interest for CM implementation was 59%. The interest in CM by physicians was low across all regions and ED categories. Nurses, on the other hand, showed more interest, especially those in EDs of high specialization.

Conclusions: The majority of ED staff reported being confronted with FUEDs on a regular basis. Staff perceived FUEDs as a vulnerable population, yet, they felt poorly informed about how to manage the issue. The majority of ED staff thought a CM intervention would be useful for FUEDs, however there appears to be a gap in their desire or willingness to implement such interventions.
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http://dx.doi.org/10.1186/s12873-020-00397-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792123PMC
January 2021

Performance of self-reported measures of alcohol use and of harmful drinking patterns against ethyl glucuronide hair testing among young Swiss men.

PLoS One 2020 23;15(12):e0244336. Epub 2020 Dec 23.

Division of Prison Health, Geneva University Hospitals and University of Geneva, Thônex, Geneva, Switzerland.

Background: There is a need for empirical studies assessing the psychometric properties of self-reported alcohol use as measures of excessive chronic drinking (ECD) compared to those of objective measures, such as ethyl glucuronide (EtG).

Objectives: To test the quality of self-reported measures of alcohol use and of risky single-occasion drinking (RSOD) to detect ECD assessed by EtG.

Methods: A total of 227 samples of hair from young Swiss men were used for the determination of EtG. Self-reported measures of alcohol use (previous twelve-month and previous-week alcohol use) and RSOD were assessed. Using EtG (<30 pg/mg) as the gold standard of ECD assessment, the sensitivity and specificity were computed, and the AUROC were compared for alcohol use measures and RSOD. Logistic regressions were used to test the contribution of RSOD to the understanding of ECD after controlling for alcohol use.

Results: A total of 23.3% of participants presented with ECD. Previous twelve-month alcohol use with a cut-off of >15 drinks per week (sensitivity = 75.5%, specificity = 78.7%) and weekly RSOD (sensitivity = 75.5%, specificity = 70.1%) yielded acceptable psychometric properties. No cut-off for previous-week alcohol use gave acceptable results. In the multivariate logistic regression, after controlling for the previous twelve months of alcohol use, RSOD was still significantly associated with EtG (p = .016).

Conclusion: Self-reported measures of the previous twelve months of alcohol use and RSOD were acceptable measures of ECD for population-based screening. Self-reported RSOD appeared to be an interesting screening measure, in addition to the previous twelve months of alcohol use, to understand ECD among young people.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244336PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757898PMC
March 2021

Protective behavioral strategies and alcohol outcomes: Impact of mood and personality disorders.

Addict Behav 2021 01 18;112:106615. Epub 2020 Aug 18.

Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Although young men or young adults with mental health disorders are at higher risk to engage in problematic drinking, they typically evince stronger associations between protective behavioral strategies (PBS) and fewer alcohol outcomes. This study aimed to contribute to this line of research by examining the moderating effect of depression, bipolar spectrum disorder, borderline personality disorder and social anxiety disorder on the association between PBS and alcohol outcomes. Participants (N = 4,960; mean age = 25.43) were young men participating in the Cohort Study on Substance Use Risk Factors. Measures of PBS use, typical drinks per week, alcohol-related consequences, depression, bipolar spectrum disorder, borderline personality disorder and social anxiety disorder were used from the second follow-up assessment. Main results indicated that the negative association between PBS and alcohol use was stronger in participants with borderline personality disorder than among those without this disorder. Unexpectedly, in participants with depression, PBS were not significantly associated with alcohol use, whereas they were related to fewer drinks among those without the disorder. Similarly, in participants with bipolar spectrum disorder, the association between PBS and alcohol-related consequences was not significant, whereas PBS were associated with fewer consequences in those without the disorder. Finally, findings indicated that social anxiety disorder did not significantly moderate the associations between PBS and alcohol outcomes. If replicated by future research, these findings imply that PBS-intervention may not equally impact young adults with diverse mental health disorders.
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http://dx.doi.org/10.1016/j.addbeh.2020.106615DOI Listing
January 2021

Screening for alcohol use disorder among individuals with comorbid psychiatric disorders: Diagnostic accuracy in a sample of young Swiss men.

Addict Behav 2020 07 15;106:106354. Epub 2020 Feb 15.

