Sverre Nesvåg

Health and the need for health promotion in hospital patients

BACKGROUND Integrated health promotion improves clinical outcomes after hospital treatment. The first step towards implementing evidence-based health promotion in hospitals is to estimate the need for health promoting activities directed at hospital patients. The aim of this study was to identify the distribution and association of individual health risk factors in a Norwegian hospital population and to estimate the need for health promotion in this population. METHODS We used a validated documentation model (HPH-DATA Model) to identify the prevalence of patients with nutritional risk (measurements of waist and weight), self-reported physical inactivity, daily smoking and hazardous drinking. We used logistic regression to describe the associations between health risk factors and demographic characteristics. RESULTS Out of 10 included patients, 9 (N = 1522) had one or more health risk factors. In total 68% (N = 1026) were overweight, 44% (N = 660) at risk of under-nutrition, 38% (N = 574) physically inactive, 19% (N = 293) were daily smokers and 4% (N = 54) hazardous drinkers. We identified a new clinical relevant association between under-nutrition and smoking. The association between hazardous drinking and smoking was sustained. CONCLUSION Nearly all patients included in this study had one or more health risk factors that could aggravate clinical outcomes. There is a significant need, and potential, for health-promoting interventions. Multi-factorial interventions may be frequently indicated and should be the subject of interventional studies.

When general practitioners talk about Alcohol: Exploring facilitating and hampering factors for pragmatic case finding

Background: The aim was to explore individual and system factors facilitating or hampering pragmatic case finding, an identification strategy based on clinical signs and targeted screening. Study design: Two focus groups with general practitioners were interviewed twice, in the context of a four-session seminar on alcohol and complex drug problems, and an additional focus group interview with general practitioners not attending the seminar. Interviews focused mainly on conditions for talking about alcohol, views on collaboration with colleagues, how they deal with complex issues, and strategies for learning and quality improvement. Results: The participants presented many deliberate strategies for quality improvement and learning together, but there was a tendency to avoid discussing complex case stories or potentially controversial topics with colleagues. Possible barriers to change were presented. The majority of their stories on talking about alcohol coincided well with the concept of pragmatic case finding. The duality between shame and normality, time constraints and a need for structure were the most important individual barriers to an open and respectful conversation about alcohol with patients. Conclusions: Our study supports pragmatic case finding as a relevant and viable strategy for talking about alcohol in general practice, and as an alternative to screening and brief intervention. Quality improvement in practice is strengthened when it is adapted to the clinical setting, and builds on and stimulates the GPs’ and staff’s own strategies for learning and quality work.

The use and costs of health and social services in patients with longstanding substance abuse

BackgroundPersons with longstanding substance abuse might become increasingly dependent on help by the public, eventually requiring permanent care. In 2006 the municipality of Stavanger established a so-called addiction ward for these clients, comprising 17 beds at the largest municipal nursing home. We assumed that the residents of this ward were high consumers of health care and social services during the last months preceding their admission. The aim of the study was to register the type and extent of services that were claimed by this client group during the last six months prior to admission, and to calculate the costs that were caused. Further, we estimated the incremental costs for nursing home placement.MethodsIn 15 residents from the addiction ward the use of all welfare services during the six months prior to admission were registered. Costs were calculated by unit costs from a municipal, national and societal perspective.ResultsMean total costs during this period were €32 474. Approximately half of these costs were borne by state-funded institutions, and half were borne by the municipality. The clients used a great variety of services aimed at subsistence, health care and support in independent living, while services aimed at drug withdrawal were not claimed. There was no correlation between costs and the level of functioning. The incremental costs for nursing home admission were borne by the municipalities.ConclusionPersons with longstanding substance abuse represent a group with a high use of welfare resources and hence cause high costs. However, our findings do not indicate any correlation between the amount of services rendered and the level of functioning. Further research should focus on the identification of the clients’ need for support in order to facilitate targeted interventions that might prevent further deterioration and, finally, the need for permanent care.

Vurdering av helsetjenester for eldre med alkoholrelaterte problemer: Hva virker og hva kan bli bedre?

På flere områder skiller etterkrigskullene seg fra tidligere generasjoner. Gjennomgående har de bedre levekår med høyere utdanning, bedre økonomi, flere utenlandsreiser, sunnere matvaner, mindre tobakksbruk, mer fysisk aktivitet osv. Majoriteten eldre, og dette er rapportens tema, drikker også mer alkohol enn sine forfedre. Økt alkoholforbruk øker risikoen for alkoholrelaterte skader og sykdommer, med påfølgende behov innsatser fra helsetjenesten. Populasjonen eldre er en heterogen gruppe. Noen eldre har friske leveår helt opp til 90-års alder. Et mindretall (økende) passerer også 100 år, før behovet for helse, velferd og omsorgstjenester (i et visst omfang) melder seg. Atter andre får aldersrelaterte plager allerede i 60 årene. Rapportens noe upresise begrep eldre, spenner med andre ord over nær to generasjoner. Med eldre menes i denne rapporten personer over 60 år, som har begynnende/eksisterende problemer av aldersrelatert karakter, og hvor alkohol mest sannsynlig er en direkte eller indirekte årsak til plagene. Rapporten beskriver hvordan erfarne fagfolk vurderer dagens helse, velferd og omsorgstjenesters kapasitet, evne og kompetanse til dekke målgruppens behov. Rapporten beskriver også typer av etablerte helsetjenester og hvilke helsetjenester som mangler.

Health and social issues among older patients in opioid maintenance treatment in Norway

In 2015 the Ministry of Health and Care Services was revising the National Action Plan for drug treatment and rehabilitation in Norway. Connected to this, Alcohol and Drug Research Western Norway (KORFOR) examined the health and social issues for older patients with substance-use disorder (SUD) and the possible challenges for the healthcare services. The report to the ministry (KORFOR, 2015) was divided into two general areas: the elderly and alcohol, and the elderly in opioid maintenance treatment (OMT). The report sought to answer the following questions:

Alcohol & drug use among employees in the private business sector in Norway

Aims The aims of this study were to map the amounts and patterns of alcohol & drug (a&d) use among employees, to analyze the relationships between a&d use and the experienced negative and positive effects of such use, and to analyze how conditions of work and structural and cultural factors in the workplace affect the a&d use of employees. Method A total of 1 245 employees from 74 companies took part in the survey, giving a response rate of 34%. Given this low response rate, the sample was still considered representative, controlling for sex, age, industry, company size and geography. Results 2.6% of the employees had used illegal drugs and 18% had used prescribed drugs the last year. 3% had used prescribed drugs each week. There were strong connections between illegal drug use and negative consequences for the workplace (absenteeism, accidents and intoxication at work), but it seemed that none of the workplace factors affected the use of illegal drugs. Extensive use of prescribed drugs was strongly connected to experiencing bad working conditions and high absenteeism. 95% of the employees had used alcohol the last year. Based on the answers about the amounts of alcohol consumed the last two weeks, 4% of the women and 5% of the men in the sample could be characterized as heavy drinkers (according to WHO gender-specific limit values). High alcohol consumption is shown to be correlated to negative effects such as absenteeism (only short-term), accidents and intoxication at work. Demographic factors such as sex, age, marital status and caring responsibilities played a lesser role in explaining the variation in drinking among employees in this sample, and especially the variation in work-related drinking. Neither did the conditions of work explain the variation in drinking. Instead, such factors as number of work journeys abroad, hours working outside the permanent worksite, norms and beliefs (especially beliefs about alcohol as a strategy for coping with work strain), offer explanations for the variation in drinking among employees. Conclusions Alcohol and drugs use among employees is a twofold challenge to the working life. First, it is a challenge to prevent the negative effects of a&d use on the workplaces and the employees. Second, it is a challenge to prevent the many occasions for drinking in relation to work, and the structural and cultural factors in the workplace, from having a major negative impact on the alcohol and drug use of employees.

Into the unknown: Treatment as a social arena for drug users’ transition into a non-using life

Background and aims: For people trying to stop using alcohol or other drugs (AOD), the process is often characterised by periods of abstinence followed by relapse into their previous drug-related way of life and subsequent re-entry into the treatment system. There is a call for greater attention to the how of these transitions, with a special focus on the phase of leaving treatment. The aim of this article was to get a better understanding of the transformation of practice when moving from a drug-using to a non-using lifestyle by exploring the experience of (1) the involvement in treatment settings, (2) the process of leaving treatment, and finally, (3) the early phase of changing everyday practice into a drug-free way of living. Method: The article takes on a social practice approach, in particular Bourdieu’s concepts of habitus, “doxa” and field to analyse 17 in-depth interviews with Norwegian men and women seeking treatment for problems resulting from the use of drugs and/or alcohol. Results: The study shows that the support of professionals operates as transitional relations that can bridge the transformation from a drug-using to a drug-free life, by providing a social web of relations, positions, settings and activities. However, leaving treatment and establishing AOD-free practice involves moving into something unknown in the sense that there is no embodied, taken-for-granted knowledge about how to relate to a world where drug use is not the focal point of existence. Conclusions: The process of change, then, involves being exposed to an existential feeling of maladjustment. To get beyond the feeling of maladjustment, and get into the doxic mode takes time, and involves reconfiguration of habitus through reorientation of social settings, relations and networks. The treatment system could potentially develop a continuum of support during these transformations.

