Anette Søgaard Nielsen

The number of persons with alcohol problems in the Danish population

Aims: A) To qualify the existing estimates of the prevalence of heavy drinking, harmful alcohol use and alcohol dependency by applying adjustment for non-participation. B) To describe socio-demographic correlates of heavy drinkers. Methods: Data came from the Danish Health Interview Survey 2005, which included a personal interview of 14,566 individuals (response rate 66.7 %), and of 5,552 individuals who completed a self-administered questionnaire containing the Alcohol Use Disorder Test (AUDIT) (response rate 50.9%). Heavy drinkers were defined as consuming >14/21 drinks/week (women/men). Identification of harmful alcohol users and dependent drinkers was based on the score of specific AUDIT questions (harmful alcohol use a score of ≥4 in questions 7—10, dependent drinkers ≥4 in questions 4—6). Adjustment for non-participation was performed using data from the Danish National Patient Registry. Results: In the Danish population, 20% were heavy drinkers (862,876 persons 95% confidence interval (95% CI): 672,002—1,195,069), 14% had harmful alcohol use (620,301 persons 95% CI: 439,221—944,992), 3% were dependent drinkers (147,528 persons 95% CI: 118,196—188,384). Being male was associated with heavy drinking (odds ratio (OR): 1.70; 95% CI: 1.53—1.89), as was being a single male (OR: 1.27; 95% CI: 1.01—1.61) and being a smoker (men: OR: 1.96; 95% CI: 1.67—2.30 / women: OR: 2.08; 95% CI: 1.72—2.52). Conclusions: The number of heavy drinkers in the Danish population and the number of people with harmful alcohol use is considerably higher than earlier prevalence estimates. The number of dependent drinkers is similar to earlier estimates.

Internet-based brief personalized feedback intervention in a non-treatment-seeking population of adult heavy drinkers: a randomized controlled trial

Background Internet-based interventions for heavy drinkers show promising results, but existing research is characterized by few studies in nonstudent adult populations and few comparisons with appropriate control groups. Objective To test whether a fully automated Internet-based brief personalized feedback intervention and a fully automated Internet-based personalized brief advice intervention in a non-treatment-seeking population of heavy drinkers would result in a reduced alcohol intake. Methods We conducted a 3-arm parallel randomized controlled trial in a general population-based sample of heavy drinkers. The 54,157 participants (median age of 58 years) were screened for heavy drinking. Of the 3418 participants who had a weekly alcohol consumption above 14 drinks for women and 21 drinks for men, 1380 (619 women) consented to take part in the trial and were randomly assigned to an Internet-based brief personalized feedback intervention group (normative feedback, n = 476), an Internet-based personalized brief advice intervention group (n = 450), or a nonintervention control group (n = 454). Follow-up after 6 and 12 months included 871 and 1064 participants, respectively, of all groups combined. The outcome measure was self-reported weekly alcohol consumption. We analyzed the data according to the intention-to-treat principle. To examine changes over time and to account for the multiple time measurements, we used a multilevel linear mixed model. To take attrition into account, we used multiple imputation to address missing data. Results The intervention effect of the Internet-based brief personalized feedback intervention, determined as the mean additional difference in changes in alcohol consumption in the Internet-based brief personalized feedback intervention compared with the control group, was –1.8 drinks/week after 6 months and –1.4 drinks/week after 12 months; these effects were nonsignificant (95% confidence interval –4.0 to 0.3 at 6 months, –3.4 to 0.6 at 12 months). The intervention effect of the Internet-based personalized brief advice intervention was –0.5 drinks/week after 6 months and –1.2 drinks/week after 12 months; these effects were nonsignificant (95% confidence interval –2.7 to 1.6 at 6 months, –3.3 to 0.9 at 12 months). Conclusions In this randomized controlled trial we found no evidence that an Internet-based brief personalized feedback intervention was effective in reducing drinking in an adult population of heavy drinkers. Trial registration ClinicalTrials.gov NCT00751985; http://clinicaltrials.gov/ct2/show/NCT00751985 (Archived by WebCite at http://www.webcitation.org/68WCRLyaP)

Factors Associated with Compliance of Alcoholics in Outpatient Treatment

Predictors of compliance with psychosocial treatment were examined in a clinical sample of 150 patients seeking outpatient treatment for alcohol problems. Predictor variables were as follows: a) patient characteristics at the beginning of treatment and b) treatment characteristics of a matching model developed from the Conceptual System Theory. This model was based on the conceptual level of patients and therapists, and on the structure of the treatment. Using logistic regression analysis, we identified predictors of compliance in the motivation phase (first four consultations) and the active treatment phase (the remainder of the agreed treatment period of 12 months). Predictors of compliance in the motivation phase were a) therapists with a high conceptual level, characterized by an attitude toward the patients of empathetic and reflective listening; b) disulfiram; and c) psychopharmacological treatment. The only patient-related predictors of compliance in the active treatment phase were a) age below 40 and b) the presence of family and social problems, both factors predicting noncompliance. The only treatment-related predictor variables were a) the matching of patients with the structure of treatment and b) disulfiram during the first month of treatment, both factors predicting compliance. Two years after the beginning of treatment, those patients who completed the motivation phase as well as the active treatment phase had a significantly better psychosocial function than the noncompliant patients.

