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  • 1.
    Domeij, Helena
    et al.
    Swedish Agcy Hlth Technol Assessment & Assessment, Stockholm, Sweden.
    Fahlstrom, Gunilla
    Swedish Agcy Hlth Technol Assessment & Assessment, Stockholm, Sweden.
    Bertilsson, Goran
    Swedish Agcy Hlth Technol Assessment & Assessment, Stockholm, Sweden.
    Hultcrantz, Monica
    Swedish Agcy Hlth Technol Assessment & Assessment, Stockholm, Sweden; Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden.
    Munthe-Kaas, Heather
    Norwegian Inst Publ Hlth, Ctr Hlth Serv, Oslo, Norway.
    Nehlin Gordh, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Helgesson, Gert
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden.
    Experiences of living with fetal alcohol spectrum disorders: a systematic review and synthesis of qualitative data2018In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 60, no 8, p. 741-+Article, review/survey (Refereed)
    Abstract [en]

    Aim: To identify and assess available evidence from qualitative studies exploring experiences of individuals living with fetal alcohol spectrum disorders (FASD) or those living with a child with FASD, as well as experiences of interventions aimed at supporting individuals with FASD and their families.

    Method: A systematic literature search was conducted in six electronic databases: PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Scopus. Included studies were analysed using manifest content analysis. Methodological limitations and confidence in the evidence were assessed using a modified version of the Critical Appraisal Skills Programme and the Grading of Recommendations, Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Qualitative Research approach respectively.

    Results: Findings from 18 studies show that individuals with FASD experience a variation of disabilities, ranging from somatic problems, high pain tolerance, destructive behaviour, hyperactivity, and aggressiveness, to social problems with friendship, school attendance, and maintenance of steady employment. Most studies reported parents’ experiences with FASD; parenting was viewed as a lifelong engagement and that the whole family is isolated and burdened because of FASD. People with FASD feel that their difficulties affect their daily life in a limiting way and make them feel different from others.

    Interpretation: From the perspective of primarily parents, individuals with FASD and their parents face many different difficulties, for which they need societal support.

  • 2.
    Hammarberg, Anders
    et al.
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Riddargatan 1, S-11435 Stockholm, Sweden.; Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Nehlin, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Drinking motives of adult patients seeking treatment for problematic alcohol use2017In: Journal of Addictive Diseases, ISSN 1055-0887, E-ISSN 1545-0848, Vol. 36, no 2, p. 127-135Article in journal (Refereed)
    Abstract [en]

    The Drinking Motives Questionnaire measures motives for alcohol consumption on four subscales. Coping with negative affect and enhancement of positive affect have been shown to be associated with high levels of alcohol consumption and alcohol-related problems. Few studies exist concerning drinking motives among treatment-seeking patients. The aims of the study were to investigate the factor structure of the shortened-form of the revised Drinking Motives Questionnaire, map main drinking motives, explore group differences in motives due to sex, age, level of drinking problems, and symptoms of depression/anxiety and to investigate whether different drinking motives predict alcohol-related problems in this group. There were 274 treatment-seeking patients recruited from four addiction treatment clinics in Sweden. The shortened-form of the revised Drinking Motives Questionnaire was administered in conjunction with a regular visit to the clinics together with measures of degree of alcohol-related problems, psychiatric symptoms, and demographic factors. Main drinking motives were identified. A confirmatory factor analysis was run to confirm the factor structure of the shortened-form of the revised Drinking Motives Questionnaire. A logistic regression using the Enter method was performed to investigate associations between predictors and Alcohol Use Disorder Identification Test scores. The results confirmed the four-factor structure reported in studies on non-treatment-seeking individuals. Coping was the most commonly expressed motive. Not previously found in a clinical sample, the results showed that coping motives, together with being male and having elevated anxiety scores, were associated to Alcohol Use Disorder Identification Test scores indicative of alcohol dependence. The shortened-form of the revised Drinking Motives Questionnaire is a brief and valid instrument that holds potential for clinical use in mapping drinking motives among treatment seekers.