School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Route des Arsenaux 16a, 1700 Fribourg, Switzerland.

Alcohol use disorder (AUD) is frequently comorbid with other psychiatric disorders. However, few studies investigated the psychometric properties of AUD screening tools in presence of co-occurring disorders. This study examined the diagnostic accuracy of a short AUD screening tool among young adults, in the presence of high vs. low or moderate symptomatology of other common psychiatric disorders. Data were collected among young Swiss men (n = 233) between 2016 and 2018. Measures included a diagnostic interview for AUD and screening tools for AUD and other psychiatric disorders (attention deficit hyperactivity disorder, antisocial personality disorder, bipolar disorder, borderline personality disorder, major depressive disorder, and social anxiety disorder). We computed receiver operating characteristic curves to test whether the AUD screening tool was an accurate indicator of AUD for groups with high vs. low or moderate symptomatology of each psychiatric disorder. The results showed that the optimal cut-off score was ≥3 (the original cut-off of the scale) for participants with a low or moderate symptomatology and ≥4 for participants with a high symptomatology. Our findings highlighted the urgent need for an integrated approach to screening. Psychiatric comorbidities should be included in the screen for AUD to obtain accurate results.
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http://dx.doi.org/10.1016/j.addbeh.2020.106354DOI Listing
July 2020

Smartphone-based secondary prevention intervention for university students with unhealthy alcohol use identified by screening: study protocol of a parallel group randomized controlled trial.

Trials 2020 Feb 17;21(1):191. Epub 2020 Feb 17.

Center for Addiction and Mental Health, Toronto, ON, Canada.

Background: Unhealthy alcohol use is a leading cause of morbidity and mortality among young people, including university students. Delivering secondary prevention interventions against unhealthy alcohol use is challenging. Information technology has the potential to reach large parts of the general population. The present study is proposed to test a proactive secondary prevention smartphone-based intervention against unhealthy alcohol use.

Methods: This is a parallel-group, randomized controlled trial (1:1 allocation ratio) among 1696 university students with unhealthy alcohol use, identified by screening and followed up at 3, 6, and 12 months. Participants will be randomized to receive access to a smartphone-based intervention or to a no intervention control condition. The primary outcome will be self-reported volume of alcohol drunk over the past 30 days, reported as the mean number of standard drinks per week over the past 30 days, measured at 6 months. Secondary outcomes will be number of heavy drinking days over the past 30 days, at 6 months. Additional outcomes will be maximum number of drinks on any day over the past 30 days, alcohol-related consequences (measured using the Short Inventory of Problems (SIP-2R), and academic performance.

Discussion: The aim of this trial is to close the evidence gap on the efficacy of smartphone-based secondary prevention interventions. If proven effective, smartphone-based interventions have the potential to reach a large portion of the population, completing what is available on the Internet.

Trial Registration: ISRCTN, 10007691. Registered on 2 December 2019. Recruitment will start in April 2020.
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http://dx.doi.org/10.1186/s13063-020-4145-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027100PMC
February 2020

Further Utilization of Emergency Department and Inpatient Psychiatric Services Among Young Adults Admitted at the Emergency Department With Clinical Alcohol Intoxication.

J Addict Med 2020 Jan/Feb;14(1):32-38

Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland (AA, MF, JBD, NB); Department of Population Health, New York University School of Medicine, New York, NY, United States (JM); Emergency Department, Lausanne University Hospital, Lausanne, Switzerland (BY).

Objectives: To assess in a cohort of young adults admitted with alcohol intoxication (AI) to the Emergency Department (ED): how many patients are readmitted to the ED or to a Psychiatric Department (PD) inpatient unit; and which characteristics are associated with further ED and PD inpatient admissions.

Methods: In 630 patients aged 18 to 30 years admitted for AI in 2006 to 2007 to the ED of a Swiss tertiary hospital, further ED and PD inpatient admissions through 2013 were assessed. Patient characteristics at the index (initial) ED visit were assessed using administrative and medical records.

Measurements: Proportion of subjects with at least 1 further ED admission, 1 further ED admission with AI, and any PD admission over the study period.Associations between patients' characteristics at index visit and readmissions were assessed using backward selection multivariate regression analyses.

