BackgroundThe prevalence of substance use in people acutely admitted to in-patient psychiatric wards is high and the patients` duration of stay is limited. Motivational interviewing is a method with evidence based effect in short interventions. The aims of the present study were to compare the effects of 2 sessions of motivational interviewing and treatment as usual (intervention group) with treatment as usual only (control group) on adult patients with comorbid substance use admitted to a psychiatric in-patient emergency unit.MethodsThis was an open randomised controlled trial including 135 patients where substance use influenced the admittance. After admission and assessments, the patients were allocated to the intervention group (n = 67) or the control group (n = 68). The primary outcome was self-reported days per month of substance use during the last 3 months at 3, 6, 12 and 24 months after inclusion. Data was analysed with a multilevel linear repeated measures regression model.ResultsBoth groups reduced substance use during the first 12 months with no substantial difference between the 2 groups. At 2 year follow-up, the control group had increased their substance use with 2.4 days (95% confidence interval (CI) –1.5 to 6.3), whereas the intervention group had reduced their monthly substance use with 4.9 days (95% CI 1.2 to 8.6) compared to baseline. The 2 year net difference was 7.3 days of substance use per month (95% CI 1.9 to 12.6, p < 0.01) in favour of the intervention group.ConclusionsThe present study suggests that 2 sessions of motivational interviewing to patients with comorbid substance use admitted to a psychiatric emergency unit reduce substance use frequency substantially at 2 year follow-up.Trial registrationClinicalTrials.gov Identifier: NCT00184223
Background: When returning to work after being on long-term sick leave, individuals may experience varying levels of motivation and self-efficacy. Motivational interviewing (MI) is a counseling style that aims to increase motivation towards change, and it may be useful in the return to work (RTW) process. The aim of this study was to explore sick-listed workers' experiences with MI in the RTW process. Methods: This qualitative study was part of a randomized controlled trial evaluating the effects of MI on the RTW process, and it was administered by caseworkers at the Norwegian Labor and Welfare Administration. Sixteen sicklisted individuals, aged 33-60, participated in semi-structured interviews. All had a sick leave status of 50-100% for at least 8 weeks when interviewed and all had completed 2 MI sessions. The data was analyzed with systematic text condensation. Results: Participants' experiences of the MI sessions were categorized into three themes: (1) relationship with the MI caseworker, (2) normalizing sick leave, and (3) adjusting RTW strategies. The MI sessions were experienced as a positive encounter due to the supportive relationship that was built between the MI caseworker and the sick-listed worker. Being sick listed led to feelings of guilt and stigmatization, but acceptance and support from the MI caseworkers helped normalize the situation for the sick-listed workers. Furthermore, MI sessions allowed for personalized feedback and discussions on adjustments to their RTW strategies. Conclusion: Sick-listed workers experienced MI as positive due to the good relationship that developed with the MI caseworker, how this normalized sick leave, and the help they received with adjusting their RTW strategies. Professionals working with individuals attempting to RTW may benefit from using MI as a method for helping sick-listed workers to RTW. Trial registration: ClinicalTrials.gov: NCT03212118 (registered July 11, 2017).
BackgroundMotivational interviewing (MI), mainly used and shown effective in health care (substance abuse, smoking cessation, increasing exercise and other life style changes), is a collaborative conversation (style) about change that could be useful for individuals having problems related to return to work (RTW). The aim of this paper is to describe the design of a randomized controlled trial evaluating the effect of MI on RTW among sick listed persons compared to usual care, in a social security setting.MethodsThe study is a randomized controlled trial with parallel group design. Individuals between 18 and 60 years who have been sick listed for more than 7 weeks, with a current sick leave status of 50–100%, are identified in the Norwegian National Social Security System and invited to participate in the study. Exclusion criteria are no employment and pregnancy. Included participants are randomly assigned to the MI intervention or one of two control groups. The MI intervention consists of two MI sessions offered by caseworkers at the Norwegian Labor and Welfare Service (NAV), while the comparative arms consist of a usual care group and a group that receives two extra sessions without MI content (to control for attentional bias). The primary outcome measure is the total number of sickness absence days during 12 months after inclusion, obtained from national registers. Secondary outcomes include time until full sustainable return to work, health-related quality of life and mental health status. In addition, a health economic evaluation, a feasibility/process evaluation and qualitative studies will be performed as part of the study.DiscussionA previous study has suggested an effect of MI on RTW for sick listed workers with musculoskeletal complaints. The present study will evaluate the effect of MI for all sick listed workers, regardless of diagnosis. The knowledge from this study will potentially be important for policy makers, clinicians and other professionals` practical work.Trial registrationClinicalTrials.gov: NCT03212118 (registered July 11, 2017).
The objective of this study was to characterize the usefulness and reliability of a commonly used urinary on-site drugs of abuse screening test device when used routinely at admittances to a psychiatric emergency unit. Urine samples from 262 emergency psychiatric admittances representing 217 patients were analyzed by a commercially available on-site test for the detection of amphetamines, benzodiazepines, cannabis, cocaine, and opiates in urine. The samples were first screened by nurses at the psychiatric department, thereafter by 2 technicians at the laboratory, and finally, analyzed by liquid chromatography/mass spectrometry. Results of 45.8% of the screening tests were true negative for all 5 drugs/drug groups tested, whereas those of 29.4% were true positive for 1 or several drugs/drug groups and true negative for the others. Thus, in total, 75.2% were correct for all 5 drugs/drug groups. In general, the sensitivities (42.9%-90.0% for the various drug groups) were lower than the specificities (92.7%-100.0%). The accuracies were 86.3% for benzodiazepines, 92.4% for cannabis, 94.7% for opiates, and 97.0% for amphetamines. No cocaine was found in any of the samples. For cannabis, the accuracy was higher among the laboratory technicians than among the nurses. The results from on-site screening testing should not be considered as the final conclusion on the intake of drugs of abuse but must be interpreted with caution.
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