Identification and management of alcohol use and illicit substance use in outpatient psychiatric clinics in Sweden: a national survey of clinic directors and staff

Abstract

Background Swedish national guidelines recommend that all health care settings systematically screen patients for alcohol use and illicit substance use. When hazardous use is identified, it should immediately be addressed, preferably through brief interventions (BI). It is well known that the prevalence of alcohol use and illicit substance use among psychiatric patients is high, but it is not known to what extent screening and BI are routinely carried out in such clinics. Methods Two online surveys investigating the use of screening and BI for alcohol and illicit substances were constructed; one for psychiatric outpatient clinic directors and one for staff at these clinics. The main analyses were calculated as simple frequencies. In secondary analyses, we investigated the associations between substance abuse training, type of clinic and screening/BI delivery. For these analyses, the Chi square test was used. Results Most clinic directors reported that they have guidelines to screen for alcohol (93.1%) and illicit substance use (78.9%) at initial assessment. Fifty percent reported having guidelines for delivering BI when identifying hazardous alcohol use (35.9% for hazardous illicit substance use). Among staff, 66.6% reported always screening for alcohol use and 57.8% reported always screening for illicit substance use at initial assessment. Further, 36.7% reported that they usually deliver BI when identifying hazardous alcohol use (35.7% for hazardous illicit substance use). Secondary analyses indicated that staff with substance abuse training were significantly more likely to screen for alcohol use than staff without such training. Further, staff at psychosis clinics were significantly less likely to screen for both alcohol and substance use than staff at both general and specialist psychiatric clinics. Conclusions Most clinic directors reported having clear guidelines for staff to screen for alcohol use and illicit substance use, but fewer staff members than expected indicated that these guidelines were adhered to. Providing training about substance use disorders for staff may increase use of screening for alcohol use, and psychosis clinics may need to improve their screening routines. Electronic supplementary material The online version of this article (10.1186/s13722-019-0140-x) contains supplementary material, which is available to authorized users.

Substance use among patients in specialized mental health services in Norway: prevalence and patient characteristics based on a national census

“…A number of studies have documented that substance use and SUD are under-reported and underdiagnosed in psychiatric treatment settings [24][25][26]. Moreover, a recent Norwegian Board of Health study highlighted the existing deficiencies in specialized mental health services regarding the investigation and examination of patients with possible concurrent SUD [27].…”

“…It is possible that the intensive treatment and close monitoring of patients in in-patient treatment allowed clinicians to make a more thorough evaluation of the patients' substance use behaviour, resulting in higher identification rates than in outpatient treatment settings. The underidentification of substance use may also be related to insufficient knowledge of substance abuse issues among clinicians [25] and/or the lower status of working with substance users [29].…”

“…The current measure of substance use was based on combined information from the clinician's recordings of a co-occurring SUD diagnosis and reports of the patients' use of alcohol and illicit substances during the four weeks preceding treatment. Research shows that substance use problems are under-reported and underdiagnosed in mental health care [24][25][26]. The reliability of substance use reporting is likely to depend on the patient-therapist relationship, and on the extent to which the patient participated in completing the form.…”

Substance use among patients in specialized mental health services in Norway: prevalence and patient characteristics based on a national census

“…A number of studies have documented that substance use and SUD are under-reported and underdiagnosed in psychiatric treatment settings [34][35][36]. A recent Norwegian Board of Health study highlighted the existing deficiencies in specialized mental health services regarding the investigation and examination of patients with possible concurrent SUD [37].…”

“…A recent Norwegian Board of Health study highlighted the existing deficiencies in specialized mental health services regarding the investigation and examination of patients with possible concurrent SUD [37]. The under-identification of substance use may be related to insufficient knowledge of substance abuse issues among clinicians [35] and/or the lower status of working with substance users [38]. Moreover, the accuracy of reported substance use may depend on the patients' responses when asked about substance use.…”