Sten Rönnberg

Brief interventions for risk consumption of alcohol at an emergency surgical ward

Patients admitted to an emergency surgical ward were screened for alcohol problems and randomized between an extensive alcohol counseling and a brief assessment followed by feedback of risky alcohol consumption. Some 165 patients were assessed for risk consumption and followed up 6 to 12 months, and it was found that patients in both interventions significantly reduced the amount they drank per occasion although they drank as often as before. The patients had also moved to a stage more ready to change. No differences in effect were found between the interventions. A brief assessment with feedback about risk consumption can be done on an emergency surgical ward by the surgical staff with a few hours of training and may reduce risky alcohol consumption significantly.

Screening and brief intervention for risky alcohol consumption in the workplace: results of a 1-year randomized controlled study.

AIMS To assess the effectiveness of brief alcohol intervention on hazardous and harmful drinking in the 12-month period after a voluntary alcohol screening. METHODS At a large transport company, employees presenting to the occupational health services for a routine health and lifestyle check-up were offered to undertake an alcohol screening by means of self-report (the Alcohol Use Disorders Identification Test-AUDIT) and a biomarker (carbohydrate-deficient transferrin in serum-CDT). Those screening positive for the AUDIT and/or CDT were randomized to a brief or comprehensive intervention group or to a control group. An identical follow-up session was performed 12 months later. RESULTS Of 990 employees (68% men) that volunteered for the alcohol screening, 194 (20%) tested positive for the AUDIT and/or CDT. Among the 158 (81%) subjects who also attended the follow-up session, the frequency of positive screening results at baseline/follow-up were 51%/23% for the AUDIT (P < 0.0001) and 58%/34% (P < 0.0001) for CDT. However, there were no significant differences between the brief and comprehensive intervention groups or between the intervention groups and the control group. CONCLUSION The results suggested that alcohol screening and brief intervention performed in connection with routine health and lifestyle examinations in the workplace may be effective in reducing alcohol consumption. Given the lack of difference in outcome between the intervention groups and the control group, alcohol screening may in itself cause reduction in drinking. In addition, at least some of the positive effect may be explained by regression towards the mean.

Mindfulness-Based Cognitive Attitude Training for Primary Care Staff: A Pilot Study

This pilot study explores feasibility and outcomes of a newly developed mindfulness-based cognitive attitude training program for health care personnel. The program was designed as an intervention to reduce the negative effects of stress on health care personnel, on both a personal and professional level, as well as to encourage personal well-being and improved management of the caregiver-patient relationship. The study group (n = 52) consisted of individuals from various categories of caregivers within a primary care setting. The study includes pre- and postintervention assessments and a 3-month follow-up assessment of levels of mindfulness (Mindfulness Attention Awareness Scale), quality of life (the WHO-5 Well-Being Questionnaire), and perceived stress (two VAS scales). As a group, course participants demonstrated significant positive changes reflected in all assessment scales after completing the course. These positive changes persisted at a 3-month follow-up assessment. The study results indicate the feasibility of this program and a need for continued research with a more powerful study design, possibly supplemented with a qualitative survey.

Time-Limited Group Psychotherapy for Moderately Alcohol Dependent Patients: A Randomized Controlled Clinical Trial

In recent reviews of treatment of alcohol dependence, psychodynamic group psychotherapy has been evaluated as being comparatively less effective than other methods. Some North American studies have, however, demonstrated differential treatment effects for subgroups of alcohol dependent patients. The focus of the present study was on the evaluation, in a different cultural setting, of psychodynamically oriented time-limited group psychotherapy for a homogeneous subgroup of moderately alcohol dependent male and female patients. After randomization, 49 patients completed either cognitive behavioral or psychodynamically oriented time-limited group treatment. At the 15 months follow-up, patients from both treatment orientations had improved. A majority of the patients in the psychodynamic group treatment, however, seemed to have been able to maintain a more positive drinking pattern during the whole follow-up period compared to the patients in the cognitive behavioral treatment who seemed gradually to deterior...

