PubMed Health⌕ Search

Biomedical subjects

Geoffrey M Curran

Publications and source records attributed to Geoffrey M Curran.

12 recordsLinked to original sources
PubMed2006

Perceived need for alcohol, drug, and mental health treatment.

BACKGROUND: To investigate determinants of perceived need for alcohol, drug, and mental (ADM) health treatment and differences in ADM treatment patterns between individuals with perceived need and those without. METHODS: We used data from a nationally representative telephone survey of 9585 adults conducted in 1997-1998. Logistic regression was used to study the determinants of perceived need and the correlation between perceived need and any ADM treatment, specialty ADM treatment, appropriate care, and medication adherence. RESULTS: Just fewer than 37% of individuals with an ADM disorder perceived a need for treatment, while 4.6% of those without an ADM disorder perceived a need for treatment. Women, the young and middle aged, the better educated, those with greater emotional support, and those with greater psychiatric morbidity were more likely to perceive need for ADM services. Perceived need was strongly correlated with receiving ADM treatment, although almost 44% of individuals in ADM treatment did not perceive a need for treatment. Among individuals in ADM treatment, those with perceived need were significantly more likely to receive specialty ADM treatment, but not more likely to be treatment adherent, or to receive appropriate care. CONCLUSION: Substantial levels of unmet need are likely to persist as long as perceived levels of need remain low. Interventions targeting perceived need may hold promise for decreasing unmet need.

Alcoholism↗
PubMed2006

Variations in drinking patterns in the rural South: joint effects of race, gender, and rural residence.

OBJECTIVES: To understand the relative contribution of gender, race (African-American vs. Caucasian), and rural residence on variations in drinking patterns, including past year abstinence, at-risk drinking, and recent drinking quantity and frequency for drinkers only. METHODS: A brief health survey was administered by telephone to a probability sample of 11,529 residents of six southern states, over-sampling rural inhabitants. RESULTS: Drinking patterns varied by gender, race, and rural residence in bivariate analysis. Gender effects were independent of rural residence, but race effects on abstinence and at-risk drinking were found only in urban residents and race differences in drinking quantity only in rural residents. Multivariate analysis, controlling for age and education, found gender and rural residence to be the strongest predictors, as well as being an African-American female. CONCLUSIONS: Female gender, African-American race, and rural residence appear protective for at-risk drinking but rural residence dominates racial differences.

Alcohol Drinking↗
PubMed2006

Lessons learned about implementing research evidence into clinical practice. Experiences from VA QUERI.

The mission of the Veterans Health Administration's (VHA) quality enhancement research initiative (QUERI) is to enhance the quality of VHA health care by implementing clinical research findings into routine care. This paper presents lessons that QUERI investigators have learned through their initial attempts to pursue the QUERI mission. The lessons in this paper represent those that were common across multiple QUERI projects and were mutually agreed on as having substantial impact on the success of implementation. While the lessons are consistent with commonly recognized ingredients of successful implementation efforts, the examples highlight the fact that, even with a thorough knowledge of the literature and thoughtful planning, unexpected circumstances arise during implementation efforts that require flexibility and adaptability. The findings stress the importance of utilizing formative evaluation techniques to identify barriers to successful implementation and strategies to address these barriers.

Benchmarking↗
PubMed2006

Gender differences in correlates of recent physical assault among untreated rural and urban at-risk drinkers: role of depression.

This study examined gender-specific correlates of past 6-month physical assault victimization among 468 men and 229 women at-risk drinkers recruited from both urban and rural settings. Both alcohol dependence and depression were associated with physical assault, but there were differences for women and men in the pattern of significant correlates. Specifically, for women the presence of alcohol dependence, depression or their comorbidity all were associated with physical assault. For men, depression by itself was not associated with physical assault, but alcohol dependence and especially alcohol dependence comorbid with depression were significant predictors. Further, there were stronger relationships between demographics and physical assault for men. The results have implications regarding identification of risk factors for physical assault victimization among at-risk drinkers. Overall, the results of this study suggest that screening and prevention interventions for physical assault among at-risk drinkers should target both alcohol use disorders and depression.

Adult↗
PubMed2005

Implementing research findings into practice using clinical opinion leaders: barriers and lessons learned.

BACKGROUND: An opinion leader-driven intervention to improve practice guideline-based medication management for patients with schizophrenia was tested at four Department of Veterans Affairs health care facilities. The concept of using opinion leaders as disseminators of research evidence and internal agents of change has been widely reported. PROJECT OVERVIEW: Each intervention site received an intensive, multicomponent intervention during the course of one year. The project's process evaluation included ongoing brief surveys of physicians' attitudes and behaviors, logs of reports from opinion leader conference calls, and interviews with the opinion leaders toward the end of the implementation period. BARRIERS OR ISSUES AND POTENTIAL SOLUTIONS: Several barriers or problematic issues surfaced: (1) physicians do not always agree on who is an opinion leader; some sites may have no opinion leader; (2) some sites had poorly developed formal and informal social networks among physicians; (3) a focus on physicians only as agents of change; and (4) how much directive should be given to the opinion leaders concerning how to influence attitudes and behaviors? DISCUSSION: Four major problematic issues encountered during the project offer potential solutions for addressing them.

Evidence-Based Medicine↗
PubMed2004

Psychological distress and return to substance use two years following treatment.