Results: Mean age was 24, 66% were male, 60% had any ED/PD admissions during the study period, 17.9% a PD admission, and 13.8% were re-admitted to ED with AI. Disruptive behavior at the index visit was associated with further ED (odds ratio [OR] 1.69 [1.13; 2.54]) and PD admissions (OR 2.41 [1.44; 4.05]). Psychiatric diagnosis was associated with any further ED admission (OR 2.07 [1.41; 3.05]), with further ED admission with AI (OR 4.56 [2.36; 8.81]) and with PD admission (OR 3.92 [2.40; 6.41]). Female sex predicted any further ED admission (OR 1.65 [1.14; 2.39]).

Conclusions: Young adults presenting with alcohol intoxication have high rates of subsequent inpatient emergency and psychiatric admissions. Being female, presenting with disruptive behavior, and having a psychiatric diagnosis at the ED visit were predictors of further admissions.
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http://dx.doi.org/10.1097/ADM.0000000000000529DOI Listing
February 2020

Cinq conseils pour la rencontre avec un patient dépendant de l’alcool.

Rev Med Suisse 2020 Jan;16(679):206-207

Service de médecine des addictions, CHUV, 1011 Lausanne.

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January 2020

[Addictions].

Rev Med Suisse 2020 Jan;16(676-7):8-11

Service de médecine des addictions, CHUV, et Société Suisse de Médecine de l'Addiction (SSAM), 1011 Lausanne.

This article describes a new form of administration of inhaled prescribed heroin currently under investigation. It underlines the particularity of opioid agonist prescription in jail and presents new perspectives in using psilocybin in addiction medicine treatment. A brief literature review about vaping confirms its interest in quitting cigarette, with a cost of addiction to vaping and recent worrisome reports of chemical pneumonia. Finally, the withdrawal of WHO guidelines on opiates use in pain management, in the context of a suspicion of conflict of interest, underlines the sensible balance between over- and under- prescription of opiates in analgesic treatment.
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January 2020

A randomized trial of brief web-based prevention of unhealthy alcohol use: Participant self-selection compared to a male young adult source population.

Internet Interv 2020 Mar 28;19:100298. Epub 2019 Nov 28.

Institute of Social and Preventive Medicine, Lausanne University Hospital, Switzerland.

Background: How much a randomized controlled trial (RCT) sample is representative of or differs from its source population is a challenging question, with major implications for generalizability of results. It is particularly crucial for freely-available web-based interventions tested in RCTs since they are designed to reach broad populations and could increase health disparities if they fail to reach the more vulnerable individuals. We assessed the representativeness of a sample of participants in a primary/secondary prevention web-based brief intervention RCT in relation to its source population. Then we compared those recruited to those not recruited in the RCT.

Methods: There is a mandatory army recruitment process in Switzerland at age 19 for men. Between August 2010 and July 2011, 12,564 men (source population) attended two recruitment centers and were asked to answer a screening questionnaire on alcohol use. Among 11,819 (94.1%) who completed it, 7027 (59.5%) agreed to participate in a longitudinal cohort study with regular assessments. In 2012, these participants were invited to a web-based brief intervention RCT. Participation was not dependent on the presence or quantity of alcohol use. We assessed the representativeness of the RCT sample in relation to the source population and compared participants recruited/not recruited in the RCT with respect to education level and alcohol use.

Results: The RCT sample differed from the source population: individuals 20 and over were significantly less represented (34.3% vs 37.9%,  = 0.006), as were those with lower education level (58.6% vs 63.0%,  = 0.0009). The prevalence of any alcohol use was higher in the RCT population (92.3% vs 90.6%,  = 0.03) but unhealthy alcohol use was less represented (37.1% vs 43.2%,  < 0.0001). Differences on alcohol use measures and education were similarly found when those recruited in the RCT were compared to those who were not, including in a multivariable model, showing independent associations between less unhealthy alcohol use and higher education and recruitment in the RCT.

Conclusions: RCT participants differed from other members of the source population, with those participating in the RCT having higher prevalence of any alcohol use but lower levels of consumption and lower prevalence of indicators of unhealthy alcohol use. Individuals with higher education were overrepresented in the RCT sample. Selection bias may exist at both ends of the drinking spectrum and individuals with some indicators of greater vulnerability were less likely to participate. Results of web-based studies may not adequately generalize to the general population.Trial registration: The trial was registered at current controlled trials: ISRCTN55991918.
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http://dx.doi.org/10.1016/j.invent.2019.100298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909170PMC
March 2020

Les étudiant·e·s en médecine mènent une recherche dans la communauté.

