Identification and treatment of alcohol use disorder with the 15-method – implementation in psychiatric care

Background: Co-morbidity between psychiatric diagnoses and alcohol use disorders (AUD) is common and a decrease in alcohol consumption is associated with improvements in psychiatric symptoms. Treatment of both conditions simultaneously leads to greater improvements in psychiatric symptoms and alcohol consumption, compared to treatment of one condition at a time. Despite this, psychiatric patients are seldom offered treatment for alcohol problems. 

Aim: The aim of this project is to study the implementation of the 15-method, a stepped care model for screening, assessment and treatment of alcohol problems adapted for use in psychiatric care. 

Intervention: Health care workers at all psychiatric outpatient units in Region Stockholm will be offered training in the 15-method together with implementation support in form of the Building Implementation Capacity (BIC) – intervention, in which a designated implementation team of health care workers participate in four workshops to plan the implementation of the 15-method.

Study 1: This study aims to investigate if training in the 15-method is associated with an increase in the proportion of patients assessed and treated for AUD. Data will be collected via the medical record system and analyzed on the level of psychiatric units. Outcome measures will be collected for the period 12 months before and 12 months after units participated in the intervention. Outcome measures are: number of administered Alcohol Use Disorder Identification Tests; registered alcohol diagnoses; prescribed alcohol drugs; blood test referrals for alcohol biomarkers; registered conversations about alcohol consumption; referrals to specialized addiction care.  

Study 2: This study aims to investigate health care workers (n ⁓400) attitudes towards working with alcohol problems among psychiatric patients and if these attitudes change following training in the 15-method. Primary outcome measure is the Short Alcohol and Alcohol Problems Perceptions Questionnaire. A second aim is to investigate how health care workers perceives working with the 15-method, as measured with the Normalization Process Theory Measures.

Study 3: This study aims to understand how health care workers (n= ⁓120) in the implementation teams perceived and operationalized the BIC-intervention and how they worked to implement the 15-method. Each team member’s implementation knowledge and skills will be measured with a questionnaire before and after the BIC-intervention. Semi-structured focus group interviews will be performed with the teams (n= ⁓12).

Study 4: This study aims to investigate how patients (n= ⁓ 20) at psychiatric outpatient units perceive receiving the interventions in the 15-method during their psychiatric treatment. Semi-structured interviews will be performed applying the Normalization Process Theory as a framework for analysis. 

The project is ongoing, and we aim to present preliminary results from the project at the conference.