  • 3.
    Hammarberg, Stina Ingesson
    et al.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Norra Stationsgatan 69, S-11364 Reg Stockholm, Sweden..
    Sundbye, Jennie
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Norra Stationsgatan 69, S-11364 Reg Stockholm, Sweden..
    Tingvall, Rebecca
    Uppsala Univ Hosp, Div Psychiat, Uppsala, Sweden..
    Hammarberg, Anders
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Norra Stationsgatan 69, S-11364 Reg Stockholm, Sweden..
    Nehlin, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Psychiatry.
    A qualitative interview study of patient experiences of receiving motivational enhancement therapy in a Swedish addiction specialist treatment setting2023In: Addiction science & clinical practice, ISSN 1940-0632, E-ISSN 1940-0640, Vol. 18, article id 44Article in journal (Refereed)
    Abstract [en]

    Background: Motivational enhancement therapy (MET) has shown to be efficacious as treatment of alcohol use disorder (AUD), in reducing alcohol consumption and related consequences. However, qualitative research on how patients perceive this treatment is lacking. The aim of this study was to explore how patients experience MET as a treatment for AUD.

    Methods: Fifteen patients (8/7 female/male) participated in semi-structured interviews after receiving MET at a specialized addiction outpatient clinic in Sweden. Data were analyzed by thematic analysis.

    Results: Five themes were identified: the therapist conveyed the MI-spirit, the therapist did not guide on how to reach the goal, participants were committed to change before starting treatment, participants were uncertain if treatment was enough to maintain change, and significant others were not wanted in sessions. Participants appreciated the supportive relationship with their therapist, but some experienced therapy as overly positive, with no room to talk about failure. Further, they experienced a low level of guidance in goal-setting. For some, this was empowering, while others requested more direction and advice. Participants perceived their motivational process to have started before treatment. MET was considered to be too brief. None of the participants brought a significant other to a session.

    Conclusions: Therapist behaviors in line with MI spirit were emphasized as key to the development of a positive therapeutic relationship. More specific advice on goal-setting may be effective for supporting change in some patients. Longer treatment is requested among patients to support the patient's self-efficacy for change. Significant others can support change without necessarily being present in sessions.

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  • 4.
    Helgesson, Gert
    et al.
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm Ctr Healthcare Eth CHE, Stockholm, Sweden..
    Bertilsson, Göran
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden..
    Domeij, Helena
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden..
    Fahlström, Gunilla
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden..
    Heintz, Emelie
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden.;Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Hjern, Anders
    Karolinska Inst, Dept Med, Clin Epidemiol, Stockholm, Sweden.;Ctr Hlth Equ Studies, Stockholm, Sweden..
    Nehlin, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Nordin, Viviann
    Karolinska Inst KIND, Ctr Neurodev Disorders, Stockholm, Sweden..
    Rangmar, Jenny
    Univ Gothenburg, Dept Psychol, Gothenburg, Sweden..
    Rydell, Ann-Margret
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Sundelin Wahlsten, Viveka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Hultcrantz, Monica
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden.;Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Ethical aspects of diagnosis and interventions for children with fetal alcohol Spectrum disorder (FASD) and their families2018In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 19, article id 1Article in journal (Refereed)
    Abstract [en]

    Background: Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD.

    Methods: Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of discussions with experts in the field, published literature, and medical ethicists.

    Results: Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the socia ! services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition. Conclusions: The value for the concerned individuals of obtaining a FASD-related description of their condition - for instance, in terms of wellbeing - is not established. Nor is it established that allocating resources based, on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs.

