Brief alcohol intervention in a psychiatric outpatient setting: a randomized controlled study

Addiction Science & Clinical Practice

Christina Nehlin¹  Leif Grönbladh¹  Anders Fredriksson²  Lennart Jansson² 

[1] Uppsala University Hospital, Uppsala, Sweden

[2] Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden

关键词: Psychiatric outpatients;    Harmful use;    Hazardous use;    Alcohol intervention;    Brief intervention;   

Others  :  789340
DOI  :  10.1186/1940-0640-7-23

 received in 2012-02-28, accepted in 2012-10-19,  发布年份 2012

【 摘 要 】

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.

【 授权许可】

   
2012 Nehlin et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Burnand B: Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2007, 2:CD004148.
• [2]Wilson GB, Heather N, Kaner EF: New developments in brief interventions to treat problem drinking in nonspecialty health care settings. Curr Psychiatry Rep 2011, 13(5):422-429.
• [3]World Health Organization: Screening and brief interventions for hazardous and harmful alcohol use: recommendations. http://www.who.int/mental_health/mhgap/evidence/alcohol/q1/en/index.html webcite
• [4]World Health Organization: WHO Expert Committee on problems related to alcohol consumption. Second report. 2007. http://www.who.int/substance_abuse/expert_committee_alcohol_trs944.pdf webcite
• [5]Berglund M, Thelander S, Salaspuro M, Franck J, Andreasson S, Öjehagen A: Treatment of alcohol abuse: an evidence-based review. Alcohol Clin Exp Res 2003, 27(10):1645-1656.
• [6]Forsberg L, Ekman S, Halldin J, Ronnberg S: Brief interventions for risk consumption of alcohol at an emergency surgical ward. Addict Behav 2000, 25(3):471-475.
• [7]Moyer A, Finney JW, Swearingen CE, Vergun P: Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction 2002, 97(3):279-292.
• [8]Miller WR, Rollnick S: Motivational interviewing. Preparing people for change. Guilford Publications, New York, USA; 2002.
• [9]Coulton S: Alcohol misuse. Clin Evid 2011. http://kar.kent.ac.uk/29695/ webcite
• [10]McQueen J, Howe TE, Allan L, Mains D, Hardy V: Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev 2011, 8:CD005191.
• [11]D'Onofrio G, Degutis LC: Screening and brief intervention in the emergency department. Alcohol Res Health 2004, 28(2):63-72.
• [12]Kessler RC: The epidemiology of dual diagnosis. Biol Psychiatry 2004, 56(10):730-737.
• [13]Eberhard S, Nordstrom G, Hoglund P, Ojehagen A: Secondary prevention of hazardous alcohol consumption in psychiatric out-patients: a randomised controlled study. Soc Psychiatry Psychiatr Epidemiol 2009, 44(12):1013-1021.
• [14]Hulse GK, Tait RJ: Five-year outcomes of a brief alcohol intervention for adult in-patients with psychiatric disorders. Addiction 2003, 98(8):1061-1068.
• [15]Kaner EF, Brown N, Jackson K: A systemativ review of the impact of brief interventions on substance use and co-morbid physical and mental health conditions. Mental Health and Substance Use 2011, 4(1):38-61.
• [16]Hulse GK, Tait RJ: Six-month outcomes associated with a brief alcohol intervention for adult in-patients with psychiatric disorders. Drug Alcohol Rev 2002, 21(2):105-112.
• [17]Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M: Development of the alcohol Use disorders identification test (AUDIT): WHO Collaborative project on early detection of persons with harmful alcohol consumption–II. Addiction 1993, 88(6):791-804.
• [18]Nehlin C, Fredriksson A, Gronbladh L, Jansson L: Three hours of training improve psychiatric staff's self-perceived knowledge and attitudes toward problem-drinking patients. Drug Alcohol Rev 2012, 31(4):544-549.
• [19]Wennberg P, Källmén H, Hermansson U, Bergman H: AUDIT manual. 5th edition. Karolinska Institute, Stockholm; 2006.
• [20]World Health Organization: The alcohol Use disorders identification test. Guidelines for use in primary care. http://whqlibdoc.who.int/hq/2001/who_msd_msb_01.6a.pdf webcite
• [21]Darker C, Sweeney B, El Hassan H, Smyth B, Ivers J, Barry J: Brief interventions are effective in reducing alcohol consumption in opiate-dependent methadone-maintained patients: Results from an implementation study. Drug Alcohol Rev 2012, 31(3):348-356.
• [22]Nehlin C, Fredriksson A, Jansson L: Brief alcohol screening in a clinical psychiatric population: Special attention needed. Drug Alcohol Rev 2012, 31(4):538-543.
• [23]Reinert DF, Allen JP: The alcohol use disorders identification test: an update of research findings. Alcohol Clin Exp Res 2007, 31(2):185-199.
• [24]Rollnick S, Heather N, Gold R, Hall W: Development of a short 'readiness to change' questionnaire for use in brief, opportunistic interventions among excessive drinkers. Br J Addict 1992, 87(5):743-754.
• [25]Miller WR, Heather N: Treating addictive behaviors. Plenum Press, New York; 1998.
• [26]Forsberg L, Ekman S, Halldin J, Ronnberg S: The readiness to change questionnaire: reliability and validity of a Swedish version and a comparison of scoring methods. Br J Health Psychol 2004, 9(Pt 3):335-346.
• [27]Heather N, Rollnick S, Bell A: Predictive validity of the readiness to change questionnaire. Addiction 1993, 88(12):1667-1677.
• [28]Rubinsky AD, Kivlahan DR, Volk RJ, Maynard C, Bradley KA: Estimating risk of alcohol dependence using alcohol screening scores. Drug Alcohol Depend 2010, 108(1–2):29-36.
• [29]Graeber DA, Moyers TB, Griffith G, Guajardo E, Tonigan S: A pilot study comparing motivational interviewing and an educational intervention in patients with schizophrenia and alcohol use disorders. Community Ment Health J 2003, 39(3):189-202.
• [30]McCambridge J, Kypri K: Can simply answering research questions change behaviour? Systematic review and meta analyses of brief alcohol intervention trials. PLoS One 2011, 6(10):e23748.
• [31]Bernstein JA, Bernstein E, Heeren TC: Mechanisms of change in control group drinking in clinical trials of brief alcohol intervention: implications for bias toward the null. Drug Alcohol Rev 2010, 29(5):498-507.
• [32]Sobell LC, Cunningham JA, Sobell MB: Recovery from alcohol problems with and without treatment: prevalence in two population surveys. Am J Public Health 1996, 86(7):966-972.
• [33]Bischof G, Rumpf HJ, Meyer C, Hapke U, John U: Influence of psychiatric comorbidity in alcohol-dependent subjects in a representative population survey on treatment utilization and natural recovery. Addiction 2005, 100(3):405-413.
• [34]Fiellin DA, Reid MC, O'Connor PG: Screening for alcohol problems in primary care: a systematic review. Arch Intern Med 2000, 160(13):1977-1989.
• [35]Hyman Z: Brief interventions for high-risk drinkers. J Clin Nurs 2006, 15(11):1383-1396.
• [36]Neumann T, Spies C: Use of biomarkers for alcohol use disorders in clinical practice. Addiction 2003, 98(Suppl 2):81-91.
• [37]Varga A, Hansson P, Lundqvist C, Alling C: Phosphatidylethanol in blood as a marker of ethanol consumption in healthy volunteers: comparison with other markers. Alcohol Clin Exp Res 1998, 22(8):1832-1837.