Rev Med Suisse 2019 Nov;15(673):2213

Direction du Module d'immersion communautaire de la Faculté de biologie et de médecine de l'UNIL.

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November 2019

Identifying an accurate self-reported screening tool for alcohol use disorder: evidence from a Swiss, male population-based assessment.

Addiction 2020 03 12;115(3):426-436. Epub 2019 Dec 12.

School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland.

Background And Aims: Short screenings for alcohol use disorder (AUD) are crucial for public health purposes, but current self-reported measures have several pitfalls and may be unreliable. The main aim of our study was to provide empirical evidence on the psychometric performance of self-reports currently used. Our research questions were: compared with a gold standard clinical interview, how accurate are (1) self-reported AUD, (2) self-reported alcohol use over time and (3) biomarkers of alcohol use among Swiss men? Finally, we aimed to identify an alternative screening tool.

Design: A single-center study with a cross-sectional design and a stratified sample selection.

Setting: Lausanne University Hospital (Switzerland) from October 2017 to June 2018.

Participants: We selected participants from the French-speaking participants of the ongoing Cohort Study on Substance Use and Risk Factors (n = 233). The sample included young men aged on average 27.0 years.

Measurements: We used the Diagnostic Interview for Genetic Studies as the gold standard for DSM-5 AUD. The self-reported measures included 11 criteria for AUD, nine alcohol-related consequences, and previous 12 months' alcohol use. We also assessed biomarkers of chronic excessive drinking (ethyl glucuronide and phosphatidylethanol).

Findings: None of the self-reported measures/biomarkers taken alone displayed both sensitivity and specificity close to 100% with respect to the gold standard (e.g. self-reported AUD: sensitivity = 92.3%, specificity = 45.8%). The best model combined eight self-reported criteria of AUD and four alcohol-related consequences. Using a cut-off of three, this screening tool yielded acceptable sensitivity (83.3%) and specificity (78.7%).

Conclusions: Neither self-reported alcohol use disorder nor heavy alcohol use appear to be adequate to screen for alcohol use disorder among young men from the Swiss population. The best screening alternative for alcohol use disorder among young Swiss men appears to be a combination of eight symptoms of alcohol use disorder and four alcohol-related consequences.
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http://dx.doi.org/10.1111/add.14864DOI Listing
March 2020

Electronic screening and brief intervention for unhealthy alcohol use in primary care waiting rooms - A pilot project.

Subst Abus 2020 31;41(3):347-355. Epub 2019 Jul 31.

Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

In primary care, electronic self-administered screening and brief interventions for unhealthy alcohol may overcome some of the implementation barriers of face-to-face intervention. We developed an anonymous electronic self-administered screening brief intervention device for unhealthy alcohol use and assessed its feasibility and acceptability in primary care practice waiting rooms. Two modes of delivery were compared: with or without the presence of a research assistant (RA) to make patients aware of the device's presence and help users. Using the device was optional. The devices were placed in 10 participating primary care practices waiting rooms for 6 weeks, and were accessible on a voluntary basis. Number of appointments by each practice during the course of the study was recorded. Access to the electronic brief intervention was voluntary among those who screened positive. Screening and brief intervention rates and characteristics of users were compared across the modes of delivery. During the study, there were 7270 appointments and 1511 individuals used the device (20.8%). Mean age of users was 45.3 (19.5), and 57.9% screened positive for unhealthy alcohol use. Of them, 53.8% accessed the brief intervention content. The presence of the RA had a major impact on the device's usage (59.6% vs 17.4% when absent). When the RA was present, participants were less likely to screen positive (49.4% vs 60.7%,  = 0.0003) but more likely to access the intervention (62.7% vs 51.4%,  = 0.009). Results from the satisfaction survey indicated that users found the device easy to use (93.5%), questions useful (89-95%) and 77.2% reported that their friends would be willing to use it. This pilot project indicates that the implementation of an electronic screening and brief intervention device for unhealthy alcohol is feasible and acceptable in primary care practices but that, without human support, its use is rather limited.
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http://dx.doi.org/10.1080/08897077.2019.1635963DOI Listing
July 2019

Attention deficit hyperactivity disorder and future alcohol outcomes: Examining the roles of coping and enhancement drinking motives among young men.