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  • 5.
    Jess, Kari
    et al.
    Department of Health and Welfare, Dalarna University, Falun, Sweden.
    Lyrberg, Ann
    Department of Social Work and Criminology; and Centre for Research and Development, Gavle University, Uppsala University/Region Gävleborg, Gävle, Sweden.
    Isaksson, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Child and Adolescent Psychiatry. Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden;Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
    Nehlin, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Psychiatry. Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden.
    Me & my family: a programme for children and parents in families with parental substance use problems – an outcome study2023In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, p. 1-12Article in journal (Refereed)
  • 6. Johannesson, Caroline
    et al.
    Nehlin Gordh, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Gordh, Torsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Hysing, Eva-Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Bothelius, Kristoffer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Pain.
    Patients' experiences of treatment-relevant processes in multimodal pain rehabilitation for severe complex regional pain syndrome - a qualitative study.2023In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, p. 1-8Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Complex regional pain syndrome (CRPS) is a longstanding condition with spontaneous and evoked pain, that usually occurs in an upper or lower extremity. Although it often resolves within the first year, it may for a minority progress to a chronic and occasionally severely disabling condition. The aim of this study was to explore patients' experiences and perceived effects of a specific treatment, designed for patients with severe and highly disabling CRPS, in order to identify possible treatment-relevant processes.

    METHODS: The method used was a qualitative design, using semi-structured interviews with open-ended questions to capture participants' experiences and perceptions. Ten interviews were analyzed using applied thematic analysis.

    RESULTS: Despite the fact that participants had a severe conditions, including nerve damage and a long duration of illness, they reported having been helped to increase flexible persistence, reduce fear and avoidance, and improve connections. This helped participants to significant improvements in daily life functioning.

    CONCLUSIONS: The participants described distinct possible treatment-relevant processes leading to a substantial improvement in everyday life. The results imply that there is hope for this group that has been severely disabled for many years. This may help guide future clinical treatment trials.

  • 7.
    Larsson, Kjerstin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Karolinska Inst, Sect Social Work, Dept Neurobiol Care Sci & Soc, S-10401 Stockholm, Sweden..
    Nehlin, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Screening accuracy of brief alcohol screening instruments in a general hospital setting2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 6, p. 599-603Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to examine the screening accuracy of four brief alcohol screening instruments in a general hospital setting.

    Methods: Ten outpatient clinics were recruited to ensure a representative mix of demographics (e.g. sex, age and diagnosis). The staff at the reception desk handed out pre-sorted envelopes with questionnaires and information letters to the visitors. The questionnaires consisted of the 10-item Alcohol Use Disorders Identification Test (AUDIT), the Weekly Consumption Question (WCQ), the Heavy Episodic Drinking (HED) question and two questions on sex and age. Sensitivity and specificity were calculated for the AUDIT-C, AUDIT-3, WCQ and HED using the full 10-item AUDIT for comparison, with cut-off points of 6 for women and 8 for men.

    Results: In all, 898 questionnaires were included (52% women). According to the full AUDIT, 12.0% of the women and 14.8% of the men were drinking above the hazardous level. Corresponding percentages for the brief screening instruments for women and men, respectively, were as follows: AUDIT-C: 17.2% and 27.4%; the AUDIT-3: 6% and 16.2%; the WCQ: 2% and 1.6%; and the HED screener: 12.9% and 21.2%.

    Conclusions: The AUDIT-C may be used as a brief screener in a general hospital setting. The WCQ, as a stand-alone screening tool, may underestimate hazardous drinking habits. Screening results from the AUDIT-3 and the HED should be interpreted with caution when applied to women because of the risk of underestimation.

  • 8.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Division of Psychiatry, Uppsala University Hospital, Uppsala, Sweden.
    Arinell, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Dyster-Aas, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Division of Psychiatry, Uppsala University Hospital, Uppsala, Sweden.
    Jess, Kari
    School of Education, Health & Social Studies, Dalarna University, Falun, Sweden.
    Alcohol Habits and Health Care Use in Patients with Psychiatric Disorders2017In: Journal of Dual Diagnosis, ISSN 1550-4263, E-ISSN 1550-4271, Vol. 13, no 4, p. 247-253Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: It is common for persons with psychiatric disorders to also have alcohol problems. Studies in the general population as well as in clinical samples have found hazardous or harmful alcohol habits to be particularly prevalent in the presence of psychiatric disorders. This study sought to explore the relationships between drinking habits and health care utilization (psychiatric as well as general medical) in persons seeking psychiatric treatment and to investigate the associations among age, sex, and type or number of diagnoses and health care use and costs. For the planning of targeted interventions, we also sought to identify subgroups with a high prevalence of hazardous drinking habits.

