Objective To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in primary care. The hypothesis was that more intensive intervention would result in a greater reduction in hazardous or harmful drinking. Design Pragmatic cluster randomised controlled trial. Setting Primary care practices in the north east and south east of England and in London. Participants 3562 patients aged 18 or more routinely presenting in primary care, of whom 2991 (84.0%) were eligible to enter the trial: 900 (30.1%) screened positive for hazardous or harmful drinking and 756 (84.0%) received a brief intervention. The sample was predominantly male (62%) and white (92%), and 34% were current smokers. Interventions Practices were randomised to three interventions, each of which built on the previous one: a patient information leaflet control group, five minutes of structured brief advice, and 20 minutes of brief lifestyle counselling. Delivery of the patient leaflet and brief advice occurred directly after screening and brief lifestyle counselling in a subsequent consultation. Main outcome measures The primary outcome was patients’ self reported hazardous or harmful drinking status as measured by the alcohol use disorders identification test (AUDIT) at six months. A negative AUDIT result (score <8) indicated non-hazardous or non-harmful drinking. Secondary outcomes were a negative AUDIT result at 12 months, experience of alcohol related problems (alcohol problems questionnaire), health utility (EQ-5D), service utilisation, and patients’ motivation to change drinking behaviour (readiness to change) as measured by a modified readiness ruler. Results Patient follow-up rates were 83% at six months (n=644) and 79% at 12 months (n=617). At both time points an intention to treat analysis found no significant differences in AUDIT negative status between the three interventions. Compared with the patient information leaflet group, the odds ratio of having a negative AUDIT result for brief advice was 0.85 (95% confidence interval 0.52 to 1.39) and for brief lifestyle counselling was 0.78 (0.48 to 1.25). A per protocol analysis confirmed these findings. Conclusions All patients received simple feedback on their screening outcome. Beyond this input, however, evidence that brief advice or brief lifestyle counselling provided important additional benefit in reducing hazardous or harmful drinking compared with the patient information leaflet was lacking. Trial registration Current Controlled Trials ISRCTN06145674.

Original article can be found at: http://content.karger.com/ Copyright Karger.Background: Although pregabalin abuse potential is reportedly low, online data related to its recreational misuse potential have recently been identified. We aimed here at formally analysing pregabalin misuse web reports and comparing these with data pertaining to similar drugs, e.g. gabapentin and clonazepam, for which an abuse potential has already been identified. Methods: An 8-language analysis of the online information on pregabalin acquisition/misuse was carried out. An initial sample of 203 websites was considered and 108 relevant websites were monitored on a regular basis. To obtain material relating to gabapentin and clonazepam, an English-language search was carried out and 32 relevant websites were examined. Results: Misuse of pregabalin, which is commonly offered for sale online, was allegedly associated with sedative and/or psychedelic effects. This was associated with both higher dosages than clinically advised and idiosyncratic (i.e.: IV, rectal, intranasal) drug intake modalities. Although perceived as less powerful than pregabalin, gabapentin misuse was associated with similar sedative/psychedelic effects. Clonazepam allegedly induced either sedation or stimulation, depending on the dosage. Conclusions: Pregabalin experimenters might be profiled as individuals with a history of recreational polydrug misuse. Pregabalin misuse might be facilitated by easy online accessibility; potency; and peculiar, including anxiolytic, psychoactive effects. Physicians should carefully evaluate patients for history of drug abuse and observe them for signs of pregabalin/gabapentin/clonazepam misuse

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet