BACKGROUND: Non-suicidal self-injury (NSSI) presents an increasingly prevalent problem for young people; however, there remains a scarce evidence base for effective, scalable treatments for adolescents. This study aimed to assess the feasibility and acceptability of a brief, cognitive analytic therapy (CAT)-informed intervention for young people who engage in NSSI (CATCH-Y).
METHODS: A case series design recruited 13 young people who met the inclusion and exclusion criteria to participate in the five-session intervention. Eligible participants were aged 13-17 years (M = 15.15, SD = 1.28) and had engaged in NSSI at least once in the previous 6 months. Feasibility and acceptability were measured via recruitment, retention, qualitative feedback and missing data. The secondary outcome measures of personal recovery and motivation were administered pre- and post-assessment, with measures of depressive symptoms and urges to self-injure.
RESULTS: The intervention was found to be largely feasible and acceptable with high rates of recruitment, retention and pre-/post-assessment data completeness. Measures showed preliminary support for positive change in rates of NSSI, urges to self-harm, low mood and personal recovery, although results were mixed. Completion rates for remote assessments were low.
CONCLUSIONS: The findings of this study support further evaluation of the CATCH-Y intervention on a larger scale. In-person assessments may be preferable to remote to ensure good completion rates.

BACKGROUND: Z-hypnotics or z-drugs are commonly prescribed for insomnia and sleep difficulties in older adults. These drugs are associated with adverse events and dependence and are not recommended for long-term use. Despite evidence of older adults being more sensitive to a wide array of adverse events and clinical guidelines advocating limiting use, inappropriate use in this population is still prevalent. Previous intervention studies have focused mainly on prescriber information. Simple, individually focused intervention designs are less studied. Brief intervention (BI) is a simple, easily transferable method mainly used to treat patients at risk of alcohol overuse.
OBJECTIVE: Our objective was to design and test the feasibility and acceptability of a BI intervention adapted to address individual, inappropriate use of z-hypnotics among older adults. This preparatory study aimed to optimize the intervention in advance of a quantitative randomized controlled trial investigating the treatment effect in a larger population.
METHODS: This feasibility case series was conducted at Akershus University Hospital, Norway, in autumn 2021. We included 5 adults aged ≥65 years with long-term (≥4 weeks) use of z-hypnotics and 2 intervening physicians. Additionally, 2 study investigators contributed with process evaluation notes. The BI consists of information on the risk of inappropriate use and individualized advice on how to reduce use. The focus of the intervention is behavioral and aims, in cooperation with the patient and based on shared decision-making, to change patient behavior regarding sleep medication rather than physician-based detoxification and termination of z-hypnotic prescriptions. Qualitative and descriptive quantitative data were collected from intervening physicians, study investigators, and participants at baseline, immediately after the intervention, and at the 6-week follow-up.
RESULTS: Data were obtained from 2 physicians, 2 study investigators, and 5 participants (4 women) with a median age of 84 years. The average time spent on the BI consultation was 15 minutes. All 5 participants completed the intervention without problems. The participants and 2 intervening physicians reported the intervention as acceptable and were satisfied with the delivery of the intervention. After the intervention, 2 participants stopped their use of z-hypnotics completely and participated in the follow-up interview. Study investigators identified logistical challenges regarding location and time requirements. Identified aspects that may improve the intervention and reduce dropouts included revising the intervention content, focusing on rebound insomnia, adding an information leaflet, and supporting the patient in the period between the intervention and follow-up. The notion that the intervention should best be located and conducted by the patient\'s own general practitioner was supported by the participants.
CONCLUSIONS: We identified important aspects to improve the designed intervention and found that the BI is feasible and acceptable for incorporation into a larger randomized trial investigating the treatment effect of BI for reducing z-hypnotic use by older adults.
BACKGROUND: ClinicalTrials.gov NCT03162081; http://tinyurl.com/rmzx6brn.

OBJECTIVE: Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been endorsed by the United States Preventive Services Task Force as an evidence-based strategy to address risky alcohol use among adults in primary care. Nevertheless, very few healthcare professionals report using SBIRT in their practice. The purpose of this study was to explore attitudes regarding addressing substance use; perceptions of effectiveness, role responsibility, and self-efficacy; and current SBIRT practice among primary care physicians, nurse practitioners, and physician assistants to identify factors which may impact routine delivery of SBIRT in primary care.
METHODS: A cross-sectional design was used to meet study objectives. Responses of physicians and non-physician providers (nurse practitioners and physician assistants) were compared.
METHODS: Primary care members of three New York State physician, nurse practitioner, and physician assistant professional organizations were surveyed between October 2013 and November 2013.
RESULTS: Barely half of participants (57%) reported screening their patients for substance use, and less than half provided brief intervention (46%) or referral to treatment (47%). Using a standardized tool to screen patients for risky substance use and assessing readiness to change were practised least frequently. Compared to physicians, nurse practitioners and physician assistants felt less responsible for addressing substance use (P = 0.019), felt less comfortable discussing substance use (P = 0.004), had more negative attitudes toward addressing substance use (P = 0.015), and were less likely to conduct brief intervention (52% vs 32%; P < 0.0005) and referral to treatment (50% vs 70%; P = 0.001).
CONCLUSIONS: This study identifies important attitudinal and perceptual differences between physicians and non-physician providers which may be targeted by education and training and underscores an opportunity for using non-physician providers to conduct SBIRT.

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