    METHODS: From a psychiatric clinic for affective disorders at a university hospital in Sweden, patients who had been screened for hazardous drinking (N = 609) were selected. Patients with primary psychosis or substance use disorder receive treatment at other clinics and did not participate. Medical records data were grouped and compared. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) was used for diagnoses and the Alcohol Use Disorders Identification Test for screening. Patients were grouped by drinking habits and sex, age, and diagnosis group, and their psychiatric as well as general medical health care use was compared.

    RESULTS: Abstainers used psychiatric care more than all other drinking groups (p < .001). Psychiatric health care costs were higher in abstainers and low-risk drinkers (1.64 to 1). No differences in general medical care could be identified between drinking groups. Specific subgroups with higher rates of hazardous drinking could not be identified (44% of all males and 34% of all females reported such habits). Inconclusive results from previous research are most likely due to different methods used to classify drinking problems.

    CONCLUSIONS: Abstainers and low-risk drinkers used psychiatric health care to a higher cost than the other drinking groups. Possible explanations are discussed from a clinical and scientific perspective. This study clarifies the need for uniform measures when classifying alcohol use in studies of relationships between alcohol use and health care use. There is also a need to separate former drinkers from abstainers in future studies.

  • 9.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Psychiatry.
    Bäckström, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Psychiatry.
    Wollert Brander, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Psychiatry.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Psychiatry.
    Patients' Perspectives on Coming Off Opioid Agonist Treatment: A Qualitative Study2022In: Substance Abuse: Research and Treatment, E-ISSN 1178-2218, Vol. 16, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Aims:

    Opioid agonist treatment (OAT) programs are life-saving, as they reduce opioid use, overdoses, and criminal activities. Disadvantages reported with long-term OAT include side effects of the medication, especially on cognitive ability and sexual function, which may discourage potential participants. Many of those who participate in OAT have a desire to come off treatment. The aims of this study were to explore patients’ thoughts about coming off OAT and to investigate their perceptions of what support they would need in order to realize a planned withdrawal from OAT.

    Methods:

    A qualitative interview study with semi-structured interviews, using applied thematic analysis. Persons with experiences of participating in OAT were invited from Swedish programs and a private Facebook community.

    Results:

    Fifteen persons, with a mean of 9.6 (±6.4) years of treatment experience, were included. The participants underlined the need for a patient-centered focus within the treatment. They wanted to be regarded as capable of deciding if, when, and how a planned ending was to take place. They also called for staff to be supportive in making such decisions. Participants recommended staff to be sensitive to the needs of the specific patient and to have strategies for coming off OAT that could be adjusted for the single person.

    Conclusions:

    OAT programs need to be continually updated and adapted to the persons who can benefit from them. Applying a person-centered, holistic perspective would enhance the quality of the treatment by emanating from individual goals. Regulatory guidelines need to take into account research on patient experiences and perspectives on coming off.

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  • 10.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Cervenka: Psychiatry.
    Carlsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Cervenka: Psychiatry.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Cervenka: Psychiatry.
    How Adolescents Think When Responding to Alcohol-Related Questionnaires: A Think-Aloud Study2022In: Youth & society, ISSN 0044-118X, E-ISSN 1552-8499, Vol. 54, no 1, p. 68-83Article in journal (Refereed)
    Abstract [en]

    Self-report questionnaires on alcohol use are commonly used in both research and in clinical work with adolescents, but little is known about how adolescent responders perceive and interpret them. This study explores how adolescents think while responding to two alcohol-related questionnaires. It also investigates whether the instruments can initiate self-reflective processes on alcohol use. Data were collected among adolescents visiting a center for young people with substance use problems in Sweden. The participants found the questionnaires easy to complete and widely relevant, and the questionnaires commonly initiated a process of self-reflection. Results support the use in clinical settings.

