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The review by Havard and colleagues [1] does not take into account
the fact that brief advice, either oral or written, is good enough to
bring about behavioral change. To have such a group as the control group
is self-defeating. In fact, in an emergency department (ED) setting, where
both emotions and tension run high, it would be futile to try and attempt
other time-consuming interventions such as motivational interviewi...
The review by Havard and colleagues [1] does not take into account
the fact that brief advice, either oral or written, is good enough to
bring about behavioral change. To have such a group as the control group
is self-defeating. In fact, in an emergency department (ED) setting, where
both emotions and tension run high, it would be futile to try and attempt
other time-consuming interventions such as motivational interviewing and
pharmacological treatment. An ideal form of treatment is therefore the
Brief advice. As the commentary [2] observes, brief interventions are
sufficient to reduce the negative health consequences, such as alcohol
related injuries in this group. I believe that such patients may also be
amenable to further behavioral changes in order to prevent development of
alcohol dependence by proper identification of "at-risk" individuals. This
can be done by enquiring for craving, tolerance and loss of control [3]
which can prove beneficial to these problem and pre-dependent drinkers
[4].
References
1)Havard A, Shakeshaft A, Sanson-Fisher R. Systematic review and meta
-analyses of strategies targeting alcohol problems in emergency
departments: interventions reduce alcohol-related injuries. Addiction
2008;103:368–76.
2)Crawford MJ. Review: Screening and intervention for alcohol misuse
in emergency rooms reduces alcohol-related injuries. Evid. Based Ment.
Health 2008;11;88
3)Manjunatha N, Saddichha S, Sinha BNP et al. Chronology of alcohol
dependence: Implications in prevention.Ind J Com Med 2008; 33: 228-32.
The only method of improving the behaviour of ADHD children is to
make them teachable. To become teachable the medical treatment needs to be
titrated to an optimal dose, given every day without exception and
monitored with an effective rating scale on a monthly basis.
Peters discusses some limitations in relation to our systematic
review of the prevelance of substance abuse and dependence in prisoners.
Peters states that we have not disaggregated findings obtained from
sentenced and unsentenced prisoners. In fact, in Table 3, we do present
the findings of sentenced and remand prisoners separately by gender, and
by type of substance (alcohol and drug).
Peters discusses some limitations in relation to our systematic
review of the prevelance of substance abuse and dependence in prisoners.
Peters states that we have not disaggregated findings obtained from
sentenced and unsentenced prisoners. In fact, in Table 3, we do present
the findings of sentenced and remand prisoners separately by gender, and
by type of substance (alcohol and drug).
Peters also states that we have reported the findings from his study
inaccurately. This depends on how the data are extracted. The Peters study
involved diagnostic interviews with 400 inmates consecutively admitted to
a state prison. Peters states that the prevalence of "drug use" was 36.8%
and "alcohol use" was 34.5% - and this uses denominators of 307 and 380
prisoners, respectively. However, we extracted the data for "dependence
disorder" rather than "use" - again, this is in order to be consistent
with the other included studies (where studies provided both data on
prevalences for "dependence" and "abuse or dependence", we used the
former). Further, we decided to use 400 inmates as the denominator. This
is based on an assumption that those who did not complete the protocols
were not substance dependent, which we believe is reasonable. Even if it
is not, as we did not meta-analyse the data, this does not alter our main
findings, and the alternative estimates from the Peters study fall within
the range of prevalences already given in our review. The alternative
prevalences for drug dependence would be 28.0% rather than 25.0%, and for
alcohol 26.3% rather than 21.5%.
Finally, Peters states that with changes in the types of drugs used
in the community, it is unclear whether the range of prevelances for drug
dependence would still be applicable. By eyeballing the figures in our
review, there does not appear to be any time trend for the prevalence
estimates in the included studies (1988-1998 in the men; 1996-2001 in the
women), periods when it is also likely for there to have been changes in
the types of drugs used in the community.
The summary notes in EBMH rightly state that the inclusion criterion
for sample size was not clearly reported in our review of reception
studies. In fact, we chose not to have a sample size criterion and all
studies - of any size - were included that met the other criteria.
The review by Havard and colleagues [1] does not take into account the fact that brief advice, either oral or written, is good enough to bring about behavioral change. To have such a group as the control group is self-defeating. In fact, in an emergency department (ED) setting, where both emotions and tension run high, it would be futile to try and attempt other time-consuming interventions such as motivational interviewi...
Dear Editor
The only method of improving the behaviour of ADHD children is to make them teachable. To become teachable the medical treatment needs to be titrated to an optimal dose, given every day without exception and monitored with an effective rating scale on a monthly basis.
Dear Editor,
Peters discusses some limitations in relation to our systematic review of the prevelance of substance abuse and dependence in prisoners. Peters states that we have not disaggregated findings obtained from sentenced and unsentenced prisoners. In fact, in Table 3, we do present the findings of sentenced and remand prisoners separately by gender, and by type of substance (alcohol and drug).
Pet...
Dear Editor,
It would have been utterly helpful if you had included a citation for the APA-NAMI-NMHA-statement in your article - or the following hypertext- link: http://www.nmha.org/newsroom/system/news.vw.cfm?do=vw&rid=662.
Kind regards,
Th. Schumann