Hazardous alcohol use in general psychiatric outpatients

Exploring barriers and facilitators to addressing hazardous alcohol use and AUD in mental health services: a qualitative study among Dutch professionals

BACKGROUND

Hazardous alcohol use and alcohol use disorder (AUD) are highly prevalent among clients in mental health services, yet significant gaps remain in the adequate assessment of alcohol use and provision of appropriate alcohol interventions. The aim of this study was to conduct an exploration of (i) alcohol intervention elements used in mental health services and (ii) professionals' reported barriers and facilitators in identifying and intervening with hazardous alcohol use and AUD.

METHODS

Qualitative data were obtained by conducting semi-structured interviews among a purposive sample of 18 professionals from 13 different Dutch mental health services organizations (i.e., five integrated mental health organizations with addiction services, five mental health organizations without addiction services, and three addiction services organizations without mental health services). Transcripts were qualitatively analyzed using inductive thematic analysis.

RESULTS

Identified alcohol intervention elements included conducting assessments, brief interventions, treatment, referrals of clients, collaborations with other parties, and providing information to professionals. Professionals mentioned nine barriers and facilitators in the identification and intervention with hazardous alcohol use and AUD, including three aspects of professionals' behavior (i.e., professionals' agenda setting, knowledge and skills, and attitudes), actions related to identification and intervening, client contact, collaboration with other parties, and three factors in a wider context (i.e., organizational characteristics, organizational resources, and governmental aspects).

CONCLUSIONS

Although diverse alcohol intervention elements are available in Dutch mental health services, it remains unclear to what extent these are routinely implemented. To better address hazardous alcohol use and AUD in mental health services, efforts should focus on enhancing alcohol training, improving collaboration with addiction services, providing appropriate tools, and facilitating support through organizational and governmental measures.

Global trends and differences in the burden of alcohol use disorders attributable to childhood sexual abuse by sex, age, and socio-demographic index: Findings from the Global Burden of Disease Study 2019

BACKGROUND

Childhood sexual abuse (CSA) is a severe global problem associated with alcohol use disorder (AUD). Previous studies have confirmed this relationship; however, there is a lack of research on the disease burden of AUD attributable to CSA.

OBJECTIVE

To analyze global spatiotemporal trends and differences in the disease burden of AUD attributable to CSA and its relationship with age, sex, and the sociodemographic index (SDI).

PARTICIPANTS AND SETTING

Data from the Global Burden of Disease 2019 Public Database.

METHODS

Summary exposure value (SEV) was used to evaluate CSA. Disability-adjusted life year (DALY), years lived with disability (YLD), years of life lost (YLL), and their annual rates of change were used to evaluate disease burden. Cluster analysis based on Ward's method was used to examine the global burden associated with age, sex, and SDI. A 95 % uncertainty intervals (UI), excluding 0, was considered statistically significant.

RESULTS

In 2019, 1.63 million (95 % UI 0.23-3.90 million) DALYs of AUD were caused by CSA and the age-standardized rates (ASRs) of DALY was 19.77 (95 % UI 2.78-47.46) globally. Annual rates of change in DALY of people over 65 years of age increased from 1990 to 2019 in all regions except the High-middle SDI regions. The ASRs of DALY of females in High SDI regions, were always at a much higher level than other SDI regions, and showed an upward trend from 1990 to 2019 (DALY 1990: 20.38 [95 % UI 2.87-47.77], 2019: 23.61 [95 % UI 3.55-54.94]).

CONCLUSIONS

Substantial geographical differences were observed in the burden of AUD attributable to CSA. The level of CSA exposure was inconsistent with the related burden of AUD in different regions according to the sociodemographic index. The burden of disease increased in the elderly population and in females in high sociodemographic index regions.

Associations between alcohol use and outcome of psychological treatment in specialist psychiatric care - a cohort study

Background

Alcohol-related issues are widespread worldwide and are fairly substantial. Numerous studies have identified and clarified the effects and prevalence of alcohol use across different contexts. However, when it comes to the prevalence of alcohol in psychiatry and its impact on treatment outcomes compared to other patient groups, studies are relatively scarce, and results often vary, sometimes with different outcomes. This study focuses on investigating the effectiveness of psychological treatment in psychiatric clinics for outpatients, considering those with and without hazardous alcohol use under naturalistic conditions.

Methods

Patients were recruited between 2012 and 2016 from psychiatric clinics in Sormland, Sweden, as part of the regular services. Patients completed symptom assessment instruments regarding depression, anxiety, quality-of-life, and alcohol consumption at the beginning of their psychological treatment, upon completion, and during a follow-up 1 year after completion. Completion of questionnaires was ongoing for some patients until 2021. A total of 324 patients were included in the study, distributed among 59 participating therapists.

