Leif Grönbladh

Alcohol and Drug Use, Smoking, and Gambling Among Psychiatric Outpatients : A 1-Year Prevalence Study

ABSTRACT 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.

The Swedish Methadone Maintenance Program

In Sweden the intravenous abuse of illegally obtained opiates has been a gradually increasing problem since the mid-sixties, but it has not yet reached American proportions. For a couple of decades amphetamine and other central stimulants were dominating the Swedish drug market. Among the opiates raw opium was the leading drug in the early seventies, to be replaced first by morphine base and since 1975 by heroin. In a recent case-finding survey (Olsson, 1981) it has been estimated that Sweden has 3,000 to 4,000 users of heroin, about half of whom are regular users with a compulsive type of dependence on this drug.

The Street Life and Treatment Response of 105 Heroin Addicted Women

The street life and subsequent methadone maintenance treatment of 105 female heroin addicts is described and contrasted against the corresponding phases of 244 male heroin addicts Seventy percent of the females were prostitutes, while the rest relied on criminal activity for their heroin supply. Half of the women were used as sources of heroin money by their male partners and, as expected, this was more common among the prostitutes than the non-prostitute women. Only in 18% the male partners contributed to the illegal heroin money of the prostitutes. Money for food and housing were in all instances obtained from the social welfare system. The sociopsychiatric background for the women showed more heredity for mental disturbance, more broken homes and school problems than the men and the prostitutes had an earlier drug debut. Despite their sinister background the women had a lower mortality rate (47 times the expected) compared with the men (70 times the expected).

Three hours of training improve psychiatric staff's self‐perceived knowledge and attitudes toward problem‐drinking patients

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 3 h 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 2 h workshop and a 1 h 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. 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.

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

BackgroundAlthough 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.MethodsPsychiatric 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.ResultsIn 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%).ConclusionsBrief 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.

Brief alcohol training for psychiatric staff

Staff attitudes are crucial to the successful implementation of systematic alcohol screening and brief intervention (SBI). The forms and extent of training needed to improve attitudes among psychiatric staff with regard to problem drinking is unclear. In this study, we assumed psychiatric staff to be familiar with alcohol as a problem area and therefore tested briefest possible training effort. This study was conducted as part of a national Swedish project aimed at promoting the use of SBI within psychiatric care. The aim of the study was to study psychiatric staff’s knowledge and attitudes to problem drinking. A further aim was to investigate whether three hours of training in a single session would be sufficient to improve knowledge and therapeutic attitudes toward problem drinking. A tailored training model for nonphysician psychiatric staff was carried out at a medium-sized university clinic. Participants included nurses and psychiatric aides (medical) and psychologists and social workers (nonmedical). The training consisted of a two-hour workshop and a one-hour follow-up session. Staff knowledge and attitudes to problem drinking patients were measured at baseline and at follow-up by case-vignette assessment and by administration of the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). In total, 115 persons completed the questionnaire (follow-up rate = 83%). Distribution of medical and nonmedical staff was 50/50. After training, nonmedical staff estimated vignette case severity higher than before training. Both groups had a higher estimate of their capacity to help a patient with alcohol problems. Self-rated role adequacy was higher in both groups. Medical staff also scored higher on work satisfaction. We conclude that three hours of tailored training improved psychiatric-staff knowledge and therapeutic attitudes toward problem drinking. Nonmedical staff in particular benefitted from the training.