PLoS One 2019 19;14(6):e0218469. Epub 2019 Jun 19.

Addiction Medicine, Lausanne University Hospital CHUV, Lausanne, Switzerland.

Objective: Although there is evidence that Attention Deficit Hyperactivity Disorder (ADHD) symptoms are positively related to alcohol use and related problems among young adults, little research has examined the mechanisms that might explain this association. In response, this study examined the mediating effects of coping and enhancement drinking motives on the prospective associations between ADHD symptoms and alcohol outcomes.

Method: Participants (N = 4,536) were young men from the Cohort Study on Substance Use Risk Factors. Measures of ADHD symptoms and those of drinking motives, heavy episodic drinking (HED) and alcohol use disorder symptoms were used from the baseline and 15-month follow-up assessments.

Results: Findings indicated that the associations of ADHD-inattention symptoms with alcohol use disorder (AUD) symptoms and with HED were partially and completely mediated through drinking motives, respectively, whereas drinking motives did not mediate the ADHD-hyperactivity/impulsivity-symptoms-alcohol outcomes associations.

Conclusion: Results indicated that coping and enhancement motives partially explained the ADHD-inattention symptoms-subsequent alcohol outcomes association. These findings suggest that interventions targeting enhancement and coping motives may help prevent problematic drinking among young men with elevated ADHD-inattention symptoms.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218469PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584013PMC
February 2020

Savoir-être en médecine de l’addiction : quelques pistes pour le praticien.

Rev Med Suisse 2019 Jun;15(654):1184-1186

Service de médecine des addictions, CHUV, 1011 Lausanne.

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June 2019

[Nutrition disorders and alcohol use disorder].

Rev Med Suisse 2019 Jun;15(654):1177-1180

Service de médecine des addictions, CHUV, 1011 Lausanne.

Patients suffering from alcohol use disorder (AUD) are at risk for malnutrition. The mechanisms are presented in this article. Nutrition disorders in the patient with AUD can include malnutrition, micronutrient deficiencies, overweight and obesity. They may contribute to tissue damage and to oncological and cognitive disorders encountered among patients with AUD. Refeeding syndrome can appear during the withdrawal period. A nutrition evaluation should be included in the evaluation of all patients with AUD.
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June 2019

[Use of clear and nonstigmatizing language is necessary in addiction medicine].

Rev Med Suisse 2019 Jun;15(654):1165-1168

Service de médecine des addictions, Département de psychiatrie, CHUV, 1011 Lausanne.

The language used has an impact on clinician attitudes and behaviors. In particular, the use of stigmatizing language or language reducing individuals in treatment to a given behavior has a negative impact on clinician attitudes, perception of people, perception of the disorders and treatment options. In addiction medicine, using clear, non-stigmatizing and scientifically appropriate language aims at delivering better care, increases treatment access, improves communication between health care professionals and improves knowledge transfer towards health care system users and their families, health care providers and society. The use of clear, slang-free, people-first language is crucial.
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June 2019

Homo addictus.

Rev Med Suisse 2019 06;15(654):1163

Service de médecine des addictions, CHUV, Lausanne.

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June 2019

Alcohol-induced blackouts at age 20 predict the incidence, maintenance and severity of alcohol dependence at age 25: a prospective study in a sample of young Swiss men.

Addiction 2019 09 17;114(9):1556-1566. Epub 2019 Jun 17.

Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Background And Aims: Alcohol-induced blackout (AIB) is a common alcohol-related adverse event occurring during teenage years. Although research provides evidence that AIB predicts acute negative consequences, less is known about the associations of AIB with chronic consequences, such as alcohol dependence (AD). This study estimated the associations between an experience of AIB at age 20 and the incidence, maintenance and severity of AD at age 25 among Swiss men.

Design: Prospective cohort study with 5.5 years separating baseline and follow-up.

Setting: Switzerland.

Participants: Swiss male drinkers (n = 5469, age 20 at baseline) drawn from the Cohort Study on Substance Use Risk Factors (C-SURF).

Measurements: Self-report questionnaires assessing AIB, AD, alcohol (drinking volume, binge drinking), cigarette and cannabis use, several risk factors (sensation-seeking, family history of problematic alcohol use, age of first alcohol intoxication) and socio-demographic variables.

