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Brief alcohol screening in a clinical psychiatric population: Special attention needed
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: 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.

Place, publisher, year, edition, pages
2012. Vol. 31, no 4, 538-543 p.
Keyword [en]
alcohol screening method, psychiatric patient, hazardous alcohol use, assessment
National Category
Medical and Health Sciences
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-168843DOI: 10.1111/j.1465-3362.2011.00333.xISI: 000304817800024OAI: oai:DiVA.org:uu-168843DiVA: diva2:503628
Available from: 2012-02-16 Created: 2012-02-16 Last updated: 2017-12-07Bibliographically 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, ChristinaFredriksson, AndersJansson, Lennart

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