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  • 11.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Carlsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Patients' Experiences of Using a Cellular Photo Digital Breathalyzer for Treatment Purposes2018In: Journal of addiction medicine, ISSN 1932-0620, E-ISSN 1935-3227, Vol. 12, no 2, p. 107-112Article in journal (Refereed)
    Abstract [en]

    Objectives: The field of eHealth systems is rapidly developing and is now expanding into alcohol treatment settings. Despite a growing public and professional interest, cellular photo digital breathalyzers (CPDBs) have not been investigated in a clinical context so far. In this study, we aimed to investigate the experiences of patients in alcohol treatment who had been using a CPDB—TripleA- for a minimum of three months. What are their personal experiences of using the CPDB? Do the patients think it supports them to change their drinking habits, and if so, in what way?

    Methods: A qualitative interview study with individuals who had been using the CPDB TripleA, for at least 3 months as complement to treatment (12-step program or hospital-based outpatient care). A thematic analysis with an inductive approach was used to identify, analyze, and interpret patterns within data.

    Results: In all, 12 interviews were conducted with 8 men and 4 women. Participants were generally enthusiastic about the CPDB and found it convenient and useful, even though it created a need for privacy when using the device. Although technical problems were substantial, participants were tolerant to those. The system was perceived to support self-control and to restore relations, but did not replace the need for close contact with caregivers. Self-motivation to change drinking habits was essential, and could not be reached by solely using the CPDB.

    Conclusions: Participants perceived the CPDB as a convenient and useful tool that was supportive under the circumstances that it was used in a context that included personal contact with a caregiver; and the user felt more than just a minimum of motivation to reduce drinking. Technical stability needs to be achieved to secure long-term use.

  • 12.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Fredriksson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Grönbladh, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Jansson, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Three hours of training improve psychiatric staff’s self-perceived knowledge and attitudes toward problem-drinking patients2012In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 31, no 4, p. 544-549Article in journal (Refereed)
    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.

     

  • 13.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Fredriksson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Jansson, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Brief alcohol screening in a clinical psychiatric population: Special attention needed2012In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 31, no 4, p. 538-543Article in journal (Refereed)
    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.

  • 14.
    Nehlin, Christina Gordh
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Grönbladh, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Fredriksson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Jansson, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Alcohol and Drug Use, Smoking, and Gambling Among Psychiatric Outpatients: A 1-Year Prevalence Study2013In: Substance Abuse, ISSN 0889-7077, E-ISSN 1573-6733, Vol. 34, no 2, p. 162-168Article in journal (Refereed)
    Abstract [en]

    Background and Aims: Studies of alcohol habits in general psychiatric populations are scarce. The objective was to investigate alcohol and drug use, smoking, and gambling in a clinical sample of psychiatric outpatients. A further aim was to study age and gender differences in the rates of these habits. Methods: Data were collected among psychiatric outpatients with mainly mood (47%) and anxiety (35%) disorders. A questionnaire package was distributed, including AUDIT (Alcohol Use Disorders Identification Test), DUDIT (Drug Use Disorders Identification Test), tobacco items, and gambling items. Two major drinking categories were formed: Nonhazardous alcohol use (NH) and Alcohol use above hazardous levels (AH). Results: In total, 2160 patients (65% females) responded to the questionnaire package. The AH rate was high among psychiatric outpatients (28.4%), particularly among young females (46.6%). Young female patients also reported a high prevalence of problematic drug use (13.8%). Problematic drug use, daily smoking, and problematic gambling were frequent. The unhealthy habits were linked to AH. Conclusions: Alcohol and drug use, smoking, and gambling are all highly prevalent among psychiatric outpatients. Young females are in particular need of attention. Interventions should be tailored for co-occurring psychiatric disorders and applied within routine psychiatric care.

  • 15.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Univ Uppsala Hosp, Uppsala, Sweden..
    Nyberg, Fred
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Jess, Kari
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Brief Intervention Within Primary Care for At-Risk Gambling: A Pilot Study2016In: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 32, no 4, p. 1327-1335Article in journal (Refereed)
    Abstract [en]

    Studies on interventions for at-risk gambling are scarce. This pilot study is the first step in a larger project aimed to develop methods to prevent more serious gambling problems. Drawing on experiences from the alcohol field, the brief intervention (BI) model was tested in a primary care setting. Primary care personnel was trained for 2 days. Patients were screened, and those with signs of problematic gambling were offered a return visit to discuss their gambling habits. Of the 537 screened, 34 (6.3 %) screened positive for problem gambling. Of those, 24 were at-risk gamblers whereof 19 agreed to participate. Six of those 19 took part in a 1-month follow-up. Important information for the planning of upcoming studies was collected from the pilot work. Given that the rate of at-risk gamblers was elevated in this setting we consider primary care a suitable arena for intervention. Staff training and support appeared essential, and questionnaires should be selected that are clear and well-presented so staff feel secure and comfortable with them. The BI model was found to be most suitable for patients already known to the caregiver. The number of participants who were willing to take part in the follow-up was low. To ensure power in future studies, a much larger number of screened patients is evidently necessary.

  • 16.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala Univ Hosp, Div Psychiat, Uppsala, Sweden..
    Wennberg, Margareta
    Uppsala Univ Hosp, Div Psychiat, Uppsala, Sweden..
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala Univ Hosp, Div Psychiat, Uppsala, Sweden..
    How do people with mood and anxiety disorders perceive and interpret the Drinking Motives Questionnaire?: A think-aloud study in a clinical setting2018In: Addiction science & clinical practice, ISSN 1940-0632, E-ISSN 1940-0640, Vol. 13, article id 7Article in journal (Refereed)
    Abstract [en]

    Background: Research has identified drinking motives as the final common pathway to alcohol use, and associations between specific drinking motives and drinking patterns have consistently been demonstrated. Data on drinking motives can be used for research, in the planning of prevention strategies and for treatment purposes. The Drinking Motives Questionnaire-Revised (DMQ-R) has become the most used measure of drinking motives. So far, the questionnaire has not been investigated with qualitative methods. The aim of this study was to investigate acceptability, accuracy and usability of the DMQ-R among persons receiving outpatient psychiatric care by studying how responders perceive and interpret the questionnaire.

    Method: A cognitive interviewing technique, the think-aloud method, was used to collect data from 16 non-alcohol dependent patients seeking outpatient psychiatric care (12 women, 4 men). To analyse data, Qualitative Content Analysis was applied in which themes were formed from data only and not from predetermined areas of interest.

    Results: Overall, acceptability of the DMQ-R was high although answers were sometimes given with low accuracy. Responders pointed out that they perceived the questionnaire as non-confrontational and exhaustive. Further, the DMQ-R seemed to launch processes of self-reflection.

    Conclusions: Taken together, the results suggest a support for the use of DMQ-R also in the group of psychiatric outpatients. Still, when interpreting the DMQ-R, a certain insecurity of the exactness of answers should be considered. The graphic design should be particularly clear in this group of patients.

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  • 17.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala Univ Hosp, Div Psychiat, Uppsala, Sweden.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala Univ Hosp, Div Psychiat, Uppsala, Sweden.
    Wollert Brander, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala Univ Hosp, Div Psychiat, Uppsala, Sweden.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala Univ Hosp, Div Psychiat, Uppsala, Sweden.
    Overcoming Heroin Addiction without the Use of Pharmaceuticals: A Qualitative Interview Study2020In: Journal of Psychoactive Drugs, ISSN 0279-1072, E-ISSN 2159-9777, Vol. 52, no 3, p. 211-217Article in journal (Refereed)
    Abstract [en]

    Although opioid maintenance treatment lowers mortality and has proven efficacy in reducing opioid use, it is not an option for every person with an opioid addiction. Studies of the experiences of those who have overcome their addiction without pharmaceuticals are rare, but vital to understanding the quitting process and how it can be facilitated. This study investigated what persons with a previous heroin addiction perceived as helpful when overcoming their addiction without the use of pharmaceuticals, and what they consider important for health services to consider. Eleven adults with former heroin addiction participated. Most described the leaving process as prolonged and including many attempts. Experiences such as being worn out and numb, life-threatening overdoses, personal losses or a growing feeling of missing important stages in life fueled the decision process. Envisioning a future without drugs was described as an important component. To maintain the decision to refrain from heroin use the possibility to gain a new social context was crucial. Results imply that health care professionals should be proactive by seizing the moment of opportunity for change (e.g., after an overdose), and should be empathetic and never give up on a person. Those concerned with care, welfare and other support or control systems in society must cooperate to offer more personalized support.