Findings: Generalized estimating equation models with and without adjustment for risk factors, including alcohol use and socio-demographics, showed that AIB at age 20 significantly predicted the incidence of AD at age 25 in men without AD at age 20 [odds ratio (OR) = 2.52, 95% confidence interval (CI), unadjusted = 2.04, 3.11, P < 0.001; fully adjusted, OR = 1.47, 95% CI = 1.13, 1.91, P = 0.004], maintenance of AD in men with AD at age 20 (unadjusted, OR = 1.82, 95% CI = 1.12, 2.95, P = 0.015; fully adjusted, OR = 1.66, 95% CI = 1.00, 2.76, P = 0.048] and AD severity [unadjusted incidence rate ratio (IRR) = 1.89, 95% CI = 1.69, 2.11, P < 0.001; fully adjusted, IRR = 1.20, 95% CI = 1.10, 1.31, P < 0.001].

Conclusions: Among Swiss men, alcohol-induced blackout at age 20 predicts the development, maintenance and severity of alcohol dependence at age 25.
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http://dx.doi.org/10.1111/add.14647DOI Listing
September 2019

Longitudinal Associations Between Life Satisfaction and Cannabis Use Initiation, Cessation, and Disorder Symptom Severity in a Cohort of Young Swiss Men.

Int J Environ Res Public Health 2019 04 16;16(8). Epub 2019 Apr 16.

Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland.

Motivations for cannabis use may include coping with negative well-being. Life satisfaction, a hallmark of subjective well-being, could play a role in cannabis use among young adults. This study aims to assess whether life satisfaction (SWLS) at age 21 is associated with cannabis initiation and cessation between the ages of 21 and 25, and with cannabis use severity (CUDIT) at age 25. Data were drawn from a cohort of young Swiss males. Associations of life satisfaction with initiation, cessation, and severity were assessed with logistic and zero-truncated negative binomial regressions. Age, family income, education, alcohol, and tobacco use at age 21 were used as adjustment variables. From a sample of 4778 males, 1477 (30.9%) reported cannabis use at age 21, 456 (9.5%) initiated use between age 21 and 25, and 515 (10.8%) ceased by age 25. Mean (SD) SWLS was significantly higher among non-users at age 21: 27.22 (5.35) vs. 26.28 (5.80), < 0.001. Negative associations between life satisfaction at age 21 and cannabis use initiation (OR = 0.98, = 0.029) and severity at age 25 (IRR = 0.97, < 0.001) were no more significant in adjusted analyses (OR = 0.98, = 0.059 and IRR = 0.99, = 0.090). Life satisfaction at age 21 was not associated with cannabis cessation (OR = 0.99, = 0.296). Results suggest that the predictive value of life satisfaction in cannabis use is questionable and may be accounted for by other behaviors, such as tobacco and alcohol use.
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http://dx.doi.org/10.3390/ijerph16081372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518131PMC
April 2019

Protective Behavioral Strategies Scale-20: Psychometric properties of a French and German version among young males in Switzerland.

Int J Methods Psychiatr Res 2019 09 7;28(3):e1777. Epub 2019 Mar 7.

Addiction Switzerland, Lausanne, Switzerland.

Objective: The Protective Behavioral Strategies Scale (PBSS-20) is one of the most commonly used measures of engagement in protective behavioral strategies (PBS). This research aimed to examine the psychometric properties of a French and German version of the PBSS-20 in a large sample of young males in Switzerland.

Method: The sample included 5,017 young males (mean age = 25.44) participating in the Cohort Study on Substance Use Risk Factors in Switzerland. Measures of PBS use, total drinks per week, and alcohol-related consequences were used from a second follow-up assessment.

Results: Confirmatory factor analysis testing different models previously documented in the literature provided initial support for a four-factor model. Fit statistics indicated that this model adequately reflects the structure of data. Further findings also provided support for adequate internal consistency and for convergent validity of this four-factor model, whereas metric-but not scalar-measurement invariance across linguistic regions was demonstrated.