Results

Among all patients in the study, 30.2% showed hazardous alcohol use at the start of their psychological treatment, with a higher proportion being men. There was a significant reduction in the proportion of patients with hazardous use and a notable decrease in the mean audit score upon completion of psychological treatment. At follow-up, there was no significant change compared to completion. There were 31.2% of the patients who achieved recovery or improvement in the audit score upon completion of treatment. Patients with hazardous alcohol use consistently scored higher mean values on the symptom assessment instruments and lower on the quality-of-life instrument at the beginning. More individuals with hazardous alcohol use typically achieved better results across all outcome instruments at both at completion and follow-up.

Conclusion

Patients with hazardous alcohol use demonstrate significant improvements in their alcohol consumption through standard psychological treatment in psychiatry, despite the treatment not specifically focusing on alcohol consumption. The progress/improvement appears to be largely maintained at follow-up. Moreover, patients with hazardous alcohol use tend to show greater progress across all outcome instruments. No significant gender differences were detected in this context.

Alcohol use disorders in patients with bipolar disorder: a systematic review and meta-analysis

Alcohol consumption has a key role in more than 200 diseases and health injuries, being an important factor for social and public health costs. Studies with clinical populations show an association between alcohol use disorders (AUD) and bipolar disorder. In this meta-analysis we included studies, reports, or summaries identified in Google Scholar, Lilacs, Medline, and MedCaribe that reported original data published up to 31 January 2023. We included cross-sectional and longitudinal observational studies that investigated the prevalence of AUD in patients with bipolar disorder. We calculated the prevalence rates and conducted a meta-analysis using a random effects model. The meta-analysis included 20 unique studies conducted in 12 countries, with a total sample of 32,886 individuals with bipolar disorder, comprising 17,923 women and 13,963 men, all aged 18 years or older. The prevalence of AUD in individuals with bipolar disorder was found to be 29.12%, while the prevalence of Alcohol Dependence (AD) was 15.87% and the prevalence of Alcohol Abuse (AA) was 18.74%. The high prevalence of AUD individuals with bipolar disorder is important because it highlights the need for targeted interventions to prevent and address comorbid conditions, which may improve treatment outcomes, reduce harm, and promote public health.

Alcohol Use among Swedish Patients with Stress-Induced Exhaustion Disorder, and Its Relation to Anxiety, Depression, and Health-Related Quality of Life

Harmful drinking may be a cause and an effect of psychological distress, and compromises the effects of treatment for psychiatric conditions. There is a paucity of studies investigating patterns of alcohol consumption among patients with stress-induced exhaustion disorder (SED). The aims of this investigation were (1) to assess the prevalence of self-rated hazardous drinking in a sample of 808 Swedish patients with SED (mean age 43 ± 9 years, 84% women), and (2) to investigate differences in sociodemographic variables, psychological symptoms, health-related quality of life, and sleep variables between patients with different drinking patterns The design was cross-sectional and data were collected with questionnaires at pre-treatment. Twelve percent of female and 13% of male patients reported Alcohol Use Disorder Identification Test (AUDIT) scores indicating hazardous drinking. Female patients with hazardous drinking reported higher levels of anxiety and depression and lower mental wellbeing, than other women. Female patients reporting no drinking reported poorer physical function and more pain, than other women. No differences were seen between male patients with different drinking patterns. Although patients with SED report a lower frequency of harmful drinking than other psychiatric samples, alcohol consumption needs to be addressed in the assessment and treatment of this condition.

Prevalence and Demographic Correlates of Substance Use among Adults with Mental Illness in Eastern Cape, South Africa: A Cross-Sectional Study

This study reports on the prevalence and demographic correlates of substance use among individuals with mental illness in the Eastern Cape, South Africa. This cross-sectional study was conducted in the Outpatient Clinic of a large hospital in the Eastern Cape, South Africa. A pre-validated tool on alcohol and psychoactive drug use was administered to 390 individuals with mental illness. Multivariable logistic regression models were fitted to explore the demographic correlates of alcohol and psychoactive drug use. Of the total participants (N = 390), 64.4% and 33.3% reported lifetime (ever used) and past-year use of alcohol, respectively, but the prevalence of risky alcohol use was 18.5%. After adjusting for relevant covariates, only male sex, younger age, and rural residence remained significantly associated with risky alcohol use. The prevalence of ever-use and past-year use of psychoactive substances was 39.7% and 17.4%, respectively. The most common substance ever used was cannabis (37.4%). Male sex, younger age, owning a business, and being unemployed were significantly associated with higher odds of lifetime and past-year use of psychoactive substances. Findings highlight the need for dedicated infrastructure and staff training in the management of these dual diagnoses in the region.