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  • 18.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Psychiatry. Division of Psychiatry, Uppsala University Hospital, Uppsala, Sweden.
    Wollert Brander, Charlotte
    Division of Psychiatry, Uppsala University Hospital, Uppsala, Sweden.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Psychiatry. Division of Psychiatry, Uppsala University Hospital, Uppsala, Sweden.
    Caregivers' Attitudes Toward Treatment Length for Persons in Swedish Opioid Agonist Treatment: A Qualitative Interview Study2023In: Journal of Psychoactive Drugs, ISSN 0279-1072, E-ISSN 2159-9777Article in journal (Refereed)
    Abstract [en]

    Although opioid agonist treatment (OAT) has several beneficial effects, the issue of optimal treatment length remains unresolved. It is plausible that caregivers’ attitudes toward treatment length are of importance to whether, how and when tapering off will take place. In this study, we investigated caregivers’ attitudes toward treatment length by interviewing 15 caregivers from a variety of professions working in seven OAT treatment programs in Sweden. Data were analyzed using applied thematic analysis. The participants were generally hesitant concerning the idea of tapering off. Few of them had experiences of patients tapering off successfully. Many of them never brought up the subject unless the patient did so her-/himself. Only younger, socially stable patients were perceived to be suitable for tapering off. Participants also expressed a need among staff for education and ethical discussions on treatment length. A person-centered focus may be promoted by recurrently discussing treatment goals and by co-operating with patients to map the recovery capital of those interested in tapering. To further support caregivers in developing person-centered care, more knowledge of opioid use disorder and professional and interprofessional discussions of caregivers’ own attitudes and beliefs are paramount.

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  • 19.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala Univ Hosp, UAS Entr 10, SE-75185 Uppsala, Sweden.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala Univ Hosp, UAS Entr 10, SE-75185 Uppsala, Sweden.
    Measuring drinking motives in undergraduates: an exploration of the Drinking Motives Questionnaire-Revised in Swedish students2019In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 14, no 1, article id 49Article in journal (Refereed)
    Abstract [en]

    Background Alcohol consumption is generally high among undergraduate students and may lead to adverse consequences. Drinking motives play a vital role in the development of alcohol-related problems. The Drinking Motives Questionnaire-Revised (DMQ-R) and the short form of DMQ-R, DMQ-R SF, are widely used tools to identify drinking motives. Still, there is a need for further exploration of the instruments in different cultures and settings. The aims of this study were 1) to explore the four-factor structure of the DMQ-R and DMQ-R SF in Swedish undergraduate students 2) to investigate if extracting the SF responses from the DMQ-R is equivalent to the factor structure of the DMQ-R SF 3) to study the association between drinking motives and hazardous drinking. Methods Data were collected among 536 Swedish undergraduate students and were analyzed by confirmatory factor analyses, Mann-Whitney, chi-square tests and logistic regressions. Results We could confirm the four-dimensional structure of both versions of the DMQ. There was a similar (or in fact even slightly better) model fit of the short form and when drawing the SF items. Emotionally oriented motives (enhancement and coping), together with social motives, were strongly associated with hazardous or harmful drinking levels, whereas conformity motives were not. The enhancement motive showed the highest group mean value and was also the most common main motive. Students with hazardous drinking endorsed their motives more strongly than those without hazardous drinking, which is a finding worthy of further investigation. Conclusions The DMQ-R SF is suitable and preferable for Swedish student populations and extracting the SF responses from the DMQ-R is equivalent to the factor structure of the DMQ-R SF. In future research, effects of including the DMQ-R SF in preventive strategies and in interventions with risk drinking students would be of particular interest.

