Abstract
BackgroundSwedish 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.MethodsTwo 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.ResultsMost 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.ConclusionsMost 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.
Highlights
Swedish national guidelines recommend that all health care settings systematically screen patients for alcohol use and illicit substance use
We have found no existing research on the extent to which screening for alcohol and illicit substance use is conducted in psychiatric outpatient clinics, nor to what extent patients with hazardous use of alcohol or illicit substances are offered brief interventions (BI)
Almost all clinic directors stated that they had clear guidelines for staff to screen for alcohol use and illicit substance use, but use of screening among staff was markedly lower than would be expected
Summary
Swedish national guidelines recommend that all health care settings systematically screen patients for alcohol use and illicit substance use. 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. It is well known from epidemiological studies that people with a psychiatric disorder frequently have a concurrent substance abuse or dependence concerning either alcohol or illicit substances [1,2,3]. A drinking pattern not deemed to be a fully developed alcohol abuse or dependence but with potential to lead to adverse consequences, is problematic in a psychiatric setting. Hazardous illicit substance use is not an established concept, but it is not controversial to suggest that sporadic use of illicit substances has negative implications for treatment and recovery from psychiatric disorders
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