Hazardous alcohol use in a sample of first episode psychosis patients in Singapore

BACKGROUND

Hazardous alcohol use has often been found to be more prevalent amongst psychiatric outpatients than the general population. Additionally, it has also been associated with poorer outcomes. The study aimed to investigate (1) the prevalence and (2) socio-demographic and clinical correlates of hazardous alcohol use, as well as (3) the relationship between hazardous alcohol use and quality of life in an outpatient sample with First Episode Psychosis (FEP) in Singapore.

METHODS

Baseline data (N = 280) was extracted from a longitudinal study investigating smoking and alcohol use amongst outpatients with FEP in a psychiatric hospital. Information on socio-demographics, hazardous alcohol use, and quality of life was collected through a self-report survey. Hazardous alcohol use was ascertained by total scores of 8 or higher on the Alcohol Use Disorders Identification Test (AUDIT). Data was analysed using logistic regression and linear regression analyses.

RESULTS

The prevalence of hazardous alcohol use over the past 12-month period was 12.9%. Those who had never smoked in their lifetime (vs current smokers) and those with a diagnosis of brief psychotic disorder (vs schizophrenia spectrum disorders) were found to have significantly lower odds of hazardous alcohol use. Hazardous alcohol use was also associated with lower negative symptom scores. Lastly, hazardous alcohol use was found to significantly predict lower scores on the physical health, social relationship and environment domains of quality of life.

CONCLUSIONS

The association between hazardous alcohol use and lower negative symptom scores is a surprising finding that needs to be further explored. The significant impact of hazardous alcohol use in reductions in quality of life suggests that early screening and interventions could benefit patients with hazardous alcohol use and comorbid psychosis.

Hazardous alcohol use among patients with schizophrenia and depression

AIMS

The current study aimed to 1) report the prevalence of hazardous alcohol use in an outpatient population among those with schizophrenia and depressive disorders, 2) assess the sociodemographic and clinical correlates of hazardous alcohol use, 3) examine the association of hazardous alcohol use with severity of depression, anxiety and smoking, and 4) assess the association of hazardous alcohol use with quality of life.

METHODS

Three hundred ten outpatients seeking treatment at a tertiary psychiatric institute with a diagnosis of either schizophrenia spectrum disorder or depressive disorder were included in the study. Patients were assessed for hazardous alcohol use using the Alcohol Use Disorders Identification Test. Information on sociodemographic correlates, clinical history, severity of symptoms of depression and anxiety, as well as quality of life (QOL) was collected.

RESULTS

The overall prevalence of hazardous alcohol use among the sample was 12.6%. The prevalence of hazardous alcohol use among patients with depression and schizophrenia was 18.8% and 6.4%, respectively. Compared to those who were students, patients who were gainfully employed or unemployed were more likely to engage in hazardous alcohol use (Odds Ratio (OR) = 5.5 and 7.7, respectively). Patients with depression compared to those with schizophrenia (OR = 11.1) and those who were current smokers compared to those who had never smoked (OR = 14.5) were more likely to engage in hazardous alcohol use. Hazardous alcohol use was associated with lower QOL in the physical health domain (p = 0.002).

CONCLUSION

Given the significant prevalence of hazardous alcohol use in this population, routine screening for hazardous alcohol use and brief interventions could be an effective way of managing this comorbidity. There is a need to develop and evaluate culturally appropriate brief interventions based on patient preference in this setting.

Automated telephone interventions for problematic alcohol use in clinical and population samples: a randomized controlled trial

Objective

The primary objective was to evaluate 6-month outcomes for brief and extensive automated telephony interventions targeting problematic alcohol use, in comparison to an assessment-only control group. The secondary objective was to compare levels of problematic alcohol use (hazardous, harmful or probable dependence), gender and age among study participants from clinical psychiatric and addiction outpatient settings and from population-based telephone helpline users and Internet help-seeker samples.

Results

The Alcohol Use Disorders Identification Test (AUDIT) was used for screening of problematic alcohol use and 6-month follow-up assessment. A total of 248 of help-seekers with at least hazardous use (AUDIT scores of ≥ 6/≥ 8 for women/men) were recruited from clinical and general population settings. Minor recruitment group differences were identified with respect to AUDIT scores and age at baseline. One hundred and sixty persons (64.5%) did not complete the follow-up assessment. The attrition group had a higher proportion of probable dependence (71% vs. 56%; p = 0.025), and higher scores on the total AUDIT, and its subscales for alcohol consumption and alcohol problems. At follow up, within-group problem levels had declined across all three groups, but there were no significant between-group differences.

Trial registration ClinicalTrials.gov NCT01958359, Registered October 9, 2013. Retrospectively registered