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  • 20.
    Nehlin Gordh, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Alcohol Use and Secondary Prevention in Psychiatric Care2012Doctoral 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.  

    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, p. 538-543Article 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.

    Keywords
    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, p. 544-549Article 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.

     

    Keywords
    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.

    Keywords
    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, p. 315-324Article 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.

    Keywords
    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: 2020-10-02Bibliographically approved
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  • 21.
    Nehlin Gordh, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Fredriksson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Young female psychiatric patients' reasons for excessive alcohol use: a qualitative interview study2013In: Mental Health and Substance Use, ISSN 1752-3281, E-ISSN 1752-3273, Vol. 6, no 4, p. 315-324Article in journal (Refereed)
    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.

  • 22.
    Nehlin Gordh, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Grönbladh, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Fredriksson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Jansson, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Brief alcohol intervention in a psychiatric outpatient setting: A randomized controlled study2012In: Addiction Science & Clinical Practice, ISSN 1940-0640, Vol. 7, no 23Article in journal (Refereed)
    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.

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  • 23.
    Nehlin Gordh, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Nyberg, Fred
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    The patient´s perspective on the link between ADHD and substance use: A qualitative interview study2015In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 19, no 4, p. 343-350Article in journal (Refereed)
    Abstract [en]

    Object

    The primary aim of this study was to investigate how adult individuals with ADHD perceive the role of alcohol and drugs in their lives. A secondary aim was to identify factors that those individuals consider useful in the treatment and prevention of co-occurring ADHD and substance use disorders.

    Method

    A qualitative interview study with ADHD outpatients (n=14) at a psychiatric clinic. Data were analyzed based on pre-defined areas of interest using a deductive content analysis method.

    Results

    The yearning for belongingness was identified as an important driving force underlying substance use. The participants felt that alcohol/drugs helped them being normal and thus respected and accepted. Early diagnosis of ADHD was perceived essential to avoid SUD.

    Conclusion

    Adults with ADHD may have strong rational and emotional reasons for the use of alcohol and drugs. When planning for the treatment of adult ADHD, investigation of personal reasons for alcohol/drug use deserves a place.

  • 24.
    Öster, Caisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala Univ Hosp, Uppsala, Sweden.
    Arinell, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Nehlin, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala Univ Hosp, Uppsala, Sweden.
    The Drinking Motives Questionnaire among Swedish psychiatric patients: An exploration of the four-factor structure2017In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 36, no 3, p. 400-407Article in journal (Refereed)
    Abstract [en]

    Introduction and Aims: Alcohol use above hazardous limits is common among persons with psychiatric disorders, and there is limited knowledge about motives for drinking. The objective of this study was to explore the adequacy of the four-factor structure of drinking motives in an adult psychiatric outpatient population in Sweden by confirming the factor structure in the Drinking Motives Questionnaire (DMQ-R) and in alternative models.

    Design and Methods: In total, 371 patients responded to the DMQ-R along with the Alcohol Use Disorders Identification Test (AUDIT). AUDIT was used to assess frequency of alcohol consumption, number of drinks consumed on a typical occasion and binge drinking frequency. Confirmatory factor analysis was used to examine the construct validity of the DMQ-R and alternative models, including the short form, DMQ-R SF.

    Results: Fit statistics suggested that the original four-factor model had questionable fit (root mean square error of approximation [RMSEA]=0.10, comparative fit index [CFI]=0.89, standardised root mean square residual [SRMR]=0.08). The model with the best fit indices was the DMQ-R SF (RMSEA=0.07, CFI=0.97, SRMR=0.04). When using DMQ-R SF in further analyses enhancement, the most strongly endorsed motives were related to quantity and AUDIT sum score. Coping motives were most strongly related to AUDIT sum score, frequency and binge drinking. Social motives were only related to binge drinking, whereas conformity motives were not statistically associated with any motives.

    Discussion and Conclusions: The study implies that the 12-item short form, DMQ-R SF, could be more appropriate than the original DMQ-R in this group.

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