Alcohol problems among suicide attempters in the Nordic countries.

The purpose of this study was to see whether and how the number of suicide attempters with alcohol problems and their drinking habits differ between the Nordic areas under study. Problem-drinkers were defined as persons who themselves felt that they had an alcohol problem. The analyses were based on data collected at five Nordic research centers participating in the WHO/Euro Multicentre Study on Parasuicide, namely: Helsinki (Finland); Umeå and Stockholm (Sweden); Słr-Trłndelag (Norway); and Odense (Denmark). The results showed that the frequency of problem-drinking among suicide attempters differed markedly between the areas under study; the Finnish male and the Danish female suicide attempters included the highest proportions of self-identified problem-drinkers. The pattern of drinking among the suicide attempters also differed between the areas. The analyses indicate that the point when alcohol becomes a problem to somebody, especially to a degree that it increases the risk of suicidal behavior, not only depends on how much and how often the person drinks alcohol; the prevailing drinking pattern, the attitudes towards drinking alcohol, and the level of social control are also important factors to take into consideration when relations between alcohol and suicidal behavior are under study.

Patient-Treatment Matching Improves Compliance of Alcoholics in Outpatient Treatment

In chronic medical disorders, patient compliance is very poor and often less than 50%. The purpose of this investigation was to determine whether the proper matching of patient, treatment, and therapist would improve patient compliance in the outpatient treatment of alcoholics. We randomly placed 119 alcoholics who had commenced protracted outpatient treatment for alcoholism in either low or high structured treatments. These 119 patients were offered 12 months of individual treatment. Interruption of this treatment was recorded as noncompliance. The treatment courses were expressed in survival curves. The consequence of compliance for long-term prognosis was described by means of the Addiction Severity Index. The form of treatment in itself had no importance for compliance. However, correct matching of a patient and a treatment structure resulted in a compliance rate of 63% as opposed to 38% compliance among mismatched patients. Twenty-four months after the initiation of treatment, patients in the compliance group had a significantly higher level of function than those in the noncompliance group. Our investigation of alcoholics involved in outpatient treatment shows that the correct matching of patients and treatment structure improves compliance and long-term prognosis. It is hoped that the present investigation will generate interest in future research on correct matching to gain improved compliance in patients with a chronic medical disorder.

Implementation of a clinical pathway may improve alcohol treatment outcome

This article describes the design, implementation, and evaluation of a clinical pathway system in a two-cohort quasi-experimental study before and after implementation, controlling for confounders. The main outcome measures were retention in care and sensible alcohol use (defined as abstinent or drinking no more than 21 standard drinks per week). Patients with harmful alcohol use or dependence as their primary problem who were seeking psychosocial treatment at one of four alcohol clinics in Denmark participated in the study. After implementation of the clinical pathway system, which incorporated a structured intake, a referral and independent follow-up system, checklists, audit, and feedback, there was no change in length of stay, but significantly more patients had a good clinical outcome (stopped or moderated their consumption) at the end of treatment (OR = 1.9; 1.2–3.1). The study documents the feasibility of using a clinical pathway framework, incorporating a local monitoring system, checklists, audit, and feedback to enhance treatment quality and improve outcomes for alcohol use disorders.

Brief Alcohol Intervention by Newly Trained Workers Versus Leaflets: Comparison of Effect in Older Heavy Drinkers Identified in a Population Health Examination Survey: A Randomized Controlled Trial

AIMS To test if a brief motivational intervention (BMI) in a non-treatment seeking population of heavy drinkers results in a reduced alcohol intake. METHODS Screening of 12,364 participants in a Danish health examination survey led to 1026 heavy drinkers of whom 772 were included and randomized to a BMI group (n = 391) or a control group (n = 381) receiving two leaflets about alcohol. Follow-up took place after 6 and 12 months including 670 and 616 participants respectively. The outcome measure was self-reported weekly alcohol consumption. Data were analysed according to the intention-to-treat principle. We used the Motivational Interviewing Treatment Integrity 3.0 code (MITI) as a quality control of the interventions delivered. RESULTS The intervention effect of the BMI was -1.0 drinks/week, but the effect was not significant. The MITI analysis showed that the quality of the BMI delivered was sub-optimal, as only one of four aspects was above the recommended level for beginning proficiency. CONCLUSION We found no effect of a BMI in reducing alcohol consumption. The generalizability of the study is questionable, as individuals with the lowest level of education, low income and unmarried individuals are under-represented.

