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Alcohol Use and Secondary Prevention in Psychiatric Care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
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 [en]
hazardous alcohol use, risk drinking, brief intervention, screening methods, staff training
National Category
Medical and Health Sciences
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-179175ISBN: 978-91-554-8451-4 (print)OAI: oai:DiVA.org:uu-179175DiVA: diva2:546736
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
List of papers
1. Brief alcohol screening in a clinical psychiatric population: Special attention needed
Open this publication in new window or tab >>Brief alcohol screening in a clinical psychiatric population: Special attention needed
2012 (English)In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 31, no 4, 538-543 p.Article in journal (Refereed) Published
Abstract [en]

Introduction and aims: Abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) and single-item screeners show promising results but have not previously been investigated in a clinical psychiatric setting. The aim of the present study was to investigate the capacity of three brief screening methods to detect hazardous drinking in a psychiatric treatment-seeking population.

Design and methods: Data was collected from consecutive patients (n = 1811) visiting a general psychiatric clinic. The screening capacity of the Heavy Episodic Drinking (HED) screener, AUDIT item # 3 (AUDIT-3) and the three consumption items of AUDIT (AUDIT-C) was compared to the result of the full 10-item AUDIT with cut-off points 6 for females and 8 for males.

Results: The HED screener and AUDIT-3 with recommended cut-offs captured low rates of hazardous drinkers when compared to the full AUDIT. Lowering the cut-offs created rates far above those of the full AUDIT. AUDIT-C with recommended cut-off limits categorised nearly the same rates of males as the full AUDIT but much higher rates of females. Raising the cut-off for females approached the detection rate of AUDIT-C closely to that of the full AUDIT.

Discussion and conclusions:The findings of this study suggest that the HED screener is not sensitive enough in the clinical psychiatric setting. When designing alcohol screening measures to be used all over health care organisations, special attention should be paid to psychiatric patients. If a somewhat more extensive screening tool is used, the full AUDIT is recommended.

Keyword
alcohol screening method, psychiatric patient, hazardous alcohol use, assessment
National Category
Medical and Health Sciences
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-168843 (URN)10.1111/j.1465-3362.2011.00333.x (DOI)000304817800024 ()
Available from: 2012-02-16 Created: 2012-02-16 Last updated: 2017-12-07Bibliographically approved
2. Three hours of training improve psychiatric staff’s self-perceived knowledge and attitudes toward problem-drinking patients
Open this publication in new window or tab >>Three hours of training improve psychiatric staff’s self-perceived knowledge and attitudes toward problem-drinking patients
2012 (English)In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 31, no 4, 544-549 p.Article in journal (Refereed) Published
Abstract [en]

Introduction and aims

Staff attitudes are an important factor in the successful implementation of systematic alcohol strategies and policies.  The forms and extent of training needed to improve therapeutic attitude among psychiatric staff to problem drinking are unclear. The aim of the investigation was to study the knowledge and attitudes of psychiatric staff toward problem drinking patients. A further aim was to investigate whether a short three-hour training is sufficient to improve knowledge and therapeutic attitude toward problem drinking.

Design and methods

A tailored training model for psychiatric staff (non-physicians) was carried out at a medium size university clinic. Participants were medical (nurses and psychiatric aides) and non-medical staff (psychologists and social workers). The training consisted of a two-hour workshop and a one-hour follow-up session. Knowledge and attitudes were measured at baseline and follow-up by a questionnaire including vignettes assessment and the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ).

Results

In total, 115 persons completed the questionnaire (follow-up rate 83.5 %). The distribution was even (50 % for the medical and 50 % for the non-medical staff). After training, the non-medical staff estimated vignette case severity higher than before. Both staff groups estimated their capacity to help a patient with complex problems higher after training. Role adequacy was higher in both subgroups after training.  Medical staff scored Work satisfaction higher after the training. 

Discussion and conclusions

Three hours of tailored training for psychiatric staff improve their knowledge and therapeutic attitude to problem drinking patients.

 

Keyword
training effect, staff attitude, psychiatric staff, alcohol training
National Category
Medical and Health Sciences
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-168846 (URN)10.1111/j.1465-3362.2011.00373.x (DOI)000304817800025 ()
Available from: 2012-02-16 Created: 2012-02-16 Last updated: 2017-12-07Bibliographically approved
3. Brief alcohol intervention in a psychiatric outpatient setting: A randomized controlled study
Open this publication in new window or tab >>Brief alcohol intervention in a psychiatric outpatient setting: A randomized controlled study
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.

Keyword
Brief intervention, alcohol intervention, hazardous alcohol use, harmful alcohol use, psychiatric outpatients
National Category
Medical and Health Sciences
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-179328 (URN)10.1186/1940-0640-7-23 (DOI)
Available from: 2012-08-13 Created: 2012-08-13 Last updated: 2013-03-14Bibliographically approved
4. Young female psychiatric patients' reasons for excessive alcohol use: a qualitative interview study
Open this publication in new window or tab >>Young female psychiatric patients' reasons for excessive alcohol use: a qualitative interview study
2013 (English)In: Mental Health and Substance Use, ISSN 1752-3281, E-ISSN 1752-3273, Vol. 6, no 4, 315-324 p.Article in journal (Refereed) Published
Abstract [en]

There is a strong and multidirectional link between excessive alcohol use and psychiatric disorders. A large proportion (46.6%) of young female psychiatric outpatients report drinking above hazardous levels. This study explores high risk-drinking young female psychiatric patients' view of the role of alcohol in their lives. A further aim was to identify factors that may facilitate changes in drinking habits. Semi-structured interviews with open-ended questions were performed. The main areas of interest were: positive/negative aspects of alcohol use, risk situations for excessive drinking and factors facilitating change in drinking habits. Data were analysed using qualitative content analysis, a process that includes identifying, coding and categorizing components of the interviews. Nine female high risk-drinking psychiatric patients (mean age 22.2 ± 3.5 years) were interviewed. The reasons for excessive alcohol use were either external, in which case the young females wanted to live up to social expectations, or internal, in which case alcohol was used as an escape from negative feelings or for the purpose of self-harm. The participants requested help from psychiatric care-givers to focus on reasons for drinking and help with addressing underlying needs more functionally. To help avoid the development of complicated comorbidity, psychiatric providers must be aware of the role of alcohol in the patient's life. The categories identified in this study can be used by psychiatric health-care professionals in an interview scheme or checklist when meeting young female patients with excessive drinking.

Keyword
Young females, risk drinking, hazardous alcohol use, harmful alcohol use, psychiatric patients, qualitative
National Category
Medical and Health Sciences
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-179332 (URN)10.1080/17523281.2012.755559 (DOI)
Available from: 2012-08-13 Created: 2012-08-13 Last updated: 2017-12-07Bibliographically approved

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