How enough becomes enough: Processes of change prior to treatment for substance use disorder

ABSTRACT Aim: Explore patient’s perceptions of change processes occurring prior to inpatient treatment for substance use disorder, forming the basis for treatment entry. Method: Four single focus-group interviews including a total of 14 patients (11 men and 3 women) were conducted in accordance with a brief interview guide. Interviews focused on patient’s perceptions of change processes prior to treatment entry, associated factors, decision-making and implications for their way forward. A content analysis was conducted to identify code and subcategorize meaning units. Results: Patients describe complex processes of change involving a new perception of life situation enabled by accumulation and escalation of negative consequences, especially related to loss and health, along with an external pressure or trigger. The transition to treatment entry is either based on a deliberate and active decision or a result of spontaneous action and less deliberate decision to initiate in treatment. Conclusions: Patient’s perceptions of treatment entry as a result of a more or less deliberate decision challenges patient’s readiness at treatment entry, constituting an important clinical challenge of relevance for clarifying treatment goals and interventions which in turn may affect the course of treatment applied to the patient.

Feasibility and Effects of Digital Interventions to Support People in Recovery From Substance Use Disorders: Systematic Review

Background The development and evaluation of digital interventions aimed at preventing or treating substance use–related problems and disorders is a rapidly growing field. Previous reviews of such interventions reveal a large and complex picture with regard to targeted users, use, and efficacy. Objective The objective of this review was to investigate the feasibility and effects of interventions developed specifically for digital platforms. These interventions are focused on supporting people in recovery from substance use disorders by helping them achieve their substance use goals and develop a more satisfying life situation. Methods The review is based on a systematic search in MEDLINE, Embase, PsycInfo, and Cochrane Library databases. Of the 1149 identified articles, 722 were excluded as obviously not relevant. Of the remaining articles, 21 were found to be previous reviews, 269 were on interventions aimed at reducing hazardous alcohol or cannabis use, and 94 were on digitized versions of standard treatment methods. The remaining 43 articles were all read in full and systematically scored by both authors. Results The 43 articles cover 28 unique interventions, of which 33 have been published after 2013. The interventions are aimed at different target groups (defined by age, substance, or comorbidity). Based on the number of features or modules, the interventions can be categorized as simple or complex. Fourteen of the 18 simple interventions and 9 of the 10 complex interventions have been studied with quantitative controlled methodologies. Thirteen of the 18 simple interventions are integrated in other treatment or support systems, mainly delivered as mobile phone apps, while 6 of the 10 complex interventions are designed as stand-alone interventions, most often delivered on a platform combining desktop/Web and mobile phone technologies. The interventions were generally easy to implement, but in most cases the implementation of the complex interventions was found to be dependent on sustained organizational support. Between 70% and 90% of the participants found the interventions to be useful and easy to use. The rates of sustained use were also generally high, except for simple interventions with an open internet-based recruitment and some information and education modules of the complex interventions. Across all interventions, slightly more than half (55%) of the studies with control groups generated positive findings on 1 or more substance use outcomes, with 57% of the interventions also found to be efficacious in 1 or more studies. In the positive studies, effects were typically in the small to moderate range, with a few studies yielding larger effects. Largely due to the inclusion of stronger control conditions, studies of simple interventions were less likely to produce positive effects. Conclusions The digital interventions included in this review are in general feasible but are not consistently effective in helping people in recovery from substance use disorder reduce their substance use or achieving other recovery goals.

Thematic issue: Substance use and ageing

In 2009, Nordisk alkohol& narkotikatidsskrift (NAT: Sandelin & Wrede-Jäntti, 2009) published a thematic issue on alcohol and the elderly. The following year, the owner and former publisher of the journal, The Nordic Welfare Centre, followed up with a report on the same theme (Mørk & Simic, 2010). Both publications focused on the increased use of alcohol among the elderly. This increase was shown to stem from both a cohort effect (a more “wet” generation getting older) and genuine changes in alcohol attitudes and behaviour among the elderly. Combined with the demographic changes toward an ageing population, this led to concern about a future increase in alcohol-related problems among the elderly and increased pressure on the treatment service system. Since 2009, the focus on the consequences of an ageing population on all aspects of society has become increasingly stronger. The combined effects of increases in the elderly population and in alcohol consumption by the elderly have become a topic of national health and social service authority reports and white papers (see, e.g., Svenska Socialstyrelsen Lägesrapport, 2015; and the Norwegian Government, Ot. prop. 15, 2015–16). On the other hand, as shown in many of the articles in the NAT 2009 special issue, there is also a strong interest in presenting a more nuanced picture of alcohol and drug use among the elderly and the consequences that might be expected. As the life expectancy has increased and even reaching an age of over 100 years has become more frequent, the category “the elderly” contains more than two generations. Given the knowledge that differences in personal characteristics and chosen lifestyles often amplify with age, this means that the elderly population will be more diverse than ever before in terms of socioeconomic status, health, attitudes, and behaviour. It remains an open question as to how ageing affects the use of alcohol and other drugs. This is discussed in different ways in this thematic issue of NAD. Bye and Rossow (2017) show that alcohol use in the 60þ general population age group decreases with age, although to a much smaller extent than one would expect;