This study examined client background characteristics, substance use severity, and psychological distress in relation to return to alcohol and drug use among men and women 2 years following substance user treatment. Participants (n = 180) completed a baseline interview within their first month of substance user treatment (conducted in 1995/1996) and follow-up interview 2 years following the baseline interview (conducted in 1997/1998). Structural equation modeling analyses were used to examine the relationship among client background characteristics and problem severity indicators, measured during treatment, in relation to alcohol and illicit drug use 2 years posttreatment. Psychological distress directly predicted alcohol and illicit drug use during follow-up and appeared to mediate the relationship between client background characteristics (such as gender, race, and marital status) and substance use consequences on posttreatment substance use. Income directly predicted alcohol use and age directly predicted illicit drug use, regardless of problem severity (including psychological distress and substance use consequences). Results support long-term clinical monitoring of psychological distress as a marker for return to drug or alcohol use.

Adolescent↗
PubMed2004

Predictors of short-term course of drinking in untreated rural and urban at-risk drinkers: effects of gender, illegal drug use and psychiatric comorbidity.

OBJECTIVE: The purpose of this study was to examine predictors of changes in drinking and drinking consequences in untreated at-risk drinkers in a community sample. METHOD: Four waves of telephone interviews were conducted at 6-month intervals with a probability sample of at-risk drinkers in the rural and urban South (initial N = 733). Participants were interviewed at each wave regarding concurrent drug use, psychopathology and social support, as well as alcohol service use. Individuals reporting receiving services for drinking (n = 69) were dropped from the analyses. Longitudinal data were analyzed for predictors of quantity and frequency of drinking, "safe" drinking levels and diagnoses of recent alcohol disorder. Simultaneous and lagged models were fit for each dependent variable. RESULTS: Over the period of study, drinking quantity and alcohol diagnoses decreased, and safe drinking increased. Only a few variables, including drug use and rural residence, predicted change over time for some outcomes. Remaining significant effects associated with drinking outcomes were constant throughout the study. Women and participants scoring high on religiosity experienced better outcomes; illegal drug use and social consequences of drinking were associated with worse outcomes. Rural residents maintained higher drinking quantity and were less likely to be safe drinkers than urban residents were. Psychiatric comorbidity was significantly associated only with drinking quantity. CONCLUSIONS: These data distinguish which at-risk drinkers might benefit from short or delayed interventions in primary care or community settings, and which should receive more intensive, targeted interventions and be encouraged to enter formal treatment as soon as possible.

Adult↗
PubMed2003

Emergency department use of persons with comorbid psychiatric and substance abuse disorders.

STUDY OBJECTIVE: This study assesses the relationship between substance abuse comorbidity and emergency department use among patients with psychiatric disorders in a large academic medical center. METHODS: Data were obtained from an administrative database including every patient visit to the ED of a large, academically affiliated county hospital from January 1994 through June 1998. This study focuses on 12,212 patients who were given a diagnosis of a primary psychiatric disorder in the ED. Diagnoses, assigned during ED visits, were made according to the Diagnostic and Statistical Manual of Mental Disorders III-R or IV. RESULTS: Primary psychiatric patients with substance use comorbidity had a significantly higher mean number of ED visits across the span of the study (mean 5.2; SD 7.4) than primary psychiatric patients without substance use comorbidity (mean 2.8; SD 3.9). In multiple logistic regression analyses predicting several categorizations of heavier use of the ED (either 4+, 8+, 12+, 16+, or 20+ visits over the span of the study), psychiatric patients with a comorbid substance use disorder had adjusted odds ratios of 2.8 to 4.9 (reference group was defined as patients with a psychiatric disorder but no substance use disorder; models controlled for age, race, and sex). CONCLUSION: Substance use comorbidity among patients presenting to an ED with a psychiatric disorder is associated with substantially increased ED service use. Improved detection, referral, and treatment of substance use disorders in this population could result in decreased ED use and improved patient outcomes.

Academic Medical Centers↗
PubMed2002

Depressive symptomatology and early attrition from intensive outpatient substance use treatment.

This study examines the relationship between depressive symptoms and attrition from outpatient treatment in a Veterans Affairs facility that had recently moved to intensive outpatient-only treatment for substance abuse. This article focuses on 126 consecutively admitted patients who were enrolled on their last day of a 3- to 4-day outpatient detoxification. Results indicate that severe depressive symptomatology presenting at treatment entry is a significant risk factor for early attrition from intensive outpatient substance use treatment but not later attrition. These data indicate that retention efforts should be directed toward the assessment and management of depressive symptoms early in the treatment process, with interventions targeted to those who report severe symptomatology. The results also indicate that future research should focus on potential distinguishing characteristics between early and later attrition.

Adult↗
PubMed2002

Depressive disorders and alcohol dependence in a community population.

This cross-sectional study examines sociodemographic, clinical and func tional correlates of comorbid depression in a community sample of 268 individuals with alcohol dependence. Results of analyses comparing drinkers with either current or past depression to never-depressed drinkers showed that respondents in the former two groups were more likely to be female and report more comorbid drug use disorders. In addition to marked functional impairment for currently depressed drinkers, we also found that respondents with past depression were significantly less likely to have health insurance coverage. This lack of insurance for previously depressed persons calls for future work examining the potential influence of this barrier to access care on both clinical and functional outcomes.

Alcoholism↗