Outpatient treatment of alcohol use disorders among subjects 60+ years: design of a randomized clinical trial conducted in three countries (Elderly Study).

BackgroundThe proportion of 60+ years with excessive alcohol intake varies in western countries between 6–16 % among men and 2–7 % among women. Specific events related to aging (e.g. loss of job, physical and mental capacity, or spouse) may contribute to onset or continuation of alcohol use disorders (AUD). We present the rationale and design of a multisite, multinational AUD treatment study for subjects aged 60+ years.Methods/Design1,000 subjects seeking treatment for AUD according to DSM-5 in outpatient clinics in Denmark, Germany, and New Mexico (USA) are invited to participate in a RCT. Participants are randomly assigned to four sessions of Motivational Enhancement Treatment (MET) or to MET plus an add-on with eight sessions based on the Community Reinforcement Approach (CRA), which include a new module targeting specific problems of older adults. A series of assessment instruments is applied, including the Form-90, Alcohol Dependence Scale, Penn Alcohol Craving Scale, Brief Symptom Inventory and WHO Quality of Life. Enrolment will be completed by April 2016 and data collection by April 2017.The primary outcome is the proportion in each group who are abstinent or have a controlled use of alcohol six months after treatment initiation. Controlled use is defined as maximum blood alcohol content not exceeding 0.05 % during the last month. Total abstinence is a secondary outcome, together with quality of life andcompliance with treatment.DiscussionThe study will provide new knowledge about brief treatment of AUD for older subjects. As the treatment is manualized and applied in routine treatment facilities, barriers for implementation in the health care system are relatively low. Finally, as the study is being conducted in three different countries it will also provide significant insight into the possible interaction of service system differences and related patient characteristics in predictionof treatment outcome.Trial registrationClinical Trials.gov NCT02084173, March 7, 2014.

The RESCueH Programme: Testing New Non-Pharmacologic Interventions for Alcohol Use Disorders: Rationale and Methods

Excessive alcohol consumption is one of the most important lifestyle factors affecting the disease burden in the Western world. The results of treatment in daily practice are modest at best. The aim of the RESCueH programme is to develop and evaluate methods, which are as practice-near as possible, and therefore can be implemented quickly and easily in everyday clinical practice. It is the first clinical alcohol programme to be transatlantic in scope, with implementation in treatment centers located in Denmark, Germany and the US. The RESCueH programme comprises 5 randomized controlled trials, and the studies can be expected to result in (1) more patients starting treatment in specialized outpatient clinics, (2) a greater number of elderly patients being treated, (3) increased patient motivation for treatment and thus improved adherence, (4) more patients with stable positive outcomes after treatment and (5) fewer patients relapsing into harmful drinking. The aim of this paper is to discuss the rationale for the RESCueH programme, to present the studies and expected results.

Combination therapy with thioridazine and dicloxacillin combats meticillin-resistant Staphylococcus aureus infection in Caenorhabditis elegans

The shortage of drugs active against meticillin-resistant Staphylococcus aureus (MRSA) is a growing clinical problem. In vitro studies indicate that the phenothiazine thioridazine (TZ) might enhance the activity of the β-lactam antibiotic dicloxacillin (DCX) to a level where MRSA is killed, but experiments in simple animal models have not been performed. In the present study, we introduced Caenorhabditis elegans infected by S. aureus as an in vivo model to test the effect of TZ as a helper drug in combination with DCX. Because TZ is an anthelmintic, initial experiments were carried out to define the thresholds of toxicity, determined by larval development, and induction of stress-response markers. No measurable effects were seen at concentrations of less than 64 mg TZ l(-1). Seven different MRSA strains were tested for pathogenicity against C. elegans, and the most virulent strain (ATCC 33591) was selected for further analyses. In a final experiment, full-grown C. elegans were exposed to the test strain for 3 days and subsequently treated with 8 mg DCX l(-1) and 8 mg TZ l(-1) for 2 days. This resulted in a 14-fold reduction in the intestinal MRSA load as compared with untreated controls. Each drug alone resulted in a two- to threefold reduction in MRSA load. In conclusion, C. elegans can be used as a simple model to test synergy between DCX and TZ against MRSA. The previously demonstrated in vitro synergy can be reproduced in vivo.