Conclusion: Although further research testing measurement invariance across linguistic regions and gender is warranted, results of the current study suggest that the French and German PBSS-20 is reliable and that it may represent a promising research and clinical tool that can be used in both French- and German-speaking countries.
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http://dx.doi.org/10.1002/mpr.1777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6877153PMC
September 2019

Comparing Mental Health across Distinct Groups of Users of Psychedelics, MDMA, Psychostimulants, and Cannabis.

J Psychoactive Drugs 2019 Jul-Aug;51(3):236-246. Epub 2019 Mar 6.

e Addiction Medicine Center, Department of Psychiatry, Lausanne University Hospital , Lausanne , Switzerland.

Differences in mental health (MH) of users of distinct psychoactive substances have been shown. Both substance use (SU) and MH in users are influenced by stressful life events. This study compared MH parameters in distinct groups of substance users and evaluated the impact of stress factors on these outcomes. Data stem from the longitudinal Swiss Cohort Study on Substance Use Risk Factors (C-SURF) involving 4,475 young adult men. Distinct groups were created for the past 12 months' use of psychedelics, MDMA, psychostimulants, and cannabis. MH measurements (depressive symptoms, overall MH, perceived stress, life satisfaction) were used as outcome variables, while indicators of past family functioning and stressful life events served as covariates. The MH of psychedelics users was not significantly different from the no-drug-use group, whereas poorer MH was found in the other SU groups. Observed effects were influenced by the tested stress factors. The absence of association between use of psychedelics and worsening of MH deserves further investigation in male and female samples. Stressful life experiences must be considered when assessing the MH of users of illicit substances. These findings suggest that some men practice SU as self-medication to cope with life adversity.
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http://dx.doi.org/10.1080/02791072.2019.1571258DOI Listing
May 2020

[Management of emergency department frequent users].

Rev Med Suisse 2019 Feb;15(640):490-493

Département vulnérabilités et médecine sociale, Centre universitaire de médecine générale et santé publique, 1011 Lausanne.

For decades, emergency departments of hospitals in industrialized countries have been dealing with the challenges of a group of patients responsible for a disproportionate number of emergency room visits : the emergency department frequent users. Although they represent only a minority of all emergency department patients, their healthcare can often be complex if not difficult due to their health vulnerability (e. g., psychiatric disorders associated with substance addictions), often aggravated by a precarious psycho-social context (e. g., homelessness, illegal status, poverty, etc.). Taking care of these patients by using a case management approach can promote the development of an interprofessional and coordinated healthcare plan that includes their empowerment.
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February 2019

Implementing a case management intervention for frequent users of the emergency department (I-CaM): an effectiveness-implementation hybrid trial study protocol.

BMC Health Serv Res 2019 Jan 11;19(1):28. Epub 2019 Jan 11.

Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center, Lausanne University Hospital, Rue du Bugnon 44, 1011, Lausanne, Switzerland.

Background: ED overcrowding represents a significant public health problem in developed countries. Frequent users of the emergency departments (FUEDs; reporting 5 or more ED visits in the past year) are often affected by medical, psychological, social, and substance use problems and account for a disproportionately high number of ED visits. Past research indicates that case management (CM) interventions are a promising way to reduce ED overcrowding and improve FUEDs' quality of life. There is, however, very limited knowledge about how to disseminate and implement this intervention on a large scale to diverse clinical settings, including community hospitals and non-academic centers. This paper describes the protocol of a research project aiming to implement a CM intervention tailored to FUEDs in the public hospitals with ED in the French-speaking region of Switzerland and evaluate both the implementation process and effectiveness of the CM intervention.

Methods: This research project uses a hybrid study design assessing both implementation and clinical outcomes. The implementation part of the study uses mixed methods a) to describe quantitatively and qualitatively factors that influence the implementation process, and b) to examine implementation effectiveness. The clinical part of the study uses a within-subject design (pre-post intervention) to evaluate participants' trajectories on clinical variables (e.g., quality of life, ED use) after receiving the CM intervention. We designed the study based on two implementation science frameworks. The Generic Implementation Framework guided the overall research protocol design, whereas the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework guided the implementation and effectiveness evaluations.

Discussion: This research project will contribute to implementation science by providing key insights into the processes of implementing CM into broader practice. This research project is also likely to have both clinical and public health implications.

Trial Registration: NCT03641274 , Registered 20 August 2018.
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http://dx.doi.org/10.1186/s12913-018-3852-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330435PMC
January 2019