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Brief alcohol intervention in a psychiatric outpatient setting: A randomized controlled study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
2012 (English)In: Addiction Science & Clinical Practice, ISSN 1940-0640, Vol. 7, no 23Article in journal (Refereed) Published
Abstract [en]

Background:Although brief alcohol intervention (BI) is widely studied, studies from psychiatric outpatient settings are rare. The aim of this study was to investigate the effects of two variants of BI in psychiatric outpatients. By using clinical psychiatric staff to perform the interventions, we sought to collect information of the usefulness of BI in the clinical setting.

Methods: Psychiatric outpatients with Alcohol Use Disorders Identification Test (AUDIT) scores indicating hazardous or harmful drinking were invited to participate in the study. The outpatients were randomized to minimal (assessment, feedback, and an informational leaflet) or BI (personalized advice added). Measurements were performed at baseline and at six and 12 months after the intervention. The primary outcome was change in AUDIT score at the 12-month follow-up.

Results: In all, 150 patients were enrolled and received either a minimal intervention (n = 68) or BI (n = 82). At 12 months, there was a small reduction in AUDIT score in both groups, with no significant differences in outcome between groups. At 12-month follow-up, 21% of participants had improved from a hazardous AUDIT score level to a nonhazardous level, and 8% had improved from a harmful level to a hazardous level (8%).

Conclusions: Brief alcohol interventions may result in a reduction of AUDIT score to a small extent in psychiatric patients with hazardous or harmful alcohol use. Results suggest that BI may be of some value in the psychiatric outpatient setting. Still, more profound forms of alcohol interventions with risky-drinking psychiatric patients need elaboration.

Place, publisher, year, edition, pages
2012. Vol. 7, no 23
Keyword [en]
Brief intervention, alcohol intervention, hazardous alcohol use, harmful alcohol use, psychiatric outpatients
National Category
Medical and Health Sciences
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-179328DOI: 10.1186/1940-0640-7-23OAI: oai:DiVA.org:uu-179328DiVA: diva2:544203
Available from: 2012-08-13 Created: 2012-08-13 Last updated: 2013-03-14Bibliographically approved
In thesis
1. Alcohol Use and Secondary Prevention in Psychiatric Care
Open this publication in new window or tab >>Alcohol Use and Secondary Prevention in Psychiatric Care
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Although alcohol plays an important role in psychiatric morbidity, there is a general lack of strategies within psychiatric care to intervene at alcohol problems in an early stage (secondary prevention). The aim of this thesis was to increase knowledge of adequate forms of secondary alcohol prevention in psychiatric care.  

The capacity of three brief screening instruments was investigated in a psychiatric outpatient sample (n=1811). The results indicate that the HED (heavy episodic drinking) screener, strongly recommended for health care settings, is not sufficiently sensitive in a psychiatric setting. Instead, the full AUDIT (Alcohol Use Disorders Identification Test) is recommended.

The knowledge and attitudes of psychiatric staff members to problem-drinking patients were studied and the effects of a three-hour training course were investigated. Confidence in self-perceived capacity to intervene in more severe alcohol problems was raised among all staff after training. Awareness of early signs of problem drinking was raised among psychologists and social workers. The therapeutic attitude of the psychiatric staff was higher when compared with primary care staff.

Two forms of brief intervention were delivered by clinical psychiatric staff. At 12 months, 29% of all participants had improved their drinking habits, moving from hazardous to non-hazardous level (21%) or from harmful to hazardous level (8%). In the improved group, mean AUDIT score was reduced from 11.0 points at baseline to 5.5 points. Differences in outcome between the two interventions could not be identified.

Nine high-risk drinking young female psychiatric patients were interviewed, focusing on reasons for excessive drinking and factors facilitating a change in drinking habits. Alcohol played an important role in the lives of the young women. It made them feel social and helped them deal with unbearable emotions. It was also used as a means of self-harm, representing the first stage in an escalating self-harm process. They expressed a need for help from their caregivers in addressing the underlying reasons for drinking.

Secondary alcohol prevention strategies including appropriate screening methods, staff training and the elaboration of tailored interventions are urgently needed in psychiatric care. The findings of this thesis can be used when forming such strategies.  

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 47 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 803
Keyword
hazardous alcohol use, risk drinking, brief intervention, screening methods, staff training
National Category
Medical and Health Sciences
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-179175 (URN)978-91-554-8451-4 (ISBN)
Public defence
2012-10-19, Gustavianum, auditorium Minus, Akademigatan 3, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-09-21 Created: 2012-08-08 Last updated: 2013-01-22Bibliographically approved

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Nehlin Gordh, ChristinaGrönbladh, LeifFredriksson, AndersJansson, Lennart
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