The Readiness to Change Questionnaire: Reliability and validity of a Swedish version and a comparison of scoring methods

OBJECTIVES The aim of this study was to investigate the relative merits of three methods of scoring the Swedish version of the Readiness to Change Questionnaire (RTCQ), either by assigning a stage in the Prochaska and DiClemente (1986) Stages of Change Model or by treating the scores as a continuous readiness to change variable. Assigning a stage of change was achieved with both the quick method and the refined method. DESIGN AND METHODS Out of 563 patients screened at an emergency surgical ward for risky alcohol consumption, 165 met risk criteria and responded to the RTCQ. The three scoring methods were examined with regard to internal consistency, test - retest reliability, construct and predictive validity. RESULTS All three methods of treating the RTCQ scores had satisfactory reliability. Since stages of change (quick method) were significantly but modestly correlated to alcohol consumption and to change-related behaviours at intervention, and moderately correlated to alcohol problems, the quick method had reasonable construct validity. The refined method had higher construct validity; however, this method left 32% of the patients without a stage assignment. The continuous readiness scale had higher construct validity than the quick method, but was not in par with the refined method. No scoring method was found to have predictive validity. CONCLUSIONS The RTCQ scores treated as a continuous readiness scale were a viable alternative to the original ways of assigning a stage of change to a patient. The Swedish RTCQ is reliable and has reasonable construct validity, but its predictive validity needs further investigation.

Screening of binge drinking among patients on an emergency surgical ward

In a sample of 149 emergency surgical patients, binge drinking was assessed through interviews. Sensitivity, specificity, and positive and negative predictive values were calculated for three questionnaires-the Malmö modification of brief MAST (Mm-MAST), CAGE, and the Trauma Scale-and two biological markers-carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT). Binge drinking was reported by 42% of male patients, aged 16-29 years; 66% of female patients, aged 16-29 years; 27% of male patients, aged 30-73 years; and 16% of female patients, aged 30-73 years. All alcohol biomarkers had low sensitivity to binge drinking among women. Mm-MAST alone and CAGE and CDT combined were sensitive to identifying binge drinking among men aged 30-73 years. The three questionnaires combined had a sensitivity of 0.82 to binge drinking among men aged 16-29 years.

Detecting early signs of alcohol problems: a clinical application of an interview method.

In this study a simple interview method to identify patients with potential alcohol problems was tested in a clinical setting. Nurses interviewed an unbiased sample of 393 patients attending practices within occupational health care. The technique used was a day by day follow back procedure covering the preceding two weeks. The time needed to accomplish the interviews varied between 2 and 15 minutes, depending on how much alcohol consumption was reported. Nurses and doctors reported that the interview was easily integrated in daily working routines. When defining the limit of high consumption as more than 200 g absolute alcohol for the two week period, 11% of the group studied (17% among men and 2% among women) were regarded as high consumers. Strategies for confronting and motivating patients for further analysis of their alcohol habits and for treatment are discussed.

Hur effektiv är behandling av alkoholproblem

Ronnberg, S.(1991). How effective is the treatment of alcohol problems? Nordisk Psykologi, 43, 37–51. Four different perspectives on the evaluation of treatment of alcohol problems are discussed: Controlled group studies, consequences of basic models of behaviour influences, clinical impressions, and the effects of treatment on macro levels. It is argued that research on the effects of care and treatment of alcohol problems should be adapted to the level of knowledge in the subject matter. When knowledge is scant in the field qualitative research is required. When basic clinical knowledge is achieved, experimental single case studies is recommended for studying the process. Experimental group studies of the effects of well-defined methods on samples of special populations are recommended when an advanced knowledge exists in the subject matter. Broad evaluation of social programs is best done when there is a firm ground of researched knowledge of individuals and groups with alcohol problems.

Experimentell analys av tillgivenhet

Abstract I en utvidgad analys av den gangse inlarningspsykologiska forestallningen om hur barn utvecklar tillgivenhet till sina foraldrar betonas aktivitetsforstarkarnas stora betydelse. Enligt den har gjorda analysen far foraldrarna en central betydelse genom att de vanligen tillhandahaller forstarkande aktiviteter kontingent pa att barnen narmar sig dem. Analysens hallbarhet provas sedan med en intensivdesign, varvid det visas att en ettarig pojkes “onskan att komma upp i kna” kraftigt paverkas av aktiviteter forbundna med sittandet i kna.

Reasons for N=l Designs in Educational Research

Abstract Nordlund, O. & Ronnberg, S. 1976. Reasons for N = 1 Designs in Educational Research. Scand. J. educ. Res. 20,73‐83. Some difficulties with field experimental research designs using groups of subjects are discussed. Special attention is given to the problem of interpreting the significant results and how the obtained results can be generalized. Single‐subject designs are suggested as suitable alternatives, and a few such designs are presented.